The Community Health Response Team: a culturally and linguistically tailored community response to COVID-19 addressing barriers to testing and vaccinations for refugee, immigrant and migrant communities in Atlanta, Georgia.

The International Rescue Committee (IRC) in Atlanta and Community Organized Relief Effort (CORE) established a Community Health Response Team in May 2020. The team members represented refugee, immigrant and migrant populations and had expertise in health care and public health. These 18 individuals were recruited from IRC Atlanta's Career Development program, had a variety of backgrounds and spoke 20 languages. They implemented a community-centered COVID-response intervention model of pairing education and outreach efforts with testing and vaccination clinics. Due to their team makeup, the Community Health Response Team conducted tailored outreach and education that was culturally and linguistically congruent with their target communities. They administered over 16,000 COVID-19 tests at mobile community sites within the first 6 months. Once COVID-19 vaccinations were available, the Community Health Response Team coordinated a total of 834 vaccination events in communities with a high number of refugees and in partnership with refugee- and immigrant-trusted community-based organizations, resulting in 31,888 vaccinations. Hiring staff from refugee, immigrant and migrant populations created a sustainable staffing model. Also, embedding culturally specific strategies in their model of pairing education and outreach led to long-term relationships and greater trust with community members. This approach of engaging and empowering community members to create tailored public health responses should serve as guidance for future public health campaigns.

Medical ethics of long-duration spaceflight.

With the advent of novel and emerging technologies, long duration spaceflight will become more common; along with it, an increase in its inherent health risks. However, health-related ethical issues arising during long-duration spaceflight remain poorly characterized, uncertain and unpredictable. Medical ethics is defined as a set of moral principles, beliefs and values that guides choices about medical care. This set of principles, founded in our sense of right and wrong, helps us make fair and just decisions. The paper conceptually and analytically investigates the ethical issues likely to arise from medical complications during spaceflight, mapping unfilled gaps of the current status quo. Furthermore, this paper explores broad ethical themes of autonomy, nonmaleficence, beneficence and justice, while also delving deeper into specific scenarios within each theme. The manuscript represents an up-to-date review of the available literature in the field of space medical ethics and recommends guiding ethical principles and a framework for their application to negotiate the resolution of complex ethical scenarios during long-duration spaceflight.

The effects of large roughness elements on the in-stream transport and retention of polystyrene microplastics.

The mechanisms controlling transport and retention of microplastics (MPs) in riverine systems are not understood well. We investigated the impact of large roughness elements (LREs) on in-stream transport and retention of the ubiquitous polystyrene-microplastics (PS-MPs). Scaled experiments were conducted with and without LREs under various shear Reynolds numbers (Re*) in an ecohydraulics flume. Our results, for the first time, demonstrated a clear dependence of the MPs' velocity on Re* in LREs-dominated channel. Two distinct regimes and thresholds were identified: lower Re* (≤ 15,000) regime corresponding to higher velocities of MPs ([Formula: see text]> 0.45), and higher Re* (> 15,000) to lower [Formula: see text]< 0.45). The presence and higher density of LREs increased Re*, decreased [Formula: see text], and enhanced the PS-MPs capture. The LREs-generated turbulence kinetic energy (TKE) was found to be a good predictor of PS-MPs transport and retention rates, indicating the effectiveness of LREs in retaining PS-MPs in streams and rivers.

Determination of emergency nurse practitioner and plastic surgery trainee disposition decision agreement for plastic surgery emergency department presentations: A prospective study.

