Repair of Failing Spirit Lake Outlet Tunnel at Mount St. Helens

The 18 May 1980 eruption of Mount St. Helens resulted in one of the largest debris avalanches recorded in history. The debris avalanche blocked the natural outlet of Spirit Lake. To prevent an uncontrolled and catastrophic lake break-out, the U.S. Army Corps of Engineers (USACE) constructed the Spirit Lake Outlet Tunnel from 1984 to 1985. Because Spirit Lake is located in the Mount St. Helens National Volcanic Monument, the project was transferred to the U.S. Forest Service (USFS) for ownership and management. During original tunnel construction, the most difficulty occurred within the 90-m-wide Julie and Kathy L. shear zone complex. In 1996, tunnel walls within this complex experienced significant convergence, which required major repair along a 30 m segment. During inspections in 2014 and 2015, a 10 m segment at the upstream end of the complex, which had experienced slow heave in the past, was observed to have experienced an increase in heave of approximately 0.6 m, which decreased the hydraulic capacity of the tunnel below acceptable limits. The USACE, in accordance with and with funding from the USFS, designed a repair based on the rib set-shotcrete support system that was used for the 1996 repair. In addition to removing and arresting the heave, the 2015 repair was sized to be compatible with a future potential rehabilitation involving stabilizing and re-grading the invert profile of the Julie and Kathy L. shear zone complex. The 2015 repair construction contract was awarded in September 2015 for $3 million

First-line, Fixed-Duration Nivolumab plus Ipilimumab Followed by Nivolumab in Clinically Diverse Patient Populations With Unresectable Stage III or IV Melanoma: CheckMate 401

PURPOSETo address the paucity of data in patients with historically poor outcomes, we conducted the single-arm phase IIIb CheckMate 401 study to evaluate the safety and efficacy of nivolumab plus ipilimumab followed by nivolumab monotherapy in clinically diverse patient populations with advanced melanoma.METHODSTreatment-naive patients with unresectable stage III-IV melanoma received nivolumab 1 mg/kg plus ipilimumab 3 mg/kg once every 3 weeks (four doses) followed by nivolumab 3 mg/kg (240 mg following a protocol amendment) once every 2 weeks for 24 months. The primary end point was the incidence of grade 3-5 select treatment-related adverse events (TRAEs). Overall survival (OS) was a secondary end point. Outcomes were evaluated in subgroups defined by Eastern Cooperative Oncology Group performance status (ECOG PS), brain metastasis status, and melanoma subtype.RESULTSIn total, 533 patients received at least one dose of study drug. Grade 3-5 select TRAEs affecting the GI (16%), hepatic (15%), endocrine (11%), skin (7%), renal (2%), and pulmonary (1%) systems occurred in the all-treated population; similar incidence rates were observed across all subgroups. At 21.6 months' median follow-up, 24-month OS rates were 63% in the all-treated population, 44% in the ECOG PS 2 subgroup (including patients with cutaneous melanoma only), 71% in the brain metastasis subgroup, 36% in the ocular/uveal melanoma subgroup, and 38% in the mucosal melanoma subgroup.CONCLUSIONNivolumab plus ipilimumab followed by nivolumab monotherapy was tolerable in patients with advanced melanoma and poor prognostic characteristics. Efficacy was similar between the all-treated population and patients with brain metastases. Reduced efficacy was observed in patients with ECOG PS 2, ocular/uveal melanoma, and/or mucosal melanoma, highlighting the continued need for novel treatment options for these difficult-to-treat patients

"It's a can of worms": understanding primary care practitioners' behaviours in relation to HPV using the Theoretical Domains Framework

