Improving the FEH statistical procedures for flood frequency estimation

This report recommends changes to the procedures contained in the Flood Estimation Handbook (FEH), which have been adopted as standard practice by the principal bodies engaged in flood frequency estimation in the UK and, in particular, by the Environment Agency. These procedures provide estimates of the flows that will occur in rivers on moderately rare occasions: flow values that have an exceedance probability in any given year of 50 per cent (a 2-year return period) to 1 per cent (a 100-year return period), or even more rare. In the majority of cases where such estimates are required, the locations affected will be ungauged and too far from established river gauging stations to provide data records that can be immediately transferred. The changes recommended arise, in part, because the HiFlows-UK project has led to the creation of a much-improved database of systematically recorded flood data. Not only are the data records now much longer than those used previously but the HiFlows-UK project put substantial effort into the quality control and assessment of the whole data-set. This means that the data available for analysis have been dramatically improved. Another influence on the renewed procedures has been feedback from users of the FEH, both informal and formal. Without substantially changing the overall framework of the methodology, most technical details of the method have been updated to improve the performance of the procedure. The updates include significant improvements to the theoretical statistical framework underlying the method. In addition, it has been possible to consider some new descriptors of catchment topography and local climate that have been proposed since the FEH study. In particular, a new descriptor that measures floodplain extent has been devised and is now included in the improved procedures. This report is largely a technical description of the studies that have led to the new recommendations. The folllowing are the key improvements. • A new regression model for estimating the median annual maximum flood (QMED) at ungauged catchments (Chapter 4). • An improved procedure for the use of donor catchments for estimation of QMED at ungauged catchments (Chapter 5). • An improved procedure for formation of pooling groups and estimation of pooled growth curves (Chapter 6). Flood estimates produced by the new procedures can be substantially different from those produced using the original FEH procedures. On taking the catchments whose data have been analysed as typical examples, and treating them as if they were ungauged, the ratios of the new estimates to the FEH estimates indicate the following changes. • The changes in QMED range from 0.55 to 2.01, with half being greater than 1.15 (25 per cent of the ratios are less than 1.00, and 25 per cent are greater than 1.24). • For floods with an annual probability of exceedance of 1 per cent (the 1 per cent flood), the changes range from 0.48 to 2.24, with half being greater than 1.14 (25 per cent of the ratios are less than 0.97 and 25 per cent are greater than 1.32). For both QMED and the 1 per cent flood, the new procedure produced lower estimates than the FEH in the East of England, whereas increases in both quantities were generally observed in West England, Wales and Scotland

Digital Metastases of Giant Cell Rich Malignant Fibrous Histiocytoma

Background. Metastatic spread of soft tissue sarcomas to the digits is extremely rare and metastasis of MFH to the fingers and toes has not been documented

Mobility of Vulnerable Elders (MOVE): study protocol to evaluate the implementation and outcomes of a mobility intervention in long-term care facilities

<p>Abstract</p> <p>Background</p> <p>Almost 90% of residents living in long-term care facilities have limited mobility which is associated with a loss of ability in activities of daily living, falls, increased risk of serious medical problems such as pressure ulcers, incontinence and a significant decline in health-related quality of life. For health workers caring for residents it may also increase the risk of injury. The effectiveness of rehabilitation to facilitate mobility has been studied with dedicated research assistants or extensively trained staff caregivers; however, few investigators have examined the effectiveness of techniques to encourage mobility by <it>usual caregivers </it>in long-term care facilities.</p> <p>Methods/Design</p> <p>This longitudinal, quasi-experimental study is designed to demonstrate the effect of the sit-to-stand activity carried out by residents in the context of daily care with health care aides. In three intervention facilities health care aides will prompt residents to repeat the sit-to-stand action on two separate occasions during each day and each evening shift as part of daily care routines. In three control facilities residents will receive usual care. Intervention and control facilities are matched on the ownership model (public, private for-profit, voluntary not-for-profit) and facility size. The dose of the mobility intervention is assessed through the use of daily documentation flowsheets in the health record. Resident outcome measures include: 1) the 30-second sit-to-stand test; 2) the <it>Functional Independence Measure</it>; 3) the <it>Health Utilities Index Mark 2 and 3; </it>and, 4) the <it>Quality of Life - Alzheimer's Disease</it>.</p> <p>Discussion</p> <p>There are several compelling reasons for this study: the widespread prevalence of limited mobility in this population; the rapid decline in mobility after admission to a long-term care facility; the importance of mobility to quality of life; the increased time (and therefore cost) required to care for residents with limited mobility; and, the increased risk of injury for health workers caring for residents who are unable to stand. The importance of these issues is magnified when considering the increasing number of people living in long-term care facilities and an aging population.</p> <p>Trial Registration</p> <p>This clinical trial is registered with ClinicalTrials.gov (trial registration number: <a href="http://www.clinicaltrials.gov/ct2/show/NCT01474616">NCT01474616</a>).</p

Drug therapy for delirium in terminally ill adult patients.