OBJECTIVE: To examine if there was a high degree of agreement for disposition decisions of emergency nurse practitioners (ENP) compared to plastic surgery trainees (PST) for plastic surgery presentations. METHODS: A prospective study of disposition decision agreement from February 2020 to January 2021 for patients who required plastic surgery consultation and managed exclusively by an ENP. Absolute percentages were used to determine the exact disposition decision accuracy of ENP and the PST, while Cohen's kappa compared disposition decision agreement. Sub-analyses of age, gender, ENP experience and presenting condition agreement were also completed. To mitigate confounding factors, operative management (OM) and non-OM groups were analysed. RESULTS: The study recruited 342 patients who presented mostly with finger or hand-related conditions (82%, n = 279) and managed by an ENP with less than 10 years of experience (65%, n = 224). Disposition decisions by ENP compared to PST were the same in 80% (n = 274) of cases. Disposition agreement for all patients was 0.72 (95% confidence interval 0.66-0.78). For the OM and non-OM groups, disposition decisions were the same in 94% (n = 320), with a Cohen's kappa 0.85 (95% confidence interval 0.79-0.91). Seven patients (2%) were discharged to GP care by the ENP when determined to need further plastic surgery involvement by the PST. CONCLUSIONS: Disposition decisions by ENP and PST were the same in most cases and had a high overall level of agreement. This may lead to greater autonomy of ENP care and reduced ED length of stay and occupancy.

Angiojet™ mechanical thrombectomy-induced hemolysis triggering blood-leak alarms.

Blood leak alarms are increasingly rare and may be triggered by rupture of the dialyzer membrane, or intravascular hemolysis. We report two patients who developed hemolysis following Angiojet™ thrombolysis and thrombectomy of thrombosed arteriovenous fistulas, triggering blood leak alarms on hemodialysis, the occurrence of which has not been reported before. AngioJet™-induced hemolysis should be considered in the differential diagnosis for blood leak alarms occurring soon after an intervention on an arterio-venous (AV) fistula.

Modifiable risk factors for inpatient violence in psychiatric hospital: prospective study and prediction model.

BACKGROUND: Violence perpetrated by psychiatric inpatients is associated with modifiable factors. Current structured approaches to assess inpatient violence risk lack predictive validity and linkage to interventions. METHODS: Adult psychiatric inpatients on forensic and general wards in three psychiatric hospitals were recruited and followed up prospectively for 6 months. Information on modifiable (dynamic) risk factors were collected every 1-4 weeks, and baseline background factors. Data were transferred to a web-based monitoring system (FOxWeb) to calculate a total dynamic risk score. Outcomes were extracted from an incident-reporting system recording aggression and interpersonal violence. The association between total dynamic score and violent incidents was assessed by multilevel logistic regression and compared with dynamic score excluded. RESULTS: We recruited 89 patients and conducted 624 separate assessments (median 5/patient). Mean age was 39 (s.d. 12.5) years with 20% (n = 18) female. Common diagnoses were schizophrenia-spectrum disorders (70%, n = 62) and personality disorders (20%, n = 18). There were 93 violent incidents. Factors contributing to violence risk were a total dynamic score of ⩾1 (OR 3.39, 95% CI 1.25-9.20), 10-year increase in age (OR 0.67, 0.47-0.96), and female sex (OR 2.78, 1.04-7.40). Non-significant associations with schizophrenia-spectrum disorder were found (OR 0.50, 0.20-1.21). In a fixed-effect model using all covariates, AUC was 0.77 (0.72-0.82) and 0.75 (0.70-0.80) when the dynamic score was excluded. CONCLUSIONS: In predicting violence risk in individuals with psychiatric disorders, modifiable factors added little incremental value beyond static ones in a psychiatric inpatient setting. Future work should make a clear distinction between risk factors that assist in prediction and those linked to needs.

Machine learning techniques to increase the performance of indirect methane quantification from a single, stationary sensor.

