Simulating tidal and storm surge hydraulics with a simple 2D inertia based model, in the Humber Estuary, U.K

The hydraulic modelling of tidal estuarine environments has been largely limited to complex 3D models that are computationally expensive. This makes them unsuitable for applications which make use of live data to make real/near time forecasts, such as the modelling of storm surge propagation and associated flood inundation risks. To address this requirement for a computationally efficient method a reduced complexity, depth-integrated 2D storage cell model (Lisflood-FP) has been applied to the Humber Estuary, UK. The capability of Lisflood-FP to reproduce the tidal heights of the Humber Estuary has been shown by comparing modelled and observed tidal stage heights over a period of a week. The feasibility of using the Lisflood-FP model to forecast flood inundation risk from a storm surge is demonstrated by reproducing the major storm surge that struck the UK East Coast and Humber Estuary on 5 December 2013. Results show that even for this 2013 extreme event the model is capable of reproducing the hydraulics and tidal levels of the estuary. Using present day flood defences and observed flooding extents, the modelled flood inundation areas produced by the model were compared, showing agreement in most areas and illustrating the model's potential as a now-casting early warning system when driven by publically available data, and in near real-time. The Lisflood-FP model used was incorporated into the CAESAR-Lisflood GUI, with the calibration and verification of the estuarine hydraulics reported herein being a key step in creating an estuary evolution model, capable of operating in the decadal to century timescales that are presently underrepresented in estuarine predictive capability, and ultimately developing a model to predict the evolution of flood risk over the longer term

A multidimensional stochastic theory of similarity

A multidimensional theory of similarity in which the mental representations of stimulus objects are assumed to be drawn from multivariate normal distributions is described. A distance-based similarity function is defined and the expected value of similarity is derived. This theory is the basis for a possible explanation of paradoxical results with highly similar stimuli regarding the form of the similarity function and the distance metric. A stochastic approach to multidimensional scaling based on same-different judgments is demonstrated using artificial and real data sets. The theory of similarity presented is used as a basis for a Thurstonian extension of Shepard's model of identification performance.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/27046/1/0000035.pd

Unicompartmental knee arthroplasty: A PearlDiver study evaluating complications rates, opioid use and utilization in the Medicare population

A grant from the One-University Open Access Fund at the University of Kansas was used to defray the author's publication fees in this Open Access journal. The Open Access Fund, administered by librarians from the KU, KU Law, and KUMC libraries, is made possible by contributions from the offices of KU Provost, KU Vice Chancellor for Research & Graduate Studies, and KUMC Vice Chancellor for Research. For more information about the Open Access Fund, please see http://library.kumc.edu/authors-fund.xml.Purpose Despite increased utilization of unicompartmental knee arthroplasty (UKA) for unicompartmental knee osteoarthritis, outcomes in Medicare patients are not well-reported. The purpose of this study is to analyze practice patterns and outcome differences between UKA and TKA in the Medicare population. It is hypothesized that UKA utilization will have increased over the course of the study period and that UKA will be associated with reduced opioid use and lower complication rates compared to TKA. Methods Using PearlDiver, the Humana Claims dataset and the Medicare Standard Analytic File (SAF) were analyzed. Patients who underwent UKA and TKA were identified by CPT codes. Postoperative complications were identified by ICD-9/ICD-10 codes. Opioid use was analyzed by the number of days patients were prescribed opioids postoperatively. Survivorship was defined as conversion to TKA. Results In the Humana dataset, 7,808 UKA and 150,680 TKA patients were identified. 8-year survivorship was 87.7% (95% CI [0.861,0.894]). Postoperative opioid use was significantly higher after TKA (186.1 days) compared to UKA (144.7 days) (p  80 years old and lowest in patients < 70 years old. In both datasets, postoperative complication rates were higher in TKA patients compared to UKA patients in nearly all categories. Conclusions UKA represents an increasingly utilized treatment for osteoarthritis in the Medicare population and may be comparatively advantageous to TKA due to reduced opioid use and complication rates after surgery

