Relative sea-level change in Newfoundland, Canada during the past ∼3000 years

Several processes contributing to coastal relative sea-level (RSL) change in the North Atlantic Ocean are observed and/or predicted to have distinctive spatial expressions that vary by latitude. To expand the latitudinal range of RSL records spanning the past ∼3000 years and the likelihood of recognizing the characteristic fingerprints of these processes, we reconstructed RSL at two sites (Big River and Placentia) in Newfoundland from salt-marsh sediment. Bayesian transfer functions established the height of former sea level from preserved assemblages of foraminifera and testate amoebae. Age-depth models constrained by radiocarbon dates and chronohorizons estimated the timing of sediment deposition. During the past ∼3000 years, RSL rose by ∼3.0 m at Big River and by ∼1.5 m at Placentia. A locally calibrated geotechnical model showed that post-depositional lowering through sediment compaction was minimal. To isolate and quantify contributions to RSL from global, regional linear, regional non-linear, and local-scale processes, we decomposed the new reconstructions (and those in an expanded, global database) using a spatio-temporal statistical model. The global component confirms that 20th century sea-level rise occurred at the fastest, century-scale rate in over 3000 years (P > 0.999). Distinguishing the contributions from local and regional non-linear processes is made challenging by a sparse network of reconstructions. However, only a small contribution from local-scale processes is necessary to reconcile RSL reconstructions and modeled RSL trends. We identified three latitudinally-organized groups of sites that share coherent regional non-linear trends and indicate that dynamic redistribution of ocean mass by currents and/or winds was likely an important driver of sea-level change in the North Atlantic Ocean during the past ∼3000 years

Cost-effectiveness of robot-assisted radical cystectomy vs open radical cystectomy for patients with bladder cancer

Importance The value to payers of robot-assisted radical cystectomy with intracorporeal urinary diversion (iRARC) when compared with open radical cystectomy (ORC) for patients with bladder cancer is unclear. Objectives To compare the cost-effectiveness of iRARC with that of ORC. Design, Setting, and Participants This economic evaluation used individual patient data from a randomized clinical trial at 9 surgical centers in the United Kingdom. Patients with nonmetastatic bladder cancer were recruited from March 20, 2017, to January 29, 2020. The analysis used a health service perspective and a 90-day time horizon, with supplementary analyses exploring patient benefits up to 1 year. Deterministic and probabilistic sensitivity analyses were undertaken. Data were analyzed from January 13, 2022, to March 10, 2023. Interventions Patients were randomized to receive either iRARC (n = 169) or ORC (n = 169). Main Outcomes and Measures Costs of surgery were calculated using surgery timings and equipment costs, with other hospital data based on counts of activity. Quality-adjusted life-years were calculated from European Quality of Life 5-Dimension 5-Level instrument responses. Prespecified subgroup analyses were undertaken based on patient characteristics and type of diversion. Results A total of 305 patients with available outcome data were included in the analysis, with a mean (SD) age of 68.3 (8.1) years, and of whom 241 (79.0%) were men. Robot-assisted radical cystectomy was associated with statistically significant reductions in admissions to intensive therapy (6.35% [95% CI, 0.42%-12.28%]), and readmissions to hospital (14.56% [95% CI, 5.00%-24.11%]), but increases in theater time (31.35 [95% CI, 13.67-49.02] minutes). The additional cost of iRARC per patient was £1124 (95% CI, −£576 to £2824 [US $1622 (95$831 to $4075)]) with an associated gain in quality-adjusted life-years of 0.01124 (95$144 312) per quality-adjusted life-year gained. Robot-assisted radical cystectomy had a much higher probability of being cost-effective for subgroups defined by age, tumor stage, and performance status. Conclusions and Relevance In this economic evaluation of surgery for patients with bladder cancer, iRARC reduced short-term morbidity and some associated costs. While the resulting cost-effectiveness ratio was in excess of thresholds used by many publicly funded health systems, patient subgroups were identified for which iRARC had a high probability of being cost-effective

Prognostic indicators and outcomes of hospitalised COVID-19 patients with neurological disease: An individual patient data meta-analysis

Background Neurological COVID-19 disease has been reported widely, but published studies often lack information on neurological outcomes and prognostic risk factors. We aimed to describe the spectrum of neurological disease in hospitalised COVID-19 patients; characterise clinical outcomes; and investigate factors associated with a poor outcome. Methods We conducted an individual patient data (IPD) meta-analysis of hospitalised patients with neurological COVID-19 disease, using standard case definitions. We invited authors of studies from the first pandemic wave, plus clinicians in the Global COVID-Neuro Network with unpublished data, to contribute. We analysed features associated with poor outcome (moderate to severe disability or death, 3 to 6 on the modified Rankin Scale) using multivariable models. Results We included 83 studies (31 unpublished) providing IPD for 1979 patients with COVID-19 and acute new-onset neurological disease. Encephalopathy (978 [49%] patients) and cerebrovascular events (506 [26%]) were the most common diagnoses. Respiratory and systemic symptoms preceded neurological features in 93% of patients; one third developed neurological disease after hospital admission. A poor outcome was more common in patients with cerebrovascular events (76% [95% CI 67–82]), than encephalopathy (54% [42–65]). Intensive care use was high (38% [35–41]) overall, and also greater in the cerebrovascular patients. In the cerebrovascular, but not encephalopathic patients, risk factors for poor outcome included breathlessness on admission and elevated D-dimer. Overall, 30-day mortality was 30% [27–32]. The hazard of death was comparatively lower for patients in the WHO European region. Interpretation Neurological COVID-19 disease poses a considerable burden in terms of disease outcomes and use of hospital resources from prolonged intensive care and inpatient admission; preliminary data suggest these may differ according to WHO regions and country income levels. The different risk factors for encephalopathy and stroke suggest different disease mechanisms which may be amenable to intervention, especially in those who develop neurological symptoms after hospital admission

Field monitoring of soil-moisture to understand the hydrological response of a road-cut slope

Rainfall and slope-cutting for road construction are two key landslide causative factors in Nepal, but how they interact to cause failures is poorly understood. To improve understanding of the effects of cut slopes during rainfall, geotechnical investigations and field monitoring were conducted in a mountainous district, Sindhupalchowk, located in central Nepal. This paper presents the results of the field-investigations and the measurements of volumetric water content obtained from the sensors installed in the study-site. Field-based evidence suggests that the slope that was cut for road construction during the dry period remained stable due to the presence of soil suction, which imparted additional strength to the soil. At the start of the monsoon, infiltration of rainwater caused saturation of the soil at shallow depth, consequently causing loss of suction and reduction of the soil strength. The presence of the road-cut in the hillslope resulting in steeper slopes then promoted the failure. These observations suggest that the presence of road-cuts in the hillslopes can cause landslides even during non-exceptional rainfall events

Teleworking The international dimension

SIGLEGBUnited Kingdo