Researchers are searching for ways to better quantify methane emissions from natural gas infrastructure. Current indirect quantification techniques (IQTs) allow for more frequent or continuous measurements with fewer personnel resources than direct methods but lack accuracy and repeatability. Two IQTs are Other Test Method (OTM) 33A and Eddy Covariance (EC). We examined a novel approach to improve the accuracy of single sensor IQT whereby the results from both OTM and EC were combined with two machine learning (ML) models, a random forest (RF) and a neural network (NN). Then, models were enhanced with feature reduction and hyper-parameter tuning and compared to traditional quantification methods. The NN and RF improved upon the default OTM by an average of 44% and 78%, respectively. When compared to traditional OTM estimates with low Data Quality Indicators (DQIs), RF and NN models reduced 1σ errors from ±66% to ±13% and ±34%, respectively. Models also reduced the standard deviation of estimates with 93% and 85% of estimates falling within ±50% of the known release rate. This approach can be deployed with single sensor systems at well sites to improve confidence in reported emissions, reducing the number of anomalous overestimates that would trigger unnecessary site evaluations. Additional improvements could be realized by expanding training datasets with more methane release rates. Further, deployment of such models in a variety of situations could enhance their ability help close the gap between bottom-up inventory and top-down studies by enabling continuous monitoring of temporal emissions that could identify with improved confidence, atypically higher emissions. Accurate remote single sensor systems are key in developing an improved understanding of methane emissions to enable industry to identify and reduce methane emissions.

The effect of COVID-19 home quarantine on the psychological state of pharmacy students: a cross-sectional study.

BACKGROUND: Psychological morbidity has been documented in medical and pharmaceutical undergraduate students in different countries around the world. In this study, we examined the impact of coronavirus disease 2019 (COVID-19) home quarantine on the depressive psychological aspects of last-grade pharmacy students. METHODS: A cross-sectional study was conducted by the Department of Clinical Pharmacy, Faculty of Pharmacy, Deraya University, Egypt. Two hundred and sixty-eight last-grade pharmacy students were included in this study, and they completed a self-administered, pre-designed, anonymous questionnaire. The main outcome measures were the Hamilton Depression Rating Scale (HRS) and Patient Health Questionnaire-9 (PHQ-9), which were measured to screen for the symptoms of psychological depression and determine the degree of depression severity between the beginning and the end of the COVID-19 home quarantine period. Data entry and analysis were done using the Statistical Package for Social Science (SPSS) software version 26. Descriptive statistics were employed for analyses of the data, and categorical variables were described by frequencies and percentages. Bivariate and multivariable analyses were performed to examine relations between demographic data and psychological scales. The study protocol was approved by the Faculty of Pharmacy, Minia University Ethical Committee. RESULTS: A total of 268 students participated in this study (102 males and 166 females). The mean ± SD score of baseline HRS and HRS at the end of the study was 6.3 ± 4.45, 7.95 ± 5.36, respectively, with the presence of a statistically significant difference between the two scores (p < 0.001). The mean ± SD score of baseline PHQ-9 and PHQ-9 at the end of the study was 4.35 ± 3.45, 5.37 ± 4.14, respectively, with the presence of a statistically significant difference between the two scores (p < 0.001). The results showed that the COVID-19 home quarantine period led to a depressive psychological effect on the students in this study. CONCLUSIONS: Students' psychological depression causes morbidity and, in some cases, mortality. Psychological depressive problems were significantly associated with the COVID-19 home quarantine period, which calls for early intervention to solve it. Student counselling services must be more accessible and affordable to overcome this problem.

Soil carbon consequences of historic hydrologic impairment and recent restoration in coastal wetlands.

