Floods of August 21-24, 2007, in Northwestern and North-Central Ohio

USGS Publications Warehouse

Straub, David E.; Ebner, Andrew D.; Astifan, Brian M.

2009-01-01

Heavy rains in northwestern and north-central Ohio on August 19-22, 2007, caused severe flooding and widespread damages to residential, public, and commercial structures in the communities of Bluffton, Bucyrus, Carey, Columbus Grove, Crestline, Findlay, Mansfield, Ottawa, and Shelby. On August 27, 2007, the Federal Emergency Management Agency (FEMA) issued a notice of a Presidential declaration of a major disaster affecting Allen, Crawford, Hancock, Hardin, Putnam, Richland, Seneca, and Wyandot Counties as a result of the severe flooding. Rainfall totals for most of the flooded area were 3 to 5 in., with some locations reporting as much as 8 to 10 in. Three National Weather Service (NWS) gages in the area indicated a rainfall recurrence interval of greater than 1,000 years, and two indicated a recurrence interval between 500 and 1,000 years. Total damages are estimated at approximately $290 million, with 8,205 residences registering for financial assistance. The U.S. Geological Survey (USGS) computed flood recurrence intervals for peak streamflows at 22 streamgages and 8 ungaged sites in and around the area of major flooding. The peak streamflows at Sandusky River near Bucyrus streamgage and at seven of the eight ungaged sites had estimated recurrence intervals of greater than 500 years. The USGS located and surveyed 421 high-water marks and plotted high-water profiles for approximately 44.5 miles of streams throughout the nine communities.

Technique for estimation of streamflow statistics in mineral areas of interest in Afghanistan

USGS Publications Warehouse

Olson, Scott A.; Mack, Thomas J.

2011-01-01

A technique for estimating streamflow statistics at ungaged stream sites in areas of mineral interest in Afghanistan using drainage-area-ratio relations of historical streamflow data was developed and is documented in this report. The technique can be used to estimate the following streamflow statistics at ungaged sites: (1) 7-day low flow with a 10-year recurrence interval, (2) 7-day low flow with a 2-year recurrence interval, (3) daily mean streamflow exceeded 90 percent of the time, (4) daily mean streamflow exceeded 80 percent of the time, (5) mean monthly streamflow for each month of the year, (6) mean annual streamflow, and (7) minimum monthly streamflow for each month of the year. Because they are based on limited historical data, the estimates of streamflow statistics at ungaged sites are considered preliminary.

Modelling recurrent events: comparison of statistical models with continuous and discontinuous risk intervals on recurrent malaria episodes data

PubMed Central

2014-01-01

Background Recurrent events data analysis is common in biomedicine. Literature review indicates that most statistical models used for such data are often based on time to the first event or consider events within a subject as independent. Even when taking into account the non-independence of recurrent events within subjects, data analyses are mostly done with continuous risk interval models, which may not be appropriate for treatments with sustained effects (e.g., drug treatments of malaria patients). Furthermore, results can be biased in cases of a confounding factor implying different risk exposure, e.g. in malaria transmission: if subjects are located at zones showing different environmental factors implying different risk exposures. Methods This work aimed to compare four different approaches by analysing recurrent malaria episodes from a clinical trial assessing the effectiveness of three malaria treatments [artesunate + amodiaquine (AS + AQ), artesunate + sulphadoxine-pyrimethamine (AS + SP) or artemether-lumefantrine (AL)], with continuous and discontinuous risk intervals: Andersen-Gill counting process (AG-CP), Prentice-Williams-Peterson counting process (PWP-CP), a shared gamma frailty model, and Generalized Estimating Equations model (GEE) using Poisson distribution. Simulations were also made to analyse the impact of the addition of a confounding factor on malaria recurrent episodes. Results Using the discontinuous interval analysis, AG-CP and Shared gamma frailty models provided similar estimations of treatment effect on malaria recurrent episodes when adjusted on age category. The patients had significant decreased risk of recurrent malaria episodes when treated with AS + AQ or AS + SP arms compared to AL arm; Relative Risks were: 0.75 (95% CI (Confidence Interval): 0.62-0.89), 0.74 (95% CI: 0.62-0.88) respectively for AG-CP model and 0.76 (95% CI: 0.64-0.89), 0.74 (95% CI: 0.62-0.87) for the Shared gamma frailty model. With both discontinuous and continuous risk intervals analysis, GEE Poisson distribution models failed to detect the effect of AS + AQ arm compared to AL arm when adjusted for age category. The discontinuous risk interval analysis was found to be the more appropriate approach. Conclusion Repeated event in infectious diseases such as malaria can be analysed with appropriate existing models that account for the correlation between multiple events within subjects with common statistical software packages, after properly setting up the data structures. PMID:25073652

Estimating the magnitude of annual peak discharges with recurrence intervals between 1.1 and 3.0 years for rural, unregulated streams in West Virginia

USGS Publications Warehouse

Wiley, Jeffrey B.; Atkins, John T.; Newell, Dawn A.

2002-01-01

Multiple and simple least-squares regression models for the log10-transformed 1.5- and 2-year recurrence intervals of peak discharges with independent variables describing the basin characteristics (log10-transformed and untransformed) for 236 streamflow-gaging stations were evaluated, and the regression residuals were plotted as areal distributions that defined three regions in West Virginia designated as East, North, and South. Regional equations for the 1.1-, 1.2-, 1.3-, 1.4-, 1.5-, 1.6-, 1.7-, 1.8-, 1.9-, 2.0-, 2.5-, and 3-year recurrence intervals of peak discharges were determined by generalized least-squares regression. Log10-transformed drainage area was the most significant independent variable for all regions. Equations developed in this study are applicable only to rural, unregulated streams within the boundaries of West Virginia. The accuracies of estimating equations are quantified by measuring the average prediction error (from 27.4 to 52.4 percent) and equivalent years of record (from 1.1 to 3.4 years).

Comparison of the 2-, 25-, and 100-year recurrence interval floods computed from observed data with the 1995 urban flood-frequency estimating equations for Georgia

USGS Publications Warehouse

Inman, Ernest J.

1997-01-01

Flood-frequency relations were computed for 28 urban stations, for 2-, 25-, and 100-year recurrence interval floods and the computations were compared to corresponding recurrence interval floods computed from the estimating equations from a 1995 investigation. Two stations were excluded from further comparisons or analyses because neither station had a significant flood during the period of observed record. The comparisons, based on the student's t-test statistics at the 0.05 level of significance, indicate that the mean residuals of the 25- and 100-year floods were negatively biased by 26.2 percent and 31.6 percent, respectively, at the 26 stations. However, the mean residuals of the 2-year floods were 2.5 percent lower than the mean of the 2-year floods computed from the equations, and were not significantly biased. The reason for this negative bias is that the period of observed record at the 26 stations was a relatively dry period. At 25 of the 26 stations, the two highest simulated peaks used to develop the estimating equations occurred many years before the observed record began. However, no attempt was made to adjust the estimating equations because higher peaks could occur after the period of observed record and an adjustment to the equations would cause an underestimation of design floods.

Spatial Distribution of the Coefficient of Variation and Bayesian Forecast for the Paleo-Earthquakes in Japan

NASA Astrophysics Data System (ADS)

Nomura, Shunichi; Ogata, Yosihiko

2016-04-01

We propose a Bayesian method of probability forecasting for recurrent earthquakes of inland active faults in Japan. Renewal processes with the Brownian Passage Time (BPT) distribution are applied for over a half of active faults in Japan by the Headquarters for Earthquake Research Promotion (HERP) of Japan. Long-term forecast with the BPT distribution needs two parameters; the mean and coefficient of variation (COV) for recurrence intervals. The HERP applies a common COV parameter for all of these faults because most of them have very few specified paleoseismic events, which is not enough to estimate reliable COV values for respective faults. However, different COV estimates are proposed for the same paleoseismic catalog by some related works. It can make critical difference in forecast to apply different COV estimates and so COV should be carefully selected for individual faults. Recurrence intervals on a fault are, on the average, determined by the long-term slip rate caused by the tectonic motion but fluctuated by nearby seismicities which influence surrounding stress field. The COVs of recurrence intervals depend on such stress perturbation and so have spatial trends due to the heterogeneity of tectonic motion and seismicity. Thus we introduce a spatial structure on its COV parameter by Bayesian modeling with a Gaussian process prior. The COVs on active faults are correlated and take similar values for closely located faults. It is found that the spatial trends in the estimated COV values coincide with the density of active faults in Japan. We also show Bayesian forecasts by the proposed model using Markov chain Monte Carlo method. Our forecasts are different from HERP's forecast especially on the active faults where HERP's forecasts are very high or low.

A New Insight into the Earthquake Recurrence Studies from the Three-parameter Generalized Exponential Distributions

NASA Astrophysics Data System (ADS)

Pasari, S.; Kundu, D.; Dikshit, O.

2012-12-01

Earthquake recurrence interval is one of the important ingredients towards probabilistic seismic hazard assessment (PSHA) for any location. Exponential, gamma, Weibull and lognormal distributions are quite established probability models in this recurrence interval estimation. However, they have certain shortcomings too. Thus, it is imperative to search for some alternative sophisticated distributions. In this paper, we introduce a three-parameter (location, scale and shape) exponentiated exponential distribution and investigate the scope of this distribution as an alternative of the afore-mentioned distributions in earthquake recurrence studies. This distribution is a particular member of the exponentiated Weibull distribution. Despite of its complicated form, it is widely accepted in medical and biological applications. Furthermore, it shares many physical properties with gamma and Weibull family. Unlike gamma distribution, the hazard function of generalized exponential distribution can be easily computed even if the shape parameter is not an integer. To contemplate the plausibility of this model, a complete and homogeneous earthquake catalogue of 20 events (M ≥ 7.0) spanning for the period 1846 to 1995 from North-East Himalayan region (20-32 deg N and 87-100 deg E) has been used. The model parameters are estimated using maximum likelihood estimator (MLE) and method of moment estimator (MOME). No geological or geophysical evidences have been considered in this calculation. The estimated conditional probability reaches quite high after about a decade for an elapsed time of 17 years (i.e. 2012). Moreover, this study shows that the generalized exponential distribution fits the above data events more closely compared to the conventional models and hence it is tentatively concluded that generalized exponential distribution can be effectively considered in earthquake recurrence studies.

The Nazca-South American convergence rate and the recurrence of the great 1960 Chilean earthquake

NASA Technical Reports Server (NTRS)

Stein, S.; Engeln, J. F.; Demets, C.; Gordon, R. G.; Woods, D.

1986-01-01

The seismic slip rate along the Chile Trench estimated from the slip in the great 1960 earthquake and the recurrence history of major earthquakes has been interpreted as consistent with the subduction rate of the Nazca plate beneath South America. The convergence rate, estimated from global relative plate motion models, depends significantly on closure of the Nazca - Antarctica - South America circuit. NUVEL-1, a new plate motion model which incorporates recently determined spreading rates on the Chile Rise, shows that the average convergence rate over the last three million years is slower than previously estimated. If this time-averaged convergence rate provides an appropriate upper bound for the seismic slip rate, either the characteristic Chilean subduction earthquake is smaller than the 1960 event, the average recurrence interval is greater than observed in the last 400 years, or both. These observations bear out the nonuniformity of plate motions on various time scales, the variability in characteristic subduction zone earthquake size, and the limitations of recurrence time estimates.

Techniques for estimating magnitude and frequency of floods in Minnesota

USGS Publications Warehouse

Guetzkow, Lowell C.

1977-01-01

 Estimating relations have been developed to provide engineers and designers with improved techniques for defining flow-frequency characteristics to satisfy hydraulic planning and design requirements. The magnitude and frequency of floods up to the 100-year recurrence interval can be determined for most streams in Minnesota by methods presented. By multiple regression analysis, equations have been developed for estimating flood-frequency relations at ungaged sites on natural flow streams. Eight distinct hydrologic regions are delineated within the State with boundaries defined generally by river basin divides. Regression equations are provided for each region which relate selected frequency floods to significant basin parameters. For main-stem streams, graphs are presented showing floods for selected recurrence intervals plotted against contributing drainage area. Flow-frequency estimates for intervening sites along the Minnesota River, Mississippi River, and the Red River of the North can be derived from these graphs. Flood-frequency characteristics are tabulated for 201 paging stations having 10 or more years of record.

Improving streamflow estimates through the use of LANDSAT. [Wisconsin and Pecatonica-Sugar River basins

NASA Technical Reports Server (NTRS)

Allord, G. J. (Principal Investigator); Scarpace, F. L.

1981-01-01

Estimates of low flow and flood frequency in several southwestern Wisconsin basins were improved by determining land cover from LANDSAT imagery. With the use of estimates of land cover in multiple-regression techniques, the standard error of estimate (SE) for the least annual 7-day low flow for 2- and 10-year recurrence intervals of ungaged sites were lowered by 9% each. The SE of flood frequency in the 'Driftless Area' of Wisconsin for 10-, 50-, and 100-year recurrence intervals were lowered by 14%. Four of nine basin characteristics determined from satellite imagery were significant variables in the multiple-regression techniques, whereas only 1 of the 12 characteristics determined from topographic maps was significant. The percentages of land cover categories in each basin were determined by merging basin boundaries, digitized from quadrangles, with a classified LANDSAT scene. Both the basin boundary X-Y polygon coordinates and the satellite coordinates were converted to latitude-longitude for merging compatibility.

Analysis of the Magnitude and Frequency of Peak Discharge and Maximum Observed Peak Discharge in New Mexico and Surrounding Areas

USGS Publications Warehouse

Waltemeyer, Scott D.

2008-01-01

Estimates of the magnitude and frequency of peak discharges are necessary for the reliable design of bridges, culverts, and open-channel hydraulic analysis, and for flood-hazard mapping in New Mexico and surrounding areas. The U.S. Geological Survey, in cooperation with the New Mexico Department of Transportation, updated estimates of peak-discharge magnitude for gaging stations in the region and updated regional equations for estimation of peak discharge and frequency at ungaged sites. Equations were developed for estimating the magnitude of peak discharges for recurrence intervals of 2, 5, 10, 25, 50, 100, and 500 years at ungaged sites by use of data collected through 2004 for 293 gaging stations on unregulated streams that have 10 or more years of record. Peak discharges for selected recurrence intervals were determined at gaging stations by fitting observed data to a log-Pearson Type III distribution with adjustments for a low-discharge threshold and a zero skew coefficient. A low-discharge threshold was applied to frequency analysis of 140 of the 293 gaging stations. This application provides an improved fit of the log-Pearson Type III frequency distribution. Use of the low-discharge threshold generally eliminated the peak discharge by having a recurrence interval of less than 1.4 years in the probability-density function. Within each of the nine regions, logarithms of the maximum peak discharges for selected recurrence intervals were related to logarithms of basin and climatic characteristics by using stepwise ordinary least-squares regression techniques for exploratory data analysis. Generalized least-squares regression techniques, an improved regression procedure that accounts for time and spatial sampling errors, then were applied to the same data used in the ordinary least-squares regression analyses. The average standard error of prediction, which includes average sampling error and average standard error of regression, ranged from 38 to 93 percent (mean value is 62, and median value is 59) for the 100-year flood. The 1996 investigation standard error of prediction for the flood regions ranged from 41 to 96 percent (mean value is 67, and median value is 68) for the 100-year flood that was analyzed by using generalized least-squares regression analysis. Overall, the equations based on generalized least-squares regression techniques are more reliable than those in the 1996 report because of the increased length of record and improved geographic information system (GIS) method to determine basin and climatic characteristics. Flood-frequency estimates can be made for ungaged sites upstream or downstream from gaging stations by using a method that transfers flood-frequency data at the gaging station to the ungaged site by using a drainage-area ratio adjustment equation. The peak discharge for a given recurrence interval at the gaging station, drainage-area ratio, and the drainage-area exponent from the regional regression equation of the respective region is used to transfer the peak discharge for the recurrence interval to the ungaged site. Maximum observed peak discharge as related to drainage area was determined for New Mexico. Extreme events are commonly used in the design and appraisal of bridge crossings and other structures. Bridge-scour evaluations are commonly made by using the 500-year peak discharge for these appraisals. Peak-discharge data collected at 293 gaging stations and 367 miscellaneous sites were used to develop a maximum peak-discharge relation as an alternative method of estimating peak discharge of an extreme event such as a maximum probable flood.

Assessment of tsunami hazard to the U.S. East Coast using relationships between submarine landslides and earthquakes

USGS Publications Warehouse

ten Brink, Uri S.; Lee, H.J.; Geist, E.L.; Twichell, D.

2009-01-01

Submarine landslides along the continental slope of the U.S. Atlantic margin are potential sources for tsunamis along the U.S. East coast. The magnitude of potential tsunamis depends on the volume and location of the landslides, and tsunami frequency depends on their recurrence interval. However, the size and recurrence interval of submarine landslides along the U.S. Atlantic margin is poorly known. Well-studied landslide-generated tsunamis in other parts of the world have been shown to be associated with earthquakes. Because the size distribution and recurrence interval of earthquakes is generally better known than those for submarine landslides, we propose here to estimate the size and recurrence interval of submarine landslides from the size and recurrence interval of earthquakes in the near vicinity of the said landslides. To do so, we calculate maximum expected landslide size for a given earthquake magnitude, use recurrence interval of earthquakes to estimate recurrence interval of landslide, and assume a threshold landslide size that can generate a destructive tsunami. The maximum expected landslide size for a given earthquake magnitude is calculated in 3 ways: by slope stability analysis for catastrophic slope failure on the Atlantic continental margin, by using land-based compilation of maximum observed distance from earthquake to liquefaction, and by using land-based compilation of maximum observed area of earthquake-induced landslides. We find that the calculated distances and failure areas from the slope stability analysis is similar or slightly smaller than the maximum triggering distances and failure areas in subaerial observations. The results from all three methods compare well with the slope failure observations of the Mw = 7.2, 1929 Grand Banks earthquake, the only historical tsunamigenic earthquake along the North American Atlantic margin. The results further suggest that a Mw = 7.5 earthquake (the largest expected earthquake in the eastern U.S.) must be located offshore and within 100??km of the continental slope to induce a catastrophic slope failure. Thus, a repeat of the 1755 Cape Anne and 1881 Charleston earthquakes are not expected to cause landslides on the continental slope. The observed rate of seismicity offshore the U.S. Atlantic coast is very low with the exception of New England, where some microseismicity is observed. An extrapolation of annual strain rates from the Canadian Atlantic continental margin suggests that the New England margin may experience the equivalent of a magnitude 7 earthquake on average every 600-3000??yr. A minimum triggering earthquake magnitude of 5.5 is suggested for a sufficiently large submarine failure to generate a devastating tsunami and only if the epicenter is located within the continental slope.

Flooding and sedimentation in Wheeling Creek basin, Belmont County, Ohio

USGS Publications Warehouse

Kolva, J.R.; Koltun, G.F.

1987-01-01

The Wheeling Creek basin, which is located primarily in Belmont County, Ohio, experienced three damaging floods and four less severe floods during the 29-month period from February 1979 through June 1981. Residents of the basin became concerned about factors that could have affected the severity and frequency of out-of-bank floods. In response to those concerns, the U.S. Geological Survey, in cooperation with the Ohio Department of Natural Resources, undertook a study to estimate peak discharges and recurrence intervals for the seven floods of interest, provide information on current and historical mining-related stream-channel fill or scour, and examine storm-period subbasin contributions to the sediment load in Wheeling Creek. Streamflow data for adjacent basins, rainfall data, and, in two cases, flood-profile data were used in conjunction with streamflow data subsequently collected on Wheeling Creek to provide estimates of peak discharge for the seven floods that occurred from February 1979 through June 1981. Estimates of recurrence intervals were assigned to the Peak discharges on the basin of regional regression equations that relate selected basin characteristics to peak discharge with fixed recurrence intervals. These estimates indicate that a statistically unusual number of floods with recurrence intervals of 2 years or more occurred within that time period. Three cross sections located on Wheeling Creek and four located on tributaries were established and surveyed quarterly for approximately 2 years. No evidence of appreciable stream-channel fill or scour was observed at any of the cross sections, although minor profile changes were apparent at some locations. Attempts were made to obtain historical cross-section profile data for comparison with current cross-section profiles; however, no usable data were found. Excavations of stream-bottom materials were made near the three main-stem cross-section locations and near the mouth of Jug Run. The bottom materials were examined for evidence of recently deposited sediments of mining-related origin. The only evidence of appreciable mining-related sediment deposition was found at Jug Run, and, to a lesser extent, at one main-stem site.

Paleoearthquake recurrence on the East Paradise fault zone, metropolitan Albuquerque, New Mexico

USGS Publications Warehouse

Personius, Stephen F.; Mahan, Shannon

2000-01-01

A fortuitous exposure of the East Paradise fault zone near Arroyo de las Calabacillas has helped us determine a post-middle Pleistocene history for a long-forgotten Quaternary fault in the City of Albuquerque, New Mexico. Mapping of two exposures of the fault zone allowed us to measure a total vertical offset of 2.75 m across middle Pleistocene fluvial and eolian deposits and to estimate individual surface-faulting events of about 1, 0.5, and 1.25 m. These measurements and several thermoluminescence ages allow us to calculate a long-term average slip rate of 0.01 ± 0.001 mm/yr and date two surface-faulting events to 208 ± 25 ka and 75 ± 7 ka. The youngest event probably occurred in the late Pleistocene, sometime after 75 ± 7 ka. These data yield a single recurrence interval of 133 ± 26 ka and an average recurrence interval of 90 ± 10 ka. However, recurrence intervals are highly variable because the two youngest events occurred in less than 75 ka. Offsets of 0.5-1.25 m and a fault length of 13-20 km indicate that surface-rupturing paleoearthquakes on the East Paradise fault zone had probable Ms or Mw magnitudes of 6.8-7.0. Although recurrence intervals are long on the East Paradise fault zone, these data are significant because they represent some of the first published slip rate, paleoearthquake magnitude, and recurrence information for any of the numerous Quaternary faults in the rapidly growing Albuquerque-Rio Rancho metropolitan area.

Techniques for Estimating the Magnitude and Frequency of Peak Flows on Small Streams in Minnesota Based on Data through Water Year 2005

USGS Publications Warehouse

Lorenz, David L.; Sanocki, Chris A.; Kocian, Matthew J.

2010-01-01

Knowledge of the peak flow of floods of a given recurrence interval is essential for regulation and planning of water resources and for design of bridges, culverts, and dams along Minnesota's rivers and streams. Statistical techniques are needed to estimate peak flow at ungaged sites because long-term streamflow records are available at relatively few places. Because of the need to have up-to-date peak-flow frequency information in order to estimate peak flows at ungaged sites, the U.S. Geological Survey (USGS) conducted a peak-flow frequency study in cooperation with the Minnesota Department of Transportation and the Minnesota Pollution Control Agency. Estimates of peak-flow magnitudes for 1.5-, 2-, 5-, 10-, 25-, 50-, 100-, and 500-year recurrence intervals are presented for 330 streamflow-gaging stations in Minnesota and adjacent areas in Iowa and South Dakota based on data through water year 2005. The peak-flow frequency information was subsequently used in regression analyses to develop equations relating peak flows for selected recurrence intervals to various basin and climatic characteristics. Two statistically derived techniques-regional regression equation and region of influence regression-can be used to estimate peak flow on ungaged streams smaller than 3,000 square miles in Minnesota. Regional regression equations were developed for selected recurrence intervals in each of six regions in Minnesota: A (northwestern), B (north central and east central), C (northeastern), D (west central and south central), E (southwestern), and F (southeastern). The regression equations can be used to estimate peak flows at ungaged sites. The region of influence regression technique dynamically selects streamflow-gaging stations with characteristics similar to a site of interest. Thus, the region of influence regression technique allows use of a potentially unique set of gaging stations for estimating peak flow at each site of interest. Two methods of selecting streamflow-gaging stations, similarity and proximity, can be used for the region of influence regression technique. The regional regression equation technique is the preferred technique as an estimate of peak flow in all six regions for ungaged sites. The region of influence regression technique is not appropriate for regions C, E, and F because the interrelations of some characteristics of those regions do not agree with the interrelations throughout the rest of the State. Both the similarity and proximity methods for the region of influence technique can be used in the other regions (A, B, and D) to provide additional estimates of peak flow. The peak-flow-frequency estimates and basin characteristics for selected streamflow-gaging stations and regional peak-flow regression equations are included in this report.

Analysis of the Magnitude and Frequency of Peak Discharges for the Navajo Nation in Arizona, Utah, Colorado, and New Mexico

USGS Publications Warehouse

Waltemeyer, Scott D.

2006-01-01

Estimates of the magnitude and frequency of peak discharges are necessary for the reliable flood-hazard mapping in the Navajo Nation in Arizona, Utah, Colorado, and New Mexico. The Bureau of Indian Affairs, U.S. Army Corps of Engineers, and Navajo Nation requested that the U.S. Geological Survey update estimates of peak discharge magnitude for gaging stations in the region and update regional equations for estimation of peak discharge and frequency at ungaged sites. Equations were developed for estimating the magnitude of peak discharges for recurrence intervals of 2, 5, 10, 25, 50, 100, and 500 years at ungaged sites using data collected through 1999 at 146 gaging stations, an additional 13 years of peak-discharge data since a 1997 investigation, which used gaging-station data through 1986. The equations for estimation of peak discharges at ungaged sites were developed for flood regions 8, 11, high elevation, and 6 and are delineated on the basis of the hydrologic codes from the 1997 investigation. Peak discharges for selected recurrence intervals were determined at gaging stations by fitting observed data to a log-Pearson Type III distribution with adjustments for a low-discharge threshold and a zero skew coefficient. A low-discharge threshold was applied to frequency analysis of 82 of the 146 gaging stations. This application provides an improved fit of the log-Pearson Type III frequency distribution. Use of the low-discharge threshold generally eliminated the peak discharge having a recurrence interval of less than 1.4 years in the probability-density function. Within each region, logarithms of the peak discharges for selected recurrence intervals were related to logarithms of basin and climatic characteristics using stepwise ordinary least-squares regression techniques for exploratory data analysis. Generalized least-squares regression techniques, an improved regression procedure that accounts for time and spatial sampling errors, then was applied to the same data used in the ordinary least-squares regression analyses. The average standard error of prediction for a peak discharge have a recurrence interval of 100-years for region 8 was 53 percent (average) for the 100-year flood. The average standard of prediction, which includes average sampling error and average standard error of regression, ranged from 45 to 83 percent for the 100-year flood. Estimated standard error of prediction for a hybrid method for region 11 was large in the 1997 investigation. No distinction of floods produced from a high-elevation region was presented in the 1997 investigation. Overall, the equations based on generalized least-squares regression techniques are considered to be more reliable than those in the 1997 report because of the increased length of record and improved GIS method. Techniques for transferring flood-frequency relations to ungaged sites on the same stream can be estimated at an ungaged site by a direct application of the regional regression equation or at an ungaged site on a stream that has a gaging station upstream or downstream by using the drainage-area ratio and the drainage-area exponent from the regional regression equation of the respective region.

Paleoseismic event dating and the conditional probability of large earthquakes on the southern San Andreas fault, California

USGS Publications Warehouse

Biasi, G.P.; Weldon, R.J.; Fumal, T.E.; Seitz, G.G.

2002-01-01

We introduce a quantitative approach to paleoearthquake dating and apply it to paleoseismic data from the Wrightwood and Pallett Creek sites on the southern San Andreas fault. We illustrate how stratigraphic ordering, sedimentological, and historical data can be used quantitatively in the process of estimating earthquake ages. Calibrated radiocarbon age distributions are used directly from layer dating through recurrence intervals and recurrence probability estimation. The method does not eliminate subjective judgements in event dating, but it does provide a means of systematically and objectively approaching the dating process. Date distributions for the most recent 14 events at Wrightwood are based on sample and contextual evidence in Fumal et al. (2002) and site context and slip history in Weldon et al. (2002). Pallett Creek event and dating descriptions are from published sources. For the five most recent events at Wrightwood, our results are consistent with previously published estimates, with generally comparable or narrower uncertainties. For Pallett Creek, our earthquake date estimates generally overlap with previous results but typically have broader uncertainties. Some event date estimates are very sensitive to details of data interpretation. The historical earthquake in 1857 ruptured the ground at both sites but is not constrained by radiocarbon data. Radiocarbon ages, peat accumulation rates, and historical constraints at Pallett Creek for event X yield a date estimate in the earliest 1800s and preclude a date in the late 1600s. This event is almost certainly the historical 1812 earthquake, as previously concluded by Sieh et al. (1989). This earthquake also produced ground deformation at Wrightwood. All events at Pallett Creek, except for event T, about A.D. 1360, and possibly event I, about A.D. 960, have corresponding events at Wrightwood with some overlap in age ranges. Event T falls during a period of low sedimentation at Wrightwood when conditions were not favorable for recording earthquake evidence. Previously proposed correlations of Pallett Creek X with Wrightwood W3 in the 1690s and Pallett Creek event V with W5 around 1480 (Fumal et al., 1993) appear unlikely after our dating reevaluation. Apparent internal inconsistencies among event, layer, and dating relationships around events R and V identify them as candidates for further investigation at the site. Conditional probabilities of earthquake recurrence were estimated using Poisson, lognormal, and empirical models. The presence of 12 or 13 events at Wrightwood during the same interval that 10 events are reported at Pallett Creek is reflected in mean recurrence intervals of 105 and 135 years, respectively. Average Poisson model 30-year conditional probabilities are about 20% at Pallett Creek and 25% at Wrightwood. The lognormal model conditional probabilities are somewhat higher, about 25% for Pallett Creek and 34% for Wrightwood. Lognormal variance ??ln estimates of 0.76 and 0.70, respectively, imply only weak time predictability. Conditional probabilities of 29% and 46%, respectively, were estimated for an empirical distribution derived from the data alone. Conditional probability uncertainties are dominated by the brevity of the event series; dating uncertainty contributes only secondarily. Wrightwood and Pallett Creek event chronologies both suggest variations in recurrence interval with time, hinting that some form of recurrence rate modulation may be at work, but formal testing shows that neither series is more ordered than might be produced by a Poisson process.

Time Interval From Breast-Conserving Surgery to Breast Irradiation in Early Stage Node-Negative Breast Cancer: 17-Year Follow-Up Results and Patterns of Recurrence

DOE Office of Scientific and Technical Information (OSTI.GOV)

Vujovic, Olga, E-mail: olga.vujovic@lhsc.on.ca; Yu, Edward; Cherian, Anil

Purpose: A retrospectivechart review was conducted to determine whether the time interval from breast-conserving surgery to breast irradiation (surgery-radiation therapy interval) in early stage node-negative breast cancer had any detrimental effects on recurrence rates. Methods and Materials: There were 566 patients with T1 to T3, N0 breast cancer treated with breast-conserving surgery and breast irradiation and without adjuvant systemic treatment between 1985 and 1992. The surgery-to-radiation therapy intervals used for analysis were 0 to 8 weeks (201 patients), >8 to 12 weeks (233 patients), >12 to 16 weeks (91 patients), and >16 weeks (41 patients). Kaplan-Meier estimates of time to local recurrence, disease-free survival, distantmore » disease-free survival, cause-specific survival, and overall survival rates were calculated. Results: Median follow-up was 17.4 years. Patients in all 4 time intervals were similar in terms of characteristics and pathologic features. There were no statistically significant differences among the 4 time groups in local recurrence (P=.67) or disease-free survival (P=.82). The local recurrence rates at 5, 10, and 15 years were 4.9%, 11.5%, and 15.0%, respectively. The distant disease relapse rates at 5, 10, and 15 years were 10.6%, 15.4%, and 18.5%, respectively. The disease-free failure rates at 5, 10, and 15 years were 20%, 32.3%, and 39.8%, respectively. Cause-specific survival rates at 5, 10, and 15 years were 92%, 84.6%, and 79.8%, respectively. The overall survival rates at 5, 10, and 15 years were 89.3%, 79.2%, and 66.9%, respectively. Conclusions: Surgery-radiation therapy intervals up to 16 weeks from breast-conserving surgery are not associated with any increased risk of recurrence in early stage node-negative breast cancer. There is a steady local recurrence rate of 1% per year with adjuvant radiation alone.« less

Estimation of peak discharge quantiles for selected annual exceedance probabilities in Northeastern Illinois.

DOT National Transportation Integrated Search

2016-06-01

This report provides two sets of equations for estimating peak discharge quantiles at annual exceedance probabilities (AEPs) of 0.50, 0.20, 0.10, : 0.04, 0.02, 0.01, 0.005, and 0.002 (recurrence intervals of 2, 5, 10, 25, 50, 100, 200, and 500 years,...

Methods for estimating selected flow-duration and flood-frequency characteristics at ungaged sites in Central Idaho

USGS Publications Warehouse

Kjelstrom, L.C.

1998-01-01

Methods for estimating daily mean discharges for selected flow durations and flood discharge for selected recurrence intervals at ungaged sites in central Idaho were applied using data collected at streamflow-gaging stations in the area. The areal and seasonal variability of discharge from ungaged drainage basins may be described by estimating daily mean discharges that are exceeded 20, 50, and 80 percent of the time each month. At 73 gaging stations, mean monthly discharge was regressed with discharge at three points—20, 50, and 80—from daily mean flow-duration curves for each month. Regression results were improved by dividing the study area into six regions. Previously determined estimates of mean monthly discharge from about 1,200 ungaged drainage basins provided the basis for applying the developed techniques to the ungaged basins. Estimates of daily mean discharges that are exceeded 20, 50, and 80 percent of the time each month at ungaged drainage basins can be made by multiplying mean monthly discharges estimated at ungaged sites by a regression factor for the appropriate region. In general, the flow-duration data were less accurately estimated at discharges exceeded 80 percent of the time than at discharges exceeded 20 percent of the time. Curves drawn through the three points for each of the six regions were most similar in July and most different from December through March. Coefficients of determination of the regressions indicate that differences in mean monthly discharge largely explain differences in discharge at points on the daily mean flow-duration curve. Inherent in the method are errors in the technique used to estimate mean monthly discharge. Flood discharge estimates for selected recurrence intervals at ungaged sites upstream or downstream from gaging stations can be determined by a transfer technique. A weighted ratio of drainage area times flood discharge for selected recurrence intervals at the gaging station can be used to estimate flood discharge at the ungaged site. Best results likely are obtained when the difference between gaged and ungaged drainage areas is small.

Postoperative maintenance levonorgestrel-releasing intrauterine system and endometrioma recurrence: a randomized controlled study.

PubMed

Chen, Yi-Jen; Hsu, Teh-Fu; Huang, Ben-Shian; Tsai, Hsiao-Wen; Chang, Yen-Hou; Wang, Peng-Hui

2017-06-01

According to 3 randomized trials, the levonorgestrel-releasing intrauterine system significantly reduced recurrent endometriosis-related pelvic pain at postoperative year 1. Only a few studies have evaluated the long-term effectiveness of the device for preventing endometrioma recurrence, and the effects of a levonorgestrel-releasing intrauterine system as a maintenance therapy remain unclear. The objective of the study was to evaluate whether a maintenance levonorgestrel-releasing intrauterine system is effective for preventing postoperative endometrioma recurrence. From May 2011 through March 2012, a randomized controlled trial including 80 patients with endometriomas undergoing laparoscopic cystectomy followed by six cycles of gonadotropin-releasing hormone agonist treatment was conducted. After surgery, the patients were randomized to groups that did or did not receive a levonorgestrel-releasing intrauterine system (intervention group, n = 40, vs control group, n = 40). The primary outcome was endometrioma recurrence 30 months after surgery. The secondary outcomes included dysmenorrhea, CA125 levels, noncyclic pelvic pain, and side effects. Endometrioma recurrence at 30 months did not significantly differ between the 2 groups (the intervention group, 10 of 40, 25% vs the control group 15 of 40, 37.5%; hazard ratio, 0.60, 95% confidence interval, 0.27-1.33, P = .209). The intervention group exhibited a lower dysmenorrhea recurrence rate, with an estimated hazard ratio of 0.32 (95% confidence interval, 0.12-0.83, P = .019). Over a 30 month follow-up, the intervention group exhibited a greater reduction in dysmenorrhea as assessed with a visual analog scale score (mean ± SD, 60.8 ± 25.5 vs 38.7 ± 25.9, P < .001, 95% confidence interval, 10.7-33.5), noncyclic pelvic pain visual analog scale score (39.1 ± 10.9 vs 30.1 ± 14.7, P = .014, 95% confidence interval, 1.9-16.1), and CA125 (median [interquartile range], -32.1 [-59.1 to 14.9], vs -15.6 [-33.0 to 5.0], P = .001) compared with the control group. The number-needed-to-treat benefit for dysmenorrhea recurrence at 30 months was 5. The number of recurrent cases requiring further surgical or hormone treatment in the intervention group (1 of 40, 2.5%, 95% confidence interval, -2.3% to 7.3%) was significantly lower than that in the control group (8 of 40, 20%, 95% confidence interval, 7.6-32.4%; P = .031). Long-term maintenance therapy using a levonorgestrel-releasing intrauterine system is not effective for preventing endometrioma recurrence. Copyright © 2017 Elsevier Inc. All rights reserved.

Precipitation areal-reduction factor estimation using an annual-maxima centered approach

USGS Publications Warehouse

Asquith, W.H.; Famiglietti, J.S.

2000-01-01

The adjustment of precipitation depth of a point storm to an effective (mean) depth over a watershed is important for characterizing rainfall-runoff relations and for cost-effective designs of hydraulic structures when design storms are considered. A design storm is the precipitation point depth having a specified duration and frequency (recurrence interval). Effective depths are often computed by multiplying point depths by areal-reduction factors (ARF). ARF range from 0 to 1, vary according to storm characteristics, such as recurrence interval; and are a function of watershed characteristics, such as watershed size, shape, and geographic location. This paper presents a new approach for estimating ARF and includes applications for the 1-day design storm in Austin, Dallas, and Houston, Texas. The approach, termed 'annual-maxima centered,' specifically considers the distribution of concurrent precipitation surrounding an annual-precipitation maxima, which is a feature not seen in other approaches. The approach does not require the prior spatial averaging of precipitation, explicit determination of spatial correlation coefficients, nor explicit definition of a representative area of a particular storm in the analysis. The annual-maxima centered approach was designed to exploit the wide availability of dense precipitation gauge data in many regions of the world. The approach produces ARF that decrease more rapidly than those from TP-29. Furthermore, the ARF from the approach decay rapidly with increasing recurrence interval of the annual-precipitation maxima. (C) 2000 Elsevier Science B.V.The adjustment of precipitation depth of a point storm to an effective (mean) depth over a watershed is important for characterizing rainfall-runoff relations and for cost-effective designs of hydraulic structures when design storms are considered. A design storm is the precipitation point depth having a specified duration and frequency (recurrence interval). Effective depths are often computed by multiplying point depths by areal-reduction factors (ARF). ARF range from 0 to 1, vary according to storm characteristics, such as recurrence interval; and are a function of watershed characteristics, such as watershed size, shape, and geographic location. This paper presents a new approach for estimating ARF and includes applications for the 1-day design storm in Austin, Dallas, and Houston, Texas. The approach, termed 'annual-maxima centered,' specifically considers the distribution of concurrent precipitation surrounding an annual-precipitation maxima, which is a feature not seen in other approaches. The approach does not require the prior spatial averaging of precipitation, explicit determination of spatial correlation coefficients, nor explicit definition of a representative area of a particular storm in the analysis. The annual-maxima centered approach was designed to exploit the wide availability of dense precipitation gauge data in many regions of the world. The approach produces ARF that decrease more rapidly than those from TP-29. Furthermore, the ARF from the approach decay rapidly with increasing recurrence interval of the annual-precipitation maxima.

Dietary Flavonoids and Colorectal Adenoma Recurrence in the Polyp Prevention Trial

PubMed Central

Bobe, Gerd; Sansbury, Leah B.; Albert, Paul S.; Cross, Amanda J.; Kahle, Lisa; Ashby, Jason; Slattery, Martha L.; Caan, Bette; Paskett, Electra; Iber, Frank; Kikendall, James Walter; Lance, Peter; Daston, Cassandra; Marshall, James R.; Schatzkin, Arthur; Lanza, Elaine

2008-01-01

Two recent case-control studies suggested that some flavonoid subgroups may play a role in preventing colorectal cancer. Previous prospective cohort studies generally reported no association; however, only a small subset of flavonoids was evaluated and partial flavonoid databases were used. We used the newly constructed U.S. Department of Agriculture flavonoid database to examine the association between consumption of total flavonoids, 6 flavonoid subgroups, and 29 individual flavonoids with adenomatous polyp recurrence in the Polyp Prevention Trial. The Polyp Prevention Trial was a randomized dietary intervention trial, which examined the effectiveness of a low-fat, high-fiber, high-fruit, and high-vegetable diet on adenoma recurrence. Intakes of flavonoids were estimated from a food frequency questionnaire. Multivariate logistic regression models (adjusted for age, body mass index, sex, regular non–steroidal anti-inflammatory use, and dietary fiber intake) were used to estimate odds ratios and 95% confidence intervals for both any and advanced adenoma recurrence within quartiles of energy-adjusted flavonoid intake (baseline, during the trial, and change during the trial). Total flavonoid intake was not associated with any or advanced adenoma recurrence. However, high intake of flavonols, which are at greater concentrations in beans, onions, apples, and tea, was associated with decreased risk of advanced adenoma recurrence (4th versus 1st quartile during the trial; odds ratio, 0.24; 95% confidence interval, 0.11, 0.53; Ptrend = 0.0006). Similar inverse associations were observed to a smaller extent for isoflavonoids, the flavonol kaempferol, and the isoflavonoids genistein and formononetin. Our data suggest that a flavonol-rich diet may decrease the risk of advanced adenoma recurrence. PMID:18559549

Monte Carlo Method for Determining Earthquake Recurrence Parameters from Short Paleoseismic Catalogs: Example Calculations for California

USGS Publications Warehouse

Parsons, Tom

2008-01-01

Paleoearthquake observations often lack enough events at a given site to directly define a probability density function (PDF) for earthquake recurrence. Sites with fewer than 10-15 intervals do not provide enough information to reliably determine the shape of the PDF using standard maximum-likelihood techniques [e.g., Ellsworth et al., 1999]. In this paper I present a method that attempts to fit wide ranges of distribution parameters to short paleoseismic series. From repeated Monte Carlo draws, it becomes possible to quantitatively estimate most likely recurrence PDF parameters, and a ranked distribution of parameters is returned that can be used to assess uncertainties in hazard calculations. In tests on short synthetic earthquake series, the method gives results that cluster around the mean of the input distribution, whereas maximum likelihood methods return the sample means [e.g., NIST/SEMATECH, 2006]. For short series (fewer than 10 intervals), sample means tend to reflect the median of an asymmetric recurrence distribution, possibly leading to an overestimate of the hazard should they be used in probability calculations. Therefore a Monte Carlo approach may be useful for assessing recurrence from limited paleoearthquake records. Further, the degree of functional dependence among parameters like mean recurrence interval and coefficient of variation can be established. The method is described for use with time-independent and time-dependent PDF?s, and results from 19 paleoseismic sequences on strike-slip faults throughout the state of California are given.

Monte Carlo method for determining earthquake recurrence parameters from short paleoseismic catalogs: Example calculations for California

USGS Publications Warehouse

Parsons, T.

2008-01-01

Paleoearthquake observations often lack enough events at a given site to directly define a probability density function (PDF) for earthquake recurrence. Sites with fewer than 10-15 intervals do not provide enough information to reliably determine the shape of the PDF using standard maximum-likelihood techniques (e.g., Ellsworth et al., 1999). In this paper I present a method that attempts to fit wide ranges of distribution parameters to short paleoseismic series. From repeated Monte Carlo draws, it becomes possible to quantitatively estimate most likely recurrence PDF parameters, and a ranked distribution of parameters is returned that can be used to assess uncertainties in hazard calculations. In tests on short synthetic earthquake series, the method gives results that cluster around the mean of the input distribution, whereas maximum likelihood methods return the sample means (e.g., NIST/SEMATECH, 2006). For short series (fewer than 10 intervals), sample means tend to reflect the median of an asymmetric recurrence distribution, possibly leading to an overestimate of the hazard should they be used in probability calculations. Therefore a Monte Carlo approach may be useful for assessing recurrence from limited paleoearthquake records. Further, the degree of functional dependence among parameters like mean recurrence interval and coefficient of variation can be established. The method is described for use with time-independent and time-dependent PDFs, and results from 19 paleoseismic sequences on strike-slip faults throughout the state of California are given.

Precipitation areal-reduction factor estimation using an annual-maxima centered approach

NASA Astrophysics Data System (ADS)

Asquith, W. H.; Famiglietti, J. S.

2000-04-01

The adjustment of precipitation depth of a point storm to an effective (mean) depth over a watershed is important for characterizing rainfall-runoff relations and for cost-effective designs of hydraulic structures when design storms are considered. A design storm is the precipitation point depth having a specified duration and frequency (recurrence interval). Effective depths are often computed by multiplying point depths by areal-reduction factors (ARF). ARF range from 0 to 1, vary according to storm characteristics, such as recurrence interval; and are a function of watershed characteristics, such as watershed size, shape, and geographic location. This paper presents a new approach for estimating ARF and includes applications for the 1-day design storm in Austin, Dallas, and Houston, Texas. The approach, termed "annual-maxima centered," specifically considers the distribution of concurrent precipitation surrounding an annual-precipitation maxima, which is a feature not seen in other approaches. The approach does not require the prior spatial averaging of precipitation, explicit determination of spatial correlation coefficients, nor explicit definition of a representative area of a particular storm in the analysis. The annual-maxima centered approach was designed to exploit the wide availability of dense precipitation gauge data in many regions of the world. The approach produces ARF that decrease more rapidly than those from TP-29. Furthermore, the ARF from the approach decay rapidly with increasing recurrence interval of the annual-precipitation maxima.

Modelling volatility recurrence intervals in the Chinese commodity futures market

NASA Astrophysics Data System (ADS)

Zhou, Weijie; Wang, Zhengxin; Guo, Haiming

2016-09-01

The law of extreme event occurrence attracts much research. The volatility recurrence intervals of Chinese commodity futures market prices are studied: the results show that the probability distributions of the scaled volatility recurrence intervals have a uniform scaling curve for different thresholds q. So we can deduce the probability distribution of extreme events from normal events. The tail of a scaling curve can be well fitted by a Weibull form, which is significance-tested by KS measures. Both short-term and long-term memories are present in the recurrence intervals with different thresholds q, which denotes that the recurrence intervals can be predicted. In addition, similar to volatility, volatility recurrence intervals also have clustering features. Through Monte Carlo simulation, we artificially synthesise ARMA, GARCH-class sequences similar to the original data, and find out the reason behind the clustering. The larger the parameter d of the FIGARCH model, the stronger the clustering effect is. Finally, we use the Fractionally Integrated Autoregressive Conditional Duration model (FIACD) to analyse the recurrence interval characteristics. The results indicated that the FIACD model may provide a method to analyse volatility recurrence intervals.

A multigene assay to predict recurrence of tamoxifen-treated, node-negative breast cancer.

PubMed

Paik, Soonmyung; Shak, Steven; Tang, Gong; Kim, Chungyeul; Baker, Joffre; Cronin, Maureen; Baehner, Frederick L; Walker, Michael G; Watson, Drew; Park, Taesung; Hiller, William; Fisher, Edwin R; Wickerham, D Lawrence; Bryant, John; Wolmark, Norman

2004-12-30

The likelihood of distant recurrence in patients with breast cancer who have no involved lymph nodes and estrogen-receptor-positive tumors is poorly defined by clinical and histopathological measures. We tested whether the results of a reverse-transcriptase-polymerase-chain-reaction (RT-PCR) assay of 21 prospectively selected genes in paraffin-embedded tumor tissue would correlate with the likelihood of distant recurrence in patients with node-negative, tamoxifen-treated breast cancer who were enrolled in the National Surgical Adjuvant Breast and Bowel Project clinical trial B-14. The levels of expression of 16 cancer-related genes and 5 reference genes were used in a prospectively defined algorithm to calculate a recurrence score and to determine a risk group (low, intermediate, or high) for each patient. Adequate RT-PCR profiles were obtained in 668 of 675 tumor blocks. The proportions of patients categorized as having a low, intermediate, or high risk by the RT-PCR assay were 51, 22, and 27 percent, respectively. The Kaplan-Meier estimates of the rates of distant recurrence at 10 years in the low-risk, intermediate-risk, and high-risk groups were 6.8 percent (95 percent confidence interval, 4.0 to 9.6), 14.3 percent (95 percent confidence interval, 8.3 to 20.3), and 30.5 percent (95 percent confidence interval, 23.6 to 37.4). The rate in the low-risk group was significantly lower than that in the high-risk group (P<0.001). In a multivariate Cox model, the recurrence score provided significant predictive power that was independent of age and tumor size (P<0.001). The recurrence score was also predictive of overall survival (P<0.001) and could be used as a continuous function to predict distant recurrence in individual patients. The recurrence score has been validated as quantifying the likelihood of distant recurrence in tamoxifen-treated patients with node-negative, estrogen-receptor-positive breast cancer. Copyright 2004 Massachusetts Medical Society.

Highly variable recurrence of tsunamis in the 7,400 years before the 2004 Indian Ocean tsunami

NASA Astrophysics Data System (ADS)

Horton, B.; Rubin, C. M.; Sieh, K.; Jessica, P.; Daly, P.; Ismail, N.; Parnell, A. C.

2017-12-01

The devastating 2004 Indian Ocean tsunami caught millions of coastal residents and the scientific community off-guard. Subsequent research in the Indian Ocean basin has identified prehistoric tsunamis, but the timing and recurrence intervals of such events are uncertain. Here, we identify coastal caves as a new depositional environment for reconstructing tsunami records and present a 5,000 year record of continuous tsunami deposits from a coastal cave in Sumatra, Indonesia which shows the irregular recurrence of 11 tsunamis between 7,400 and 2,900 years BP. The data demonstrates that the 2004 tsunami was just the latest in a sequence of devastating tsunamis stretching back to at least the early Holocene and suggests a high likelihood for future tsunamis in the Indian Ocean. The sedimentary record in the cave shows that ruptures of the Sunda megathrust vary between large (which generated the 2004 Indian Ocean tsunami) and smaller slip failures. The chronology of events suggests the recurrence of multiple smaller tsunamis within relatively short time periods, interrupted by long periods of strain accumulation followed by giant tsunamis. The average time period between tsunamis is about 450 years with intervals ranging from a long, dormant period of over 2,000 years, to multiple tsunamis within the span of a century. The very long dormant period suggests that the Sunda megathrust is capable of accumulating large slip deficits between earthquakes. Such a high slip rupture would produce a substantially larger earthquake than the 2004 event. Although there is evidence that the likelihood of another tsunamigenic earthquake in Aceh province is high, these variable recurrence intervals suggest that long dormant periods may follow Sunda Megathrust ruptures as large as that of 2004 Indian Ocean tsunami. The remarkable variability of recurrence suggests that regional hazard mitigation plans should be based upon the high likelihood of future destructive tsunami demonstrated by the cave record and other paleotsunami sites, rather than estimates of recurrence intervals.

Real-time individual predictions of prostate cancer recurrence using joint models

PubMed Central

Taylor, Jeremy M. G.; Park, Yongseok; Ankerst, Donna P.; Proust-Lima, Cecile; Williams, Scott; Kestin, Larry; Bae, Kyoungwha; Pickles, Tom; Sandler, Howard

2012-01-01

Summary Patients who were previously treated for prostate cancer with radiation therapy are monitored at regular intervals using a laboratory test called Prostate Specific Antigen (PSA). If the value of the PSA test starts to rise, this is an indication that the prostate cancer is more likely to recur, and the patient may wish to initiate new treatments. Such patients could be helped in making medical decisions by an accurate estimate of the probability of recurrence of the cancer in the next few years. In this paper, we describe the methodology for giving the probability of recurrence for a new patient, as implemented on a web-based calculator. The methods use a joint longitudinal survival model. The model is developed on a training dataset of 2,386 patients and tested on a dataset of 846 patients. Bayesian estimation methods are used with one Markov chain Monte Carlo (MCMC) algorithm developed for estimation of the parameters from the training dataset and a second quick MCMC developed for prediction of the risk of recurrence that uses the longitudinal PSA measures from a new patient. PMID:23379600

Estimating the magnitude of peak flows at selected recurrence intervals for streams in Idaho

USGS Publications Warehouse

Berenbrock, Charles

2002-01-01

The region-of-influence method is not recommended for use in determining flood-frequency estimates for ungaged sites in Idaho because the results, overall, are less accurate and the calculations are more complex than those of regional regression equations. The regional regression equations were considered to be the primary method of estimating the magnitude and frequency of peak flows for ungaged sites in Idaho.

A Comprehensive Study of Costs Associated With Recurrent Clostridium difficile Infection.

PubMed

Rodrigues, Rodrigo; Barber, Grant E; Ananthakrishnan, Ashwin N

2017-02-01

BACKGROUND Clostridium difficile infection (CDI) is the most common healthcare-associated infection and is associated with considerable morbidity. Recurrent CDI is a key contributing factor to this morbidity. Despite an estimated 83,000 recurrences annually in the United States, there are few accurate estimates of costs associated with recurrent CDI. OBJECTIVE We performed this study (1) to identify the health consequences of recurrent CDI including need for repeat hospitalization, intensive care unit (ICU) stay, and surgery; (2) to determine costs associated with recurrent CDI and identify determinants of such costs; and (3) to compare the outcomes and costs of recurrent CDI to those who develop reinfection. METHODS We identified all patients with confirmed recurrent CDI between January to December 2013 at a single referral center. Healthcare burden associated with recurrence including diagnostic testing, pharmacologic treatment, and inpatient and outpatient healthcare visits were identified in the 12 months following the first recurrence. Total healthcare costs were calculated, and the predictors of high healthcare utilization were identified. RESULTS Our study population included 98 patients with recurrent CDI. The median interval between the initial infection and recurrence was 37 days. The mean age of the cohort was 67 years, two-thirds were women (62%), and the mean Charlson index was 8.6. During the year following the first recurrence of CDI, each patient underwent a mean of 4.4 stool C. difficile toxin tests and received a mean of 2.5 prescriptions for oral vancomycin (range, 0-6). Most patients (84%) with recurrence had a CDI-related hospitalization, and 6% underwent colectomy. The mean total CDI-associated cost was $34,104 per patient, with hospitalization costs accounting for 68%, surgery 20%, and drug treatment 8% of this cost, respectively. Extrapolating to the United States overall, we estimate an annual cost of $2.8 billion related to recurrent CDI. CONCLUSION Recurrent CDI is associated with considerable morbidity and cost. Infect Control Hosp Epidemiol 2017;38:196-202.

User's Manual for Program PeakFQ, Annual Flood-Frequency Analysis Using Bulletin 17B Guidelines

USGS Publications Warehouse

Flynn, Kathleen M.; Kirby, William H.; Hummel, Paul R.

2006-01-01

Estimates of flood flows having given recurrence intervals or probabilities of exceedance are needed for design of hydraulic structures and floodplain management. Program PeakFQ provides estimates of instantaneous annual-maximum peak flows having recurrence intervals of 2, 5, 10, 25, 50, 100, 200, and 500 years (annual-exceedance probabilities of 0.50, 0.20, 0.10, 0.04, 0.02, 0.01, 0.005, and 0.002, respectively). As implemented in program PeakFQ, the Pearson Type III frequency distribution is fit to the logarithms of instantaneous annual peak flows following Bulletin 17B guidelines of the Interagency Advisory Committee on Water Data. The parameters of the Pearson Type III frequency curve are estimated by the logarithmic sample moments (mean, standard deviation, and coefficient of skewness), with adjustments for low outliers, high outliers, historic peaks, and generalized skew. This documentation provides an overview of the computational procedures in program PeakFQ, provides a description of the program menus, and provides an example of the output from the program.

Magnitude and frequency of floods in Washington

USGS Publications Warehouse

Cummans, J.E.; Collings, Michael R.; Nasser, Edmund George

1975-01-01

Relations are provided to estimate the magnitude and frequency of floods on Washington streams. Annual-peak-flow data from stream gaging stations on unregulated streams having 1 years or more of record were used to determine a log-Pearson Type III frequency curve for each station. Flood magnitudes having recurrence intervals of 2, 5, i0, 25, 50, and 10years were then related to physical and climatic indices of the drainage basins by multiple-regression analysis using the Biomedical Computer Program BMDO2R. These regression relations are useful for estimating flood magnitudes of the specified recurrence intervals at ungaged or short-record sites. Separate sets of regression equations were defined for western and eastern parts of the State, and the State was further subdivided into 12 regions in which the annual floods exhibit similar flood characteristics. Peak flows are related most significantly in western Washington to drainage-area size and mean annual precipitation. In eastern Washington-they are related most significantly to drainage-area size, mean annual precipitation, and percentage of forest cover. Standard errors of estimate of the estimating relations range from 25 to 129 percent, and the smallest errors are generally associated with the more humid regions.

RECURRENCE RATES OF OCULAR TOXOPLASMOSIS DURING PREGNANCY

PubMed Central

Braakenburg, Arthur M.D.; Crespi, Catherine M.; Holland, Gary N.; Wu, Sheng; Yu, Fei; Rothova, Aniki

2014-01-01

Purpose To investigate whether recurrence rates of ocular toxoplasmosis are higher during pregnancy among women of childbearing age. Design Retrospective longitudinal cohort study. Methods We reviewed medical records of all women seen at a university eye clinic (Utrecht, Netherlands) during episodes of active toxoplasmic retinochoroiditis that occurred while the women were of childbearing age (16–42 years). Each woman was sent a questionnaire requesting information regarding all pregnancies and episodes of ocular toxoplasmosis, whether or not episodes were observed at the eye clinic. Conditional fixed-effects Poisson regression was used to model incident rate ratios of recurrence during pregnant versus non-pregnant intervals, adjusted for potential confounders, including age at time of active toxoplasmic retinochoroiditis and interval since last episode of active disease, which are known to influence risk of recurrence. Results Questionnaires were returned by 50 (58%) of 86 women, 34 of whom had 69 pregnancies during 584 person-years of study. There were 128 episodes of ocular toxoplasmosis during the study period (6 during pregnancy). First episodes of ocular toxoplasmosis occurred between ages 9.6 and 38.5 years. Youngest age at pregnancy was 16.1 years; oldest age at childbirth was 40.9 years. Incident rate ratios for pregnant versus non-pregnant intervals were in the direction of lower recurrence rates during pregnancy, with point estimates of 0.54 and 0.75 under two different approaches, but ratios were not significantly different from the null value (p-values of 0.16 and 0.55). Conclusions Recurrence rates of ocular toxoplasmosis are likely not higher during pregnancy, in contrast to traditional beliefs. PMID:24412127

Recurrence rates of ocular toxoplasmosis during pregnancy.

PubMed

Braakenburg, Arthur M D; Crespi, Catherine M; Holland, Gary N; Wu, Sheng; Yu, Fei; Rothova, Aniki

2014-04-01

To investigate whether recurrence rates of ocular toxoplasmosis are higher during pregnancy in women of childbearing age. Retrospective longitudinal cohort study. We reviewed medical records of all women seen at a university eye clinic (Utrecht, Netherlands) during episodes of active toxoplasmic retinochoroiditis that occurred while the women were of childbearing age (16-42 years). Each woman was sent a questionnaire requesting information regarding all pregnancies and episodes of ocular toxoplasmosis, whether or not episodes were observed at the eye clinic. Conditional fixed-effects Poisson regression was used to model incidence rate ratios of recurrence during pregnant versus nonpregnant intervals, adjusted for potential confounders, including age at time of active toxoplasmic retinochoroiditis and interval since last episode of active disease, which are known to influence risk for recurrence. Questionnaires were returned by 50 (58%) of 86 women, 34 of whom had had 69 pregnancies during 584 person-years of study. There were 128 episodes of ocular toxoplasmosis during the study period (6 during pregnancy). First episodes of ocular toxoplasmosis occurred between ages 9.6 and 38.5 years. The youngest age at pregnancy was 16.1 years; the oldest age at childbirth was 40.9 years. The incidence-rate ratios for pregnant versus nonpregnant intervals were in the direction of lower recurrence rates during pregnancy, with point estimates of 0.54 and 0.75 under 2 different approaches, but the ratios were not significantly different from the null value (P values of 0.16 and 0.55). Recurrence rates of ocular toxoplasmosis are probably not higher during pregnancy, in contrast to traditional beliefs. Copyright © 2014 Elsevier Inc. All rights reserved.

New Madrid seismic zone recurrence intervals

DOE Office of Scientific and Technical Information (OSTI.GOV)

Schweig, E.S.; Ellis, M.A.

1993-03-01

Frequency-magnitude relations in the New Madrid seismic zone suggest that great earthquakes should occur every 700--1,200 yrs, implying relatively high strain rates. These estimates are supported by some geological and GPS results. Recurrence intervals of this order should have produced about 50 km of strike-slip offset since Miocene time. No subsurface evidence for such large displacements is known within the seismic zone. Moreover, the irregular fault pattern forming a compressive step that one sees today is not compatible with large displacements. There are at least three possible interpretations of the observations of short recurrence intervals and high strain rates, butmore » apparently youthful fault geometry and lack of major post-Miocene deformation. One is that the seismological and geodetic evidence are misleading. A second possibility is that activity in the region is cyclic. That is, the geological and geodetic observations that suggest relatively short recurrence intervals reflect a time of high, but geologically temporary, pore-fluid pressure. Zoback and Zoback have suggested such a model for intraplate seismicity in general. Alternatively, the New Madrid seismic zone is geologically young feature that has been active for only the last few tens of thousands of years. In support of this, observe an irregular fault geometry associated with a unstable compressive step, a series of en echelon and discontinuous lineaments that may define the position of a youthful linking fault, and the general absence of significant post-Eocene faulting or topography.« less

Uranium/Thorium Dating and Growth Laminae Counting of Stalagmites Reveal a Record of Major Earthquakes in the Midwestern US

NASA Astrophysics Data System (ADS)

Zhang, Z.; Lundstrom, C.; Panno, S.; Hackley, K. C.; Fouke, B. W.; Curry, B.

2009-12-01

The recurrence interval of large New Madrid Seismic Zone (NMSZ) earthquakes is uncertain because of the limited number and likely incomplete nature of the record of dated seismic events. Data on paleoseismicity in this area is necessary for refining estimates of a recurrence interval for these earthquakes and for characterizing the geophysical nature of the NMSZ. Studies of the paleoseismic history of the NMSZ have previously used liquefaction features and flood plain deposits along the Mississippi River to estimate recurrence interval with considerable uncertainties. More precise estimates of the number and ages of paleoseismic events would enhance the ability of federal, state, and local agencies to make critical preparedness decisions. Initiation of new speleothems (cave deposits) has been shown in several localities to record large earthquake events. Our ongoing work in caves of southwestern Illinois, Missouri, Indiana and Arkansas has used both U/Th age dating techniques and growth laminae counting of actively growing stalagmites to determine the age of initiation of stalagmites in caves across the Midwestern U.S. These age initiations cluster around two known events, the great NMSZ earthquakes of 1811-1812 and the Missouri earthquake of 1917, suggesting that cave deposits in this region constitute a unique record of paleo-seismic history of the NMSZ. Furthermore, the U-Th disequilibria growth laminae ages of young, white stalagmites and of older stalagmites on which they grew, plus published Holocene stalagmite ages of initiation and regrowth from Missouri caves, are all coincident with suspected NMSZ earthquakes based on liquefaction and other paleoseimic techniques. We hypothesize that these speleothems were initiated by earthquake-induced opening/closing of fracture-controlled flowpaths in the ceilings of cave passages.

Antibiotic Resistance and the Risk of Recurrent Bacteremia.

PubMed

Woudt, Sjoukje H S; de Greeff, Sabine C; Schoffelen, Annelot F; Vlek, Anne L M; Bonten, Marc J M

2018-05-17

Direct health effects of antibiotic resistance are difficult to assess. We quantified the risk of recurrent bacteremia associated with resistance. We extracted antimicrobial susceptibility testing data on blood isolates from the Dutch surveillance system for antimicrobial resistance between 2008 and 2017. First and first recurrent (4-30 days) bacteremia episodes were categorized as susceptible, single nonsusceptible, or co-nonsusceptible to third-generation cephalosporins without or with carbapenems (Enterobacteriaceae), ceftazidime without or with carbapenems (Pseudomonas species), aminopenicillins without or with vancomycin (Enterococcus species), or as methicillin-sensitive/-resistant S. aureus (MSSA/MRSA). We calculated risks of recurrent bacteremia after nonsusceptible vs susceptible first bacteremia, estimated the crude population attributable effect of resistance for the Netherlands, and calculated risks of nonsusceptible recurrent bacteremia after a susceptible first episode. Risk ratios for recurrent bacteremia after a single- and co-nonsusceptible first episode, respectively, vs susceptible first episode, were 1.7 (95% confidence interval [CI], 1.5-2.0) and 5.2 (95% CI, 2.1-12.4) for Enterobacteriaceae, 1.3 (95% CI, 0.5-3.1) and 5.0 (95% CI, 2.9-8.5) for Pseudomonas species, 1.4 (95% CI, 1.2-1.7) and 1.6 (95% CI, 0.6-4.2) for Enterococcus species, and 1.6 (95% CI, 1.1-2.4) for MRSA vs MSSA. The estimated population annual number of recurrent bacteremias associated with nonsusceptibility was 40. The risk of nonsusceptible recurrent bacteremia after a susceptible first episode was at most 0.4% (Pseudomonas species). Although antibiotic nonsusceptibility was consistently associated with higher risks of recurrent bacteremia, the estimated annual number of additional recurrent episodes in the Netherlands (40) was rather limited.

Colorectal adenoma recurrence rates among post-polypectomy patients in the placebo-controlled groups of randomized clinical trials: a meta-analysis

PubMed Central

Shi, Xin; Yang, Zhiping; Wu, Qiong; Fan, Daiming

2017-01-01

Background Evidence regarding the benefit of therapy to prevent the post-polypectomy recurrence of colorectal adenoma is limited. Endoscopic recurrence is the main outcome according to an evaluation of trials involving recurrence prevention. Aim To estimate the recurrence rates of post-polypectomy colorectal adenoma in placebo-controlled arms of randomized clinical trials and to identify the prognostic factors influencing these rates. Methods We combined data from all randomized controlled trials evaluating therapies for colorectal adenoma using placebo from 1988 to 2016. The data were combined in a random-effects model. Primary outcomes were endoscopic adenoma and advanced adenoma recurrence of colorectal adenoma. Results The pooled estimates of the adenoma recurrence rates were 37% (95% confidence interval [CI], 33%-41%; range, 33%-52%) at 1 year, 47% (95% CI, 41%-54%; range, 46%-51%) at 2 years, 41% (95% CI, 33%-48%; range, 20%-61%) at 3 years, 48% (95% CI, 38%-57%; range, 37%-53%) at 4 years, and 60% (95% CI, 52%-68%; range, 48%-68%) at 5 years. The pooled estimates of the advanced adenoma recurrence rates were 10% (95% CI, 6%-15%; range, 7%-13%) at 1 year, 12% (95% CI, 8%-16%; range, 3%-19%) at 3 years, 14% (95% CI, 10%-18%; range, 13%-16%) at 4 years, and 14% (95% CI, 10%-19%; range, 9%-21%) at 5 years. Significant heterogeneity among the randomized clinical trials (P < 0.001) was observed for each recurrence rate. Conclusions This meta-analysis confirms the heterogeneity of recurrence rates among post-polypectomy colorectal adenoma patients who received placebo. No single design variable was identified that might explain the heterogeneity. PMID:28977952

The impact of HIV and ART on recurrent tuberculosis in a sub-Saharan setting.

