A spatially distributed model for the dynamic prediction of sediment erosion and transport in mountainous forested watersheds

Erosion and sediment transport in a temperate forested watershed are predicted with a new sediment model that represents the main sources of sediment generation in forested environments (mass wasting, hillslope erosion, and road surface erosion) within the distributed hydrology-soil-vegetation model (DHSVM) environment. The model produces slope failures on the basis of a factor-of-safety analysis with the infinite slope model through use of stochastically generated soil and vegetation parameters. Failed material is routed downslope with a rule-based scheme that determines sediment delivery to streams. Sediment from hillslopes and road surfaces is also transported to the channel network. A simple channel routing scheme is implemented to predict basin sediment yield. We demonstrate through an initial application of this model to the Rainy Creek catchment, a tributary of the Wenatchee River, which drains the east slopes of the Cascade Mountains, that the model produces plausible sediment yield and ratios of landsliding and surface erosion when compared to published rates for similar catchments in the Pacific Northwest. A road removal scenario and a basin-wide fire scenario are both evaluated with the model

Comparison of Outcomes of antibiotic Drugs and Appendectomy (CODA) trial: a protocol for the pragmatic randomised study of appendicitis treatment.

INTRODUCTION: Several European studies suggest that some patients with appendicitis can be treated safely with antibiotics. A portion of patients eventually undergo appendectomy within a year, with 10%-15% failing to respond in the initial period and a similar additional proportion with suspected recurrent episodes requiring appendectomy. Nearly all patients with appendicitis in the USA are still treated with surgery. A rigorous comparative effectiveness trial in the USA that is sufficiently large and pragmatic to incorporate usual variations in care and measures the patient experience is needed to determine whether antibiotics are as good as appendectomy. OBJECTIVES: The Comparing Outcomes of Antibiotic Drugs and Appendectomy (CODA) trial for acute appendicitis aims to determine whether the antibiotic treatment strategy is non-inferior to appendectomy. METHODS/ANALYSIS: CODA is a randomised, pragmatic non-inferiority trial that aims to recruit 1552 English-speaking and Spanish-speaking adults with imaging-confirmed appendicitis. Participants are randomised to appendectomy or 10 days of antibiotics (including an option for complete outpatient therapy). A total of 500 patients who decline randomisation but consent to follow-up will be included in a parallel observational cohort. The primary analytic outcome is quality of life (measured by the EuroQol five dimension index) at 4 weeks. Clinical adverse events, rate of eventual appendectomy, decisional regret, return to work/school, work productivity and healthcare utilisation will be compared. Planned exploratory analyses will identify subpopulations that may have a differential risk of eventual appendectomy in the antibiotic treatment arm. ETHICS AND DISSEMINATION: This trial was approved by the University of Washington\u27s Human Subjects Division. Results from this trial will be presented in international conferences and published in peer-reviewed journals. TRIAL REGISTRATION NUMBER: NCT02800785