Comparison of empirical models with intensively observed data for prediction of salt intrusion in the Sumjin River estuary, Korea

Performance of empirical models has been compared with extensively observed data to determine the most suitable model for prediction of salt intrusion in the Sumjin River estuary, Korea. Intensive measurements of salt intrusion were taken at high and low waters during both spring and neap tide in each season from August 2004 to April 2007. The stratification parameter varied with the distance along the estuary, tidal period and freshwater discharge, indicating that the Sumjin River estuary experiences a transition from partially- or well-mixed during spring tide to stratified during neap tide. The salt intrusion length at high water varied from 13.4 km in summer 2005 to 25.6 km in autumn 2006. The salt intrusion mostly depends on the freshwater discharge rather than spring-neap tidal oscillation. Analysis of three years observed salinity data indicates that the scale of the salt intrusion length in the Sumjin River estuary is proportional to the river discharge to the −1/5 power. Four empirical models have been applied to the Sumjin River estuary to explore the most suitable model for prediction of the salt intrusion length. Comparative results show that the Nguyen and Savenije (2006) model, developed under both partially- and well-mixed estuaries, performs best of all models studied (relative error of 4.6%). The model was also applied under stratified neap tide conditions, with a relative error of 5.2%, implying applicability of this model under stratified conditions as well

Determination of spatially varying Van der Burgh's coefficient from estuarine parameter to describe salt transport in an estuary

The estuarine parameter <i>v</i> is widely accepted as describing the relative contribution of the tide-driven and density-driven mixing mechanism of salt transport in estuaries. Van der Burgh's coefficient <i>K</i> is another parameter that also determines the relative strength of two mechanisms. However, a single value of <i>K</i>, which has been considered in previous studies, can not represent the spatial variation of these mechanisms in an estuary. In this study, the spatially varying <i>K</i> has been determined from the <i>v</i> value calculated using intensively observed longitudinal salinity transects of the Sumjin River Estuary with exponential shape. The spatially varying <i>K</i> describes the spatial variation of these mechanisms reasonably well and is independent of the river discharge downstream of the estuary where the strong tides cause well mixed conditions. However, <i>K</i> values increase upstream and are found to depend on the freshwater discharge, with suppressing vertical mixing. The <i>K</i> value has been scaled on the basis of the <i>v</i> value and ranges between 0 and 1. If <i>K</i> < 0.3, the up-estuary salt transport is entirely dominated by tide-driven mixing near the mouth. If 0.3 < <i>K</i> < 0.8, both tide-driven and density-driven mixing contribute to transporting salt in the central regimes. If <i>K</i> > 0.8, the salt transport is almost entirely by density-driven circulation in the upper most regimes. In addition, another <i>K</i>-based dispersion equation has been solved by using this spatially varying <i>K</i>. The spatially varying <i>K</i> demonstrates density-driven circulation more prominently at the location of strong salinity gradient compared with a single <i>K</i> value

Surface roughness evolution of nanocomposite thin films

An analysis of dynamic roughening and smoothening mechanisms of thin films grown with pulsed-dc magnetron sputtering is presented. The roughness evolution has been described by a linear stochastic equation, which contains the second- and fourth-order gradient terms. Dynamic smoothening of the growing interface is explained by ballistic effects resulting from impingements of ions to the growing thin film. These ballistic effects are sensitive to the flux and energy of impinging ions. The predictions of the model are compared with experimental data, and it is concluded that the thin film roughness can be further controlled by adjusting waveform, frequency, and width of dc pulses

American Thyroid Association Consensus Review and Statement Regarding the Anatomy, Terminology, and Rationale for Lateral Neck Dissection in Differentiated Thyroid Cancer