PubMed

Houben, Rein M G J; Glynn, Judith R; Mboma, Sebastian; Mzemba, Themba; Mwaungulu, Nimrod J; Mwaungulu, Lorren; Mwenibabu, Michael; Mpunga, James; French, Neil; Crampin, Amelia C

2012-11-13

To estimate the impact of antiretroviral therapy (ART) on the incidence of recurrent tuberculosis (TB) in an African population. A long-term population cohort in Karonga District, northern Malawi. Patients who had completed treatment for laboratory-confirmed TB diagnosed since 1996 were visited annually to record vital status, ART use and screen for TB. Survival analysis estimated the effect of HIV/ART status at completion of treatment on mortality and recurrence. Analyses were stratified by time since treatment completion to estimate the effects on relapse (predominates during first year) and reinfection disease (predominates later). Among 1133 index TB cases contributing 4353 person-years of follow-up, there were 307 deaths and 103 laboratory-confirmed recurrences (recurrence rate 4.6 per 100 person-years). Half the recurrences occurred in the first year since completing treatment. HIV infection increased the recurrence rate [rate ratio adjusted for age, sex, period and TB type 2.69, 95% confidence interval (CI) 1.69-4.26], but with less effect in the first year (adjusted rate ratio 1.71, 95% CI 0.87-3.35) than subsequently (adjusted rate ratio 4.2, 95% CI 2.16-8.15). Recurrence rates on ART were intermediate between those of HIV-negative individuals and HIV-positive individuals without ART. Compared with HIV-positive individuals without ART, the adjusted rate ratio was 0.74 (95% CI 0.27-2.06) in the first year, and 0.43 (95% CI 0.11-1.73) later. The increased incidence of TB recurrence observed in HIV-positive patients appeared to be reduced by ART. The effects are mostly on later (likely reinfection) disease so the impact of ART on reducing recurrence will be highest in high TB incidence settings.

Local Failure After Episcleral Brachytherapy for Posterior Uveal Melanoma: Patterns, Risk Factors, and Management.

PubMed

Bellerive, Claudine; Aziz, Hassan A; Bena, James; Wilkinson, Allan; Suh, John H; Plesec, Thomas; Singh, Arun D

2017-05-01

To evaluate the patterns, the risk factors, and the management of recurrence following brachytherapy in patients with posterior uveal melanoma, given that an understanding of the recurrence patterns can improve early recognition and management of local treatment failure in such patients. Retrospective cohort study. Setting: Multispecialty tertiary care center. A total of 375 eyes treated with episcleral brachytherapy for posterior uveal melanoma from January 2004 to December 2014. Exclusion criteria included inadequate follow-up (<1 year) and previous radiation therapy. Main Outcomes and Measures: Local control rate and time to recurrence were the primary endpoints. Kaplan-Meier estimation and Cox proportional hazards models were conducted to identify risk factors for recurrence. Twenty-one patients (5.6%) experienced recurrence (follow-up range 12-156 months; median 47 months). The median time to recurrence was 18 months (range 4-156 months). Five-year estimated local recurrence rate was 6.6%. The majority (90.5%) of the recurrences occurred within the first 5 years. The predominant site of recurrence was at the tumor margin (12 patients, 57.1%). Univariate analysis identified 3 statistically significant recurrence risk factors: advanced age, largest basal diameter, and the use of adjuvant transpupillary thermotherapy (TTT). Recurrent tumors were managed by repeat brachytherapy, TTT, or enucleation. Local recurrences following brachytherapy are uncommon 5 years after episcleral brachytherapy. Follow-up intervals can be adjusted to reflect time to recurrence. Most of the eyes with recurrent tumor can be salvaged by conservative methods. Copyright © 2017 Elsevier Inc. All rights reserved.

Recurrence interval analysis of trading volumes

NASA Astrophysics Data System (ADS)

Ren, Fei; Zhou, Wei-Xing

2010-06-01

We study the statistical properties of the recurrence intervals τ between successive trading volumes exceeding a certain threshold q . The recurrence interval analysis is carried out for the 20 liquid Chinese stocks covering a period from January 2000 to May 2009, and two Chinese indices from January 2003 to April 2009. Similar to the recurrence interval distribution of the price returns, the tail of the recurrence interval distribution of the trading volumes follows a power-law scaling, and the results are verified by the goodness-of-fit tests using the Kolmogorov-Smirnov (KS) statistic, the weighted KS statistic and the Cramér-von Mises criterion. The measurements of the conditional probability distribution and the detrended fluctuation function show that both short-term and long-term memory effects exist in the recurrence intervals between trading volumes. We further study the relationship between trading volumes and price returns based on the recurrence interval analysis method. It is found that large trading volumes are more likely to occur following large price returns, and the comovement between trading volumes and price returns is more pronounced for large trading volumes.

Recurrence interval analysis of trading volumes.

PubMed

Ren, Fei; Zhou, Wei-Xing

2010-06-01

We study the statistical properties of the recurrence intervals τ between successive trading volumes exceeding a certain threshold q. The recurrence interval analysis is carried out for the 20 liquid Chinese stocks covering a period from January 2000 to May 2009, and two Chinese indices from January 2003 to April 2009. Similar to the recurrence interval distribution of the price returns, the tail of the recurrence interval distribution of the trading volumes follows a power-law scaling, and the results are verified by the goodness-of-fit tests using the Kolmogorov-Smirnov (KS) statistic, the weighted KS statistic and the Cramér-von Mises criterion. The measurements of the conditional probability distribution and the detrended fluctuation function show that both short-term and long-term memory effects exist in the recurrence intervals between trading volumes. We further study the relationship between trading volumes and price returns based on the recurrence interval analysis method. It is found that large trading volumes are more likely to occur following large price returns, and the comovement between trading volumes and price returns is more pronounced for large trading volumes.

Pancreatic β-Cell Function and Prognosis of Nondiabetic Patients With Ischemic Stroke.

PubMed

Pan, Yuesong; Chen, Weiqi; Jing, Jing; Zheng, Huaguang; Jia, Qian; Li, Hao; Zhao, Xingquan; Liu, Liping; Wang, Yongjun; He, Yan; Wang, Yilong

2017-11-01

Pancreatic β-cell dysfunction is an important factor in the development of type 2 diabetes mellitus. This study aimed to estimate the association between β-cell dysfunction and prognosis of nondiabetic patients with ischemic stroke. Patients with ischemic stroke without a history of diabetes mellitus in the ACROSS-China (Abnormal Glucose Regulation in Patients with Acute Stroke across China) registry were included. Disposition index was estimated as computer-based model of homeostatic model assessment 2-β%/homeostatic model assessment 2-insulin resistance based on fasting C-peptide level. Outcomes included stroke recurrence, all-cause death, and dependency (modified Rankin Scale, 3-5) at 12 months after onset. Among 1171 patients, 37.2% were women with a mean age of 62.4 years. At 12 months, 167 (14.8%) patients had recurrent stroke, 110 (9.4%) died, and 184 (16.0%) had a dependency. The first quartile of the disposition index was associated with an increased risk of stroke recurrence (adjusted hazard ratio, 3.57; 95% confidence interval, 2.13-5.99) and dependency (adjusted hazard ratio, 2.30; 95% confidence interval, 1.21-4.38); both the first and second quartiles of the disposition index were associated with an increased risk of death (adjusted hazard ratio, 5.09; 95% confidence interval, 2.51-10.33; adjusted hazard ratio, 2.42; 95% confidence interval, 1.17-5.03) compared with the fourth quartile. Using a multivariable regression model with restricted cubic spline, we observed an L-shaped association between the disposition index and the risk of each end point. In this large-scale registry, β-cell dysfunction was associated with an increased risk of 12-month poor prognosis in nondiabetic patients with ischemic stroke. © 2017 American Heart Association, Inc.

Estimating the Recurrence Rate of Gestational Diabetes Mellitus (GDM) in Massachusetts 1998-2007: Methods and Findings.

PubMed

England, Lucinda; Kotelchuck, Milton; Wilson, Hoyt G; Diop, Hafsatou; Oppedisano, Paul; Kim, Shin Y; Cui, Xiaohui; Shapiro-Mendoza, Carrie K

2015-10-01

Women with gestational diabetes mellitus (GDM) may be able to reduce their risk of recurrent GDM and progression to type 2 diabetes mellitus through lifestyle change; however, there is limited population-based information on GDM recurrence rates. We used data from a population of women delivering two sequential live singleton infants in Massachusetts (1998-2007) to estimate the prevalence of chronic diabetes mellitus (CDM) and GDM in parity one pregnancies and recurrence of GDM and progression from GDM to CDM in parity two pregnancies. We examined four diabetes classification approaches; birth certificate (BC) data alone, hospital discharge (HD) data alone, both sources hierarchically combined with a diagnosis of CDM from either source taking priority over a diagnosis of GDM, and both sources combined including only pregnancies with full agreement in diagnosis. Descriptive statistics were used to describe population characteristics, prevalence of CDM and GDM, and recurrence of diabetes in successive pregnancies. Diabetes classification agreement was assessed using the Kappa statistic. Associated maternal characteristics were examined through adjusted model-based t tests and Chi square tests. A total of 134,670 women with two sequential deliveries of parities one and two were identified. While there was only slight agreement on GDM classification across HD and BC records, estimates of GDM recurrence were fairly consistent; nearly half of women with GDM in their parity one pregnancy developed GDM in their subsequent pregnancy. While estimates of progression from GDM to CDM across sequential pregnancies were more variable, all approaches yielded estimates of ≤5 %. The development of either GDM or CDM following a parity one pregnancy with no diagnosis of diabetes was <3 % across approaches. Women with recurrent GDM were disproportionately older and foreign born. Recurrent GDM is a serious life course public health issue; the inter-pregnancy interval provides an important window for diabetes prevention.

Recurrence risk of ictal asystole in epilepsy.

PubMed

Hampel, Kevin G; Thijs, Roland D; Elger, Christian E; Surges, Rainer

2017-08-22

To determine the recurrence risk of ictal asystole (IA) and its determining factors in people with epilepsy. We performed a systematic review of published cases with IA in 3 databases and additionally searched our local database for patients with multiple seizures simultaneously recorded with ECG and EEG and at least one IA. IA recurrence risk was estimated by including all seizures without knowledge of the chronological order. Various clinical features were assessed by an individual patient data meta-analysis. A random mixed effect logistic regression model was applied to estimate the average recurrence risk of IA. Plausibility of the calculated IA recurrence risk was checked by analyzing the local dataset with available information in chronological order. Eighty patients with 182 IA in 537 seizures were included. Recurrence risk of IA amounted to 40% (95% confidence interval [CI] 32%-50%). None of the clinical factors (age, sex, type and duration of epilepsy, hemispheric lateralization, duration of IA per patient) appeared to have a significant effect on the short-term recurrence risk of IA. When considering the local dataset only, IA recurrence risk was estimated to 30% (95% CI 14%-53%). Information whether IA coincided with symptoms (i.e., syncope) or not was given in 60 patients: 100 out of 142 IAs were symptomatic. Our data suggest that in case of clinically suspected IA, the recording of 1 or 2 seizures is not sufficient to rule out IA. Furthermore, the high short-term recurrence risk favors aggressive treatment, including pacemaker implantation if seizure freedom cannot be achieved. Copyright © 2017 The Author(s). Published by Wolters Kluwer Health, Inc. on behalf of the American Academy of Neurology.

Pseudo and conditional score approach to joint analysis of current count and current status data.

PubMed

Wen, Chi-Chung; Chen, Yi-Hau

2018-04-17

We develop a joint analysis approach for recurrent and nonrecurrent event processes subject to case I interval censorship, which are also known in literature as current count and current status data, respectively. We use a shared frailty to link the recurrent and nonrecurrent event processes, while leaving the distribution of the frailty fully unspecified. Conditional on the frailty, the recurrent event is assumed to follow a nonhomogeneous Poisson process, and the mean function of the recurrent event and the survival function of the nonrecurrent event are assumed to follow some general form of semiparametric transformation models. Estimation of the models is based on the pseudo-likelihood and the conditional score techniques. The resulting estimators for the regression parameters and the unspecified baseline functions are shown to be consistent with rates of square and cubic roots of the sample size, respectively. Asymptotic normality with closed-form asymptotic variance is derived for the estimator of the regression parameters. We apply the proposed method to a fracture-osteoporosis survey data to identify risk factors jointly for fracture and osteoporosis in elders, while accounting for association between the two events within a subject. © 2018, The International Biometric Society.

Flood of April 2007 in Southern Maine

USGS Publications Warehouse

Lombard, Pamela J.

2009-01-01

Up to 8.5 inches of rain fell from April 15 through 18, 2007, in southern Maine. The rain - in combination with up to an inch of water from snowmelt - resulted in extensive flooding. York County, Maine, was declared a presidential disaster area following the event. The U.S. Geological Survey, in cooperation with the Federal Emergency Management Agency (FEMA), determined peak streamflows and recurrence intervals at 24 locations and peak water-surface elevations at 63 sites following the April 2007 flood. Peak streamflows were determined with data from continuous-record streamflow-gaging stations where available and through hydraulic models where station data were not available. The flood resulted in peak streamflows with recurrence intervals greater than 100 years throughout most of York County, and recurrence intervals up to 50 years in Cumberland County. Peak flows for selected recurrence intervals varied from less than 10 percent to greater than 100 percent different than those in the current FEMA flood-insurance studies due to additional data or newer regression equations. Water-surface elevations observed during the April 2007 flood were bracketed by elevation profiles in FEMA flood-insurance studies with the same recurrence intervals as the recurrence intervals bracketing the observed peak streamflows at seven sites, with higher elevation-profile recurrence intervals than streamflow recurrence intervals at six sites, and with lower elevation-profile recurrence intervals than streamflow recurrence intervals at one site. The April 2007 flood resulted in higher peak flows and water-surface elevations than the flood of May 2006 in coastal locations in York County, and lower peak flows and water-surface elevations than the May 2006 flood further from the coast and in Cumberland County. The Mousam River watershed with over 13 dams and reservoirs was severely impacted by both events. Analyses indicate that the April 2007 peak streamflows in the Mousam River watershed occurred despite the fact that up to 287 million ft3 of runoff was stored by 13 dams and reservoirs.

The 1993 Mississippi river flood: A one hundred or a one thousand year event?

USGS Publications Warehouse

Malamud, B.D.; Turcotte, D.L.; Barton, C.C.

1996-01-01

Power-law (fractal) extreme-value statistics are applicable to many natural phenomena under a wide variety of circumstances. Data from a hydrologic station in Keokuk, Iowa, shows the great flood of the Mississippi River in 1993 has a recurrence interval on the order of 100 years using power-law statistics applied to partial-duration flood series and on the order of 1,000 years using a log-Pearson type 3 (LP3) distribution applied to annual series. The LP3 analysis is the federally adopted probability distribution for flood-frequency estimation of extreme events. We suggest that power-law statistics are preferable to LP3 analysis. As a further test of the power-law approach we consider paleoflood data from the Colorado River. We compare power-law and LP3 extrapolations of historical data with these paleo-floods. The results are remarkably similar to those obtained for the Mississippi River: Recurrence intervals from power-law statistics applied to Lees Ferry discharge data are generally consistent with inferred 100- and 1,000-year paleofloods, whereas LP3 analysis gives recurrence intervals that are orders of magnitude longer. For both the Keokuk and Lees Ferry gauges, the use of an annual series introduces an artificial curvature in log-log space that leads to an underestimate of severe floods. Power-law statistics are predicting much shorter recurrence intervals than the federally adopted LP3 statistics. We suggest that if power-law behavior is applicable, then the likelihood of severe floods is much higher. More conservative dam designs and land-use restrictions Nay be required.

Re-Irradiation of Locoregional NSCLC Recurrence Using Robotic Stereotactic Body Radiotherapy.

PubMed

Ceylan, Cemile; Hamacı, Andaç; Ayata, Hande; Berberoglu, Kezban; Kılıç, Ayhan; Güden, Metin; Engin, Kayıhan

2017-01-01

We evaluated the efficacy, toxicity, and dose responses of re-irradiation with stereotactic body radiotherapy (SBRT) in patients with recurrent non- small cell lung cancer (NSCLC) after previous irradiation. 28 patients were included. Previous median radiation doses were 54 and 66 Gy. The median interval time between previous radiotherapy and SBRT was 14 months. The median follow-up time after SBRT was 9 months (range 3-93 months). To evaluate the effectiveness of SBRT, local control, overall survival, and treatment-related toxicity were reported. SBRT doses and fractionation ranged from 60 to 30 Gy and from 3 to 8, respectively, according to previous doses, location of the recurrence, and interval time. 65% of tumor recurrences overlapped with previous treatment, while 35% of tumors recurred outside of the previous treatment. 4 patients had local progression after SBRT at their first follow-up. The Kaplan-Meier estimates of the 1- and 2-year actuarial overall survival were 71 and 42%, respectively. The mean survival following SBRT was 32.8 months, and the median survival was 21 months. No grade 3 or higher toxicities were observed. Robotic SBRT is a tolerable treatment option with manageable toxicity which can be used with radical or palliative intent in carefully selected patients with locally recurrent tumors after previous irradiation. © 2017 S. Karger GmbH, Freiburg.

Differences in the role of black race and stroke risk factors for first vs. recurrent stroke.

PubMed

Howard, George; Kissela, Brett M; Kleindorfer, Dawn O; McClure, Leslie A; Soliman, Elsayed Z; Judd, Suzanne E; Rhodes, J David; Cushman, Mary; Moy, Claudia S; Sands, Kara A; Howard, Virginia J

2016-02-16

To assess whether black race and other cerebrovascular risk factors have a differential effect on first vs. recurrent stroke events. Estimate the differences in the magnitude of the association of demographic (age, back race, sex) or stroke risk factors (hypertension, diabetes, cigarette smoking, atrial fibrillation, left ventricular hypertrophy, or heart disease) for first vs. recurrent stroke from a longitudinal cohort study of 29,682 black or white participants aged 45 years and older. Over an average 6.8 years follow-up, 301 of 2,993 participants with a previous stroke at baseline had a recurrent stroke, while 818 of 26,689 participants who were stroke-free at baseline had a first stroke. Among those stroke-free at baseline, there was an age-by-race interaction (p = 0.0002), with a first stroke risk 2.70 (95% confidence interval: 1.86-3.91) times greater for black than white participants at age 45, but no racial disparity at age 85 (hazard ratio = 0.91; 95% confidence interval: 0.70-1.18). In contrast, there was no evidence of a higher risk of recurrent stroke at any age for black participants (p > 0.05). The association of traditional stroke risk factors was generally similar for first and recurrent stroke. The association of age and black race differs substantially on first vs. recurrent stroke risk, with risk factors playing a similar role. © 2016 American Academy of Neurology.

Attributable inpatient costs of recurrent Clostridium difficile infections.

PubMed

Dubberke, Erik R; Schaefer, Eric; Reske, Kimberly A; Zilberberg, Marya; Hollenbeak, Christopher S; Olsen, Margaret A

2014-11-01

To determine the attributable inpatient costs of recurrent Clostridium difficile infections (CDIs). Retrospective cohort study. Academic, urban, tertiary care hospital. A total of 3,958 patients aged 18 years or more who developed an initial CDI episode from 2003 through 2009. Data were collected electronically from hospital administrative databases and were supplemented with chart review. Patients with an index CDI episode during the study period were followed up for 180 days from the end of their index hospitalization or the end of their index CDI antibiotic treatment (whichever occurred later). Total hospital costs during the outcome period for patients with recurrent versus a single episode of CDI were analyzed using zero-inflated lognormal models. There were 421 persons with recurrent CDI (recurrence rate, 10.6%). Recurrent CDI case patients were significantly more likely than persons without recurrence to have any hospital costs during the outcome period (P < .001). The estimated attributable cost of recurrent CDI was $11,631 (95% confidence interval, $8,937-$14,588). The attributable costs of recurrent CDI are considerable. Patients with recurrent CDI are significantly more likely to have inpatient hospital costs than patients who do not develop recurrences. Better strategies to predict and prevent CDI recurrences are needed.

Estimation of magnitude and frequency of floods for streams in Puerto Rico : new empirical models

USGS Publications Warehouse

Ramos-Gines, Orlando

1999-01-01

Flood-peak discharges and frequencies are presented for 57 gaged sites in Puerto Rico for recurrence intervals ranging from 2 to 500 years. The log-Pearson Type III distribution, the methodology recommended by the United States Interagency Committee on Water Data, was used to determine the magnitude and frequency of floods at the gaged sites having 10 to 43 years of record. A technique is presented for estimating flood-peak discharges at recurrence intervals ranging from 2 to 500 years for unregulated streams in Puerto Rico with contributing drainage areas ranging from 0.83 to 208 square miles. Loglinear multiple regression analyses, using climatic and basin characteristics and peak-discharge data from the 57 gaged sites, were used to construct regression equations to transfer the magnitude and frequency information from gaged to ungaged sites. The equations have contributing drainage area, depth-to-rock, and mean annual rainfall as the basin and climatic characteristics in estimating flood peak discharges. Examples are given to show a step-by-step procedure in calculating a 100-year flood at a gaged site, an ungaged site, a site near a gaged location, and a site between two gaged sites.

Effects of long memory in the order submission process on the properties of recurrence intervals of large price fluctuations

NASA Astrophysics Data System (ADS)

Meng, Hao; Ren, Fei; Gu, Gao-Feng; Xiong, Xiong; Zhang, Yong-Jie; Zhou, Wei-Xing; Zhang, Wei

2012-05-01

Understanding the statistical properties of recurrence intervals (also termed return intervals in econophysics literature) of extreme events is crucial to risk assessment and management of complex systems. The probability distributions and correlations of recurrence intervals for many systems have been extensively investigated. However, the impacts of microscopic rules of a complex system on the macroscopic properties of its recurrence intervals are less studied. In this letter, we adopt an order-driven stock model to address this issue for stock returns. We find that the distributions of the scaled recurrence intervals of simulated returns have a power-law scaling with stretched exponential cutoff and the intervals possess multifractal nature, which are consistent with empirical results. We further investigate the effects of long memory in the directions (or signs) and relative prices of the order flow on the characteristic quantities of these properties. It is found that the long memory in the order directions (Hurst index Hs) has a negligible effect on the interval distributions and the multifractal nature. In contrast, the power-law exponent of the interval distribution increases linearly with respect to the Hurst index Hx of the relative prices, and the singularity width of the multifractal nature fluctuates around a constant value when Hx<0.7 and then increases with Hx. No evident effects of Hs and Hx are found on the long memory of the recurrence intervals. Our results indicate that the nontrivial properties of the recurrence intervals of returns are mainly caused by traders' behaviors of persistently placing new orders around the best bid and ask prices.

Systematic review with meta-analysis: recurrence of hepatocellular carcinoma following direct-acting antiviral therapy.

PubMed

Saraiya, N; Yopp, A C; Rich, N E; Odewole, M; Parikh, N D; Singal, A G

2018-05-30

Although studies suggest decreased incident hepatocellular carcinoma (HCC) after direct-acting antivirals (DAA), data are conflicting regarding HCC recurrence and aggressiveness in patients who have a history of HCC with complete response. Characterize HCC recurrence patterns after DAA therapy. Two reviewers searched MEDLINE and SCOPUS from January 2015 to December 2017 and identified studies evaluating HCC recurrence patterns following DAA therapy. A pooled estimate was calculated using the DerSimonian and Laird method for a random effects model. The study was conducted in accordance with PRISMA guidelines. Among 24 studies (n = 1820 patients), the proportion of patients with HCC recurrence following DAA therapy ranged from 0% to 59% (pooled estimate 24.4%; 95% CI: 18.4%-30.4%). Among 11 full text manuscripts, pooled HCC recurrence was 21.9% (95% CI: 16.2%-28.3%). Factors associated with recurrence included history of prior HCC recurrence and a shorter interval between HCC complete response and DAA initiation. Nine studies comparing DAA-treated and interferon-treated or untreated patients found similar recurrence among DAA-treated patients. Most (77.8%) patients with HCC recurrence were detected at an early tumour stage, of whom 64.7% received curative treatment. Study limitations included heterogeneous cohorts, potential misclassification of HCC absence prior to DAA, ascertainment bias for recurrence, and short durations of follow-up. Current data suggest acceptable HCC recurrence rates after DAA therapy, particularly if DAA therapy is delayed at least 6 months after HCC complete response. However, data characterising HCC recurrence after DAA therapy are of limited quality, highlighting the need for high quality prospective studies. © 2018 John Wiley & Sons Ltd.

Timing of paleoearthquakes on the northern Hayward Fault: preliminary evidence in El Cerrito, California

USGS Publications Warehouse

Lienkaemper, J.J.; Schwartz, D.P.; Kelson, K.I.; Lettis, W.R.; Simpson, Gary D.; Southon, J.R.; Wanket, J.A.; Williams, P.L.

1999-01-01

The Working Group on California Earthquake Probabilities estimated that the northern Hayward fault had the highest probability (0.28) of producing a M7 Bay Area earthquake in 30 years (WGCEP, 1990). This probability was based, in part, on the assumption that the last large earthquake occurred on this segment in 1836. However, a recent study of historical documents concludes that the 1836 earthquake did not occur on the northern Hayward fault, thereby extending the elapsed time to at least 220 yr ago, the beginning of the written record. The average recurrence interval for a M7 on the northern Hayward is unknown. WGCEP (1990) assumed an interval of 167 years. The 1996 Working Group on Northern California Earthquake Potential estimated ~210 yr, based on extrapolations from southern Hayward paleoseismological studies and a revised estimate of 1868 slip on the southern Hayward fault. To help constrain the timing of paleoearthquakes on the northern Hayward fault for the 1999 Bay Area probability update, we excavated two trenches that cross the fault and a sag pond on the Mira Vista golf course. As the site is on the second fairway, we were limited to less than ten days to document these trenches. Analysis was aided by rapid C-14 dating of more than 90 samples which gave near real-time results with the trenches still open. A combination of upward fault terminations, disrupted strata, and discordant angular relations indicates at least four, and possibly seven or more, surface faulting earthquakes occurred during a 1630-2130 yr interval. Hence, average recurrence time could be <270 yr, but is no more than 710 yr. The most recent earthquake (MRE) occurred after AD 1640. Preliminary analysis of calibrated dates supports the assumption that no large historical (post-1776) earthquakes have ruptured the surface here, but the youngest dates need more corroboration. Analyses of pollen for presence of non-native species help to constrain the time of the MRE. The earthquake recurrence estimates described in this report are preliminary and should not be used as a basis for hazard estimates. Additional trenching is planned for this location to answer questions raised during the initial phase of trenching.

Self-organized criticality in complex systems: Applicability to the interoccurrent and recurrent statistical behavior of earthquakes

NASA Astrophysics Data System (ADS)

Abaimov, Sergey G.

The concept of self-organized criticality is associated with scale-invariant, fractal behavior; this concept is also applicable to earthquake systems. It is known that the interoccurrent frequency-size distribution of earthquakes in a region is scale-invariant and obeys the Gutenberg-Richter power-law dependence. Also, the interoccurrent time-interval distribution is known to obey Poissonian statistics excluding aftershocks. However, to estimate the hazard risk for a region it is necessary to know also the recurrent behavior of earthquakes at a given point on a fault. This behavior has been investigated in the literature, however, major questions remain unresolved. The reason is the small number of earthquakes in observed sequences. To overcome this difficulty this research utilizes numerical simulations of a slider-block model and a sand-pile model. Also, experimental observations of creep events on the creeping section of the San Andreas fault are processed and sequences up to 100 events are studied. Then the recurrent behavior of earthquakes at a given point on a fault or at a given fault is investigated. It is shown that both the recurrent frequency-size and the time-interval behaviors of earthquakes obey the Weibull distribution.

Periodic, chaotic, and doubled earthquake recurrence intervals on the deep San Andreas Fault

USGS Publications Warehouse

Shelly, David R.

2010-01-01

Earthquake recurrence histories may provide clues to the timing of future events, but long intervals between large events obscure full recurrence variability. In contrast, small earthquakes occur frequently, and recurrence intervals are quantifiable on a much shorter time scale. In this work, I examine an 8.5-year sequence of more than 900 recurring low-frequency earthquake bursts composing tremor beneath the San Andreas fault near Parkfield, California. These events exhibit tightly clustered recurrence intervals that, at times, oscillate between ~3 and ~6 days, but the patterns sometimes change abruptly. Although the environments of large and low-frequency earthquakes are different, these observations suggest that similar complexity might underlie sequences of large earthquakes.

Regression equations for estimating flood flows for the 2-, 10-, 25-, 50-, 100-, and 500-Year recurrence intervals in Connecticut

USGS Publications Warehouse

Ahearn, Elizabeth A.

2004-01-01

Multiple linear-regression equations were developed to estimate the magnitudes of floods in Connecticut for recurrence intervals ranging from 2 to 500 years. The equations can be used for nonurban, unregulated stream sites in Connecticut with drainage areas ranging from about 2 to 715 square miles. Flood-frequency data and hydrologic characteristics from 70 streamflow-gaging stations and the upstream drainage basins were used to develop the equations. The hydrologic characteristics?drainage area, mean basin elevation, and 24-hour rainfall?are used in the equations to estimate the magnitude of floods. Average standard errors of prediction for the equations are 31.8, 32.7, 34.4, 35.9, 37.6 and 45.0 percent for the 2-, 10-, 25-, 50-, 100-, and 500-year recurrence intervals, respectively. Simplified equations using only one hydrologic characteristic?drainage area?also were developed. The regression analysis is based on generalized least-squares regression techniques. Observed flows (log-Pearson Type III analysis of the annual maximum flows) from five streamflow-gaging stations in urban basins in Connecticut were compared to flows estimated from national three-parameter and seven-parameter urban regression equations. The comparison shows that the three- and seven- parameter equations used in conjunction with the new statewide equations generally provide reasonable estimates of flood flows for urban sites in Connecticut, although a national urban flood-frequency study indicated that the three-parameter equations significantly underestimated flood flows in many regions of the country. Verification of the accuracy of the three-parameter or seven-parameter national regression equations using new data from Connecticut stations was beyond the scope of this study. A technique for calculating flood flows at streamflow-gaging stations using a weighted average also is described. Two estimates of flood flows?one estimate based on the log-Pearson Type III analyses of the annual maximum flows at the gaging station, and the other estimate from the regression equation?are weighted together based on the years of record at the gaging station and the equivalent years of record value determined from the regression. Weighted averages of flood flows for the 2-, 10-, 25-, 50-, 100-, and 500-year recurrence intervals are tabulated for the 70 streamflow-gaging stations used in the regression analysis. Generally, weighted averages give the most accurate estimate of flood flows at gaging stations. An evaluation of the Connecticut's streamflow-gaging network was performed to determine whether the spatial coverage and range of geographic and hydrologic conditions are adequately represented for transferring flood characteristics from gaged to ungaged sites. Fifty-one of 54 stations in the current (2004) network support one or more flood needs of federal, state, and local agencies. Twenty-five of 54 stations in the current network are considered high-priority stations by the U.S. Geological Survey because of their contribution to the longterm understanding of floods, and their application for regionalflood analysis. Enhancements to the network to improve overall effectiveness for regionalization can be made by increasing the spatial coverage of gaging stations, establishing stations in regions of the state that are not well-represented, and adding stations in basins with drainage area sizes not represented. Additionally, the usefulness of the network for characterizing floods can be maintained and improved by continuing operation at the current stations because flood flows can be more accurately estimated at stations with continuous, long-term record.

Surgical Techniques for Diaphragmatic Resection During Cytoreduction in Advanced or Recurrent Ovarian Carcinoma: A Systematic Review and Meta-analysis.

PubMed

Bogani, Giorgio; Ditto, Antonino; Martinelli, Fabio; Lorusso, Domenica; Chiappa, Valentina; Donfrancesco, Cristina; Di Donato, Violante; Indini, Alice; Aletti, Giovanni; Raspagliesi, Francesco

2016-02-01

Optimal cytoreduction is one the main factors improving survival outcomes in patients affected by ovarian cancer (OC). It is estimated that approximately 40% of OC patients have gross disease located on the diaphragm. However, no mature data evaluating outcomes of surgical techniques for the management of diaphragmatic carcinosis exist. In the present study, we aimed to estimate surgery-related morbidity of different surgical techniques for diaphragmatic cytoreduction in advanced or recurrent OC. PubMed (MEDLINE), Web of Science, and Clincaltrials.gov databases were searched for records estimating outcomes of diaphragmatic peritoneal stripping (DPS) or diaphragmatic full-thickness resection (DFTR) for OC. The meta-analysis was performed using the Cochrane Review software. For the final analysis, 5 articles were available, including 272 patients. Diaphragmatic peritoneal stripping and DFTR were performed in 197 patients (72%) and 75 patients (28%), respectively. Pooled analysis suggested that the estimated pleural effusion rate was 43% and 51% after DPS and DFTR, respectively. The need for pleural punctures or chest tube placement was 4% and 9% after DPS and DFTR, respectively. The rate of postoperative pneumothorax (4% vs 9%; odds ratio, 0.31; 95% confidence interval, 0.05-2.08) and subdiaphragmatic abscess (3% vs 3%; odds ratio, 0.45; 95% confidence interval, 0.09-2.31) were similar after the execution of DPS and DFTR. Diaphragmatic surgery is a crucial step during cytoreduction for advanced or recurrent OC. Obviously, the choice to perform DPS or DFTR depends on the infiltration of the diaphragmatic muscle or not. Both the procedures are associated with a low pulmonary complication and chest tube placement rates.

Recurrence time statistics for finite size intervals

NASA Astrophysics Data System (ADS)

Altmann, Eduardo G.; da Silva, Elton C.; Caldas, Iberê L.

2004-12-01

We investigate the statistics of recurrences to finite size intervals for chaotic dynamical systems. We find that the typical distribution presents an exponential decay for almost all recurrence times except for a few short times affected by a kind of memory effect. We interpret this effect as being related to the unstable periodic orbits inside the interval. Although it is restricted to a few short times it changes the whole distribution of recurrences. We show that for systems with strong mixing properties the exponential decay converges to the Poissonian statistics when the width of the interval goes to zero. However, we alert that special attention to the size of the interval is required in order to guarantee that the short time memory effect is negligible when one is interested in numerically or experimentally calculated Poincaré recurrence time statistics.

A plate boundary earthquake record from a wetland adjacent to the Alpine fault in New Zealand refines hazard estimates

NASA Astrophysics Data System (ADS)

Cochran, U. A.; Clark, K. J.; Howarth, J. D.; Biasi, G. P.; Langridge, R. M.; Villamor, P.; Berryman, K. R.; Vandergoes, M. J.

2017-04-01

Discovery and investigation of millennial-scale geological records of past large earthquakes improve understanding of earthquake frequency, recurrence behaviour, and likelihood of future rupture of major active faults. Here we present a ∼2000 year-long, seven-event earthquake record from John O'Groats wetland adjacent to the Alpine fault in New Zealand, one of the most active strike-slip faults in the world. We linked this record with the 7000 year-long, 22-event earthquake record from Hokuri Creek (20 km along strike to the north) to refine estimates of earthquake frequency and recurrence behaviour for the South Westland section of the plate boundary fault. Eight cores from John O'Groats wetland revealed a sequence that alternated between organic-dominated and clastic-dominated sediment packages. Transitions from a thick organic unit to a thick clastic unit that were sharp, involved a significant change in depositional environment, and were basin-wide, were interpreted as evidence of past surface-rupturing earthquakes. Radiocarbon dates of short-lived organic fractions either side of these transitions were modelled to provide estimates for earthquake ages. Of the seven events recognised at the John O'Groats site, three post-date the most recent event at Hokuri Creek, two match events at Hokuri Creek, and two events at John O'Groats occurred in a long interval during which the Hokuri Creek site may not have been recording earthquakes clearly. The preferred John O'Groats-Hokuri Creek earthquake record consists of 27 events since ∼6000 BC for which we calculate a mean recurrence interval of 291 ± 23 years, shorter than previously estimated for the South Westland section of the fault and shorter than the current interseismic period. The revised 50-year conditional probability of a surface-rupturing earthquake on this fault section is 29%. The coefficient of variation is estimated at 0.41. We suggest the low recurrence variability is likely to be a feature of other strike-slip plate boundary faults similar to the Alpine fault.

Flood characteristics of streams in Owyhee County, Idaho

USGS Publications Warehouse

Riggs, H.C.; Harenberg, W.A.

1976-01-01

Channel-width measurements were used to estimate annual peaks with a recurrence interval of 10 years at 79 sites in Owyhee County, Idaho, and adjacent areas. These discharges and those from 33 gaging stations are plotted on a map of the area. The map will allow the user to interpolate between sites. (Woodard-USGS)

Flood of March 1997 in southern Ohio

USGS Publications Warehouse

Jackson, K.S.; Vivian, S.A.; Diam, F.J.; Crecelius, C.J.

1997-01-01

Rainfall amounts of up to 12 inches produced by thunderstorms during March 1-2, 1997 resulted in severe flooding throughout much of southern Ohio. Eighteen counties were declared Federal and State disaster areas. Cost estimates of damage in Ohio from the flooding are nearly $180 million. About 6,500 residences and more than 800 businesses were affected by flooding. Nearly 20,000 persons were evacuated, and 5 deaths were attributed to the flooding. Record peak stage and streamflow were recorded at U.S. Geological Survey (USGS) streamflow-gaging stations on Ohio Brush Creek near West Union and Shade River near Chester. The peak streamflow at these two locations exceeded the estimate of the 100-year-recurrence- interval peak streamflow. The recurrence intervals of peak stream flow at selected USGS streamflow gaging stations throughout southern Ohio ranged from less than 2 years to greater than 100 years. The most severe flooding in the State was generally confined to areas within 50 to 70 miles of the Ohio River. Many communities along the Ohio River experienced the worst flooding in more than 30 years.

Atmospheric Rivers and floods in Southern California: Climate forcing of extreme weather events.

NASA Astrophysics Data System (ADS)

Hendy, I. L.; Heusser, L. E.; Napier, T.; Pak, D. K.

2016-12-01

Southern California has a Mediterranean type climate characterized by warm dry summers associated with the North Pacific High pressure system and cool, wet winters primarily associated in low pressure systems originating in the high latitude North Pacific. Extreme precipitation, however, is connected to strong zonal flow that brings warm, moist tropical across the Pacific (AKA atmospheric river). Here we present a revised record of flood events in Santa Barbara Basin that have been linked to atmospheric rivers focusing on events associated with transitions between known climate events using new radiocarbon chronology and detailed sediment composition. Flood events identified by homogenous grey layers are present throughout the Holocene with a recurrence every 110 years, but are particularly common (85 year recurrence) between 4,200 and 2,000 years BP. Interval between 6,500 and 4,500 commonly associated with dry conditions in California was associated with fewer flood events (recurrence interval increased to 176 years). Intervals of high lake levels in California associated with pluvials appear to be associated with more frequent extreme precipitation events. The longest recurrence interval (535 years) is associated with the Medieval Climate Anomaly. The season in which the atmospheric river occurs was estimated using the relative abundance of pollen within the flood deposit. The 735 and 1270 C.E. flood events are associated with May-June flowering vegetation, while the most recent events (1861-2 and 1761 C.E.) were associated with November to March flowering vegetation. This agrees with the December-January rainfall records of the historic 1861-62. We conclude the frequency of extreme precipitation events appears to increase as climate cools (e.g. the Little Ice Age).

June 2002 floods in the Red River of the North basin in northeastern North Dakota and northwestern Minnesota

USGS Publications Warehouse

Wiche, Gregg J.; Guttormson, K.G.; Robinson, S.M.; Mitton, G.B.; Bramer, B.J.

2002-01-01

Historical peak stages and peak discharges and the June 2002 peak stages, peak discharges, and recurrence intervals are shown in table 1.  The streamflow-gaging stations are listed in downstream order by station number, and station locations are shown in figure 1.  The June 2002 peak stages and peak discharges given in this preliminary report may be revised as site surveys are completed and additional field data are reviewed in the upcoming months.  The peak discharges are used to determine the probability, often expressed in recurrence intervals, that a given discharge will be exceeded in the future.  For example, a flood that has a 1-percent chance of exceedance in any given year would, on the long-term average, be expected to occur only about once a century; therefore, the flood would be termed a "100-year flood."  However, the chance of such a flood occurring in any given year is 1 percent.  Thus, a 100-year flood can occur in successive years at the same location.  In some instances, recurrence interval estimates can be based on periods of regulated flow or made with historic adjustments when historic data are available.

Triggering of repeating earthquakes in central California

USGS Publications Warehouse

Wu, Chunquan; Gomberg, Joan; Ben-Naim, Eli; Johnson, Paul

2014-01-01

Dynamic stresses carried by transient seismic waves have been found capable of triggering earthquakes instantly in various tectonic settings. Delayed triggering may be even more common, but the mechanisms are not well understood. Catalogs of repeating earthquakes, earthquakes that recur repeatedly at the same location, provide ideal data sets to test the effects of transient dynamic perturbations on the timing of earthquake occurrence. Here we employ a catalog of 165 families containing ~2500 total repeating earthquakes to test whether dynamic perturbations from local, regional, and teleseismic earthquakes change recurrence intervals. The distance to the earthquake generating the perturbing waves is a proxy for the relative potential contributions of static and dynamic deformations, because static deformations decay more rapidly with distance. Clear changes followed the nearby 2004 Mw6 Parkfield earthquake, so we study only repeaters prior to its origin time. We apply a Monte Carlo approach to compare the observed number of shortened recurrence intervals following dynamic perturbations with the distribution of this number estimated for randomized perturbation times. We examine the comparison for a series of dynamic stress peak amplitude and distance thresholds. The results suggest a weak correlation between dynamic perturbations in excess of ~20 kPa and shortened recurrence intervals, for both nearby and remote perturbations.

Quality of life declines after first ischemic stroke

PubMed Central

Dhamoon, M.S.; Moon, Y.P.; Paik, M.C.; Boden-Albala, B.; Rundek, T.; Sacco, R.L.; Elkind, M.S.V.

2010-01-01

Objectives: Quality of life (QOL) after stroke is poorly characterized. We sought to determine long-term natural history and predictors of QOL among first ischemic stroke survivors without stroke recurrence or myocardial infarction (MI). Methods: In the population-based, multiethnic Northern Manhattan Study, QOL was prospectively assessed at 6 months and annually for 5 years using the Spitzer QOL index (QLI), a 10-point scale. Functional status was assessed using the Barthel Index (BI) at regular intervals, and cognition using the Mini-Mental State Examination at 1 year. Generalized estimating equations estimated the association between patient characteristics and repeated QOL measures over 5 years. Follow-up was censored at death, recurrent stroke, or MI. Results: There were 525 incident ischemic stroke patients ≥40 years (mean age 68.6 ± 12.4 years). QLI declined after stroke (annual change −0.10, 95% confidence interval −0.17 to −0.04), after adjusting for age, sex, race-ethnicity, education, insurance, depressed mood, stroke severity, bladder continence, and stroke laterality. This decline remained when BI ≥95 was added to the model as a time-dependent covariate, and functional status also predicted QLI. Changes in QLI over time differed by insurance status (p for interaction = 0.0017), with a decline for those with Medicaid/no insurance (p < 0.0001) but not Medicare/private insurance (p = 0.98). Conclusions: In this population-based study, QOL declined annually up to 5 years after stroke among survivors free of recurrence or MI and independently of other risk factors. QLI declined more among Medicaid patients and was associated with age, mood, stroke severity, urinary incontinence, functional status, cognition, and stroke laterality. GLOSSARY BI = Barthel Index; CAD = coronary artery disease; CHF = congestive heart failure; CI = confidence interval; CUMC = Columbia University Medical Center; DM = diabetes mellitus; GEE = generalized estimating equation; HTN = hypertension; MI = myocardial infarction; MMSE = Mini-Mental State Examination; NIHSS = NIH Stroke Scale; NOMAS = Northern Manhattan Study; QOL = quality of life; QLI = quality of life index. PMID:20574034

Is Transcellular Potassium Shifting With Insulin, Albuterol, or Sodium Bicarbonate in Emergency Department Patients With Hyperkalemia Associated With Recurrent Hyperkalemia After Dialysis?

PubMed

Driver, Brian E; Klein, Lauren R; Chittineni, Chaitanya; Cales, Ellen K; Scott, Nathaniel

2018-04-13

Emergency department (ED) treatment of hyperkalemia often involves shifting potassium into the intracellular space. There is uncertainty whether transcellular shifting causes insufficient potassium removal during hemodialysis, resulting in a subsequent need for further medical therapy or multiple sessions of hemodialysis. We sought to determine whether transcellular potassium shifting in ED patients with hyperkalemia who undergo hemodialysis is associated with recurrent hyperkalemia with or without repeat hemodialysis within 24 h. This was a retrospective observational study of ED patients with a potassium value > 5.3 mmol/L and ≥1 hemodialysis run. Transcellular shifting medications were defined as albuterol, insulin, and sodium bicarbonate. Primary outcomes were recurrent hyperkalemia with and without repeat hemodialysis within 24 h of the initial dialysis run. Generalized estimating equation models were created for the outcomes using administration of a shifting medication as the primary predictor. Four hundred seventy-nine encounters were identified. In 238 (50%) encounters, a shifting medication was administered. There were 85 outcomes of recurrent hyperkalemia and 36 outcomes of recurrent hyperkalemia with repeat hemodialysis. After adjustment, administration of shifting medications was not associated with recurrent hyperkalemia (adjusted odds ratio 1.26, 95% confidence interval 0.71-2.23) or recurrent hyperkalemia with repeat dialysis (adjusted odds ratio 1.90, 95% confidence interval 0.80-4.48). Administration of transcellular shifting medications for hyperkalemia in the ED was not associated with either recurrent hyperkalemia after hemodialysis or the need for a second dialysis session within 24 h. Our findings address the uncertainty regarding transcellular potassium shifting before emergent dialysis and support safe ED administration of medications that shift potassium to the intracellular space. Copyright © 2018 Elsevier Inc. All rights reserved.

Regression equations for estimation of annual peak-streamflow frequency for undeveloped watersheds in Texas using an L-moment-based, PRESS-minimized, residual-adjusted approach

USGS Publications Warehouse

Asquith, William H.; Roussel, Meghan C.

2009-01-01

Annual peak-streamflow frequency estimates are needed for flood-plain management; for objective assessment of flood risk; for cost-effective design of dams, levees, and other flood-control structures; and for design of roads, bridges, and culverts. Annual peak-streamflow frequency represents the peak streamflow for nine recurrence intervals of 2, 5, 10, 25, 50, 100, 200, 250, and 500 years. Common methods for estimation of peak-streamflow frequency for ungaged or unmonitored watersheds are regression equations for each recurrence interval developed for one or more regions; such regional equations are the subject of this report. The method is based on analysis of annual peak-streamflow data from U.S. Geological Survey streamflow-gaging stations (stations). Beginning in 2007, the U.S. Geological Survey, in cooperation with the Texas Department of Transportation and in partnership with Texas Tech University, began a 3-year investigation concerning the development of regional equations to estimate annual peak-streamflow frequency for undeveloped watersheds in Texas. The investigation focuses primarily on 638 stations with 8 or more years of data from undeveloped watersheds and other criteria. The general approach is explicitly limited to the use of L-moment statistics, which are used in conjunction with a technique of multi-linear regression referred to as PRESS minimization. The approach used to develop the regional equations, which was refined during the investigation, is referred to as the 'L-moment-based, PRESS-minimized, residual-adjusted approach'. For the approach, seven unique distributions are fit to the sample L-moments of the data for each of 638 stations and trimmed means of the seven results of the distributions for each recurrence interval are used to define the station specific, peak-streamflow frequency. As a first iteration of regression, nine weighted-least-squares, PRESS-minimized, multi-linear regression equations are computed using the watershed characteristics of drainage area, dimensionless main-channel slope, and mean annual precipitation. The residuals of the nine equations are spatially mapped, and residuals for the 10-year recurrence interval are selected for generalization to 1-degree latitude and longitude quadrangles. The generalized residual is referred to as the OmegaEM parameter and represents a generalized terrain and climate index that expresses peak-streamflow potential not otherwise represented in the three watershed characteristics. The OmegaEM parameter was assigned to each station, and using OmegaEM, nine additional regression equations are computed. Because of favorable diagnostics, the OmegaEM equations are expected to be generally reliable estimators of peak-streamflow frequency for undeveloped and ungaged stream locations in Texas. The mean residual standard error, adjusted R-squared, and percentage reduction of PRESS by use of OmegaEM are 0.30log10, 0.86, and -21 percent, respectively. Inclusion of the OmegaEM parameter provides a substantial reduction in the PRESS statistic of the regression equations and removes considerable spatial dependency in regression residuals. Although the OmegaEM parameter requires interpretation on the part of analysts and the potential exists that different analysts could estimate different values for a given watershed, the authors suggest that typical uncertainty in the OmegaEM estimate might be about +or-0.1010. Finally, given the two ensembles of equations reported herein and those in previous reports, hydrologic design engineers and other analysts have several different methods, which represent different analytical tracks, to make comparisons of peak-streamflow frequency estimates for ungaged watersheds in the study area.

Techniques for estimating the magnitude and frequency of floods in rural basins of South Carolina, 1999

USGS Publications Warehouse

Feaster, Toby D.; Tasker, Gary D.

2002-01-01

Data from 167 streamflow-gaging stations in or near South Carolina with 10 or more years of record through September 30, 1999, were used to develop two methods for estimating the magnitude and frequency of floods in South Carolina for rural ungaged basins that are not significantly affected by regulation. Flood frequency estimates for 54 gaged sites in South Carolina were computed by fitting the water-year peak flows for each site to a log-Pearson Type III distribution. As part of the computation of flood-frequency estimates for gaged sites, new values for generalized skew coefficients were developed. Flood-frequency analyses also were made for gaging stations that drain basins from more than one physiographic province. The U.S. Geological Survey, in cooperation with the South Carolina Department of Transportation, updated these data from previous flood-frequency reports to aid officials who are active in floodplain management as well as those who design bridges, culverts, and levees, or other structures near streams where flooding is likely to occur. Regional regression analysis, using generalized least squares regression, was used to develop a set of predictive equations that can be used to estimate the 2-, 5-, 10-, 25-, 50-, 100-, 200-, and 500-year recurrence-interval flows for rural ungaged basins in the Blue Ridge, Piedmont, upper Coastal Plain, and lower Coastal Plain physiographic provinces of South Carolina. The predictive equations are all functions of drainage area. Average errors of prediction for these regression equations ranged from -16 to 19 percent for the 2-year recurrence-interval flow in the upper Coastal Plain to -34 to 52 percent for the 500-year recurrence interval flow in the lower Coastal Plain. A region-of-influence method also was developed that interactively estimates recurrence- interval flows for rural ungaged basins in the Blue Ridge of South Carolina. The region-of-influence method uses regression techniques to develop a unique relation between flow and basin characteristics for an individual watershed. This, then, can be used to estimate flows at ungaged sites. Because the computations required for this method are somewhat complex, a computer application was developed that performs the computations and compares the predictive errors for this method. The computer application includes the option of using the region-of-influence method, or the generalized least squares regression equations from this report to compute estimated flows and errors of prediction specific to each ungaged site. From a comparison of predictive errors using the region-of-influence method with those computed using the regional regression method, the region-of-influence method performed systematically better only in the Blue Ridge and is, therefore, not recommended for use in the other physiographic provinces. Peak-flow data for the South Carolina stations used in the regionalization study are provided in appendix A, which contains gaging station information, log-Pearson Type III statistics, information on stage-flow relations, and water-year peak stages and flows. For informational purposes, water-year peak-flow data for stations on regulated streams in South Carolina also are provided in appendix D. Other information pertaining to the regulated streams is provided in the text of the report.

Interventions for non-metastatic squamous cell carcinoma of the skin: systematic review and pooled analysis of observational studies.

PubMed

Lansbury, Louise; Bath-Hextall, Fiona; Perkins, William; Stanton, Wendy; Leonardi-Bee, Jo

2013-11-04

To assess the effects of treatments for non-metastatic invasive squamous cell carcinoma (SCC) of the skin using evidence from observational studies, given the paucity of evidence from randomised controlled trials. Systematic review of observational studies. Medline, Embase, to December 2012. Observational studies of interventions for primary, non-metastatic, invasive, SCC of the skin that reported recurrence during follow-up, quality of life, initial response to treatment, adverse events, cosmetic appearance, or death from disease. Studies were excluded if data for primary cutaneous SCC was not separable from other data. Data were extracted independently by two reviewers. Meta-analysis was performed where appropriate using a random effects model to estimate the pooled proportion of an event with 95% confidence intervals. 118 publications were included, covering seven treatment modalities. Pooled estimates of recurrence of SCCs were lowest after cryotherapy (0.8% (95% confidence interval 0.1% to 2%)) and curettage and electrodesiccation (1.7% (0.5% to 3.4%)), but most treated SCCs were small, low risk lesions. After Mohs micrographic surgery, the pooled estimate of local recurrence during variable follow-up periods from 10 studies was 3.0% (2.2% to 3.9%), which was non-significantly lower than the pooled average local recurrence of 5.4% (2.5% to 9.1%) after standard surgical excision (12 studies), and 6.4% (3.0% to 11.0%) after external radiotherapy (7 studies). After an apparently successful initial response of SCCs to photodynamic therapy, pooled average recurrence of 26.4% (12.3% to 43.7%; 8 studies) was significantly higher than other treatments. Evidence was limited for laser treatment (1 study) and for topical and systemic treatments (mostly single case reports or small non-comparative series with limited follow-up). Many observational studies have looked at different treatment modalities for SCC, but the evidence base for the effectiveness of these interventions is poor. Comparison of outcomes after different treatments should be interpreted cautiously owing to biases inherent in the types of study included, and lack of direct comparisons to enable the estimation of relative treatment effect. Further evidence is needed to develop a prognostic model and stratify individuals at high risk of developing SCC, to improve the evidence base for this common cancer and to optimise clinical management. International Prospective Register of Systematic Reviews (PROSPERO) registration number CRD42011001450.

Technique for estimating depth of floods in Tennessee

USGS Publications Warehouse

Gamble, C.R.

1983-01-01

Estimates of flood depths are needed for design of roadways across flood plains and for other types of construction along streams. Equations for estimating flood depths in Tennessee were derived using data for 150 gaging stations. The equations are based on drainage basin size and can be used to estimate depths of the 10-year and 100-year floods for four hydrologic areas. A method also was developed for estimating depth of floods having recurrence intervals between 10 and 100 years. Standard errors range from 22 to 30 percent for the 10-year depth equations and from 23 to 30 percent for the 100-year depth equations. (USGS)

Technique for simulating peak-flow hydrographs in Maryland

USGS Publications Warehouse

Dillow, Jonathan J.A.

1998-01-01

The efficient design and management of many bridges, culverts, embankments, and flood-protection structures may require the estimation of time-of-inundation and (or) storage of floodwater relating to such structures. These estimates can be made on the basis of information derived from the peak-flow hydrograph. Average peak-flow hydrographs corresponding to a peak discharge of specific recurrence interval can be simulated for drainage basins having drainage areas less than 500 square miles in Maryland, using a direct technique of known accuracy. The technique uses dimensionless hydrographs in conjunction with estimates of basin lagtime and instantaneous peak flow. Ordinary least-squares regression analysis was used to develop an equation for estimating basin lagtime in Maryland. Drainage area, main channel slope, forest cover, and impervious area were determined to be the significant explanatory variables necessary to estimate average basin lagtime at the 95-percent confidence interval. Qualitative variables included in the equation adequately correct for geographic bias across the State. The average standard error of prediction associated with the equation is approximated as plus or minus (+/-) 37.6 percent. Volume correction factors may be applied to the basin lagtime on the basis of a comparison between actual and estimated hydrograph volumes prior to hydrograph simulation. Three dimensionless hydrographs were developed and tested using data collected during 278 significant rainfall-runoff events at 81 stream-gaging stations distributed throughout Maryland and Delaware. The data represent a range of drainage area sizes and basin conditions. The technique was verified by applying it to the simulation of 20 peak-flow events and comparing actual and simulated hydrograph widths at 50 and 75 percent of the observed peak-flow levels. The events chosen are considered extreme in that the average recurrence interval of the selected peak flows is 130 years. The average standard errors of prediction were +/- 61 and +/- 56 percent at the 50 and 75 percent of peak-flow hydrograph widths, respectively.

Assessing the Reliability of Regional Depth-Duration-Frequency Equations for Gauged and Ungauged Sites

NASA Astrophysics Data System (ADS)

Castellarin, A.; Montanari, A.; Brath, A.

2002-12-01

The study derives Regional Depth-Duration-Frequency (RDDF) equations for a wide region of northern-central Italy (37,200 km 2) by following an adaptation of the approach originally proposed by Alila [WRR, 36(7), 2000]. The proposed RDDF equations have a rather simple structure and allow an estimation of the design storm, defined as the rainfall depth expected for a given storm duration and recurrence interval, in any location of the study area for storm durations from 1 to 24 hours and for recurrence intervals up to 100 years. The reliability of the proposed RDDF equations represents the main concern of the study and it is assessed at two different levels. The first level considers the gauged sites and compares estimates of the design storm obtained with the RDDF equations with at-site estimates based upon the observed annual maximum series of rainfall depth and with design storm estimates resulting from a regional estimator recently developed for the study area through a Hierarchical Regional Approach (HRA) [Gabriele and Arnell, WRR, 27(6), 1991]. The second level performs a reliability assessment of the RDDF equations for ungauged sites by means of a jack-knife procedure. Using the HRA estimator as a reference term, the jack-knife procedure assesses the reliability of design storm estimates provided by the RDDF equations for a given location when dealing with the complete absence of pluviometric information. The results of the analysis show that the proposed RDDF equations represent practical and effective computational means for producing a first guess of the design storm at the available raingauges and reliable design storm estimates for ungauged locations. The first author gratefully acknowledges D.H. Burn for sponsoring the submission of the present abstract.

The exposure-crossover design is a new method for studying sustained changes in recurrent events.

PubMed

Redelmeier, Donald A

2013-09-01

To introduce a new design that explores how an acute exposure might lead to a sustained change in the risk of a recurrent outcome. The exposure-crossover design uses self-matching to control within-person confounding due to genetics, personality, and all other stable patient characteristics. The design is demonstrated using population-based individual-level health data from Ontario, Canada, for three separate medical conditions (n > 100,000 for each) related to the risk of a motor vehicle crash (total outcomes, >2,000 for each). The exposure-crossover design yields numerical risk estimates during the baseline interval before an intervention, the induction interval immediately ahead of the intervention, and the subsequent interval after the intervention. Accompanying graphs summarize results, provide an intuitive display to readers, and show risk comparisons (absolute and relative). Self-matching increases statistical efficiency, reduces selection bias, and yields quantitative analyses. The design has potential limitations related to confounding, artifacts, pragmatics, survivor bias, statistical models, potential misunderstandings, and serendipity. The exposure-crossover design may help in exploring selected questions in epidemiology science. Copyright © 2013 Elsevier Inc. All rights reserved.

Analyzing recurrent events when the history of previous episodes is unknown or not taken into account: proceed with caution.

PubMed

Navarro, Albert; Casanovas, Georgina; Alvarado, Sergio; Moriña, David

Researchers in public health are often interested in examining the effect of several exposures on the incidence of a recurrent event. The aim of the present study is to assess how well the common-baseline hazard models perform to estimate the effect of multiple exposures on the hazard of presenting an episode of a recurrent event, in presence of event dependence and when the history of prior-episodes is unknown or is not taken into account. Through a comprehensive simulation study, using specific-baseline hazard models as the reference, we evaluate the performance of common-baseline hazard models by means of several criteria: bias, mean squared error, coverage, confidence intervals mean length and compliance with the assumption of proportional hazards. Results indicate that the bias worsen as event dependence increases, leading to a considerable overestimation of the exposure effect; coverage levels and compliance with the proportional hazards assumption are low or extremely low, worsening with increasing event dependence, effects to be estimated, and sample sizes. Common-baseline hazard models cannot be recommended when we analyse recurrent events in the presence of event dependence. It is important to have access to the history of prior-episodes per subject, it can permit to obtain better estimations of the effects of the exposures. Copyright © 2016 SESPAS. Publicado por Elsevier España, S.L.U. All rights reserved.

Comparison of Time-to-First Event and Recurrent Event Methods in Randomized Clinical Trials.

PubMed

Claggett, Brian; Pocock, Stuart; Wei, L J; Pfeffer, Marc A; McMurray, John J V; Solomon, Scott D

2018-03-27

Background -Most Phase-3 trials feature time-to-first event endpoints for their primary and/or secondary analyses. In chronic diseases where a clinical event can occur more than once, recurrent-event methods have been proposed to more fully capture disease burden and have been assumed to improve statistical precision and power compared to conventional "time-to-first" methods. Methods -To better characterize factors that influence statistical properties of recurrent-events and time-to-first methods in the evaluation of randomized therapy, we repeatedly simulated trials with 1:1 randomization of 4000 patients to active vs control therapy, with true patient-level risk reduction of 20% (i.e. RR=0.80). For patients who discontinued active therapy after a first event, we assumed their risk reverted subsequently to their original placebo-level risk. Through simulation, we varied a) the degree of between-patient heterogeneity of risk and b) the extent of treatment discontinuation. Findings were compared with those from actual randomized clinical trials. Results -As the degree of between-patient heterogeneity of risk was increased, both time-to-first and recurrent-events methods lost statistical power to detect a true risk reduction and confidence intervals widened. The recurrent-events analyses continued to estimate the true RR=0.80 as heterogeneity increased, while the Cox model produced estimates that were attenuated. The power of recurrent-events methods declined as the rate of study drug discontinuation post-event increased. Recurrent-events methods provided greater power than time-to-first methods in scenarios where drug discontinuation was ≤30% following a first event, lesser power with drug discontinuation rates of ≥60%, and comparable power otherwise. We confirmed in several actual trials in chronic heart failure that treatment effect estimates were attenuated when estimated via the Cox model and that increased statistical power from recurrent-events methods was most pronounced in trials with lower treatment discontinuation rates. Conclusions -We find that the statistical power of both recurrent-events and time-to-first methods are reduced by increasing heterogeneity of patient risk, a parameter not included in conventional power and sample size formulas. Data from real clinical trials are consistent with simulation studies, confirming that the greatest statistical gains from use of recurrent-events methods occur in the presence of high patient heterogeneity and low rates of study drug discontinuation.

Flood of April 2007 in New Hampshire

USGS Publications Warehouse

Flynn, Robert H.

2008-01-01

During April 16-18, 2007, central and southeastern New Hampshire experienced severe flooding as a result of up to 7 inches of rainfall from a storm that stalled off the New England coast. As a result of the flooding, a Presidential Disaster Declaration was issued on April 27, 2007. On that day, disaster declarations were announced for Grafton, Hillsborough, Merrimack, Rockingham, and Strafford Counties. On May 10, 2007, Belknap County was added to the disaster declaration. Following the flooding, the U.S. Geological Survey, in a cooperative investigation with the Federal Emergency Management Agency, determined the peak stages, peak discharges, and recurrence-interval estimates of the April 2007 flood at 57 streamgages and 4 ungaged sites in and adjacent to the counties named in the disaster declaration. Data from flood-insurance studies published by the Federal Emergency Management Agency also were compiled for each streamgage site for comparison purposes. The peak discharges during the April 2007 flood were the highest ever recorded at five long-term (more than 10 years of record) streamgage sites on the New Hampshire-Salmon Falls River at Milton, Cocheco River near Rochester, Oyster River near Durham, Contoocook River at Peterborough, and South Branch Piscataquog River near Goffstown. In addition, peak discharges equaled or exceeded a 100-year recurrence interval at 10 streamgages and a 50-year recurrence interval at 16 streamgages. The most severe flooding occurred in Rockingham, Strafford, Merrimack, and Hillsborough Counties.

Using low-frequency earthquake families on the San Andreas fault as deep creepmeters

NASA Astrophysics Data System (ADS)

Thomas, A.; Beeler, N. M.; Bletery, Q.; Burgmann, R.; Shelly, D. R.

2017-12-01

The San Andreas fault hosts tectonic tremor and low-frequency earthquakes (LFEs) similar to those in subduction zone environments. These LFEs are grouped into families based on waveform similarity and locate between 16 and 29 km depth along a 150-km-long section of the fault centered on Parkfield, CA. ­Within individual LFE families event occurrence is not steady. In some families, bursts of a few events recur on timescales of days while in other families there are nearly quiescent periods that often last for months followed by episodes where hundreds of events occur over the course of a few days. These two different styles of LFE occurrence are called continuous and episodic respectively. LFEs are often assumed to reflect persistent regions that periodically fail during the aseismic shear of the surrounding fault allowing them to be used as creepmeters. We test this idea by formalizing the definition of a creepmeter (the LFE occurrence rate is proportional to the local fault slip rate), determining whether this definition is consistent with the observations, and over what timescale. We use the recurrence intervals of LFEs within individual families to create a catalog of LFE bursts. For the episodic families, we consider both longer duration (multiday) inferred creep episodes (dubbed long-timescale episodic) as well as the frequent short-term bursts of events that occur many times during inferred creep episodes (dubbed short-timescale episodic). We then use the recurrence intervals of LFE bursts to estimate the timing, duration, recurrence interval, slip, and slip rate associated with inferred slow slip events. We find that continuous families and the short-timescale episodic families appear to be inconsistent with our definition of a creepmeter (defined on the recurrence interval timescale) because their estimated durations are not physically meaningful. A straight-forward interpretation of the frequent short-term bursts of the continuous and short-timescale episodic families is that they do not represent individual creep events but rather are persistent asperities that are driven to failure by quasi-continuous creep on the surrounding fault. In contrast, episodic families likely define sections of the fault where slip is distinctly episodic in well-defined SSEs that slip at 15 times the long-term rate.

Tumour mutation status and melanoma recurrence following a negative sentinel lymph node biopsy.

PubMed

Adler, Nikki R; Wolfe, Rory; McArthur, Grant A; Kelly, John W; Haydon, Andrew; McLean, Catriona A; Mar, Victoria J

2018-05-14

A proportion of patients develop recurrence following a tumour-negative sentinel lymph node biopsy (SLNB). This study aimed to explore whether melanoma patients with BRAF or NRAS mutant tumours have an increased risk of developing disease recurrence following a negative SLNB compared to patients with wild-type tumours. Prospective cohort study of melanoma patients at three tertiary referral centres in Melbourne, who underwent SLNB. Clinical, pathological and molecular characteristics and recurrence data were prospectively recorded. Multivariate Cox proportional hazards regression models estimated the adjusted hazard ratio (aHR) and corresponding 95% confidence interval (CI) for the association between mutation status and development of recurrence following a negative-SLNB. Overall, 344/477 (72.1%) patients had a negative SLNB. Of these, 54 (15.7%) developed subsequent recurrence. The risk of disease recurrence following a negative SLNB was increased for patients with either a BRAF or NRAS mutant tumour compared to wild-type tumours (aHR 1.92, 95% CI: 1.02-3.60, p = 0.04). Melanoma patients with BRAF or NRAS mutant tumours had an increased risk compared to patients with BRAF/NRAS wild-type tumours of developing disease recurrence following a tumour-negative SLNB. The findings also confirm the importance of continued surveillance to monitor for disease recurrence among SLNB-negative patients.