Coastal wetlands provide key ecosystem services, including substantial long-term storage of atmospheric CO2 in soil organic carbon pools. This accumulation of soil organic matter is a vital component of elevation gain in coastal wetlands responding to sea-level rise. Anthropogenic activities that alter coastal wetland function through disruption of tidal exchange and wetland water levels are ubiquitous. This study assesses soil vertical accretion and organic carbon accretion across five coastal wetlands that experienced over a century of impounded hydrology, followed by restoration of tidal exchange 5 to 14 years prior to sampling. Nearby marshes that never experienced tidal impoundment served as controls with natural hydrology to assess the impact of impoundment and restoration. Dated soil cores indicate that elevation gain and carbon storage were suppressed 30-70 % during impoundment, accounting for the majority of elevation deficit between impacted and natural sites. Only one site had substantial subsidence, likely due to oxidation of soil organic matter. Vertical and carbon accretion gains were achieved at all restored sites, with carbon burial increasing from 96 ± 33 to 197 ± 64 g C m-2 y-1. The site with subsidence was able to accrete at double the rate (13 ± 5.6 mm y-1) of the natural complement, due predominantly to organic matter accumulation rather than mineral deposition, indicating these ecosystems are capable of large dynamic responses to restoration when conditions are optimized for vegetation growth. Hydrologic restoration enhanced elevation resilience and climate benefits of these coastal wetlands.

Plant Growth-Promoting Rhizobacteria Eliminate the Effect of Drought Stress in Plants: A Review.

Plants evolve diverse mechanisms to eliminate the drastic effect of biotic and abiotic stresses. Drought is the most hazardous abiotic stress causing huge losses to crop yield worldwide. Osmotic stress decreases relative water and chlorophyll content and increases the accumulation of osmolytes, epicuticular wax content, antioxidant enzymatic activities, reactive oxygen species, secondary metabolites, membrane lipid peroxidation, and abscisic acid. Plant growth-promoting rhizobacteria (PGPR) eliminate the effect of drought stress by altering root morphology, regulating the stress-responsive genes, producing phytohormones, osmolytes, siderophores, volatile organic compounds, and exopolysaccharides, and improving the 1-aminocyclopropane-1-carboxylate deaminase activities. The use of PGPR is an alternative approach to traditional breeding and biotechnology for enhancing crop productivity. Hence, that can promote drought tolerance in important agricultural crops and could be used to minimize crop losses under limited water conditions. This review deals with recent progress on the use of PGPR to eliminate the harmful effects of drought stress in traditional agriculture crops.

Frail patients having vascular surgery during the early COVID-19 pandemic experienced high rates of adverse perioperative events and amputation.

BACKGROUND: Frailty predicts adverse perioperative outcomes and increased mortality in patients having vascular surgery. Frailty assessment is a potential tool to inform resource allocation, and shared decision-making about vascular surgery in the resource constrained COVID-19 pandemic environment. This cohort study describes the prevalence of frailty in patients having vascular surgery and the association between frailty, mortality and perioperative outcomes. METHODS: The COVID-19 Vascular Service in Australia (COVER-AU) prospective cohort study evaluates 30-day and six-month outcomes for consecutive patients having vascular surgery in 11 Australian vascular units, March-July 2020. The primary outcome was mortality, with secondary outcomes procedure-related outcomes and hospital utilization. Frailty was assessed using the nine-point visual Clinical Frailty Score, scores of 5 or more considered frail. RESULTS: Of the 917 patients enrolled, 203 were frail (22.1%). The 30 day and 6 month mortality was 2.0% (n = 20) and 5.9% (n = 35) respectively with no significant difference between frail and non-frail patients (OR 1.68, 95%CI 0.79-3.54). However, frail patients stayed longer in hospital, had more perioperative complications, and were more likely to be readmitted or have a reoperation when compared to non-frail patients. At 6 months, frail patients had twice the odds of major amputation compared to non-frail patients, after adjustment (OR 2.01; 95% CI 1.17-3.78), driven by a high rate of amputation during the period of reduced surgical activity. CONCLUSION: Our findings highlight that older, frail patients, experience potentially preventable adverse outcomes and there is a need for targeted interventions to optimize care, especially in times of healthcare stress.