Background: Cervical lymph node metastases from differentiated thyroid cancer (DTC) are common. Thirty to eighty percent of patients with papillary thyroid cancer harbor lymph node metastases, with the central neck being the most common compartment involved. The goals of this study were to: (1) identify appropriate methods for determining metastatic DTC in the lateral neck and (2) address the extent of lymph node dissection for the lateral neck necessary to control nodal disease balanced against known risks of surgery. Methods: A literature review followed by formulation of a consensus statement was performed. Results: Four proposals regarding management of the lateral neck are made for consideration by organizations developing management guidelines for patients with thyroid nodules and DTC including the next iteration of management guidelines developed by the American Thyroid Association (ATA). Metastases to lateral neck nodes must be considered in the evaluation of the newly diagnosed thyroid cancer patient and for surveillance of the previously treated DTC patient. Conclusions: Lateral neck lymph nodes are a significant consideration in the surgical management of patients with DTC. When current guidelines formulated by the ATA and by other international medical societies are followed, initial evaluation of the DTC patient with ultrasound (or other modalities when indicated) will help to identify lateral neck lymph nodes of concern. These findings should be addressed using fine-needle aspiration biopsy. A comprehensive neck dissection of at least nodal levels IIa, III, IV, and Vb should be performed when indicated to optimize disease control.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/98486/1/thy%2E2011%2E0312.pd

Participatory learning and action to address type 2 diabetes in rural Bangladesh: a qualitative process evaluation

BACKGROUND: Diabetes is 7th largest cause of death worldwide, and prevalence is increasing rapidly in low-and middle-income countries. There is an urgent need to develop and test interventions to prevent and control diabetes and develop the theory about how such interventions can be effective. We conducted a participatory learning and action (PLA) intervention with community groups in rural Bangladesh which was evaluated through a cluster randomised controlled trial. There was a large reduction in the combined prevalence of type 2 diabetes and intermediate hyperglycaemia in the PLA group compared with the control group. We present findings from qualitative process evaluation research to explore how this intervention was effective. // METHODS: We conducted group interviews and focus group discussions using photovoice with purposively sampled group attenders and non-attenders, and intervention implementers. Data were collected before the trial analysis. We used inductive content analysis to generate theory from the data. // RESULTS: The intervention increased the health literacy of individuals and communities - developing their knowledge, capacity and self-confidence to enact healthy behaviours. Community, household and individual capacity increased through social support and social networks, which then created an enabling community context, further strengthening agency and enabling community action. This increased opportunities for healthy behaviour. Community actions addressed lack of awareness about diabetes, gendered barriers to physical activity and lack of access to blood glucose testing. The interaction between the individual, household, and community contexts amplified change, and yet there was limited engagement with macro level, or ‘state’, barriers to healthy behaviour. // CONCLUSIONS: The participatory approach enabled groups to analyse how context affected their ability to have healthy behaviours and participants engaged with issues as a community in the ways that they felt comfortable. We suggest measuring health literacy and social networks in future interventions and recommend specific capacity strengthening to develop public accountability mechanisms and health systems strengthening to complement community-based interventions

Community participatory learning and action cycle groups to reduce type 2 diabetes in Bangladesh (D:Clare trial): study protocol for a stepped-wedge cluster randomised controlled trial.

BACKGROUND: An estimated 463 million people globally have diabetes, with the prevalence growing in low-and middle-income settings, such as Bangladesh. Given the need for context-appropriate interventions to prevent type 2 diabetes mellitus (T2DM), the 'Diabetes: Community-led Awareness, Response and Evaluation' (D:Clare) trial will rigorously evaluate the replication and scale-up of a participatory learning and action (PLA) cycle intervention in Bangladesh, to inform policy on population-level T2DM prevention and control. METHODS: This is a stepped-wedge cluster randomised controlled trial, with integrated process and economic evaluations, conducted from March 2020 to September 2022. The trial will evaluate a community-based four-phase PLA cycle intervention focused on prevention and control of T2DM implemented over 18 months, against a control of usual care. Twelve clusters will be randomly allocated (1:1) to implement the intervention at project month 1 or 12. The intervention will be evaluated through three cross-sectional surveys at months 1, 12 and 24. The trial will be conducted in Alfadanga Upazila, Faridpur district, with an estimated population of 120,000. Clusters are defined as administrative geographical areas, with approximately equal populations. Each of the six unions in Alfadanga will be divided into two clusters, forming 12 clusters in total. Given the risk of inter-cluster contamination, evaluation surveys will exclude villages in border areas. Participants will be randomly sampled, independently for each survey, from a population census conducted in January 2020. The primary outcome is the combined prevalence of intermediate hyperglycaemia and T2DM, measured through fasting and 2-h post-glucose load blood tests. A total of 4680 participants provide 84% power to detect a 30% reduction in the primary outcome, assuming a baseline of 30% and an ICC of 0.07. The analysis will be by intention-to-treat, comparing intervention and control periods across all clusters, adjusting for geographical clustering. DISCUSSION: This study will provide further evidence of effectiveness for community-based PLA to prevent T2DM at scale in a rural Bangladesh setting. However, we encountered several challenges in applying the stepped-wedge design to our research context, with particular consideration given to balancing seasonality, timing and number of steps and estimation of partial versus full effect. TRIAL REGISTRATION: ISRCTN: ISRCTN42219712 . Registered on 31 October 2019