Low-flow characteristics of streams in Ohio through water year 1997

USGS Publications Warehouse

Straub, David E.

2001-01-01

This report presents selected low-flow and flow-duration characteristics for 386 sites throughout Ohio. These sites include 195 long-term continuous-record stations with streamflow data through water year 1997 (October 1 to September 30) and for 191 low-flow partial-record stations with measurements into water year 1999. The characteristics presented for the long-term continuous-record stations are minimum daily streamflow; average daily streamflow; harmonic mean flow; 1-, 7-, 30-, and 90-day minimum average low flow with 2-, 5-, 10-, 20-, and 50-year recurrence intervals; and 98-, 95-, 90-, 85-, 80-, 75-, 70-, 60-, 50-, 40-, 30-, 20-, and 10-percent daily duration flows. The characteristics presented for the low-flow partial-record stations are minimum observed streamflow; estimated 1-, 7-, 30-, and 90-day minimum average low flow with 2-, 10-, and 20-year recurrence intervals; and estimated 98-, 95-, 90-, 85- and 80-percent daily duration flows. The low-flow frequency and duration analyses were done for three seasonal periods (warm weather, May 1 to November 30; winter, December 1 to February 28/29; and autumn, September 1 to November 30), plus the annual period based on the climatic year (April 1 to March 31).

Flood-inundation map and water-surface profiles for floods of selected recurrence intervals, Consumnes River and Deer Creek, Sacramento County, California

USGS Publications Warehouse

Guay, Joel R.; Harmon, Jerry G.; McPherson, Kelly R.

1998-01-01

The damage caused by the January 1997 floods along the Cosumnes River and Deer Creek generated new interest in planning and managing land use in the study area. The 1997 floodflow peak, the highest on record and considered to be a 150-year flood, caused levee failures at 24 locations. In order to provide a technical basis for floodplain management practices, the U.S. Goelogical Survey, in cooperation with the Federal Emergency Management Agency, completed a flood-inundation map of the Cosumnes River and Deer Creek drainage from Dillard Road bridge to State Highway 99. Flood frequency was estimated from streamflow records for the Cosumnes River at Michigan Bar and Deer Creek near Sloughhouse. Cross sections along a study reach, where the two rivers generally flow parallel to one another, were used with a step-backwater model (WSPRO) to estimate the water-surface profile for floods of selected recurrence intervals. A flood-inundation map was developed to show flood boundaries for the 100-year flood. Water-surface profiles were developed for the 5-, 10-, 50-, 100-, and 500-year floods.

Techniques for estimating flood-peak discharges from urban basins in Missouri

USGS Publications Warehouse

Becker, L.D.

1986-01-01

Techniques are defined for estimating the magnitude and frequency of future flood peak discharges of rainfall-induced runoff from small urban basins in Missouri. These techniques were developed from an initial analysis of flood records of 96 gaged sites in Missouri and adjacent states. Final regression equations are based on a balanced, representative sampling of 37 gaged sites in Missouri. This sample included 9 statewide urban study sites, 18 urban sites in St. Louis County, and 10 predominantly rural sites statewide. Short-term records were extended on the basis of long-term climatic records and use of a rainfall-runoff model. Linear least-squares regression analyses were used with log-transformed variables to relate flood magnitudes of selected recurrence intervals (dependent variables) to selected drainage basin indexes (independent variables). For gaged urban study sites within the State, the flood peak estimates are from the frequency curves defined from the synthesized long-term discharge records. Flood frequency estimates are made for ungaged sites by using regression equations that require determination of the drainage basin size and either the percentage of impervious area or a basin development factor. Alternative sets of equations are given for the 2-, 5-, 10-, 25-, 50-, and 100-yr recurrence interval floods. The average standard errors of estimate range from about 33% for the 2-yr flood to 26% for the 100-yr flood. The techniques for estimation are applicable to flood flows that are not significantly affected by storage caused by manmade activities. Flood peak discharge estimating equations are considered applicable for sites on basins draining approximately 0.25 to 40 sq mi. (Author 's abstract)

Estimating bridge scour in New York from historical U.S. geological survey streamflow measurements

USGS Publications Warehouse

Butch, Gerard K.; ,

1993-01-01

Historical streamflow measurements by the U.S. Geological Survey an bridge-inspection reports by the New York State Department of Transportation are being used to estimate scour at 31 bridges in New York State. Streamflow measurements that were made before, during, or after high flows are used to estimate scour and to define hydraulic properties associated with floods. Clear-water scour is common at most sites; local scour holes that formed during high flows did not refill after subsequent high flows. The 31 streambeds are armored by gravel; median particle size ranges form 22 to 68 millimeters. Streambed elevations measured after a high flow are assumed to represent the elevations during peak flow. Measurements at several bridges indicate scour by multiple high flows, severe floods, and debris. Three high flows at State Route 23 over the Otselic River in Cortland County produced 6.1 feet of local scour and partly exposed concrete pilings below the footing. Although the recurrence interval of each flow was less than 10 years, a 30-degree angle between the flow and the pier increased the tendency of the streambed to scour. State Route 427 over the Chemung River in Chemung County survived the 1972 flood ( recurrence interval greater than 100 years) because pilings supported the undermined piers. The maximum local scour during the 1972 flood was estimated to be 5.4 feet. A local-scour hole, 2.4 feet deep before the flood, was deepened to 7.8 feet.

Epidemiological characteristics of human brucellosis in Hamadan Province during 2009-2015: results from the National Notifiable Diseases Surveillance System.

PubMed

Nematollahi, Shahrzad; Ayubi, Erfan; Karami, Manoochehr; Khazaei, Salman; Shojaeian, Masoud; Zamani, Reza; Mansori, Kamyar; Gholamaliee, Behzad

2017-08-01

Human brucellosis and recurrent brucellosis is an ever-increasing public health concern, especially in endemic areas like Iran. Nevertheless, little is known regarding the epidemiology and determinants of recurrent brucellosis. Therefore, the objective of this study was to investigate epidemiological patterns and potential determinants of recurrent brucellosis in Hamadan Province during the years 2009-2015. Data on reported cases of new and recurrent brucellosis from 2009 to 2015 were obtained from the provincial Notifiable Diseases Surveillance System at Hamadan University of Medical Sciences. Incidence rates per 100000 were estimated at the county level. Binary logistic regression was used to estimate the effects of background characteristics and recurrent brucellosis. The power of discrimination of the model for recurrent brucellosis was assessed using the area under the curve (AUC). Among 7318 brucellosis cases, the total frequency (%) of recurrent cases was 472 (6.45%). The rate of recurrent brucellosis was higher in females, people aged 50 years and over, people with a history of consuming unpasteurized dairy products with no history of contact with animals, and in the winter season. Multivariable logistic regression analysis showed that female sex (adjusted odds ratio (AOR) 1.36, 95% confidence interval (CI) 1.13-1.65), age ≥55 years (AOR 4.15, 95% CI 2.32-7.42), consumption of unpasteurized dairy products (AOR 1.16, 95% CI 0.96-1.40), and winter season (AOR 1.32, 95% CI 1.03-1.71) are potential risk factors for recurrent brucellosis. The final model that involved all the determinants showed moderate discrimination (AUC 0.61). Female sex, older age, and winter months were found to be significant determinants of recurrent human brucellosis. Enhanced surveillance systems with an emphasis on these population characteristics will allow effective preventive and protective measures to be implemented and might alleviate the recurrence of brucellosis in the country. Copyright © 2017 The Authors. Published by Elsevier Ltd.. All rights reserved.

The association of statin therapy with the risk of recurrent venous thrombosis.

PubMed

Smith, N L; Harrington, L B; Blondon, M; Wiggins, K L; Floyd, J S; Sitlani, C M; McKnight, B; Larson, E B; Rosendaal, F R; Heckbert, S R; Psaty, B M

2016-07-01

Essentials A lowered risk of recurrent venous thrombosis (VT) with statin treatment is controversial. Among observational inception cohort of 2,798 adults with incident VT, 457 had recurrent VT. Time-to-event models with time-varying statin use and adjustment for potential confounders was used for analysis. Compared to nonuse, current statin use was associated with 26% lower risk of recurrent VT. Click to hear Prof. Büller's perspective on Anticoagulant Therapy in the Treatment of Venous Thromboembolism Background Meta-analyses of randomized controlled trials suggest that treatment with hydroxymethylglutaryl-coenzyme A reductase inhibitors (statins) lowers the risk of incident venous thrombosis (VT), particularly among those without prevalent clinical cardiovascular disease (CVD). Whether this is true for the prevention of recurrent VT is debated. We used an observational inception cohort to estimate the association of current statin use with the risk of recurrent VT. Methods and Results The study setting was a large healthcare organization with detailed medical record and pharmacy information at cohort entry and throughout follow-up. We followed 2798 subjects 18-89 years of age who experienced a validated incident VT between January 1, 2002, and December 31, 2010, for a first recurrent VT, validated by medical record review. During follow-up, 457 (16%) developed a first recurrent VT. In time-to-event models incorporating time-varying statin use and adjusting for potential confounders, current statin use was associated with a 26% lower risk of recurrent VT: hazard ratio 0.74, 95% confidence interval 0.59-0.94. Among cohort members free of CVD (n = 2134), current statin use was also associated with a lower risk (38%) of recurrent VT: hazard ratio 0.62, 95% confidence interval 0.45-0.85. We found similar results when restricting to new users of statins and in subgroups of different statin types and doses. Conclusions In a population-based cohort of subjects who had experienced an incident VT, statin use, compared with nonuse, was associated with a clinically relevant lower risk of recurrent VT. These findings suggest a potential secondary benefit of statins among patients who have experienced an incident VT. © 2016 International Society on Thrombosis and Haemostasis.

Seismic hazard and risk assessment in the intraplate environment: The New Madrid seismic zone of the central United States

USGS Publications Warehouse

Wang, Z.

2007-01-01

Although the causes of large intraplate earthquakes are still not fully understood, they pose certain hazard and risk to societies. Estimating hazard and risk in these regions is difficult because of lack of earthquake records. The New Madrid seismic zone is one such region where large and rare intraplate earthquakes (M = 7.0 or greater) pose significant hazard and risk. Many different definitions of hazard and risk have been used, and the resulting estimates differ dramatically. In this paper, seismic hazard is defined as the natural phenomenon generated by earthquakes, such as ground motion, and is quantified by two parameters: a level of hazard and its occurrence frequency or mean recurrence interval; seismic risk is defined as the probability of occurrence of a specific level of seismic hazard over a certain time and is quantified by three parameters: probability, a level of hazard, and exposure time. Probabilistic seismic hazard analysis (PSHA), a commonly used method for estimating seismic hazard and risk, derives a relationship between a ground motion parameter and its return period (hazard curve). The return period is not an independent temporal parameter but a mathematical extrapolation of the recurrence interval of earthquakes and the uncertainty of ground motion. Therefore, it is difficult to understand and use PSHA. A new method is proposed and applied here for estimating seismic hazard in the New Madrid seismic zone. This method provides hazard estimates that are consistent with the state of our knowledge and can be easily applied to other intraplate regions. ?? 2007 The Geological Society of America.

Predictors of long-term recurrent vascular events after ischemic stroke at young age: the Italian Project on Stroke in Young Adults.

PubMed

Pezzini, Alessandro; Grassi, Mario; Lodigiani, Corrado; Patella, Rosalba; Gandolfo, Carlo; Zini, Andrea; Delodovici, Maria Luisa; Paciaroni, Maurizio; Del Sette, Massimo; Toriello, Antonella; Musolino, Rossella; Calabrò, Rocco Salvatore; Bovi, Paolo; Adami, Alessandro; Silvestrelli, Giorgio; Sessa, Maria; Cavallini, Anna; Marcheselli, Simona; Bonifati, Domenico Marco; Checcarelli, Nicoletta; Tancredi, Lucia; Chiti, Alberto; Del Zotto, Elisabetta; Spalloni, Alessandra; Giossi, Alessia; Volonghi, Irene; Costa, Paolo; Giacalone, Giacomo; Ferrazzi, Paola; Poli, Loris; Morotti, Andrea; Rasura, Maurizia; Simone, Anna Maria; Gamba, Massimo; Cerrato, Paolo; Micieli, Giuseppe; Melis, Maurizio; Massucco, Davide; De Giuli, Valeria; Iacoviello, Licia; Padovani, Alessandro

2014-04-22

Data on long-term risk and predictors of recurrent thrombotic events after ischemic stroke at a young age are limited. We followed 1867 patients with first-ever ischemic stroke who were 18 to 45 years of age (mean age, 36.8±7.1 years; women, 49.0%), as part of the Italian Project on Stroke in Young Adults (IPSYS). Median follow-up was 40 months (25th to 75th percentile, 53). The primary end point was a composite of ischemic stroke, transient ischemic attack, myocardial infarction, or other arterial events. One hundred sixty-three patients had recurrent thrombotic events (average rate, 2.26 per 100 person-years at risk). At 10 years, cumulative risk was 14.7% (95% confidence interval, 12.2%-17.9%) for primary end point, 14.0% (95% confidence interval, 11.4%-17.1%) for brain ischemia, and 0.7% (95% confidence interval, 0.4%-1.3%) for myocardial infarction or other arterial events. Familial history of stroke, migraine with aura, circulating antiphospholipid antibodies, discontinuation of antiplatelet and antihypertensive medications, and any increase of 1 traditional vascular risk factor were independent predictors of the composite end point in multivariable Cox proportional hazards analysis. A point-scoring system for each variable was generated by their β-coefficients, and a predictive score (IPSYS score) was calculated as the sum of the weighted scores. The area under the receiver operating characteristic curve of the 0- to 5-year score was 0.66 (95% confidence interval, 0.61-0.71; mean, 10-fold internally cross-validated area under the receiver operating characteristic curve, 0.65). Among patients with ischemic stroke aged 18 to 45 years, the long-term risk of recurrent thrombotic events is associated with modifiable, age-specific risk factors. The IPSYS score may serve as a simple tool for risk estimation.

Estimating the magnitude of peak flows for streams in Kentucky for selected recurrence intervals

USGS Publications Warehouse

Hodgkins, Glenn A.; Martin, Gary R.

2003-01-01

This report gives estimates of, and presents techniques for estimating, the magnitude of peak flows for streams in Kentucky for recurrence intervals of 2, 5, 10, 25, 50, 100, 200, and 500 years. A flowchart in this report guides the user to the appropriate estimates and (or) estimating techniques for a site on a specific stream. Estimates of peak flows are given for 222 U.S. Geological Survey streamflow-gaging stations in Kentucky. In the development of the peak-flow estimates at gaging stations, a new generalized skew coefficient was calculated for the State. This single statewide value of 0.011 (with a standard error of prediction of 0.520) is more appropriate for Kentucky than the national skew isoline map in Bulletin 17B of the Interagency Advisory Committee on Water Data. Regression equations are presented for estimating the peak flows on ungaged, unregulated streams in rural drainage basins. The equations were developed by use of generalized-least-squares regression procedures at 187 U.S. Geological Survey gaging stations in Kentucky and 51 stations in surrounding States. Kentucky was divided into seven flood regions. Total drainage area is used in the final regression equations as the sole explanatory variable, except in Regions 1 and 4 where main-channel slope also was used. The smallest average standard errors of prediction were in Region 3 (from -13.1 to +15.0 percent) and the largest average standard errors of prediction were in Region 5 (from -37.6 to +60.3 percent). One section of this report describes techniques for estimating peak flows for ungaged sites on gaged, unregulated streams in rural drainage basins. Another section references two previous U.S. Geological Survey reports for peak-flow estimates on ungaged, unregulated, urban streams. Estimating peak flows at ungaged sites on regulated streams is beyond the scope of this report, because peak flows on regulated streams are dependent upon variable human activities.

Salvage HDR Brachytherapy for Recurrent Prostate Cancer After Previous Definitive Radiation Therapy: 5-Year Outcomes

DOE Office of Scientific and Technical Information (OSTI.GOV)

Chen, Chien Peter; Weinberg, Vivian; Shinohara, Katsuto

Purpose: Evaluate efficacy and toxicity of salvage high-dose-rate brachytherapy (HDRB) for locally recurrent prostate cancer after definitive radiation therapy (RT). Methods and Materials: We retrospectively analyzed 52 consecutively accrued patients undergoing salvage HDRB between 1998 and 2009 for locally recurrent prostate cancer after previous definitive RT. After pathologic confirmation of locally recurrent disease, patients received 36 Gy in 6 fractions. Twenty-four patients received neoadjuvant hormonal therapy before salvage, and no patients received adjuvant hormonal therapy. Determination of biochemical failure after salvage HDRB was based on the Phoenix definition. Overall survival (OS) and bF distributions were calculated using the Kaplan-Meier method.more » Univariate analyses were performed to identify predictors of biochemical control. Acute and late genitourinary (GU) and gastrointestinal (GI) toxicities, based on Common Terminology Criteria for Adverse Events (version 4), were documented. Results: Median follow-up after salvage HDRB was 59.6 months. The 5-year OS estimate was 92% (95% confidence interval [CI]: 80%-97%) with median survival not yet reached. Five-year biochemical control after salvage was 51% (95% CI: 34%-66%). Median PSA nadir postsalvage was 0.1 (range: 0-7.2) reached at a median of 10.2 months after completing HDRB. As for complications, acute and late grade 3 GU toxicities were observed in only 2% and 2%, respectively. No grade 2 or higher acute GI events and 4% grade 2 GI late events were observed. On univariate analysis, disease-free interval after initial definitive RT (P=.07), percent of positive cores at the time of diagnosis (P=.08), interval from first recurrence to salvage HDRB (P=.09), and pre-HDRB prostate-specific antigen (P=.07) were each of borderline significance in predicting biochemical control after salvage HDRB. Conclusions: Prostate HDRB is an effective salvage modality with relatively few long-term toxicities. We provide potential predictors of biochemical control for prostate salvage HDRB.« less

Peak-flow frequency for tributaries of the Colorado River downstream of Austin, Texas

USGS Publications Warehouse

Asquith, William H.

1998-01-01

Peak-flow frequency for 38 stations with at least 8 years of data in natural (unregulated and nonurbanized) basins was estimated on the basis of annual peak-streamflow data through water year 1995. Peak-flow frequency represents the peak discharges for recurrence intervals of 2, 5, 10, 25, 50, 100, 250, and 500 years. The peak-flow frequency and drainage basin characteristics for the stations were used to develop two sets of regression equations to estimate peak-flow frequency for tributaries of the Colorado River in the study area. One set of equations was developed for contributing drainage areas less than 32 square miles, and another set was developed for contributing drainage areas greater than 32 square miles. A procedure is presented to estimate the peak discharge at sites where both sets of equations are considered applicable. Additionally, procedures are presented to compute the 50-, 67-, and 90-percent prediction interval for any estimation from the equations.

The 1992 M=7 Cape Mendocino, California, earthquake: Coseismic deformation at the south end of the Cascadia megathrust

USGS Publications Warehouse

Murray, M.H.; Marshall, G.A.; Lisowski, M.; Stein, R.S.

1996-01-01

We invert geodetic measurements of coseismic surface displacements to determine a dislocation model for the April 25, 1992, M=7 Cape Mendocino, California, earthquake. The orientation of the model slip vector, which nearly parallels North America-Juan de Fuca relative plate convergence, and the location and orientation of the model fault relative to the offshore Cascadia megathrust, suggest that the 1992 Cape Mendocino earthquake is the first well-recorded event to relieve strain associated with the Cascadia subduction zone. We use data from three geodetic techniques: (1) the horizontal and vertical displacements of 13 monuments surveyed with the Global Positioning System, corrected for observed horizontal interseismic strain accumulation, (2) 88 section-elevation differences between leveling monuments, and (3) the uplift of 12 coastal sites observed from the die-off of intertidal marine organisms. Maximum observed displacements are 0.4 m of horizontal movement and 1.5 m of uplift along the coast. We use Monte Carlo techniques to estimate an optimal uniform slip rectangular fault geometry and its uncertainties. The optimal model using all the data resolves 4.9 m of slip on a 14 by 15 km fault that dips 28?? SE. The fault extends from 1.5 to 8.7 km in depth and the main-shock hypocenter is close to the downdip projection of the fault. The shallowly dipping fault plane is consistent with the observed aftershock locations, and the estimated geodetic moment is 3.1??1019 N m, 70% of the seismic moment. Other models that exclude leveling data collected in 1935 and 1942 are more consistent with seismological estimates of the fault geometry. If the earthquake is characteristic for this segment, the estimated horizontal slip vector compared with plate convergence rates suggests a recurrence interval of 140 years, with a 95% confidence range of 100-670 years. The coseismic uplift occurred in a region that also has high Quaternary uplift rates determined from marine terrace studies. If repeated ruptures of this southernmost segment of the Cascadia megathrust are responsible for the Quaternary uplift, a comparison of the coseismic uplift with coastal uplift rates suggests a recurrence interval of 200-400 years. Thus comparing horizontal and vertical coseismic to long-term deformation suggests a recurrence interval of about 100-300 years for M=7 events at the south end of the Cascadia megathrust.

Interventions for non-metastatic squamous cell carcinoma of the skin: systematic review and pooled analysis of observational studies

PubMed Central

Bath-Hextall, Fiona; Perkins, William; Stanton, Wendy; Leonardi-Bee, Jo

2013-01-01

Objectives To assess the effects of treatments for non-metastatic invasive squamous cell carcinoma (SCC) of the skin using evidence from observational studies, given the paucity of evidence from randomised controlled trials. Design Systematic review of observational studies. Data sources Medline, Embase, to December 2012. Review methods Observational studies of interventions for primary, non-metastatic, invasive, SCC of the skin that reported recurrence during follow-up, quality of life, initial response to treatment, adverse events, cosmetic appearance, or death from disease. Studies were excluded if data for primary cutaneous SCC was not separable from other data. Data were extracted independently by two reviewers. Meta-analysis was performed where appropriate using a random effects model to estimate the pooled proportion of an event with 95% confidence intervals. Results 118 publications were included, covering seven treatment modalities. Pooled estimates of recurrence of SCCs were lowest after cryotherapy (0.8% (95% confidence interval 0.1% to 2%)) and curettage and electrodesiccation (1.7% (0.5% to 3.4%)), but most treated SCCs were small, low risk lesions. After Mohs micrographic surgery, the pooled estimate of local recurrence during variable follow-up periods from 10 studies was 3.0% (2.2% to 3.9%), which was non-significantly lower than the pooled average local recurrence of 5.4% (2.5% to 9.1%) after standard surgical excision (12 studies), and 6.4% (3.0% to 11.0%) after external radiotherapy (7 studies). After an apparently successful initial response of SCCs to photodynamic therapy, pooled average recurrence of 26.4% (12.3% to 43.7%; 8 studies) was significantly higher than other treatments. Evidence was limited for laser treatment (1 study) and for topical and systemic treatments (mostly single case reports or small non-comparative series with limited follow-up). Conclusions Many observational studies have looked at different treatment modalities for SCC, but the evidence base for the effectiveness of these interventions is poor. Comparison of outcomes after different treatments should be interpreted cautiously owing to biases inherent in the types of study included, and lack of direct comparisons to enable the estimation of relative treatment effect. Further evidence is needed to develop a prognostic model and stratify individuals at high risk of developing SCC, to improve the evidence base for this common cancer and to optimise clinical management. Protocol registration International Prospective Register of Systematic Reviews (PROSPERO) registration number CRD42011001450. PMID:24191270

Recurrence of gastroesophageal reflux disease correlated with a short dinner-to-bedtime interval.

PubMed

Yang, Jae Hoon; Kang, Ho Suk; Lee, Sun-Young; Kim, Jeong Hwan; Sung, In-Kyung; Park, Hyung Seok; Shim, Chan Sup; Jin, Choon Jo

2014-04-01

Gastroesophageal reflux disease (GERD) can be classified into erosive reflux disease (ERD) and nonerosive gastroesophageal reflux disease (NERD). We aimed to compare the recurrence rates of ERD and NERD and determine the risk factors related to the recurrence. This prospective study comprised 337 consecutive adults who completed questionnaires on their GERD symptoms, height, weight, sleeping position, dinner time, and bedtime. During upper gastrointestinal endoscopy, the presence of a hiatal hernia and mucosal breaks in the low esophagus, esophageal length (the distance between the Z-line and the incisors), and the esophageal length-to-height ratio were recorded. Recurrence was diagnosed when the patient required additional proton pump inhibitor medication after initial recovery with 4-8 weeks of treatment. Recurrence was experienced by 47 (26.0%) of 181 GERD patients. The recurrence rate did not differ between the 48 ERD (27.1%) and 133 NERD (25.6%) patients (P = 0.849). Of the various factors studied, recurrence was found to be correlated with a dinner-to-bedtime interval of less than 3 h (P = 0.002), globus sensation (P = 0.031), and old age (P = 0.047). Logistic regression analysis revealed that a short interval between dinner and bedtime was the only factor significantly related to the recurrence (P = 0.002). Both ERD and NERD patients who sleep within 3 h after eating have a higher risk of GERD recurrence. Our findings highlight the impact of a short dinner-to-bedtime interval on the recurrence of GERD (ClinicalTrials.gov ID: KCT0000134). © 2013 Journal of Gastroenterology and Hepatology Foundation and Wiley Publishing Asia Pty Ltd.

Influence of fluctuations of historic water bodies on fault stability and earthquake recurrence interval: The Dead Sea Rift as a case study

NASA Astrophysics Data System (ADS)

Belferman, Mariana; Katsman, Regina; Agnon, Amotz; Ben-Avraham, Zvi

2017-04-01

Despite the global, social and scientific impact of earthquakes, their triggering mechanisms remain often poorly defined. We suggest that dynamic changes in the levels of the historic water bodies occupying tectonic depressions at the Dead Sea Rift cause significant variations in the shallow crustal stress field and affect local fault systems in a way that may promote or suppress earthquakes. This mechanism and its spatial and temporal scales differ from those in tectonically-driven deformations. We use analytical and numerical poroelastic models to simulate immediate and delayed seismic responses resulting from the observed historic water level changes. The role of variability in the poroelastic and the elastic properties of the rocks composing the upper crust in inducing or retarding deformations under a strike-slip faulting regime is studied. The solution allows estimating a possible reduction in a seismic recurrence interval. Considering the historic water level fluctuation, our preliminary simulations show a promising agreement with paleo-seismic rates identified in the field.

An analysis of the magnitude and frequency of floods on Oahu, Hawaii

USGS Publications Warehouse

Nakahara, R.H.

1980-01-01

An analysis of available peak-flow data for the island of Oahu, Hawaii, was made by using multiple regression techniques which related flood-frequency data to basin and climatic characteristics for 74 gaging stations on Oahu. In the analysis, several different groupings of stations were investigated, including divisions by geographic location and size of drainage area. The grouping consisting of two leeward divisions and one windward division produced the best results. Drainage basins ranged in area from 0.03 to 45.7 square miles. Equations relating flood magnitudes of selected frequencies to basin characteristics were developed for the three divisions of Oahu. These equations can be used to estimate the magnitude and frequency of floods for any site, gaged or ungaged, for any desired recurrence interval from 2 to 100 years. Data on basin characteristics, flood magnitudes for various recurrence intervals from individual station-frequency curves, and computed flood magnitudes by use of the regression equation are tabulated to provide the needed data. (USGS)

Flood of May 2006 in York County, Maine

USGS Publications Warehouse

Stewart, Gregory J.; Kempf, Joshua P.

2008-01-01

A stalled low-pressure system over coastal New England on Mother's Day weekend, May 13-15, 2006, released rainfall in excess of 15 inches. This flood (sometimes referred to as the 'Mother's Day flood') caused widespread damage to homes, businesses, roads, and structures in southern Maine. The damage to public property in York County was estimated to be $7.5 million. As a result of these damages, a presidential disaster declaration was enacted on May 25, 2006, for York County, Maine. Peak-flow recurrence intervals for eight of the nine streams studied were calculated to be greater than 500 years. The peak-flow recurrence interval of the remaining stream was calculated to be between a 100-year and a 500-year interval. This report provides a detailed description of the May 2006 flood in York County, Maine. Information is presented on peak streamflows and peak-flow recurrence intervals on nine streams, peak water-surface elevations for 80 high-water marks at 25 sites, hydrologic conditions before and after the flood, comparisons with published Flood Insurance Studies, and places the May 2006 flood in context with historical floods in York County. At sites on several streams, differences were observed between peak flows published in the Flood Insurance Studies and those calculated for this study. The differences in the peak flows from the published Flood Insurance Studies and the flows calculated for this report are within an acceptable range for flows calculated at ungaged locations, with the exception of those for the Great Works River and Merriland River. For sites on the Mousam River, Blacksmith Brook, Ogunquit River, and Cape Neddick River, water-surface elevations from Flood Insurance Studies differed with documented water-surface elevations from the 2006 flood.

Reading a 400,000-year record of earthquake frequency for an intraplate fault

NASA Astrophysics Data System (ADS)

Williams, Randolph T.; Goodwin, Laurel B.; Sharp, Warren D.; Mozley, Peter S.

2017-05-01

Our understanding of the frequency of large earthquakes at timescales longer than instrumental and historical records is based mostly on paleoseismic studies of fast-moving plate-boundary faults. Similar study of intraplate faults has been limited until now, because intraplate earthquake recurrence intervals are generally long (10s to 100s of thousands of years) relative to conventional paleoseismic records determined by trenching. Long-term variations in the earthquake recurrence intervals of intraplate faults therefore are poorly understood. Longer paleoseismic records for intraplate faults are required both to better quantify their earthquake recurrence intervals and to test competing models of earthquake frequency (e.g., time-dependent, time-independent, and clustered). We present the results of U-Th dating of calcite veins in the Loma Blanca normal fault zone, Rio Grande rift, New Mexico, United States, that constrain earthquake recurrence intervals over much of the past ˜550 ka—the longest direct record of seismic frequency documented for any fault to date. The 13 distinct seismic events delineated by this effort demonstrate that for >400 ka, the Loma Blanca fault produced periodic large earthquakes, consistent with a time-dependent model of earthquake recurrence. However, this time-dependent series was interrupted by a cluster of earthquakes at ˜430 ka. The carbon isotope composition of calcite formed during this seismic cluster records rapid degassing of CO2, suggesting an interval of anomalous fluid source. In concert with U-Th dates recording decreased recurrence intervals, we infer seismicity during this interval records fault-valve behavior. These data provide insight into the long-term seismic behavior of the Loma Blanca fault and, by inference, other intraplate faults.

Flood Frequenices and Bridge and Culvert Sizes for Forested Mountains of North Carolina

Treesearch

James E. Douglass

1974-01-01

A method is presented for predicting flood discharge from the forested Blue Ridge Mountains of North Carolina for storms at recurrence intervals of 2.33, 5, 10, 20, 30, 40, and 50 years. These predictions are based on area and maximum elevation of the drainage. Once storm discharge has been estimated, the proper size of culvert can be determined from tables which list...

The Black Hills (South Dakota) flood of June 1972: Impacts and implications

Treesearch

Howard K. Orr

1973-01-01

Rains of 12 inches or more in 6 hours fell on the east slopes of the Black Hills the night of June 9, 1972. Resulting flash floods exacted a disastrous toll in human life and property. Rainfall and discharge so greatly exceeded previous records that recurrence intervals have been presented in terms of multiples of the estimated 50- or 100- year event. Quick runoff was...

Annual Peak-Flow Frequency Characteristics and (or) Peak Dam-Pool-Elevation Frequency Characteristics of Dry Dams and Selected Streamflow-Gaging Stations in the Great Miami River Basin, Ohio

USGS Publications Warehouse

Koltun, G.F.

2009-01-01

This report describes the results of a study to determine frequency characteristics of postregulation annual peak flows at streamflow-gaging stations at or near the Lockington, Taylorsville, Englewood, Huffman, and Germantown dry dams in the Miami Conservancy District flood-protection system (southwestern Ohio) and five other streamflow-gaging stations in the Great Miami River Basin further downstream from one or more of the dams. In addition, this report describes frequency characteristics of annual peak elevations of the dry-dam pools. In most cases, log-Pearson Type III distributions were fit to postregulation annual peak-flow values through 2007 (the most recent year of published peak-flow values at the time of this analysis) and annual peak dam-pool storage values for the period 1922-2008 to determine peaks with recurrence intervals of 2, 5, 10, 25, 50, 100, 200, and 500 years. For one streamflow-gaging station (03272100) with a short period of record, frequency characteristics were estimated by means of a process involving interpolation of peak-flow yields determined for an upstream and downstream gage. Once storages had been estimated for the various recurrence intervals, corresponding dam-pool elevations were determined from elevation-storage ratings provided by the Miami Conservancy District.

Flood of July 27-31, 2006, on the Grand River near Painesville, Ohio

USGS Publications Warehouse

Ebner, Andrew D.; Sherwood, James M.; Astifan, Brian; Lombardy, Kirk

2007-01-01

Two separate weather systems produced storms resulting in more than 11 inches of rain in parts of Lake County, Ohio, on July 27-28, 2006. As a result of the storms and ensuing flooding caused by the weather systems, the counties of Lake, Geauga, and Ashtabula were declared Federal and State disaster areas, with damages estimated at $30 million and one fatality in Lake County. About 600 people were evacuated in Lake County. The U.S. Geological Survey streamflow-gaging station at Grand River near Painesville, Ohio (station 04212100), had a record peak stage of 19.35 feet (elevation, 614.94 feet), with a record peak streamflow of 35,000 cubic feet per second, and an estimated recurrence interval of approximately 500 years. This report describes the meteorological factors that resulted in severe flooding on the Grand River near Painesville from July 27 to July 31, 2006, and addresses the damages caused by the storms and flooding. Peak-stage, peak-streamflow, and recurrence-interval data are reported for the Grand River near Painesville. A plot of high-water marks is also presented for the Grand River in a reach that includes the City of Painesville, Painesville Township, the Village of Fairport Harbor, and the Village of Grand River.

Statin Prescriptions and Breast Cancer Recurrence Risk: A Danish Nationwide Prospective Cohort Study

PubMed Central

Pedersen, Lars; Tarp, Maja; Cronin-Fenton, Deirdre P.; Garne, Jens Peter; Silliman, Rebecca A.; Sørensen, Henrik Toft; Lash, Timothy L.

2011-01-01

Background Accumulating evidence suggests that statins affect diseases other than cardiovascular disease, including cancer, and that these effects may depend on the lipid solubility of specific statins. Though many studies have reported an association between statin use and breast cancer incidence, the relationship between statin use and breast cancer recurrence has not been well studied. Methods We conducted a nationwide, population-based prospective cohort study of all female residents in Denmark diagnosed with stage I–III invasive breast carcinoma who were reported to the Danish Breast Cancer Cooperative Group registry between 1996 and 2003 (n = 18 769). Women were followed for a median of 6.8 years after diagnosis. Prescriptions for lipophilic and hydrophilic statins were ascertained from the national electronic pharmacy database. Associations between statin prescriptions and breast cancer recurrence were estimated with generalized linear models and Cox proportional hazards regression with adjustment for age and menopausal status at diagnosis; histological grade; estrogen receptor status; receipt of adjuvant therapy; type of primary surgery received; pre-diagnosis hormone replacement therapy; and co-prescriptions of aspirin, angiotensin-converting enzyme inhibitors, nonsteroidal anti-inflammatory drugs, or anticoagulants. All statistical tests were two-sided. Results Most prescriptions for lipophilic statins in the study population were for simvastatin. Exclusive simvastatin users experienced approximately 10 fewer breast cancer recurrences per 100 women after 10 years of follow-up (adjusted 10-year risk difference = −0.10, 95% confidence interval = −0.11 to −0.08), compared with women who were not prescribed a statin. Exclusive hydrophilic statin users had approximately the same risk of breast cancer recurrence as women not prescribed a statin over follow-up (adjusted 10-year risk difference = 0.05, 95% confidence interval = −0.01 to 0.11). Conclusions Simvastatin, a highly lipophilic statin, was associated with a reduced risk of breast cancer recurrence among Danish women diagnosed with stage I–III breast carcinoma, whereas no association between hydrophilic statin use and breast cancer recurrence was observed. PMID:21813413

Isolation of herpes simplex virus from the genital tract during symptomatic recurrence on the buttocks.

PubMed

Kerkering, Katrina; Gardella, Carolyn; Selke, Stacy; Krantz, Elizabeth; Corey, Lawrence; Wald, Anna

2006-10-01

To estimate the frequency of isolation of herpes simplex virus (HSV) from the genital tract when recurrent herpes lesions were present on the buttocks. Data were extracted from a prospectively observed cohort attending a research clinic for genital herpes infections between 1975 and 2001. All patients with a documented herpes lesion on the buttocks, upper thigh or gluteal cleft ("buttock recurrence") and concomitant viral cultures from genital sites including the perianal region were eligible. We reviewed records of 237 subjects, 151 women and 86 men, with a total of 572 buttock recurrences. Of the 1,592 days with genital culture information during a buttock recurrence, participants had concurrent genital lesions on 311 (20%, 95% confidence interval [CI] 14-27%) of these days. Overall, HSV was isolated from the genital region on 12% (95% CI 8-17%) of days during a buttock recurrence. In the absence of genital lesions, HSV was isolated from the genital area on 7% (95% CI 4%-11%) of days during a buttock recurrence and, among women, from the vulvar or cervical sites on 1% of days. Viral shedding of herpes simplex virus from the genital area is a relatively common occurrence during a buttock recurrence of genital herpes, even without concurrent genital lesions, reflecting perhaps reactivation from concomitant regions of the sacral neural ganglia. Patients with buttock herpes recurrences should be instructed about the risk of genital shedding during such recurrences. II-2.

Methods for estimating the magnitude and frequency of peak discharges of rural, unregulated streams in Virginia

USGS Publications Warehouse

Bisese, James A.

1995-01-01

Methods are presented for estimating the peak discharges of rural, unregulated streams in Virginia. A Pearson Type III distribution is fitted to the logarithms of the unregulated annual peak-discharge records from 363 stream-gaging stations in Virginia to estimate the peak discharge at these stations for recurrence intervals of 2 to 500 years. Peak-discharge characteristics for 284 unregulated stations are divided into eight regions based on physiographic province, and regressed on basin characteristics, including drainage area, main channel length, main channel slope, mean basin elevation, percentage of forest cover, mean annual precipitation, and maximum rainfall intensity. Regression equations for each region are computed by use of the generalized least-squares method, which accounts for spatial and temporal correlation between nearby gaging stations. This regression technique weights the significance of each station to the regional equation based on the length of records collected at each cation, the correlation between annual peak discharges among the stations, and the standard deviation of the annual peak discharge for each station.Drainage area proved to be the only significant explanatory variable in four regions, while other regions have as many as three significant variables. Standard errors of the regression equations range from 30 to 80 percent. Alternate equations using drainage area only are provided for the five regions with more than one significant explanatory variable.Methods and sample computations are provided to estimate peak discharges at gaged and engaged sites in Virginia for recurrence intervals of 2, 5, 10, 25, 50, 100, 200, and 500 years, and to adjust the regression estimates for sites on gaged streams where nearby gaging-station records are available.

The impact of ICD-9 revascularization procedure codes on estimates of racial disparities in ischemic stroke.

PubMed

Boan, Andrea D; Voeks, Jenifer H; Feng, Wuwei Wayne; Bachman, David L; Jauch, Edward C; Adams, Robert J; Ovbiagele, Bruce; Lackland, Daniel T

2014-01-01

The use of International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9) diagnostic codes can identify racial disparities in ischemic stroke hospitalizations; however, inclusion of revascularization procedure codes as acute stroke events may affect the magnitude of the risk difference. This study assesses the impact of excluding revascularization procedure codes in the ICD-9 definition of ischemic stroke, compared with the traditional inclusive definition, on racial disparity estimates for stroke incidence and recurrence. Patients discharged with a diagnosis of ischemic stroke (ICD-9 codes 433.00-434.91 and 436) were identified from a statewide inpatient discharge database from 2010 to 2012. Race-age specific disparity estimates of stroke incidence and recurrence and 1-year cumulative recurrent stroke rates were compared between the routinely used traditional classification and a modified classification of stroke that excluded primary ICD-9 cerebral revascularization procedures codes (38.12, 00.61, and 00.63). The traditional classification identified 7878 stroke hospitalizations, whereas the modified classification resulted in 18% fewer hospitalizations (n = 6444). The age-specific black to white rate ratios were significantly higher in the modified than in the traditional classification for stroke incidence (rate ratio, 1.50; 95% confidence interval [CI], 1.43-1.58 vs. rate ratio, 1.24; 95% CI, 1.18-1.30, respectively). In whites, the 1-year cumulative recurrence rate was significantly reduced by 46% (45-64 years) and 49% (≥ 65 years) in the modified classification, largely explained by a higher rate of cerebral revascularization procedures among whites. There were nonsignificant reductions of 14% (45-64 years) and 19% (≥ 65 years) among blacks. Including cerebral revascularization procedure codes overestimates hospitalization rates for ischemic stroke and significantly underestimates the racial disparity estimates in stroke incidence and recurrence. Copyright © 2014 National Stroke Association. Published by Elsevier Inc. All rights reserved.

DOE Office of Scientific and Technical Information (OSTI.GOV)

F. Perry

Studies of volcanic risk to the proposed high-level radioactive waste repository at Yucca Mountain have been ongoing for 25 years. These studies are required because three episodes of small-volume, alkalic basaltic volcanism have occurred within 50 km of Yucca Mountain during the Quaternary. Probabilistic hazard estimates for the proposed repository depend on the recurrence rate and spatial distribution of past episodes of volcanism in the region. Several independent research groups have published estimates of the annual probability of a future volcanic disruption of the proposed repository, most of which fall in the range of 10{sup -7} to 10{sup -9} permore » year; similar conclusions were reached. through an extensive expert elicitation sponsored by the Department of Energy in 1995-1996. The estimated probability values are dominated by a regional recurrence rate of 10{sup -5} to 10{sup -6} volcanic events per year (equating to recurrence intervals of several hundred thousand years). The recurrence rate, as well as the spatial density of volcanoes, is low compared to most other basaltic volcanic fields in the western United States, factors that may be related to both the tectonic history of the region and a lithospheric mantle source that is relatively cold and not prone to melting. The link between volcanism and tectonism in the Yucca Mountain region is not well understood beyond a general association between volcanism and regional extension, although areas of locally high extension within the region may control the location of some volcanoes. Recently, new geologic data or hypotheses have emerged that could potentially increase past estimates of the recurrence rate, and thus the probability of repository disruption. These are (1) hypothesized episodes of anomalously high strain rate, (2) hypothesized presence of a regional mantle hotspot, and (3) new aeromagnetic data suggesting as many as twelve previously unrecognized volcanoes buried in alluvial-filled basins near Yucca Mountain.« less

Variations in rupture process with recurrence interval in a repeated small earthquake

USGS Publications Warehouse

Vidale, J.E.; Ellsworth, W.L.; Cole, A.; Marone, Chris

1994-01-01

In theory and in laboratory experiments, friction on sliding surfaces such as rock, glass and metal increases with time since the previous episode of slip. This time dependence is a central pillar of the friction laws widely used to model earthquake phenomena. On natural faults, other properties, such as rupture velocity, porosity and fluid pressure, may also vary with the recurrence interval. Eighteen repetitions of the same small earthquake, separated by intervals ranging from a few days to several years, allow us to test these laboratory predictions in situ. The events with the longest time since the previous earthquake tend to have about 15% larger seismic moment than those with the shortest intervals, although this trend is weak. In addition, the rupture durations of the events with the longest recurrence intervals are more than a factor of two shorter than for the events with the shortest intervals. Both decreased duration and increased friction are consistent with progressive fault healing during the time of stationary contact.In theory and in laboratory experiments, friction on sliding surfaces such as rock, glass and metal increases with time since the previous episode of slip. This time dependence is a central pillar of the friction laws widely used to model earthquake phenomena. On natural faults, other properties, such as rupture velocity, porosity and fluid pressure, may also vary with the recurrence interval. Eighteen repetitions of the same small earthquake, separated by intervals ranging from a few days to several years, allow us to test these laboratory predictions in situ. The events with the longest time since the previous earthquake tend to have about 15% larger seismic moment than those with the shortest intervals, although this trend is weak. In addition, the rupture durations of the events with the longest recurrence intervals are more than a factor of two shorter than for the events with the shortest intervals. Both decreased duration and increased friction are consistent with progressive fault healing during the time of stationary contact.

Magnitude of increase in QTc interval after initiation of dofetilide in patients with persistent atrial fibrillation is associated with increased rates of pharmacological cardioversion and long-term freedom from recurrent atrial fibrillation.

PubMed

Huang, Henry D; Waks, Jonathan W; Steinhaus, Daniel A; Zimetbaum, Peter

2016-07-01

Dofetilide is a class III antiarrhythmic drug approved for the treatment of atrial fibrillation (AF). Dofetilide-induced corrected QT (QTc) interval prolongation is a surrogate for the degree of drug effect, but the relationships between drug-induced QTc interval prolongation, pharmacological cardioversion (PCV), and freedom from recurrent AF are unclear. The purpose of this study was to assess associations between QTc interval change during dofetilide initiation and PCV and long-term AF recurrence. We performed retrospective analyses of a prospective cohort of patients with AF admitted for dofetilide initiation between 2001 and 2014. Clinical characteristics and electrocardiographic variables were assessed. We evaluated outcomes of successful PCV in patients with persistent AF and time to recurrence of AF in patients with paroxysmal and persistent AF. During the study, 243 patients with persistent AF and 176 patients with paroxysmal AF initiated dofetilide. PCV occurred in 93/243 (41.7%) patients with persistent AF. After multivariable adjustment, QTc interval change was associated with PCV (adjusted odds ratio 1.21; P = .003 per 10-ms QTc increase). Inhospital QTc interval change was associated with long-term freedom from AF in patients with persistent AF (adjusted hazard ratio 0.92; P = .011 at 4 years per 10-ms QTc increase), but not in patients with paroxysmal AF. In patients with persistent AF, PCV was also associated with long-term freedom from recurrent AF (adjusted hazard ratio 0.62; P = .009 at 4 years). The magnitude of QTc interval prolongation during dofetilide initiation is an independent predictor of successful PCV and long-term freedom from arrhythmia in patients with persistent AF. QTc interval change had no association with AF recurrence in patients with paroxysmal AF, suggesting that different mechanisms of arrhythmogenesis may be operant in different AF types. Copyright © 2016 Heart Rhythm Society. Published by Elsevier Inc. All rights reserved.

Flood profiles for lower Brooker Creek, west-central Florida

USGS Publications Warehouse

Murphy, W.R.

1978-01-01

Flood heights are computed for a range of recurrence intervals for a 12.6 mile reach of Brooker Creek, beginning at the mouth at Lake Tarpon. A Geological Survey step-backwater computer program, E431, was used in these analyses using: (1) Stream and valley cross-section geometry and roughness data; (2) Recurrence interval flood-peak discharges; (3) Recurrence interval starting elevations; (4) Gaging station stage-discharge relations. Flood heights may be plotted versus distance above stream mouth and connected to construct flood profiles. They may also be used to indicate areas of inundation on detailed topographic maps.

High-grade hemorrhoids requiring surgical treatment are common after laparoscopic ventral mesh rectopexy.

PubMed

van Iersel, J J; Formijne Jonkers, H A; Verheijen, P M; Draaisma, W A; Consten, E C J; Broeders, I A M J

2016-04-01

To describe patients developing grade III and IV hemorrhoids requiring surgery after laparoscopic ventral mesh rectopexy (LVMR) and to explore the relationship between developing such hemorrhoids and recurrence of rectal prolapse after LVMR. All consecutive patients receiving LVMR at the Meander Medical Centre, Amersfoort, the Netherlands, between 2004 and 2013 were analyzed. Kaplan-Meier estimates were calculated for recurrences. A total of 420 patients underwent LVMR. Sixty-five of these patients (actuarial 5-year incidence 24.3, 95 % confidence interval (CI) 18.6-30.0) developed symptomatic grade III/IV hemorrhoids requiring stapled or excisional hemorrhoidectomy. Re-do surgery for recurrent grade III/IV hemorrhoids was required for 15 of the 65 patients (actuarial 5-year recurrence rate 40.6, 95 % CI 23.2-58.0) after the primary hemorrhoidectomy. Three of the 65 patients developed an external rectal prolapse (ERP) recurrence and eight an internal rectal prolapse (IRP) recurrence. This generated a 5-year recurrence rate of 25.3 % (95 % CI 0-53.9) for ERP recurrence and 24.4 % (95 % CI 9.1-39.7) for IRP recurrence. The rest of the LVMR cohort not receiving additional surgery for hemorrhoids (n = 355) showed significantly lower actuarial 5-year ERP (0.8 %, p = 0.011) and IRP (11 %, p = 0.020) recurrence rates. High-grade hemorrhoids requiring surgery may be common after LVMR. The development of high-grade hemorrhoids after LVMR might be considered a predictor of rectal prolapse recurrence.

Cost-effectiveness of the 21-gene recurrence score assay in the context of multifactorial decision making to guide chemotherapy for early-stage breast cancer.

PubMed

Reed, Shelby D; Dinan, Michaela A; Schulman, Kevin A; Lyman, Gary H

2013-03-01

New evidence is available regarding the utility of the 21-gene recurrence score assay in guiding chemotherapy use for node-negative, estrogen receptor-positive breast cancer. We applied this evidence in a decision-analytic model to re-evaluate the cost-effectiveness of the assay. We cross-classified patients by clinicopathologic characteristics from the Adjuvant! risk index and by recurrence score risk group. For non-recurrence score-guided treatment, we assumed patients receiving hormonal therapy alone had low-risk characteristics and patients receiving chemotherapy and hormonal therapy had higher-risk characteristics. For recurrence score-guided treatment, we assigned chemotherapy probabilities conditional on recurrence score risk group and clinicopathologic characteristics. An estimated 40.4% of patients in the recurrence score-guided strategy and 47.3% in the non-recurrence score-guided strategy were expected to receive chemotherapy. The incremental gain in quality-adjusted life-years was 0.16 (95% confidence interval, 0.08-0.28) with the recurrence score-guided strategy. Lifetime medical costs to the health system were $2,692 ($1,546-$3,821) higher with the recurrence score-guided strategy, for an incremental cost-effectiveness ratio of $16,677/quality-adjusted life-year ($7,613-$37,219). From a societal perspective, the incremental cost-effectiveness was $10,788/quality-adjusted life-year ($6,840-$30,265). The findings provide supportive evidence for the economic value of the 21-gene recurrence score assay in node-negative, estrogen receptor-positive breast cancer.

Intrinsic Predictive Factors of Noncontact Lateral Ankle Sprain in Collegiate Athletes

PubMed Central

Kobayashi, Takumi; Yoshida, Masahiro; Yoshida, Makoto; Gamada, Kazuyoshi

2013-01-01

Background: Lateral ankle sprain (LAS) is one of the most common injuries in sports. Despite extensive research, intrinsic factors that predict initial and recurrent noncontact LAS remain undefined. Purpose: To identify the predictive factors of initial and recurrent noncontact LAS, focusing on ankle flexibility and/or alignment in collegiate athletes. Study Design: Case-control study; Level of evidence, 3. Methods: A total of 191 athletes were assessed during the preseason for factors predictive of noncontact LAS. The baseline measurements included weightbearing dorsiflexion range of motion (ROM), leg-heel angle, foot internal rotation angle in plantar flexion, classification according to the mortise test, and navicular–medial malleolus (NMM) distance. Occurrence of noncontact LAS and participation in practice and games were prospectively recorded for 11 months. Results: Of the 191 athletes assessed, 169 (145 males, 24 females) completed the study; 125 athletes had a history of ankle sprain. During the observational period, 16 athletes suffered noncontact LAS (0.58 per 1000 athlete-exposures) consisting of 4 initial sprains and 12 recurrences. The hazard ratio estimated by a Cox regression analysis showed that athletes with an NMM distance ≥4.65 cm were 4.14 times more likely to suffer an initial noncontact LAS than were athletes with a shorter NMM distance (95% confidence interval, 1.12-14.30) and that athletes with a weightbearing dorsiflexion ROM >49.5° were 1.12 times as likely to suffer a recurrent noncontact LAS compared with athletes with a lower ROM (95% confidence interval, 1.05-1.20). Conclusion: NMM distance predicts initial noncontact LAS, and weightbearing dorsiflexion ROM predicts recurrent noncontact LAS. PMID:26535263

Floods of September 16, 1975 in the Tallaboa Valley, Puerto Rico

USGS Publications Warehouse

Johnson, Karl G.

1981-01-01

The most severe flood since 1928 inundated the Rio Tallaboa Valley on the south coast of Puerto Rico on September 16, 1975. Peak discharge was about 666 cubic meters per second. The flood has an estimated recurrence interval of 20 years. The data provided in the report can be used in making rational decisions in formulating effective flood-plain regulations that would minimize flood problems in the Tallaboa Valley. (USGS)

Flash floods of August 10, 2009, in the Villages of Gowanda and Silver Creek, New York

USGS Publications Warehouse

Szabo, Carolyn O.; Coon, William F.; Niziol, Thomas A.

2011-01-01

Late during the night of August 9, 2009, two storm systems intersected over western New York and produced torrential rain that caused severe flash flooding during the early morning hours of August 10 in parts of Cattaraugus, Chautauqua, and Erie Counties. Nearly 6 inches of rain fell in 1.5 hours as recorded by a National Weather Service weather observer in Perrysburg, which lies between Gowanda and Silver Creek-the communities that suffered the most damage. This storm intensity had an annual exceedance probability of less than 0.2 percent (recurrence interval greater than 500 years). Although flooding along Cattaraugus Creek occurred elsewhere, Cattaraugus Creek was responsible for very little flooding in Gowanda. Rather the small tributaries, Thatcher Brook and Grannis Brook, caused the flooding in Gowanda, as did Silver Creek and Walnut Creek in the Village of Silver Creek. Damages from the flooding were widespread. Numerous road culverts were washed out, and more than one-quarter of the roads in Cattaraugus County were damaged. Many people were evacuated or rescued in Gowanda and Silver Creek, and two deaths occurred during the flood in Gowanda. The water supplies of both communities were compromised by damages to village reservoirs and water-transmission infrastructures. Water and mud damage to residential and commercial properties was extensive. The tri-county area was declared a Federal disaster area and more than $45 million in Federal disaster assistance was distributed to more than 1,500 individuals and an estimated 1,100 public projects. The combined total estimate of damages from the flash floods was greater than $90 million. Over 240 high-water marks were surveyed by the U.S. Geological Survey; a subset of these marks was used to create flood-water-surface profiles for four streams and to delineate the areal extent of flooding in Gowanda and Silver Creek. Flood elevations exceeded previously defined 0.2-percent annual exceedance probability (500-year recurrence interval) elevations by 2 to 4 feet in Gowanda and as much as 6 to 8 feet in Silver Creek. Most of the high-water marks were used in indirect hydraulic computations to estimate peak flows for four streams. The peak flows in Grannis Brook and Thatcher Brook were computed, using the slope-area method, to be 1,400 and 7,600 cubic feet per second, respectively, and peak flow in Silver Creek was computed, using the width-contraction method, to be 19,500 cubic feet per second. The annual exceedance probabilities for flows in these and other basins with small drainage areas that fell almost entirely within the area of heaviest precipitation were less than 0.2 percent (or recurrence intervals greater than 500 years). The peak flow in Cattaraugus Creek at Gowanda was computed, using the slope-area method, to be 33,200 cubic feet per second with an annual exceedance probability of 2.2 percent (recurrence interval of 45 years).

Estimating the magnitude and frequency of floods for streams in west-central Florida, 2001

USGS Publications Warehouse

Hammett, Kathleen M.; DelCharco, Michael J.

2005-01-01

Flood discharges were estimated for recurrence intervals of 2, 5, 10, 25, 50, 100, 200, and 500 years for 94 streamflow stations in west-central Florida. Most of the stations are located within the 10,000 square-mile, 16-county area that forms the Southwest Florida Water Management District. All stations had at least 10 years of homogeneous record, and none have flood discharges that are significantly affected by regulation or urbanization. Guidelines established by the U.S. Water Resources Council in Bulletin 17B were used to estimate flood discharges from gaging station records. Multiple linear regression analysis was then used to mathematically relate estimates of flood discharge for selected recurrence intervals to explanatory basin characteristics. Contributing drainage area, channel slope, and the percent of total drainage area covered by lakes (percent lake area) were the basin characteristics that provided the best regression estimates. The study area was subdivided into four geographic regions to further refine the regression equations. Region 1 at the northern end of the study area includes large rivers that are characteristic of the rolling karst terrain of northern Florida. Only a small part of Region 1 lies within the boundaries of the Southwest Florida Water Management District. Contributing drainage area and percent lake area were the most statistically significant basin characteristics in Region 1; the prediction error of the regression equations varied with the recurrence interval and ranged from 57 to 69 percent. In the three other regions of the study area, contributing drainage area, channel slope, and percent lake area were the most statistically significant basin characteristics, and are the three characteristics that can be used to best estimate the magnitude and frequency of floods on most streams within the Southwest Florida Water Management District. The Withlacoochee River Basin dominates Region 2; the prediction error of the regression models in the region ranged from 65 to 68 percent. The basins that drain into the northern part of Tampa Bay and the upper reaches of the Peace River Basin are in Region 3, which had prediction errors ranging from 54 to 74 percent. Region 4, at the southern end of the study area, had prediction errors that ranged from 40 to 56 percent. Estimates of flood discharge become more accurate as longer periods of record are used for analyses; results of this study should be used in lieu of results from earlier U.S. Geological Survey studies of flood magnitude and frequency in west-central Florida. A comparison of current results with earlier studies indicates that use of a longer period of record with additional high-water events produces substantially higher flood-discharge estimates for many gaging stations. Another comparison indicates that the use of a computed, generalized skew in a previous study in 1979 tended to overestimate flood discharges.

Cost savings associated with prevention of recurrent lumbar disc herniation with a novel annular closure device: a multicenter prospective cohort study.

PubMed

Parker, Scott L; Grahovac, Gordan; Vukas, Duje; Ledic, Darko; Vilendecic, Milorad; McGirt, Matthew J

2013-09-01

Same-level recurrent disc herniation is a well-defined complication following lumbar discectomy. Reherniation results in increased morbidity and health care costs. Techniques to reduce these consequences may improve outcomes and reduce cost after lumbar discectomy. In a prospective cohort study, we set out to evaluate the cost associated with surgical management of recurrent, same-level lumbar disc herniation following primary discectomy. Forty-six consecutive European patients undergoing lumbar discectomy for a single-level herniated disc at two institutions were prospectively followed with clinical and radiographic evaluations. A second consecutive cohort of 30 patients undergoing 31 lumbar discectomies with implantation of an annular closure device was followed at the same hospitals and same follow-up intervals. Cost estimates for reherniation were modeled on Medicare national allowable payment amounts (direct cost) and patient work-day losses (indirect cost). Annular closure and control cohorts were matched at baseline. By 2 years follow-up, symptomatic recurrent same-level disc herniation occurred in three (6.5%) patients in the control cohort versus zero (0%) patients in the annular closure cohort. For patients experiencing recurrent disc herniation, mean estimated direct and indirect cost of management of recurrent disc herniation was $34,242 and $3,778, respectively. Use of an annular closure device potentially results in a cost savings of $222,573 per 100 primary discectomy procedures performed (or $2,226 per discectomy), based solely on the reduction of reoperated reherniations when modeled on U.S. Medicare costs. Recurrent disc herniation did not occur in any patients after annular closure within the 12-month follow-up. The reduction in the incidence of reherniation was associated with potentially significant cost savings. Development of novel techniques to prevent recurrent lumbar disc herniation is warranted to decrease the associated morbidity and health care costs associated with this complication. Georg Thieme Verlag KG Stuttgart · New York.

Techniques for estimating flood hydrographs for ungaged urban watersheds

USGS Publications Warehouse

Stricker, V.A.; Sauer, V.B.

1984-01-01

The Clark Method, modified slightly was used to develop a synthetic, dimensionless hydrograph which can be used to estimate flood hydrographs for ungaged urban watersheds. Application of the technique results in a typical (average) flood hydrograph for a given peak discharge. Input necessary to apply the technique is an estimate of basin lagtime and the recurrence interval peak discharge. Equations for this purpose were obtained from a recent nationwide study on flood frequency in urban watersheds. A regression equation was developed which relates flood volumes to drainage area size, basin lagtime, and peak discharge. This equation is useful where storage of floodwater may be a part of design of flood prevention. (USGS)

Regularized joint inverse estimation of extreme rainfall amounts in ungauged coastal basins of El Salvador

USGS Publications Warehouse

Friedel, M.J.

2008-01-01

A regularized joint inverse procedure is presented and used to estimate the magnitude of extreme rainfall events in ungauged coastal river basins of El Salvador: Paz, Jiboa, Grande de San Miguel, and Goascoran. Since streamflow measurements reflect temporal and spatial rainfall information, peak-flow discharge is hypothesized to represent a similarity measure suitable for regionalization. To test this hypothesis, peak-flow discharge values determined from streamflow recurrence information (10-year, 25-year, and 100-year) collected outside the study basins are used to develop regional (country-wide) regression equations. Peak-flow discharge derived from these equations together with preferred spatial parameter relations as soft prior information are used to constrain the simultaneous calibration of 20 tributary basin models. The nonlinear range of uncertainty in estimated parameter values (1 curve number and 3 recurrent rainfall amounts for each model) is determined using an inverse calibration-constrained Monte Carlo approach. Cumulative probability distributions for rainfall amounts indicate differences among basins for a given return period and an increase in magnitude and range among basins with increasing return interval. Comparison of the estimated median rainfall amounts for all return periods were reasonable but larger (3.2-26%) than rainfall estimates computed using the frequency-duration (traditional) approach and individual rain gauge data. The observed 25-year recurrence rainfall amount at La Hachadura in the Paz River basin during Hurricane Mitch (1998) is similar in value to, but outside and slightly less than, the estimated rainfall confidence limits. The similarity in joint inverse and traditionally computed rainfall events, however, suggests that the rainfall observation may likely be due to under-catch and not model bias. ?? Springer Science+Business Media B.V. 2007.

A post hoc evaluation of a sample size re-estimation in the Secondary Prevention of Small Subcortical Strokes study.

PubMed

McClure, Leslie A; Szychowski, Jeff M; Benavente, Oscar; Hart, Robert G; Coffey, Christopher S

2016-10-01

The use of adaptive designs has been increasing in randomized clinical trials. Sample size re-estimation is a type of adaptation in which nuisance parameters are estimated at an interim point in the trial and the sample size re-computed based on these estimates. The Secondary Prevention of Small Subcortical Strokes study was a randomized clinical trial assessing the impact of single- versus dual-antiplatelet therapy and control of systolic blood pressure to a higher (130-149 mmHg) versus lower (<130 mmHg) target on recurrent stroke risk in a two-by-two factorial design. A sample size re-estimation was performed during the Secondary Prevention of Small Subcortical Strokes study resulting in an increase from the planned sample size of 2500-3020, and we sought to determine the impact of the sample size re-estimation on the study results. We assessed the results of the primary efficacy and safety analyses with the full 3020 patients and compared them to the results that would have been observed had randomization ended with 2500 patients. The primary efficacy outcome considered was recurrent stroke, and the primary safety outcomes were major bleeds and death. We computed incidence rates for the efficacy and safety outcomes and used Cox proportional hazards models to examine the hazard ratios for each of the two treatment interventions (i.e. the antiplatelet and blood pressure interventions). In the antiplatelet intervention, the hazard ratio was not materially modified by increasing the sample size, nor did the conclusions regarding the efficacy of mono versus dual-therapy change: there was no difference in the effect of dual- versus monotherapy on the risk of recurrent stroke hazard ratios (n = 3020 HR (95% confidence interval): 0.92 (0.72, 1.2), p = 0.48; n = 2500 HR (95% confidence interval): 1.0 (0.78, 1.3), p = 0.85). With respect to the blood pressure intervention, increasing the sample size resulted in less certainty in the results, as the hazard ratio for higher versus lower systolic blood pressure target approached, but did not achieve, statistical significance with the larger sample (n = 3020 HR (95% confidence interval): 0.81 (0.63, 1.0), p = 0.089; n = 2500 HR (95% confidence interval): 0.89 (0.68, 1.17), p = 0.40). The results from the safety analyses were similar to 3020 and 2500 patients for both study interventions. Other trial-related factors, such as contracts, finances, and study management, were impacted as well. Adaptive designs can have benefits in randomized clinical trials, but do not always result in significant findings. The impact of adaptive designs should be measured in terms of both trial results, as well as practical issues related to trial management. More post hoc analyses of study adaptations will lead to better understanding of the balance between the benefits and the costs. © The Author(s) 2016.

Physiologic Growth Hormone-Replacement Therapy and Craniopharyngioma Recurrence in Pediatric Patients: A Meta-Analysis.

PubMed

Alotaibi, Nawaf M; Noormohamed, Nadia; Cote, David J; Alharthi, Salman; Doucette, Joanne; Zaidi, Hasan A; Mekary, Rania A; Smith, Timothy R

2018-01-01

A systematic review and meta-analysis were conducted to examine the effect of growth hormone-replacement therapy (GHRT) on the recurrence of craniopharyngioma in children. PubMed, Embase, and Cochrane databases were searched through April 2017 for studies that evaluated the effect of GHRT on the recurrence of pediatric craniopharyngioma. Pooled effect estimates were calculated with fixed- and random-effects models. Ten studies (n = 3487 patients) met all inclusion criteria, including 2 retrospective cohorts and 8 case series. Overall, 3436 pediatric patients were treated with GHRT after surgery and 51 were not. Using the fixed effect model, we found that the overall craniopharyngioma recurrence rate was lower among children who were treated by GHRT (10.9%; 95% confidence interval 9.80%-12.1%; I 2  = 89.1%; P for heterogeneity <0.01; n = 10 groups) compared with those who were not (35.2%; 95% confidence interval 23.1%-49.6%; I 2  = 61.7%; P for heterogeneity = 0.11; n = 3); the P value comparing the 2 groups was <0.01. Among patients who were treated with GHRT, subgroup analysis revealed that there was a greater prevalence of craniopharyngioma recurrence among studies conducted outside the United States (P < 0.01), single-center studies (P < 0.01), lower impact factor studies (P = 0.03), or studies with a lower quality rating (P = 0.01). Using the random-effects model, we found that the results were not materially different except for when stratifying by GHRT, impact factor, or study quality; this led to nonsignificant differences. Both Begg's rank correlation test (P = 0.7) and Egger's linear regression test (P = 0.06) indicated no publication bias. This meta-analysis demonstrated a lower recurrence rate of craniopharyngioma among children treated with GHRT than those who were not. Copyright © 2017 Elsevier Inc. All rights reserved.

Risk of Cardiac Events Associated With Antidepressant Therapy in Patients With Long QT Syndrome.