BACKGROUND: Delirium is a syndrome characterised by a disturbance of consciousness (often fluctuating), cognition and perception. In terminally ill patients it is one of the most common causes of admission to clinical care. Delirium may arise from any number of causes and treatment should be directed at addressing these causes rather than the symptom cluster. In cases where this is not possible, or treatment does not prove successful, the use of drug therapy to manage the symptoms may become necessary. This is an update of the review published on 'Drug therapy for delirium in terminally ill adult patients' in The Cochrane Library 2004, Issue 2 ( Jackson 2004). OBJECTIVES: To evaluate the effectiveness of drug therapies to treat delirium in adult patients in the terminal phase of a disease. SEARCH METHODS: We searched the following sources: CENTRAL (The Cochrane Library 2012, Issue 7), MEDLINE (1966 to 2012), EMBASE (1980 to 2012), CINAHL (1982 to 2012) and PSYCINFO (1990 to 2012). SELECTION CRITERIA: Prospective trials with or without randomisation or blinding involving the use of drug therapies for the treatment of delirium in adult patients in the terminal phase of a disease. DATA COLLECTION AND ANALYSIS: Two authors independently assessed trial quality using standardised methods and extracted trial data. We collected outcomes related to efficacy and adverse effects. MAIN RESULTS: One trial met the criteria for inclusion. In the 2012 update search we retrieved 3066 citations but identified no new trials. The included trial evaluated 30 hospitalised AIDS patients receiving one of three agents: chlorpromazine, haloperidol and lorazepam. The trial under-reported key methodological features. It found overall that patients in the chlorpromazine group and those in the haloperidol group had fewer symptoms of delirium at follow-up (to below the diagnostic threshold using the Diagnostic and Statistical Manual of Mental Disorders (DSM-III) and that both were equally effective (at two days mean difference (MD) 0.37; 95% confidence interval (CI) -4.58 to 5.32; between two and six days MD -0.21; 95% CI -5.35 to 4.93). Chlorpromazine and haloperidol were found to be no different in improving cognitive status in the short term (at 48 hours) but at subsequent follow-up cognitive status was reduced in those taking chlorpromazine. Improvements from baseline to day two for patients randomised to lorazepam were not apparent. All patients on lorazepam (n = 6) developed adverse effects, including oversedation and increased confusion, leading to trial drug discontinuation. AUTHORS' CONCLUSIONS: There remains insufficient evidence to draw conclusions about the role of drug therapy in the treatment of delirium in terminally ill patients. Thus, practitioners should continue to follow current clinical guidelines. Further research is essential

Chronic Invasive Aspergillosis caused by Aspergillus viridinutans

Aspergillus viridinutans, a mold phenotypically resembling A. fumigatus, was identified by gene sequence analyses from 2 patients. Disease was distinct from typical aspergillosis, being chronic and spreading in a contiguous manner across anatomical planes. We emphasize the recognition of fumigati-mimetic molds as agents of chronic or refractory aspergillosis

The impact of the mixing properties within the Antarctic stratospheric vortex on ozone loss in spring

Calculations of equivalent length from an artificial advected tracer provide new insight into the isentropic transport processes occurring within the Antarctic stratospheric vortex. These calculations show two distinct regions of approximately equal area: a strongly mixed vortex core and a broad ring of weakly mixed air extending out to the vortex boundary. This broad ring of vortex air remains isolated from the core between late winter and midspring. Satellite measurements of stratospheric H2O confirm that the isolation lasts until at least mid-October. A three-dimensional chemical transport model simulation of the Antarctic ozone hole quantifies the ozone loss within this ring and demonstrates its isolation. In contrast to the vortex core, ozone loss in the weakly mixed broad ring is not complete. The reasons are twofold. First, warmer temperatures in the broad ring prevent continuous polar stratospheric cloud (PSC) formation and the associated chemical processing (i.e., the conversion of unreactive chlorine into reactive forms). Second, the isolation prevents ozone-rich air from the broad ring mixing with chemically processed air from the vortex core. If the stratosphere continues to cool, this will lead to increased PSC formation and more complete chemical processing in the broad ring. Despite the expected decline in halocarbons, sensitivity studies suggest that this mechanism will lead to enhanced ozone loss in the weakly mixed region, delaying the future recovery of the ozone hole

Development of core outcome sets for people undergoing major lower limb amputation for complications of peripheral vascular disease