Background: The relationship between infection with high-risk human papillomavirus (HPV) and cervical cancer is transforming cervical cancer prevention. HPV tests and vaccinations have recently become available. In Ireland, as elsewhere, primary care practitioners play a key role in prevention. ATHENS (A Trial of HPV Education and Support) aims to develop a theorybased intervention to support primary care practitioners in their HPV-related practice. This study, the first step in the intervention development process, aimed to: identify HPV-related clinical behaviours that the intervention will target; clarify general practitioners’ (GPs’) and practice nurses’ roles and responsibilities; and determine factors that potentially influence clinical behaviour. A secondary objective was to informally assess the utility of the Theoretical Domains Framework (TDF) in understanding clinical behaviours in an area with an evolving evidence-base. Methods: In-depth semi-structured telephone interviews were conducted with GPs and practice nurses. The topic guide, which contained open questions and HPV-related clinical scenarios, was developed through literature review and clinical experience. Interview transcripts were content-analysed using the TDF as the coding framework. Results: 19 GPs and 14 practice nurses were interviewed. The major HPV-related clinical behaviours were: initiating a discussion about HPV infection with female patients; offering/recommending HPV vaccination to appropriate patients; and answering patients’ questions about HPV testing. While the responsibility for taking smears was considered a female role, both male and female practitioners dealt with HPV-related issues. All 12 theoretical domains arose in relation to HPV infection; the domains judged to be most important were: knowledge, emotion, social influences, beliefs about capabilities and beliefs about consequences. Eleven domains emerged in relation to HPV vaccination, with beliefs about consequences, social influences, knowledge and environmental context and resources judged to be the most important. Nine domains were relevant to HPV testing, with knowledge and beliefs about capabilities judged to be the most important. Conclusions: The findings confirm the need for an intervention to support primary care practitioners around HPV and suggest it should target a range of theoretical domains. The TDF proved valuable in analysing qualitative data collected using a topic guide not specifically designed to capture TDF domains and understanding clinical behaviours in an area with an evolving evidence-base

Numerical Modeling of the Spillways for the Dam Raise at Isabella Dam

The Sacramento District Corps of Engineers is designing modifications to the Isabella Dam located on the KernRiver in the Tulare Lake Basin in the southern portion of the San Joaquin Basin, in Kern County, California. These modifications include: raising the elevation of two high head dams (185 ft and 100 ft respectively) by 16 ft;modifying a service spillway to better suit the needs of flood capacity, and creating a new labyrinth weir emergency spillway. To aid in the design of both spillways, a series of three-dimensional (3D) computational fluid dynamics(CFD) models of the Isabella Reservoir and outlet works were developed. The design process for the emergency spillway has been streamlined using a composite modelling approach with physical and CFD modeling of the labyrinth weir. The CFD models of the Isabella Dam forebay, the main and auxiliary dams, and service and emergency spillways provide an efficient test bed for design alternatives of the spillways, support for rating curve development, and validation of the information obtained in the physical model.CFD model results were also used to evaluate hydraulic conditions in and down the spillway chute. Velocity,pressure and stream power were computed so appropriate measures could be taken to protect the chutes from damaging erosion

Northern Goshawk (Accipiter gentilis) Genetic Diversity and Connectivity among the Naturally Fragmented Forests of the Northern Great Basin, USA.

Forest fragmentation limits movement of individuals, and even highly mobile species, like birds, can fail to disperse across such landscapes. The naturally fragmented forests of the northern Great Basin are thought to have led to the evolution of unique species. Other species in these forests may also exhibit unique genetic diversity. The Northern Goshawk, a species occupying these forests, has shown low integration between geographically dispersed populations elsewhere in its range. We evaluated genetic diversity and connectivity of the goshawks in the northern Great Basin by extracting mitochondrial DNA and placing the birds in biogeographical context of other populations in the West. We utilized blood and feather samples from nestling and adult birds from five forest islands in south-central Idaho, as well as, the Owyhee Mountains in South West Idaho and Malheur National Forest in Eastern Oregon to compare mitochondrial DNA sequences among individuals. Our work provides a continuation of understanding the genetic ecology of Goshawks in the northern Great Basin, and the genetic health and integration of these birds compared with other populations