Remote Sensing of Suspended Sediment Concentration and Hydrologic Connectivity in a Complex Wetland Environment

Maintaining the ecological diversity and hydrologic connectivity of freshwater delta systems depends on regular recharge of floodplains with river water, which can be difficult to observe on the ground. Rivers that form deltas often carry large amounts of suspended sediment, but floodplain lakes and wetlands usually have little sediment in suspension. Remote observation of high sediment water in lakes and wetlands therefore often indicates connectivity with the river network. In this study, we use daily 250-m MODIS imagery in band 1 (620-670 nm) and band 2 (841-876 nm) to monitor suspended sediment transport and, by proxy, hydrologic recharge in the Peace-Athabasca Delta, Canada. To identify an appropriate suspended sediment concentration (SSC)-reflectance model, we compare 31 published empirical equations using a field dataset containing 147 observations of SSC and in situ spectral reflectance. Results suggest potential for spatial transferability of such models, but success is contingent on the equation meeting certain criteria: 1) use of a near infrared band in combination with at least one visible band, 2) development based on SSCs similar to those in the observed region, and 3) a nonlinear form. Using a highly predictive SSC-reflectance model (Spearman's ρ=0.95), we develop a twelve-year time series of SSC in the westernmost end of Lake Athabasca, observe the timing and sources of major sediment flux events, and identify a threshold river discharge of ~1700 m3/s above which SSC in Lake Athabasca is clearly associated with flow in the Athabasca River. We also track the influx of Athabasca River water to floodplain lakes, and in three of the lakes identify distinct discharge thresholds (1040 m3/s, 1150 m3/s, and 1850 m3/s) which result in lake recharge. For each of these lakes, we find a statistically significant decline in the threshold exceedence frequency since 1970, suggesting less frequent recharge during the summer.Master of Scienc

Newton’s Unfinished Business: Uncovering the Hidden Powers of Eleven in Pascal’s Triangle

Sir Isaac Newton once observed that the first five rows of Pascal’s Triangle, when concatenated, yield the corresponding powers of eleven. He claimed without proof that subsequent rows also generate powers of eleven. Was he correct? While not all rows can simply be concatenated, the powers of eleven can still be easily derived from each. We have uncovered an algorithm the supports Newton’s claim and will prove its validity for all rows of the Triangle

Newton’s Unfinished Business: Uncovering the Hidden Powers of Eleven in Pascal’s Triangle

Sir Isaac Newton once observed that the first five rows of Pascal’s Triangle, when concatenated, yield the corresponding powers of eleven. He claimed without proof that subsequent rows also generate powers of eleven. Was he correct? While not all rows can simply be concatenated, the powers of eleven can still be easily derived from each. We have uncovered an algorithm the supports Newton’s claim and will prove its validity for all rows of the Triangle

A National Spinal Muscular Atrophy Registry for Real-World Evidence.

BACKGROUND: Spinal muscular atrophy (SMA) is a devastating rare disease that affects individuals regardless of ethnicity, gender, and age. The first-approved disease-modifying therapy for SMA, nusinursen, was approved by Health Canada, as well as by American and European regulatory agencies following positive clinical trial outcomes. The trials were conducted in a narrow pediatric population defined by age, severity, and genotype. Broad approval of therapy necessitates close follow-up of potential rare adverse events and effectiveness in the larger real-world population. METHODS: The Canadian Neuromuscular Disease Registry (CNDR) undertook an iterative multi-stakeholder process to expand the existing SMA dataset to capture items relevant to patient outcomes in a post-marketing environment. The CNDR SMA expanded registry is a longitudinal, prospective, observational study of patients with SMA in Canada designed to evaluate the safety and effectiveness of novel therapies and provide practical information unattainable in trials. RESULTS: The consensus expanded dataset includes items that address therapy effectiveness and safety and is collected in a multicenter, prospective, observational study, including SMA patients regardless of therapeutic status. The expanded dataset is aligned with global datasets to facilitate collaboration. Additionally, consensus dataset development aimed to standardize appropriate outcome measures across the network and broader Canadian community. Prospective outcome studies, data use, and analyses are independent of the funding partner. CONCLUSION: Prospective outcome data collected will provide results on safety and effectiveness in a post-therapy approval era. These data are essential to inform improvements in care and access to therapy for all SMA patients

Efficacy of niraparib by time of surgery and postoperative residual disease status: A post hoc analysis of patients in the PRIMA/ENGOT-OV26/GOG-3012 study