PubMed

Wang, Meng; Szepietowska, Barbara; Polonsky, Bronislava; McNitt, Scott; Moss, Arthur J; Zareba, Wojciech; Auerbach, David S

2018-01-15

Patients with long QT syndrome (LQTS) are at a high risk of cardiac events. Many patients with LQTS are treated with antidepressant drugs (ADs). We investigated the LQTS genotype-specific risk of recurrent cardiac arrhythmic events (CAEs) associated with AD therapy. The study included 59 LQT1 and 72 LQT2 patients from the Rochester-based LQTS Registry with corrected QT (QT c ) prolongation and a history of AD therapy. Using multivariate Anderson-Gill models, we estimated the LQTS genotype-specific risk of recurrent CAEs (ventricular tachyarrhythmias, aborted cardiac arrest, or sudden cardiac death) associated with time-dependent ADs. Specifically, we examined the risk associated with all ADs, selective serotonin reuptake inhibitor (SSRI), and ADs classified on the CredibleMeds list (www.CredibleMeds.org) as "Conditional" or "Known risk of Torsades de pointes (TdP)." After adjusting for baseline QT c duration, sex, and time-dependent beta-blocker usage, there was an increased risk of recurrent CAEs associated with ADs in LQT1 patients (hazard ratio = 3.67, 95% confidence interval 1.98-6.82, p < 0.001) but not in LQT2 patients (hazard ratio = 0.89, 95% confidence interval 0.49-1.64, p = 0.716; LQT1 vs LQT2 interaction, p < 0.001). Similarly, LQT1 patients who were on SSRIs or ADs with "Known risk of TdP" had a higher risk of recurrent CAEs than those patients off all ADs, whereas there was no association in LQT2 patients. ADs with "Conditional risk of TdP" were not associated with the risk of recurrent CAEs in any of the groups. In conclusion, the risk of recurrent CAEs associated with time-dependent ADs is higher in LQT1 patients but not in LQT2 patients. Results suggest a LQTS genotype-specific effect of ADs on the risk of arrhythmic events. Copyright © 2017 Elsevier Inc. All rights reserved.

Insulin Resistance and Prognosis of Nondiabetic Patients With Ischemic Stroke: The ACROSS-China Study (Abnormal Glucose Regulation in Patients With Acute Stroke Across China).

PubMed

Jing, Jing; Pan, Yuesong; Zhao, Xingquan; Zheng, Huaguang; Jia, Qian; Mi, Donghua; Chen, Weiqi; Li, Hao; Liu, Liping; Wang, Chunxue; He, Yan; Wang, David; Wang, Yilong; Wang, Yongjun

2017-04-01

Insulin resistance was common in patients with stroke. This study investigated the association between insulin resistance and outcomes in nondiabetic patients with first-ever acute ischemic stroke. Patients with ischemic stroke without history of diabetes mellitus in the ACROSS-China registry (Abnormal Glucose Regulation in Patients With Acute Stroke Across China) were included. Insulin resistance was defined as a homeostatis model assessment-insulin resistance (HOMA-IR) index in the top quartile (Q4). HOMA-IR was calculated as fasting insulin (μU/mL)×fasting glucose (mmol/L)/22.5. Multivariable logistic regression or Cox regression was performed to estimate the association between HOMA-IR and 1-year prognosis (mortality, stroke recurrence, poor functional outcome [modified Rankin scale score 3-6], and dependence [modified Rankin scale score 3-5]). Among the 1245 patients with acute ischemic stroke enrolled in this study, the median HOMA-IR was 1.9 (interquartile range, 1.1-3.1). Patients with insulin resistance were associated with a higher mortality risk than those without (adjusted hazard ratio, 1.68; 95% confidence interval, 1.12-2.53; P =0.01), stroke recurrence (adjusted hazard ratio, 1.57, 95% confidence interval, 1.12-2.19; P =0.008), and poor outcome (adjusted odds ratio, 1.42; 95% confidence interval, 1.03-1.95; P =0.03) but not dependence after adjustment for potential confounders. Higher HOMA-IR quartile categories were associated with a higher risk of 1-year death, stroke recurrence, and poor outcome ( P for trend =0.005, 0.005, and 0.001, respectively). Insulin resistance was associated with an increased risk of death, stroke recurrence, and poor outcome but not dependence in nondiabetic patients with acute ischemic stroke. © 2017 American Heart Association, Inc.

Flood characteristics of Alaskan streams

USGS Publications Warehouse

Lamke, R.D.

1979-01-01

Peak discharge data for Alaskan streams are summarized and analyzed. Multiple-regression equations relating peak discharge magnitude and frequency to climatic and physical characteristics of 260 gaged basins were determined in order to estimate average recurrence interval of floods at ungaged sites. These equations are for 1.25-, 2-, 5-, 10-, 25-, and 50-year average recurrence intervals. In this report, Alaska was divided into two regions, one having a maritime climate with fall and winter rains and floods, the other having spring and summer floods of a variety or combinations of causes. Average standard errors of the six multiple-regression equations for these two regions were 48 and 74 percent, respectively. Maximum recorded floods at more than 400 sites throughout Alaska are tabulated. Maps showing lines of equal intensity of the principal climatic variables found to be significant (mean annual precipitation and mean minimum January temperature), and location of the 260 sites used in the multiple-regression analyses are included. Little flood data have been collected in western and arctic Alaska, and the predictive equations are therefore less reliable for those areas. (Woodard-USGS)

Hydrologic and Hydraulic Analyses of Selected Streams in Lorain County, Ohio, 2003

USGS Publications Warehouse

Jackson, K. Scott; Ostheimer, Chad J.; Whitehead, Matthew T.

2003-01-01

Hydrologic and hydraulic analyses were done for selected reaches of nine streams in Lorain County Ohio. To assess the alternatives for flood-damage mitigation, the Lorain County Engineer and the U.S. Geological Survey (USGS) initiated a cooperative study to investigate aspects of the hydrology and hydraulics of the nine streams. Historical streamflow data and regional regression equations were used to estimate instantaneous peak discharges for floods having recurrence intervals of 2, 5, 10, 25, 50, and 100 years. Explanatory variables used in the regression equations were drainage area, main-channel slope, and storage area. Drainage areas of the nine stream reaches studied ranged from 1.80 to 19.3 square miles. The step-backwater model HEC-RAS was used to determine water-surface-elevation profiles for the 10-year-recurrence-interval (10-year) flood along a selected reach of each stream. The water-surface pro-file information was used then to generate digital mapping of flood-plain boundaries. The analyses indicate that at the 10-year flood elevation, road overflow results at numerous hydraulic structures along the nine streams.

Paleoseismology of the Southern Section of the Black Mountains and Southern Death Valley Fault Zones, Death Valley, United States

USGS Publications Warehouse

Sohn, Marsha S.; Knott, Jeffrey R.; Mahan, Shannon

2014-01-01

The Death Valley Fault System (DVFS) is part of the southern Walker Lane–eastern California shear zone. The normal Black Mountains Fault Zone (BMFZ) and the right-lateral Southern Death Valley Fault Zone (SDVFZ) are two components of the DVFS. Estimates of late Pleistocene-Holocene slip rates and recurrence intervals for these two fault zones are uncertain owing to poor relative age control. The BMFZ southernmost section (Section 1W) steps basinward and preserves multiple scarps in the Quaternary alluvial fans. We present optically stimulated luminescence (OSL) dates ranging from 27 to 4 ka of fluvial and eolian sand lenses interbedded with alluvial-fan deposits offset by the BMFZ. By cross-cutting relations, we infer that there were three separate ground-rupturing earthquakes on BMFZ Section 1W with vertical displacement between 5.5 m and 2.75 m. The slip-rate estimate is ∼0.2 to 1.8 mm/yr, with an earthquake recurrence interval of 4,500 to 2,000 years. Slip-per-event measurements indicate Mw 7.0 to 7.2 earthquakes. The 27–4-ka OSL-dated alluvial fans also overlie the putative Cinder Hill tephra layer. Cinder Hill is offset ∼213 m by SDVFZ, which yields a tentative slip rate of 1 to 8 mm/yr for the SDVFZ.

Systematic review on the recurrence of postoperative nausea and vomiting after a first episode in the recovery room – implications for the treatment of PONV and related clinical trials

PubMed Central

Eberhart, Leopold HJ; Frank, Silke; Lange, Henning; Morin, Astrid M; Scherag, André; Wulf, Hinnerk; Kranke, Peter

2006-01-01

Background Despite the presence of a plethora of publications on the prevention of postoperative nausea and vomiting (PONV) only little is known how to treat established symptoms. Besides the high effort of performing these efficacy trials (much more patients must give their consent than are actually included in a study) and ethical concerns, little is known about the rate of re-occurring PONV/vomiting after placebo. As a consequence investigators will have difficulties defining a clinically relevant effect for the new treatment which is crucial for any planning. A quantitative systematic review was performed in order to provide more reliable estimates of the incidence of re-occurring PONV/vomiting after placebo and to help investigators defining a clinically relevant treatment effect. Methods A systematic search of the literature was performed using an extended search strategy of a previous review. Data on the recurrence of PONV (any nausea or emetic symptom) and vomiting (retching or vomiting) was extracted from published reports treating PONV with placebo and unpublished results from two observational trials where no treatment was given. A nonlinear random effects model was used to calculate estimates of the recurrence of symptoms and their 95%-confidence intervals (95%-CI). Results A total of 29 trials (including the unpublished data) were eligible for the calculations. Depending on the length of observation after administering placebo or no treatment the recurrence rate of PONV was between 65% (95%-CI: 53%...75%) and 84% (95%-CI: 73%...91%) and that of vomiting was between 65% (95%-CI: 44%...81%) and 78% (95%-CI: 59%...90%). Conclusion Almost all trials showed a considerable and consistently high rate of recurrence of emetic symptoms after placebo highlighting the need for a consequent antiemetic treatment. Future (placebo) controlled efficacy trials may use the presented empirical estimates for defining clinically relevant effects and for statistical power considerations. PMID:17166262

Hydrology and Flood Profiles of Duck Creek and Jordan Creek Downstream from Egan Drive, Juneau, Alaska

USGS Publications Warehouse

Curran, Janet H.

2007-01-01

Hydrologic and hydraulic updates for Duck Creek and the lower part of Jordan Creek in Juneau, Alaska, included computation of new estimates of peak streamflow magnitudes and new water-surface profiles for the 10-, 50-, 100-, and 500-year floods. Computations for the 2-, 5-, 10-, 25-, 50-, 100-, 200-, and 500-year recurrence interval flood magnitudes for both streams used data from U.S. Geological Survey stream-gaging stations weighted with regional regression equations for southeast Alaska. The study area for the hydraulic model consisted of three channels: Duck Creek from Taku Boulevard near the stream's headwaters to Radcliffe Road near the end of the Juneau International Airport runway, an unnamed tributary to Duck Creek from Valley Boulevard to its confluence with Duck Creek, and Jordan Creek from a pedestrian bridge upstream from Egan Drive to Crest Street at Juneau International Airport. Field surveys throughout the study area provided channel geometry for 206 cross sections, and geometric and hydraulic characteristics for 29 culverts and 15 roadway, driveway, or pedestrian bridges. Hydraulic modeling consisted of application of the U.S. Army Corps of Engineers' Hydrologic Engineering Center River Analysis System (HEC-RAS) for steady-state flow at the selected recurrence intervals using an assumed high tide of 20 feet and roughness coefficients refined by calibration to measured water-surface elevations from a 2- to 5-year flood that occurred on November 21, 2005. Model simulation results identify inter-basin flow from Jordan Creek to the southeast at Egan Drive and from Duck Creek to Jordan Creek downstream from Egan Drive at selected recurrence intervals.

Retrospective analysis of treatment modalities in diabetic muscle infarction

PubMed Central

Onyenemezu, Ikenna; Capitle, Eugenio

2014-01-01

Background Diabetic muscle infarction (DMI) is a spontaneous necrosis of skeletal muscle of unknown etiology. The major risk factor is longstanding uncontrolled diabetes mellitus (DM). Optimal treatment for DMI is not known. The purpose of this study was to analyze the outcome of surgical treatment, physiotherapy, and bed rest in DMI. Methods We searched Medline from its inception to April 2013. We selected cases that provided sufficient data on recovery duration, recurrences, and non-recurrences. Baseline characteristics, including age, sex, microvascular complications, lesion size estimated on magnetic resonance imaging, type of diabetes, and duration of diabetes were assessed. The primary outcome was mean time to recovery from initial treatment and secondary outcomes were mean time to recurrence and recurrence rate. Results Mean time to recovery was 149 (95% confidence interval [CI] 113–186), 71 (95% CI 47–96), and 43 (95% CI 30–57) days for surgery, physiotherapy and bed rest, respectively. These figures were statistically significant only for surgery versus physiotherapy and surgery versus bed rest (P<0.01). Mean time to recurrence was 30, 107, and 297 days for surgery, physiotherapy, and bed rest, respectively. The recurrence rate was 57%, 44%, and 24% for surgery, physiotherapy, and bed rest, respectively. Conclusion Our results show a similar outcome for physiotherapy as compared with bed rest. It also confirms nonsurgical treatment as a better therapeutic option compared with surgical treatment. PMID:27790029

Coffee and tea consumption in relation to prostate cancer prognosis

PubMed Central

Geybels, Milan S.; Neuhouser, Marian L.; Wright, Jonathan L.; Stott-Miller, Marni; Stanford, Janet L.

2013-01-01

Background Bioactive compounds found in coffee and tea may delay the progression of prostate cancer. Methods We investigated associations of pre-diagnostic coffee and tea consumption with risk of prostate cancer recurrence/progression. Study participants were men diagnosed with prostate cancer in 2002–2005 in King County, Washington, USA. We assessed the usual pattern of coffee and tea consumption two years before diagnosis date. Prostate cancer outcome events were identified using a detailed follow-up survey. Multivariable Cox proportional hazards regression models were used to estimate hazard ratios (HRs) and 95% confidence intervals (CIs). Results The analysis of coffee intake in relation to prostate cancer recurrence/progression included 630 patients with a median follow-up of 6.4 years, during which 140 prostate cancer recurrence/progression events were recorded. Approximately 61% of patients consumed at least one cup of coffee per day. Coffee consumption was associated with a reduced risk of prostate cancer recurrence/progression; the adjusted HR for ≥4 cups/day versus ≤1 cup/week was 0.41 (95% CI: 0.20, 0.81; P for trend = 0.01). Approximately 14% of patients consumed one or more cups of tea per day, and tea consumption was unrelated to prostate cancer recurrence/progression. Conclusion Results indicate that pre-diagnostic coffee consumption is associated with a lower risk of prostate cancer recurrence/progression. This finding will require replication in larger studies. PMID:23907772

[Local recurrence based on size after conservative surgery in breast cancer stage T1-T2. A population-based study].

PubMed

Martínez-Ramos, David; Fortea-Sanchis, Carlos; Escrig-Sos, Javier; Prats-de Puig, Miguel; Queralt-Martín, Raquel; Salvador-Sanchis, José Luís

2014-01-01

Conservative surgery can be regarded as the standard treatment for most early stage breast tumors. However, a minority of patients treated with conservative surgery will present local or locoregional recurrence. Therefore, it is of interest to evaluate the possible factors associated with this recurrence. A population-based retrospective study using data from the Tumor Registry of Castellón (Valencia, Spain) of patients operated on for primary nonmetastatic breast cancer between January 2000 and December 2008 was designed. Kaplan-Meier curves and log-rank test to estimate 5-year local recurrence were used. Two groups of patients were defined, one with conservative surgery and another with nonconservative surgery. Cox multivariate analysis was conducted. The total number of patients was 410. Average local recurrence was 6.8%. In univariate analysis, only tumor size and lymph node involvement showed significant differences. On multivariate analysis, independent prognostic factors were conservative surgery (hazard ratio [HR] 4.62; 95% confidence interval [CI]: 1.12-16.82), number of positive lymph nodes (HR 1.07; 95% CI: 1.01-1.17) and tumor size (in mm) (HR 1.02; 95% CI: 1.01-1.06). Local recurrence after breast-conserving surgery is higher in tumors >2 cm. Although tumor size should not be a contraindication for conservative surgery, it should be a risk factor to be considered.

Recurrent Urinary Tract Infection After Midurethral Sling: A Retrospective Study.

PubMed

Hammett, Jessica; Lukman, Revana; Oakes, Megan; Whitcomb, Emily L

Our primary objective was to estimate the proportion of patients with culture-proven urinary tract infection (UTI) and recurrent UTI after midurethral sling (MUS), as well as to evaluate their risk factors. Our secondary objective was to characterize the difference in the proportion of patients with recurrent UTI before and after MUS. We conducted a retrospective study of patients who underwent MUS from 2009 to 2012 within a large health maintenance organization and subsequently had documentation of at least 1 positive urine culture (>100 K CFU/mL) within 1 year. Validated procedural and diagnostic codes were used to identify patients undergoing MUS and the diagnosis of UTI, respectively. Of the 7461 MUS performed, 883 (12%) patients had at least 1 culture-proven UTI and 258 (3.5%) patients met the definition of recurrent UTI postoperatively. Of those 883 patients, 89 (10%) patients met the definition of recurrent UTI before, and 258 (29%) patients after, MUS. McNemar χ test revealed that patients were more likely to have recurrent UTI after MUS compared with before (P < 0.0001). In multivariate logistic regression, Caucasian (odds ratio [OR], 1.60, 95% confidence interval [95% CI], 1.12-2.29; P = 0.01) and African-American (OR, 3.42; 95% CI, 1.42-8.29; P = 0.01) ethnicity, older age (OR, 1.02; 95% CI, 1.00-1.04; P = 0.03), and a history of recurrent UTI (OR 3.79, 95% CI 1.88-7.93, P = 0.0003) were risk factors for postoperative recurrent UTI. In this population, preoperative recurrent UTI was the only modifiable risk factor associated with an increased risk of postoperative recurrent UTI.

Recurrence Interval and Event Age Data for Type A Faults

USGS Publications Warehouse

Dawson, Timothy E.; Weldon, Ray J.; Biasi, Glenn P.

2008-01-01

This appendix summarizes available recurrence interval, event age, and timing of most recent event data for Type A faults considered in the Earthquake Rate Model 2 (ERM 2) and used in the ERM 2 Appendix C analysis as well as Appendix N (time-dependent probabilities). These data have been compiled into an Excel workbook named Appendix B A-fault event ages_recurrence_V5.0 (herein referred to as the Appendix B workbook). For convenience, the Appendix B workbook is attached to the end of this document as a series of tables. The tables within the Appendix B workbook include site locations, event ages, and recurrence data, and in some cases, the interval of time between earthquakes is also reported. The Appendix B workbook is organized as individual worksheets, with each worksheet named by fault and paleoseismic site. Each worksheet contains the site location in latitude and longitude, as well as information on event ages, and a summary of recurrence data. Because the data has been compiled from different sources with different presentation styles, descriptions of the contents of each worksheet within the Appendix B spreadsheet are summarized.

Post-recurrence survival in hepatocellular carcinoma after percutaneous radiofrequency ablation.

PubMed

Facciorusso, Antonio; Del Prete, Valentina; Antonino, Matteo; Crucinio, Nicola; Neve, Viviana; Di Leo, Alfredo; Carr, Brian I; Barone, Michele

2014-11-01

Overall survival in hepatocellular carcinoma patients treated with percutaneous radiofrequency ablation is influenced by both recurrence and successive treatments. We investigated post-recurrence survival after radiofrequency ablation. Data on 103 early/intermediate patients initially treated with radiofrequency ablation and followed for a median of 78 months (range 68-82) were retrospectively analysed. If intrahepatic disease recurrence occurred within or contiguous to the previously treated area it was defined as local, otherwise as distant; recurrence classified as Barcelona Clinic Liver Cancer stage C was defined by neoplastic portal vein thrombosis or metastases. A total of 103 patients were included (82.5% male; median age 70 years, range 39-86). During follow-up, 64 recurrences were observed. Median overall survival was 62 months (95% confidence interval: 54-78) and survival rates were 97%, 65% and 52% at 1, 4 and 5 years, respectively. Median post-recurrence survival was 22 months (95% confidence interval: 16-35). Child-Pugh score, performance status, sum of tumour diameters at recurrence and recurrence patterns were independent predictors of post-recurrence survival. In patients with hepatocellular carcinoma after radiofrequency ablation, clinical and tumour parameters assessed at relapse, in particular the type of recurrence pattern, influence post-recurrence survival. Copyright © 2014 Editrice Gastroenterologica Italiana S.r.l. Published by Elsevier Ltd. All rights reserved.

Attributable Healthcare Resource Utilization and Costs for Patients With Primary and Recurrent Clostridium difficile Infection in the United States.

PubMed

Zhang, Dongmu; Prabhu, Vimalanand S; Marcella, Stephen W

2018-04-17

The economic burden of Clostridium difficile infection (CDI), the leading cause of nosocomial infectious diarrhea, is not well understood. The objective of this study was to estimate the healthcare resource utilization (HCRU) and costs attributable to primary CDI and recurrent CDI (rCDI). This is a database (MarketScan) study. Patients without CDI were matched 1:1 by propensity score to those with primary CDI but no recurrences to obtain HCRU and costs attributable to primary CDI. Patients with primary CDI but no recurrences were matched 1:1 by propensity score to those with primary CDI plus 1 recurrence in order to obtain HCRU and costs attributable to rCDI. Adjusted estimates for incremental cumulative hospitalized days and healthcare costs over a 6-month follow-up period were obtained by generalized linear models with a Poisson or gamma distribution and a log link. Bootstrapping was used to obtain 95% confidence intervals (CIs). A total of 55504 eligible CDI patients were identified. Approximately 25% of these CDI patients had rCDI. The cumulative hospitalized days attributable to primary CDI and rCDI over the 6-month follow-up period were 5.20 days (95% CI, 5.01-5.39) and 1.95 days (95% CI, 1.48-2.43), respectively. The healthcare costs attributable to primary CDI and rCDI over the 6-month follow-up period were $24205 (95% CI, $23436-$25013) and $10580 (95% CI, $8849-$12446), respectively. The HCRU and costs attributable to primary CDI and rCDI are quite substantial. It is necessary to reduce the burden of CDI, especially rCDI.

Attributable Healthcare Resource Utilization and Costs for Patients With Primary and Recurrent Clostridium difficile Infection in the United States

PubMed Central

Zhang, Dongmu; Prabhu, Vimalanand S; Marcella, Stephen W

2018-01-01

Abstract Background The economic burden of Clostridium difficile infection (CDI), the leading cause of nosocomial infectious diarrhea, is not well understood. The objective of this study was to estimate the healthcare resource utilization (HCRU) and costs attributable to primary CDI and recurrent CDI (rCDI). Methods This is a database (MarketScan) study. Patients without CDI were matched 1:1 by propensity score to those with primary CDI but no recurrences to obtain HCRU and costs attributable to primary CDI. Patients with primary CDI but no recurrences were matched 1:1 by propensity score to those with primary CDI plus 1 recurrence in order to obtain HCRU and costs attributable to rCDI. Adjusted estimates for incremental cumulative hospitalized days and healthcare costs over a 6-month follow-up period were obtained by generalized linear models with a Poisson or gamma distribution and a log link. Bootstrapping was used to obtain 95% confidence intervals (CIs). Results A total of 55504 eligible CDI patients were identified. Approximately 25% of these CDI patients had rCDI. The cumulative hospitalized days attributable to primary CDI and rCDI over the 6-month follow-up period were 5.20 days (95% CI, 5.01–5.39) and 1.95 days (95% CI, 1.48–2.43), respectively. The healthcare costs attributable to primary CDI and rCDI over the 6-month follow-up period were $24205 (95% CI, $23436–$25013) and $10580 (95% CI, $8849–$12446), respectively. Conclusions The HCRU and costs attributable to primary CDI and rCDI are quite substantial. It is necessary to reduce the burden of CDI, especially rCDI. PMID:29360950

Follow-Up of 58 Traumatic Carotid-Cavernous Fistulas after Endovascular Detachable-Balloon Embolization at a Single Center

PubMed Central

Xu, Xiao-Quan; Liu, Sheng; Zu, Qing-Quan; Zhao, Lin-Bo; Xia, Jin-Guo; Zhou, Chun-Gao; Zhou, Wei-Zhong

2013-01-01

Background and Purpose This study evaluated the clinical value of detachable-balloon embolization for traumatic carotid-cavernous fistula (TCCF), focusing on the frequency, risk factors, and retreatment of recurrence. Methods Fifty-eight patients with TCCF underwent transarterial detachable-balloon embolization between October 2004 and March 2011. The clinical follow-up was performed every 3 months until up to 3 years postprocedure. Each patient was placed in either the recurrence group or the nonrecurrence group according to whether a recurrence developed after the first procedure. The relevant factors including gender, fistula location, interval between trauma and the interventional procedure, blood flow in the carotid-cavernous fistula, number of balloons, and whether the internal carotid artery (ICA) was sacrificed were evaluated. Results All 58 TCCFs were successfully treated with transarterial balloon embolization, including 7 patients with ICA sacrifice. Recurrent fistulas occurred in seven patients during the follow-up period. Univariate analysis indicated that the interval between trauma and the interventional procedure (p=0.006) might be the main factor related to the recurrence of TCCF. The second treatments involved ICA sacrifice in two patients, fistula embolization with balloons in four patients, and placement of a covered stent in one patient. Conclusions Detachable balloons can still serve as the first-line treatment for TCCFs and recurrent TCCFs despite having a nonnegligible recurrence rate. Shortening the interval between trauma and the interventional procedure may reduce the risk of recurrence. PMID:23626645

PREDICTORS OF BIOCHEMICAL REMISSION AND RECURRENCE AFTER SURGICAL AND RADIATION TREATMENTS OF CUSHING DISEASE: A SYSTEMATIC REVIEW AND META-ANALYSIS.

PubMed

Abu Dabrh, Abd Moain Abu; Singh Ospina, Naykky M; Al Nofal, Alaa; Farah, Wigdan H; Barrionuevo, Patricia; Sarigianni, Maria; Mohabbat, Arya B; Benkhadra, Khalid; Carranza Leon, Barbara G; Gionfriddo, Michael R; Wang, Zhen; Mohammed, Khaled; Ahmed, Ahmed T; Elraiyah, Tarig A; Haydour, Qusay; Alahdab, Fares; Prokop, Larry J; Murad, Mohammad Hassan

2016-04-01

We conducted a systematic review and meta-analysis to synthesize the evidence about predictors that may affect biochemical remission and recurrence after transsphenoidal surgery (TSS), radiosurgery (RS), and radiotherapy (RT) in Cushing disease. We searched multiple databases through December 2014 including original controlled and uncontrolled studies that enrolled patients with Cushing disease who received TSS (first-line), RS, or RT. We extracted data independently, in duplicates. Outcomes of interest were biochemical remission and recurrence. A meta-analysis was conducted using the random-effects model to estimate event rates with 95% confidence intervals (CIs). First-line TSS was associated with high remission (76% [95% CI, 72 to 79%]) and low recurrence rates (10% [95% CI, 6 to 16%]). Remission after TSS was higher in patients with microadenomas or positive-adrenocorticotropic hormone tumor histology. RT was associated with a high remission rate (RS, 68% [95% CI, 61 to 77%]; RT, 66% [95% CI, 58 to 75%]) but also with a high recurrence rate (RS, 32% [95% CI, 16 to 60%]; RT, 26% [95% CI, 14 to 48%]). Remission after RS was higher at short-term follow-up (≤2 years) and with high-dose radiation, while recurrence was higher in women and with lower-dose radiation. Remission was after RT in adults who received TSS prior to RT, and with lower radiation doses. There was heterogeneity (nonstandardization) in the criteria and cutoff points used to define biochemical remission and recurrence. First-line TSS is associated with high remission and low recurrence, while RS and RT are associated with reasonable remission rates but important recurrence rates. The current evidence warrants low confidence due to the noncomparative nature of the studies, high heterogeneity, and imprecision.

Direct Vision Internal Urethrotomy for Short Anterior Urethral Strictures and Beyond: Success Rates, Predictors of Treatment Failure, and Recurrence Management.

PubMed

Kluth, Luis A; Ernst, Lukas; Vetterlein, Malte W; Meyer, Christian P; Reiss, C Philip; Fisch, Margit; Rosenbaum, Clemens M

2017-08-01

To determine success rates, predictors of recurrence, and recurrence management of patients treated for short anterior urethral strictures by direct vision internal urethrotomy (DVIU). We identified 128 patients who underwent DVIU of the anterior urethra between December 2009 and March 2016. Follow-up was conducted by telephone interviews. Success rates were assessed by Kaplan-Meier estimators. Predictors of stricture recurrence and different further therapy strategies were identified by uni- and multivariable Cox regression analyses. The mean age was 63.8 years (standard deviation: 16.3) and the overall success rate was 51.6% (N = 66) at a median follow-up of 16 months (interquartile range: 6-43). Median time to stricture recurrence was six months (interquartile range: 2-12). In uni- and multivariable analyses, only repeat DVIU (hazard ratio [HR] = 1.87, 95% confidence interval (CI) = 1.13-3.11, P= .015; and HR=1.78, 95% CI = 1.05-3.03, P = .032, respectively) was a risk factor for recurrence. Of 62 patients with recurrence, 35.5% underwent urethroplasty, 29% underwent further endoscopic treatment, and 33.9% did not undergo further interventional therapy. Age (HR = 1.05, 95% CI = 1.01-1.09, P = .019) and diabetes (HR = 2.90, 95% CI = 1.02-8.26, P = .047) were predictors of no further interventional therapy. DVIU seems justifiable in short urethral strictures as a primary treatment. Prior DVIU was a risk factor for recurrence. In case of recurrence, about one-third of the patients did not undergo any further therapy. Higher age and diabetes predicted the denial of any further treatment. Copyright © 2017 Elsevier Inc. All rights reserved.

Methods for estimating selected low-flow frequency statistics and harmonic mean flows for streams in Iowa

USGS Publications Warehouse

Eash, David A.; Barnes, Kimberlee K.

2017-01-01

A statewide study was conducted to develop regression equations for estimating six selected low-flow frequency statistics and harmonic mean flows for ungaged stream sites in Iowa. The estimation equations developed for the six low-flow frequency statistics include: the annual 1-, 7-, and 30-day mean low flows for a recurrence interval of 10 years, the annual 30-day mean low flow for a recurrence interval of 5 years, and the seasonal (October 1 through December 31) 1- and 7-day mean low flows for a recurrence interval of 10 years. Estimation equations also were developed for the harmonic-mean-flow statistic. Estimates of these seven selected statistics are provided for 208 U.S. Geological Survey continuous-record streamgages using data through September 30, 2006. The study area comprises streamgages located within Iowa and 50 miles beyond the State's borders. Because trend analyses indicated statistically significant positive trends when considering the entire period of record for the majority of the streamgages, the longest, most recent period of record without a significant trend was determined for each streamgage for use in the study. The median number of years of record used to compute each of these seven selected statistics was 35. Geographic information system software was used to measure 54 selected basin characteristics for each streamgage. Following the removal of two streamgages from the initial data set, data collected for 206 streamgages were compiled to investigate three approaches for regionalization of the seven selected statistics. Regionalization, a process using statistical regression analysis, provides a relation for efficiently transferring information from a group of streamgages in a region to ungaged sites in the region. The three regionalization approaches tested included statewide, regional, and region-of-influence regressions. For the regional regression, the study area was divided into three low-flow regions on the basis of hydrologic characteristics, landform regions, and soil regions. A comparison of root mean square errors and average standard errors of prediction for the statewide, regional, and region-of-influence regressions determined that the regional regression provided the best estimates of the seven selected statistics at ungaged sites in Iowa. Because a significant number of streams in Iowa reach zero flow as their minimum flow during low-flow years, four different types of regression analyses were used: left-censored, logistic, generalized-least-squares, and weighted-least-squares regression. A total of 192 streamgages were included in the development of 27 regression equations for the three low-flow regions. For the northeast and northwest regions, a censoring threshold was used to develop 12 left-censored regression equations to estimate the 6 low-flow frequency statistics for each region. For the southern region a total of 12 regression equations were developed; 6 logistic regression equations were developed to estimate the probability of zero flow for the 6 low-flow frequency statistics and 6 generalized least-squares regression equations were developed to estimate the 6 low-flow frequency statistics, if nonzero flow is estimated first by use of the logistic equations. A weighted-least-squares regression equation was developed for each region to estimate the harmonic-mean-flow statistic. Average standard errors of estimate for the left-censored equations for the northeast region range from 64.7 to 88.1 percent and for the northwest region range from 85.8 to 111.8 percent. Misclassification percentages for the logistic equations for the southern region range from 5.6 to 14.0 percent. Average standard errors of prediction for generalized least-squares equations for the southern region range from 71.7 to 98.9 percent and pseudo coefficients of determination for the generalized-least-squares equations range from 87.7 to 91.8 percent. Average standard errors of prediction for weighted-least-squares equations developed for estimating the harmonic-mean-flow statistic for each of the three regions range from 66.4 to 80.4 percent. The regression equations are applicable only to stream sites in Iowa with low flows not significantly affected by regulation, diversion, or urbanization and with basin characteristics within the range of those used to develop the equations. If the equations are used at ungaged sites on regulated streams, or on streams affected by water-supply and agricultural withdrawals, then the estimates will need to be adjusted by the amount of regulation or withdrawal to estimate the actual flow conditions if that is of interest. Caution is advised when applying the equations for basins with characteristics near the applicable limits of the equations and for basins located in karst topography. A test of two drainage-area ratio methods using 31 pairs of streamgages, for the annual 7-day mean low-flow statistic for a recurrence interval of 10 years, indicates a weighted drainage-area ratio method provides better estimates than regional regression equations for an ungaged site on a gaged stream in Iowa when the drainage-area ratio is between 0.5 and 1.4. These regression equations will be implemented within the U.S. Geological Survey StreamStats web-based geographic-information-system tool. StreamStats allows users to click on any ungaged site on a river and compute estimates of the seven selected statistics; in addition, 90-percent prediction intervals and the measured basin characteristics for the ungaged sites also are provided. StreamStats also allows users to click on any streamgage in Iowa and estimates computed for these seven selected statistics are provided for the streamgage.

Time patterns of recurrences and factors predisposing for a higher risk of recurrence of ocular toxoplasmosis.

PubMed

Reich, Michael; Ruppenstein, Mira; Becker, Matthias D; Mackensen, Friederike

2015-04-01

To ascertain time patterns of recurrences and factors predisposing for a higher risk of recurrence of ocular toxoplasmosis. Retrospective observational case series with follow-up examination. Database of 4,381 patients with uveitis was used. Data of 84 patients with ocular toxoplasmosis (sample group) could be included. Two hundred and eighty active lesions in the first affected eye were detected. The mean number of recurrences per year was 0.29 (standard deviation, 0.24). Median recurrence-free survival time was 2.52 years (95% confidence interval, 2.03-3.02 years). Risk of recurrence was highest in the first year after the most recent episode (26%) implying a decrease with increasing recurrence-free interval. The risk of recurrence decreased with the duration of disease (P < 0.001). Treatment of the first active lesion influenced the risk of recurrence (P = 0.048). Furthermore, the risk of recurrence was influenced by patient age at the time of the first active lesion (P = 0.021) and the most recent episode (P = 0.002). A secondary antibiotic prophylaxis could be discussed 1) during the first year after an active lesion has occurred, especially in case of the first active lesion of ocular toxoplasmosis, and 2) in older patients, especially if primarily infected with Toxoplasma gondii at an older age.

Characterising infant inter-breath interval patterns during active and quiet sleep using recurrence plot analysis.

PubMed

Terrill, Philip I; Wilson, Stephen J; Suresh, Sadasivam; Cooper, David M

2009-01-01

Breathing patterns are characteristically different between active and quiet sleep states in infants. It has been previously identified that breathing dynamics are governed by a non-linear controller which implies the need for a nonlinear analytical tool. Further, it has been shown that quantified nonlinear variables are different between adult sleep states. This study aims to determine whether a nonlinear analytical tool known as recurrence plot analysis can characterize breath intervals of active and quiet sleep states in infants. Overnight polysomnograms were obtained from 32 healthy infants. The 6 longest periods each of active and quiet sleep were identified and a software routine extracted inter-breath interval data for recurrence plot analysis. Determinism (DET), laminarity (LAM) and radius (RAD) values were calculated for an embedding dimension of 4, 6, 8 and 16, and fixed recurrence of 0.5, 1, 2, 3.5 and 5%. Recurrence plots exhibited characteristically different patterns for active and quiet sleep. Active sleep periods typically had higher values of RAD, DET and LAM than for quiet sleep, and this trend was invariant to a specific choice of embedding dimension or fixed recurrence. These differences may provide a basis for automated sleep state classification, and the quantitative investigation of pathological breathing patterns.

Ablative Intravesical Chemotherapy for Small Recurrent Non-Muscle-Invasive Bladder Cancer: A Prospective Study.

PubMed

Decaestecker, Karel; Lumen, Nicolaas; Ringoir, Annelies; Oosterlinck, Willem

2016-01-01

The efficacy of intravesical chemotherapy in abolishing small papillary recurrences of non-muscle-invasive bladder cancer (NMIBC), the disease-free interval in responders and patients' preferences were explored. When a small (≤1 cm) papillary recurrence of a NMIBC was diagnosed, the patient could choose between immediate transurethral resection of the bladder (TURB) or four weekly intravesical instillations with mitomycin C (MMC) or epirubicin (ERC). Control cystoscopy was scheduled 2-3 weeks after the last instillation. Complete remission was defined as total disappearance of all papillary tumours and negative cytology. 25 patients with 47 recurrence episodes were recruited from February 2003 until August 2011. The median follow-up was 35 months. After exclusion of 2 patients with intolerance to the instillations, 45 study episodes could be analysed. All patients to whom this was proposed preferred the instillations over immediate TURB. Complete, partial and no response was seen in 23 (51%), 6 (13%) and 16 (36%) out of 45 episodes, respectively. The median disease-free interval after complete remission was 16 months (95% confidence interval 9-24). Small papillary recurrences of NMIBC completely disappear in about half of the cases receiving four weekly bladder instillations with MMC or ERC. This is followed by a disease-free interval. Intravesical chemotherapy was preferred by all patients over immediate TURB. © 2015 S. Karger AG, Basel.

Determination of the 100-year flood plain on Upper Three Runs and selected tributaries, and the Savannah River at the Savannah River site, South Carolina, 1995

USGS Publications Warehouse

Lanier, T.H.

1996-01-01

The 100-year flood plain was determined for Upper Three Runs, its tributaries, and the part of the Savannah River that borders the Savannah River Site. The results are provided in tabular and graphical formats. The 100-year flood-plain maps and flood profiles provide water-resource managers of the Savannah River Site with a technical basis for making flood-plain management decisions that could minimize future flood problems and provide a basis for designing and constructing drainage structures along roadways. A hydrologic analysis was made to estimate the 100-year recurrence- interval flow for Upper Three Runs and its tributaries. The analysis showed that the well-drained, sandy soils in the head waters of Upper Three Runs reduce the high flows in the stream; therefore, the South Carolina upper Coastal Plain regional-rural-regression equation does not apply for Upper Three Runs. Conse- quently, a relation was established for 100-year recurrence-interval flow and drainage area using streamflow data from U.S. Geological Survey gaging stations on Upper Three Runs. This relation was used to compute 100-year recurrence-interval flows at selected points along the stream. The regional regression equations were applicable for the tributaries to Upper Three Runs, because the soil types in the drainage basins of the tributaries resemble those normally occurring in upper Coastal Plain basins. This was verified by analysis of the flood-frequency data collected from U.S. Geological Survey gaging station 02197342 on Fourmile Branch. Cross sections were surveyed throughout each reach, and other pertinent data such as flow resistance and land-use were col- lected. The surveyed cross sections and computed 100-year recurrence-interval flows were used in a step-backwater model to compute the 100-year flood profile for Upper Three Runs and its tributaries. The profiles were used to delineate the 100-year flood plain on topographic maps. The Savannah River forms the southwestern border of the Savannah River Site. Data from previously published reports were used to delineate the 100-year flood plain for the Savannah River from the downstream site boundary at the mouth of Lower Three Runs at river mile 125 to the upstream site boundary at river mile 163.

Methods for estimating selected low-flow frequency statistics for unregulated streams in Kentucky

USGS Publications Warehouse

Martin, Gary R.; Arihood, Leslie D.

2010-01-01

This report provides estimates of, and presents methods for estimating, selected low-flow frequency statistics for unregulated streams in Kentucky including the 30-day mean low flows for recurrence intervals of 2 and 5 years (30Q2 and 30Q5) and the 7-day mean low flows for recurrence intervals of 5, 10, and 20 years (7Q2, 7Q10, and 7Q20). Estimates of these statistics are provided for 121 U.S. Geological Survey streamflow-gaging stations with data through the 2006 climate year, which is the 12-month period ending March 31 of each year. Data were screened to identify the periods of homogeneous, unregulated flows for use in the analyses. Logistic-regression equations are presented for estimating the annual probability of the selected low-flow frequency statistics being equal to zero. Weighted-least-squares regression equations were developed for estimating the magnitude of the nonzero 30Q2, 30Q5, 7Q2, 7Q10, and 7Q20 low flows. Three low-flow regions were defined for estimating the 7-day low-flow frequency statistics. The explicit explanatory variables in the regression equations include total drainage area and the mapped streamflow-variability index measured from a revised statewide coverage of this characteristic. The percentage of the station low-flow statistics correctly classified as zero or nonzero by use of the logistic-regression equations ranged from 87.5 to 93.8 percent. The average standard errors of prediction of the weighted-least-squares regression equations ranged from 108 to 226 percent. The 30Q2 regression equations have the smallest standard errors of prediction, and the 7Q20 regression equations have the largest standard errors of prediction. The regression equations are applicable only to stream sites with low flows unaffected by regulation from reservoirs and local diversions of flow and to drainage basins in specified ranges of basin characteristics. Caution is advised when applying the equations for basins with characteristics near the applicable limits and for basins with karst drainage features.

Erosion and Sedimentation from the Bagley Fire, Eastern Klamath Mountains, Northern CA

NASA Astrophysics Data System (ADS)

De La Fuente, J. A.; Bachmann, S.; Mai, C.; Mikulovsky, R.; Mondry, Z. J.; Rust, B.; Young, D.

2014-12-01

The Bagley Fire burned about 19,000 hectares on the Shasta-Trinity National Forest in the late summer of 2012, with soil burn severities of 11% high, 19% moderate and 48% low. Two strong storms in November and December followed the fire. The first storm had a recurrence interval of about 2 years, and generated runoff with a return interval of 10-25 years, causing many road stream crossing failures in parts of the fire. The second storm had a recurrence interval of 25-50 years, and initiated more severe erosion throughout the fire area. Erosional processes were dominated by sheet, rill and gully erosion, and landslides were uncommon. A model predicted high potential for debris flows, but few were documented, and though most stream channels exhibited fresh scour and deposition, residual deposits lacked boulder levees or other evidence of debris flow. Rather, deposits were stratified and friable, suggesting a sediment laden flood flow rather than debris flow origin. The resulting sediment was rich in gravel and finer particles, and poor in larger rock. Soil loss was estimated at 0.5-5.6 cm on most hillslopes. A high resolution DEM (LiDAR) was used to measure gullies, small landslides, and stream scour, and also to estimate sedimentation in Squaw Creek, and Shasta Lake. A soil erosion model was used to estimate surface erosion. Total erosion in the Squaw Creek watershed was estimated at 2.24 million metric tons, which equates to 260 metric tons/hectare. Of this, about 0.89 million metric tons were delivered to the stream system (103 metric tons/hectare). Nearly half of this sediment, 0.41 million metric tons, was temporarily stored in the Squaw Creek channel, and around 0.33 million metric tons of fine sediment were carried into Shasta Lake. Squaw Creek also delivered about 0.17 million metric tons of sand, gravel and cobbles to the lake. This estimate is very tenuous, and was made by measuring the volume of a delta in Shasta Lake from a tributary to Squaw Creek and extrapolating to the entire watershed. LidAR measurements of gully and landslide volume were considered the most reliable values, followed by estimates of channel scour and deposition in Squaw Creek and tributaries. The soil erosion model outputs were calibrated with data from a small debris basin. The most uncertain estimates were those for Shasta Lake sedimentation.

Flood of October 8 and 9, 2005, on Cold River in Walpole, Langdon, and Alstead and on Warren Brook in Alstead, New Hampshire

USGS Publications Warehouse

Olson, Scott A.

2006-01-01

Southwestern New Hampshire experienced damaging flooding on October 8 and 9, 2005. The flooding was the result of a storm producing at least 7 inches of rain in a 30-hour period. The heavy, intense rainfall resulted in runoff and severe flooding, especially in regions of steep topography that are vulnerable to flash flooding. Some of the worst property damage was in the towns of Alstead, Langdon, and Walpole, New Hampshire along Cold River and Warren Brook. Warren Brook was severely flooded and had flows that exceeded a 100-year recurrence interval upstream of Cooper Hill Road. Downstream of Cooper Hill Road, the flooding was worsened as a result of a sudden release of impounded water, making the flood levels greater than what would be experienced from a 500-year recurrence-interval flood. Along Cold River, upstream of its confluence with Warren Brook, flooding was at approximately a 100-year recurrence interval. Downstream of the confluence of Cold River and Warren Brook, the streamflows, which were swollen by the surge of water from Warren Brook, exceeded a 500year recurrence interval.

Floods of March 1982, Indiana, Michigan, and Ohio

USGS Publications Warehouse

Glatfelter, D.R.; Butch, G.K.; Stewart, J.A.

1984-01-01

Rapid melting of a snowpack containing 2 to 6 inches of water equivalent coinciding with moderate rainfall caused flooding in March 1982 across northern Indiana, southern Michigan, and northwestern Ohio. Millions of dollars in property damage and the loss of four lives resulted from the flooding. Peak discharges at several gaging stations in each of the following river basins have recurrence intervals of 50 to greater than 100 years: Wabash, St. Joseph, River Raisin, Maumee, and Kankakee. Flooding in the Wabash River basin was confined to major tributaries draining from the north. The St. Joseph River experienced flooding having a recurrence interval of about 50 years. Peak discharges having recurrence intervals of 50 to greater than 100 years were recorded on the River Raisin. Flooding on most large streams in the Maumee River basin was the worst since 1913. The Kankakee River and its major tributary, Yellow River, recorded peak discharges having recurrence intervals greater than 100 years. Hydrologic data have been tabulated for 83 gaging stations and partial-record sites. Maps are presented to emphasize the severity and untimely sequence of meteorological conditions that provided the potential and triggered the floods. Hydrographs are shown for 32 gaging stations.

Regional analysis of annual precipitation maxima in Montana

USGS Publications Warehouse

Parrett, Charles

1997-01-01

Dimensionless precipitation-frequency curves for estimating precipitation depths having large recurrence intervals were developed for 2-, 6-, and 24-hour storm durations for three homogeneous regions in Montana. Within each homogeneous region, at-site annual precipitation maxima were made dimensionless by dividing by the at-site mean and grouped so that a single frequency curve would be applicable for each duration. L-moment statistics were used to help define the homogeneous regions and to develop the dimensionless precipitation- frequency curves. Data from 459 precipitation stations were used after application of statistical tests to ensure that the data were not serially correlated and were stationary over the general period of data collection (1900-92). The data were found to have a small, but significant, degree of interstation correlation. The GEV distribution was used to construct dimensionless frequency curves of annual precipitation maxima for each duration within each region. Each dimensionless frequency curve was considered to be reliable for recurrence intervals up to the effective record length. Because of significant, though small, interstation correlation in all regions for all durations, and because the selected regions exhibited some heterogeneity, the effective record length was considered to be less than the total number of station-years of data. The effective record length for each duration in each region was estimated using a graphical method and found to range from 500 years for 6-hour duration data in Region 2 to 5,100 years for 24-hour duration data in Region 3.

Systematic Review with Meta-analysis: Recurrence of Crohn's disease after Total Colectomy with Permanent Ileostomy

PubMed Central

Fumery, Mathurin; Dulai, Parambir S.; Meirick, Paul; Farrell, Ann M.; Ramamoorthy, Sonia; Sandborn, William J.; Singh, Siddharth

2016-01-01

Background Subtotal or total colectomy or proctocolectomy with permanent ileostomy (TC-PI) may be a treatment option for medically refractory colonic Crohn's disease (CD). Aim To perform a systematic review and meta-analysis to evaluate the rate, risk factors and outcomes of CD recurrence after TC-PI. Methods In a systematic review ending March 31, 2016, we identified 18 cohort studies (1438 adults) who underwent TC-PI for colonic CD (median follow-up, 7.4 years; interquartile range, 5.3-9.0). We estimated pooled rates (with 95% confidence interval [CI]) of clinical and surgical recurrence, and risk factors for disease recurrence. Results On meta-analysis, the risk of clinical recurrence after TC-PI was 28.0% (95% CI, 21.7-35.3; 14 studies, 260/1004 patients), with a 5- and 10-year median cumulative rate of 23.5% (range, 7-35) and 40% (range, 11-60), respectively. The risk of surgical recurrence was 16.0% (95% CI, 11.1-22.7; 10 studies; 183/1092 patients), with a 5- and 10-year median cumulative rate of 10% (range, 3-29) and 18.5% (range, 14-34), respectively. The risk of clinical and surgical recurrence in patients without ileal disease at baseline was 11.5% (95% CI, 7.7-16.8) and 10.4% (95% CI, 4.5-22.5), respectively. History of ileal disease was associated with 3.2 times higher risk of disease recurrence (RR, 3.2; 95% CI, 1.8-5.6). Other inconsistent risk factors for disease recurrence were penetrating disease and young age at disease onset. Conclusions Small bowel clinical recurrence occurs in about 28% of patients after TC-PI for colonic CD. Disease recurrence risk is 3.2 times higher in patients with history of ileal disease, and continued medical therapy may be advisable in this population. In patients without ileal inflammation at surgery, continued endoscopic surveillance may identify asymptomatic disease recurrence to guide therapy. PMID:27928830

A statistical model of extreme storm rainfall

NASA Astrophysics Data System (ADS)

Smith, James A.; Karr, Alan F.

1990-02-01

A model of storm rainfall is developed for the central Appalachian region of the United States. The model represents the temporal occurrence of major storms and, for a given storm, the spatial distribution of storm rainfall. Spatial inhomogeneities of storm rainfall and temporal inhomogeneities of the storm occurrence process are explicitly represented. The model is used for estimating recurrence intervals of extreme storms. The parameter estimation procedure developed for the model is based on the substitution principle (method of moments) and requires data from a network of rain gages. The model is applied to a 5000 mi2 (12,950 km2) region in the Valley and Ridge Province of Virginia and West Virginia.

Flood of September 2008 in Northwestern Indiana

USGS Publications Warehouse

Fowler, Kathleen K.; Kim, Moon H.; Menke, Chad D.; Arvin, Donald V.

2010-01-01

During September 12-15, 2008, rainfall ranging from 2 to more than 11 inches fell on northwestern Indiana. The rainfall resulted in extensive flooding on many streams within the Lake Michigan and Kankakee River Basins during September 12-18, causing two deaths, evacuation of hundreds of residents, and millions of dollars of damage to residences, businesses, and infrastructure. In all, six counties in northwestern Indiana were declared Federal disaster areas. U.S. Geological Survey (USGS) streamgages at four locations recorded new record peak streamflows as a result of the heavy rainfall. Peak-gage-height data, peak-streamflow data, annual exceedance probabilities, and recurrence intervals are tabulated in this report for 10 USGS streamgages in northwestern Indiana. Recurrence intervals of flood-peak streamflows were estimated to be greater than 100 years at six streamgages. Because flooding was particularly severe in the communities of Munster, Dyer, Hammond, Highland, Gary, Lake Station, Hobart, Schererville, Merrillville, Michiana Shores, and Portage, high-water-park data collected after the flood were tabulated for those communities. Flood peak inundation maps and water-surface profiles for selected streams were made in a geographic information system by combining high-water-mark data with the highest resolution digital elevation model data available.

The Rurrand Fault, Germany: A Holocene surface rupture and new slip rate estimates

NASA Astrophysics Data System (ADS)

Grützner, Christoph; Fischer, Peter; Reicherter, Klaus

2016-04-01

Very low deformation rates in continental interiors are a challenge for research on active tectonics and seismic hazard. Faults tend to have very long earthquake recurrence intervals and morphological evidence of surface faulting is often obliterated by erosion and sedimentation. The Lower Rhine Graben in Central Europe is characterized by slow active faults with individual slip rates of well less than 0.1 mm/a. As a consequence, most geodetic techniques fail to record tectonic motions and the morphological expression of the faults is subtle. Although damaging events are known from this region, e.g. the 1755/56 Düren earthquakes series, there is no account for surface rupturing events in instrumental and historical records. Owing to the short temporal coverage with respect to the fault recurrence intervals, these records probably fail to depict the maximum possible magnitudes. In this study we used morphological evidence from a 1 m airborne LiDAR survey, near surface geophysics, and paleoseismological trenching to identify surface rupturing earthquakes at the Rurrand Fault between Cologne and Aachen in W Germany. LiDAR data allowed identifying a young fault strand parallel to the already known main fault with the subtle morphological expression of recent surface faulting. In the paleoseismological trenches we found evidence for two surface rupturing earthquakes. The most recent event occurred in the Holocene, and a previous earthquake probably happened in the last 150 ka. Geophysical data allowed us to estimate a minimum slip rate of 0.03 mm/a from an offset gravel horizon. We estimate paleomagnitudes of MW5.9-6.8 based on the observed offsets in the trench (<0.5 m per event) and fault scaling relationships. Our data imply that the Rurrand Fault did not creep during the last 150 ka, but rather failed in large earthquakes. These events were much stronger than those known from historical sources. We are able to show that the Rurrand Fault did not rupture the surface during the Düren 1755/56 seismic crisis and conclude that these events likely occurred on another nearby fault system or did not rupture the surface at all. The very long recurrence interval of 25-65 ka for surface rupturing events illustrates the problems of assessing earthquake hazard in such slowly deforming regions. We emphasize that geological data must be included in seismic hazard and surface rupture hazard assessments in order to obtain a complete picture of a region's seismic potential.

Change in Pattern of Relapse After Antiangiogenic Therapy in High-Grade Glioma

DOE Office of Scientific and Technical Information (OSTI.GOV)

Narayana, Ashwatha, E-mail: ashwatha.narayana@nyumc.org; Department of Neurosurgery, New York University Langone Medical Center, New York, NY; Kunnakkat, Saroj D.

2012-01-01

Purpose: Local recurrence is the dominant pattern of relapse in high-grade glioma (HGG) after conventional therapy. The recent use of antiangiogenic therapy has shown impressive radiologic and clinical responses in adult HGG. The preclinical data suggesting increased invasiveness after angiogenic blockade have necessitated a detailed analysis of the pattern of recurrence after therapy. Methods and Materials: A total of 162 consecutive patients with HGG, either newly diagnosed (n = 58) or with recurrent disease (n = 104) underwent therapy with bevacizumab at 10 mg/kg every 2 weeks and conventional chemotherapy with or without involved field radiotherapy until disease progression. Themore » pattern of recurrence and interval to progression were the primary aims of the present study. Diffuse invasive recurrence (DIR) was defined as the involvement of multiple lobes with or without crossing the midline. Results: At a median follow-up of 7 months (range, 1-37), 105 patients had recurrence, and 79 patients ultimately developed DIR. The interval to progression was similar in the DIR and local recurrence groups (6.5 and 6.3 months, p = .296). The hazard risk of DIR increased exponentially with time and was similar in those with newly diagnosed and recurrent HGG (R{sup 2} = 0.957). The duration of bevacizumab therapy increased the interval to recurrence (p < .0001) and improved overall survival (p < .0001). However, the pattern of relapse did not affect overall survival (p = .253). Conclusion: Along with an increase in median progression-free survival, bevacizumab therapy increased the risk of DIR in HGG patients. The risk of increased invasion with prolonged angiogenic blockade should be addressed in future clinical trials.« less

Nankai-Tokai subduction hazard for catastrophe risk modeling

NASA Astrophysics Data System (ADS)

Spurr, D. D.

2010-12-01

The historical record of Nankai subduction zone earthquakes includes nine event sequences over the last 1300 years. Typical characteristic behaviour is evident, with segments rupturing either co-seismically or as two large earthquakes less than 3 yrs apart (active phase), followed by periods of low seismicity lasting 90 - 150 yrs or more. Despite the long historical record, the recurrence behaviour and consequent seismic hazard remain uncertain and controversial. In 2005 the Headquarters for Earthquake Research Promotion (HERP) published models for hundreds of faults as part of an official Japanese seismic hazard map. The HERP models have been widely adopted in part or full both within Japan and by the main international catastrophe risk model companies. The time-dependent recurrence modelling we adopt for the Nankai faults departs considerably from HERP in three main areas: ■ A “Linked System” (LS) source model is used to simulate the strong correlation between segment ruptures evident in the historical record, whereas the HERP recurrence estimates assume the Nankai, Tonankai and Tokai segments rupture independently. The LS component models all historical events with a common rupture recurrence cycle for the three segments. System rupture probabilities are calculated assuming BPT behaviour and parameter uncertainties assessed from the full 1300 yr historical record. ■ An independent, “Tokai Only” (TO) rupture source is used specifically to model potential “Tokai only” earthquakes. There are widely diverging views on the possibility of this segment rupturing independently. Although all historical Tokai ruptures appear to have been composite Tonankai -Tokai earthquakes, the available data do not preclude the possibility of future “Tokai only” events. The HERP model also includes “Tokai only” earthquakes but the recurrence parameters are based on historical composite Tonankai -Tokai ruptures and do not appear to recognise the complex tectonic environment in the Tokai area. ■ For the Nankai and Tonankai segments only, HERP assumed Time-Predictable (TP) recurrence behaviour. The resulting calculated 30 and 50 year rupture probabilities are considerably higher than standard renewal model estimates as used in the adopted model. While perhaps more contentious, the weight of evidence available does not appear to be consistent with TP behaviour. For the adopted modelling the estimated probabilities of no Nankai segment rupture within the next 30 & 50 years are 56% & 27% respectively. The disparity between the models is highlighted by the much lower estimates obtained by HERP (2.5% & 0.039% respectively as at 2006). Even for just the Nankai and Tonankai segments (ie. ignoring Tokai), HERP estimated only 1.7% probability of no rupture in 50yrs. These estimates can be contrasted with the fact that in 2056 (50 yrs from 2006), the elapsed time since the start of the last rupture cycle (112yrs) will still be 5 yrs short of the historical mean recurrence interval since 1360. Net effects on nation-wide catastrophe risk estimates for all earthquake sources depend on modelled exposure distributions but can be as much as a factor of two. The differences are important as they impact on multi-billion dollar international risk transfer programs.

Risk Factors for Recurrent Urinary Tract Infection and Renal Scarring

PubMed Central

Shaikh, Nader; Pohl, Hans; Gravens-Mueller, Lisa; Ivanova, Anastasia; Zaoutis, Lisa; Patel, Melissa; deBerardinis, Rachel; Parker, Allison; Bhatnagar, Sonika; Haralam, Mary Ann; Pope, Marcia; Kearney, Diana; Sprague, Bruce; Barrera, Raquel; Viteri, Bernarda; Egigueron, Martina; Shah, Neha; Hoberman, Alejandro

2015-01-01

OBJECTIVES: To identify risk factors for recurrent urinary tract infection (UTI) and renal scarring in children who have had 1 or 2 febrile or symptomatic UTIs and received no antimicrobial prophylaxis. METHODS: This 2-year, multisite prospective cohort study included 305 children aged 2 to 71 months with vesicoureteral reflux (VUR) receiving placebo in the RIVUR (Randomized Intervention for Vesicoureteral Reflux) study and 195 children with no VUR observed in the CUTIE (Careful Urinary Tract Infection Evaluation) study. Primary exposure was presence of VUR; secondary exposures included bladder and bowel dysfunction (BBD), age, and race. Outcomes were recurrent febrile or symptomatic urinary tract infection (F/SUTI) and renal scarring. RESULTS: Children with VUR had higher 2-year rates of recurrent F/SUTI (Kaplan-Meier estimate 25.4% compared with 17.3% for VUR and no VUR, respectively). Other factors associated with recurrent F/SUTI included presence of BBD at baseline (adjusted hazard ratio: 2.07 [95% confidence interval (CI): 1.09–3.93]) and presence of renal scarring on the baseline 99mTc-labeled dimercaptosuccinic acid scan (adjusted hazard ratio: 2.88 [95% CI: 1.22–6.80]). Children with BBD and any degree of VUR had the highest risk of recurrent F/SUTI (56%). At the end of the 2-year follow-up period, 8 (5.6%) children in the no VUR group and 24 (10.2%) in the VUR group had renal scars, but the difference was not statistically significant (adjusted odds ratio: 2.05 [95% CI: 0.86–4.87]). CONCLUSIONS: VUR and BBD are risk factors for recurrent UTI, especially when they appear in combination. Strategies for preventing recurrent UTI include antimicrobial prophylaxis and treatment of BBD. PMID:26055855

Risk Factors for Recurrent Urinary Tract Infection and Renal Scarring.

PubMed

Keren, Ron; Shaikh, Nader; Pohl, Hans; Gravens-Mueller, Lisa; Ivanova, Anastasia; Zaoutis, Lisa; Patel, Melissa; deBerardinis, Rachel; Parker, Allison; Bhatnagar, Sonika; Haralam, Mary Ann; Pope, Marcia; Kearney, Diana; Sprague, Bruce; Barrera, Raquel; Viteri, Bernarda; Egigueron, Martina; Shah, Neha; Hoberman, Alejandro

2015-07-01

To identify risk factors for recurrent urinary tract infection (UTI) and renal scarring in children who have had 1 or 2 febrile or symptomatic UTIs and received no antimicrobial prophylaxis. This 2-year, multisite prospective cohort study included 305 children aged 2 to 71 months with vesicoureteral reflux (VUR) receiving placebo in the RIVUR (Randomized Intervention for Vesicoureteral Reflux) study and 195 children with no VUR observed in the CUTIE (Careful Urinary Tract Infection Evaluation) study. Primary exposure was presence of VUR; secondary exposures included bladder and bowel dysfunction (BBD), age, and race. Outcomes were recurrent febrile or symptomatic urinary tract infection (F/SUTI) and renal scarring. Children with VUR had higher 2-year rates of recurrent F/SUTI (Kaplan-Meier estimate 25.4% compared with 17.3% for VUR and no VUR, respectively). Other factors associated with recurrent F/SUTI included presence of BBD at baseline (adjusted hazard ratio: 2.07 [95% confidence interval (CI): 1.09-3.93]) and presence of renal scarring on the baseline (99m)Tc-labeled dimercaptosuccinic acid scan (adjusted hazard ratio: 2.88 [95% CI: 1.22-6.80]). Children with BBD and any degree of VUR had the highest risk of recurrent F/SUTI (56%). At the end of the 2-year follow-up period, 8 (5.6%) children in the no VUR group and 24 (10.2%) in the VUR group had renal scars, but the difference was not statistically significant (adjusted odds ratio: 2.05 [95% CI: 0.86-4.87]). VUR and BBD are risk factors for recurrent UTI, especially when they appear in combination. Strategies for preventing recurrent UTI include antimicrobial prophylaxis and treatment of BBD. Copyright © 2015 by the American Academy of Pediatrics.

Tumour stage and gender predict recurrence and second primary malignancies in head and neck cancer: a multicentre study within the INHANCE consortium.

PubMed

Leoncini, Emanuele; Vukovic, Vladimir; Cadoni, Gabriella; Giraldi, Luca; Pastorino, Roberta; Arzani, Dario; Petrelli, Livia; Wünsch-Filho, Victor; Toporcov, Tatiana Natasha; Moyses, Raquel Ayub; Matsuo, Keitaro; Bosetti, Cristina; La Vecchia, Carlo; Serraino, Diego; Simonato, Lorenzo; Merletti, Franco; Boffetta, Paolo; Hashibe, Mia; Lee, Yuan-Chin Amy; Boccia, Stefania

2018-05-19

Recurrence and second primary cancer (SPC) continue to represent major obstacles to long-term survival in head and neck cancer (HNC). Our aim was to evaluate whether established demographics, lifestyle-related risk factors for HNC and clinical data are associated with recurrence and SPC in HNC. We conducted a multicentre study by using data from five studies members of the International Head and Neck Cancer Epidemiology consortium-Milan, Rome, Western Europe, Sao Paulo, and Japan, totalling 4005 HNC cases with a median age of 59 (interquartile range 52-67). Multivariate hazard ratios (HRs) and 95% confidence intervals (CIs) were estimated for recurrence and SPC. During follow-up, 1161 (29%) patients had recurrence and 343 (8.6%) developed SPC. Advanced tumour stage was associated with increased risk of recurrence in HNC overall (HR = 1.76, 95% CI 1.41-2.19). Women with laryngeal cancer had a reduced risk of recurrence compared to men (HR = 0.39, 95% CI: 0.24-0.74). Concerning predictors of SPC, advanced age (HR = 1.02; 95% CI: 1.00-1.04) and alcohol consumption (> 1 drink per day, HR = 2.11; 95% CI: 1.13-3.94) increased the risk of SPC among patients with laryngeal cancer. Additionally, women were at higher risk of SPC, in HNC overall group (HR = 1.68; 95% CI: 1.13-2.51) and oropharyngeal cancer group (HR = 1.74; 95% CI: 1.02-2.98). Tumour stage and male gender (larynx only) were positive predictors of cancer recurrence in HNC patients. Predictors of SPC were advanced age and alcohol use among laryngeal cancer cases, and female gender for oropharyngeal and HNC overall.

Poor Prognosis after Second Locoregional Recurrences in the CALOR Trial

PubMed Central

Wapnir, Irene L.; Gelber, Shari; Anderson, Stewart J.; Mamounas, Eleftherios P.; Robidoux, André; Martín, Miguel; Nortier, Johan W.R.; Geyer, Charles E.; Paterson, Alexander H.G.; Láng, István; Price, Karen N.; Coates, Alan S.; Gelber, Richard D.; Rastogi, Priya; Regan, Meredith M.; Wolmark, Norman; Aebi, Stefan

2016-01-01

Purpose Isolated locoregional recurrences (ILRR) of breast cancer confer a significant risk of developing distant metastasis. Management practices and second-ILRR events in the CALOR trial are investigated. Methods 162 patients with ILRR were randomly assigned to receive post-operative chemotherapy, or no chemotherapy. Descriptive statistics characterize outcomes according to local therapy and the influence of hormone receptor status on subsequent recurrences. Competing risk regression models, Kaplan-Meier estimates, and Cox proportional hazards models evaluate associations between treatment, site of second recurrence and outcome. Results The median follow-up was 4.9 years. Of the 98 patients who received breast-conserving primary surgery (BCS), 89 had an ipsilateral-breast tumor recurrence (IBTR); salvage mastectomy was performed in 73 and repeat lumpectomy in 16. Another 8 had nodal-ILRR and 1 chest wall-ILRR. Among 64 whose primary surgery was mastectomy, 52 had chest wall/skin-ILRR and 12 nodal-ILRR. Fifteen patients developed a second-ILRR at a median time from ILRR of 1.6 years (range: 0.08–4.8). All second-ILRR occurred in patients with PR-negative ILRR. Seven (47%) of 15 patients with second-ILRR, and 19 (51%) of 37 with a distant recurrence have died. On multivariable analysis, chemotherapy for the primary cancer (HR 3.55, 95% CI 1.15–10.9, p=0.03) and time interval (continuous) from primary surgery (HR 0.87 95% CI 0.75–1.00, p=0.05) were significant predictors of survival following either a second-ILRR or distant recurrence. Conclusions Second-ILRRs represented about one-third of all recurrence events after ILRR and all were PR negative. These second-ILRRs, as well as distant metastases, portend an unfavorable outcome. PMID:27663567

The Effect of Strict Adherence to a High-Fiber, High-Fruit and -Vegetable, and Low-Fat Eating Pattern on Adenoma Recurrence

PubMed Central

Wanke, Kay; Albert, Paul S.; Kahle, Lisa; Schatzkin, Arthur; Lanza, Elaine

2009-01-01

Individual differences in dietary intake are thought to account for substantial variation in cancer incidence. However, there has been a consistent lack of effect for low-fat, high-fiber dietary interventions and risk of colorectal cancer. These inconsistencies may reflect the multistage process of cancer as well as the range and timing of dietary change. Another potential reason for the lack of effect is poor dietary adherence among participants in these trials. The authors examined the effect of strict adherence to a low-fat, high-fiber, high-fruit and -vegetable intervention over 4 years among participants (n = 1,905) in the US Polyp Prevention Trial (1991–1998) on colorectal adenoma recurrence. There was a wide range of individual variation in the level of compliance among intervention participants. The most adherent participants, defined as “super compliers” (n = 210), consistently reported that they met or exceeded each of the 3 dietary goals at all 4 annual visits. Multivariate logistic regression models were used to estimate the association between dietary adherence and adenoma recurrence. The authors observed a 35% reduced odds of adenoma recurrence among super compliers compared with controls (odds ratio = 0.65, 95% confidence interval: 0.47, 0.92). Findings suggest that high compliance with a low-fat, high-fiber diet is associated with reduced risk of adenoma recurrence. PMID:19643809

Earthquakes: Recurrence and Interoccurrence Times

NASA Astrophysics Data System (ADS)

Abaimov, S. G.; Turcotte, D. L.; Shcherbakov, R.; Rundle, J. B.; Yakovlev, G.; Goltz, C.; Newman, W. I.