A link between the ice nucleation activity and the biogeochemistry of seawater

Emissions of ice-nucleating particles (INPs) from sea spray can impact climate and precipitation by changing cloud formation, precipitation, and albedo. However, the relationship between seawater biogeochemistry and the ice nucleation activity of sea spray aerosols remains unclarified. Here, we demonstrate a link between the biological productivity in seawater and the ice nucleation activity of sea spray aerosol under conditions relevant to cirrus and mixed-phase cloud formation. We show for the first time that aerosol particles generated from both subsurface and microlayer seawater from the highly productive eastern tropical North Pacific Ocean are effective INPs in the deposition and immersion freezing modes. Seawater particles of composition similar to subsurface waters of highly productive regions may therefore be an unrealized source of effective INPs. In contrast, the subsurface water from the less productive Florida Straits produced less effective immersion mode INPs and ineffective depositional mode INPs. These results indicate that the regional biogeochemistry of seawater can strongly affect the ice nucleation activity of sea spray aerosol

Lymphovascular space invasion and lack of downstaging after neoadjuvant chemotherapy are strong predictors of adverse outcome in young women with locally advanced breast cancer

Younger age diagnosis of breast cancer is a predictor of adverse outcome. Here, we evaluate prognostic factors in young women with locally advanced breast cancer (LABC). We present a retrospective review of 104 patients younger than 40 years with LABC treated with surgery, radiotherapy (RT), and chemotherapy from 2003 to 2014. Patient‐, tumor‐, and treatment‐related factors important for overall survival (OS), local/regional recurrence (LRR), distant metastasis (DM), and recurrence‐free survival (RFS) were evaluated. Mean age at diagnosis was 34 years (23–39 years) with a median follow‐up of 47 months (8–138 months). Breast‐conserving surgery was performed in 27%. Axillary lymph node dissection was performed in 85%. Sixty percent of patients received neoadjuvant chemotherapy with 19% achieving pathologic complete response (pCR), and 61% downstaged. Lymph node positivity was present in 91% and lymphovascular space invasion (LVSI) in 35%. Thirty‐two percent of patients had triple negative tumors (TN, ER‐/PR‐/HER2 nonamplified). Four‐year OS and RFS was 84% and 71%, respectively. Factors associated with worse OS on multivariate analysis include TN status, LVSI, and number of positive lymph nodes. LVSI was also associated with DM and LRR, as well as worse RFS. Downstaging was associated with improved 4 year RFS in patients receiving neoadjuvant chemotherapy (74% vs. 38%, P = 0.002). With high risks of recurrence and inferior OS compared to older women, breast cancer in young women can be difficult to treat. Among additional factors, presence of LVSI and lack of downstaging portends a particularly worse prognosis

Long-Term Outcomes After Transcatheter Aortic Valve Implantation in High-Risk Patients With Severe Aortic Stenosis The U.K. TAVI (United Kingdom Transcatheter Aortic Valve Implantation) Registry

ObjectivesThe objective was to define the characteristics of a real-world patient population treated with transcatheter aortic valve implantation (TAVI), regardless of technology or access route, and to evaluate their clinical outcome over the mid to long term.BackgroundAlthough a substantial body of data exists in relation to early clinical outcomes after TAVI, there are few data on outcomes beyond 1 year in any notable number of patients.MethodsThe U.K. TAVI (United Kingdom Transcatheter Aortic Valve Implantation) Registry was established to report outcomes of all TAVI procedures performed within the United Kingdom. Data were collected prospectively on 870 patients undergoing 877 TAVI procedures up until December 31, 2009. Mortality tracking was achieved in 100% of patients with mortality status reported as of December 2010.ResultsSurvival at 30 days was 92.9%, and it was 78.6% and 73.7% at 1 year and 2 years, respectively. There was a marked attrition in survival between 30 days and 1 year. In a univariate model, survival was significantly adversely affected by renal dysfunction, the presence of coronary artery disease, and a nontransfemoral approach; whereas left ventricular function (ejection fraction <30%), the presence of moderate/severe aortic regurgitation, and chronic obstructive pulmonary disease remained the only independent predictors of mortality in the multivariate model.ConclusionsMidterm to long-term survival after TAVI was encouraging in this high-risk patient population, although a substantial proportion of patients died within the first year