ObjectiveTo evaluate the association between surgical timing and postoperative residual disease status on the efficacy of niraparib first-line maintenance therapy in patients with newly diagnosed advanced ovarian cancer at high risk of recurrence.MethodsPost hoc analysis of the phase 3 PRIMA/ENGOT-OV26/GOG-3012 (NCT02655016) study of niraparib in patients with newly diagnosed primary advanced ovarian, primary peritoneal, or fallopian tube cancer with a complete/partial response to first-line platinum-based chemotherapy. Progression-free survival (PFS) was assessed by surgical status (primary debulking surgery [PDS] vs neoadjuvant chemotherapy/interval debulking surgery [NACT/IDS]) and postoperative residual disease status (no visible residual disease [NVRD] vs visible residual disease [VRD]) in the intent-to-treat population.ResultsIn PRIMA (N = 733), 236 (32.2%) patients underwent PDS, and 481 (65.6%) received NACT/IDS before enrollment. Median PFS (niraparib vs placebo) and hazard ratios (95% CI) for progression were similar in PDS (13.7 vs 8.2 months; HR, 0.67 [0.47–0.96]) and NACT/IDS (14.2 vs 8.2 months; HR, 0.57 [0.44–0.73]) subgroups. In patients who received NACT/IDS and had NVRD (n = 304), the hazard ratio (95% CI) for progression was 0.65 (0.46–0.91). In patients with VRD following PDS (n = 183) or NACT/IDS (n = 149), the hazard ratios (95% CI) for progression were 0.58 (0.39–0.86) and 0.41 (0.27–0.62), respectively. PFS was not evaluable for patients with PDS and NVRD because of sample size (n = 37).ConclusionsIn this post hoc analysis, niraparib efficacy was similar across PDS and NACT/IDS subgroups. Patients who had NACT/IDS and VRD had the highest reduction in the risk of progression with niraparib maintenance.</p

Tetanus Toxoid, Reduced Diphtheria Toxoid and Acellular Pertussis Vaccination and Influenza Vaccination of Pregnant and Postpartum Women

Introduction: Infants ≤2 months are at greatest risk for morbidity/mortality from pertussis. Tdap vaccines given in late pregnancy or postpartum can protect infants from pertussis. Pregnancy increases risks for maternal and perinatal complications. Influenza vaccine (FLUV) given in pregnancy can protect women and newborns. Objectives: To determine Tdap and FLUV rates in pregnant and postpartum patients and identify factors associated with vaccination. Methods: Miami Valley Hospital delivery records from 01/2009-12/2011 were retrospectively reviewed. Data reviewed included age, insurance, race/ethnicity, and county of residence. Descriptive statistics analyzed prevalence of immunization, timing, and demographics. Chi-square and odds ratios detected differences between characteristics. Main Findings:A total of 13704 charts were reviewed. Tdap was administered to 42%, with 93% vaccinated within 10 days after birth. Tdap uptake was significantly greater among younger mothers (49%, p=0.023), those with government insurance (48%, p Conclusions: Despite current recommendations, only a minority received vaccinations during pregnancy or postpartum. Vaccination rates increased over time and with certain demographics. Improved strategies may increase FLUV and Tdap administration in this population

Things are Looking up Since We Started Listening to Patients: Trends in the Application of Conjoint Analysis in Health 1982-2007

Clinical and healthcare decision makers have repeatedly endorsed patient-centered care as a goal of the health system. However, traditional methods of evaluation reinforce societal views, and research focusing on views of patients is often referred to as 'soft science.' Conjoint analysis presents a scientifically rigorous research tool that can be used to understand patient preferences and inform decision making. This paper documents applications of conjoint analysis in medicine and systematically reviews this literature in order to identify publication trends and the range of topics to which conjoint analysis has been applied. In addition, we document important methodological aspects such as sample size, experimental design, and method of analysis. Publications were identified through a MEDLINE search using multiple search terms for identification. We classified each article into one of three categories: clinical applications (n - 122); methodological contributions (n - 56); and health system applications (n - 47). Articles that did not use or adequately discuss conjoint analysis methods (n - 164) were discarded. We identified a near exponential increase in the application of conjoint analyses over the last 10 years of the study period (1997-2007). Over this period, the proportion of applications on clinical topics increased from 40% of articles published in MEDLINE from 1998 to 2002, to 64% of articles published from 2003 to 2007 (p - 0.002). The average sample size among articles focusing on health system applications (n - 556) was significantly higher than clinical applications (n - 277) &lsqb;p - 0.001&rsqb;, although this 2-fold difference was primarily due to a number of outliers reporting sample sizes in the thousands. The vast majority of papers claimed to use orthogonal factorial designs, although over a quarter of papers did not report their design properties. In terms of types of analysis, logistic regression was favored among clinical applications (28%), while probit was most commonly used among health systems applications (38%). However, 25% of clinical applications and 33% of health systems articles failed to report what regression methods were used. We used the International Classification of Diseases - version 9 (ICD-9) coding system to categorize clinical applications, with approximately 26% of publications focusing on neoplasm. Program planning and evaluation applications accounted for 22% of the health system articles. While interest in conjoint analysis in health is likely to continue, better guidelines for conducting and reporting conjoint analyses are needed.