2008-04-01

The purpose of this paper is to discuss the statistical distributions of recurrence times of earthquakes. Recurrence times are the time intervals between successive earthquakes at a specified location on a specified fault. Although a number of statistical distributions have been proposed for recurrence times, we argue in favor of the Weibull distribution. The Weibull distribution is the only distribution that has a scale-invariant hazard function. We consider three sets of characteristic earthquakes on the San Andreas fault: (1) The Parkfield earthquakes, (2) the sequence of earthquakes identified by paleoseismic studies at the Wrightwood site, and (3) an example of a sequence of micro-repeating earthquakes at a site near San Juan Bautista. In each case we make a comparison with the applicable Weibull distribution. The number of earthquakes in each of these sequences is too small to make definitive conclusions. To overcome this difficulty we consider a sequence of earthquakes obtained from a one million year “Virtual California” simulation of San Andreas earthquakes. Very good agreement with a Weibull distribution is found. We also obtain recurrence statistics for two other model studies. The first is a modified forest-fire model and the second is a slider-block model. In both cases good agreements with Weibull distributions are obtained. Our conclusion is that the Weibull distribution is the preferred distribution for estimating the risk of future earthquakes on the San Andreas fault and elsewhere.

Antiplatelet Agents for the Secondary Prevention of Ischemic Stroke or Transient Ischemic Attack: A Network Meta-Analysis.

PubMed

Wang, Wen; Zhang, Lu; Liu, Weiming; Zhu, Qin; Lan, Qing; Zhao, Jizong

2016-05-01

Stroke can cause high morbidity and mortality, and ischemic stroke (IS) and transient ischemic attack (TIA) patients have a high stroke recurrence rate. Antiplatelet agents are the standard therapy for these patients, but it is often difficult for clinicians to select the best therapy from among the multiple treatment options. We therefore performed a network meta-analysis to estimate the efficacy of antiplatelet agents for secondary prevention of recurrent stroke. We systematically searched 3 databases (PubMed, Embase, and Cochrane) for relevant studies published through August 2015. The primary end points of this meta-analysis were overall stroke, hemorrhagic stroke, and fatal stroke. A total of 30 trials were included in our network meta-analysis and abstracted data. Among the therapies evaluated in the included trials, the estimates for overall stroke and hemorrhagic stroke for cilostazol (Cilo) were significantly better than those for aspirin (odds ratio [OR] = .64, 95% credibility interval [CrI], .45-.91; OR = .23, 95% CrI, .08-.58). The estimate for fatal stroke was highest for Cilo plus aspirin combination therapy, followed by Cilo therapy. The results of our meta-analysis indicate that Cilo significantly improves overall stroke and hemorrhagic stroke in IS or TIA patients and reduces fatal stroke, but with low statistical significance. Our results also show that Cilo was significantly more efficient than other therapies in Asian patients; therefore, future trials should focus on Cilo treatment for secondary prevention of recurrent stroke in non-Asian patients. Copyright © 2016 National Stroke Association. Published by Elsevier Inc. All rights reserved.

Detecting independent and recurrent copy number aberrations using interval graphs.

PubMed

Wu, Hsin-Ta; Hajirasouliha, Iman; Raphael, Benjamin J

2014-06-15

Somatic copy number aberrations SCNAS: are frequent in cancer genomes, but many of these are random, passenger events. A common strategy to distinguish functional aberrations from passengers is to identify those aberrations that are recurrent across multiple samples. However, the extensive variability in the length and position of SCNA: s makes the problem of identifying recurrent aberrations notoriously difficult. We introduce a combinatorial approach to the problem of identifying independent and recurrent SCNA: s, focusing on the key challenging of separating the overlaps in aberrations across individuals into independent events. We derive independent and recurrent SCNA: s as maximal cliques in an interval graph constructed from overlaps between aberrations. We efficiently enumerate all such cliques, and derive a dynamic programming algorithm to find an optimal selection of non-overlapping cliques, resulting in a very fast algorithm, which we call RAIG (Recurrent Aberrations from Interval Graphs). We show that RAIG outperforms other methods on simulated data and also performs well on data from three cancer types from The Cancer Genome Atlas (TCGA). In contrast to existing approaches that employ various heuristics to select independent aberrations, RAIG optimizes a well-defined objective function. We show that this allows RAIG to identify rare aberrations that are likely functional, but are obscured by overlaps with larger passenger aberrations. http://compbio.cs.brown.edu/software. © The Author 2014. Published by Oxford University Press.

Colorectal cancer (CRC) monitoring by 6-monthly 18FDG-PET/CT: an open-label multicentre randomised trial.

PubMed

Sobhani, I; Itti, E; Luciani, A; Baumgaertner, I; Layese, R; André, T; Ducreux, M; Gornet, J-M; Goujon, G; Aparicio, T; Taieb, J; Bachet, J-B; Hemery, F; Retbi, A; Mons, M; Flicoteaux, R; Rhein, B; Baron, S; Cherrak, I; Rufat, P; Le Corvoisier, P; de'Angelis, N; Natella, P-A; Maoulida, H; Tournigand, C; Durand Zaleski, I; Bastuji-Garin, S

2018-04-01

[18F]2-fluoro-2-deoxy-d-glucose positron emission tomography/computed tomography (18FDG-PET/CT) has high sensitivity for detecting recurrences of colorectal cancer (CRC). Our objective was to determine whether adding routine 6-monthly 18FDG-PET/CT to our usual monitoring strategy improved patient outcomes and to assess the effect on costs. In this open-label multicentre trial, patients in remission of CRC (stage II perforated, stage III, or stage IV) after curative surgery were randomly assigned (1 : 1) to usual monitoring alone (3-monthly physical and tumour marker assays, 6-monthly liver ultrasound and chest radiograph, and 6-monthly whole-body computed tomography) or with 6-monthly 18FDG-PET/CT, for 3 years. A multidisciplinary committee reviewed each patient's data every 3 months and classified the recurrence status as yes/no/doubtful. Recurrences were treated with curative surgery alone if feasible and with chemotherapy otherwise. The primary end point was treatment failure defined as unresectable recurrence or death. Relative risks were estimated, and survival was analysed using the Kaplan-Meier method, log-rank test, and Cox models. Direct costs were compared. Of the 239 enrolled patients, 120 were in the intervention arm and 119 in the control arm. The failure rate was 29.2% (31 unresectable recurrences and 4 deaths) in the intervention group and 23.7% (27 unresectable recurrences and 1 death) in the control group (relative risk = 1.23; 95% confidence interval, 0.80-1.88; P = 0.34). The multivariate analysis also showed no significant difference (hazards ratio, 1.33; 95% confidence interval, 0.8-2.19; P = 0.27). Median time to diagnosis of unresectable recurrence (months) was significantly shorter in the intervention group [7 (3-20) versus 14.3 (7.3-27), P = 0.016]. Mean cost/patient was higher in the intervention group (18 192 ± 27 679 € versus 11 131 ± 13  €, P < 0.033). 18FDG-PET/CT, when added every 6 months, increased costs without decreasing treatment failure rates in patients in remission of CRC. The control group had very close follow-up, and any additional improvement (if present) would be small and hard to detect. NCT00624260.

Development of Procedures for Computing Site Seismicity

DTIC Science & Technology

1993-02-01

surface wave magnitude when in the range of 5 to 7.5. REFERENCES Ambraseys, N.N. (1970). "Some characteristic features of the Anatolian fault zone...geology seismicity and environmental impact, Association of Engineering Geologists , Special Publication. Los Angeles, CA, University Publishers, 1973... Geologists ) Recurrenc.e Recurrence Slip Intervals (yr) at Intervals (yr) over Fault Rate Length a Point on Fault Length of Fault (cm/yI) (km) (Rý) (R

Nitrofurantoin vs other prophylactic agents in reducing recurrent urinary tract infections in adult women: a systematic review and meta-analysis.

PubMed

Price, Jameca Renee; Guran, Larissa A; Gregory, W Thomas; McDonagh, Marian S

2016-11-01

The clinical and financial burden from bladder infections is significant. Daily antibiotic use is the recommended strategy for recurrent urinary tract infection prevention. Increasing antibiotic resistance rates, however, require immediate identification of innovative alternative prophylactic therapies. This systematic review aims to provide guidance on gaps in evidence to guide future research. The objective of this review was to provide current pooled estimates of randomized control trials comparing the effects of nitrofurantoin vs other agents in reducing recurrent urinary tract infections in adult, nonpregnant women and assess relative adverse side effects. Data sources included the following: MEDLINE, Jan. 1, 1946, to Jan. 31, 2015; Cochrane Central Register of Controlled Trials the Cochrane Database of Systematic Reviews, and web sites of the National Institute for Clinical Excellence, and the National Guideline Clearinghouse from 2000 to 2015. Randomized control trials of women with recurrent urinary tract infections comparing nitrofurantoin with any other treatment were included. A protocol for the study was developed a priori. Published guidance was followed for assessment of study quality. All meta-analyses were performed using random-effects models with Stats Direct Software. Dual review was used for all decisions and data abstraction. Twelve randomized control trials involving 1063 patients were included. One study that had a serious flaw was rated poor in quality, one study rated good, and the remainder fair. No significant differences in prophylactic antibiotic treatment with nitrofurantoin and norfloxacin, trimethoprim, sulfamethoxazole/trimethoprim, methamine hippurate, estriol, or cefaclor were found in clinical or microbiological cure in adult nonpregnant women with recurrent urinary tract infections (9 randomized control trials, 673 patients, relative risk ratio, 1.06; 95% confidence interval, 0.89-1.27; I 2 , 65%; and 12 randomized control trials, 1063 patients, relative risk ratio, 1.06; 95% confidence interval, 0.90-1.26; I 2 , 76%, respectively). Duration of prophylaxis also did not have a significant impact on outcomes. There was a statistically significant difference in overall adverse effects, with nitrofurantoin resulting in greater risk than other prophylactic treatments (10 randomized control trials, 948 patients, relative risk ratio, 2.17; 95% confidence interval, 1.34-3.50; I 2 , 61%). Overall, the majority of nitrofurantoin adverse effects were gastrointestinal, with a significant difference for withdrawals (12 randomized control trials, 1063 patients, relative risk ratio, 2.14; 95% confidence interval, 1.28-3.56; I 2 , 8%). Nitrofurantoin had similar efficacy but a greater risk of adverse events than other prophylactic treatments. Balancing the risks of adverse events, particularly gastrointestinal symptoms, with potential benefits of decreasing collateral ecological damage should be considered if selecting nitrofurantoin. Copyright © 2016 Elsevier Inc. All rights reserved.

Rethinking turbidite paleoseismology along the Cascadia subduction zone

USGS Publications Warehouse

Atwater, Brian F.; Carson, Bobb; Griggs, Gary B.; Johnson, H. Paul; Salmi, Marie

2014-01-01

A stratigraphic synthesis of dozens of deep-sea cores, most of them overlooked in recent decades, provides new insights into deep-sea turbidites as guides to earthquake and tsunami hazards along the Cascadia subduction zone, which extends 1100 km along the Pacific coast of North America. The synthesis shows greater variability in Holocene stratigraphy and facies off the Washington coast than was recognized a quarter century ago in a confluence test for seismic triggering of sediment gravity flows. That test compared counts of Holocene turbidites upstream and downstream of a deep-sea channel junction. Similarity in the turbidite counts among seven core sites provided evidence that turbidity currents from different submarine canyons usually reached the junction around the same time, as expected of widespread seismic triggering. The fuller synthesis, however, shows distinct differences between tributaries, and these differences suggest sediment routing for which the confluence test was not designed. The synthesis also bears on recent estimates of Cascadia earthquake magnitudes and recurrence intervals. The magnitude estimates hinge on stratigraphic correlations that discount variability in turbidite facies. The recurrence estimates require turbidites to represent megathrust earthquakes more dependably than they do along a flow path where turbidite frequency appears limited less by seismic shaking than by sediment supply. These concerns underscore the complexity of extracting earthquake history from deep-sea turbidites at Cascadia.

Thiopurines are associated with a reduction in surgical re-resections in patients with Crohn's disease: a long-term follow-up study in a regional and academic cohort.

PubMed

van Loo, Ellen S; Vosseberg, Ninke W; van der Heide, Frans; Pierie, Jean-Pierre E N; van der Linde, Klaas; Ploeg, Rutger J; Dijkstra, Gerard; Nieuwenhuijs, Vincent B

2013-12-01

Combination therapy of thiopurines and anti-tumor necrosis factor alpha (TNF-α) antibodies is the most effective medical treatment of Crohn's disease (CD). Data on thiopurines and anti-TNF-α antibodies in preventing surgical recurrence (need for re-resection) of CD are scarce. Therefore, we analyzed which factors were involved in surgical recurrence of CD in a large cohort of patients with CD operated in a regional and a university hospital. This is a retrospective cohort study of 567 patients who underwent surgery for CD. Clinical data and risk factors for surgical recurrence were analyzed, focusing on medical therapy and hospital type. Overall, 237 (41.8%) patients developed a surgical recurrence, after a median of 70 (2-482) months. Before surgical recurrence, 235 patients (41.4%) and 116 patients (20.5%) used thiopurines and anti-TNF-α antibodies, respectively. Multivariate analysis identified 3 independent risk factors associated with surgical recurrence of CD. A higher risk was seen in patients with colonic disease compared with patients with ileal disease (hazard ratio, 1.56; 95% confidence interval, 1.10-2.21; P = 0.012) and in patients using multiple types of medication (hazard ratio, 1.38; 95% confidence interval, 1.25-1.54; P < 0.001). However, a lower risk was seen in patients using thiopurines (hazard ratio, 0.51; 95% confidence interval, 0.34-0.77; P = 0.001). Thiopurines are effective in preventing surgical recurrence of CD. The role of anti-TNF-α antibodies seems promising as well. Combination therapy of thiopurines and anti-TNF-α antibodies for prevention of surgical recurrence of CD should be studied in a randomized trial.

Earthquake shaking hazard estimates and exposure changes in the conterminous United States

USGS Publications Warehouse

Jaiswal, Kishor S.; Petersen, Mark D.; Rukstales, Kenneth S.; Leith, William S.

2015-01-01

A large portion of the population of the United States lives in areas vulnerable to earthquake hazards. This investigation aims to quantify population and infrastructure exposure within the conterminous U.S. that are subjected to varying levels of earthquake ground motions by systematically analyzing the last four cycles of the U.S. Geological Survey's (USGS) National Seismic Hazard Models (published in 1996, 2002, 2008 and 2014). Using the 2013 LandScan data, we estimate the numbers of people who are exposed to potentially damaging ground motions (peak ground accelerations at or above 0.1g). At least 28 million (~9% of the total population) may experience 0.1g level of shaking at relatively frequent intervals (annual rate of 1 in 72 years or 50% probability of exceedance (PE) in 50 years), 57 million (~18% of the total population) may experience this level of shaking at moderately frequent intervals (annual rate of 1 in 475 years or 10% PE in 50 years), and 143 million (~46% of the total population) may experience such shaking at relatively infrequent intervals (annual rate of 1 in 2,475 years or 2% PE in 50 years). We also show that there is a significant number of critical infrastructure facilities located in high earthquake-hazard areas (Modified Mercalli Intensity ≥ VII with moderately frequent recurrence interval).

Peak data for U.S. Geological Survey gaging stations, Texas network and computer program to estimate peak-streamflow frequency

USGS Publications Warehouse

Slade, R.M.; Asquith, W.H.

1996-01-01

About 23,000 annual peak streamflows and about 400 historical peak streamflows exist for about 950 stations in the surface-water data-collection network of Texas. These data are presented on a computer diskette along with the corresponding dates, gage heights, and information concerning the basin, and nature or cause for the flood. Also on the computer diskette is a U.S. Geological Survey computer program that estimates peak-streamflow frequency based on annual and historical peak streamflow. The program estimates peak streamflow for 2-, 5-, 10-, 25-, 50-, and 100-year recurrence intervals and is based on guidelines established by the Interagency Advisory Committee on Water Data. Explanations are presented for installing the program, and an example is presented with discussion of its options.

Association of Locoregional Control With High Body Mass Index in Women Undergoing Breast Conservation Therapy for Early-Stage Breast Cancer

DOE Office of Scientific and Technical Information (OSTI.GOV)

Bergom, Carmen; Kelly, Tracy; Bedi, Meena

Purpose: Obesity, as measured by the body mass index (BMI), is a risk factor for distant recurrence and decreased survival in breast cancer. We sought to determine whether the BMI correlated with local recurrence and reduced survival in a cohort of predominantly obese women treated with breast conservation therapy. Methods and Materials: From 1998 to 2010, 154 women with early-stage invasive breast cancer and 39 patients with ductal carcinoma in situ underwent prone whole breast irradiation. Cox proportional hazards regression, Kaplan-Meier methods with the log-rank test, and multivariate analysis were used to explore the association of the outcomes with themore » BMI. Results: The median patient age was 60 years, and the median follow-up duration was 73 months. The median BMI was 33.2 kg/m{sup 2}; 91% of the patients were overweight (BMI ≥25 kg/m{sup 2}) and 69% of the patients were clinically obese (BMI ≥30 kg/m{sup 2}). The BMI was significantly associated with the locoregional recurrence-free interval for patients with invasive cancer and ductal carcinoma in situ (hazard ratio [HR], 1.09; P=.047). Also, a trend was seen for increased locoregional recurrence with a higher BMI (P=.09) for patients with invasive disease, which was significant when examining the outcomes with a BMI stratified by the median value of 33.2 kg/m{sup 2} (P=.008). A greater BMI was also significantly associated with decreased distant recurrence-free interval (HR, 1.09; P=.011) and overall survival (HR, 1.09; P=.004); this association remained on multivariate analysis (distant recurrence-free interval, P=.034; overall survival, P=.0007). Conclusions: These data suggest that the BMI might affect the rate of locoregional recurrence in breast cancer patients. A higher BMI predicted a worse distant recurrence-free interval and overall survival. The present investigation adds to the increasing evidence that BMI is an important prognostic factor in early-stage breast cancer treated with breast conservation therapy.« less

Low-dimensional recurrent neural network-based Kalman filter for speech enhancement.

PubMed

Xia, Youshen; Wang, Jun

2015-07-01

This paper proposes a new recurrent neural network-based Kalman filter for speech enhancement, based on a noise-constrained least squares estimate. The parameters of speech signal modeled as autoregressive process are first estimated by using the proposed recurrent neural network and the speech signal is then recovered from Kalman filtering. The proposed recurrent neural network is globally asymptomatically stable to the noise-constrained estimate. Because the noise-constrained estimate has a robust performance against non-Gaussian noise, the proposed recurrent neural network-based speech enhancement algorithm can minimize the estimation error of Kalman filter parameters in non-Gaussian noise. Furthermore, having a low-dimensional model feature, the proposed neural network-based speech enhancement algorithm has a much faster speed than two existing recurrent neural networks-based speech enhancement algorithms. Simulation results show that the proposed recurrent neural network-based speech enhancement algorithm can produce a good performance with fast computation and noise reduction. Copyright © 2015 Elsevier Ltd. All rights reserved.

Hydrologic Modeling and Flood Frequency Analysis for Ordinary High Water Mark Delineation

DTIC Science & Technology

2016-02-01

that may have adjacent floodplains and terraces. Each of these geomorphic features may have different characteristic sediment grain sizes, different...relationship between streamflow recurrence intervals and ERDC/CRREL TR-16-2 7 geomorphic features observed in the field. The bankfull channel is the cu... geomorphic features is one of many reasons described in this document why a specific recurrence interval cannot be used to determine the OHWM. At the same

A record of large earthquakes on the southern Hayward fault for the past 1800 years

USGS Publications Warehouse

Lienkaemper, J.J.; Williams, P.L.

2007-01-01

This is the second article presenting evidence of the occurrence and timing of paleoearthquakes on the southern Hayward fault as interpreted from trenches excavated within a sag pond at the Tyson's Lagoon site in Fremont, California. We use the information to estimate the mean value and aperiodicity of the fault's recurrence interval (RI): two fundamental parameters for estimation of regional seismic hazard. An earlier article documented the four most recent earthquakes, including the historic 1868 earthquake. In this article we present evidence for at least seven earlier paleoruptures since about A.D. 170. We document these events with evidence for ground rupture, such as the presence of blocky colluvium at the base of the main trace fault scarp, and by corroborating evidence such as simultaneous liquefaction or an increase in deformation immediately below event horizons. The mean RI is 170 ?? 82 yr (1??, standard deviation of the sample), aperiodicity is 0.48, and individual intervals may be expected to range from 30 to 370 yr (95.4% confidence). The mean RI is consistent with the recurrence model of the Working Group on California Earthquake Probabilities (2003) (mean, 161 yr; range, 99 yr [2.5%]; 283 yr [97.5%]). We note that the mean RI for the five most recent events may have been only 138 ?? 58 yr (1??). Hypothesis tests for the shorter RI do not demonstrate that any recent acceleration has occurred compared to the earlier period or the entire 1800-yr record, principally because of inherent uncertainties of the event ages.

Geomagnetic detection of the sectorial solar magnetic field and the historical peculiarity of minimum 23-24

USGS Publications Warehouse

Love, Jeffrey J.; Rigler, J.

2012-01-01

[1] Analysis is made of the geomagnetic-activityaaindex covering solar cycle 11 to the beginning of 24, 1868–2011. Autocorrelation shows 27.0-d recurrent geomagnetic activity that is well-known to be prominent during solar-cycle minima; some minima also exhibit a smaller amount of 13.5-d recurrence. Previous work has shown that the recent solar minimum 23–24 exhibited 9.0 and 6.7-d recurrence in geomagnetic and heliospheric data, but those recurrence intervals were not prominently present during the preceding minima 21–22 and 22–23. Using annual-averages and solar-cycle averages of autocorrelations of the historicalaadata, we put these observations into a long-term perspective: none of the 12 minima preceding 23–24 exhibited prominent 9.0 and 6.7-d geomagnetic activity recurrence. We show that the detection of these recurrence intervals can be traced to an unusual combination of sectorial spherical-harmonic structure in the solar magnetic field and anomalously low sunspot number. We speculate that 9.0 and 6.7-d recurrence is related to transient large-scale, low-latitude organization of the solar dynamo, such as seen in some numerical simulations.

Herpes simplex virus type 2-associated recurrent aseptic meningitis (Mollaret's meningitis) with a recurrence after 11-year interval: a case report.

PubMed

Nakamura, Yoshitsugu; Nakajima, Hideto; Kano, Yosuke; Unoda, Kiichi; Ishida, Shimon; Kimura, Fumiharu

2016-11-29

A 55-year-old woman was diagnosed with aseptic meningitis at the age of 43 and 44. She developed sudden fever and headache, and she showed nuchal rigidity. Cerebrospinal fluid examination revealed pleocytosis (cell count 208/mm 3 ) and was positive for herpes simplex virus type 2 (HSV-2) DNA by PCR. Acyclovir was started on the first day of admission, and she was complete recovery. Preserved cerebrospinal fluid specimen from aseptic meningitis at the age of 44 was also positive for HSV-2 DNA by PCR. She was diagnosed with HSV-2 associated recurrent aseptic meningitis (Mollaret's meningitis) with a recurrence after 11-year interval. She repeatedly relapsed genital herpes after 44 years old and she was treated with valacyclovir whenever genital herpes relapses. But she showed no genital herpes at the onset of meningitis. Because HSV-2 is one of the most significant causes of recurrent meningitis, we would like to stress that HSV-2 infection and antiviral therapy should always be kept in mind for a recurrent meningitis case.

Internal urethrotomy for recurrence after perineal anastomotic urethroplasty for posttraumatic pediatric posterior urethral stricture: could it be sufficient?

PubMed

Helmy, Tamer E; Hafez, Ashraf T

2013-06-01

To evaluate the long-term outcome of visual internal urethrotomy (VIU) after perineal anastomotic urethroplasty for posttraumatic pediatric posterior urethral strictures. Data of 22 boys who had undergone internal urethrotomy for recurrent stricture after perineal anastomotic urethroplasty for posttraumatic posterior urethral strictures between 1998 and 2008 were analyzed retrospectively regarding patient age, interval between anastomotic urethroplasty and internal urethrotomy, stricture length, surgical technique, and postoperative complications. VIU was performed in patients in whom a guidewire could be passed beyond the stricture segment. The eventual surgical success was defined as asymptomatic voiding without clinical evidence of residual stricture (good flow rate and absence of residual urine). The mean (range) age of patients was 12.2 (3-17) years. All patients had a road traffic accident with associated pelvic fracture. The perineal approach for anastomotic urethroplasty was adopted in all. The estimated stricture length was 0.5 cm or less in 15 patients and was 0.5 to 1 cm in 7 patients. The interval between anastomotic urethroplasty and internal urethrotomy was early-after 12 weeks or less-in 13 children or late-beyond 12 weeks-in the remaining 9. The overall mean interval was 18 (5-63) weeks. In all patients, a guidewire could be passed through the strictured area. One VIU was performed in 17 patients, 2 VIU in 3 patients, while 3 VIU were performed in 2 patients. There was no extravasation reported. The mean follow-up duration was 98 (38-210) months. VIU was successful in 20 of 22 (90%) patients. All patients voided with no symptoms and were continent. VIU offers high success rate and can be sufficient in recurrent strictures of less than 1 cm length after anastomotic urethroplasty in children whenever a guidewire can be passed through the stricture area.

Inter-plate aseismic slip on the subducting plate boundaries estimated from repeating earthquakes

NASA Astrophysics Data System (ADS)

Igarashi, T.

2015-12-01

Sequences of repeating earthquakes are caused by repeating slips of small patches surrounded by aseismic slip areas at plate boundary zones. Recently, they have been detected in many regions. In this study, I detected repeating earthquakes which occurred in Japan and the world by using seismograms observed in the Japanese seismic network, and investigated the space-time characteristics of inter-plate aseismic slip on the subducting plate boundaries. To extract repeating earthquakes, I calculate cross-correlation coefficients of band-pass filtering seismograms at each station following Igarashi [2010]. I used two data-set based on USGS catalog for about 25 years from May 1990 and JMA catalog for about 13 years from January 2002. As a result, I found many sequences of repeating earthquakes in the subducting plate boundaries of the Andaman-Sumatra-Java and Japan-Kuril-Kamchatka-Aleutian subduction zones. By applying the scaling relations among a seismic moment, recurrence interval and slip proposed by Nadeau and Johnson [1998], they indicate the space-time changes of inter-plate aseismic slips. Pairs of repeating earthquakes with the longest time interval occurred in the Solomon Islands area and the recurrence interval was about 18.5 years. The estimated slip-rate is about 46 mm/year, which correspond to about half of the relative plate motion in this area. Several sequences with fast slip-rates correspond to the post-seismic slips after the 2004 Sumatra-Andaman earthquake (M9.0), the 2006 Kuril earthquake (M8.3), the 2007 southern Sumatra earthquake (M8.5), and the 2011 Tohoku-oki earthquake (M9.0). The database of global repeating earthquakes enables the comparison of the inter-plate aseismic slips of various plate boundary zones of the world. I believe that I am likely to detect more sequences by extending analysis periods in the area where they were not found in this analysis.

Placental weight in the first pregnancy and risk for preeclampsia in the second pregnancy: A population-based study of 186 859 women.

PubMed

Dypvik, Johanne; Larsen, Sandra; Haavaldsen, Camilla; Jukic, Anne M; Vatten, Lars J; Eskild, Anne

2017-07-01

To study whether placental weight in the first pregnancy is associated with preeclampsia in the second pregnancy. In this population-based study, we included all women with two consecutive singleton pregnancies reported to the Medical Birth Registry of Norway during 1999-2012 (n=186 859). Placental weight in the first pregnancy was calculated as z-scores, and the distribution was divided into five groups of equal size (quintiles). We estimated crude and adjusted odds ratios with 95% confidence intervals for preeclampsia in the second pregnancy according to quintiles of placental weight z-scores in the first pregnancy. The 3rd quintile was used as the reference group. Among women without preeclampsia in the first pregnancy, 1.4% (2507/177 149) developed preeclampsia in the second pregnancy. In these women, the risk for preeclampsia in the second pregnancy was associated with placental weight in the first pregnancy in both lowest (crude odds ratio (cOR) 1.30, 95% confidence interval (CI); 1.14-1.47) and highest quintile (cOR 1.20, 95% CI; 1.06-1.36). The risk associated with the highest quintile of placental weight was confined to term preeclampsia. Among women with preeclampsia in the first pregnancy, 15.7% (1522/9710) developed recurrent preeclampsia, and the risk for recurrent preeclampsia was associated with placental weight in lowest quintile in the first pregnancy (cOR 1.30, 95% CI; 1.10-1.55). Adjustment for interval between pregnancies, maternal diabetes, age, and smoking in the first pregnancy did not alter these estimates notably. Placental weight in the first pregnancy might help to identify women who could be at risk for developing preeclampsia in a second pregnancy. Copyright © 2017 The Authors. Published by Elsevier B.V. All rights reserved.

Associations of Statin Use With Colorectal Cancer Recurrence and Mortality in a Danish Cohort.

PubMed

Lash, Timothy L; Riis, Anders H; Ostenfeld, Eva B; Erichsen, Rune; Vyberg, Mogens; Ahern, Thomas P; Thorlacius-Ussing, Ole

2017-09-15

In earlier studies of the influence of hydroxymethylglutaryl-coenzyme A reductase inhibitors (also known as statins) on colorectal cancer prognosis, investigators reported a reduced rate of cancer-specific mortality. Studies of recurrence are few and small. Using data from Danish registries, we followed 21,152 patients diagnosed with stage I-III colorectal cancer from 2001 to 2011. We estimated the association between statin use in the preceding year and cancer recurrence, cancer-specific mortality, and all-cause mortality rates. We identified 5,036 recurrences, 7,084 deaths from any cause, and 4,066 deaths from colorectal cancer. After adjustment for potential confounders, statin use was not associated with recurrence (adjusted hazard ratio (aHR) = 1.01, 95% confidence interval (CI): 0.93, 1.09), but it was associated with death from colorectal cancer (aHR = 0.72, 95% CI: 0.65, 0.79) and death from any cause (aHR = 0.72, 95% CI: 0.67, 0.76). Statin use in the year preceding recurrence was associated with a reduced risk of cancer-specific mortality (aHR = 0.83, 95% CI: 0.74, 0.92) but also a reduced risk of death from any other cause (aHR = 0.78, 95% CI: 0.61, 1.00). Statin use was not associated with a reduced rate of colorectal cancer recurrence, but it was associated with a reduced rate of cancer-specific mortality, which suggests that there is no cancer-directed benefit; therefore, there is no basis to prescribe statins to colorectal cancer patients who do not have cardiovascular indications. © The Author(s) 2017. Published by Oxford University Press on behalf of the Johns Hopkins Bloomberg School of Public Health. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

Do Interleukin Polymorphisms Play a Role in the Prevention of Colorectal Adenoma Recurrence by Dietary Flavonols?

PubMed Central

Bobe, Gerd; Murphy, Gwen; Albert, Paul S.; Sansbury, Leah B.; Young, Matthew R.; Lanza, Elaine; Schatzkin, Arthur; Colburn, Nancy H.; Cross, Amanda J.

2010-01-01

Chemopreventive dietary compounds, such as flavonols, may inhibit colorectal carcinogenesis partly by altering cytokine expression and attenuating inflammation. Single nucleotide polymorphisms (SNPs) in the promoter regions of genes encoding cytokines may influence flavonol-induced changes in cytokine expression and consequently cancer risk. Using logistic regression, we estimated odds ratios (OR) and 95% confidence intervals (CI) for the association between SNPs of interleukin (IL)-1β, 6, 8, and 10, alone or combined with flavonol intake or serum IL concentration changes, and adenoma recurrence in 808 participants from the intervention arm of the Polyp Prevention Trial, a 4-year intervention study evaluating the effectiveness of a low-fat, high-fiber, high-fruit and vegetable diet on adenoma recurrence.. Overall, SNPs in genes encoding IL-1β, 6, 8, and 10 were not associated with their corresponding serum concentrations or adenoma recurrence. However, individuals homozygous for IL-10 -592 C (OR = 2.23, 95% CI: 1.07–4.66, P interaction = 0.03) or IL-10 -819 C (OR = 2.18, 95% CI: 1.05–4.51, P interaction = 0.05) had an elevated risk of high risk adenoma recurrence when their serum IL-10 concentrations increased during the trial. In addition, IL-6 -174 GG in combination with above median flavonol intake (OR = 0.14, 95% CI: 0.03–0.66) or with decreased IL 6 concentrations (OR = 0.14, 95% CI: 0.03–0.65) reduced the risk of advanced adenoma recurrence, although the interaction term was not statistically significant. In conclusion, our results suggest that IL SNPs, in combination with a flavonol-rich diet or decreased serum IL, may lower the risk of adenoma recurrence. PMID:21160427

Discovering the Complexity of Capable Faults in Northern Chile

NASA Astrophysics Data System (ADS)

Gonzalez, G.; del Río, I. A.; Rojas Orrego, C., Sr.; Astudillo, L. A., Sr.

2017-12-01

Great crustal earthquakes (Mw >7.0) in the upper plate of subduction zones are relatively uncommon and less well documented. We hypothesize that crustal earthquakes are poorly represented in the instrumental record because they have long recurrence intervals. In northern Chile, the extreme long-term aridity permits extraordinary preservation of landforms related to fault activity, making this region a primary target to understand how upper plate faults work at subduction zones. To understand how these faults relate to crustal seismicity in the long-term, we have conducted a detailed palaeoseismological study. We performed a palaeoseismological survey integrating trench logging and photogrammetry based on UAVs. Optically stimulated luminescence (OSL) age determinations were practiced for dating deposits linked to faulting. In this contribution we present the study case of two primary faults located in the Coastal Cordillera of northern Chile between Iquique (21ºS) and Antofagasta (24ºS). We estimate the maximum moment magnitude of earthquakes generated in these upper plate faults, their recurrence interval and the fault-slip rate. We conclude that the studied upper plate faults show a complex kinematics on geological timescales. Faults seem to change their kinematics from normal (extension) to reverse (compression) or from normal to transcurrent (compression) according to the stage of subduction earthquake cycle. Normal displacement is related to coseismic stages and compression is linked to interseismic period. As result this complex interaction these faults are capable of generating Mw 7.0 earthquakes, with recurrence times on the order of thousands of years during every stage of the subduction earthquake cycle.

The Impact of Frictional Healing on Stick-Slip Recurrence Interval and Stress Drop: Implications for Earthquake Scaling

NASA Astrophysics Data System (ADS)

Im, Kyungjae; Elsworth, Derek; Marone, Chris; Leeman, John

2017-12-01

Interseismic frictional healing is an essential process in the seismic cycle. Observations of both natural and laboratory earthquakes demonstrate that the magnitude of stress drop scales with the logarithm of recurrence time, which is a cornerstone of the rate and state friction (RSF) laws. However, the origin of this log linear behavior and short time "cutoff" for small recurrence intervals remains poorly understood. Here we use RSF laws to demonstrate that the back-projected time of null-healing intrinsically scales with the initial frictional state θi. We explore this behavior and its implications for (1) the short-term cutoff time of frictional healing and (2) the connection between healing rates derived from stick-slip sliding versus slide-hold-slide tests. We use a novel, continuous solution of RSF for a one-dimensional spring-slider system with inertia. The numerical solution continuously traces frictional state evolution (and healing) and shows that stick-slip cutoff time also scales with frictional state at the conclusion of the dynamic slip process θi (=Dc/Vpeak). This numerical investigation on the origins of stick-slip response is verified by comparing laboratory data for a range of peak slip velocities. Slower slip motions yield lesser magnitude of friction drop at a given time due to higher frictional state at the end of each slip event. Our results provide insight on the origin of log linear stick-slip evolution and suggest an approach to estimating the critical slip distance on faults that exhibit gradual accelerations, such as for slow earthquakes.

RANDOMIZED TRIAL OF PEGYLATED LIPOSOMAL DOXORUBICIN (PLD) PLUS CARBOPLATIN VERSUS CARBOPLATIN IN PLATINUM-SENSITIVE (PS) PATIENTS WITH RECURRENT EPITHELIAL OVARIAN OR PERITONEAL CARCINOMA AFTER FAILURE OF INITIAL PLATINUM-BASED CHEMOTHERAPY (SOUTH WEST ONCOLOGY GROUP PROTOCOL S0200)

PubMed Central

Alberts, David S.; Liu, P. Y.; Wilczynski, Sharon P.; Clouser, Mary C.; Lopez, Ana Maria; Michelin, David P.; Lanzotti, Victor J.; Markman, Maurie

2008-01-01

Objective Because debate continues over the role of combination, platinum-based chemotherapy for platinum sensitive (PS), recurrent ovarian cancer (OC), we compared overall survival (OS), progression-free survival (PFS), confirmed complete response rate and time to treatment failure in this population. Methods Patients with recurrent stage III or IV OC, a progression-free and platinum-free interval of 6- 24 months after first-line platinum-based chemotherapy and up to 12 courses of a non-platinum containing consolidation treatment were eligible. Patients were randomized to IV pegylated liposomal doxorubicin (PLD) (30 mg/m2) plus IV carboplatin (AUC=5 mg/mL × min) once every 4 weeks (PLD arm) or IV carboplatin alone (AUC=5mg/mL × min) once every 4 weeks. Results The PLD arm enrolled 31 patients and the carboplatin alone arm 30 for a total of 61 patients out of 900 planned. Response rates were 67% for the PLD arm and 32% for the carboplatin only arm (Fisher’s exact p=0.02). The estimated median PFS was 12 and 8 months for PLD versus carboplatin alone. The estimated median OS on the PLD arm was 26 months and 18 months on the carboplatin only arm (p=0.02). Twenty-six percent of the patients on the PLD arm reported grade 4 toxicities, all hematological in nature. Conclusion This study was closed early because of slow patient accrual. The response rate, median PFS and OS results are intriguing. These data suggest that there may be an advantage to the PLD plus carboplatin combination treatment in patients with PS, recurrent OC. The regimen should be further tested. PMID:17949799

Patent foramen ovale closure and medical treatments for secondary stroke prevention: a systematic review of observational and randomized evidence.

PubMed

Kitsios, Georgios D; Dahabreh, Issa J; Abu Dabrh, Abd Moain; Thaler, David E; Kent, David M

2012-02-01

Patients discovered to have a patent foramen ovale in the setting of a cryptogenic stroke may be treated with percutaneous closure, antiplatelet therapy, or anticoagulants. A recent randomized trial (CLOSURE I) did not detect any benefit of closure over medical treatment alone; the optimal medical therapy is also unknown. We synthesized the available evidence on secondary stroke prevention in patients with patent foramen ovale and cryptogenic stroke. A MEDLINE search was performed for finding longitudinal studies investigating medical treatment or closure, meta-analysis of incidence rates (IR), and IR ratios of recurrent cerebrovascular events. Fifty-two single-arm studies and 7 comparative nonrandomized studies and the CLOSURE I trial were reviewed. The summary IR of recurrent stroke was 0.36 events (95% confidence interval [CI], 0.24-0.56) per 100 person-years with closure versus 2.53 events (95% CI, 1.91-3.35) per 100 person-years with medical therapy. In comparative observational studies, closure was superior to medical therapy (IR ratio=0.19; 95% CI, 0.07-0.54). The IR for the closure arm of the CLOSURE I trial was higher than the summary estimate from observational studies; there was no significant benefit of closure over medical treatment (P=0.002 comparing efficacy estimates between observational studies and the trial). Observational and randomized data (9 studies) comparing medical therapies were consistent and suggested that anticoagulants are superior to antiplatelets for preventing stroke recurrence (IR ratio=0.42; 95% CI, 0.18-0.98). Although further randomized trial data are needed to precisely determine the effects of closure on stroke recurrence, the results of CLOSURE I challenge the credibility of a substantial body of observational evidence strongly favoring mechanical closure over medical therapy.

Repeated transsphenoidal surgery or gamma knife radiosurgery in recurrent cushing disease after transsphenoidal surgery.

PubMed

Bodaghabadi, Mohammad; Riazi, Hooman; Aran, Shima; Bitaraf, Mohammad Ali; Alikhani, Mazdak; Alahverdi, Mahmud; Mohamadi, Masoumeh; Shalileh, Keivan; Azar, Maziar

2014-03-01

This study compared Gamma knife radiosurgery (GKRS) and repeated transsphenoidal adenomectomy (TSA) to find the best approach for recurrence of Cushing disease (CD) after unsuccessful first TSA. Fifty-two patients with relapse of CD after TSA were enrolled and randomly underwent a second surgery or GKRS as the next therapeutic approach. They were followed for a mean period of 3.05 ± 0.8 years by physical examination and hormone measurement as well as magnetic resonance imaging. No significant difference was observed in sex ratio, mean age, adenoma type, follow-up duration, and initial hormone level between the two groups. No significant relationship was found between preoperative 24-hour free urine cortisol and disease-free months or tumor volume among both groups. Our statistical analysis showed higher recurrence-free interval in the GKRS group compared with TSA group. With longer recurrence-free interval, GKRS could be considered a good treatment alternative to repeated TSA in recurrent CD. Georg Thieme Verlag KG Stuttgart · New York.

Clinical Investigation of Refractory Chronic Subdural Hematoma: A Comparison of Clinical Factors Between Single and Repeated Recurrences.

PubMed

Matsumoto, Hiroaki; Hanayama, Hiroaki; Okada, Takashi; Sakurai, Yasuo; Minami, Hiroaki; Masuda, Atsushi; Tominaga, Shogo; Miyaji, Katsuya; Yamaura, Ikuya; Yoshida, Yasuhisa; Yoshida, Kozo

2017-11-01

Chronic subdural hematoma (CSDH) is sometimes refractory, and this is troublesome for neurosurgeons. Although many studies have reported risk factors or treatments in efforts to prevent recurrence, those have focused on single recurrence, and few cumulative data are available to analyze refractory CSDH. We defined refractory CSDH as ≥2 recurrences, then analyzed and compared clinical factors between patients with single recurrence and those with refractory CSDH in a cohort study, to clarify whether patients with refractory CSDH experience different or more risk factors than patients with single recurrence, and whether burr-hole irrigation with closed-system drainage reduces refractory CSDH. Seventy-five patients had at least 1 recurrence, with single recurrence in 62 patients and ≥2 recurrences in 13 patients. In comparing clinical characteristics, patients with refractory CSDH were significantly younger (P = 0.04) and showed shorter interval to first recurrence (P < 0.001). Organized CSDH was also significantly associated with refractory CSDH (P = 0.02). Multivariate logistic regression analysis identified first recurrence interval <1 month (odds ratio, 6.66, P < 0.001) and age <71 years (odds ratio, 4.16, P < 0.001) as independent risk factors for refractory CSDH. On the other hand, burr-hole irrigation with closed-system drainage did not reduce refractory CSDH. When patients with risk factors for refractory CSDH experience recurrence, alternative surgical procedures may be considered as the second surgery, because burr-hole irrigation with closed-system drainage did not reduce refractory CSDH in our study. Copyright © 2017 Elsevier Inc. All rights reserved.

C-reactive Protein may Predict the Recurrence of Appendicitis in Children Formerly with Appendiceal Mass after Successful Non-operative Treatment.

PubMed

Chang, Yi-Jung; Chao, Hsun-Chin; Chen, Chyi-Liang; Chen, Shin-Yann; Yan, Dah-Chin; Tsai, Ming-Han

2017-08-01

This study identified factors associated with the recurrence of appendicitis in children with appendiceal masses after successful nonsurgical treatment. In this retrospective study, children who were diagnosed as having appendiceal masses after undergoing conservative treatment between 2000 and 2014 were enrolled and the medical records of those who did not undergo an interval appendectomy were reviewed. The clinical features and outcomes of patients with and those without recurrent appendicitis were compared. Regression analysis was used to identify risk factors of appendicitis recurrence. Seventy patients were included and successfully discharged after receiving nonsurgical treatment for appendiceal masses. Of the patients, 35 (50.0%) developed recurrent appendicitis and 85.7% (30/35) recurrences developed within 3 months. Multivariate analyses showed that patients with a higher serum C-reactive protein (CRP) level and peritonitis more frequently developed recurrence. The appendicitis recurrence rate was significantly higher in the patients with CRP levels of ≥103 mg/L with an odds ratio of 16.9 or in those with peritonitis with an odds ratio of 4.9. Children with appendiceal masses who develop peritonitis or have CRP levels of ≥103 mg/L have a higher recurrence rate of appendicitis and should undergo an interval appendectomy. Copyright © 2017. Published by Elsevier B.V.

Brain hemorrhage recurrence, small vessel disease type, and cerebral microbleeds

PubMed Central

Charidimou, Andreas; Imaizumi, Toshio; Moulin, Solene; Biffi, Alexandro; Samarasekera, Neshika; Yakushiji, Yusuke; Peeters, Andre; Vandermeeren, Yves; Laloux, Patrice; Baron, Jean-Claude; Hernandez-Guillamon, Mar; Montaner, Joan; Casolla, Barbara; Gregoire, Simone M.; Kang, Dong-Wha; Kim, Jong S.; Naka, H.; Smith, Eric E.; Viswanathan, Anand; Jäger, Hans R.; Al-Shahi Salman, Rustam; Greenberg, Steven M.; Cordonnier, Charlotte

2017-01-01

Objective: We evaluated recurrent intracerebral hemorrhage (ICH) risk in ICH survivors, stratified by the presence, distribution, and number of cerebral microbleeds (CMBs) on MRI (i.e., the presumed causal underlying small vessel disease and its severity). Methods: This was a meta-analysis of prospective cohorts following ICH, with blood-sensitive brain MRI soon after ICH. We estimated annualized recurrent symptomatic ICH rates for each study and compared pooled odds ratios (ORs) of recurrent ICH by CMB presence/absence and presumed etiology based on CMB distribution (strictly lobar CMBs related to probable or possible cerebral amyloid angiopathy [CAA] vs non-CAA) and burden (1, 2–4, 5–10, and >10 CMBs), using random effects models. Results: We pooled data from 10 studies including 1,306 patients: 325 with CAA-related and 981 CAA-unrelated ICH. The annual recurrent ICH risk was higher in CAA-related ICH vs CAA-unrelated ICH (7.4%, 95% confidence interval [CI] 3.2–12.6 vs 1.1%, 95% CI 0.5–1.7 per year, respectively; p = 0.01). In CAA-related ICH, multiple baseline CMBs (versus none) were associated with ICH recurrence during follow-up (range 1–3 years): OR 3.1 (95% CI 1.4–6.8; p = 0.006), 4.3 (95% CI 1.8–10.3; p = 0.001), and 3.4 (95% CI 1.4–8.3; p = 0.007) for 2–4, 5–10, and >10 CMBs, respectively. In CAA-unrelated ICH, only >10 CMBs (versus none) were associated with recurrent ICH (OR 5.6, 95% CI 2.1–15; p = 0.001). The presence of 1 CMB (versus none) was not associated with recurrent ICH in CAA-related or CAA-unrelated cohorts. Conclusions: CMB burden and distribution on MRI identify subgroups of ICH survivors with higher ICH recurrence risk, which may help to predict ICH prognosis with relevance for clinical practice and treatment trials. PMID:28747441

Meteorology of the storm of November 3-5, 1985, in West Virginia and Virginia: Chapter B in Geomorphic studies of the storm and flood of November 3-5, 1985, in the upper Potomac and Cheat River basins in West Virginia and Virginia

USGS Publications Warehouse

Colucci, Stephen J.; Jacobson, Robert B.; Greco, Steven

1993-01-01

The storm of November 3-5, 1985, in the central Appalachian Mountains of West Virginia and Virginia resulted from a complex sequence of meteorological events. The stage was set by Hurricane Juan, which made landfall in the Gulf Coast on October 31. Juan brought moisture northward up the Mississippi Valley; latent heat released by condensation aloft probably helped to render stationary a high-pressure anticyclone over southeastern Canada. A second low-pressure cyclone, moving north through the Southeastern United States, was blocked by the stationary anticyclone, intensifying a surface-pressure gradient that forced moist air from the Atlantic westward up the slope of the Appalachian Mountains. In the Cheat and Potomac River basins the resulting rainfall was of moderate intensity but of long duration. In Pendleton County, W. Va., the 1985 storm was the largest on record for durations from 24 to 72 h; the highest rainfall recurrence intervals were registered at durations of 24 to 48 h. Estimates of rainfall recurrence intervals from highly skewed records yield values ranging from 80 to 300 yr.

The floods of May 17-18, 1985 and October 6-7, 1985 in Puerto Rico

USGS Publications Warehouse

Quinones, Ferdinand; Johnson, K.G.

1987-01-01

Severe floods occurred in Puerto Rico twice in 1985. During May 15-19, 1985, as much as 25 in. of rainfall produced significant floods along north and north-central basins in the island. A nearly stationary tropical depression affected Puerto Rico during October 5-8, 1985, resulting in 24-hr precipitation totals of as much as 23 in. and severe floods along the south-central coastal areas. During the May 17-18, 1985 event, the areas most seriously affected by flooding were along the north coast. These included the lower reaches of the Rio Grande de Manati and the Rio Grande de Arecibo. Significant flooding also occurred at Utuado and Jayuya. The recurrence interval of most of the flood peaks was generally < 25 yr. The floods of October 6-7, 1985, affected mostly rural areas in southern Puerto Rico, but caused significant loss of life and widespread property damages. Landslides near Ponce, the collapse of a bridge at Rio Coamo, and the destruction of homes near Ponce resulted in about 170 fatalities and > 125 million dollars in damages. Flooding was also severe at Barceloneta on the north coast. Recurrence intervals = or > 100 yr were estimated for peak discharges at several index stations. (Author 's abstract)

Controls on the long term earthquake behavior of an intraplate fault revealed by U-Th and stable isotope analyses of syntectonic calcite veins

NASA Astrophysics Data System (ADS)

Williams, Randolph; Goodwin, Laurel; Sharp, Warren; Mozley, Peter

2017-04-01

U-Th dates on calcite precipitated in coseismic extension fractures in the Loma Blanca normal fault zone, Rio Grande rift, NM, USA, constrain earthquake recurrence intervals from 150-565 ka. This is the longest direct record of seismicity documented for a fault in any tectonic environment. Combined U-Th and stable isotope analyses of these calcite veins define 13 distinct earthquake events. These data show that for more than 400 ka the Loma Blanca fault produced earthquakes with a mean recurrence interval of 40 ± 7 ka. The coefficient of variation for these events is 0.40, indicating strongly periodic seismicity consistent with a time-dependent model of earthquake recurrence. Stochastic statistical analyses further validate the inference that earthquake behavior on the Loma Blanca was time-dependent. The time-dependent nature of these earthquakes suggests that the seismic cycle was fundamentally controlled by a stress renewal process. However, this periodic cycle was punctuated by an episode of clustered seismicity at 430 ka. Recurrence intervals within the earthquake cluster were as low as 5-11 ka. Breccia veins formed during this episode exhibit carbon isotope signatures consistent with having formed through pronounced degassing of a CO2 charged brine during post-failure, fault-localized fluid migration. The 40 ka periodicity of the long-term earthquake record of the Loma Blanca fault is similar in magnitude to recurrence intervals documented through paleoseismic studies of other normal faults in the Rio Grande rift and Basin and Range Province. We propose that it represents a background rate of failure in intraplate extension. The short-term, clustered seismicity that occurred on the fault records an interruption of the stress renewal process, likely by elevated fluid pressure in deeper structural levels of the fault, consistent with fault-valve behavior. The relationship between recurrence interval and inferred fluid degassing suggests that pore fluid pressure along the fault may have been driven by variations in CO2 content, thereby fundamentally affecting earthquake frequency. Thus, the Loma Blanca fault provides a record of "naturally induced" seismicity, with lessons for better understanding anthropogenic induced seismicity.

Intermittent tremor migrations beneath Guerrero, Mexico, and implications for fault healing within the slow slip zone

NASA Astrophysics Data System (ADS)

Peng, Yajun; Rubin, Allan M.

2017-01-01

Slow slip events exhibit significant complexity in slip evolution and variations in recurrence intervals. Behavior that varies systematically with recurrence interval is likely to reflect different extents of fault healing between these events. Here we use high-resolution tremor catalogs beneath Guerrero, Mexico, to investigate the mechanics of slow slip. We observe complex tremor propagation styles, including rapid tremor migrations propagating either along the main tremor front or backward, reminiscent of those in northern Cascadia. We also find many migrations that originate well behind the front and repeatedly occupy the same source region during a tremor episode, similar to those previously reported from Shikoku, Japan. These migrations could be driven by slow slip in the surrounding regions, with recurrence intervals possibly modulated by tides. The propagation speed of these migrations decreases systematically with time since the previous migration over the same source area. Tremor amplitudes seem consistent with changes in the propagation speeds being controlled primarily by changes in the slip speeds. One interpretation is that the high propagation speeds and inferred high slip speeds during the migrations with short recurrence intervals are caused by incomplete healing within the host rock adjacent to the shear zone, which could lead to high permeability and reduced dilatant strengthening of the fault gouge. Similar processes may operate in other slow slip source regions such as Cascadia.

Flood of May 23, 2004, in the Turkey and Maquoketa River basins, northeast Iowa

USGS Publications Warehouse

Eash, David A.

2006-01-01

Severe flooding occurred on May 23, 2004, in the Turkey River Basin in Clayton County and in the Maquoketa River Basin in Delaware County following intense thunderstorms over northeast Iowa. Rain gages at Postville and Waucoma, Iowa, recorded 72-hour rainfall of 6.32 and 6.55 inches, respectively, on May 23. Unofficial rainfall totals of 8 to 10 inches were reported in the Turkey River Basin. The peak discharge on May 23 at the Turkey River at Garber streamflow-gaging station was 66,700 cubic feet per second (recurrence interval greater than 500 years) and is the largest flood on record in the Turkey River Basin. The timing of flood crests on the Turkey and Volga Rivers, and local tributaries, coincided to produce a record flood on the lower part of the Turkey River. Three large floods have occurred at the Turkey River at Garber gaging station in a 13-year period. Peak discharges of the floods of June 1991 and May 1999 were 49,900 cubic feet per second (recurrence interval about 150 years) and 53,900 cubic feet per second (recurrence interval about 220 years), respectively. The peak discharge on May 23 at the Maquoketa River at Manchester gaging station was 26,000 cubic feet per second (recurrence interval about 100 years) and is the largest known flood in the upper part of the Maquoketa River Basin.

Efficacy of fibrin glue versus sutures for attaching conjunctival autografts in pterygium surgery: a systematic review with meta-analysis and trial sequential analysis of evidence.

PubMed

Lan, Aihua; Xiao, Feifan; Wang, Yun; Luo, Zhen; Cao, Qixin

2017-06-20

Previous meta-analyses have been conducted to compare the efficacy of fibrin glue (FG) versus sutures in pterygium surgery; however, additional clinical trials have since been published. Therefore, we conducted an updated meta-analysis to further explore the association between FG application in pterygium surgery, and the recurrence rate, complication rate, and surgical duration. An electronic literature search for eligible studies published before July 29, 2016 was conducted across multiple databases. Odds ratios (ORs), standardized mean difference (SMD), and 95% confidence intervals (CI) were calculated. Publication bias of the included articles was evaluated by funnel plots. Differences in recurrence rate and complication rate between the FG and suture groups were evaluated in terms of OR with 95% CI, and SMD with 95% CI were used to estimate the difference in surgical duration. Trial sequential analysis (TSA) was used to determine whether the currently available evidence was sufficient and conclusive. Twenty-four studies were included in this study. The pooled ORs for recurrence rate and complication rate were 0.35 and 1.121, respectively. The pooled SMD for surgical duration was -4.142. The TSA results indicated that evidence of the effect was sufficient in the recurrence group and surgical duration group. Although there was no difference in complication rate between FG and sutures, the apparent advantages of FG over sutures are shorter surgical duration and greater reduction in the recurrence rate of pterygium.

Efficacy of fibrin glue versus sutures for attaching conjunctival autografts in pterygium surgery: a systematic review with meta-analysis and trial sequential analysis of evidence

PubMed Central

Luo, Zhen; Cao, Qixin

2017-01-01

Previous meta-analyses have been conducted to compare the efficacy of fibrin glue (FG) versus sutures in pterygium surgery; however, additional clinical trials have since been published. Therefore, we conducted an updated meta-analysis to further explore the association between FG application in pterygium surgery, and the recurrence rate, complication rate, and surgical duration. An electronic literature search for eligible studies published before July 29, 2016 was conducted across multiple databases. Odds ratios (ORs), standardized mean difference (SMD), and 95% confidence intervals (CI) were calculated. Publication bias of the included articles was evaluated by funnel plots. Differences in recurrence rate and complication rate between the FG and suture groups were evaluated in terms of OR with 95% CI, and SMD with 95% CI were used to estimate the difference in surgical duration. Trial sequential analysis (TSA) was used to determine whether the currently available evidence was sufficient and conclusive. Twenty-four studies were included in this study. The pooled ORs for recurrence rate and complication rate were 0.35 and 1.121, respectively. The pooled SMD for surgical duration was −4.142. The TSA results indicated that evidence of the effect was sufficient in the recurrence group and surgical duration group. Although there was no difference in complication rate between FG and sutures, the apparent advantages of FG over sutures are shorter surgical duration and greater reduction in the recurrence rate of pterygium. PMID:28489563

Wrightwood and the earthquake cycle: What a long recurrence record tells us about how faults work

USGS Publications Warehouse

Weldon, R.; Scharer, K.; Fumal, T.; Biasi, G.

2004-01-01

The concept of the earthquake cycle is so well established that one often hears statements in the popular media like, "the Big One is overdue" and "the longer it waits, the bigger it will be." Surprisingly, data to critically test the variability in recurrence intervals, rupture displacements, and relationships between the two are almost nonexistent. To generate a long series of earthquake intervals and offsets, we have conducted paleoseismic investigations across the San Andreas fault near the town of Wrightwood, California, excavating 45 trenches over 18 years, and can now provide some answers to basic questions about recurrence behavior of large earthquakes. To date, we have characterized at least 30 prehistoric earthquakes in a 6000-yr-long record, complete for the past 1500 yr and for the interval 3000-1500 B.C. For the past 1500 yr, the mean recurrence interval is 105 yr (31-165 yr for individual intervals) and the mean slip is 3.2 m (0.7-7 m per event). The series is slightly more ordered than random and has a notable cluster of events, during which strain was released at 3 times the long-term average rate. Slip associated with an earthquake is not well predicted by the interval preceding it, and only the largest two earthquakes appear to affect the time interval to the next earthquake. Generally, short intervals tend to coincide with large displacements and long intervals with small displacements. The most significant correlation we find is that earthquakes are more frequent following periods of net strain accumulation spanning multiple seismic cycles. The extent of paleoearthquake ruptures may be inferred by correlating event ages between different sites along the San Andreas fault. Wrightwood and other nearby sites experience rupture that could be attributed to overlap of relatively independent segments that each behave in a more regular manner. However, the data are equally consistent with a model in which the irregular behavior seen at Wrightwood typifies the entire southern San Andreas fault; more long event series will be required to definitively outline prehistoric rupture extents.

Pretreatment prostate-specific antigen velocity is associated with freedom from biochemical recurrence of prostate cancer after low-dose-rate prostate brachytherapy alone.

PubMed

Rossi, Peter J; Urbanic, James; Clark, Peter E; McCullough, David L; Lee, W Robert

2008-01-01

This report examines the relationship between pretreatment prostate-specific antigen (PSA) velocity (PSAV) and freedom from biochemical recurrence (FFBR) in men with prostate cancer treated with low-dose-rate prostate brachytherapy (LDRPB). This is a report of 51 men treated with LDRPB between 1997 and 1999. two or more evaluable PSA values >3 months apart and <18 months before treatment. PSAV is calculated using a linear regression equation. All patients had biopsy confirmed, clinically localized prostate cancer. All men were treated with (125)I LDRPB. The prescription dose was 144Gy. Biochemical failure is determined from PSA values over time using the ASTRO Consensus Definition. FFBR is estimated using Kaplan-Meier method. Pretreatment variables analyzed include percentage positive biopsy cores, D(90), risk group, and PSAV. All p values are two-sided. The median followup is 60 months. The median pretreatment PSA is 6.5, 75% of men were Stage T1c, and 88% had Gleason score > or =6; 10% developed evidence of biochemical recurrence at a median of 13 months (range, 6-36). The 6-year estimate of FFBR is 90% for the entire cohort. On univariate analysis, pretreatment PSAV and risk group are associated with FFBR. The 6-year estimate of FFBR in patients with a PSAV <2 ng/mL/yr is 100% vs. 80% (95% confidence interval: 64-96%) when the pretreatment PSAV is > or =2 ng/mL/yr before LDRPB (p = 0.017). Pretreatment PSAV is a predictor of FFBR after LDRPB in this population of men with prostate cancer. Men with a pretreatment PSAV > or =2 ng/mL/yr may warrant more aggressive treatment.

Pulmonary Vein Antral Isolation and Nonpulmonary Vein Trigger Ablation Are Sufficient to Achieve Favorable Long-Term Outcomes Including Transformation to Paroxysmal Arrhythmias in Patients With Persistent and Long-Standing Persistent Atrial Fibrillation.

PubMed

Liang, Jackson J; Elafros, Melissa A; Muser, Daniele; Pathak, Rajeev K; Santangeli, Pasquale; Zado, Erica S; Frankel, David S; Supple, Gregory E; Schaller, Robert D; Deo, Rajat; Garcia, Fermin C; Lin, David; Hutchinson, Mathew D; Riley, Michael P; Callans, David J; Marchlinski, Francis E; Dixit, Sanjay

2016-11-01

Transformation from persistent to paroxysmal atrial fibrillation (AF) after ablation suggests modification of the underlying substrate. We examined the nature of initial arrhythmia recurrence in patients with nonparoxysmal AF undergoing antral pulmonary vein isolation and nonpulmonary vein trigger ablation and correlated recurrence type with long-term ablation efficacy after the last procedure. Three hundred and seventeen consecutive patients with persistent (n=200) and long-standing persistent (n=117) AF undergoing first ablation were included. AF recurrence was defined as early (≤6 weeks) or late (>6 weeks after ablation) and paroxysmal (either spontaneous conversion or treated with cardioversion ≤7 days) or persistent (lasting >7 days). During median follow-up of 29.8 (interquartile range: 14.8-49.9) months, 221 patients had ≥1 recurrence. Initial recurrence was paroxysmal in 169 patients (76%) and persistent in 52 patients (24%). Patients experiencing paroxysmal (versus persistent) initial recurrence were more likely to achieve long-term freedom off antiarrhythmic drugs (hazard ratio, 2.2; 95% confidence interval, 1.5-3.2; P<0.0001), freedom on/off antiarrhythmic drugs (hazard ratio, 2.5; 95% confidence interval, 1.6-3.8; P<0.0001), and arrhythmia control (hazard ratio, 5.2; 95% confidence interval, 2.9-9.2; P<0.0001) after last ablation. In patients with persistent and long-standing persistent AF, limited ablation targeting pulmonary veins and documented nonpulmonary vein triggers improves the maintenance of sinus rhythm and reverses disease progression. Transformation to paroxysmal AF after initial ablation may be a step toward long-term freedom from recurrent arrhythmia. © 2016 American Heart Association, Inc.

Timing of Radiotherapy and Outcome in Patients Receiving Adjuvant Endocrine Therapy

DOE Office of Scientific and Technical Information (OSTI.GOV)

Karlsson, Per, E-mail: per.karlsson@oncology.gu.s; Cole, Bernard F.; International Breast Cancer Study Group Statistical Center, Department of Biostatistics and Computational Biology, Dana-Farber Cancer Institute, Boston, MA

2011-06-01

Purpose: To evaluate the association between the interval from breast-conserving surgery (BCS) to radiotherapy (RT) and the clinical outcome among patients treated with adjuvant endocrine therapy. Patients and Methods: Patient information was obtained from three International Breast Cancer Study Group trials. The analysis was restricted to 964 patients treated with BCS and adjuvant endocrine therapy. The patients were divided into two groups according to the median number of days between BCS and RT and into four groups according to the quartile of time between BCS and RT. The endpoints were the interval to local recurrence, disease-free survival, and overall survival.more » Proportional hazards regression analysis was used to perform comparisons after adjustment for baseline factors. Results: The median interval between BCS and RT was 77 days. RT timing was significantly associated with age, menopausal status, and estrogen receptor status. After adjustment for these factors, no significant effect of a RT delay {<=}20 weeks was found. The adjusted hazard ratio for RT within 77 days vs. after 77 days was 0.94 (95% confidence interval [CI], 0.47-1.87) for the interval to local recurrence, 1.05 (95% CI, 0.82-1.34) for disease-free survival, and 1.07 (95% CI, 0.77-1.49) for overall survival. For the interval to local recurrence the adjusted hazard ratio for {<=}48, 49-77, and 78-112 days was 0.90 (95% CI, 0.34-2.37), 0.86 (95% CI, 0.33-2.25), and 0.89 (95% CI, 0.33-2.41), respectively, relative to {>=}113 days. Conclusion: A RT delay of {<=}20 weeks was significantly associated with baseline factors such as age, menopausal status, and estrogen-receptor status. After adjustment for these factors, the timing of RT was not significantly associated with the interval to local recurrence, disease-free survival, or overall survival.« less

Integration of paleoseismic data from multiple sites to develop an objective earthquake chronology: Application to the Weber segment of the Wasatch fault zone, Utah

USGS Publications Warehouse

DuRoss, Christopher B.; Personius, Stephen F.; Crone, Anthony J.; Olig, Susan S.; Lund, William R.