Discovery of a Novel Class of d-Amino Acid Oxidase Inhibitors Using the Schrödinger Computational Platform.

d-Serine is a coagonist of the N-methyl d-aspartate (NMDA) receptor, a key excitatory neurotransmitter receptor. In the brain, d-serine is synthesized from its l-isomer by serine racemase and is metabolized by the D-amino acid oxidase (DAO, DAAO). Many studies have linked decreased d-serine concentration and/or increased DAO expression and enzyme activity to NMDA dysfunction and schizophrenia. Thus, it is feasible to employ DAO inhibitors for the treatment of schizophrenia and other indications. Powered by the Schrödinger computational modeling platform, we initiated a research program to identify novel DAO inhibitors with the best-in-class properties. The program execution leveraged an hDAO FEP+ model to prospectively predict compound potency. A new class of DAO inhibitors with desirable properties has been discovered from this endeavor. Our modeling technology on this program has not only enhanced the efficiency of structure-activity relationship development but also helped to identify a previously unexplored subpocket for further optimization.

Severe Crohn's Disease With Intra-abdominal Fistula: First Reported Case From Tanzania.

We describe a case of Crohn's disease occurring in a young Tanzanian female. Crohn's disease is rare in Africa and not encountered normally. The presentation of Crohn's disease overlaps with many other abdominal disorders that are common in an African setting, such as tuberculosis and schistosomiasis. The disease is probably underdiagnosed in Africa due to limitations in diagnostic testing and rarity.

Metabolic scaling of stream dissolved oxygen across the U.S. Atlantic Coast.

We investigated the hypothesis of emergent 'biogeochemical' similitude (parametric reduction) and scaling of dissolved oxygen (DO) in coastal streams across the U.S. Atlantic Coast by employing dimensional analysis methodology from fluid mechanics and hydraulic engineering. Two mechanistically meaningful dimensionless numbers were discovered as the stream 'metabolic' number and the fraction of 'DO saturation' number. The 'metabolic' number represented the synergistic control on stream DO from various climatic, hydrologic, biochemical, and ecological drivers (e.g., water temperature, atmospheric pressure, stream width and depth, total phosphorus, pH, and salinity). A graphical exploration of the 'metabolic' versus the 'DO saturation' numbers led to collapse of data during 1998-2015 from diverse coastal streams into an emergent process diagram, indicating three metabolism regimes (high, transitional, and low). The high and low metabolism regimes were, respectively, characterized by the most and least favorable environmental conditions for stream DO depletion-through reduced dissolution and reaeration, as well as increased organic decomposition, respiration, and nitrification. The emergent process diagram led to a generalized power law scaling relationship of the 'DO saturation' number as a function of the 'metabolic' number (exponent ~ 1/3; Nash-Sutcliffe Efficiency, NSE = 0.83-0.85). The metabolic scaling law was leveraged to develop a generalized empirical model to successfully predict DO in diverse streams across the U.S. Atlantic Coast (NSE = 0.83). The emergent process diagram, metabolic scaling law, and prediction model of DO would help understand and manage water quality and ecosystem health of coastal streams in the U.S. and elsewhere.

Outcomes of Surgical Tracheostomy on Mechanically Ventilated COVID-19 Patients Admitted to a Private Tertiary Hospital in Tanzania.

OBJECTIVES:  The coronavirus disease 2019 (COVID-19) pandemic has resulted in an increase in the number of patients necessitating prolonged mechanical ventilation. Data on patients with COVID-19 undergoing tracheostomy indicating timing and outcomes are very limited. Our study illustrates--- outcomes for surgical tracheotomies performed on COVID-19 patients in Tanzania. METHODS:  This was a retrospective observational study conducted at the Aga Khan Hospital in Dar es Salaam, Tanzania. RESULTS:  Nineteen patients with COVID-19 underwent surgical tracheotomy between 16th March and 31st December 2021. All surgical tracheostomies were performed in the operating theatre. The average duration of intubation prior to tracheotomy and tracheostomy to ventilator liberation was 16 days and 27 days respectively. Only five patients were successfully liberated from the ventilator, decannulated, and discharged successfully. CONCLUSIONS:  This is the first and largest study describing tracheotomy outcomes in COVID-19 patients in Tanzania. Our results revealed a high mortality rate. Multicenter studies in the private and public sectors are needed in Tanzania to determine optimal timing, identification of patients, and risk factors predictive of improved outcomes.