The role of radioactive iodine in the management of patients with differentiated thyroid cancer - An oncologic surgical perspective

With improved understanding of the biology of differentiated thyroid carcinoma its management is evolving. The approach to surgery for the primary tumour and elective nodal surgery is moving from a "one-size-fits -all" recommendation to a more personalised approach based on risk group stratification. With this selective approach to initial surgery, the indications for adjuvant radioactive iodine (RAI) therapy are also changing. This selective approach to adjuvant therapy requires understanding by the entire treatment team of the rationale for RAI, the potential for benefit, the limitations of the evidence, and the potential for side-effects. This review considers the evidence base for the benefits of using RAI in the primary and recurrent setting as well as the side-effects and risks from RAI treatment. By considering the pros and cons of adjuvant therapy we present an oncologic surgical perspective on selection of treatment for patients, both following pre-operative diagnostic biopsy and in the setting of a post-operative diagnosis of malignancy. (C) 2020 Elsevier Ltd, BASO similar to The Association for Cancer Surgery, and the European Society of Surgical Oncology. All rights reserved.Peer reviewe

Outcomes of multimodal therapy in a large series of patients with anaplastic thyroid cancer

Background The role of radiotherapy (RT) in the treatment of patients with anaplastic thyroid cancer (ATC) for local tumor control is critical because mortality often is secondary to complications of tumor volume rather than metastatic disease. Herein, the authors report the long-term outcomes of RT for patients with ATC. Methods A total of 104 patients with histologically confirmed ATC were identified who presented to the study institution between 1984 and 2017 and who received curative-intent or postoperative RT. Locoregional progression-free survival (LPFS), overall survival (OS), and distant metastasis-free survival were assessed. Results The median age of the patients was 63.5 years. The median follow-up was 5.9 months (interquartile range, 2.7-17.0 months) for the entire cohort and 10.6 months (interquartile range, 5.3-40.0 months) for surviving patients. Thirty-one patients (29.8%) had metastatic disease prior to the initiation of RT. Concurrent chemoradiation was administered in 99 patients (95.2%) and 53 patients (51.0%) received trimodal therapy. Systemic therapy included doxorubicin (73.7%), paclitaxel with or without pazopanib (24.3%), and other systemic agents (2.0%). The 1-year OS and LPFS rates were 34.4% and 74.4%, respectively. On multivariate analysis, RT >= 60 Gy was associated with improved LPFS (hazard ratio [HR], 0.135; P = .001) and improved OS (HR, 0.487; P = .004), and trimodal therapy was associated with improved LPFS (HR, 0.060; P = .017). The most commonly observed acute grade 3 adverse events included dermatitis (20%) and mucositis (13%), with no grade 4 subacute or late adverse events noted (adverse events were graded according to the National Cancer Institute Common Terminology Criteria for Adverse Events [version 4.0]). Conclusions RT appears to demonstrate a dose-dependent, persistent LPFS and OS benefit in patients with locally advanced ATC with an acceptable toxicity profile. Aggressive RT should be strongly considered for the treatment of patients with ATC as part of a trimodal treatment approach