2011-01-01

We present a method to evaluate and integrate paleoseismic data from multiple sites into a single, objective measure of earthquake timing and recurrence on discrete segments of active faults. We apply this method to the Weber segment (WS) of the Wasatch fault zone using data from four fault-trench studies completed between 1981 and 2009. After systematically reevaluating the stratigraphic and chronologic data from each trench site, we constructed time-stratigraphic OxCal models that yield site probability density functions (PDFs) of the times of individual earthquakes. We next qualitatively correlated the site PDFs into a segment-wide earthquake chronology, which is supported by overlapping site PDFs, large per-event displacements, and prominent segment boundaries. For each segment-wide earthquake, we computed the product of the site PDF probabilities in common time bins, which emphasizes the overlap in the site earthquake times, and gives more weight to the narrowest, best-defined PDFs. The product method yields smaller earthquake-timing uncertainties compared to taking the mean of the site PDFs, but is best suited to earthquakes constrained by broad, overlapping site PDFs. We calculated segment-wide earthquake recurrence intervals and uncertainties using a Monte Carlo model. Five surface-faulting earthquakes occurred on the WS at about 5.9, 4.5, 3.1, 1.1, and 0.6 ka. With the exception of the 1.1-ka event, we used the product method to define the earthquake times. The revised WS chronology yields a mean recurrence interval of 1.3 kyr (0.7–1.9-kyr estimated two-sigma [2δ] range based on interevent recurrence). These data help clarify the paleoearthquake history of the WS, including the important question of the timing and rupture extent of the most recent earthquake, and are essential to the improvement of earthquake-probability assessments for the Wasatch Front region.

Integration of paleoseismic data from multiple sites to develop an objective earthquake chronology: Application to the Weber segment of the Wasatch fault zone, Utah

USGS Publications Warehouse

DuRoss, C.B.; Personius, S.F.; Crone, A.J.; Olig, S.S.; Lund, W.R.

2011-01-01

We present a method to evaluate and integrate paleoseismic data from multiple sites into a single, objective measure of earthquake timing and recurrence on discrete segments of active faults. We apply this method to the Weber segment (WS) of the Wasatch fault zone using data from four fault-trench studies completed between 1981 and 2009. After systematically reevaluating the stratigraphic and chronologic data from each trench site, we constructed time-stratigraphic OxCal models that yield site probability density functions (PDFs) of the times of individual earthquakes. We next qualitatively correlated the site PDFs into a segment-wide earthquake chronology, which is supported by overlapping site PDFs, large per-event displacements, and prominent segment boundaries. For each segment-wide earthquake, we computed the product of the site PDF probabilities in common time bins, which emphasizes the overlap in the site earthquake times, and gives more weight to the narrowest, best-defined PDFs. The product method yields smaller earthquake-timing uncertainties compared to taking the mean of the site PDFs, but is best suited to earthquakes constrained by broad, overlapping site PDFs. We calculated segment-wide earthquake recurrence intervals and uncertainties using a Monte Carlo model. Five surface-faulting earthquakes occurred on the WS at about 5.9, 4.5, 3.1, 1.1, and 0.6 ka. With the exception of the 1.1-ka event, we used the product method to define the earthquake times. The revised WS chronology yields a mean recurrence interval of 1.3 kyr (0.7-1.9-kyr estimated two-sigma [2??] range based on interevent recurrence). These data help clarify the paleoearthquake history of the WS, including the important question of the timing and rupture extent of the most recent earthquake, and are essential to the improvement of earthquake-probability assessments for the Wasatch Front region.

Interval Between Hysterectomy and Start of Radiation Treatment Is Predictive of Recurrence in Patients With Endometrial Carcinoma

DOE Office of Scientific and Technical Information (OSTI.GOV)

Cattaneo, Richard; Hanna, Rabbie K.; Jacobsen, Gordon

Purpose: Adjuvant radiation therapy (RT) has been shown to improve local control in patients with endometrial carcinoma. We analyzed the impact of the time interval between hysterectomy and RT initiation in patients with endometrial carcinoma. Methods and Materials: In this institutional review board-approved study, we identified 308 patients with endometrial carcinoma who received adjuvant RT after hysterectomy. All patients had undergone hysterectomy, oophorectomy, and pelvic and para-aortic lymph node evaluation from 1988 to 2010. Patients' demographics, pathologic features, and treatments were compared. The time interval between hysterectomy and the start of RT was calculated. The effects of time interval onmore » recurrence-free (RFS), disease-specific (DSS), and overall survival (OS) were calculated. Following univariate analysis, multivariate modeling was performed. Results: The median age and follow-up for the study cohort was 65 years and 72 months, respectively. Eighty-five percent of the patients had endometrioid carcinoma. RT was delivered with high-dose-rate brachytherapy alone (29%), pelvic RT alone (20%), or both (51%). Median time interval to start RT was 42 days (range, 21-130 days). A total of 269 patients (74%) started their RT <9 weeks after undergoing hysterectomy (group 1) and 26% started ≥9 weeks after surgery (group 2). There were a total of 43 recurrences. Tumor recurrence was significantly associated with treatment delay of ≥9 weeks, with 5-year RFS of 90% for group 1 compared to only 39% for group 2 (P<.001). On multivariate analysis, RT delay of ≥9 weeks (P<.001), presence of lymphovascular space involvement (P=.001), and higher International Federation of Gynecology and Obstetrics grade (P=.012) were independent predictors of recurrence. In addition, RT delay of ≥9 weeks was an independent significant predictor for worse DSS and OS (P=.001 and P=.01, respectively). Conclusions: Delay in administering adjuvant RT after hysterectomy was associated with worse survival endpoints. Our data suggest that shorter time interval between hysterectomy and start of RT may be beneficial.« less

Infliximab Reduces Endoscopic, but Not Clinical, Recurrence of Crohn's Disease After Ileocolonic Resection.

PubMed

Regueiro, Miguel; Feagan, Brian G; Zou, Bin; Johanns, Jewel; Blank, Marion A; Chevrier, Marc; Plevy, Scott; Popp, John; Cornillie, Freddy J; Lukas, Milan; Danese, Silvio; Gionchetti, Paolo; Hanauer, Stephen B; Reinisch, Walter; Sandborn, William J; Sorrentino, Dario; Rutgeerts, Paul

2016-06-01

Most patients with Crohn's disease (CD) eventually require an intestinal resection. However, CD frequently recurs after resection. We performed a randomized trial to compare the ability of infliximab vs placebo to prevent CD recurrence. We evaluated the efficacy of infliximab in preventing postoperative recurrence of CD in 297 patients at 104 sites worldwide from November 2010 through May 2012. All study patients had undergone ileocolonic resection within 45 days before randomization. Patients were randomly assigned (1:1) to groups given infliximab (5 mg/kg) or placebo every 8 weeks for 200 weeks. The primary end point was clinical recurrence, defined as a composite outcome consisting of a CD Activity Index score >200 and a ≥70-point increase from baseline, and endoscopic recurrence (Rutgeerts score ≥i2, determined by a central reader) or development of a new or re-draining fistula or abscess, before or at week 76. Endoscopic recurrence was a major secondary end point. A smaller proportion of patients in the infliximab group had a clinical recurrence before or at week 76 compared with the placebo group, but this difference was not statistically significant (12.9% vs 20.0%; absolute risk reduction [ARR] with infliximab, 7.1%; 95% confidence interval: -1.3% to 15.5%; P = .097). A significantly smaller proportion of patients in the infliximab group had endoscopic recurrence compared with the placebo group (30.6% vs 60.0%; ARR with infliximab, 29.4%; 95% confidence interval: 18.6% to 40.2%; P < .001). Additionally, a significantly smaller proportion of patients in the infliximab group had endoscopic recurrence based only on Rutgeerts scores ≥i2 (22.4% vs 51.3%; ARR with infliximab, 28.9%; 95% confidence interval: 18.4% to 39.4%; P < .001). Patients previously treated with anti-tumor necrosis factor agents or those with more than 1 resection were at greater risk for clinical recurrence. The safety profile of infliximab was similar to that from previous reports. Infliximab is not superior to placebo in preventing clinical recurrence after CD-related resection. However, infliximab does reduce endoscopic recurrence. ClinicalTrials.gov ID NCT01190839. Copyright © 2016 AGA Institute. Published by Elsevier Inc. All rights reserved.

NADiA ProsVue prostate-specific antigen slope is an independent prognostic marker for identifying men at reduced risk of clinical recurrence of prostate cancer after radical prostatectomy.

PubMed

Moul, Judd W; Lilja, Hans; Semmes, O John; Lance, Raymond S; Vessella, Robert L; Fleisher, Martin; Mazzola, Clarisse; Sarno, Mark J; Stevens, Barbara; Klem, Robert E; McDermed, Jonathan E; Triebell, Melissa T; Adams, Thomas H

2012-12-01

To validate the hypothesis that men displaying serum prostate-specific antigen (PSA) slopes ≤ 2.0 pg/mL/mo after prostatectomy, measured using a new immuno-polymerase chain reaction diagnostic test (NADiA ProsVue), have a reduced risk of clinical recurrence as determined by positive biopsy, imaging findings, or death from prostate cancer. From 4 clinical sites, we selected a cohort of 304 men who had been followed up for 17.6 years after prostatectomy for clinical recurrence. We assessed the prognostic value of a PSA slope cutpoint of 2.0 pg/mL/mo against established risk factors to identify men at low risk of clinical recurrence using uni- and multivariate Cox proportional hazards regression and Kaplan-Meier analyses. The univariate hazard ratio of a PSA slope >2.0 pg/mL/mo was 18.3 (95% confidence interval 10.6-31.8) compared with a slope ≤ 2.0 pg/mL/mo (P <.0001). The median disease-free survival interval was 4.8 years vs >10 years in the 2 groups (P <.0001). The multivariate hazard ratio for PSA slope with the covariates of preprostatectomy PSA, pathologic stage, and Gleason score was 9.8 (95% confidence interval 5.4-17.8), an 89.8% risk reduction for men with PSA slopes ≤ 2.0 pg/mL/mo (P <.0001). The Gleason score (<7 vs ≥ 7) was the only other significant predictor (hazard ratio 5.4, 95% confidence interval 2.1-13.8, P = .0004). Clinical recurrence after radical prostatectomy is difficult to predict using established risk factors. We have demonstrated that a NADiA ProsVue PSA slope of ≤ 2.0 pg/mL/mo after prostatectomy is prognostic for a reduced risk of prostate cancer recurrence and adds predictive power to the established risk factors. Copyright © 2012 Elsevier Inc. All rights reserved.

Treatment modalities and outcomes of pleomorphic hyalinizing angiectatic tumor: a systematic review of the literature.

PubMed

Rush, A J; Patel, P D; Shemesh, S; Subhawong, T K; Pretell-Mazzini, J

2018-02-01

A systematic review of the cases documented in the literature regarding Pleomorphic hyalinizing angiectatic tumor of soft parts (PHAT) was performed in order to identify (1) location on presentation (2) surgical treatment modality (3) recurrence rate (4) any associations between location, age, histology, surgery type on recurrence. A systematic review of medical literature listed on PubMed was conducted identifying any prior case report and/or case series of diagnosed PHAT, with no exclusion based on language or time. Twenty-nine articles were identified removing any articles with duplicated cases yielding a total of 93 cases. Cases were broken down by gender, presenting location (UE/LE/axial), surgery type [wide local resection, non-wide local, wide local with radiation therapy (RT), non-wide local with RT], recurrence, and time to recurrence. The mean age at presentation was 54.5 ± 17.1 (range 10-89) with the 76% of cases appearing in the lower extremity (15% UE, 9% Axial). Of the 93 patients, 74 had a known surgical procedure, 31% WL, 40% NWL, 8% WL + RT, 1% NWL + RT. Of those treated surgically, 63 pts had documented follow-up and 18 (29%) had recurrence. A strong association was observed between surgery type and recurrence. Local recurrence was more common within the group undergoing NWLE in 52% (16/41) of cases (p = 0.002). Kaplan-Meier analysis showed an estimate mean time for recurrence of 43.87 months [95% confidence interval (CI) 24.52-63.22; and standard error (SE) 7.59] for the entire population. A trend was also seen toward males having a shorter disease-free survival than females (29.4 mos. vs. 69.5 mos.). No significant association seen between size, location, histology type and recurrence. PHAT has a characteristic presentation in the LE with a relatively high rate of local recurrence and slow-growing potential. Wide local excision appears to be superior in decreasing recurrence rates and a long-term follow-up period is needed.

ESTIMATING LOW-FLOW FREQUENCIES OF UNGAGED STREAMS IN NEW ENGLAND.

USGS Publications Warehouse

Wandle, S. William

1987-01-01

Equations to estimate low flows were developed using multiple-regression analysis with a sample of 48 river basins, which were selected from the U. S. Geological Survey's network of gaged river basins in Massachusetts, New Hampshire, Rhode Island, Vermont, and southwestern Maine. Low-flow characteristics are represented by the 7Q2 and 7Q10 (the annual minimum 7-day mean low flow at the 2- and 10-year recurrence intervals). These statistics for each of the 48 basins were determined from a low-flow frequency analysis of streamflow records for 1942-71, or from a graphical or mathematical relationship if the record did not cover this 30-year period. Estimators for the mean and variance of the 7-day low flows at the index and short-term sites were used for two stations where discharge measurements of base flow were available and for two sites where the graphical technique was unsatisfactory.

Streamflow characteristics related to channel geometry of streams in western United States

USGS Publications Warehouse

Hedman, E.R.; Osterkamp, W.R.

1982-01-01

Assessment of surface-mining and reclamation activities generally requires extensive hydrologic data. Adequate streamflow data from instrumented gaging stations rarely are available, and estimates of surface- water discharge based on rainfall-runoff models, drainage area, and basin characteristics sometimes have proven unreliable. Channel-geometry measurements offer an alternative method of quickly and inexpensively estimating stream-flow characteristics for ungaged streams. The method uses the empirical development of equations to yield a discharge value from channel-geometry and channel-material data. The equations are developed by collecting data at numerous streamflow-gaging sites and statistically relating those data to selected discharge characteristics. Mean annual runoff and flood discharges with selected recurrence intervals can be estimated for perennial, intermittent, and ephemeral streams. The equations were developed from data collected in the western one-half of the conterminous United States. The effect of the channel-material and runoff characteristics are accounted for with the equations.

NEW STUDIES OF URBAN FLOOD FREQUENCY IN THE SOUTHEASTERN UNITED STATES.

USGS Publications Warehouse

Sauer, Vernon B.

1986-01-01

Five reports dealing with flood magnitude and frequency in urban areas in the southeastern United States have been published during the past 2 years by the U. S. Geological Survey (USGS). These reports are based on data collected in Tampa and Tallahassee, Florida; Atlanta, Georgia; and several cities in Alabama and Tennessee. Each report contains regression equations useful for estimating flood peaks for selected recurrence intervals at ungauged urban sites. A nationwide study of urban flood characteristics by the USGS published in 1983 contains equations for estimating urban peak discharges for ungauged sites. At the time that the nationwide study was conducted, data from only 35 sites in the southeastern United States were available. The five new reports contain data for 88 additional sites. These new data show that the seven-parameter estimating equations developed in the nationwide study are unbiased and have prediction errors less than those described in the nationwide report.

Earthquake Clustering on Normal Faults: Insight from Rate-and-State Friction Models

NASA Astrophysics Data System (ADS)

Biemiller, J.; Lavier, L. L.; Wallace, L.

2016-12-01

Temporal variations in slip rate on normal faults have been recognized in Hawaii and the Basin and Range. The recurrence intervals of these slip transients range from 2 years on the flanks of Kilauea, Hawaii to 10 kyr timescale earthquake clustering on the Wasatch Fault in the eastern Basin and Range. In addition to these longer recurrence transients in the Basin and Range, recent GPS results there also suggest elevated deformation rate events with recurrence intervals of 2-4 years. These observations suggest that some active normal fault systems are dominated by slip behaviors that fall between the end-members of steady aseismic creep and periodic, purely elastic, seismic-cycle deformation. Recent studies propose that 200 year to 50 kyr timescale supercycles may control the magnitude, timing, and frequency of seismic-cycle earthquakes in subduction zones, where aseismic slip transients are known to play an important role in total deformation. Seismic cycle deformation of normal faults may be similarly influenced by its timing within long-period supercycles. We present numerical models (based on rate-and-state friction) of normal faults such as the Wasatch Fault showing that realistic rate-and-state parameter distributions along an extensional fault zone can give rise to earthquake clusters separated by 500 yr - 5 kyr periods of aseismic slip transients on some portions of the fault. The recurrence intervals of events within each earthquake cluster range from 200 to 400 years. Our results support the importance of stress and strain history as controls on a normal fault's present and future slip behavior and on the characteristics of its current seismic cycle. These models suggest that long- to medium-term fault slip history may influence the temporal distribution, recurrence interval, and earthquake magnitudes for a given normal fault segment.

The effect of growth hormone replacement in patients with hypopituitarism on pituitary tumor recurrence, secondary cancer, and stroke.

PubMed

Jasim, Sina; Alahdab, Fares; Ahmed, Ahmed T; Tamhane, Shrikant U; Sharma, Anu; Donegan, Diane; Nippoldt, Todd B; Murad, M Hassan

2017-05-01

Growth hormone replacement therapy has benefits for patients with hypopituitarism. The safety profile in regard to tumor recurrence or progression, development of secondary malignancies, or cerebrovascular stroke is still an area of debate. A comprehensive search of multiple databases-MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews, and Scopus was conducted through August 2015. Eligible studies that evaluated long-term adverse events in adult patients with hypopituitarism treated with growth hormone replacement therapy and reported development of pituitary tumor recurrence or progression, secondary malignancies, or cerebrovascular stroke were selected following a predefined protocol. Reviewers, independently and in duplicate, extracted data and assessed the risk of bias. Random-effects meta-analysis was used to pool relative risks and 95 % confidence intervals. We included 15 studies (published 1995-2015) that reported on 46,148 patients. Compared to non-replacement, growth hormone replacement therapy in adults with hypopituitarism was not associated with statistically significant change in pituitary tumor progression or recurrence (relative risk, 0.77; 95 % confidence interval, 0.53-1.13) or development of secondary malignancy (relative risk, 0.99; 95 % confidence interval, 0.70-1.39). In two retrospective studies, there was higher risk of stroke in patients who did not receive replacement (relative risk, 2.07; 95 % confidence interval, 1.51-2.83). The quality of evidence is low due to study limitations and imprecision. This systematic review and meta-analysis supports the overall safety of growth hormone therapeutic use in adults with hypopituitarism with no clear evidence of increased risk of pituitary tumor recurrence, malignancy, or stroke.

Midline dorsal plication to repair recurrent chordee at reoperation for hypospadias surgery complication.

PubMed

Yucel, Selcuk; Sanli, Ahmet; Kukul, Erdal; Karaguzel, Gungor; Melikoglu, Mustafa; Guntekin, Erol

2006-02-01

Midline dorsal plication is an efficient and safe surgical technique to correct chordee. We investigated the efficacy of midline dorsal plication for recurrent chordee in complicated hypospadias reoperations. We retrospectively evaluated the charts of 25 boys who underwent reoperation between 1999 and 2004 due to complications of primary hypospadias repair other than meatal stenosis. A total of 15 cases were initially managed elsewhere for primary repair or complications. The etiology of recurrent chordee was defined at surgical correction. When recurrent chordee was noted a midline dorsal plication was performed. Of 25 patients 10 had previously undergone chordee repair. Nine of these patients were observed to have recurrent chordee and 1 had de novo chordee. A total of 10 patients had recurrent or delayed onset chordee. Mean patient age at primary repair was 6.28 years (range 1 to 33). Mean age at last operation for chordee was 15.9 years (range 4 to 66). Mean interval to recurrent chordee was 6 years (range 1 to 16), excluding a 66-year-old blind patient who did not know when recurrent chordee developed. Five patients had chordee recur before puberty at a mean interval of 2.6 years. Mean reoperation rate was 2.4 for recurrent chordee cases and 2.6 for chordee-free cases. Mean followup after midline dorsal plication for recurrent chordee repair was 22 months (range 8 to 56), while mean followup in pubertal and postpubertal cases was 20 months. No recurrence of chordee or surgery related morbidity was observed after recurrent chordee repair by midline dorsal plication. Chordee may recur during puberty following successful chordee repair. The midline dorsal plication technique is simple, efficient and safe even in patients who have undergone multiple surgeries for hypospadias and chordee repair.

Individualized prediction of seizure relapse and outcomes following antiepileptic drug withdrawal after pediatric epilepsy surgery.

PubMed

Lamberink, Herm J; Boshuisen, Kim; Otte, Willem M; Geleijns, Karin; Braun, Kees P J

2018-03-01

The objective of this study was to create a clinically useful tool for individualized prediction of seizure outcomes following antiepileptic drug withdrawal after pediatric epilepsy surgery. We used data from the European retrospective TimeToStop study, which included 766 children from 15 centers, to perform a proportional hazard regression analysis. The 2 outcome measures were seizure recurrence and seizure freedom in the last year of follow-up. Prognostic factors were identified through systematic review of the literature. The strongest predictors for each outcome were selected through backward selection, after which nomograms were created. The final models included 3 to 5 factors per model. Discrimination in terms of adjusted concordance statistic was 0.68 (95% confidence interval [CI] 0.67-0.69) for predicting seizure recurrence and 0.73 (95% CI 0.72-0.75) for predicting eventual seizure freedom. An online prediction tool is provided on www.epilepsypredictiontools.info/ttswithdrawal. The presented models can improve counseling of patients and parents regarding postoperative antiepileptic drug policies, by estimating individualized risks of seizure recurrence and eventual outcome. Wiley Periodicals, Inc. © 2018 International League Against Epilepsy.

Substorm occurrence rates, substorm recurrence times, and solar wind structure

NASA Astrophysics Data System (ADS)

Borovsky, Joseph E.; Yakymenko, Kateryna

2017-03-01

Two collections of substorms are created: 28,464 substorms identified with jumps in the SuperMAG AL index in the years 1979-2015 and 16,025 substorms identified with electron injections into geosynchronous orbit in the years 1989-2007. Substorm occurrence rates and substorm recurrence-time distributions are examined as functions of the phase of the solar cycle, the season of the year, the Russell-McPherron favorability, the type of solar wind plasma at Earth, the geomagnetic-activity level, and as functions of various solar and solar wind properties. Three populations of substorm occurrences are seen: (1) quasiperiodically occurring substorms with recurrence times (waiting times) of 2-4 h, (2) randomly occurring substorms with recurrence times of about 6-15 h, and (3) long intervals wherein no substorms occur. A working model is suggested wherein (1) the period of periodic substorms is set by the magnetosphere with variations in the actual recurrence times caused by the need for a solar wind driving interval to occur, (2) the mesoscale structure of the solar wind magnetic field triggers the occurrence of the random substorms, and (3) the large-scale structure of the solar wind plasma is responsible for the long intervals wherein no substorms occur. Statistically, the recurrence period of periodically occurring substorms is slightly shorter when the ram pressure of the solar wind is high, when the magnetic field strength of the solar wind is strong, when the Mach number of the solar wind is low, and when the polar-cap potential saturation parameter is high.

Fuzzy recurrence plots

NASA Astrophysics Data System (ADS)

Pham, T. D.

2016-12-01

Recurrence plots display binary texture of time series from dynamical systems with single dots and line structures. Using fuzzy recurrence plots, recurrences of the phase-space states can be visualized as grayscale texture, which is more informative for pattern analysis. The proposed method replaces the crucial similarity threshold required by symmetrical recurrence plots with the number of cluster centers, where the estimate of the latter parameter is less critical than the estimate of the former.

Cores Of Recurrent Events (CORE) | Informatics Technology for Cancer Research (ITCR)

Cancer.gov

CORE is a statistically supported computational method for finding recurrently targeted regions in massive collections of genomic intervals, such as those arising from DNA copy number analysis of single tumor cells or bulk tumor tissues.

Seismic hazards at Kilauea and Mauna Loa volcanoes, Hawaii

NASA Astrophysics Data System (ADS)

Klein, Fred W.

1994-04-01

A significant seismic hazard exists in south Hawaii from large tectonic earthquakes that can reach magnitude 8 and intensity XII. This paper quantifies the hazard by estimating the horizontal peak ground acceleration (PGA) in south Hawaii which occurs with a 90% probability of not being exceeded during exposure times from 10 to 250 years. The largest earthquakes occur beneath active, unbuttressed and mobile flanks of volcanos in their shield building stage. The flanks are compressed and pushed laterally by rift zone intrusions. The largest earthquakes are thus not directly caused by volcanic activity. Historic earthquakes (since 1823) and the best Hawaiian Volcano Observatory catalog (since 1970) under the south side of the island define linear frequency-magnitude distributions that imply average recurrence intervals for M greater than 5.5 earthquakes of 3.4-5 years, for M greater than 7 events of 29-44 years, and for M greater than 8 earthquakes of 120-190 years. These estimated recurrences are compatable with the 107 year interval between the two major April 2, 1868 (M(approximately)7.9) and November 29, 1975 (M=7.2) earthquakes. Frequency-magnitude distributions define the activity levels of 19 different seismic source zones for probabilistic ground motion estimations. The available measurements of PGA (33 from 7 moderate earthquakes) are insufficient to define a new attenuation curve. We use the Boore et al. (1993) curve shifted upward by a factor of 1.2 to fit Hawaiian data. Amplification of sites on volcanic ash or unconsolidated soil are about two times those of hard lava sites. On a map for a 50 year exposure time with a 90% probability of not being exceeded, the peak ground accelerations are 1.0 g Kilauea's and Mauna Loa's mobile south flanks and 0.9 g in the Kaoiki seismic zone. This hazard from strong ground shaking is comparable to that near the San Andreas Fault in California or the subduction zone in the Gulf of Alaska.

Highly variable recurrence of tsunamis in the 7,400 years before the 2004 Indian Ocean tsunami

PubMed Central

Rubin, Charles M.; Horton, Benjamin P.; Sieh, Kerry; Pilarczyk, Jessica E.; Daly, Patrick; Ismail, Nazli; Parnell, Andrew C.

2017-01-01

The devastating 2004 Indian Ocean tsunami caught millions of coastal residents and the scientific community off-guard. Subsequent research in the Indian Ocean basin has identified prehistoric tsunamis, but the timing and recurrence intervals of such events are uncertain. Here we present an extraordinary 7,400 year stratigraphic sequence of prehistoric tsunami deposits from a coastal cave in Aceh, Indonesia. This record demonstrates that at least 11 prehistoric tsunamis struck the Aceh coast between 7,400 and 2,900 years ago. The average time period between tsunamis is about 450 years with intervals ranging from a long, dormant period of over 2,000 years, to multiple tsunamis within the span of a century. Although there is evidence that the likelihood of another tsunamigenic earthquake in Aceh province is high, these variable recurrence intervals suggest that long dormant periods may follow Sunda megathrust ruptures as large as that of the 2004 Indian Ocean tsunami. PMID:28722009

Highly variable recurrence of tsunamis in the 7,400 years before the 2004 Indian Ocean tsunami.

PubMed

Rubin, Charles M; Horton, Benjamin P; Sieh, Kerry; Pilarczyk, Jessica E; Daly, Patrick; Ismail, Nazli; Parnell, Andrew C

2017-07-19

The devastating 2004 Indian Ocean tsunami caught millions of coastal residents and the scientific community off-guard. Subsequent research in the Indian Ocean basin has identified prehistoric tsunamis, but the timing and recurrence intervals of such events are uncertain. Here we present an extraordinary 7,400 year stratigraphic sequence of prehistoric tsunami deposits from a coastal cave in Aceh, Indonesia. This record demonstrates that at least 11 prehistoric tsunamis struck the Aceh coast between 7,400 and 2,900 years ago. The average time period between tsunamis is about 450 years with intervals ranging from a long, dormant period of over 2,000 years, to multiple tsunamis within the span of a century. Although there is evidence that the likelihood of another tsunamigenic earthquake in Aceh province is high, these variable recurrence intervals suggest that long dormant periods may follow Sunda megathrust ruptures as large as that of the 2004 Indian Ocean tsunami.

Highly variable recurrence of tsunamis in the 7,400 years before the 2004 Indian Ocean tsunami

NASA Astrophysics Data System (ADS)

Rubin, Charles M.; Horton, Benjamin P.; Sieh, Kerry; Pilarczyk, Jessica E.; Daly, Patrick; Ismail, Nazli; Parnell, Andrew C.

2017-07-01

The devastating 2004 Indian Ocean tsunami caught millions of coastal residents and the scientific community off-guard. Subsequent research in the Indian Ocean basin has identified prehistoric tsunamis, but the timing and recurrence intervals of such events are uncertain. Here we present an extraordinary 7,400 year stratigraphic sequence of prehistoric tsunami deposits from a coastal cave in Aceh, Indonesia. This record demonstrates that at least 11 prehistoric tsunamis struck the Aceh coast between 7,400 and 2,900 years ago. The average time period between tsunamis is about 450 years with intervals ranging from a long, dormant period of over 2,000 years, to multiple tsunamis within the span of a century. Although there is evidence that the likelihood of another tsunamigenic earthquake in Aceh province is high, these variable recurrence intervals suggest that long dormant periods may follow Sunda megathrust ruptures as large as that of the 2004 Indian Ocean tsunami.

Complementary role of the Memorial Sloan Kettering Cancer Center nomogram to the American Joint Committee on Cancer system for the prediction of relapse of major salivary gland carcinoma after surgery.

PubMed

Chou, Wen-Chi; Chang, Kai-Ping; Lu, Chang-Hsien; Chen, Miao-Fen; Cheng, Yu-Fan; Yeh, Kun-Yun; Wang, Cheng-Hsu; Lin, Yung-Chang; Yeh, Ta-Sen

2017-05-01

The purpose of this study was to test the Memorial Sloan Kettering Cancer Center (MSKCC) nomogram in predicting recurrence risk of major salivary gland carcinoma in an Asian cohort. We retrospectively enrolled 149 patients who had undergone intended curative resections for major salivary gland carcinoma between 2007 and 2012. The performance of the MSKCC nomogram and the American Joint Committee on Cancer (AJCC) seventh staging system in predicting recurrence risk was compared. The MSKCC nomogram and the AJCC staging system both accurately predicted the 5-year recurrence probabilities, with the concordance index (c-index = 0.82; 95% confidence interval [CI], 0.75-0.89 vs c-index, 0.77; 95% CI, 0.68-0.87; p = .45) in patients with major salivary gland carcinomas after curative surgeries. Comparing to the actual observed events, the calibration plot indicated that the MSKCC nomogram accurately estimated the recurrence in low-risk groups but tended to overestimate in high-risk groups. When using the MSKCC nomogram to predict the 5-year recurrence-free probability in each AJCC stage, the prediction was very good for patients with AJCC stages I and II disease (c-index = 0.92 and 0.90, respectively) and modest for those of AJCC stages III and IVa (c-index = 0.51 and 0.62, respectively). The MSKCC nomogram and the AJCC staging system each had its value in predicting recurrence of major salivary gland cancers. When using the MSKCC nomogram to predict the 5-year recurrence-free probability in each AJCC stage, the MSKCC nomogram was more accurate in predicting recurrence risks in those patients with AJCC stage I and II diseases than those with late-stage diseases. © 2017 Wiley Periodicals, Inc. Head Neck 39: 860-867, 2017. © 2017 Wiley Periodicals, Inc.

The Utility of a Benign Biliary Stricture Protocol in Preventing Symptomatic Recurrence and Surgical Revision.

PubMed

Kirkpatrick, Daniel L; Hasham, Hasnain; Collins, Zachary; Johnson, Philip; Lemons, Steven; Shahzada, Hassan; Hunt, Suzanne L; Walter, Carissa; Hill, Jacqueline; Fahrbach, Thomas

2018-05-01

To determine whether treating benign biliary strictures via a stricture protocol reduced the probability of developing symptomatic recurrence and requiring surgical revision compared to nonprotocol treatment. A stricture protocol was designed to include serial upsizing of internal/external biliary drainage catheters to a target maximum dilation of 18-French, optional cholangioplasty at each upsizing, and maintenance of the largest catheter for at least 6 months. Patients were included in this retrospective analysis if they underwent biliary ductal dilation at a single institution from 2005 to 2016. Forty-two patients were included, 25 women and 17 men, with an average age of 51.9 years (standard deviation ± 14.6). Logistic regression models were used to determine the probability of symptomatic recurrence and surgical revision by stricture treatment type. Twenty-two patients received nonprotocol treatment, while 20 received treatment on a stricture protocol. After treatment, 7 (32%) patients in the nonprotocol group experienced clinical or laboratory recurrence of a benign stricture, whereas only 1 patient in the stricture protocol group experienced symptom recurrence. Patients in the protocol group were 8.9 times (95% confidence interval [CI] = 1.4-175.3) more likely to remain symptom free than patients in the nonprotocol group. Moreover, patients in the protocol group had an estimated 89% reduction in the probability of undergoing surgical revision compared to patients receiving nonprotocol treatment (odds ratio = .11, 95% CI = .01-.73). Establishing a stricture protocol may decrease the risk of stricture recurrence and the need for surgical revision when compared to a nonprotocol treatment approach. Copyright © 2017 SIR. Published by Elsevier Inc. All rights reserved.

Recent Biomarker-Confirmed Unprotected Vaginal Sex, But Not Self-reported Unprotected Sex, Is Associated With Recurrent Bacterial Vaginosis.

PubMed

Norris Turner, Abigail; Carr Reese, Patricia; Snead, Margaret Christine; Fields, Karen; Ervin, Melissa; Kourtis, Athena P; Klebanoff, Mark A; Gallo, Maria F

2016-03-01

Self-reported unprotected vaginal sex seems to increase risk of bacterial vaginosis (BV). However, the validity of self-reports is questionable, given their inconsistency with more objective measures of recent semen exposure such as detection of prostate-specific antigen (PSA). We examined whether recent unprotected sex, as measured both by PSA detection on vaginal swabs and by self-report, was associated with increased BV recurrence. We analyzed randomized trial data from nonpregnant, BV-positive adult women recruited from a sexually transmitted disease clinic. Participants received BV therapy at enrollment and were scheduled to return after 4, 12, and 24 weeks. Bacterial vaginosis (by Nugent score) and PSA were measured at each visit. We used Cox proportional hazards models to examine the association between PSA positivity and recurrent BV. We also evaluated associations between self-reported unprotected sex (ever/never since the last visit and in the last 48 hours, analyzed separately) and recurrent BV. Prostate-specific antigen and BV results were available for 96 women who contributed 226 follow-up visits. Prostate-specific antigen positivity was associated with increased BV recurrence (adjusted hazard ratio [aHR], 2.32; 95% confidence interval [CI], 1.28-4.21). In contrast, we observed no significant increase in BV recurrence among women self-reporting unprotected sex since the last visit (aHR, 1.63; 95% CI, 0.77-3.43) or in the last 48 hours (aHR, 1.28; 95% CI, 0.70-2.36). Estimates from earlier studies linking self-reported unprotected sex and BV may be biased by misclassification. Biomarkers can improve measurement of unprotected sex, a critical exposure variable in sexual health research.

Increased pulse wave velocity in patients with acute lacunar infarction doubled the risk of future ischemic stroke.

PubMed

Saji, Naoki; Murotani, Kenta; Shimizu, Hirotaka; Uehara, Toshiyuki; Kita, Yasushi; Toba, Kenji; Sakurai, Takashi

2017-04-01

The aim of this study was to determine whether pulse wave velocity (PWV), a marker of vascular endothelial impairment and arteriosclerosis, predicts future ischemic stroke in patients who developed acute lacunar infarction. Patients with a first-ever ischemic stroke due to acute lacunar infarction were enrolled in this study. An oscillometric device (Form PWV/ABI; Omron Colin, Tokyo, Japan) was used to measure brachial-ankle PWV 1 week after stroke onset. Patients were followed for at least 5 years. The main end point of the study was recurrent ischemic stroke. Event-free survival was analyzed using Kaplan-Meier plots and log-rank tests. The risk of recurrent ischemic stroke was estimated using the Cox proportional-hazards model. Of the 156 patients (61% male, mean age: 69.2±11.3 years) assessed in this study, 29 developed recurrent ischemic stroke. The median brachial-ankle PWV value was 20.4 m s -1 . Patients with high PWV values had a greater risk of recurrent ischemic stroke than patients with low PWV values (28% vs. 15%, P=0.08). Kaplan-Meier curve analysis showed that patients with high PWV values had a less favorable (that is, free of recurrent ischemic stroke) survival time (P=0.015). A multivariate Cox proportional-hazards model identified high PWV as an independent predictor of recurrent ischemic stroke after adjusting for age, sex and blood pressure (hazard ratio 2.35, 95% confidence interval, 1.02-5.70, P=0.044). In patients with acute lacunar infarction, a high PWV predicts a twofold greater risk of future ischemic stroke, independent of patient age, sex and blood pressure levels.

Interleukin-6 as a Potential Indicator for Prevention of High Risk Adenoma Recurrence by Dietary Flavonols in the Polyp Prevention Trial

PubMed Central

Bobe, Gerd; Albert, Paul S.; Sansbury, Leah B.; Lanza, Elaine; Schatzkin, Arthur; Colburn, Nancy H.; Cross, Amanda J.

2010-01-01

Serum interleukin (IL)-6, a pro-inflammatory cytokine, is considered an indicator of inflammation and may be an indicator of colorectal carcinogenesis given that inflammation can promote carcinogenesis. Flavonols, which can be found in fruits and vegetables, may inhibit colorectal carcinogenesis partly by inhibiting inflammation. We estimated odds ratios (ORs) and 95% confidence intervals (CIs) to determine whether serum IL-6 was associated with colorectal adenoma recurrence and flavonol intake and, thus may serve as a risk indicator and as a response indicator to dietary flavonols. Serum IL-6 concentrations at baseline, year 1 and 3 were measured in 872 participants from the intervention arm of the Polyp Prevention Trial, a 4-year trial that examined the effectiveness of a low-fat, high-fiber, high-fruit and vegetable diet on adenoma recurrence. Intake of flavonols, especially of isorhamnetin, kaempferol, and quercetin, was inversely associated with serum IL-6 concentrations (highest vs. lowest flavonol intake quartile, 1.80 vs. 2.20 pg/mL) and high risk (OR = 0.51, 95% CI: 0.26–0.98) and advanced adenoma recurrence (OR = 0.17, 95% CI: 0.06–0.50). A decrease in IL-6 concentration during the trial was inversely associated with high risk (OR = 0.44, 95% CI: 0.23–0.84) and advanced adenoma recurrence (OR = 0.47, 95% CI: 0.19–1.18). Individuals with above median flavonol intake and equal or below median IL-6 change after baseline had the lowest risk of recurrence of high risk and advanced adenoma. Our results suggest that serum IL-6 may serve as a risk indicator and as a response indicator to dietary flavonols for colorectal cancer prevention. PMID:20484173

Estimating flood hydrographs and volumes for Alabama streams

USGS Publications Warehouse

Olin, D.A.; Atkins, J.B.

1988-01-01

The hydraulic design of highway drainage structures involves an evaluation of the effect of the proposed highway structures on lives, property, and stream stability. Flood hydrographs and associated flood volumes are useful tools in evaluating these effects. For design purposes, the Alabama Highway Department needs information on flood hydrographs and volumes associated with flood peaks of specific recurrence intervals (design floods) at proposed or existing bridge crossings. This report will provide the engineer with a method to estimate flood hydrographs, volumes, and lagtimes for rural and urban streams in Alabama with drainage areas less than 500 sq mi. Existing computer programs and methods to estimate flood hydrographs and volumes for ungaged streams have been developed in Georgia. These computer programs and methods were applied to streams in Alabama. The report gives detailed instructions on how to estimate flood hydrographs for ungaged rural or urban streams in Alabama with drainage areas less than 500 sq mi, without significant in-channel storage or regulations. (USGS)

Estimating the magnitude of peak discharges for selected flood frequencies on small streams in South Carolina (1975)

USGS Publications Warehouse

Whetstone, B.H.

1982-01-01

A program to collect and analyze flood data from small streams in South Carolina was conducted from 1967-75, as a cooperative research project with the South Carolina Department of Highways and Public Transportation and the Federal Highway Administration. As a result of that program, a technique is presented for estimating the magnitude and frequency of floods on small streams in South Carolina with drainage areas ranging in size from 1 to 500 square miles. Peak-discharge data from 74 stream-gaging stations (25 small streams were synthesized, whereas 49 stations had long-term records) were used in multiple regression procedures to obtain equations for estimating magnitude of floods having recurrence intervals of 10, 25, 50, and 100 years on small natural streams. The significant independent variable was drainage area. Equations were developed for the three physiographic provinces of South Carolina (Coastal Plain, Piedmont, and Blue Ridge) and can be used for estimating floods on small streams. (USGS)

Mean annual runoff and peak flow estimates based on channel geometry of streams in northeastern and western Montana

USGS Publications Warehouse

Parrett, Charles; Omang, R.J.; Hull, J.A.

1983-01-01

Equations for estimating mean annual runoff and peak discharge from measurements of channel geometry were developed for western and northeastern Montana. The study area was divided into two regions for the mean annual runoff analysis, and separate multiple-regression equations were developed for each region. The active-channel width was determined to be the most important independent variable in each region. The standard error of estimate for the estimating equation using active-channel width was 61 percent in the Northeast Region and 38 percent in the West region. The study area was divided into six regions for the peak discharge analysis, and multiple regression equations relating channel geometry and basin characteristics to peak discharges having recurrence intervals of 2, 5, 10, 25, 50 and 100 years were developed for each region. The standard errors of estimate for the regression equations using only channel width as an independent variable ranged from 35 to 105 percent. The standard errors improved in four regions as basin characteristics were added to the estimating equations. (USGS)

Methodology for Estimation of Flood Magnitude and Frequency for New Jersey Streams

USGS Publications Warehouse

Watson, Kara M.; Schopp, Robert D.

2009-01-01

Methodologies were developed for estimating flood magnitudes at the 2-, 5-, 10-, 25-, 50-, 100-, and 500-year recurrence intervals for unregulated or slightly regulated streams in New Jersey. Regression equations that incorporate basin characteristics were developed to estimate flood magnitude and frequency for streams throughout the State by use of a generalized least squares regression analysis. Relations between flood-frequency estimates based on streamflow-gaging-station discharge and basin characteristics were determined by multiple regression analysis, and weighted by effective years of record. The State was divided into five hydrologically similar regions to refine the regression equations. The regression analysis indicated that flood discharge, as determined by the streamflow-gaging-station annual peak flows, is related to the drainage area, main channel slope, percentage of lake and wetland areas in the basin, population density, and the flood-frequency region, at the 95-percent confidence level. The standard errors of estimate for the various recurrence-interval floods ranged from 48.1 to 62.7 percent. Annual-maximum peak flows observed at streamflow-gaging stations through water year 2007 and basin characteristics determined using geographic information system techniques for 254 streamflow-gaging stations were used for the regression analysis. Drainage areas of the streamflow-gaging stations range from 0.18 to 779 mi2. Peak-flow data and basin characteristics for 191 streamflow-gaging stations located in New Jersey were used, along with peak-flow data for stations located in adjoining States, including 25 stations in Pennsylvania, 17 stations in New York, 16 stations in Delaware, and 5 stations in Maryland. Streamflow records for selected stations outside of New Jersey were included in the present study because hydrologic, physiographic, and geologic boundaries commonly extend beyond political boundaries. The StreamStats web application was developed cooperatively by the U.S. Geological Survey and the Environmental Systems Research Institute, Inc., and was designed for national implementation. This web application has been recently implemented for use in New Jersey. This program used in conjunction with a geographic information system provides the computation of values for selected basin characteristics, estimates of flood magnitudes and frequencies, and statistics for stream locations in New Jersey chosen by the user, whether the site is gaged or ungaged.

Recurrent obstetric anal sphincter injury and the risk of long-term anal incontinence.

PubMed

Jangö, Hanna; Langhoff-Roos, Jens; Rosthøj, Susanne; Sakse, Abelone

2017-06-01

Women with an obstetric anal sphincter injury are concerned about the risk of recurrent obstetric anal sphincter injury in their second pregnancy. Existing studies have failed to clarify whether the recurrence of obstetric anal sphincter injury affects the risk of anal and fecal incontinence at long-term follow-up. The objective of the study was to evaluate whether recurrent obstetric anal sphincter injury influenced the risk of anal and fecal incontinence more than 5 years after the second vaginal delivery. We performed a secondary analysis of data from a postal questionnaire study in women with obstetric anal sphincter injury in the first delivery and 1 subsequent vaginal delivery. The questionnaire was sent to all Danish women who fulfilled inclusion criteria and had 2 vaginal deliveries 1997-2005. We performed uni- and multivariable analyses to assess how recurrent obstetric anal sphincter injury affects the risk of anal incontinence. In 1490 women with a second vaginal delivery after a first delivery with obstetric anal sphincter injury, 106 had a recurrent obstetric anal sphincter injury. Of these, 50.0% (n = 53) reported anal incontinence compared with 37.9% (n = 525) of women without recurrent obstetric anal sphincter injury. Fecal incontinence was present in 23.6% (n = 25) of women with recurrent obstetric anal sphincter injury and in 13.2% (n = 182) of women without recurrent obstetric anal sphincter injury. After adjustment for third- or fourth-degree obstetric anal sphincter injury in the first delivery, maternal age at answering the questionnaire, birthweight of the first and second child, years since first and second delivery, and whether anal incontinence was present before the second pregnancy, the risk of flatal and fecal incontinence was still increased in patients with recurrent obstetric anal sphincter injury (adjusted odds ratio, 1.68 [95% confidence interval, 1.05-2.70), P = .03, and adjusted odds ratio, 1.98 [95% confidence interval, 1.13-3.47], P = .02, respectively). More women with recurrent obstetric anal sphincter injury reported affected the quality of life because of anal incontinence (34.9%, n = 37) compared with women without recurrent obstetric anal sphincter injury (24.2%, n = 335), although this difference did not reach statistical significance after adjustment (adjusted odds ratio, 1.53 [95% confidence interval, 0.92-2.56] P = .10). Women opting for vaginal delivery after obstetric anal sphincter injury should be informed about the risk of recurrence, which is associated with an increased risk of long-term flatal and fecal incontinence. Copyright © 2017 Elsevier Inc. All rights reserved.

Prior Tubal Ligation Might Influence Metastatic Spread of Nonendometrioid Endometrial Carcinoma.

PubMed

Li, Mingxia; Li, Mingzhu; Zhao, Lijun; Wang, Zhiqi; Wang, Yue; Shen, Danhua; Wang, Jianliu; Wei, Lihui

2016-07-01

The exfoliation of endometrial carcinoma might intraperitoneally spread through the fallopian tube. We analyzed the influence of prior tubal ligation (TL) in endometrial carcinoma to evaluate whether it can prevent the process and improve patients' survival. A total of 562 patients with a diagnosis of endometrial carcinoma at the Peking University People's Hospital between July 1995 and June 2012 were enrolled in this study. The patients were divided into 2 groups based on the presence or absence of prior TL. International Federation of Gynecology and Obstetrics stage distributions, recurrence rates, survival status, and histopathological findings were compared between the 2 groups. Kaplan-Meier estimates and log-rank tests were used to compare the survival status based on TL in the overall population and stratified by histopathological subtypes and International Federation of Gynecology and Obstetrics stages. Cox models analysis was used to estimate the hazard ratios and 95% confidence intervals for associations between TL and carcinoma-specific mortality. All statistical tests were 2-sided. Of the 562 patients, 482 (85.7%) had a diagnosis of endometrioid and 80 patients (14.2%) with nonendometrioid carcinoma. Tubal ligation was associated with negative peritoneal cytology in the total population (P = 0.015) and in patients with endometrioid carcinomas (P = 0.02) but not help to reduce carcinoma-specific mortality (P = 0.095 and P = 0.277, respectively). In the nonendometrioid group, TL was not only associated with negative peritoneal cytology (P = 0.004) but also with lower stage (P < 0.001) and lower recurrence rate(P < 0.005), resulting in improved prognosis (P = 0.022). In Cox models analysis adjusted for covariates, TL was inversely associated with lower endometrial carcinoma-specific mortality (hazard ratio, 0.47; 95% confidence interval, 0.14-2.6). Tubal ligation was associated with lower positive peritoneal cytology, stages, and recurrence rate, and improved prognosis among patients with nonendometrioid carcinoma. Tubal ligation might influence metastatic spread of nonendometrioid endometrial carcinoma. It could also help to reduce positive peritoneal cytology among patients with endometrioid carcinoma, but lacked prognostic significance.

Simulations of Flooding on Pea River and Whitewater Creek in the Vicinity of the Proposed Elba Bypass at Elba, Alabama

USGS Publications Warehouse

Hedgecock, T. Scott

2003-01-01

A two-dimensional finite-element surface-water model was used to study the effects of proposed modifications to the State Highway 203 corridor (proposed Elba Bypass/relocated U.S. Highway 84) on water-surface elevations and flow distributions during flooding in the Pea River and Whitewater Creek Basins at Elba, Coffee County, Alabama. Flooding was first simulated for the March 17, 1990, flood, using the 1990 flood-plain conditions to calibrate the model to match measured data collected by the U.S. Geological Survey and the U.S. Army Corps of Engineers after the flood. After model calibration, the effects of flooding were simulated for four scenarios: (1) floods having the 50- and 100-year recurrence intervals for the existing flood-plain, bridge, highway, and levee conditions; (2) floods having the 50- and 100-year recurrence intervals for the existing flood-plain and levee conditions with the State Highway 203 embankment and bridge removed; (3) floods having the 50- and 100-year recurrence intervals for the existing flood-plain, bridge, and highway conditions with proposed modifications (elevating) to the levee; and (4) floods having the 50- and 100-year recurrence intervals for the proposed conditions reflecting the Elba Bypass and modified levee. The simulation of floodflow for the Pea River and Whitewater Creek flood of March 17, 1990, in the study reach compared closely to flood profile data obtained after the flood. The flood of March 17, 1990, had an estimated peak discharge of 58,000 cubic feet per second at the gage (just below the confluence) and was estimated to be between a 50-year and 100-year flood event. The estimated peak discharge for Pea River and Whitewater Creek was 40,000 and 42,000 cubic feet per second, respectively. Simulation of floodflows for the 50-year flood (51,400 cubic feet per second) at the gage for existing flood-plain, bridge, highway, and levee conditions indicated that about 31 percent of the peak flow was conveyed by the State Highway 203 bridge over Whitewater Creek, approximately 12 percent overtopped the State Highway 203 embankment, and about 57 percent was conveyed by the Pea River flood plain east of State Highway 125. For this simulation, flow from Pea River (2,380 cubic feet per second) overtopped State Highway 125 and crossed over into the Whitewater Creek flood plain north of State Highway 203, creating one common flood plain. The water-surface elevation estimated at the downstream side of the State Highway 203 bridge crossing Whitewater Creek was 202.82 feet. The girders for both the State Highway 203 and U.S. Highway 84 bridges were partially submerged, but U.S. Highway 84 was not overtopped. For the 100-year flood (63,500 cubic feet per second) at the gage, the simulation indicated that about 25 percent of the peak flow was conveyed by the State Highway 203 bridge over Whitewater Creek, approximately 24 percent overtopped the State Highway 203 embankment, and about 51 percent was conveyed by the Pea River flood plain east of State Highway 125. The existing levee adjacent to Whitewater Creek was overtopped by a flow of 3,200 cubic feet per second during the 100-year flood. For this simulation, flow from Pea River (6,710 cubic feet per second) overtopped State Highway 125 and crossed over into the Whitewater Creek flood plain north of State Highway 203. The water-surface elevation estimated at the downstream side of the State Highway 203 bridge crossing Whitewater Creek was 205.60 feet. The girders for both the State Highway 203 and U.S. Highway 84 bridges were partially submerged, and the west end of the U.S. Highway 84 bridge was overtopped. Simulation of floodflows for the 50-year flood at the gage for existing flood-plain and levee conditions, but with the State Highway 203 embankment and bridge removed, yielded a lower water-surface elevation (202.90 feet) upstream of this bridge than that computed for the existing conditions. For the 100-year flood, the simulation indi

Recurrent Pregnancy Loss and Cardiovascular Disease Mortality in Japanese Women: A Population-Based, Prospective Cohort Study.

PubMed

Yamada, Keiko; Iso, Hiroyasu; Cui, Renzhe; Tamakoshi, Akiko

2017-05-01

This study aimed to examine the association between recurrent pregnancy loss and the risk of cardiovascular disease mortality. We identified 54,652 women who were pregnant during the Japan Collaborative Cohort Study. These women were 40-79 years at the date of cohort entry between 1988 and 1990. Participants received municipal health screening examinations and completed self-administered questionnaires. The cause of death was confirmed by annual or biannual follow-up surveys for a median of 18 years. The exposure was the number of pregnancy loss. The outcome was mortality from total cardiovascular disease and its subtypes according to the International Classification of Diseases, 10th Revision. Adjustment variables included age, number of deliveries, education, body mass index, physical activity, smoking status, and drinking status. Kaplan-Meier survival curves were used to estimate the cumulative mortality. The number of pregnancy loss tended to be inversely associated with the risk of mortality from total stroke, intracerebral hemorrhage, and total cardiovascular disease. The multivariable hazard ratio of total cardiovascular disease for ≥2 pregnancy losses versus no pregnancy loss was .84 (95% confidence interval, .74-0.95). A 2-fold excess risk of mortality from ischemic stroke associated with ≥2 pregnancy losses was observed in women aged 40-59 years, with a multivariable hazard ratio of 2.19 (95% confidence interval, 1.06-4.49), but not in older women. Recurrentpregnancy loss tends to be associated with a lower risk of mortality from cardiovascular disease at 40-79 years. Younger women have an excess risk of ischemic stroke mortality associated with recurrent pregnancy loss. Copyright © 2017. Published by Elsevier Inc.

Impact of USPSTF recommendations for aspirin for prevention of recurrent preeclampsia.

PubMed

Tolcher, Mary Catherine; Chu, Derrick M; Hollier, Lisa M; Mastrobattista, Joan M; Racusin, Diana A; Ramin, Susan M; Sangi-Haghpeykar, Haleh; Aagaard, Kjersti M

2017-09-01

The US Preventive Services Task Force recommends low-dose aspirin for the prevention of preeclampsia among women at high risk for primary occurrence or recurrence of disease. Recommendations for the use of aspirin for preeclampsia prevention were issued by the US Preventive Services Task Force in September 2014. The objective of the study was to evaluate the incidence of recurrent preeclampsia in our cohort before and after the US Preventive Services Task Force recommendation for aspirin for preeclampsia prevention. This was a retrospective cohort study designed to evaluate the rates of recurrent preeclampsia among women with a history of preeclampsia. We utilized a 2-hospital, single academic institution database from August 2011 through June 2016. We excluded multiple gestations and included only the first delivery for women with multiple deliveries during the study period. The cohort of women with a history of preeclampsia were divided into 2 groups, before and after the release of the US Preventive Services Task Force 2014 recommendations. Potential confounders were accounted for in multivariate analyses, and relative risk and adjusted relative risk were calculated. A total of 17,256 deliveries occurred during the study period. A total of 417 women had a documented history of prior preeclampsia: 284 women before and 133 women after the US Preventive Services Task Force recommendation. Comparing the before and after groups, the proportion of Hispanic women in the after group was lower and the method of payment differed between the groups (P <.0001). The prevalence of type 1 diabetes was increased in the after period, but overall rates of pregestational diabetes were similar (6.3% before vs 5.3% after [P > .05]). Risk factors for recurrent preeclampsia included maternal age >35 years (relative risk, 1.83; 95% confidence interval, 1.34-2.48), Medicaid insurance (relative risk, 2.08; 95% confidence interval, 1.15-3.78), type 2 diabetes (relative risk, 2.13; 95% confidence interval, 1.37-3.33), and chronic hypertension (relative risk, 1.96; 95% confidence interval, 1.44-2.66). The risk of recurrent preeclampsia was decreased by 30% in the after group (adjusted relative risk, 0.70; 95% confidence interval, 0.52-0.95). Rates of recurrent preeclampsia among women with a history of preeclampsia decreased by 30% after release of the US Preventive Services Task Force recommendation for aspirin for preeclampsia prevention. Future prospective studies should include direct measures of aspirin compliance, gestational age at initiation, and explore the influence of race and ethnicity on the efficacy of this primary prevention. Copyright © 2017 Elsevier Inc. All rights reserved.

Quaternary Slip History for the Agua Blanca Fault, northern Baja California, Mexico

NASA Astrophysics Data System (ADS)

Gold, P. O.; Behr, W. M.; Rockwell, T. K.; Fletcher, J. M.

2017-12-01

The Agua Blanca Fault (ABF) is the primary structure accommodating San Andreas-related right-lateral slip across the Peninsular Ranges of northern Baja California. Activity on this fault influences offshore faults that parallel the Pacific coast from Ensenada to Los Angeles and is a potential threat to communities in northern Mexico and southern California. We present a detailed Quaternary slip history for the ABF, including new quantitative constraints on geologic slip rates, slip-per-event, the timing of most recent earthquake, and the earthquake recurrence interval. Cosmogenic 10Be exposure dating of clasts from offset fluvial geomorphic surfaces at 2 sites located along the western, and most active, section of the ABF yield preliminary slip rate estimates of 2-4 mm/yr and 3 mm/yr since 20 ka and 2 ka, respectively. Fault zone geomorphology preserved at the younger site provides evidence for right-lateral surface displacements measuring 2.5 m in the past two ruptures. Luminescence dating of an offset alluvial fan at a third site is in progress, but is expected to yield a slip rate relevant to the past 10 kyr. Adjacent to this third site, we excavated 2 paleoseismic trenches across a sag pond formed by a right step in the fault. Preliminary radiocarbon dates indicate that the 4 surface ruptures identified in the trenches occurred in the past 6 kyr, although additional dating should clarify earthquake timing and the mid-Holocene to present earthquake recurrence interval, as well as the likely date of the most recent earthquake. Our new slip rate estimates are somewhat lower than, but comparable within error to, previous geologic estimates based on soil morphology and geodetic estimates from GPS, but the new record of surface ruptures exposed in the trenches is the most complete and comprehensively dated earthquake history yet determined for this fault. Together with new and existing mapping of tectonically generated geomorphology along the ABF, our constraints show that contrary to some theories of fault interaction and activity for this section of the San Andreas system, the Agua Blanca Fault has been active over the late Holocene, and should be considered as a potential source of seismic hazard.

Interseismic deformation and moment deficit along the Manila subduction zone and the Philippine Fault system

NASA Astrophysics Data System (ADS)

Hsu, Y. J.; Yu, S. B.; Loveless, J. P.; Bacolcol, T.; Woessner, J.; Solidum, R., Jr.

2015-12-01

The Sunda plate converges obliquely with the Philippine Sea plate with a rate of ~100 mm/yr and results in the sinistral slip along the 1300 km-long Philippine fault. Using GPS data from 1998 to 2013 as well as a block modeling approach, we decompose the crustal motion into multiple rotating blocks and elastic deformation associated with fault slip at block boundaries. Our preferred model composed of 8 blocks, produces a mean residual velocity of 3.4 mm/yr at 93 GPS stations. Estimated long-term slip rates along the Manila subduction zone show a gradual southward decrease from 66 mm/yr at the northwest tip of Luzon to 60 mm/yr at the southern portion of the Manila Trench. We infer a low coupling fraction of 11% offshore northwest Luzon and a coupling fraction of 27% near the subduction of Scarborough Seamount. The accumulated strain along the Manila subduction zone at latitudes 15.5°~18.5°N could be balanced by earthquakes with composite magnitudes of Mw 8.7 and Mw 8.9 based on a recurrence interval of 500 years and 1000 years, respectively. Estimates of sinistral slip rates on the major splay faults of the Philippine fault system in central Luzon increase from east to west: sinistral slip rates are 2 mm/yr on the Dalton fault, 8 mm/yr on the Abra River fault, and 12 mm/yr on the Tubao fault. On the southern segment of the Philippine fault (Digdig fault), we infer left-lateral slip of ~20 mm/yr. The Vigan-Aggao fault in northwest Luzon exhibits significant reverse slip of up to 31 mm/yr, although deformation may be distributed across multiple offshore thrust faults. On the Northern Cordillera fault, we calculate left-lateral slip of ~7 mm/yr. Results of block modeling suggest that the majority of active faults in Luzon are fully locked to a depth of 15-20 km. Inferred moment magnitudes of inland large earthquakes in Luzon fall in the range of Mw 7.0-7.5 based on a recurrence interval of 100 years. Using the long-term plate convergence rate between the Sunda plate and Philippine Sea plate as well as seismic moment release rate, we calculate the moment budget for the entire Luzon plate boundary zone that could be balanced by earthquakes with a composite magnitude of ~Mw 9 based on recurrence intervals of 500-1000 years.

Optimal estimation of recurrence structures from time series

NASA Astrophysics Data System (ADS)

beim Graben, Peter; Sellers, Kristin K.; Fröhlich, Flavio; Hutt, Axel

2016-05-01

Recurrent temporal dynamics is a phenomenon observed frequently in high-dimensional complex systems and its detection is a challenging task. Recurrence quantification analysis utilizing recurrence plots may extract such dynamics, however it still encounters an unsolved pertinent problem: the optimal selection of distance thresholds for estimating the recurrence structure of dynamical systems. The present work proposes a stochastic Markov model for the recurrent dynamics that allows for the analytical derivation of a criterion for the optimal distance threshold. The goodness of fit is assessed by a utility function which assumes a local maximum for that threshold reflecting the optimal estimate of the system's recurrence structure. We validate our approach by means of the nonlinear Lorenz system and its linearized stochastic surrogates. The final application to neurophysiological time series obtained from anesthetized animals illustrates the method and reveals novel dynamic features of the underlying system. We propose the number of optimal recurrence domains as a statistic for classifying an animals' state of consciousness.

Efficacy, safety and outcome of frameless image-guided robotic radiosurgery for brain metastases after whole brain radiotherapy.

PubMed

Lohkamp, Laura-Nanna; Vajkoczy, Peter; Budach, Volker; Kufeld, Markus

2018-05-01

Estimating efficacy, safety and outcome of frameless image-guided robotic radiosurgery for the treatment of recurrent brain metastases after whole brain radiotherapy (WBRT). We performed a retrospective single-center analysis including patients with recurrent brain metastases after WBRT, who have been treated with single session radiosurgery, using the CyberKnife® Radiosurgery System (CKRS) (Accuray Inc., CA) between 2011 and 2016. The primary end point was local tumor control, whereas secondary end points were distant tumor control, treatment-related toxicity and overall survival. 36 patients with 140 recurrent brain metastases underwent 46 single session CKRS treatments. Twenty one patients had multiple brain metastases (58%). The mean interval between WBRT and CKRS accounted for 2 years (range 0.2-7 years). The median number of treated metastases per treatment session was five (range 1-12) with a tumor volume of 1.26 ccm (mean) and a median tumor dose of 18 Gy prescribed to the 70% isodose line. Two patients experienced local tumor recurrence within the 1st year after treatment and 13 patients (36%) developed novel brain metastases. Nine of these patients underwent additional one to three CKRS treatments. Eight patients (22.2%) showed treatment-related radiation reactions on MRI, three with clinical symptoms. Median overall survival was 19 months after CKRS. The actuarial 1-year local control rate was 94.2%. CKRS has proven to be locally effective and safe due to high local tumor control rates and low toxicity. Thus CKRS offers a reliable salvage treatment option for recurrent brain metastases after WBRT.

Favorable Prognosis in Patients With High-Grade Glioma With Radiation Necrosis: The University of Colorado Reoperation Series

DOE Office of Scientific and Technical Information (OSTI.GOV)

Rusthoven, Kyle E.; Olsen, Christine; Franklin, Wilbur

Purpose: To analyze the pathology, outcomes, and prognostic factors in patients with high-grade glioma undergoing reoperation after radiotherapy (RT). Methods and Materials: Fifty-one patients with World Health Organization Grade 3-4 glioma underwent reoperation after prior RT. The median dose of prior RT was 60 Gy, and 84% received chemotherapy as part of their initial treatment. Estimation of the percentage of necrosis and recurrent tumor in each reoperation specimen was performed. Pathology was classified as RT necrosis if {>=}80% of the specimen was necrotic and as tumor recurrence if {>=}20% was tumor. Predictors of survival were analyzed using log-rank comparisons andmore » Cox proportional hazards regression. Results: The median interval between the completion of RT and reoperation was 6.7 months (range, 1-59 months). Pathologic analysis showed RT necrosis in 27% and recurrence in 73% of cases. Thirteen patients required a reoperation for uncontrolled symptoms. Among them, 1 patient (8%) had pathology showing RT necrosis, and 12 (92%) had tumor recurrence. Median survival after reoperation was longer for patients with RT necrosis (21.8 months vs. 7.0 months, p = 0.047). In 7 patients with Grade 4 tumors treated with temozolomide-based chemoradiation with RT necrosis, median survival from diagnosis and reoperation were 30.2 months and 21.8 months, respectively. Conclusions: Patients with RT necrosis at reoperation have improved survival compared with patients with tumor recurrence. Future efforts to intensify local therapy and increase local tumor control in patients with high-grade glioma seem warranted.« less

Variability of disease activity in patients treated with ranibizumab for neovascular age-related macular degeneration.

PubMed

Enders, P; Scholz, P; Muether, P S; Fauser, S

2016-08-01

PurposeTo analyze choroidal neovasularization (CNV) activity and recurrence patterns in patients with neovascular age-related macular degeneration (nAMD) treated with ranibizumab, and the correlation with individual intraocular vascular endothelial growth factor (VEGF) suppression time (VST).MethodsPost-hoc analysis of data from a prospective, non-randomized clinical study. Patients with nAMD treated with ranibizumab on a pro re nata regimen. Disease activity was analyzed monthly by spectral-domain optical coherence tomography and correlated with VSTs.ResultsOverall, 73 eyes of 73 patients were included in the study with a mean follow-up of 717 days (range: 412-1239 days). Overall, the mean CNV-activity-free interval was 76.5 days (range: 0-829 days). The individual range of the length of dry intervals was high. A total of 42% of patients had a range of more than 90 days. Overall, 16% of patients showed persistent activity. And 12% stayed dry after the initial ranibizumab treatment. No significant correlation was found between the CNV-recurrence pattern and VST (P=0.12).ConclusionsCNV activity in nAMD is irregular, which is reflected in the range of the duration of dry intervals and late recurrences. The biomarker VST solely seems not to be sufficient to explain recurrence pattern of CNV in all AMD patients.

Characterization of QT and RR interval series during acute myocardial ischemia by means of recurrence quantification analysis.

PubMed

Peng, Yi; Sun, Zhongwei

2011-01-01

This study is aimed to investigate the nonlinear dynamic properties of the fluctuations in ventricular repolarization, heart rate and their correlation during acute myocardial ischemia. From 13 ECG records in long-term ST-T database, 170 ischemic episodes were selected with the duration of 34 s to 23 min 18 s, and two 5-min episodes immediately before and after each ischemic episode as non-ischemic ones for comparison. QT interval (QTI) and RR interval (RRI) were extracted and the ectopic beats were removed. Recurrence quantification analysis (RQA) was performed on QTI and RRI series, respectively, and cross recurrence quantification analysis (CRQA) on paired normalized QTI and RRI series. Wilcoxon signed-rank test was used for statistical analysis. Results revealed that the RQA indexes for QTI and HRI series had the same changing trend during ischemia with more significantly changed indexes in QTI series. In the CRQA, indexes related to the vertical and horizontal structures in recurrence plot significantly increased, representing decreased dependency of QTI on RRI. Both QTI and RRI series showed reduced complexity during ischemia with higher sensitivity in ventricular repolarization. The weakened coupling between QTI and RRI suggests the decreased influence of sinoatrial node on QTI modulation during ischemia.