Performance in mortality prediction of SAPS 3 And MPM-III scores among adult patients admitted to the ICU of a private tertiary referral hospital in Tanzania: a retrospective cohort study.

BACKGROUND: Illness predictive scoring systems are significant and meaningful adjuncts of patient management in the Intensive Care Unit (ICU). They assist in predicting patient outcomes, improve clinical decision making and provide insight into the effectiveness of care and management of patients while optimizing the use of hospital resources. We evaluated mortality predictive performance of Simplified Acute Physiology Score (SAPS 3) and Mortality Probability Models (MPM0-III) and compared their performance in predicting outcome as well as identifying disease pattern and factors associated with increased mortality. METHODS: This was a retrospective cohort study of adult patients admitted to the ICU of the Aga Khan Hospital, Dar- es- Salaam, Tanzania between August 2018 and April 2020. Demographics, clinical characteristics, outcomes, source of admission, primary admission category, length of stay and the support provided with the worst physiological data within the first hour of ICU admission were extracted. SAPS 3 and MPM0-III scores were calculated using an online web-based calculator. The performance of each model was assessed by discrimination and calibration. Discrimination between survivors and non-survivors was assessed by the area under the receiver operator characteristic curve (ROC) and calibration was estimated using the Hosmer-Lemeshow goodness-of-fit test. RESULTS: A total of 331 patients were enrolled in the study with a median age of 58 years (IQR 43-71), most of whom were male (n = 208, 62.8%), of African origin (n = 178, 53.8%) and admitted from the emergency department (n = 306, 92.4%). In- hospital mortality of critically ill patients was 16.1%. Discrimination was very good for all models, the area under the receiver-operating characteristic (ROC) curve for SAPS 3 and MPM0-III was 0.89 (95% CI [0.844-0.935]) and 0.90 (95% CI [0.864-0.944]) respectively. Calibration as calculated by Hosmer-Lemeshow goodness-of-fit test showed good calibration for SAPS 3 and MPM0-III with Chi- square values of 4.61 and 5.08 respectively and P-Value > 0.05. CONCLUSION: Both SAPS 3 and MPM0-III performed well in predicting mortality and outcome in our cohort of patients admitted to the intensive care unit of a private tertiary hospital. The in-hospital mortality of critically ill patients was lower compared to studies done in other intensive care units in tertiary referral hospitals within Tanzania.

Smart Watch Detection of Supraventricular Tachycardia (SVT): First Case from Tanzania.

Smartwatches like the Apple Watch have been on the rise worldwide and their use is gaining popularity in developing countries. Their ability to detect dysrhythmias is well documented. Present practice discourages the use of these devices as a diagnostic tool. Nevertheless, atypical findings from these devices should be clinically investigated. This case demonstrates an eventual diagnosis of supraventricular tachycardia (SVT) based on an Apple watch alert which was subsequently confirmed by electrophysiological evaluation.

Factors Associated with Mortality Among Hospitalized Adults with COVID-19 Pneumonia at a Private Tertiary Hospital in Tanzania: A Retrospective Cohort Study.

