Monitored Retrievable Storage of Spent Nuclear Fuel in Indian Country: Liability, Sovereignty, and Socioeconomics

WP 1993-11 August 199

The State of the Great Central Valley -- Public Health and Access to Care

Part of a series that provides various quality of life indicators for California's Central Valley. Examines public health and access to health care in the region. Focuses on maternal and child health, senior health, and chronic and communicable diseases

Asbestos exposure and mesothelioma in South Africa

Objectives. To describe the exposure experiences of South African mesothelioma  cases, with emphasis on the contribution made to the caseload by different fibre  types, the proportion of subjects with no recall of asbestos exposure and only environmental contact, and the importance of putative causes other than asbestos.Design. A multicentred case-control study.Subjects and setting. 123 patients with mesothelioma interviewed by trained  interviewers in study centres established in  Johannesburg, Kimberley, Pretoria, Bloemfontein, Cape Town and Port Elizabeth.Results. A convincing history of asbestos exposure was obtained in the overwhelming majority of cases (only 5 cases had unlikely asbestos exposure). Twenty-three subjects had worked on Cape crocidolite mines, 3 at Penge (an amosite mine), 3 on mines  producing amosite and Transvaal crocidolite and 1 on a Transvaal crocidolite mine. Exclusively environmental exposure  accounted for at least 18% of cases; 91% of these cases (20/'22 subjects) had had contact with Cape crocidolite. There was a relative paucity of cases linked to amosite and no convincing chrysotile case. Non-asbestos causes occur rarely, if at all; in South  Africa.Conclusion. The preponderance of crocidolite cases, followed by amosite and then chrysotile cases, is consistent with the view that there is a fibre gradient of mesotheliomagenic potential for South African asbestos (crocidolite > amosite >chrysotile)

ECOSSE: Estimating Carbon in Organic Soils - Sequestration and Emissions: Final Report

Background Climate change, caused by greenhouse gas ( GHG) emissions, is one of the most serious threats facing our planet, and is of concern at both UK and devolved administration levels. Accurate predictions for the effects of changes in climate and land use on GHG emissions are vital for informing land use policy. Models which are currently used to predict differences in soil carbon (C) and nitrogen (N) caused by these changes, have been derived from those based on mineral soils or deep peat. None of these models is entirely satisfactory for describing what happens to organic soils following land-use change. Reports of Scottish GHG emissions have revealed that approximately 15% of Scotland's total emissions come from land use changes on Scotland's high carbon soils; the figure is much lower for Wales. It is therefore important to reduce the major uncertainty in assessing the carbon store and flux from land use change on organic soils, especially those which are too shallow to be deep peats but still contain a large reserve of C. In order to predict the response of organic soils to external change we need to develop a model that reflects more accurately the conditions of these soils. The development of a model for organic soils will help to provide more accurate values of net change to soil C and N in response to changes in land use and climate and may be used to inform reporting to UKGHG inventories. Whilst a few models have been developed to describe deep peat formation and turnover, none have so far been developed suitable for examining the impacts of land-use and climate change on the types of organic soils often subject to land-use change in Scotland and Wales. Organic soils subject to land-use change are often (but not exclusively) characterised by a shallower organic horizon than deep peats (e.g. organo-mineral soils such as peaty podzols and peaty gleys). The main aim of the model developed in this project was to simulate the impacts of land-use and climate change in these types of soils. The model is, a) be driven by commonly available meteorological data and soil descriptions, b) able to simulate and predict C and N turnover in organic soils, c) able to predict the impacts of land-use change and climate change on C and N stores in organic soils in Scotland and Wales. In addition to developing the model, we have undertaken a number of other modelling exercises, literature searches, desk studies, data base exercises, and experimentation to answer a range of other questions associated with the responses of organic soils in Scotland and Wales to climate and land-use change. Aims of the ECOSSE project The aims of the study were: To develop a new model of C and N dynamics that reflects conditions in organic soils in Scotland and Wales and predicts their likely responses to external factors To identify the extent of soils that can be considered organic in Scotland and Wales and provide an estimate of the carbon contained within them To predict the contribution of CO 2, nitrous oxide and methane emissions from organic soils in Scotland and Wales, and provide advice on how changes in land use and climate will affect the C and N balance In order to fulfil these aims, the project was broken down into modules based on these objectives and the report uses that structure. The first aim is covered by module 2, the second aim by module 1, and the third aim by modules 3 to 8. Many of the modules are inter-linked. Objectives of the ECOSSE project The main objectives of the project were to: Describe the distribution of organic soils in Scotland and Wales and provide an estimate of the C contained in them Develop a model to simulate C and N cycling in organic soils and provide predictions as to how they will respond to land-use, management and climate change using elements of existing peat, mineral and forest soil models Provide predictive statements on the effects of land-use and climate change on organic soils and the relationships to GHG emissions, including CO 2, nitrous oxide and methane. Provide predictions on the effects of land use change and climate change on the release of Dissolved Organic Matter from organic soils Provide estimates of C loss from scenarios of accelerated erosion of organic soils Suggest best options for mitigating C and N loss from organic soils Provide guidelines on the likely effects of changing land-use from grazing or semi-natural vegetation to forestry on C and N in organic soils Use the land-use change data derived from the Countryside Surveys of Scotland and Wales to provide predictive estimates for changes to C and N balance in organic soils over time