Comparative Study of Different {beta}-Radiation Doses for Preventing Pterygium Recurrence

DOE Office of Scientific and Technical Information (OSTI.GOV)

Yamada, Takayuki, E-mail: tyamada-oph@umin.ac.jp; Mochizuki, Hideki; Ue, Takahiro

Purpose: To compare the pterygium recurrence rates after treatment with two different {beta}-radiation doses. Methods and Materials: A total of 84 patients with a mean age of 63.0 {+-} 10.3 years (men, 48 eyes, and women, 47 eyes) and initially treated with {beta}-radiation after pterygium excision were recruited. The mean follow-up period was 49.9 {+-} 51.3 months. The patients were assigned to two dose groups: a high-dose (40 Gy) or a low-dose (20 Gy) group. The statistical significance of differences in patient age, pterygium size, and interval between surgery and radiotherapy were analyzed in the 20-Gy group using the Coxmore » proportional hazard model at p < .05. Results: The high- and low-dose groups included 28 and 67 eyes, respectively. Pterygia recurred in 11 eyes, all in the low-dose group. The interval between surgery and radiotherapy was not a significant predictor of recurrence. Smaller pterygia had a lower risk of recurrence than pterygia that had encroached the pupillary area (pterygium located within one-third of the corneal radius from the limbus, corrected hazard ratio [HR], 0.069; 95% confidence interval [CI], 0.006-0.766; p = .030; pterygium extending beyond one-third of the corneal radius, corrected HR, 0.188; 95% CI, 0.018-0.696; p = 0.019; and pterygium reaching the pupillary area, corrected HR, 0.184; 95% CI, 0.036-0.929; p = .040). Older age was marginally significant as a negative predictor of recurrence (HR, 0.943; 95% CI, 0.887-1.003; p = .061). No scleromalacia developed during the follow-up period. Conclusions: {beta}-Radiation at 40 Gy was more efficacious than at 20 Gy in preventing pterygium recurrence without scleromalacia development, particularly for large-size pterygia and those in young patients.« less

Lupus enteritis: clinical characteristics and predictive factors for recurrence.

PubMed

Koo, B S; Hong, S; Kim, Y J; Kim, Y-G; Lee, C-K; Yoo, B

2015-05-01

To compare the clinical characteristics of lupus enteritis (LE) and non-enteric lupus (non-LE) patients and identify predictors of LE recurrence. We retrospectively reviewed the medical records of 62 systemic lupus erythematosus (SLE) patients in a tertiary hospital who experienced enteric symptoms and underwent abdominal computed tomography scanning between January 1997 and December 2013. We compared the clinical characteristics between LE and non-LE patients and between recurrent LE and non-recurrent LE cases. Out of 62 SLE patients with enteric symptoms, 46 cases (74%) were compatible with LE based on computed tomography findings. The C4 level was decreased in the LE group compared with the non-LE group (9.0 ± 5.6 vs. 12.3 ± 6.2, p = 0.032). Recurrence of LE was observed in 14 patients (28%). Initial involvement at the colon (79% vs. 41%, p = 0.026) and bladder with/without the ureter was more common in the recurrent group (57% vs. 25%, p = 0.048). By multivariate analysis, the hazard ratios of variables associated with recurrence were 4.689 for colon involvement (95% confidence interval: 1.245-17.659, p = 0.0220] and 5.468 for cystitis with/without ureteritis (95% confidence interval: 1.629-18.360, p = 0.006). Colon and urinary tract involvement in LE patients may be associated with the recurrence of LE. © The Author(s) 2014 Reprints and permissions: sagepub.co.uk/journalsPermissions.nav.

The outcome and risk factors for recurrence and extended hospitalization of secondary spontaneous pneumothorax.

PubMed

Saito, Yoshitaro; Suzuki, Yohei; Demura, Ryo; Kawai, Hideki

2018-03-01

Secondary spontaneous pneumothorax (SSP) is difficult to treat by itself and due to its association with serious underlying diseases. It has a high rate of recurrence and often requires extended hospitalization. Therefore, we evaluated the outcome and risk factors associated with recurrence and extended hospitalization. We retrospectively examined 61 patients with SSP, and evaluated the patients' characteristics, underlying diseases, introduction of home oxygen therapy, Brinkman index, and X-ray imaging findings to determine the risk factors for recurrence and extended hospitalization. There were 28 patients (46.0%) with chronic obstructive pulmonary disease, 8 (13.1%) with interstitial pneumonia, 16 (26.2%) with massive emphysema, and 9 (14.8%) with other diseases. Adhesion and mediastinal shift visualized by X-ray imaging were observed in 37 (37.9%) and 25 patients (40.1%), respectively. Recurrence occurred in 25 patients (40.9%) and the average hospitalization duration was 14.5 days (±11.2). A multivariate analysis showed that adhesion on X-ray imaging was a significant risk factor for recurrence (odds ratio 4.90, 95% confidence interval 1.38-21.44) and mediastinal shift on X-ray imaging was a significant risk factor for extended hospitalization (odds ratio 6.05, 95% confidence interval 1.44-31.06). Findings from X-ray imaging, and not underlying diseases, are risk factors for recurrence and extended hospitalization.

Exploring patterns of recurrent melanoma in Northeast Scotland to inform the introduction a digital self-examination intervention

PubMed Central

2014-01-01

Background Melanoma incidence is growing and more people require follow-up to detect recurrent melanoma quickly. Those detecting their own recurrent melanoma appear to have the best prognosis, so total skin self examination (TSSE) is advocated, but practice is suboptimal. A digital intervention to support TSSE has potential but it is not clear which patient groups could benefit most. The aim of this study was to explore cutaneous melanoma recurrence patterns between 1991 and 2012 in Northeast Scotland. The objectives were to: determine how recurrent melanomas were detected during the period; explore factors potentially predictive of mode of recurrence detection; identify groups least likely to detect their own recurrent melanoma and with most potential to benefit from digital TSSE support. Methods Pathology records were used to identify those with a potential recurrent melanoma of any type (local, regional and distant). Following screening of potential cases available secondary care-held records were subsequently scrutinised. Data was collected on demographics and clinical characteristics of the initial and recurrent melanoma. Data were handled in Microsoft Excel and transported into SPSS 20.0 for statistical analysis. Factors predicting detection at interval or scheduled follow-up were explored using univariate techniques, with potentially influential factors combined in a multivariate binary logistic model to adjust for confounding. Results 149 potential recurrences were identified from the pathology database held at Aberdeen Royal Infirmary. Reliable data could be obtained on 94 cases of recurrent melanoma of all types. 30 recurrences (31.9%) were found by doctors at follow-up, and 64 (68.1%) in the interval between visits, usually by the patient themselves. Melanoma recurrences of all types occurring within one-year were significantly more likely to be found at follow-up visits, and this remained so following adjustment for other factors that could be used to target digital TSSE support. Conclusions A digital intervention should be offered to all newly diagnosed patients. This group could benefit most from optimal TSSE practice. PMID:24612627

The 1994 heat wave in South Korea: mortality impacts and recurrence probability in a changing climate

NASA Astrophysics Data System (ADS)

Kysely, J.; Kim, J.

2010-03-01

The study deals with mortality impacts of the July-August 1994 heat wave in the population of South Korea, including the megacity of Seoul (with the population exceeding 10 million for the city and 20 million for the metropolitan area), and estimates recurrence probability of the heat wave in a changing climate in terms of simulations of daily temperature series with a stochastic model. The 1994 heat wave is found exceptional with respect to both climatological characteristics and the mortality effects: significantly elevated mortality occurred in all population groups, including children up to 14 years of age, and the total death toll exceeded 3000 in the Korean population, which ranks the 1994 heat wave among the worst weather-related disasters in East Asia. The estimate represents net excess mortality as no mortality displacement effect appeared. A comparison with other documented natural disasters shows that the death toll of the heat wave was much higher than those of the most disastrous floodings and typhoons over Korean Peninsula in the 20th century. The mortality response was stronger in males than females although males are found to be less vulnerable during average heat waves. A climatological analysis reveals that the July-August 1994 heat wave might be considered an extremely rare event with a return period in the order of hundreds of years if stationarity of temperature time series is assumed. However, under a more realistic assumption of gradual warming related to climate change, recurrence probability of an event analogous to the 1994 heat wave sharply rises for near-future time horizons. If warming of 0.04°C/year is assumed over 2001-2060, the recurrence interval of a very long spell of days with temperature exceeding a high threshold (as in the 1994 heat wave) is estimated to decrease to around 40 (10) years in the 2021-2030 (2041-2050) decade. This emphasizes the need for setting up an efficient heat-watch-warning system in this area in order to reduce human mortality impacts of heat waves.

Simulation of Flood Profiles for Fivemile Creek at Tarrant, Alabama, 2006

USGS Publications Warehouse

Lee, K.G.; Hedgecock, T.S.

2007-01-01

A one-dimensional step-backwater model was used to simulate flooding conditions for Fivemile Creek at Tarrant, Alabama. The 100-year flood stage published in the current flood insurance study for Tarrant by the Federal Emergency Management Agency was significantly exceeded by the March 2000 and May 2003 floods in this area. A peak flow of 14,100 cubic feet per second was computed by the U.S. Geological Survey for the May 2003 flood in the vicinity of Lawson Road. Using this estimated peak flow, flood-plain surveys with associated roughness coefficients, and the surveyed high-water profile for the May 2003 flood, a flow model was calibrated to closely match this known event. The calibrated model was then used to simulate flooding for the 10-, 50-, 100-, and 500-year recurrence interval floods. The results indicate that for the 100-year recurrence interval, the flood profile is about 2.5 feet higher, on average, than the profile published by the Federal Emergency Management Agency. The absolute maximum and minimum difference is 6.80 feet and 0.67 foot, respectively. All water-surface elevations computed for the 100-year flood are higher than those published by the Federal Emergency Management Agency, except for cross section H. The results of this study provide the community with flood-profile information that can be used for existing flood-plain mitigation, future development, and safety plans for the city.

Potential hazards from floodflows in Grapevine Canyon, Death Valley National Monument, California and Nevada

USGS Publications Warehouse

Bowers, J.C.

1990-01-01

Grapevine Canyon is on the western slope of the Grapevine Mountains in the northern part of Death Valley National Monument , California and Nevada. Grapevine Canyon Road covers the entire width of the canyon floor in places and is a frequently traveled route to Scotty 's Castle in the canyon. The region is arid and subject to flash flooding because of infrequent but intense convective storms. When these storms occur, normally in the summer, the resulting floods may create a hazard to visitor safety and property. Historical data on rainfall and floodflow in Grapevine Canyon are sparse. Data from studies made for similar areas in the desert mountains of southern California provide the basis for estimating discharges and the corresponding frequency of floods in the study area. Results of this study indicate that high-velocity flows of water and debris , even at shallow depths, may scour and damage Grapevine Canyon Road. When discharge exceeds 4,900 cu ft/sec, expected at a recurrence interval of between 25 and 50 years, the Scotty 's Castle access road and bridge may be damaged and the parking lot partly inundated. A flood having a 100-year or greater recurrence interval probably would wash out the bridge and present a hazard to the stable and garage buildings but not to the castle buildings, whose foundations are higher than the predicted maximum flood level. (USGS)

Active fault databases: building a bridge between earthquake geologists and seismic hazard practitioners, the case of the QAFI v.3 database

NASA Astrophysics Data System (ADS)

García-Mayordomo, Julián; Martín-Banda, Raquel; Insua-Arévalo, Juan M.; Álvarez-Gómez, José A.; Martínez-Díaz, José J.; Cabral, João

2017-08-01

Active fault databases are a very powerful and useful tool in seismic hazard assessment, particularly when singular faults are considered seismogenic sources. Active fault databases are also a very relevant source of information for earth scientists, earthquake engineers and even teachers or journalists. Hence, active fault databases should be updated and thoroughly reviewed on a regular basis in order to keep a standard quality and uniformed criteria. Desirably, active fault databases should somehow indicate the quality of the geological data and, particularly, the reliability attributed to crucial fault-seismic parameters, such as maximum magnitude and recurrence interval. In this paper we explain how we tackled these issues during the process of updating and reviewing the Quaternary Active Fault Database of Iberia (QAFI) to its current version 3. We devote particular attention to describing the scheme devised for classifying the quality and representativeness of the geological evidence of Quaternary activity and the accuracy of the slip rate estimation in the database. Subsequently, we use this information as input for a straightforward rating of the level of reliability of maximum magnitude and recurrence interval fault seismic parameters. We conclude that QAFI v.3 is a much better database than version 2 either for proper use in seismic hazard applications or as an informative source for non-specialized users. However, we already envision new improvements for a future update.

Space Geodesy and the New Madrid Seismic Zone

NASA Astrophysics Data System (ADS)

Smalley, Robert; Ellis, Michael A.

2008-07-01

One of the most contentious issues related to earthquake hazards in the United States centers on the midcontinent and the origin, magnitudes, and likely recurrence intervals of the 1811-1812 New Madrid earthquakes that occurred there. The stakeholder groups in the debate (local and state governments, reinsurance companies, American businesses, and the scientific community) are similar to the stakeholder groups in regions more famous for large earthquakes. However, debate about New Madrid seismic hazard has been fiercer because of the lack of two fundamental components of seismic hazard estimation: an explanatory model for large, midplate earthquakes; and sufficient or sufficiently precise data about the causes, effects, and histories of such earthquakes.

Reconciling short recurrence intervals with minor deformation in the new madrid seismic zone.

PubMed

Schweig, E S; Ellis, M A

1994-05-27

At least three great earthquakes occurred in the New Madrid seismic zone in 1811 and 1812. Estimates of present-day strain rates suggest that such events may have a repeat time of 1000 years or less. Paleoseismological data also indicate that earthquakes large enough to cause soil liquefaction have occurred several times in the past 5000 years. However, pervasive crustal deformation expected from such a high frequency of large earthquakes is not observed. This suggests that the seismic zone is a young feature, possibly as young as several tens of thousands of years old and no more than a few million years old.

Individual education, area income, and mortality and recurrence of myocardial infarction in a Medicare cohort: the National Longitudinal Mortality Study.

PubMed

Coady, Sean A; Johnson, Norman J; Hakes, Jahn K; Sorlie, Paul D

2014-07-09

The Medicare program provides universal access to hospital care for the elderly; however, mortality disparities may still persist in this population. The association of individual education and area income with survival and recurrence post Myocardial Infarction (MI) was assessed in a national sample. Individual level education from the National Longitudinal Mortality Study was linked to Medicare and National Death Index records over the period of 1991-2001 to test the association of individual education and zip code tabulation area median income with survival and recurrence post-MI. Survival was partitioned into 3 periods: in-hospital, discharge to 1 year, and 1 year to 5 years and recurrence was partitioned into two periods: 28 day to 1 year, and 1 year to 5 years. First MIs were found in 8,043 women and 7,929 men. In women and men 66-79 years of age, less than a high school education compared with a college degree or more was associated with 1-5 year mortality in both women (HRR 1.61, 95% confidence interval 1.03-2.50) and men (HRR 1.37, 1.06-1.76). Education was also associated with 1-5 year recurrence in men (HRR 1.68, 1.18-2.41, < High School compared with college degree or more), but not women. Across the spectrum of survival and recurrence periods median zip code level income was inconsistently associated with outcomes. Associations were limited to discharge-1 year survival (RR lowest versus highest quintile 1.31, 95% confidence interval 1.03-1.67) and 28 day-1 year recurrence (RR lowest versus highest quintile 1.72, 95% confidence interval 1.14-2.57) in older men. Despite the Medicare entitlement program, disparities related to individual socioeconomic status remain. Additional research is needed to elucidate the barriers and mechanisms to eliminating health disparities among the elderly.

Estimation of Recurrence of Colorectal Adenomas with Dependent Censoring Using Weighted Logistic Regression

PubMed Central

Hsu, Chiu-Hsieh; Li, Yisheng; Long, Qi; Zhao, Qiuhong; Lance, Peter

2011-01-01

In colorectal polyp prevention trials, estimation of the rate of recurrence of adenomas at the end of the trial may be complicated by dependent censoring, that is, time to follow-up colonoscopy and dropout may be dependent on time to recurrence. Assuming that the auxiliary variables capture the dependence between recurrence and censoring times, we propose to fit two working models with the auxiliary variables as covariates to define risk groups and then extend an existing weighted logistic regression method for independent censoring to each risk group to accommodate potential dependent censoring. In a simulation study, we show that the proposed method results in both a gain in efficiency and reduction in bias for estimating the recurrence rate. We illustrate the methodology by analyzing a recurrent adenoma dataset from a colorectal polyp prevention trial. PMID:22065985

Restoring platinum sensitivity in recurrent ovarian cancer by extending the platinum-free interval: Myth or reality?

PubMed

Tomao, Federica; D'Incalci, Maurizio; Biagioli, Elena; Peccatori, Fedro A; Colombo, Nicoletta

2017-09-15

The platinum-free interval is the most important predictive factor of a response to subsequent lines of chemotherapy and the most important prognostic factor for progression-free and overall survival in patients with recurrent epithelial ovarian cancer. A nonplatinum regimen is generally considered the most appropriate approach when the disease recurs very early after the end of chemotherapy, whereas platinum-based chemotherapy is usually adopted when the platinum-free interval exceeds 12 months. However, the therapeutic management of patients with intermediate sensitivity (ie, when the relapse occurs between 6 and 12 months) remains debatable. Preclinical and clinical data suggest that the extension of platinum-free interval (using a nonplatinum-based regimen) might restore platinum sensitivity, thus allowing survival improvement. The objective of this review was to critically analyze preclinical and clinical evidences supporting this hypothesis. Cancer 2017;123:3450-9. © 2017 American Cancer Society. © 2017 American Cancer Society.

A novel approach for analyzing data on recurrent events with duration to estimate the combined cumulative rate of both variables over time.

PubMed

Bhattacharya, Sudipta

2018-06-01

Recurrent adverse events, once occur often continue for some duration of time in clinical trials; and the number of events along with their durations is clinically considered as a measure of severity of a disease under study. While there are methods available for analyzing recurrent events or durations or for analyzing both side by side, no effort has been made so far to combine them and present as a single measure. However, this single-valued combined measure may help clinicians assess the wholesome effect of recurrence of incident comprising events and durations. Non-parametric approach is adapted here to develop an estimator for estimating the combined rate of both, the recurrence of events as well as the event-continuation, that is the duration per event. The proposed estimator produces a single numerical value, the interpretation and meaningfulness of which are discussed through the analysis of a real-life clinical dataset. The algebraic expression of variance is derived, asymptotic normality of the estimator is noted, and demonstration is provided on how the estimator can be used in the setup of testing of statistical hypothesis. Further possible development of the estimator is also noted, to adjust for the dependence of event occurrences on the history of the process generating recurrent events through covariates and for the case of dependent censoring.

A first hazard analysis of the Harrat Ash Shamah volcanic field, Syria-Jordan Borderline

NASA Astrophysics Data System (ADS)

Cagnan, Zehra; Akkar, Sinan; Moghimi, Saed

2017-04-01

The northernmost part of the Saudi Cenozoic Volcanic Fields, the 100,000 km2 Harrat Ash Shamah has hosted some of the most recent volcanic eruptions along the Syria-Jordan borderline. With rapid growth of the cities in this region, exposure to any potential renewed volcanism increased considerably. We present here a first-order probabilistic hazard analysis related to new vent formation and subsequent lava flow from Harrat Ash Shamah. The 733 visible eruption vent sites were utilized to develop a probability density function for new eruption sites using Gaussian kernel smoothing. This revealed a NNW striking zone of high spatial hazard surrounding the cities Amman and Irbid in Jordan. The temporal eruption recurrence rate is estimated to be approximately one vent per 3500 years, but the temporal record of the field is so poorly constrained that the lower and upper bounds for the recurrence interval are 17,700 yrs and 70 yrs, respectively. A Poisson temporal model is employed within the scope of this study. In order to treat the uncertainties associated with the spatio-temporal models as well as size of the area affected by the lava flow, the logic tree approach is adopted. For the Syria-Jordan borderline, the spatial variation of volcanic hazard is computed as well as uncertainty associated with these estimates.

Soy isoflavones and risk of cancer recurrence in a cohort of breast cancer survivors: the Life After Cancer Epidemiology study.

PubMed

Guha, Neela; Kwan, Marilyn L; Quesenberry, Charles P; Weltzien, Erin K; Castillo, Adrienne L; Caan, Bette J

2009-11-01

Soy isoflavones, structurally similar to endogenous estrogens, may affect breast cancer through both hormonally mediated and non-hormonally related mechanisms. Although the effects of soy are not well understood, some breast cancer survivors increase their soy intake post-diagnosis in attempt to improve their prognosis. Therefore, we examined the role of soy isoflavone intake and the risk of breast cancer recurrence by hormone receptor status, menopausal status, and tamoxifen therapy. A cohort of 1,954 female breast cancer survivors, diagnosed during 1997-2000, was prospectively followed for 6.31 years and 282 breast cancer recurrences were ascertained. Isoflavone intake was assessed by mailing modified Block and supplemental soy food frequency questionnaires to participants, on average 23 months post-diagnosis. Risk of breast cancer recurrence, measured by hazard ratios (HR) and 95% confidence intervals (CI), was estimated using multivariable delayed entry Cox proportional hazards models. Suggestive trends for a reduced risk of cancer recurrence were observed with increasing quintiles of daidzein and glycetin intake compared to no intake among postmenopausal women (P for trend: P = 0.08 for daidzein, P = 0.06 for glycetin) and among tamoxifen users (P = 0.10 for daidzein, P = 0.05 for glycetin). Among postmenopausal women treated with tamoxifen, there was an approximately 60% reduction in breast cancer recurrence comparing the highest to the lowest daidzein intakes (>1,453 vs. <7.7 microg/day; HR, 0.48; 95% CI, 0.21-0.79, P = 0.008). Soy isoflavones consumed at levels comparable to those in Asian populations may reduce the risk of cancer recurrence in women receiving tamoxifen therapy and moreover, appears not to interfere with tamoxifen efficacy. Further confirmation is required in other large prospective studies before recommendations regarding soy intake can be issued to breast cancer survivors.

Gender-specific Differences in Recurrence of Non-muscle-invasive Bladder Cancer: A Systematic Review and Meta-analysis.

PubMed

Uhlig, Annemarie; Strauss, Arne; Seif Amir Hosseini, Ali; Lotz, Joachim; Trojan, Lutz; Schmid, Marianne; Uhlig, Johannes

2017-09-06

The incidence of urothelial carcinoma of the bladder (UCB) is lower in women; however, women tend to present with more advanced disease. To date, there is no quantitative synthesis of studies reporting gender-specific outcomes in non-muscle-invasive UCB. To conduct a meta-analysis evaluating gender-specific differences in recurrence of non-muscle-invasive urinary bladder cancer (NMIBC). An unrestricted systematic literature search of the MEDLINE, EMBASE, and Cochrane libraries was conducted. Studies evaluating the impact of gender on disease recurrence after local treatment of NMIBC using multivariable Cox proportional hazard models were included. Random effect meta-analysis, subgroup analyses, meta-influence, and cumulative meta-analyses were conducted. Publication bias was assessed via a funnel plot and Eggeŕs test. Of 609 studies screened, 27 comprising 23 754 patients were included. Random effect meta-analyses indicated women at increased risk for UCB recurrence compared with men (hazard ratio [HR]=1.11, 95% confidence interval [CI]: 1.01-1.23, p=0.03). Subgroup analyses yielded estimates between HR=0.99 and HR=1.68. Gender-specific differences in UCB recurrence were most pronounced in studies administering exclusively bacillus Calmette-Guerin (BCG; HR=1.64, 95% CI: 1.13-2.39, p=0.01), especially in a long-term treatment regimen (HR=1.68, 95% CI: 1.32-2.15, p<0.001). Sensitivity analyses confirmed female patients at increased risk for UCB recurrence. Women are at increased risk for disease recurrence after local treatment of NMIBC compared with male patients. Reduced effectiveness of BCG treatment might underlie this observation. Gender-specific differences were evident across various subgroups and proved robust upon sensitivity analyses. In this report, we combined several studies on gender-specific differences in relapse of superficial bladder cancer. Women were more likely to experience cancer relapse than men. Copyright © 2017 European Association of Urology. Published by Elsevier B.V. All rights reserved.

Is the first seizure epilepsy--and when?

PubMed

Lawn, Nicholas; Chan, Josephine; Lee, Judy; Dunne, John

2015-09-01

Epilepsy has recently been redefined to include a single unprovoked seizure if the probability of recurrence is ≥60% over the following 10 years. This definition is based on the estimated risk of a third seizure after two unprovoked seizures, using the lower-limit 95% confidence interval (CI) at 4 years, and does not account for the initially high recurrence rate after first-ever seizure that rapidly falls with increasing duration of seizure freedom. We analyzed long-term outcomes after the first-ever seizure, and the influence of duration of seizure freedom on the likelihood of seizure recurrence, and their relevance to the new definition of epilepsy. Prospective analysis of 798 adults with a first-ever unprovoked seizure seen at a hospital-based first seizure clinic between 2000 and 2011. The likelihood of seizure recurrence was analyzed according to the duration of seizure freedom, etiology, electroencephalography (EEG), and neuroimaging findings. The likelihood of seizure recurrence at 10 years was ≥60% in patients with epileptiform abnormalities on EEG or neuroimaging abnormalities, therefore, meeting the new definition of epilepsy. However, the risk of recurrence was highly time dependent; after a brief period (≤12 weeks) of seizure freedom, no patient group continued to fulfill the new definition of epilepsy. Of 407 patients who had a second seizure, the likelihood of a third seizure at 4 years was 68% (95% CI 63-73%) and at 10 years was 85% (95% CI 79-91%). The duration of seizure freedom following first-ever seizure substantially influences the risk of recurrence, with none of our patients fulfilling the new definition of epilepsy after a short period of seizure freedom. When a threshold was applied based on the 10-year risk of a third seizure from our data, no first-seizure patient group ever had epilepsy. These data may be utilized in a definition of epilepsy after a first-ever seizure. Wiley Periodicals, Inc. © 2015 International League Against Epilepsy.

Wasatch fault zone, Utah - segmentation and history of Holocene earthquakes

USGS Publications Warehouse

Machette, Michael N.; Personius, Stephen F.; Nelson, Alan R.; Schwartz, David P.; Lund, William R.

1991-01-01

The Wasatch fault zone (WFZ) forms the eastern boundary of the Basin and Range province and is the longest continuous, active normal fault (343 km) in the United States. It underlies an urban corridor of 1.6 million people (80% of Utah's population) representing the largest earthquake risk in the interior of the western United States. The authors have used paleoseismological data to identify 10 discrete segments of the WFZ. Five are active, medial segments with Holocene slip rates of 1-2 mm a-1, recurrence intervals of 2000-4000 years and average lengths of about 50 km. Five are less active, distal segments with mostly pre-Holocene surface ruptures, late Quaternary slip rates of <0.5 mm a-1, recurrence intervals of ???10,000 years and average lengths of about 20 km. Surface-faulting events on each of the medial segments of the WFZ formed 2-4-m-high scarps repeatedly during the Holocene. Paleoseismological records for the past 6000 years indicate that a major surface-rupturing earthquake has occurred along one of the medial segments about every 395 ?? 60 years. However, between about 400 and 1500 years ago, the WFZ experienced six major surface-rupturing events, an average of one event every 220 years, or about twice as often as expected from the 6000-year record. Evidence has been found that surface-rupturing events occurred on the WFZ during the past 400 years, a time period which is twice the average intracluster recurrence interval and equal to the average Holocene recurrence interval.

Improving estimates of streamflow characteristics by using Landsat-1 imagery

USGS Publications Warehouse

Hollyday, Este F.

1976-01-01

Imagery from the first Earth Resources Technology Satellite (renamed Landsat-1) was used to discriminate physical features of drainage basins in an effort to improve equations used to estimate streamflow characteristics at gaged and ungaged sites. Records of 20 gaged basins in the Delmarva Peninsula of Maryland, Delaware, and Virginia were analyzed for 40 statistical streamflow characteristics. Equations relating these characteristics to basin characteristics were obtained by a technique of multiple linear regression. A control group of equations contains basin characteristics derived from maps. An experimental group of equations contains basin characteristics derived from maps and imagery. Characteristics from imagery were forest, riparian (streambank) vegetation, water, and combined agricultural and urban land use. These basin characteristics were isolated photographically by techniques of film-density discrimination. The area of each characteristic in each basin was measured photometrically. Comparison of equations in the control group with corresponding equations in the experimental group reveals that for 12 out of 40 equations the standard error of estimate was reduced by more than 10 percent. As an example, the standard error of estimate of the equation for the 5-year recurrence-interval flood peak was reduced from 46 to 32 percent. Similarly, the standard error of the equation for the mean monthly flow for September was reduced from 32 to 24 percent, the standard error for the 7-day, 2-year recurrence low flow was reduced from 136 to 102 percent, and the standard error for the 3-day, 2-year flood volume was reduced from 30 to 12 percent. It is concluded that data from Landsat imagery can substantially improve the accuracy of estimates of some streamflow characteristics at sites in the Delmarva Peninsula.

Late Holocene paleoseismicity, tsunamis and relative sea- level changes along the south-central Cascadia subduction zone, southern Oregon, United States of America

NASA Astrophysics Data System (ADS)

Witter, Robert Carleton

1999-10-01

This dissertation investigates stratigraphic evidence for great (M w >= 8) earthquakes, tsunamis and relative sea-level change at three coastal sites above the Cascadia subduction zone (CSZ). Accelerator mass spectrometry radiocarbon analyses, diatom analyses and vibracoring techniques were employed. Euchre Creek marsh stratigraphic sequences contain four sand beds deposited by extreme storm waves within the last 600 years and a tsunami ~300 years ago. A 150- year recurrence interval for sand deposition compared to an average recurrence interval of 500-540 years for great Cascadia, earthquakes precludes local tsunamis that accompany Cascadia earthquakes as the only candidate depositional mechanism for the sand beds. Alternatively, magnitude-frequency analyses of extreme ocean levels generated during El Niño years suggest that storm- wave runup is a more likely mechanism for sand deposition in washover settings than either locally or remotely generated tsunamis. Late Holocene stratigraphic sequences at the Coquille River estuary provide a ~6600-year record of twelve great Cascadia earthquakes and attendant tsunamis in southern Oregon. A relative sea-level history chronicles repeated sudden expansion followed by gradual emergence of the Coquille estuary in response to the earthquake cycle. The average earthquake-recurrence interval for the central CSZ (~570-590 yrs) overlaps similar estimates for northern Oregon estuaries. In contrast, more inferred earthquakes recorded at Willapa and Humboldt Bays in the last ~2000 years compared to the earthquake record at Coquille suggest that segmented rupture of the CSZ occurs. Late Holocene (since 6.3 ka) relative sea-level data generated within the Coquille estuary allow 20 m of vertical deformation across the Coquille anticline in the last 80 ky. Contrasting relative sea-level histories in southern Oregon provide evidence for late Holocene contraction on upper-plate anticlines. Two relative sea-level curves, 35 km apart, show 0.5-0.6 m/ka difference in uplift rate, although both sites demonstrate long-term tectonic uplift. Upper-plate structures above the central CSZ probably deform during megathrust events. The Cape Blanco and Coquille anticlines overlie a candidate segment boundary because they separate subduction zone segments with different earthquake histories. This dissertation includes co-authored material.

Elastic strain budget and inelastic deformation in northeast Japan

NASA Astrophysics Data System (ADS)

Sagiya, T.; Meneses Gutierrez, A. D. V.

2016-12-01

A degree of magnitude discrepancy between geodetic and geologic strain rates of the Japan islands has been debated for a long time. Ikeda (1996) hypothesized that geodetic strain rate is affected by interseismic locking at the plate interface, which was later supported by the occurrence of the 2011 Tohoku-oki earthquake. The hypothesis also predicts that the interseismic elastic strain must be fully released in association with large earthquakes and do not accumulates in time. However, there has been no such quantitative discussion about the elastic strain budget of the Japan Islands so far. A 261 km-long baseline connecting GEONET stations Ryotsu (950232) and Oshika (960550) runs across the northeast Japan in the E-W direction. The baseline length change shows interseismic contraction at 0.11 ppm/yr before 2011, and coseismic extension of about 20 ppm, which comprises only 200 years of interseismic strain. Geologically the recurrence interval of 2011-type giant earthquakes is estimated as 400-800 years, much longer than a prediction from the elastic strain budget. Menese-Gutierrez and Sagiya (2016) recently identified persistent crustal shortening of 4-10 mm/yr along the Japan Sea coastal area from continuous GPS data. This contribution of inelastic deformation corresponds to 10 30% of the total interseismic shortening. The discrepancy can be also partly resolved by considering the effects of M7-class earthquakes and inelastic deformation of the island arc. M7-class earthquakes such as the 1978 and 2005 Miyagi-oki earthquakes cause 0.05-0.10 cm of baseline extension every about 40 years, releasing about 10 % of the totals strain. In addition, a postseismic extension still continues after 5 years from the main shock. By assuming this postseismic phase continues for about 50-100 years, the total elastic strain budget is balanced for a recurrence interval of about 400 yrs. If we assume a longer recurrence interval, we need additional ingredients such as inelastic deformation in the Ou Backbone range, long-term budget balancing over multiple cycles, and significant temporal variation of interseismic strain rate.

Nonlinear dynamic systems identification using recurrent interval type-2 TSK fuzzy neural network - A novel structure.

PubMed

El-Nagar, Ahmad M

2018-01-01

In this study, a novel structure of a recurrent interval type-2 Takagi-Sugeno-Kang (TSK) fuzzy neural network (FNN) is introduced for nonlinear dynamic and time-varying systems identification. It combines the type-2 fuzzy sets (T2FSs) and a recurrent FNN to avoid the data uncertainties. The fuzzy firing strengths in the proposed structure are returned to the network input as internal variables. The interval type-2 fuzzy sets (IT2FSs) is used to describe the antecedent part for each rule while the consequent part is a TSK-type, which is a linear function of the internal variables and the external inputs with interval weights. All the type-2 fuzzy rules for the proposed RIT2TSKFNN are learned on-line based on structure and parameter learning, which are performed using the type-2 fuzzy clustering. The antecedent and consequent parameters of the proposed RIT2TSKFNN are updated based on the Lyapunov function to achieve network stability. The obtained results indicate that our proposed network has a small root mean square error (RMSE) and a small integral of square error (ISE) with a small number of rules and a small computation time compared with other type-2 FNNs. Copyright © 2017 ISA. Published by Elsevier Ltd. All rights reserved.

Copeptin and Long-Term Risk of Recurrent Vascular Events After Transient Ischemic Attack and Ischemic Stroke: Population-Based Study.

PubMed

Greisenegger, Stefan; Segal, Helen C; Burgess, Annette I; Poole, Debbie L; Mehta, Ziyah; Rothwell, Peter M

2015-11-01

Copeptin, the c-terminal portion of provasopressin, is a useful prognostic marker in patients after myocardial infarction and heart failure. More recently, high levels of copeptin have also been associated with worse functional outcome and increased mortality within the first year after ischemic stroke and transient ischemic attack (TIA). However, to date, there are no published data on whether copeptin predicts long-term risk of vascular events after TIA and stroke. We measured copeptin levels in consecutive patients with TIA or ischemic stroke in a population-based study (Oxford Vascular Study) recruited from 2002 to 2007 and followed up to 2014. Associations with risk of recurrent vascular events were determined by Cox-regression. During ≈6000 patient-years in 1076 patients, there were 357 recurrent vascular events, including 174 ischemic strokes. After adjustment for age, sex, and risk factors, copeptin was predictive of recurrent vascular events (adjusted hazard ratio per SD, 1.47; 95% confidence interval, 1.31-1.64; P=0.0001), vascular death (1.85; 1.60-2.14; P<0.0001), all-cause death (1.75; 1.58-1.93; P<0.0001), and recurrent ischemic stroke (1.22; 1.04-1.44; P=0.017); and improved model-discrimination significantly: net reclassification improvement for recurrent vascular events (32%; P<0.0001), vascular death (55%; P<0.0001), death (66%; P<0.0001), and recurrent stroke (16%; P=0.044). The predictive value of copeptin was largest in patients with cardioembolic index events (adjusted hazard ratio, 1.84; 95% confidence interval, 1.53-2.20 versus 1.31, 1.14-1.50 in noncardioembolic stroke; P=0.0025). In patients with cardioembolic stroke, high copeptin levels were associated with a 4-fold increased risk of vascular events within the first year of follow-up (adjusted hazard ratio, 4.02; 95% confidence interval, 2.13-7.70). In patients with TIA and ischemic stroke, copeptin predicted recurrent vascular events and death, particularly after cardioembolic TIA/stroke. Further validation is required, in particular, in studies using more extensive cardiac evaluation. © 2015 American Heart Association, Inc.

Fluvial erosion and post-erosional processes on Titan

USGS Publications Warehouse

Jaumann, R.; Brown, R.H.; Stephan, K.; Barnes, J.W.; Soderblom, L.A.; Sotin, Christophe; Le, Mouelic S.; Clark, R.N.; Soderblom, J.; Buratti, B.J.; Wagner, R.; McCord, T.B.; Rodriguez, S.; Baines, K.H.; Cruikshank, D.P.; Nicholson, P.D.; Griffith, C.A.; Langhans, M.; Lorenz, R.D.

2008-01-01

The surface of Titan has been revealed by Cassini observations in the infrared and radar wavelength ranges as well as locally by the Huygens lander instruments. Sand seas, recently discovered lakes, distinct landscapes and dendritic erosion patterns indicate dynamic surface processes. This study focus on erosional and depositional features that can be used to constrain the amount of liquids involved in the erosional process as well as on the compositional characteristics of depositional areas. Fluvial erosion channels on Titan as identified at the Huygens landing site and in RADAR and Visible and Infrared Mapping Spectrometer (VIMS) observations have been compared to analogous channel widths on Earth yielding average discharges of up to 1600 m3/s for short recurrence intervals that are sufficient to move centimeter-sized sediment and significantly higher discharges for long intervals. With respect to the associated drainage areas, this roughly translates to 1-150 cm/day runoff production rates with 10 years recurrence intervals and by assuming precipitation this implies 0.6-60 mm/h rainfall rates. Thus the observed surface erosion fits with the methane convective storm models as well as with the rates needed to transport sediment. During Cassini's T20 fly-by, the VIMS observed an extremely eroded area at 30?? W, 7?? S with resolutions of up to 500 m/pixel that extends over thousands of square kilometers. The spectral characteristics of this area change systematically, reflecting continuous compositional and/or particle size variations indicative of transported sediment settling out while flow capacities cease. To account for the estimated runoff production and widespread alluvial deposits of fine-grained material, release of area-dependent large fluid volumes are required. Only frequent storms with heavy rainfall or cryovolcanic induced melting can explain these erosional features. ?? 2008 Elsevier Inc.

The effect of lymphadenectomy on survival and recurrence in patients with ovarian cancer: a systematic review and meta-analysis.

PubMed

Zhou, Jinhong; Shan, Guoping; Chen, Yiwen

2016-08-01

Our objective was to perform a meta-analysis examining the effectiveness of lymphadenectomy in patients with ovarian cancer. PubMed and CENTRAL databases were searched on 15 November 2015 using the terms 'lymphadenectomy', 'ovarian cancer', 'dissection', 'para-aortic', 'pelvic' and survival. Prospective and retrospective studies comparing the outcomes of surgery with or without lymphadenectomy were included. Outcomes were 5-year overall survival, progression-free survival and recurrence rate. Of the 556 studies identified, 3 randomized controlled trials and 11 retrospective studies were included. Lymphadenectomy was associated with greater 5-year overall survival than no lymphadenectomy (pooled odds ratio = 1.58, 95% confidence interval: 1.41-1.77, p < 0.001). There was no difference in progression-free survival between the groups (pooled overall survival = 1.62, 95% confidence interval: 0.82-3.21, p = 0.168). Lymphadenectomy was associated with greater progression-free survival in randomized clinical trials (pooled overall survival = 1.57, 95% confidence interval: 1.11-2.21, p = 0.010), but not in retrospective studies. Lymphadenectomy was associated with a significantly lower recurrence rate (pooled overall survival = 0.51, 95% confidence interval: 0.30-0.85, p = 0.011). Lymphadenectomy was associated with greater 5-year overall survival in patients with both early and advanced stage cancer, but was associated with greater progression-free survival and lower recurrence rate only in patients with advanced stage cancer. Lymphadenectomy is associated with greater 5-year overall survival in patients with early and advanced stage ovarian cancer, but an effect on progression-free survival and recurrence rate was only found in patients with advanced stage ovarian cancer. © The Author 2016. Published by Oxford University Press. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

Statin Adherence Is Associated With Reduced Recurrent Stroke Risk in Patients With or Without Atrial Fibrillation.

PubMed

Flint, Alexander C; Conell, Carol; Ren, Xiushui; Kamel, Hooman; Chan, Sheila L; Rao, Vivek A; Johnston, S Claiborne

2017-07-01

Outpatient statin use reduces the risk of recurrent ischemic stroke among patients with stroke of atherothrombotic cause. It is not known whether statins have similar effects in ischemic stroke caused by atrial fibrillation (AFib). We studied outpatient statin adherence, measured by percentage of days covered, and the risk of recurrent ischemic stroke in patients with or without AFib in a 21-hospital integrated healthcare delivery system. Among 6116 patients with ischemic stroke discharged on a statin over a 5-year period, 1446 (23.6%) had a diagnosis of AFib at discharge. The mean statin adherence rate (percentage of days covered) was 85, and higher levels of percentage of days covered correlated with greater degrees of low-density lipoprotein suppression. In multivariable survival models of recurrent ischemic stroke over 3 years, after controlling for age, sex, race/ethnicity, medical comorbidities, and hospital center, higher statin adherence predicted reduced stroke risk both in patients without AFib (hazard ratio, 0.78; 95% confidence interval, 0.63-0.97) and in patients with AFib (hazard ratio, 0.59; 95% confidence interval, 0.43-0.81). This association was robust to adjustment for the time in the therapeutic range for international normalized ratio among AFib subjects taking warfarin (hazard ratio, 0.61; 95% confidence interval, 0.41-0.89). The relationship between statin adherence and reduced recurrent stroke risk is as strong among patients with AFib as it is among patients without AFib, suggesting that AFib status should not be a reason to exclude patients from secondary stroke prevention with a statin. © 2017 American Heart Association, Inc.

Performance of transient elastography and serum fibrosis biomarkers for non-invasive evaluation of recurrent fibrosis after liver transplantation: A meta-analysis.

PubMed

Bhat, Mamatha; Tazari, Mahmood; Sebastiani, Giada

2017-01-01

Recurrent fibrosis after liver transplantation (LT) impacts on long-term graft and patient survival. We performed a meta-analysis to compare the accuracy of non-invasive methods to diagnose significant recurrent fibrosis (stage F2-F4) following LT. Studies comparing serum fibrosis biomarkers, namely AST-to-platelet ratio index (APRI), fibrosis score 4 (FIB-4), or transient elastography (TE) with liver biopsy in LT recipients were systematically identified through electronic databases. In the meta-analysis, we calculated the weighted pooled odds ratio and used a fixed effect model, as there was no significant heterogeneity between studies. Eight studies were included for APRI, four for FIB-4, and twelve for TE. The mean prevalence of significant liver fibrosis was 37.4%. The summary odds ratio was significantly higher for TE (21.17, 95% CI confidence interval 14.10-31.77, p = 1X10-30) as compared to APRI (9.02, 95% CI 5.79-14.07; p = 1X10-30) and FIB-4 (7.08, 95% CI 4.00-12.55; p = 1.93X10-11). In conclusion, TE performs best to diagnose recurrent fibrosis in LT recipients. APRI and FIB-4 can be used as an estimate of significant fibrosis at centres where TE is not available. Longitudinal assessment of fibrosis by means of these non-invasive tests may reduce the need for liver biopsy.

Mean cerebral blood volume is an effective diagnostic index of recurrent and radiation injury in glioma patients: A meta-analysis of diagnostic test.

PubMed

Li, Zhanzhan; Zhou, Qin; Li, Yanyan; Yan, Shipeng; Fu, Jun; Huang, Xinqiong; Shen, Liangfang

2017-02-28

We conducted a meta-analysis to evaluate the diagnostic values of mean cerebral blood volume for recurrent and radiation injury in glioma patients. We performed systematic electronic searches for eligible study up to August 8, 2016. Bivariate mixed effects models were used to estimate the combined sensitivity, specificity, positive likelihood ratios, negative likelihood ratios, diagnostic odds ratios and their 95% confidence intervals (CIs). Fifteen studies with a total number of 576 participants were enrolled. The pooled sensitivity and specificity of diagnostic were 0.88 (95%CI: 0.82-0.92) and 0.85 (95%CI: 0.68-0.93). The pooled positive likelihood ratio is 5.73 (95%CI: 2.56-12.81), negative likelihood ratio is 0.15 (95%CI: 0.10-0.22), and the diagnostic odds ratio is 39.34 (95%CI:13.96-110.84). The summary receiver operator characteristic is 0.91 (95%CI: 0.88-0.93). However, the Deek's plot suggested publication bias may exist (t=2.30, P=0.039). Mean cerebral blood volume measurement methods seems to be very sensitive and highly specific to differentiate recurrent and radiation injury in glioma patients. The results should be interpreted with caution because of the potential bias.

Aggressive Regimens for Multidrug-Resistant Tuberculosis Reduce Recurrence

PubMed Central

Franke, Molly F.; Appleton, Sasha C.; Mitnick, Carole D.; Furin, Jennifer J.; Bayona, Jaime; Chalco, Katiuska; Shin, Sonya; Murray, Megan; Becerra, Mercedes C.

2013-01-01

Background. Recurrent tuberculosis disease occurs within 2 years in as few as 1% and as many as 29% of individuals successfully treated for multidrug-resistant (MDR) tuberculosis. A better understanding of treatment-related factors associated with an elevated risk of recurrent tuberculosis after cure is urgently needed to optimize MDR tuberculosis therapy. Methods. We conducted a retrospective cohort study among adults successfully treated for MDR tuberculosis in Peru. We used multivariable Cox proportional hazards regression analysis to examine whether receipt of an aggressive MDR tuberculosis regimen for ≥18 months following sputum conversion from positive to negative was associated with a reduced rate of recurrent tuberculosis. Results. Among 402 patients, the median duration of follow-up was 40.5 months (interquartile range, 21.2–53.4). Receipt of an aggressive MDR tuberculosis regimen for ≥18 months following sputum conversion was associated with a lower risk of recurrent tuberculosis (hazard ratio, 0.40 [95% confidence interval, 0.17–0.96]; P = .04). A baseline diagnosis of diabetes mellitus also predicted recurrent tuberculosis (hazard ratio, 10.47 [95% confidence interval, 2.17–50.60]; P = .004). Conclusions. Individuals who received an aggressive MDR tuberculosis regimen for ≥18 months following sputum conversion experienced a lower rate of recurrence after cure. Efforts to ensure that an aggressive regimen is accessible to all patients with MDR tuberculosis, such as minimization of sequential ineffective regimens, expanded drug access, and development of new MDR tuberculosis compounds, are critical to reducing tuberculosis recurrence in this population. Patients with diabetes mellitus should be carefully managed during initial treatment and followed closely for recurrent disease. PMID:23223591

Variability of disease activity in patients treated with ranibizumab for neovascular age-related macular degeneration

PubMed Central

Enders, P; Scholz, P; Muether, P S; Fauser, S

2016-01-01

Purpose To analyze choroidal neovasularization (CNV) activity and recurrence patterns in patients with neovascular age-related macular degeneration (nAMD) treated with ranibizumab, and the correlation with individual intraocular vascular endothelial growth factor (VEGF) suppression time (VST). Methods Post-hoc analysis of data from a prospective, non-randomized clinical study. Patients with nAMD treated with ranibizumab on a pro re nata regimen. Disease activity was analyzed monthly by spectral-domain optical coherence tomography and correlated with VSTs. Results Overall, 73 eyes of 73 patients were included in the study with a mean follow-up of 717 days (range: 412–1239 days). Overall, the mean CNV-activity-free interval was 76.5 days (range: 0–829 days). The individual range of the length of dry intervals was high. A total of 42% of patients had a range of more than 90 days. Overall, 16% of patients showed persistent activity. And 12% stayed dry after the initial ranibizumab treatment. No significant correlation was found between the CNV-recurrence pattern and VST (P=0.12). Conclusions CNV activity in nAMD is irregular, which is reflected in the range of the duration of dry intervals and late recurrences. The biomarker VST solely seems not to be sufficient to explain recurrence pattern of CNV in all AMD patients. PMID:27197870

Applying new Magee equations for predicting the Oncotype Dx recurrence score.

PubMed

Sughayer, Maher; Alaaraj, Rolla; Alsughayer, Ahmad

2018-04-24

Breast cancer is one of the most prevalent cancers in women. Oncotype Dx is a multi-gene assay frequently used to predict the recurrence risk for estrogen receptor-positive early breast cancer, with values < 18 considered low risk; ≥ 18 and ≤ 30, intermediate risk; and > 30, high risk. Patients at a high risk for recurrence are more likely to benefit from chemotherapy treatment. In this study, clinicopathological parameters for 37 cases of early breast cancer with available Oncotype Dx results were used to estimate the recurrence score using the three new Magee equations. Correlation studies with Oncotype Dx results were performed. Applying the same cutoff points as Oncotype Dx, patients were categorized into low-, intermediate- and high-risk groups according to their estimated recurrence scores. Pearson correlation coefficient (R) values between estimated and actual recurrence score were 0.73, 0.66, and 0.70 for Magee equations 1, 2 and 3, respectively. The concordance values between actual and estimated recurrence scores were 57.6%, 52.9%, and 57.6% for Magee equations 1, 2 and 3, respectively. Using standard pathologic measures and immunohistochemistry scores in these three linear Magee equations, most low and high recurrence risk cases can be predicted with a strong positive correlation coefficient, high concordance and negligible two-step discordance. Magee equations are user-friendly and can be used to predict the recurrence score in early breast cancer cases.

Association of Progression of Carotid Artery Wall Volume and Recurrent Transient Ischemic Attack or Stroke: A Magnetic Resonance Imaging Study.

PubMed

Lu, Mingming; Peng, Peng; Cui, Yuanyuan; Qiao, Huiyu; Li, Dongye; Cai, Jianming; Zhao, Xihai

2018-03-01

This study aimed to investigate the association between carotid plaque progression and subsequent recurrent events using magnetic resonance imaging. Sixty-three symptomatic patients with ipsilateral carotid atherosclerotic stenosis (30%-69% stenosis) determined by ultrasound underwent first and second carotid artery magnetic resonance imaging for carotid artery at baseline and ≥6 months after the first scan, respectively. All the patients had clinical follow-up after the second magnetic resonance scan for ≤5 years until the onset of recurrent transient ischemic attack or stroke. Presence/absence of carotid plaque compositional features, particularly intraplaque hemorrhage and fibrous cap rupture was identified. The annual progression of carotid wall volume between 2 magnetic resonance scans was measured. Univariate and multivariate Cox regression was used to calculate the hazard ratio and corresponding 95% confidence interval of carotid plaque features in discriminating recurrent events. Receiver-operating-characteristic-curve analysis was conducted to determine the area-under-the-curve of carotid plaque features in predicting recurrent events. Sixty-three patients (mean age: 66.5±10.0 years old; 54 males) were eligible for final statistics analysis. During a mean follow-up duration of 55.1±13.6 months, 14.3% of patients (n=9) experienced ipsilateral recurrent transient ischemic attack/stroke. The annual progression of carotid wall volume was significantly associated with recurrent events before (hazard ratio, 1.14 per 10 mm 3 ; 95% confidence interval, 1.02-1.27; P =0.019) and after (hazard ratio, 1.19 per 10 mm3; 95% confidence interval, 1.03-1.37; P =0.022) adjusted for confounding factors. In discriminating the recurrence of transient ischemia attack/stroke, receiver-operator curve analysis indicated that combined with annual progression of wall volume, there was a significant incremental improvement in the area-under-the-curve of intraplaque hemorrhage (area-under-the-curve: 0.69-0.81) and fibrous cap rupture (area-under-the-curve: 0.73-0.84). The annual progression of carotid wall volume is independently associated with recurrent ischemic cerebrovascular events, and this measurement has added value for intraplaque hemorrhage and fibrous cap rupture in predicting future events. © 2018 American Heart Association, Inc.

Peak-flow frequency estimates through 1994 for gaged streams in South Dakota

USGS Publications Warehouse

Burr, M.J.; Korkow, K.L.

1996-01-01

Annual peak-flow data are listed for 250 continuous-record and crest-stage gaging stations in South Dakota. Peak-flow frequency estimates for selected recurrence intervals ranging from 2 to 500 years are given for 234 of these 250 stations. The log-Pearson Type III procedure was used to compute the frequency relations for the 234 stations, which in 1994 included 105 active and 129 inactive stations. The log-Pearson Type III procedure is recommended by the Hydrology Subcommittee of the Interagency Advisory Committee on Water Data, 1982, "Guidelines for Determining Flood Flow Frequency."No peak-flow frequency estimates are given for 16 of the 250 stations because: (1) of extreme variability in data set; (2) more than 20 percent of years had no flow; (3) annual peak flows represent large outflow from a spring; (4) of insufficient peak-flow record subsequent to reservoir regulation; and (5) peak-flow records were combined with records from nearby stations.

Estimating the effect of a rare time-dependent treatment on the recurrent event rate.

PubMed

Smith, Abigail R; Zhu, Danting; Goodrich, Nathan P; Merion, Robert M; Schaubel, Douglas E

2018-05-30

In many observational studies, the objective is to estimate the effect of treatment or state-change on the recurrent event rate. If treatment is assigned after the start of follow-up, traditional methods (eg, adjustment for baseline-only covariates or fully conditional adjustment for time-dependent covariates) may give biased results. We propose a two-stage modeling approach using the method of sequential stratification to accurately estimate the effect of a time-dependent treatment on the recurrent event rate. At the first stage, we estimate the pretreatment recurrent event trajectory using a proportional rates model censored at the time of treatment. Prognostic scores are estimated from the linear predictor of this model and used to match treated patients to as yet untreated controls based on prognostic score at the time of treatment for the index patient. The final model is stratified on matched sets and compares the posttreatment recurrent event rate to the recurrent event rate of the matched controls. We demonstrate through simulation that bias due to dependent censoring is negligible, provided the treatment frequency is low, and we investigate a threshold at which correction for dependent censoring is needed. The method is applied to liver transplant (LT), where we estimate the effect of development of post-LT End Stage Renal Disease (ESRD) on rate of days hospitalized. Copyright © 2018 John Wiley & Sons, Ltd.

Tephrostratigraphy of the late Quaternary record from Lake Chalco, central México

NASA Astrophysics Data System (ADS)

Ortega-Guerrero, Beatriz; Caballero García, Lizeth; Linares-López, Carlos

2018-01-01

Lacustrine sequences in active volcanic settings preserve the record of fall-out products (tephras) from explosive volcanic activity from both proximal and distal sources. Sediments of Lake Chalco, located in the western part of the Trans Mexican Volcanic Belt, offer the opportunity to develop a detailed tephrostratigraphy of proximal and distal sources, and to provide stratigraphic marker horizons for the correlation of paleoclimate records. Here, we present major oxide glass and pumice data from 18 tephra layers interbedded in the lacustrine sediments of Chalco, from 11.5 to 31.3 cal ka BP. Tephra glass compositions range from basaltic trachyandesitic to rhyolitic. Two tephras were successfully correlated with the Tutti Frutti Plinian Eruption of Popocatépetl volcano; and two tephra layers from the Nevado de Toluca Plinian activity: the Upper Toluca Pumice and the Lower Toluca Pumice. Although the source of most of the tephras analyzed is unknown, their geochemical characterization, coupled with a robust chronology, contributes to establish a detailed tephrostratigraphy for the region. This tephra record also contributes to improving the estimated frequency of explosive volcanic activity for future hazards in the Basin of México and surrounding areas, where more than 29 million people live. Our findings estimate a recurrence interval of volcanic activity of ca. 1100 years in the interval between ca. 32 and 11.5 cal ka BP, shorter than previously estimated.

Local Composite Quantile Regression Smoothing for Harris Recurrent Markov Processes

PubMed Central

Li, Degui; Li, Runze

2016-01-01

In this paper, we study the local polynomial composite quantile regression (CQR) smoothing method for the nonlinear and nonparametric models under the Harris recurrent Markov chain framework. The local polynomial CQR regression method is a robust alternative to the widely-used local polynomial method, and has been well studied in stationary time series. In this paper, we relax the stationarity restriction on the model, and allow that the regressors are generated by a general Harris recurrent Markov process which includes both the stationary (positive recurrent) and nonstationary (null recurrent) cases. Under some mild conditions, we establish the asymptotic theory for the proposed local polynomial CQR estimator of the mean regression function, and show that the convergence rate for the estimator in nonstationary case is slower than that in stationary case. Furthermore, a weighted type local polynomial CQR estimator is provided to improve the estimation efficiency, and a data-driven bandwidth selection is introduced to choose the optimal bandwidth involved in the nonparametric estimators. Finally, we give some numerical studies to examine the finite sample performance of the developed methodology and theory. PMID:27667894

Disease progression and recurrence in women treated for vulvovaginal intraepithelial neoplasia

PubMed Central

Baumann, Marc; Mueller, Michael; Fink, Daniel; Heinzl, Siegfried; Imesch, Patrick; Dedes, Konstantin

2013-01-01

Objective The malignant potential of intraepithelial neoplasia of the vulva and vagina after treatment is not well defined. Our objective was to examine risk factors for recurrence and invasive disease. Methods Four hundred sixty-four women with biopsy proven high-grade intraepithelial neoplasia of the vulva and vagina were identified in the electronic databases of four colposcopy clinics. Inclusion criteria were a follow-up of more than one year, no history of invasive cancer and no invasive cancer within the first year after initial treatment. We investigated the potential factors associated with recurrence and progression using a logistic regression analysis to estimate odds ratios (ORs) and 95% confidence intervals (CIs). Results Of the 411 eligible patients, 123 patients (29.9%) recurred later than one year after initial treatment and 24 patients (5.8%) progressed to invasive disease. According to multivariate analyses, the risk factors associated with recurrence were multifocality (OR, 3.33; 95% CI, 2.02 to 5.51), immunosuppression (OR, 2.51; 95% CI, 1.09 to 5.81), excision as initial treatment (vs. laser evaporation; OR, 1.79; 95% CI, 1.11 to 2.91) and smoking (OR, 1.61; 95% CI, 1.02 to 2.55). Risk factors for progression to invasive disease were immunosuppression (OR, 4.00; 95% CI, 1.30 to 12.25), multifocality (OR, 3.05; 95% CI, 1.25 to 7.43) and smoking (OR, 2.97; 95% CI, 1.16 to 7.60), but not treatment modality. Conclusion Laser evaporation combined with extensive biopsy is at least as efficacious as initial treatment of intraepithelial neoplasia with excision. Smoking is a risk factor for both recurrence and progression to invasive disease. Hence, smoking cessation should be advised and maintaining a long follow-up period due to late relapses is necessary. PMID:23875073

Nonsteroidal Anti-inflammatory Drugs and Endometrial Carcinoma Mortality and Recurrence

PubMed Central

Felix, Ashley S.; Cohn, David E.; McMeekin, D. Scott; Mutch, David G.; Creasman, William T.; Thaker, Premal H.; Walker, Joan L.; Moore, Richard G.; Lele, Shashikant B.; Guntupalli, Saketh R.; Downs, Levi S.; Nagel, Christa I.; Boggess, John F.; Pearl, Michael L.; Ioffe, Olga B.; Park, Kay J.; Ali, Shamshad; Brinton, Louise A.

2017-01-01

Abstract Background: Recent data suggest that the use of nonsteroidal anti-inflammatory drugs (NSAIDs) may be associated with reductions in endometrial cancer risk, yet very few have examined whether their use is related to prognosis among endometrial cancer patients. Methods: Study subjects comprised 4374 participants of the NRG Oncology/Gynecology Oncology Group 210 Study with endometrial carcinoma who completed a presurgical questionnaire that assessed history of regular prediagnostic NSAID use and endometrial cancer risk factors. Recurrences, vital status, and causes of death were obtained from medical records and cancer registries. Fine-Gray semiproportional hazards regression estimated adjusted subhazard ratios (HRs) and 95% confidence intervals (CIs) for associations of NSAID use with endometrial carcinoma–specific mortality and recurrence. Models were stratified by endometrial carcinoma type (ie, type I [endometrioid] vs type II [serous, clear cell, or carcinosarcoma]) and histology. Results: Five hundred fifty endometrial carcinoma–specific deaths and 737 recurrences occurred during a median of five years of follow-up. NSAID use was associated with 66% (HR = 1.66, 95% CI = 1.21 to 2.30) increased endometrial carcinoma–specific mortality among women with type I cancers. Associations were statistically significant for former and current users, and strongest among former users who used NSAIDs for 10 years or longer (HR = 2.23, 95% CI = 1.19 to 4.18, two-sided Ptrend = .01). NSAID use was not associated with recurrence or endometrial carcinoma–specific mortality among women with type II tumors. Conclusions: In this study, use of NSAIDs was associated with increased endometrial carcinoma–specific mortality, especially in patients with type I tumors. Barring a clear biologic mechanism by which NSAIDs would increase the risk of cause-specific mortality, cautious interpretation is warranted. PMID:28376204

Suture, synthetic, or biologic in contaminated ventral hernia repair.

PubMed

Bondre, Ioana L; Holihan, Julie L; Askenasy, Erik P; Greenberg, Jacob A; Keith, Jerrod N; Martindale, Robert G; Roth, J Scott; Liang, Mike K

2016-02-01

Data are lacking to support the choice between suture, synthetic mesh, or biologic matrix in contaminated ventral hernia repair (VHR). We hypothesize that in contaminated VHR, suture repair is associated with the lowest rate of surgical site infection (SSI). A multicenter database of all open VHR performed at from 2010-2011 was reviewed. All patients with follow-up of 1 mo and longer were included. The primary outcome was SSI as defined by the Centers for Disease Control and Prevention. The secondary outcome was hernia recurrence (assessed clinically or radiographically). Multivariate analysis (stepwise regression for SSI and Cox proportional hazard model for recurrence) was performed. A total of 761 VHR were reviewed for a median (range) follow-up of 15 (1-50) mo: there were 291(38%) suture, 303 (40%) low-density and/or mid-density synthetic mesh, and 167(22%) biologic matrix repair. On univariate analysis, there were differences in the three groups including ethnicity, ASA, body mass index, institution, diabetes, primary versus incisional hernia, wound class, hernia size, prior VHR, fascial release, skin flaps, and acute repair. The unadjusted outcomes for SSI (15.1%; 17.8%; 21.0%; P = 0.280) and recurrence (17.8%; 13.5%; 21.5%; P = 0.074) were not statistically different between groups. On multivariate analysis, biologic matrix was associated with a nonsignificant reduction in both SSI and recurrences, whereas synthetic mesh associated with fewer recurrences compared to suture (hazard ratio = 0.60; P = 0.015) and nonsignificant increase in SSI. Interval estimates favored biologic matrix repair in contaminated VHR; however, these results were not statistically significant. In the absence of higher level evidence, surgeons should carefully balance risk, cost, and benefits in managing contaminated ventral hernia repair. Copyright © 2016 Elsevier Inc. All rights reserved.

Work stress and the risk of recurrent coronary heart disease events: A systematic review and meta-analysis.

PubMed

Li, Jian; Zhang, Min; Loerbroks, Adrian; Angerer, Peter; Siegrist, Johannes

2015-01-01

Though much evidence indicates that work stress increases the risk of incident of coronary heart disease (CHD), little is known about the role of work stress in the development of recurrent CHD events. The objective of this study was to review and synthesize the existing epidemiological evidence on whether work stress increases the risk of recurrent CHD events in patients with the first CHD. A systematic literature search in the PubMed database (January 1990 - December 2013) for prospective studies was performed. Inclusion criteria included: peer-reviewed English papers with original data, studies with substantial follow-up (> 3 years), end points defined as cardiac death or nonfatal myocardial infarction, as well as work stress assessed with reliable and valid instruments. Meta-analysis using random-effects modeling was conducted in order to synthesize the observed effects across the studies. Five papers derived from 4 prospective studies conducted in Sweden and Canada were included in this systematic review. The measurement of work stress was based on the Demand- Control model (4 papers) or the Effort-Reward Imbalance model (1 paper). According to the estimation by meta-analysis based on 4 papers, a significant effect of work stress on the risk of recurrent CHD events (hazard ratio: 1.65, 95% confidence interval: 1.23-2.22) was observed. Our findings suggest that, in patients with the first CHD, work stress is associated with an increased relative risk of recurrent CHD events by 65%. Due to the limited literature, more well-designed prospective research is needed to examine this association, in particular, from other than western regions of the world. This work is available in Open Access model and licensed under a CC BY-NC 3.0 PL license.

Membranectomy in Chronic Subdural Hematoma: Meta-Analysis.

PubMed

Sahyouni, Ronald; Mahboubi, Hossein; Tran, Peter; Roufail, John S; Chen, Jefferson W

2017-08-01

Initial management strategies of chronic subdural hematoma (cSDH) are controversial and range from bedside twist-drill or burr-hole drainage to craniotomy with membranectomy (CWM). We aim to 1) perform a meta-analysis of the available data on the outcomes of CWM for treatment of cSDH in published English-language literature and 2) evaluate collective outcomes of CWM with respect to morbidity, mortality, and recurrence rates. A search of English-language literature performed in PubMed, Ovid, and Cochrane databases using key words ("subdural hematoma" or "chronic subdural hematoma") and ("membrane" or "membranectomy") from inception to December 2016 was conducted. Studies reporting outcomes of CWM in cSDH were included. Mortality, morbidity, follow-up duration, and recurrence rate data were extracted and analyzed. Pooled estimates and confidence intervals (CIs) were calculated for all outcomes using a random-effects model. Of 301 articles found, 17 articles containing 5369 patients met our eligibility criteria. Mean follow-up duration ranged from 1-30.8 months. Collective mean mortality and morbidity rates were 3.7% and 6.9%, respectively (95% CI 2-5.4% and 2.1-11.6%; P < 0.001 and P = 0.004). The collective mean recurrence rate was 7.6% (95% CI: 5%-10.2%; P < 0.001). Clinical data on outcomes of CWM in cSDH are limited to single institutional analyses, with considerable variation in recurrence rates and follow-up time. The rates we reported are comparable with the 5% mortality and 3%-12% morbidity rates and lower than the 10%-21% recurrence rate in the literature for burr holes or craniotomy without membranectomy. This meta-analysis provides an in-depth analysis of available data and reviews reported outcomes. Copyright © 2017 Elsevier Inc. All rights reserved.

A Prospective Study of Back Pain and Risk of Falls Among Older Community-dwelling Women

PubMed Central

Litwack-Harrison, Stephanie; Cawthon, Peggy M.; Kado, Deborah M.; Deyo, Richard A.; Makris, Una E.; Carlson, Hans L.; Nevitt, Michael C.