Futility in Transcatheter Aortic Valve Implantation: A Search for Clarity

Although transcatheter aortic valve implantation (TAVI) has revolutionised the landscape of treatment for aortic stenosis, there exists a cohort of patients where TAVI is deemed futile. Among the pivotal high-risk trials, one-third to half of patients either died or received no symptomatic benefit from the procedure at 1 year. Futility of TAVI results in the unnecessary exposure of risk for patients and inefficient resource utilisation for healthcare services. Several cardiac and extra-cardiac conditions and frailty increase the risk of mortality despite TAVI. Among the survivors, these comorbidities can inhibit improvements in symptoms and quality of life. However, certain conditions are reversible with TAVI (e.g. functional mitral regurgitation), attenuating the risk and improving outcomes. Quantification of disease severity, identification of reversible factors and a systematic evaluation of frailty can substantially improve risk stratification and outcomes. This review examines the contribution of pre-existing comorbidities towards futility in TAVI and suggests a systematic approach to guide patient evaluation

Suppressed basal melting in the eastern Thwaites Glacier grounding zone

This work is from the MELT project, a component of the International Thwaites Glacier Collaboration (ITGC). Support from the National Science Foundation (NSF, grant no. 1739003) and the Natural Environment Research Council (NERC, grant no. NE/S006656/1). Logistics provided by NSF U.S. Antarctic Program and NERC British Antarctic Survey. The ship-based CTD data were supported by the ITGC TARSAN project (NERC grant nos. NE/S006419/1 and NE/S006591/1; NSF grant no. 1929991). ITGC contribution no. ITGC 047.Thwaites Glacier is one of the fastest-changing ice–ocean systems in Antarctica1,2,3. Much of the ice sheet within the catchment of Thwaites Glacier is grounded below sea level on bedrock that deepens inland4, making it susceptible to rapid and irreversible ice loss that could raise the global sea level by more than half a metre2,3,5. The rate and extent of ice loss, and whether it proceeds irreversibly, are set by the ocean conditions and basal melting within the grounding-zone region where Thwaites Glacier first goes afloat3,6, both of which are largely unknown. Here we show—using observations from a hot-water-drilled access hole—that the grounding zone of Thwaites Eastern Ice Shelf (TEIS) is characterized by a warm and highly stable water column with temperatures substantially higher than the in situ freezing point. Despite these warm conditions, low current speeds and strong density stratification in the ice–ocean boundary layer actively restrict the vertical mixing of heat towards the ice base7,8, resulting in strongly suppressed basal melting. Our results demonstrate that the canonical model of ice-shelf basal melting used to generate sea-level projections cannot reproduce observed melt rates beneath this critically important glacier, and that rapid and possibly unstable grounding-line retreat may be associated with relatively modest basal melt rates.Publisher PDFPeer reviewe

Adherence to guidelines strongly improves reproducibility of brachial artery flow-mediated dilation.

BACKGROUND: Brachial artery FMD is widely used as a non-invasive measure of endothelial function. Adherence to expert guidelines is believed to be of vital importance to obtain reproducible measurements. We conducted a systematic review of studies reporting on the reproducibility of the FMD in order to determine the relation between adherence to current expert guidelines for FMD measurement and its reproducibility. METHODS: Medline-database was searched through July 2015 and 458 records were screened for FMD reproducibility studies reporting the mean difference and variance of repeated FMD measurements. An adherence score was assigned to each of the included studies based on reported adherence to published guidelines on the assessment of brachial artery FMD. A Typical Error Estimate (TEE) of the FMD was calculated for each included study. The relation between the FMD TEE and the adherence score was investigated by means of Pearson correlation coefficients and multiple linear regression analysis. RESULTS: Twenty-seven studies involving 48 study groups and 1537 subjects were included in the analyses. The adherence score ranged from 2.4 to 9.2 (out of a maximum of 10) and was strongly and inversely correlated with FMD TEE (adjusted R(2) = 0.36, P < 0.01). Use of automated edge-detection software, continuous diameter measurement, true peak diameter for %FMD calculation, a stereostatic probe holder, and higher age emerged as factors associated with a lower FMD TEE. CONCLUSIONS: These data demonstrate that adherence to current expert consensus guidelines and applying contemporary techniques for measuring brachial artery FMD decreases its measurement error