A Landslide in Glacial Soils of New Jersey

On August 13, 2000, a massive landslide occurred in Northern New Jersey following an extreme rainfall event during which at least 381mm (15 in) of precipitation fell during a 4-day period. The composite earth slide-earth flow, with an estimated volume of 22,800 m3 (29,821 yd3) traveled up to 365 m (1200 ft) in a short period. While landslides do occasionally occur along the coastal bluffs of the Atlantic Coastal Plain, slides of this magnitude are uncommon in the glacial soils of the New Jersey Highlands section, where the slide occurred. A geotechnical investigation was undertaken to identify the causative factors of the slide. Soils within the rupture zone were found to be distinctly stratified in a direction parallel with the ground slope, which averaged 15% to 20%. The soil profile consisted of an Upper Till overlying a more compact Lower Till. A rupture surface developed at the stratigraphic contact between the two tills, with the Upper Till failing in translation. A significant factor in the location of the rupture surface was the density difference between the Upper and Lower Tills (averaging 16.11 kN/m3 (102.5 lb/ft3) and 20.44 kN/m3 (130 lb/ft3), respectively). Grain size analyses confirmed that the dominance of silt and sand in the Upper Till made it especially prone to sliding. Land use of the site was also a factor, since the rupture occurred on a hay field that was within a residential subdivision in the early stages of construction. The beneficial effects of root reinforcement were especially evident around the rupture scar, since headward and lateral migration of the slide were arrested by a bordering forest. Analyses suggest that the main trigger of the landslide was groundwater perching at the contact between the two tills leading to excess pore pressure which caused failure. Two other conditions contributing to elevated groundwater pressure were a small topographic swale and outcrops of low permeability granite bedrock directly above the rupture zone. The paper concludes with a brief discussion of the implications of the Sparta landslide on the burgeoning development of Northern New Jersey

Analysis of the universal immunization programme and introduction of a rotavirus vaccine in India with IndiaSim

India has the highest under-five death toll globally, approximately 20% of which is attributed to vaccine-preventable diseases. India's Universal Immunization Programme (UIP) is working both to increase immunization coverage and to introduce new vaccines. Here, we analyze the disease and financial burden alleviated across India's population (by wealth quintile, rural or urban area, and state) through increasing vaccination rates and introducing a rotavirus vaccine. We use IndiaSim, a simulated agent-based model (ABM) of the Indian population (including socio-economic characteristics and immunization status) and the health system to model three interventions. In the first intervention, a rotavirus vaccine is introduced at the current DPT3 immunization coverage level in India. In the second intervention, coverage of three doses of rotavirus and DPT and one dose of the measles vaccine are increased to 90% randomly across the population. In the third, we evaluate an increase in immunization coverage to 90% through targeted increases in rural and urban regions (across all states) that are below that level at baseline. For each intervention, we evaluate the disease and financial burden alleviated, costs incurred, and the cost per disability-adjusted life-year (DALY) averted. Baseline immunization coverage is low and has a large variance across population segments and regions. Targeting specific regions can approximately equate the rural and urban immunization rates. Introducing a rotavirus vaccine at the current DPT3 level (intervention one) averts 34.7 (95% uncertainty range [UR], 31.7–37.7) deaths and $215,569 (95$207,846–$223,292) out-of-pocket (OOP) expenditure per 100,000 under-five children. Increasing all immunization rates to 90$45,914 (95% UR, $37,909–$53,920) OOP expenditure. Scaling up immunization by targeting regions with low coverage (intervention three) averts a slightly higher number of deaths and OOP expenditure. The reduced burden of rotavirus diarrhea is the primary driver of the estimated health and economic benefits in all intervention scenarios. All three interventions are cost saving. Improving immunization coverage and the introduction of a rotavirus vaccine significantly alleviates disease and financial burden in Indian households. Population subgroups or regions with low existing immunization coverage benefit the most from the intervention. Increasing coverage by targeting those subgroups alleviates the burden more than simply increasing coverage in the population at large