BACKGROUND: The emergence of the novel coronavirus disease 2019 (COVID-19) has caused millions of deaths worldwide. There has been paucity of data for hospitalized African patients suffering from COVID-19. This study aimed to identify factors associated with in-hospital mortality in patients suffering from COVID-19 in Tanzania. METHODS: This was a single center, retrospective, observational cohort study in adult patients hospitalized with confirmed COVID-19 infection. Demographics, clinical pattern, laboratory and radiological investigations associated with increased odds of mortality were analyzed. RESULTS: Of the 157 patients, 107 (68.1%) patients survived and 50 (31.8%) died. Mortality was highest in patients suffering with severe (26%) and critical (68%) forms of the disease. The median age of the cohort was 52 years (IQR 42-61), majority of patients were male (86%) and of African origin (46%), who presented with fever (69%), cough (62%) and difficulty in breathing (43%). Factors that were associated with mortality among our cohort were advanced age (OR 1.07, 95% CI 1.03-1.11), being overweight and obese (OR 9.44, 95% CI 2.71-41.0), suffering with severe form of the disease (OR 4.77, 95% CI 1.18-25.0) and being admitted to the HDU and ICU (OR 6.68, 95% CI 2.06-24.6). CONCLUSION: The overall in-hospital mortality was 31.8%. Older age, obesity, the severe form of the disease and admission to the ICU and HDU were major risk factors associated with in-hospital mortality.

The positive environmental impact of virtual isotretinoin management.

BACKGROUND/OBJECTIVES: Other medical specialties have studied how their practices influence the environment, but environmental impact studies in the field of dermatology remain limited. With respect to dermatology, vehicle emissions by patients traveling to and from appointments are an important factor influencing climate change. This study was undertaken to determine the greenhouse gas emissions avoided by managing isotretinoin virtually at West Virginia University Hospital. METHODS: A retrospective cross-sectional study was conducted during the COVID-19 outbreak from March 25 to December 1, 2020, where travel data were acquired and converted to emission data. RESULTS: 5,137 kg of GHG emissions in CO2 equivalents were prevented by managing isotretinoin virtually during the study period. 49 400 kg of GHG emissions in CO2 equivalents would be prevented annually. This is the emission load released when 24 690 kg of coal are burned. CONCLUSIONS: Environmental impact studies in the field of dermatology remain limited. GHG emissions were significantly reduced by virtually managing isotretinoin at a single institution. The practice of dermatology could reduce its carbon footprint by managing isotretinoin virtually, even in non-pandemic periods. Given that isotretinoin management represents a small percentage of the overall carbon footprint associated with dermatology, dermatologists should identify other conditions amenable to virtual medicine to produce greater environmental impact.

Climate and land cover change impacts on stormwater runoff in large-scale coastal-urban environments.

This study aims to evaluate the individual and synergistic controls of climatic and land cover changes on stormwater runoff regimes, and perform a comparative synthesis of the historical and future runoffs for complex coastal-urban environments. A large-scale (7117 km2) mechanistic hydrologic model was developed for Florida Southeast Coasts Basin as the study area using U.S. Environmental Protection Agency (EPA)'s Storm Water Management Model 5.1. The model was calibrated and validated with daily streamflow observations (Nash-Sutcliffe Efficiency = 0.74 to 0.92) during 2004-2013 (termed 2010s), computing the corresponding runoff volume as a historical reference. Runoffs for 2050s (2044-2053) and 2080s (2076-2085) were quantified by incorporating climatic projections from 20 General Circulation Models and land cover projections from EPA under the Representative Concentration Pathways (RCP) 4.5 and 8.5 scenarios. We found a predominant climatic control on the potential runoff changes and a high vulnerability in the coastal-urban environments. The concurrent changes in climate and land cover led to synergistic (stronger than the sum of individual effects) nonlinear responses of runoff. The projected changes in climate and land cover together would increase the annual basin runoff volume by 118%, 106%, 86%, and 80% under the 2080s-RCP 4.5, 2050s-RCP 4.5, 2050s-RCP 8.5, and 2080s-RCP 8.5 scenarios, respectively. Greater increases in runoff were noted at and around the urban centers than that at the non-urban areas across the basin. The relative increases in runoff were higher during the dry season and transitional months (October-May) than the wet season (June-September). Our findings would guide stormwater management and ecosystem protection for southeast Florida and coastal built environments across the world.