Engaging Patients with Late-Stage Non-Small Cell Lung Cancer in Shared Decision Making about Treatment

Few treatment decision support interventions (DSIs) are available to engage patients diagnosed with late-stage non-small cell lung cancer (NSCLC) in treatment shared decision making (SDM). We designed a novel DSI that includes care plan cards and a companion patient preference clarification tool to assist in shared decision making. The cards answer common patient questions about treatment options (chemotherapy, chemotherapy plus immunotherapy, targeted therapy, immunotherapy, clinical trial participation, and supportive care). The form elicits patient treatment preference. We then conducted interviews with clinicians and patients to obtain feedback on the DSI. We also trained oncology nurse educators to implement the prototype. Finally, we pilot tested the DSI among five patients with NSCLC in treatment SDM at the beginning of an office visit scheduled to discuss Treatment with an oncologist. Analyses of pilot study baseline and exit survey data showed that DSI use was associated with increased patient awareness of the alternatives’ treatment options and benefits/risks. In contrast, patient concern about treatment costs and uncertainty in treatment decision making decreased. All patients expressed a treatment preference. Future randomized controlled trials are needed to assess DSI implementation feasibility and efficacy in clinical care

Deflated GMRES for Systems with Multiple Shifts and Multiple Right-Hand Sides

We consider solution of multiply shifted systems of nonsymmetric linear equations, possibly also with multiple right-hand sides. First, for a single right-hand side, the matrix is shifted by several multiples of the identity. Such problems arise in a number of applications, including lattice quantum chromodynamics where the matrices are complex and non-Hermitian. Some Krylov iterative methods such as GMRES and BiCGStab have been used to solve multiply shifted systems for about the cost of solving just one system. Restarted GMRES can be improved by deflating eigenvalues for matrices that have a few small eigenvalues. We show that a particular deflated method, GMRES-DR, can be applied to multiply shifted systems. In quantum chromodynamics, it is common to have multiple right-hand sides with multiple shifts for each right-hand side. We develop a method that efficiently solves the multiple right-hand sides by using a deflated version of GMRES and yet keeps costs for all of the multiply shifted systems close to those for one shift. An example is given showing this can be extremely effective with a quantum chromodynamics matrix.Comment: 19 pages, 9 figure

Tolvaptan in ADPKD Patients With Very Low Kidney Function

Introduction: Tolvaptan slowed estimated glomerular filtration rate (eGFR) decline in subjects with autosomal dominant polycystic kidney disease (ADPKD) in TEMPO 3:4 and REPRISE trials. Tolvaptan effects in subjects with eGFR 15 to 24 ml/min per 1.73 m2 were not investigated. This post hoc analysis retrospectively investigated eGFR decline in REPRISE versus an open-label, phase 3b extension trial (open-label extension [OLE] NCT02251275) in subjects who received placebo in REPRISE and tolvaptan in OLE with eGFR 15 to 24 and 25 to 29 ml/min per 1.73 m2, respectively. Methods: One data subset comprised subjects with OLE baseline eGFR 15 to 29 ml/min per 1.73 m2 who had received placebo in REPRISE and began tolvaptan in OLE. The second comprised subjects who had received tolvaptan in REPRISE and were matched to REPRISE placebo-treated subjects for REPRISE baseline characteristics. Annualized eGFR slopes in REPRISE versus OLE were compared within the REPRISE placebo (i.e., placebo vs. tolvaptan treatment) and tolvaptan (i.e., 2 periods of tolvaptan treatment) subsets. Results: Mean annualized eGFR slopes (ml/min per 1.73 m2) during tolvaptan treatment in OLE versus placebo treatment in REPRISE were -3.4 versus -5.2 for subjects with OLE baseline eGFR 15 to 29 (difference, 1.7; P < 0.001), -3.6 versus -5.4 with baseline eGFR 15 to 24 (difference, 1.8; P < 0.001), and -3.3 versus -4.9 with baseline eGFR 25 to 29 (difference, 1.6; P < 0.001). In REPRISE tolvaptan subjects who continued tolvaptan in OLE, treatment effect was maintained (no difference between mean annualized eGFR slopes). Conclusion: Initiating or maintaining tolvaptan therapy significantly delayed eGFR decline in subjects with baseline eGFR 15 to 24 and 25 to 29 ml/min per 1.73 m2