Clinical Fellowships in Surgical Training: Analysis of a National Pan-specialty Workforce Survey

BACKGROUND: Fellowship posts are increasingly common and offer targeted opportunities for training and personal development. Despite international demand, there is little objective information quantifying this effect or the motivations behind undertaking such a post. The present study investigated surgical trainees’ fellowship aims and intentions. METHODS: An electronic, 38-item, self-administered questionnaire survey was distributed in the United Kingdom via national and regional surgical mailing lists and websites via the Association of Surgeons in Training, Royal Surgical Colleges, and Specialty Associations. RESULTS: In all, 1,581 fully completed surveys were received, and 1,365 were included in the analysis. These represented trainees in core or higher training programs or research from all specialties and training regions: 66 % were male; the mean age was 32 years; 77.6 % intended to or had already completed a fellowship. Plastic surgery (95.2 %) and cardiothoracic (88.6 %) trainees were most likely to undertake a fellowship, with pediatrics (51.2 %), and urology (54.3 %) the least likely. Fellowship uptake increased with seniority (p < 0.01) and was positively correlated (p = 0.016, r = 0.767) with increasing belief that fellowships are necessary to the attainment of clinical competence, agreed by 73.1 %. Fellowship aims were ranked in descending order of importance as attaining competence, increasing confidence, and attaining subspecialist skills. CONCLUSIONS: Over three-quarters of trainees have or will undertake a clinical fellowship, varying with gender, specialty, and seniority. Competence, confidence, and subspecialty skills development are the main aims. The findings will influence workforce planning, and perceptions that current training does not deliver sufficient levels of competence and confidence merit further investigation

TCT-100 Real-World Experience and Outcomes of Protected Versus Unprotected Left Main Percutaneous Coronary Intervention: Insights From the VA CART Program

Background: Outcomes of protected left main (PLM) and unprotected left main (ULM) percutaneous coronary intervention (PCI) are not well defined in contemporary U.S. practice. Previous studies of real-world data have shown worse in-hospital outcomes of ULM PCI compared with randomized trial data. We used a large national registry to characterize real-world practice and outcomes of left main PCI. Methods: Data were collected from the Veteran Affairs (VA) Clinical Assessment Reporting and Tracking (CART) Program for patients undergoing left main PCI between 2009 and 2019. PLM PCI was defined by the presence of at least 1 functioning bypass graft, and ULM PCI was defined as patients with no bypass grafting. Temporal trends, patient and procedure characteristics, anatomic complexity, and clinical complexity were assessed. A 1-to-1 propensity-matched analysis was performed using common comorbidities and clinical variables. One-year outcome analyses were conducted for major adverse cardiovascular events (MACE), all-cause mortality, rehospitalization for myocardial infarction (MI) and revascularization. Results: Of 4,351 patients undergoing left main PCI, 2,800 were PLM PCI and 1,551 were ULM PCI, of which 1,335 PLM and ULM PCI were included in the propensity matched cohort. Patients undergoing ULM PCI were older, more likely to present with acute coronary syndrome (ACS) and had a higher clinical complexity. In the propensity-matched cohort, there was no difference in age, rate of ACS presentation, burden of comorbidities, or left ventricular ejection fraction. There were no differences in in-hospital adverse events between the 2 groups. At 12 months, MACE occurred more frequently with ULM PCI compared with PLM PCI (25% [334] vs 20% [270]; P = 0.004), and all-cause mortality was also higher (18% [239] vs 14% [185]; P = 0.005). There was no difference in rehospitalization for MI, stroke, or revascularization at 12 months. Conclusion: In the VA Healthcare System, patients undergoing ULM PCI were older and more clinically complex than those undergoing PLM PCI. In the propensity-matched cohort, patients undergoing PLM PCI had better 12 outcomes than those undergoing ULM PCI, but there was a high rate of mortality and MACE at 1 year in both groups, despite a relatively low rate of MI or revascularization