Objective Every year, thousands of patients with peripheral vascular disease undergo major lower limb amputation. Despite this, evidence for optimal management is weak. Core outcome sets capture consensus on the most important outcomes for a patient group to improve the consistency and quality of research. The aim was to define short and medium term core outcome sets for studies involving patients undergoing major lower limb amputation. Methods A systematic review of the literature and focus groups involving patients, carers, and healthcare professionals were used to derive a list of potential outcomes. Findings informed a three round online Delphi consensus process, where outcomes were rated for both short and medium term studies. The results of the Delphi process were discussed at a face to face consensus meeting, and recommendations were made for each core outcome set. Results A systematic review revealed 45 themes to cazrry forward to the consensus survey. These were supplemented by a further five from focus groups. The consensus survey received responses from 123 participants in round one, and 91 individuals completed all three rounds. In the final round, nine outcomes were rated as “core” for short term studies and a further nine for medium term studies. Wound infection and healing were rated as “core” for both short and medium term studies. Outcomes related to mortality, quality of life, communication, and additional healthcare needs were also rated as “core” for short term studies. In medium term studies, outcomes related to quality of life, mobility, and social integration/independence were rated as “core”. The face to face stakeholder meeting ratified inclusion of all outcomes from the Delphi and suggested that deterioration of the other leg and psychological morbidity should also be reported for both short and medium term studies. Conclusion Consensus was established on 11 core outcomes for short and medium term studies. It is recommended that all future studies involving patients undergoing major lower limb amputation should report these outcomes

Multi-scale variations in invertebrate and fish megafauna in the mid-eastern Clarion Clipperton Zone

The abyssal seafloor of the Clarion Clipperton Zone (CCZ) in the central Pacific has the largest known deposits of polymetallic nodules and associated benthic faunal communities with high biodiversity. The environmental factors that structure these communities, both at regional and local scales, are not well understood. In this study, seabed image surveys were used to assess distribution patterns in invertebrate and fish megafauna (>1 cm) at multiple scales in relation to key environmental factors: food supply to the seabed varying at the regional scale (hundreds of km), seabed geomorphological variations varying at the broad local scale (tens of km), and seabed nodule cover varying at the fine local scale (tens of meters). We found significant differences in megafaunal density and community composition between all study areas. Variations in faunal density did not appear to match with regional productivity gradients, although faunal density generally decreased with increasing water depth (from E to W). In contrast, geomorphology and particularly nodule cover appeared to exert strong control on local faunal abundance and community composition, but not in species richness. Local variations in faunal density and beta-diversity, particularly those driven by nodule presence (within study areas), were of comparable magnitude to those observed at a regional level (between study areas). However, regional comparisons of megabenthic assemblages showed clear shifts in dominance between taxonomic groups (perceivable even at Phylum levels) across the mid-eastern CCZ seabed, suggesting a higher regional heterogeneity than was previously thought

Game of Stones:feasibility randomised controlled trial of how to engage men with obesity in text message and incentive interventions for weight loss

Objectives To examine the acceptability and feasibility of narrative text messages with or without financial incentives to support weight loss for men. Design Individually randomised three-arm feasibility trial with 12 months’ follow-up. Setting Two sites in Scotland with high levels of disadvantage according to Scottish Index for Multiple Deprivation (SIMD). Participants Men with obesity (n=105) recruited through community outreach and general practitioner registers. Interventions Participants randomised to: (A) narrative text messages plus financial incentive for 12 months (short message service (SMS)+I), (B) narrative text messages for 12 months (SMS only), or (C) waiting list control. Outcomes Acceptability and feasibility of recruitment, retention, intervention components and trial procedures assessed by analysing quantitative and qualitative data at 3, 6 and 12 months. Results 105 men were recruited, 60% from more disadvantaged areas (SIMD quintiles 1 or 2). Retention at 12 months was 74%. Fewer SMS+I participants (64%) completed 12-month assessments compared with SMS only (79%) and control (83%). Narrative texts were acceptable to many men, but some reported negative reactions. No evidence emerged that level of disadvantage was related to acceptability of narrative texts. Eleven SMS+I participants (31%) successfully met or partially met weight loss targets. The cost of the incentive per participant was £81.94 (95% CI £34.59 to £129.30). Incentives were acceptable, but improving health was reported as the key motivator for weight loss. All groups lost weight (SMS+I: −2.51 kg (SD=4.94); SMS only: −1.29 kg (SD=5.03); control: −0.86 kg (SD=5.64) at 12 months). Conclusions This three-arm weight management feasibility trial recruited and retained men from across the socioeconomic spectrum, with the majority from areas of disadvantage, was broadly acceptable to most participants and feasible to deliver