Long-range potential fluctuations and 1/f noise in hydrogenated amorphous silicon

We present a microscopic theory of the low-frequency voltage noise (known as "1/f" noise) in micrometer-thick films of hydrogenated amorphous silicon. This theory traces the noise back to the long-range fluctuations of the Coulomb potential produced by deep defects, thereby predicting the absolute noise intensity as a function of the distribution of defect activation energies. The predictions of this theory are in very good agreement with our own experiments in terms of both the absolute intensity and the temperature dependence of the noise spectra.Comment: 8 pages, 3 figures, several new parts and one new figure are added, but no conceptual revision

Racial Differences in Cardiovascular Biomarkers in the General Population

Background-The incidence and clinical manifestations of cardiovascular disease (CVD) differ between blacks and whites. Biomarkers that reflect important pathophysiological pathways may provide a window to allow deeper understanding of racial differences in CVD. Methods and Results-The study included 2635 white and black participants from the Dallas Heart Study who were free from existing CVD. Cross-sectional associations between race and 32 biomarkers were evaluated using multivariable linear regression adjusting for age, traditional CVD risk factors, imaging measures of body composition, renal function, insulin resistance, left ventricular mass, and socioeconomic factors. In fully adjusted models, black women had higher lipoprotein(a), leptin, D-dimer, osteoprotegerin, antinuclear antibody, homoarginine, suppression of tumorigenicity-2, and urinary microalbumin, and lower adiponectin, soluble receptor for advanced glycation end products and N-terminal pro-B-type natriuretic peptide versus white women. Black men had higher lipoprotein(a), leptin, D-dimer, high-sensitivity C-reactive protein, antinuclear antibody, symmetrical dimethylarginine, homoarginine, high-sensitivity cardiac troponin T, suppression of tumorigenicity-2, and lower adiponectin, soluble receptor for advanced glycation end products, and N-terminal pro-B-type natriuretic peptide versus white men. Adjustment for biomarkers that were associated with higher CVD risk, and that differed between blacks and whites, attenuated the risk for CVD events in black women (unadjusted hazard ratio 2.05, 95% CI 1.32, 3.17 and adjusted hazard ratio 1.15, 95% CI 0.69, 1.92) and black men (unadjusted hazard ratio 2.39, 95% CI 1.64, 3.46, and adjusted hazard ratio 1.21, 95% CI 0.76, 1.95). Conclusions-Significant racial differences were seen in biomarkers reflecting lipids, adipokines, and biomarkers of endothelial function, inflammation, myocyte injury, and neurohormonal stress, which may contribute to racial differences in the development and complications of CVD

Practice Patterns and Preferences Among Hematopoietic Cell Transplantation Clinicians

Hematopoietic cell transplantation can cure many high-risk diseases but is associated with complexity, cost, and risk. Several areas in transplantation practice were identified in the 2014 Blood and Marrow Transplant Clinical Trials Network State of the Science Symposium (BMT CTN SOSS) as high priorities for further study. We developed a survey for hematopoietic cell transplantation clinicians to identify current practices in BMT CTN SOSS priority areas and to understand, more generally, the variation in approach to transplantation and estimation of transplantation benefit in current medical practice. Of 1439 transplantation clinicians surveyed, 305 responded (20% response rate). Clinicians were well represented by age, experience, geography, and size of practice. We found that several techniques identified in the BMT CTN SOSS, such as maintenance therapy for acute myeloid leukemia or myelodysplastic syndromes after allogeneic transplantation, were already being utilized in practice on and off study, with higher rates of use in higher-volume centers. There was significant variation among clinicians in use of transplantation technologies and approaches to common transplantation scenarios. Appraisals of risks and benefits of transplantation appeared to converge upon similar estimates despite the presentation of different hypothetical scenarios. These results suggest overall equipoise in several BMT CTN SOSS high-priority areas and support the need for better data to inform clinical practice