2016-01-01

Background. Back pain and falls are common health conditions among older U.S. women. The extent to which back pain is an independent risk factor for falls has not been established. Methods. We conducted a prospective study among 6,841 community-dwelling U.S. women at least 65 years of age from the Study of Osteoporotic Fractures (SOF). Baseline questionnaires inquired about any back pain, pain severity, and frequency in the past year. During 1 year of follow-up, falls were summed from self-reports obtained every 4 months. Two outcomes were studied: recurrent falls (≥2 falls) and any fall (≥1 fall). Associations of back pain and each fall outcome were estimated with risk ratios (RRs) and 95% confidence intervals (CIs) from multivariable log-binomial regression. Adjustments were made for age, education, smoking status, fainting history, hip pain, stroke history, vertebral fracture, and Geriatric Depression Scale. Results. Most (61%) women reported any back pain. During follow-up, 10% had recurrent falls and 26% fell at least once. Any back pain relative to no back pain was associated with a 50% increased risk of recurrent falls (multivariable RR = 1.5, 95% CI: 1.3, 1.8). Multivariable RRs for recurrent falls were significantly elevated for all back pain symptoms, ranging from 1.4 (95% CI: 1.1, 1.8) for mild back pain to 1.8 (95% CI: 1.4, 2.3) for activity-limiting back pain. RRs of any fall were also significantly increased albeit smaller than those for recurrent falls. Conclusions. Older community-dwelling women with a recent history of back pain are at increased risk for falls. PMID:26757988

Maximum magnitude in the Lower Rhine Graben

NASA Astrophysics Data System (ADS)

Vanneste, Kris; Merino, Miguel; Stein, Seth; Vleminckx, Bart; Brooks, Eddie; Camelbeeck, Thierry

2014-05-01

Estimating Mmax, the assumed magnitude of the largest future earthquakes expected on a fault or in an area, involves large uncertainties. No theoretical basis exists to infer Mmax because even where we know the long-term rate of motion across a plate boundary fault, or the deformation rate across an intraplate zone, neither predict how strain will be released. As a result, quite different estimates can be made based on the assumptions used. All one can say with certainty is that Mmax is at least as large as the largest earthquake in the available record. However, because catalogs are often short relative to the average recurrence time of large earthquakes, larger earthquakes than anticipated often occur. Estimating Mmax is especially challenging within plates, where deformation rates are poorly constrained, large earthquakes are rarer and variable in space and time, and often occur on previously unrecognized faults. We explore this issue for the Lower Rhine Graben seismic zone where the largest known earthquake, the 1756 Düren earthquake, has magnitude 5.7 and should occur on average about every 400 years. However, paleoseismic studies suggest that earthquakes with magnitudes up to 6.7 occurred during the Late Pleistocene and Holocene. What to assume for Mmax is crucial for critical facilities like nuclear power plants that should be designed to withstand the maximum shaking in 10,000 years. Using the observed earthquake frequency-magnitude data, we generate synthetic earthquake histories, and sample them over shorter intervals corresponding to the real catalog's completeness. The maximum magnitudes appearing most often in the simulations tend to be those of earthquakes with mean recurrence time equal to the catalog length. Because catalogs are often short relative to the average recurrence time of large earthquakes, we expect larger earthquakes than observed to date to occur. In a next step, we will compute hazard maps for different return periods based on the synthetic catalogs, in order to determine the influence of underestimating Mmax.

Comparison of the Prognostic and Predictive Utilities of the 21-Gene Recurrence Score Assay and Adjuvant! for Women with Node-Negative, ER-Positive Breast Cancer: Results from NSABP B-14 and NSABP B-20

PubMed Central

Tang, Gong; Shak, Steven; Paik, Soonmyung; Anderson, Stewart J.; Costantino, Joseph P.; Geyer, Charles E.; Mamounas, Eleftherios P.; Wickerham, D. Lawrence; Wolmark, Norman

2012-01-01

The Oncotype DX® Recurrence Score® (RS) is a validated genomic predictor of outcome and response to adjuvant chemotherapy in ER-positive breast cancer. Adjuvant! was developed using SEER registry data and results from the Early Breast Cancer Clinical Trialists’ overview analyses to estimate outcome and benefit from adjuvant hormonal therapy and chemotherapy. In this report we compare the prognostic and predictive utility of these two tools in node-negative, ER-positive breast cancer. RS and Adjuvant! results were available from 668 tamoxifen-treated NSABP B-14 patients: 227 tamoxifen-treated NSABP B-20 patients, and 424 chemotherapy-plus-tamoxifen-treated B-20 patients. Adjuvant! results were also available from 1952 B-20 patients. The primary endpoint was distant recurrence-free interval (DRFI). Cox proportional hazards models were used to compare the prognostic and predictive utility of RS and Adjuvant!. Both RS (p<0.001) and Adjuvant! (p=0.002) provided strong independent prognostic information in tamoxifen-treated patients. Combining RS and individual clinicopathologic characteristics provided greater prognostic discrimination than combining RS and the composite Adjuvant!. In the B-20 cohort with RS results (n=651), RS was significantly predictive of chemotherapy benefit (interaction p=0.031 for DRFI, p=0.011 for overall survival [OS], p=0.082 for disease-free survival [DFS]), but Adjuvant! was not (interaction p=0.99, p=0.311 and p=0.357, respectively). However, in the larger B-20 sub-cohort (n=1952), Adjuvant! was significantly predictive of chemotherapy benefit for OS (interaction p=0.009) but not for DRFI (p=0.219) or DFS (p=0.099). Prognostic estimates can be optimized by combining RS and clinicopathologic information instead of simply combining RS and Adjuvant!. RS should be used for estimating relative chemotherapy benefit. PMID:21221771

Comparison of the prognostic and predictive utilities of the 21-gene Recurrence Score assay and Adjuvant! for women with node-negative, ER-positive breast cancer: results from NSABP B-14 and NSABP B-20.

PubMed

Tang, Gong; Shak, Steven; Paik, Soonmyung; Anderson, Stewart J; Costantino, Joseph P; Geyer, Charles E; Mamounas, Eleftherios P; Wickerham, D Lawrence; Wolmark, Norman

2011-05-01

The Oncotype DX Recurrence Score (RS) is a validated genomic predictor of outcome and response to adjuvant chemotherapy in ER-positive breast cancer. Adjuvant! was developed using SEER registry data and results from the Early Breast Cancer Clinical Trialists' overview analyses to estimate outcome and benefit from adjuvant hormonal therapy and chemotherapy. In this report we compare the prognostic and predictive utility of these two tools in node-negative, ER-positive breast cancer. RS and Adjuvant! results were available from 668 tamoxifen-treated NSABP B-14 patients, 227 tamoxifen-treated NSABP B-20 patients, and 424 chemotherapy plus tamoxifen-treated B-20 patients. Adjuvant! results were also available from 1952 B-20 patients. The primary endpoint was distant recurrence-free interval (DRFI). Cox proportional hazards models were used to compare the prognostic and predictive utility of RS and Adjuvant!. Both RS (P < 0.001) and Adjuvant! (P = 0.002) provided strong independent prognostic information in tamoxifen-treated patients. Combining RS and individual clinicopathologic characteristics provided greater prognostic discrimination than combining RS and the composite Adjuvant!. In the B-20 cohort with RS results (n = 651), RS was significantly predictive of chemotherapy benefit (interaction P = 0.031 for DRFI, P = 0.011 for overall survival [OS], P = 0.082 for disease-free survival [DFS]), but Adjuvant! was not (interaction P = 0.99, P = 0.311, and P = 0.357, respectively). However, in the larger B-20 sub-cohort (n = 1952), Adjuvant! was significantly predictive of chemotherapy benefit for OS (interaction P = 0.009) but not for DRFI (P = 0.219) or DFS (P = 0.099). Prognostic estimates can be optimized by combining RS and clinicopathologic information instead of simply combining RS and Adjuvant!. RS should be used for estimating relative chemotherapy benefit.

INCIDENCE OF HYPOTHYROIDISM AND RECURRENCES FOLLOWING I$sup 131$ TREATMENT OF HYPERTHYROIDISM

DOE Office of Scientific and Technical Information (OSTI.GOV)

Beling, U.; Einhorn, J.

1961-10-01

The incidences of hypothyroidism and its recurrence were studied in 791 patients at varying intervals after I/sup 131/ treatment of hyperthyroidism. Radiotherapy with I/sup 131/ tends to lead to hypothyroidism, both early and, especially, late. After a long remission, however, there is small likelihood of recurrence of hyperthyroidism. The influence of sex, age, type of goiter, and number of I/sup 131/ therapy doses administered on the incidence of hypothyroidism was studied. (auth)

Systematic follow-up after curative surgery for colorectal cancer in Norway: a population-based audit of effectiveness, costs, and compliance.

PubMed

Körner, Hartwig; Söreide, Kjetil; Stokkeland, Pål J; Söreide, Jon Arne

2005-03-01

In this study, we analyzed the Norwegian guidelines for systematic follow-up after curative colorectal cancer surgery in a large single institution. Three hundred fourteen consecutive unselected patients undergoing curative surgery for colorectal cancer between 1996 and 1999 were studied with regard to asymptomatic curable recurrence, compliance with the program, and cost. Follow-up included carcinoembryonic antigen (CEA) interval measurements, colonoscopy, ultrasonography of the liver, and radiography of the chest. In 194 (62%) of the patients, follow-up was conducted according to the Norwegian guidelines. Twenty-one patients (11%) were operated on for curable recurrence, and 18 patients (9%) were disease free after curative surgery for recurrence at evaluation. Four metachronous tumors (2%) were found. CEA interval measurement had to be made most frequently (534 tests needed) to detect one asymptomatic curable recurrence. Follow-up program did not influence cancer-specific survival. Overall compliance with the surveillance program was 66%, being lowest for colonoscopy (55%) and highest for ultrasonography of the liver (85%). The total program cost was 228,117 euro (US 280,994 dollars), translating into 20,530 euro (US 25,289 dollars) for one surviving patient after surgery for recurrence. The total diagnosis yield with regard to disease-free survival after surgery for recurrence was 9%. Compliance was moderate. Whether the continuing implementation of such program and cost are justified should be debated.

Recurrence intervals for the closure of the Dutch Maeslant surge barrier

NASA Astrophysics Data System (ADS)

van den Brink, Henk W.; de Goederen, Sacha

2017-09-01

The Dutch Maeslant Barrier, a movable surge barrier in the mouth of the river Rhine, closes when there is a surge in the North Sea and the water level in the river at Rotterdam exceeds 3 m above mean sea level. An important aspect of the failure probability is that the barrier might get damaged during a closure and that, within the time needed for repair, a second critical storm surge may occur. With an estimated closure frequency of once in 10 years, the question of how often the barrier has to be closed twice within one month arises.Instead of tackling this problem by the application of statistical models on the (short) observational series, we solve the problem by combining the surge model WAQUA/DCSMv5 with the output of all seasonal forecasts of the European Centre of Medium-Range Weather Forecasting (ECMWF) in the period 1981-2015, whose combination cumulates in a pseudo-observational series of more than 6000 years.We show that the Poisson process model leads to wrong results as it neglects the temporal correlations that are present on daily, weekly and monthly timescales.By counting the number of double events over a threshold of 2.5 m and assuming that the number of events is exponentially related to the threshold, it is found that two closures occur on average once in 150 years within a month, and once in 330 years within a week. The large uncertainty in these recurrence intervals of more than a factor of two is caused by the sensitivity of the results to the Gumbel parameters of the observed record, which are used for bias correction.Sea level rise has a significant impact on the recurrence time for both single and double closures. The recurrence time of single closures doubles with every 18 cm mean sea level rise (assuming that other influences remain unchanged) and double closures double with every 10 cm rise. This implies a 3-14 times higher probability of a double closure for a 15-40 cm sea level rise in 2050 (according to the KNMI climate scenarios).

Early Cerebral Blood Volume Changes Predict Progression After Convection-Enhanced Delivery of Topotecan for Recurrent Malignant Glioma.

PubMed

Surapaneni, Krishna; Kennedy, Benjamin C; Yanagihara, Ted K; DeLaPaz, Robert; Bruce, Jeffrey N

2015-07-01

To assess whether early changes in enhancing tumor volume (eTV) and relative cerebral blood volume (rCBV) 1 month after convection-enhanced delivery of topotecan in patients with recurrent malignant glioma correlated with 6-month disease progression status. Sixteen patients were enrolled in a Phase Ib trial of convection-enhanced delivery of topotecan for recurrent malignant glioma. Each patient was evaluated with serial follow-up magnetic resonance imaging at baseline and at 4- to 8-week intervals. Changes at 1 month compared with baseline in eTV and rCBV were evaluated as potential predictors of 6-month progression status, classified as either progressive disease or nonprogressive disease. Relationships between percent changes in eTV and rCBV at 1 month with the probability of progressive disease at 6 months were estimated by the use of logistic regression analysis. Receiver operating characteristic curves for varying percent change thresholds in eTV and rCBV were evaluated by the use of 6-month progressive disease as the reference. There was a significant difference in the percent change in rCBV at 1 month in patients with progressive disease compared with those with nonprogressive disease at 6 months (+12% vs. -29%, P = 0.02). Logistic regression analysis demonstrated on average that a 10% increase in rCBV at 1 month after convection-enhanced delivery of topotecan was associated with 1.7 times the odds of developing progressive disease at 6 months (95% confidence interval [CI] 1.0-2.9 P = 0.05). Receiver operating characteristic analysis for determining progressive disease at 6 months showed a greater area under the curve with rCBV (0.867; 95% CI 0.66-1.00) than with change in enhancing tumor volume (0.767; 95% CI 0.51-1.00). In this selected population of patients with recurrent malignant glioma treated with convection-enhanced delivery of topotecan, early changes in rCBV at 4 weeks after therapy may help predict progression status at 6 months. Copyright © 2015 Elsevier Inc. All rights reserved.

Regression analysis of mixed recurrent-event and panel-count data

PubMed Central

Zhu, Liang; Tong, Xinwei; Sun, Jianguo; Chen, Manhua; Srivastava, Deo Kumar; Leisenring, Wendy; Robison, Leslie L.

2014-01-01

In event history studies concerning recurrent events, two types of data have been extensively discussed. One is recurrent-event data (Cook and Lawless, 2007. The Analysis of Recurrent Event Data. New York: Springer), and the other is panel-count data (Zhao and others, 2010. Nonparametric inference based on panel-count data. Test 20, 1–42). In the former case, all study subjects are monitored continuously; thus, complete information is available for the underlying recurrent-event processes of interest. In the latter case, study subjects are monitored periodically; thus, only incomplete information is available for the processes of interest. In reality, however, a third type of data could occur in which some study subjects are monitored continuously, but others are monitored periodically. When this occurs, we have mixed recurrent-event and panel-count data. This paper discusses regression analysis of such mixed data and presents two estimation procedures for the problem. One is a maximum likelihood estimation procedure, and the other is an estimating equation procedure. The asymptotic properties of both resulting estimators of regression parameters are established. Also, the methods are applied to a set of mixed recurrent-event and panel-count data that arose from a Childhood Cancer Survivor Study and motivated this investigation. PMID:24648408

Flood of January 1982 in the San Francisco Bay area, California

USGS Publications Warehouse

Blodgett, J.C.; Chin, E.H.

1989-01-01

A major winter storm originating over the Pacific Ocean moved through central California in early January 1982. As much as 16 inches of rain fell in Marin County and 25 inches in the mountains bordering Santa Cruz County. The storm of January 3-5, 1982 had a stable atmospheric structure, and the layer of moist maritime air was confined to altitudes between 50 and 700 ft; this phenomenon caused the rain to fall most heavily along the lower slopes of the coastal mountains. As a result of antecedent rainfall, streamflow in the San Francisco Bay area exceeded normal from the end of October to the end of December 1981. For most streams, the January 1982 flood was the largest since the flood of December 1955, but it was not significantly large in comparison with historic peak-flow data. Damages associated with the storm were substantial, but flooding from stream runoff was not the major problem. Greater than normal antecedent rainfall, together with the prolonged heavy rain, liquified the supersaturated soil cover and caused numerous slope failures and debris flows on steep, unstable slopes. The median recurrence interval of the 1982 peak for 66 streamflow-gaging stations in the San Francisco Bay area is 10 years; for the 1955 flood, the median recurrence interval for 16 stations is 11 years. Streams with highest unit peak runoff were in the Santa Cruz Mountains and North Bay subareas. Median recurrence intervals of flood volumes for durations of 1, 3, and 8 consecutive days during the January 1982 flood are 18, 11, and 8; these recurrence intervals are comparable to those of the December 1955 flood, which are 13 , 16, and 14 years. (USGS)

Magnitude and frequency of floods in the United States, Part 3-A, Ohio River Basin except Cumberland and Tennessee River Basins

USGS Publications Warehouse

Speer, Paul R.; Gamble, Charles R.

1965-01-01

This report presents a means of determining the probable magnitude and frequency of floods of any recurrence interval from 1.1 to 50 years at most points on streams in the Ohio River basin except Cumberland and Tennessee River basins. Curves are defined that show the relation between the drainage area and the mean annual flood in eight hydrologic areas, and composite frequency curves define the relation of a flood of any recurrence interval from 1.1 to 50 years to the mean annual flood. These two relations are based upon gaging-station records having 10 or more years of record not materially affected by storage or diversion, and the results obtainable from them will represent the magnitude and frequency of natural floods within the range and recurrence intervals defined by the base data. The report also contains a compilation of flood records at all sites in the area at which records have been collected for 5 or more consecutive years. As far as was possible at each location for which discharge has been determined, the tabulations include all floods above a selected base. Where only gage heights have been obtained or where the data did not warrant computation of peach discharges above a selected base, only annual peaks are shown. The maximum known flood discharges for the streamflow stations and miscellaneous points except Ohio River main stem stations, together with areal floods of 10- and 50-year recurrence intervals, are plotted against the size of drainage area for each flood region and hydrologic area to provide a convenient means of judging the frequency of the maximum known floods that have been recorded for these points.

Sensitivity analysis of seismic hazard for the northwestern portion of the state of Gujarat, India

USGS Publications Warehouse

Petersen, M.D.; Rastogi, B.K.; Schweig, E.S.; Harmsen, S.C.; Gomberg, J.S.

2004-01-01

We test the sensitivity of seismic hazard to three fault source models for the northwestern portion of Gujarat, India. The models incorporate different characteristic earthquake magnitudes on three faults with individual recurrence intervals of either 800 or 1600 years. These recurrence intervals imply that large earthquakes occur on one of these faults every 266-533 years, similar to the rate of historic large earthquakes in this region during the past two centuries and for earthquakes in intraplate environments like the New Madrid region in the central United States. If one assumes a recurrence interval of 800 years for large earthquakes on each of three local faults, the peak ground accelerations (PGA; horizontal) and 1-Hz spectral acceleration ground motions (5% damping) are greater than 1 g over a broad region for a 2% probability of exceedance in 50 years' hazard level. These probabilistic PGAs at this hazard level are similar to median deterministic ground motions. The PGAs for 10% in 50 years' hazard level are considerably lower, generally ranging between 0.2 g and 0.7 g across northwestern Gujarat. Ground motions calculated from our models that consider fault interevent times of 800 years are considerably higher than other published models even though they imply similar recurrence intervals. These higher ground motions are mainly caused by the application of intraplate attenuation relations, which account for less severe attenuation of seismic waves when compared to the crustal interplate relations used in these previous studies. For sites in Bhuj and Ahmedabad, magnitude (M) 7 3/4 earthquakes contribute most to the PGA and the 0.2- and 1-s spectral acceleration ground motion maps at the two considered hazard levels. ?? 2004 Elsevier B.V. All rights reserved.

Prediction of paroxysmal atrial fibrillation using recurrence plot-based features of the RR-interval signal.

PubMed

Mohebbi, Maryam; Ghassemian, Hassan

2011-08-01

Atrial fibrillation (AF) is the most common cardiac arrhythmia and increases the risk of stroke. Predicting the onset of paroxysmal AF (PAF), based on noninvasive techniques, is clinically important and can be invaluable in order to avoid useless therapeutic intervention and to minimize risks for the patients. In this paper, we propose an effective PAF predictor which is based on the analysis of the RR-interval signal. This method consists of three steps: preprocessing, feature extraction and classification. In the first step, the QRS complexes are detected from the electrocardiogram (ECG) signal and then the RR-interval signal is extracted. In the next step, the recurrence plot (RP) of the RR-interval signal is obtained and five statistically significant features are extracted to characterize the basic patterns of the RP. These features consist of the recurrence rate, length of longest diagonal segments (L(max )), average length of the diagonal lines (L(mean)), entropy, and trapping time. Recurrence quantification analysis can reveal subtle aspects of dynamics not easily appreciated by other methods and exhibits characteristic patterns which are caused by the typical dynamical behavior. In the final step, a support vector machine (SVM)-based classifier is used for PAF prediction. The performance of the proposed method in prediction of PAF episodes was evaluated using the Atrial Fibrillation Prediction Database (AFPDB) which consists of both 30 min ECG recordings that end just prior to the onset of PAF and segments at least 45 min distant from any PAF events. The obtained sensitivity, specificity, positive predictivity and negative predictivity were 97%, 100%, 100%, and 96%, respectively. The proposed methodology presents better results than other existing approaches.

Radiation therapy and surgery for fibrosarcoma in 33 cats.

PubMed

Cronin, K; Page, R L; Spodnick, G; Dodge, R; Hardie, E N; Price, G S; Ruslander, D; Thrall, D E

1998-01-01

Thirty-three cats with histologically confirmed fibrosarcomas were treated with radiation therapy followed by surgery. The median (95% confidence interval) disease free interval and overall survival were 398 (261,924) and 600 (lower limit 515) days, respectively. There were 19 treatment failures; 11 cats had only local recurrence, 4 cats developed metastatic disease, 3 cats had local recurrence followed by metastasis, and 1 cat developed simultaneous local and distant disease. Twelve cats are alive and disease free. Two cats died without evidence of treatment failure. The presence of tumor cells at the margin of resected tissue after radiation was the only variable which influenced treatment success. The median (95% confidence interval) disease free interval in 5 cats with tumor cells at the margin of the resected specimen was 112 (94,150) days versus 700 (lower limit 328) days for 26 cats with negative tumor margins, p < 0.0001. We did not identify a relationship between tumor volume, number of prior tumor excisions, concomitant use of chemotherapy or various descriptors of the radiation therapy technique and disease free interval.

Floods of March 1978, in the Maumee River basin, northeastern Indiana

USGS Publications Warehouse

Hoggatt, Richard Earl

1981-01-01

Floods in the Maumee River basin in northeastern Indiana in March 1978 resulted in heavy damage in Fort Wayne and surrounding areas. Flood damage in Fort Wayne was estimated by the Mayor to be 11 million dollars. Approximately 15 percent of the city was inundated, and 2,400 of its 190,000 residents were forced to leave their homes. The estimate of damage in Adams and Allen Counties by Civil Defense officials was 44 million dollars. The Maumee River at New Haven exceeded the peak stage of record, 21.4 feet, by 2.2 feet. The peak discharge at this stream-gaging station, 22,400 cubic feet per second, was about equal to that of a 75-year flood. Recurrence intervals of peak flows on streams tributary to the Maumee River ranged from 5 to 50 years. Records of peak and daily discharges and some precipitation data are given in this report. 

Safety and Efficacy of High-Dose Tamoxifen and Sulindac for Desmoid Tumor in Children: Results of a Children’s Oncology Group (COG) Phase II Study

PubMed Central

Skapek, Stephen X.; Anderson, James R.; Hill, D. Ashley; Henry, David; Spunt, Sheri L.; Meyer, William; Kao, Simon; Hoffer, Fredric A.; Grier, Holcombe E.; Hawkins, Douglas S.; Raney, R. Beverly

2015-01-01

Background Desmoid fibromatosis (desmoid tumor, DT) is a soft tissue neoplasm prone to recurrence despite complete surgical resection. Numerous small retrospective reports suggest that non-cytotoxic chemotherapy using tamoxifen and sulindac may be effective for DT. We evaluated the safety and efficacy of tamoxifen and sulindac in a prospective phase II study within the Children’s Oncology Group. Procedures Eligible patients were <19 years of age who had measurable DT that was recurrent or not amenable to surgery or radiation. The primary objective was to estimate progression-free survival (PFS). Patients received tamoxifen and sulindac daily for 12 months or until disease progression or intolerable toxicity occurred. Response was assessed by magnetic resonance imaging. Results Fifty-nine eligible patients were enrolled from 2004 to 2009; 78% were 10–18 years old. Twenty-two (38%) were previously untreated; 15 (41%) of the remaining 37 enrolling with recurrent DT had prior systemic chemotherapy and six (16%) had prior radiation. No life-threatening toxicity was reported. Twelve (40%) of 30 females developed ovarian cysts, which were asymptomatic in 11 cases. Ten patients completed therapy without disease progression or discontinuing treatment. Responses included four partial and one complete (5/59, 8%). The estimated 2-year PFS and survival rates were 36% (95% confidence interval: 0.23–0.48) and 96%, respectively. All three deaths were due to progressive DT. Conclusions Tamoxifen and sulindac caused few serious side effects in children with DT, although ovarian cysts were common. However, the combination showed relatively little activity as measured by response and PFS rates. PMID:23281268

Safety and efficacy of high-dose tamoxifen and sulindac for desmoid tumor in children: results of a Children's Oncology Group (COG) phase II study.

PubMed

Skapek, Stephen X; Anderson, James R; Hill, D Ashley; Henry, David; Spunt, Sheri L; Meyer, William; Kao, Simon; Hoffer, Fredric A; Grier, Holcombe E; Hawkins, Douglas S; Raney, R Beverly

2013-07-01

Desmoid fibromatosis (desmoid tumor, DT) is a soft tissue neoplasm prone to recurrence despite complete surgical resection. Numerous small retrospective reports suggest that non-cytotoxic chemotherapy using tamoxifen and sulindac may be effective for DT. We evaluated the safety and efficacy of tamoxifen and sulindac in a prospective phase II study within the Children's Oncology Group. Eligible patients were <19 years of age who had measurable DT that was recurrent or not amenable to surgery or radiation. The primary objective was to estimate progression-free survival (PFS). Patients received tamoxifen and sulindac daily for 12 months or until disease progression or intolerable toxicity occurred. Response was assessed by magnetic resonance imaging. Fifty-nine eligible patients were enrolled from 2004 to 2009; 78% were 10-18 years old. Twenty-two (38%) were previously untreated; 15 (41%) of the remaining 37 enrolling with recurrent DT had prior systemic chemotherapy and six (16%) had prior radiation. No life-threatening toxicity was reported. Twelve (40%) of 30 females developed ovarian cysts, which were asymptomatic in 11 cases. Ten patients completed therapy without disease progression or discontinuing treatment. Responses included four partial and one complete (5/59, 8%). The estimated 2-year PFS and survival rates were 36% (95% confidence interval: 0.23-0.48) and 96%, respectively. All three deaths were due to progressive DT. Tamoxifen and sulindac caused few serious side effects in children with DT, although ovarian cysts were common. However, the combination showed relatively little activity as measured by response and PFS rates. Copyright © 2012 Wiley Periodicals, Inc.

Radiocarbon dating of plant macrofossils from tidal-marsh sediment

USGS Publications Warehouse

Kemp, A.C.; Nelson, Alan R.; Horton, B.P.

2013-01-01

Tidal-marsh sediment is an archive of Holocene environmental changes, including movements of sea and land levels, and extreme events such as hurricanes, earthquakes, and tsunamis. Accurate and precise radiocarbon dating of environmental changes is necessary to estimate rates of change and the recurrence interval (frequency) of events. Plant macrofossils preserved in growth position (or deposited soon after death) in tidal-marsh sediment are ideal samples for dating such changes. In this chapter, we focus on the selection of plant macrofossils for radiocarbon dating and the application of ages from different types of macrofossils to varied research projects, and make recommendations for selection and preparation of tidal-marsh samples for dating.

Relationship between Topoisomerase 2A RNA Expression and Recurrence after Adjuvant Chemotherapy for Breast Cancer.

PubMed

Sparano, Joseph A; Goldstein, Lori J; Childs, Barrett H; Shak, Steven; Brassard, Diana; Badve, Sunil; Baehner, Frederick L; Bugarini, Roberto; Rowley, Steve; Perez, Edith; Shulman, Lawrence N; Martino, Silvana; Davidson, Nancy E; Sledge, George W; Gray, Robert

2009-12-15

PURPOSE: To perform an exploratory analysis of the relationship between gene expression and recurrence in operable hormone receptor (HR)-positive, human epidermal growth factor receptor 2 (HER2)-normal breast cancer patients treated with adjuvant doxorubicin-containing chemotherapy. EXPERIMENTAL DESIGN: RNA was extracted from archived tumor samples derived from 378 patients with stage I to III HR-positive, HER2-normal breast cancer and analyzed by reverse transcription-PCR for a panel of 374 genes, including the 21-gene recurrence score (RS). Patients were randomized to receive adjuvant doxorubicin plus cyclophosphamide or docetaxel in trial E2197, with no difference in recurrence seen in the treatment arms. All available recurrent cases were selected plus a nonrecurrent cohort. Cox proportional hazard models were used to identify relationships between gene expression and recurrence. RESULTS: TOP2A expression exhibited the strongest association with increased recurrence risk (P = 0.01), and was significantly associated with recurrence (P = 0.008) in a multivariate analysis adjusted for clinicopathologic features. Elevated TOP2A expression above the median was associated with a 2.6-fold increase (95% confidence interval, 1.3-5.2; P = 0.008) in risk of recurrence if the RS was <18, and a 2.0-fold increase (95% confidence interval, 1.2-3.2, P = 0.003) if there was an intermediate RS of 18 to 30. CONCLUSIONS: In patients with HR-positive, HER2-normal breast cancer, a population known to have a low incidence of TOP2A gene alterations thought to be predictive of anthracycline benefit, there is a range of TOP2A RNA expression that is strongly associated with recurrence after adjuvant anthracyclines, which provides information complementary to RS, indicating that it merits further evaluation as a prognostic and predictive marker. (Clin Cancer Res 2009;15(24):7693-700).

Re-irradiation Using Intensity-modulated Radiotherapy for Recurrent and Second Primary Head and Neck Cancer.

PubMed

Choi, Seo Hee; Chang, Jee Suk; Choi, Jinhyun; Park, So Hyun; Keum, Ki Chang; Park, Kyung Ran; Lee, Chang Geol

2018-05-01

Information on re-irradiation (re-RT) for recurrent and second primary head and neck cancer is limited. Herein, a description of our long-term experience of re-RT for previously irradiated head and neck cancer is provided. A retrospective review was performed for 73 consecutive patients re-irradiated for head and neck cancer between 2006 and 2015. Re-RT targets encompassed only the recurrent gross tumor and had tight margins (5-10 mm). Salvage surgery was performed on 28 (38%) patients before re-RT and 53 (73%) patients received chemotherapy concurrent with re-RT. The median interval between initial and re-RT was 31 months and the median cumulative dose of the two irradiations was 126 Gy (biologically equivalent to 2 Gy fractionation). With a median survival of 33 months, locoregional recurrence after re-RT developed in 37 patients (51%; 25 infield, 12 outfield). In multivariate analysis, higher re-RT dose (≥66 Gy), longer time interval (>2 years), and use of concurrent chemotherapy were associated with improved locoregional recurrence-free survival (all p<0.05). Additionally, performance status, additional surgical resection, and longer interval were associated with better overall survival (p=0.006, 0.021, 0.004, respectively). Clinically significant acute and late toxicities occurred in 14% and 22% of evaluable patients, but no grade 5 toxicity was observed. Moderate safety and acceptable toxicity was found after re-RT using tight margins, sufficient radiation dose, and daily image guidance. Encouraging local control and survival were obtained, similar to historical data using 1-2 cm margins. Copyright© 2018, International Institute of Anticancer Research (Dr. George J. Delinasios), All rights reserved.

Development and validation of a nomogram predicting recurrence risk in women with symptomatic urinary tract infection.

PubMed

Cai, Tommaso; Mazzoli, Sandra; Migno, Serena; Malossini, Gianni; Lanzafame, Paolo; Mereu, Liliana; Tateo, Saverio; Wagenlehner, Florian M E; Pickard, Robert S; Bartoletti, Riccardo

2014-09-01

To develop and externally validate a novel nomogram predicting recurrence risk probability at 12 months in women after an episode of urinary tract infection. The study included 768 women from Santa Maria Annunziata Hospital, Florence, Italy, affected by urinary tract infections from January 2005 to December 2009. Another 373 women with the same criteria enrolled at Santa Chiara Hospital, Trento, Italy, from January 2010 to June 2012 were used to externally validate and calibrate the nomogram. Univariate and multivariate Cox regression models tested the relationship between urinary tract infection recurrence risk, and patient clinical and laboratory characteristics. The nomogram was evaluated by calculating concordance probabilities, as well as testing calibration of predicted urinary tract infection recurrence with observed urinary tract infections. Nomogram variables included: number of partners, bowel function, type of pathogens isolated (Gram-positive/negative), hormonal status, number of previous urinary tract infection recurrences and previous treatment of asymptomatic bacteriuria. Of the original development data, 261 out of 768 women presented at least one episode of recurrence of urinary tract infection (33.9%). The nomogram had a concordance index of 0.85. The nomogram predictions were well calibrated. This model showed high discrimination accuracy and favorable calibration characteristics. In the validation group (373 women), the overall c-index was 0.83 (P = 0.003, 95% confidence interval 0.51-0.99), whereas the area under the receiver operating characteristic curve was 0.85 (95% confidence interval 0.79-0.91). The present nomogram accurately predicts the recurrence risk of urinary tract infection at 12 months, and can assist in identifying women at high risk of symptomatic recurrence that can be suitable candidates for a prophylactic strategy. © 2014 The Japanese Urological Association.

Effects of aspirin and non-aspirin nonsteroidal anti-inflammatory drugs on the incidence of recurrent colorectal adenomas: a systematic review with meta-analysis and trial sequential analysis of randomized clinical trials.

PubMed

Veettil, Sajesh K; Lim, Kean Ghee; Ching, Siew Mooi; Saokaew, Surasak; Phisalprapa, Pochamana; Chaiyakunapruk, Nathorn

2017-11-14

Beneficial effects of aspirin and non-aspirin nonsteroidal anti-inflammatory drugs (NSAIDs) against recurrent colorectal adenomas have been documented in systematic reviews; however, the results have not been conclusive. Uncertainty remains about the appropriate dose of aspirin for adenoma prevention. The persistence of the protective effect of NSAIDs against recurrent adenomas after treatment cessation is yet to be established. Our objective was to update and systematically evaluate the evidence for aspirin and other NSAIDs on the incidence of recurrent colorectal adenomas taking into consideration the risks of random error and to appraise the quality of evidence using GRADE (The Grading of Recommendations, Assessment, Development and Evaluation) approach. Retrieved trials were evaluated using Cochrane risk of bias instrument. Meta-analytic estimates were calculated with random-effects model and random errors were evaluated with trial sequential analysis (TSA). In patients with a previous history of colorectal cancer or adenomas, low-dose aspirin (80-160 mg/day) compared to placebo taken for 2 to 4 years reduces the risk of recurrent colorectal adenomas (relative risk (RR), 0.80 [95% CI (confidence interval), 0.70-0.92]). TSA indicated a firm evidence for this beneficial effect. The evidence indicated moderate GRADE quality. Low-dose aspirin also reduces the recurrence of advanced adenomas (RR, 0.66 [95% CI, 0.44-0.99]); however, TSA indicated lack of firm evidence for a beneficial effect. High-dose aspirin (300-325 mg/day) did not statistically reduce the recurrent adenomas (RR, 0.90 [95% CI, 0.68-1.18]). Cyclooxygenase-2 (COX-2) inhibitors (e.g. celecoxib 400 mg/day) were associated with a significant decrease in the recurrence of both adenomas (RR, 0.66 [95% CI, 0.59-0.72]) and advanced adenomas (RR, 0.45 [95% CI, 0.33-0.57]); however, this association did not persist and there was a trend of an increased risk of recurrent adenomas observed 2 years after the withdrawal. Our findings confirm the beneficial effect of low-dose aspirin on recurrence of any adenomas; however, effect on advanced adenomas was inconclusive. COX-2 inhibitors seem to be more effective in preventing recurrence of adenomas; however, there was a trend of an increased risk of recurrence of adenomas observed after discontinuing regular use.

Soluble CD40L Is a Useful Marker to Predict Future Strokes in Patients With Minor Stroke and Transient Ischemic Attack.

PubMed

Li, Jiejie; Wang, Yilong; Lin, Jinxi; Wang, David; Wang, Anxin; Zhao, Xingquan; Liu, Liping; Wang, Chunxue; Wang, Yongjun

2015-07-01

Elevated soluble CD40 ligand (sCD40L) was shown to be related to cardiovascular events, but the role of sCD40L in predicting recurrent stroke remains unclear. Baseline sCD40L levels were measured in 3044 consecutive patients with acute minor stroke and transient ischemic attack, who had previously been enrolled in the Clopidogrel in High-Risk Patients With Acute Nondisabling Cerebrovascular Events (CHANCE) trial. Cox proportional-hazards model was used to assess the association of sCD40L with recurrent stroke. Patients in the top tertile of sCD40L levels had increased risk of recurrent stroke comparing with those in the bottom tertile, after adjusted for conventional confounding factors (hazard ratio, 1.49; 95% confidence interval, 1.11-2.00; P=0.008). The patients with elevated levels of both sCD40L and high-sensitive C-reactive protein also had increased risk of recurrent stroke (hazard ratio, 1.81; 95% confidence interval, 1.23-2.68; P=0.003). Elevated sCD40L levels independently predict recurrent stroke in patients with minor stroke and transient ischemic attack. URL: http://www.clinicaltrials.gov. Unique identifier: NCT00979589. © 2015 American Heart Association, Inc.

Flooding in the southern Midwestern United States, April–May 2017

USGS Publications Warehouse

Heimann, David C.; Holmes, Robert R.; Harris, Thomas E.

2018-03-09

Excessive rainfall resulted in flooding on numerous rivers throughout the southern Midwestern United States (southern Midwest) in late April and early May of 2017. The heaviest rainfall, between April 28 and 30, resulted in extensive flooding from eastern Oklahoma to southern Indiana including parts of Missouri, Arkansas, and Illinois.Peak-of-record streamflows were set at 21 U.S. Geological Survey (USGS) streamgages in the southern Midwest during the resulting April–May 2017 flooding and each of the five States included in the study area had at least one streamgage with a peak of record during the flood. The annual exceedance probability (AEP) estimates for the April–May 2017 peak streamflows indicate that peaks at 5 USGS streamgages had AEPs of 0.2 percent or less (500-year recurrence interval or greater), and peak streamflows at 15 USGS streamgages had AEPs in the range from greater than 0.2 to 1 percent (500- to 100-year recurrence intervals).Examination of the magnitude of the temporal changes in median annual peak streamflows indicated positive increases, in general, throughout the study area for each of the 1930–2017, 1956–2017, 1975–2017, and 1989–2017 analysis periods. The median increase in peak streamflows was greatest in 1975–2017 and 1989–2017 with maximum increases of 8 to 10 percent per year. No stations in the 1975–2017 or 1989–2017 analysis period had median negative changes in peak streamflows.

Meta-analysis of aberrant lymphatic drainage in recurrent breast cancer.

PubMed

Ahmed, M; Baker, R; Rubio, I T

2016-11-01

Sentinel node biopsy (SNB) in recurrent breast cancer offers targeted axillary staging compared with axillary lymph node dissection (ALND) or no treatment. The evidence for lymphatic mapping in recurrent breast cancer is reviewed, focusing on aberrant drainage and its implications for patient management. A meta-analysis of studies evaluating lymphatic mapping in recurrent breast cancer was performed. Outcomes included sentinel node identification, aberrant lymphatic pathways and metastatic node rates in aberrant drainage and ipsilateral axilla. Pooled odds ratios (ORs) and 95 per cent confidence intervals (c.i.) were estimated using fixed-effect analyses, or random-effects analyses in the event of statistically significant heterogeneity. Seven studies reported data on lymphatic mapping in 1053 patients with recurrent breast cancer. The intraoperative sentinel node identification rate was 59·6 (95 per cent c.i. 56·7 to 62·6) per cent, and significantly greater when the original axillary surgery was SNB compared with ALND (OR 2·97, 95 per cent c.i. 1·66 to 5·32). The rate of aberrant lymphatic drainage identification was 25·7 (23·0 to 28·3) per cent, and significantly greater when the original axillary surgery was ALND (OR 0·27, 0·19 to 0·38). The metastatic sentinel node rate was 10·4 (8·6 to 12·3) per cent, and a significantly greater metastatic nodal burden was identified in the ipsilateral axilla (OR 6·31, 1·03 to 38·79). Lymphatic mapping is feasible in recurrent breast cancer. It avoids ALND in over 50 per cent of patients who have undergone SNB, and allows the 4 per cent of patients with metastatically involved aberrant nodes to receive targeted surgical and adjuvant therapies. © 2016 BJS Society Ltd Published by John Wiley & Sons Ltd.

Does Early Resumption of Low-Dose Aspirin After Evacuation of Chronic Subdural Hematoma With Burr-Hole Drainage Lead to Higher Recurrence Rates?

PubMed

Kamenova, Maria; Lutz, Katharina; Schaedelin, Sabine; Fandino, Javier; Mariani, Luigi; Soleman, Jehuda

2016-11-01

Antiplatelet therapy in patients with chronic subdural hematoma (cSDH) presents significant neurosurgical challenges. Given the lack of guidelines regarding perioperative management with antiplatelet therapy, it is difficult to balance the patient's increased cardiovascular risk and prevalence of cSDH. To better understand the risk and recurrence rates related to resuming low-dose acetylsalicylic acid (ASA) by evaluating our patients' resumption of low-dose ASA at various times after burr-hole drainage of the hematoma. In our retrospective study, 140 consecutive patients taking low-dose ASA undergoing surgical evacuation of cSDH were included. Data included baseline characteristics and rates of recurrence, morbidity, and mortality. A multivariate logistic regression model analyzed the association between ASA resumption time and recurrence rates. No statistically significant association was observed between early postoperative resumption of low-dose ASA and recurrence of cSDH (odds ratio, 1.01; 95% confidence interval, 1.001-1.022; P = .06). Corresponding odds ratios and risk differences for restarting ASA treatment on postoperative days 1, 7, 14, 21, 28, 35, or 42 were estimated at 1.53 and 5.9%, 1.42 and 5.1%, 1.33 and 4.1%, 1.23 and 3.2%, 1.15 and 2.2%, 1.07 and 1.1%, and 1.01 and 0.2%, respectively (P > .05). Cardiovascular event rates, surgical morbidity, and mortality did not significantly differ between patients with or without ASA therapy. Given the few published studies regarding ASA use in cranial neurosurgery, our findings elucidate one issue, showing comparable recurrence rates with early or late resumption of low-dose ASA after burr-hole evacuation of cSDH. ASA, acetylsalicylic acidCAD, coronary artery diseaseCI, confidence intervalcSDH, chronic subdural hematomaGCS, Glasgow Coma ScalemRS, modified Rankin ScaleOR, odds ratioRD, risk difference.

Embolic Strokes of Undetermined Source in the Athens Stroke Registry: An Outcome Analysis.

PubMed

Ntaios, George; Papavasileiou, Vasileios; Milionis, Haralampos; Makaritsis, Konstantinos; Vemmou, Anastasia; Koroboki, Eleni; Manios, Efstathios; Spengos, Konstantinos; Michel, Patrik; Vemmos, Konstantinos

2015-08-01

Information about outcomes in Embolic Stroke of Undetermined Source (ESUS) patients is unavailable. This study provides a detailed analysis of outcomes of a large ESUS population. Data set was derived from the Athens Stroke Registry. ESUS was defined according to the Cryptogenic Stroke/ESUS International Working Group criteria. End points were mortality, stroke recurrence, functional outcome, and a composite cardiovascular end point comprising recurrent stroke, myocardial infarction, aortic aneurysm rupture, systemic embolism, or sudden cardiac death. We performed Kaplan-Meier analyses to estimate cumulative probabilities of outcomes by stroke type and Cox-regression to investigate whether stroke type was outcome predictor. 2731 patients were followed-up for a mean of 30.5±24.1months. There were 73 (26.5%) deaths, 60 (21.8%) recurrences, and 78 (28.4%) composite cardiovascular end points in the 275 ESUS patients. The cumulative probability of survival in ESUS was 65.6% (95% confidence intervals [CI], 58.9%-72.2%), significantly higher compared with cardioembolic stroke (38.8%, 95% CI, 34.9%-42.7%). The cumulative probability of stroke recurrence in ESUS was 29.0% (95% CI, 22.3%-35.7%), similar to cardioembolic strokes (26.8%, 95% CI, 22.1%-31.5%), but significantly higher compared with all types of noncardioembolic stroke. One hundred seventy-two (62.5%) ESUS patients had favorable functional outcome compared with 280 (32.2%) in cardioembolic and 303 (60.9%) in large-artery atherosclerotic. ESUS patients had similar risk of composite cardiovascular end point as all other stroke types, with the exception of lacunar strokes, which had significantly lower risk (adjusted hazard ratio, 0.70 [95% CI, 0.52-0.94]). Long-term mortality risk in ESUS is lower compared with cardioembolic strokes, despite similar rates of recurrence and composite cardiovascular end point. Recurrent stroke risk is higher in ESUS than in noncardioembolic strokes. © 2015 American Heart Association, Inc.

Pregnancy and recurrence rates in infertile patients operated for ovarian endometriosis.

PubMed

Luţuc, Monica Holicov; Nemescu, D; Onofriescu, Alina; Târnovanu, Mihaela; Moscalu, Mihaela; Onofriescu, M

2015-01-01

The study deals with the preoperative ultrasound diagnosis of ovarian endometriosis, postoperative ultrasound reassessment, laparoscopic surgical resolution of ovarian endometriosis, estimation of recurrence risk 12 months after surgery by ultrasound, reappearance of clinical symptoms (such as pain) or second-look laparoscopy, and pregnancy rate 2 years after surgery. 140 patients with en- dometriosis and infertility admitted to the Iasi "Cuza-Vodă" Clinical Hospital of Obstetrics and Gynecology between the years 2009-2011 were included in the study. The patients were divided into 2 groups: group 1-59 cases that refused in vitro fertilization procedures, did not afford in vitro fertilization (IVF) or had minimal endometriosis and young ages and thus a possibility of delaying treatment, and group 2--62 cases which underwent IVF procedures immediately after surgery. No significant differences in the chance of becoming pregnant were found between the two groups (χ2 = 2.06, p = 0.0891, 95% CI); in group 1, 11.86% pregnancies were obtained while in group 2 the pregnancy rate was 11.29%. Based on the nonparametric method of analysis of contingency tables we could estimate the odds of becoming pregnant in the study groups, obtaining an odds ratio (OR = 1.16, CI: 1.04-2.23, 95% CI). This result indicated that in group 1 the odds of becoming pregnant was not significantly higher, and the estimation was made for a confidence interval of 95%. The study had in view the assessment of pregnancies obtained in the study groups and the time interval (number of weeks) from the time of intervention until the occurrence of pregnancy. The Kaplan-Meier analysis enabled the assessment of the mean value and the median value of the number of weeks until becoming pregnant, and these values did not show significant differences (χ2 = 1.55, p = 0.212, 95% CI). For endometriosis associated with infertility, hormonal suppression does not improve fertility, and therefore surgery followed by controlled ovarian hyperstimulation and intrauterine insemi- nation (IUI), provided the anatomy of the pelvis is preserved in early cases or in vitro fertilization in severe cases is preferred.

[TREATMENT OF PATIENTS WITH CHRONIC RECURRENT HERPES VIRUS INFECTION OF GENITAL LOCALIZATION: A CLINICAL STUDY OF FORTEPREN PREPARATION].

PubMed

Narovlyansky, A N; Sedov, A M; Pronin, A V; Shulzhenko, A E; Sanin, A V; Zuikova, I N; Schubelko, R V; Savchenko, A Yu; Parfenova, T M; Izmestieva, A V; Izmestieva, An V; Grigorieva, E A; Suprun, O V; Zubashev, I K; Kozlov, V S

2015-01-01

Selection of optimal dosage regimen, length of treatment course (frequency of administration), safety, tolerance and clinical effectiveness evaluation of the medical preparation fortepren in patients with chronical recurrent herpes virus infection of genital localization. The medical product of antiviral and immune modulating effect--fortepren (sodium polyprenyl phosphate) as a 4 mg/ml solution for injections combined with the base course of acyclic nucleoside acyclovir, 400 mg tablets, held studies. 40 male and female patients participated in the study. After a 10-day acyclovir course (400 mg x 3 times a day) for removing the acute phase, 4 groups of 10 individuals were formed: 1--5 ml (20 mg) of fortepren i/m once at day 13 ± 2 after the start of the study after the completion of the treatment of the acute phase of the disease; 2--5 ml (20 mg) fortepren i/m 3 times at an interval of 21 days; 3--2 ml (8 mg) fortepren i/m 3 times at an interval of 21 days; 4 (control)--5 ml of placebo i/m at remission stage 3 times at an interval of 21 days. Increase of the duration of inter-recurrence period, decrease of the severity of the recurrences, state of skin and mucous damage elements, improvements of immunologic parameters were considered during effectiveness evaluation. Significant differences in the frequency of recurrences of genital herpes were shown for 3 months of observation in experimental and control groups. A significant reduction of genital herpes recurrence frequency from 3.52 ± 0.09 (before treatment) to 2.89 ± 0.08 (after treatment) was noted in patients of group 3 (p < 0.001). The frequency of recurrences in the control group was 3.84 ± 0.10, that was higher than the parameters in all the experimental groups. A significant reduction of the rash area was noted in group 3, moreover, a redution of frequency of detection of clinical manifestations of genital herpes in the form of vesicle elements after treatment in groups 2 (p = 0.02) and 3 (p = 0.005) was found. Evaluation of local symptoms has established that burning have caused minimal discomfort for patients of groups 3 and 4 and itch and soreness--of groups 1 and 3. The least pronounced exacerbations were noted in patients of group 3. Intramuscular administration of fortepren preparation was established to result in the increase of titers of leukocyte virus-induced interferon for the whole duration of treatment. An intramuscular dose of 2 ml (8 mg) at recurrence stage 3 times at an interval of 21 days after the completion of the 10-day base course of treatment of the acute phase of chronical recurrent herpes virus infection of genital localization using acyclovir was accepted as an optimal dosage regimen. Analysis of the obtained results has shown an acceptable safety profile and a good level of tolerance for fortepren preparation.

The effect of metformin on the recurrence of colorectal adenoma in diabetic patients with previous colorectal adenoma.

PubMed

Han, Min Seok; Lee, Hyun Jung; Park, Soo Jung; Hong, Sung Pil; Cheon, Jae Hee; Kim, Won Ho; Kim, Tae Il

2017-08-01

Existing studies suggest that metformin lowers the risk and mortality of colorectal cancer. However, the effect of metformin on the suppression and prevention of colorectal adenomas is not clear. The aim of this study was to evaluate the effect of metformin on the recurrence of colorectal adenoma in diabetic patients with previous colorectal adenoma. Among 423 diabetic patients who underwent surveillance colonoscopy after resection of colorectal adenoma between 2005 and 2011, 257 patients were retrospectively reviewed. The patients were divided into two groups: one group comprising 106 patients who took metformin and another group comprising 151 patients who did not take metformin. The clinical characteristics, colorectal adenoma recurrence, and valuable factors for adenoma recurrence were analyzed. At surveillance colonoscopy after colonoscopic polypectomy for adenoma, 38 patients (35.8%) exhibited colorectal adenoma among 106 patients who took metformin, compared with 85 patients (56.3%) with colorectal adenoma among 151 patients who did not take metformin (odds ratio 0.434, 95% confidence interval 0.260-0.723, P = 0.001). Multivariate Cox analysis showed that metformin was associated with decreased recurrence of colorectal adenoma (hazard ratio 0.572, 95% confidence interval 0.385-0.852, P = 0.006) in diabetic patients with previous colorectal adenoma. The cumulative probability of colorectal adenoma recurrence was significantly lower in the metformin group than in the non-metformin group (P = 0.001). Metformin use in diabetic patients with previous colorectal adenoma is associated with a lower risk of colorectal adenoma recurrence.

Factors Associated With Treatment Failure of Infected Pressure Sores.

PubMed

Jugun, Kheeldass; Richard, Jean-Christophe; Lipsky, Benjamin A; Kressmann, Benjamin; Pittet-Cuenod, Brigitte; Suvà, Domizio; Modarressi, Ali; Uçkay, Ilker

2016-08-01

In this study, we assess interdisciplinary surgical and medical parameters associated to recurrences of infected pressure ulcers. There is a little in the published literature regarding factors associated with the outcome of treatment of infected pressure ulcers. We undertook a single-center review of spinal injured adults hospitalized for an infected pressure ulcer or implant-free osteomyelitis and reviewed the literature on this topic from 1990-2015. We found 70 lesions in 31 patients (52 with osteomyelitis) who had a median follow-up of 2.7 years (range, 4 months to 19 years). The median duration of antibiotic therapy was 6 weeks, of which 1 week was parenteral. Clinical recurrence after treatment was noted in 44 infected ulcers (63%), after a median interval of 1 year. In 86% of these recurrences, cultures yielded a different organism than the preceding episode. By multivariate analyses, the following factors were not significantly related to recurrence: number of surgical interventions (hazard ratio 0.9, 95% confidence interval 0.5-1.5); osteomyelitis (hazard ratio 1.5; 0.7-3.1); immune suppression; prior sacral infections, and duration of total (or just parenteral) antibiotic sue. Patients with antibiotic treatment for <6 weeks had the same failure rate as those with as >12 weeks (χ test; P = 0.90). In patients with infected pressure ulcers, clinical recurrence occurs in almost two-thirds of lesions, but in only 14% with the same pathogen(s). The number of surgical debridements, flap use, or duration of antibiotic therapy was not associated with recurrence, suggesting recurrences are caused by reinfections caused by other extrahospital factors.

Risk of recurrence of Barrett's esophagus after successful endoscopic therapy

PubMed Central

Krishnamoorthi, Rajesh; Singh, Siddharth; Ragunathan, Karthik; Katzka, David A.; Wang, Kenneth K.; Iyer, Prasad G.

2016-01-01

Background and Aims Previous estimates of incidence of intestinal metaplasia (IM) recurrence after achieving complete remission of IM (CRIM) through endoscopic therapy of Barrett's esophagus (BE) have varied widely. We performed a systematic review and meta-analysis of studies to estimate an accurate recurrence risk after CRIM. Methods We performed a systematic search of multiple literature databases through June 2015 to identify studies reporting long-term follow-up after achieving CRIM through endoscopic therapy. Pooled incidence rate (IR) of recurrent IM, dysplastic BE, and high-grade dysplasia (HGD)/esophageal adenocarcinoma (EAC) per person-year of follow-up after CRIM was estimated. Factors associated with recurrence were also assessed. Results We identified 41 studies that reported 795 cases of recurrence in 4443 patients over 10,427 patient-years of follow-up. This included 21 radiofrequency ablation studies that reported 603 cases of IM recurrence in 3186 patients over 5741 patient-years of follow-up. Pooled IRs of recurrent IM, dysplastic BE, and HGD/EAC after radiofrequency ablation were 9.5% (95% CI, 6.7-12.3), 2.0% (95% CI, 1.3-2.7), and 1.2% (95% CI, .8-1.6) per patient-year, respectively. When all endoscopic modalities were included, pooled IRs of recurrent IM, dysplastic BE, and HGD/EAC were 7.1% (95% CI, 5.6-8.6), 1.3% (95% CI, .8-1.7), and .8% (95% CI, .5-1.1) per patient-year, respectively. Substantial heterogeneity was noted. Increasing age and BE length were predictive of recurrence; 97% of recurrences were treated endoscopically. Conclusions The incidence of recurrence after achieving CRIM through endoscopic therapy was substantial. A small minority of recurrences were dysplastic BE and HGD/EAC. Hence, continued surveillance after CRIM is imperative. Additional studies with long-term follow-up are needed. PMID:26902843

Genetic epidemiology of tooth agenesis in Japan: a population- and family-based study.

PubMed

Machida, J; Nishiyama, T; Kishino, H; Yamaguchi, S; Kimura, M; Shibata, A; Tatematsu, T; Kamamoto, M; Yamamoto, K; Makino, S; Miyachi, H; Shimozato, K; Tokita, Y

2015-08-01

Tooth agenesis is one of the most common congenital anomalies in humans. However, the etiology of tooth agenesis remains largely unclear, as well as evidence base useful for genetic counseling. Therefore, we estimated the prevalence and sibling recurrence risk, and investigated agenetic patterns systematically. Tooth agenesis was classified into two subtypes: hypodontia (one to five missing teeth) and oligodontia (six or more missing teeth). The prevalence of these two subtypes were 6.8% [95% confidence interval (CI): 6.1-7.7%] and 0.1% (95% CI: 0.04-0.3%), respectively, and sibling recurrence risk of these were 24.5% (95% CI: 13.8-38.3%) and 43.8% (95% CI: 26.4-62.3%), respectively. This result suggests that the severe phenotype, oligodontia, might be mostly transmitted in a dominant fashion. Using a simple statistical modeling approach, our data were found to be consistent with a bilateral symmetry model, meaning that there was equal probability of missing teeth from the right and left sides. © 2014 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

Predecessors of the giant 1960 Chile earthquake.

PubMed

Cisternas, Marco; Atwater, Brian F; Torrejón, Fernando; Sawai, Yuki; Machuca, Gonzalo; Lagos, Marcelo; Eipert, Annaliese; Youlton, Cristián; Salgado, Ignacio; Kamataki, Takanobu; Shishikura, Masanobu; Rajendran, C P; Malik, Javed K; Rizal, Yan; Husni, Muhammad

2005-09-15

It is commonly thought that the longer the time since last earthquake, the larger the next earthquake's slip will be. But this logical predictor of earthquake size, unsuccessful for large earthquakes on a strike-slip fault, fails also with the giant 1960 Chile earthquake of magnitude 9.5 (ref. 3). Although the time since the preceding earthquake spanned 123 years (refs 4, 5), the estimated slip in 1960, which occurred on a fault between the Nazca and South American tectonic plates, equalled 250-350 years' worth of the plate motion. Thus the average interval between such giant earthquakes on this fault should span several centuries. Here we present evidence that such long intervals were indeed typical of the last two millennia. We use buried soils and sand layers as records of tectonic subsidence and tsunami inundation at an estuary midway along the 1960 rupture. In these records, the 1960 earthquake ended a recurrence interval that had begun almost four centuries before, with an earthquake documented by Spanish conquistadors in 1575. Two later earthquakes, in 1737 and 1837, produced little if any subsidence or tsunami at the estuary and they therefore probably left the fault partly loaded with accumulated plate motion that the 1960 earthquake then expended.

Recurrence plots of discrete-time Gaussian stochastic processes

NASA Astrophysics Data System (ADS)

Ramdani, Sofiane; Bouchara, Frédéric; Lagarde, Julien; Lesne, Annick

2016-09-01

We investigate the statistical properties of recurrence plots (RPs) of data generated by discrete-time stationary Gaussian random processes. We analytically derive the theoretical values of the probabilities of occurrence of recurrence points and consecutive recurrence points forming diagonals in the RP, with an embedding dimension equal to 1. These results allow us to obtain theoretical values of three measures: (i) the recurrence rate (REC) (ii) the percent determinism (DET) and (iii) RP-based estimation of the ε-entropy κ(ε) in the sense of correlation entropy. We apply these results to two Gaussian processes, namely first order autoregressive processes and fractional Gaussian noise. For these processes, we simulate a number of realizations and compare the RP-based estimations of the three selected measures to their theoretical values. These comparisons provide useful information on the quality of the estimations, such as the minimum required data length and threshold radius used to construct the RP.

Regression analysis of mixed recurrent-event and panel-count data.

PubMed

Zhu, Liang; Tong, Xinwei; Sun, Jianguo; Chen, Manhua; Srivastava, Deo Kumar; Leisenring, Wendy; Robison, Leslie L

2014-07-01

In event history studies concerning recurrent events, two types of data have been extensively discussed. One is recurrent-event data (Cook and Lawless, 2007. The Analysis of Recurrent Event Data. New York: Springer), and the other is panel-count data (Zhao and others, 2010. Nonparametric inference based on panel-count data. Test 20: , 1-42). In the former case, all study subjects are monitored continuously; thus, complete information is available for the underlying recurrent-event processes of interest. In the latter case, study subjects are monitored periodically; thus, only incomplete information is available for the processes of interest. In reality, however, a third type of data could occur in which some study subjects are monitored continuously, but others are monitored periodically. When this occurs, we have mixed recurrent-event and panel-count data. This paper discusses regression analysis of such mixed data and presents two estimation procedures for the problem. One is a maximum likelihood estimation procedure, and the other is an estimating equation procedure. The asymptotic properties of both resulting estimators of regression parameters are established. Also, the methods are applied to a set of mixed recurrent-event and panel-count data that arose from a Childhood Cancer Survivor Study and motivated this investigation. © The Author 2014. Published by Oxford University Press. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

Methods for estimating magnitude and frequency of peak flows for natural streams in Utah

USGS Publications Warehouse

Kenney, Terry A.; Wilkowske, Chris D.; Wright, Shane J.

2007-01-01

Estimates of the magnitude and frequency of peak streamflows is critical for the safe and cost-effective design of hydraulic structures and stream crossings, and accurate delineation of flood plains. Engineers, planners, resource managers, and scientists need accurate estimates of peak-flow return frequencies for locations on streams with and without streamflow-gaging stations. The 2-, 5-, 10-, 25-, 50-, 100-, 200-, and 500-year recurrence-interval flows were estimated for 344 unregulated U.S. Geological Survey streamflow-gaging stations in Utah and nearby in bordering states. These data along with 23 basin and climatic characteristics computed for each station were used to develop regional peak-flow frequency and magnitude regression equations for 7 geohydrologic regions of Utah. These regression equations can be used to estimate the magnitude and frequency of peak flows for natural streams in Utah within the presented range of predictor variables. Uncertainty, presented as the average standard error of prediction, was computed for each developed equation. Equations developed using data from more than 35 gaging stations had standard errors of prediction that ranged from 35 to 108 percent, and errors for equations developed using data from less than 35 gaging stations ranged from 50 to 357 percent.

Recurrent neural tube defects, risk factors and vitamins.

PubMed Central

Wild, J; Read, A P; Sheppard, S; Seller, M J; Smithells, R W; Nevin, N C; Schorah, C J; Fielding, D W; Walker, S; Harris, R

1986-01-01

Data from our trial of periconceptional vitamin supplementation for the prevention of neural tube defects have been analysed to assess the influence of various factors on recurrence rates of neural tube defect. Our data suggest that the risk of recurrence of neural tube defect is influenced by the number of previous neural tube defects, area of residence, immediately prior miscarriage, and interpregnancy interval. None of these factors, however, contributed any significant differential risk between supplemented and unsupplemented mothers. Hence we conclude that the highly significant difference in recurrence rates of neural tube defect between supplemented and unsupplemented mothers was due to vitamin supplementation. PMID:3521496

Complex partial status epilepticus: a recurrent problem.

PubMed Central

Cockerell, O C; Walker, M C; Sander, J W; Shorvon, S D

1994-01-01

Twenty patients with complex partial status epilepticus were identified retrospectively from a specialist neurology hospital. Seventeen patients experienced recurrent episodes of complex partial status epilepticus, often occurring at regular intervals, usually over many years, and while being treated with effective anti-epileptic drugs. No unifying cause for the recurrences, and no common epilepsy aetiologies, were identified. In spite of the frequency of recurrence and length of history, none of the patients showed any marked evidence of cognitive or neurological deterioration. Complex partial status epilepticus is more common than is generally recognised, should be differentiated from other forms of non-convulsive status, and is often difficult to treat. PMID:8021671

Automated digital volume measurement of melanoma metastases in sentinel nodes predicts disease recurrence and survival.

PubMed

Riber-Hansen, Rikke; Nyengaard, Jens R; Hamilton-Dutoit, Stephen J; Sjoegren, Pia; Steiniche, Torben

2011-09-01

Total metastatic volume (TMV) is an important prognostic factor in melanoma sentinel lymph nodes (SLNs) that avoids both the interobserver variation and unidirectional upstaging seen when using semi-quantitative size estimates. However, it is somewhat laborious for routine application. Our aim was to investigate whether digital image analysis can estimate TMV accurately in melanoma SLNs. TMV was measured in 147 SLNs from 95 patients both manually and by automated digital image analysis. The results were compared by Bland-Altman plots (numerical data) and kappa statistics (categorical data). In addition, disease-free and melanoma-specific survivals were calculated. Mean metastatic volume per patient was 10.6 mm(3) (median 0.05 mm(3); range 0.0001-621.3 mm(3)) and 9.62 mm(3) (median 0.05 mm(3); range 0.00001-564.3 mm(3)) with manual and digital measurement, respectively. The Bland-Altman plot showed an even distribution of the differences, and the kappa statistic was 0.84. In multivariate analysis, both manual and digital metastasis volume measurements were independent progression markers when corrected for primary tumour thickness [manual: hazard ratio (HR): 1.21, 95% confidence interval (CI): 1.07-1.36, P = 0.002; digital: HR: 1.21, 95% CI: 1.06-1.37, P = 0.004]. Stereology-based, automated digital metastasis volume measurement in melanoma SLNs predicts disease recurrence and survival. © 2011 Blackwell Publishing Limited.

High lifetime probability of screen-detected cervical abnormalities.

PubMed

Pankakoski, Maiju; Heinävaara, Sirpa; Sarkeala, Tytti; Anttila, Ahti

2017-12-01

Objective Regular screening and follow-up is an important key to cervical cancer prevention; however, screening inevitably detects mild or borderline abnormalities that would never progress to a more severe stage. We analysed the cumulative probability and recurrence of cervical abnormalities in the Finnish organized screening programme during a 22-year follow-up. Methods Screening histories were collected for 364,487 women born between 1950 and 1965. Data consisted of 1 207,017 routine screens and 88,143 follow-up screens between 1991 and 2012. Probabilities of cervical abnormalities by age were estimated using logistic regression and generalized estimating equations methodology. Results The probability of experiencing any abnormality at least once at ages 30-64 was 34.0% (95% confidence interval [CI]: 33.3-34.6%) . Probability was 5.4% (95% CI: 5.0-5.8%) for results warranting referral and 2.2% (95% CI: 2.0-2.4%) for results with histologically confirmed findings. Previous occurrences were associated with an increased risk of detecting new ones, specifically in older women. Conclusion A considerable proportion of women experience at least one abnormal screening result during their lifetime, and yet very few eventually develop an actual precancerous lesion. Re-evaluation of diagnostic criteria concerning mild abnormalities might improve the balance of harms and benefits of screening. Special monitoring of women with recurrent abnormalities especially at older ages may also be needed.

Magnitude and frequency of floods in Arkansas

USGS Publications Warehouse

Hodge, Scott A.; Tasker, Gary D.

1995-01-01

Methods are presented for estimating the magnitude and frequency of peak discharges of streams in Arkansas. Regression analyses were developed in which a stream's physical and flood characteristics were related. Four sets of regional regression equations were derived to predict peak discharges with selected recurrence intervals of 2, 5, 10, 25, 50, 100, and 500 years on streams draining less than 7,770 square kilometers. The regression analyses indicate that size of drainage area, main channel slope, mean basin elevation, and the basin shape factor were the most significant basin characteristics that affect magnitude and frequency of floods. The region of influence method is included in this report. This method is still being improved and is to be considered only as a second alternative to the standard method of producing regional regression equations. This method estimates unique regression equations for each recurrence interval for each ungaged site. The regression analyses indicate that size of drainage area, main channel slope, mean annual precipitation, mean basin elevation, and the basin shape factor were the most significant basin and climatic characteristics that affect magnitude and frequency of floods for this method. Certain recommendations on the use of this method are provided. A method is described for estimating the magnitude and frequency of peak discharges of streams for urban areas in Arkansas. The method is from a nationwide U.S. Geeological Survey flood frequency report which uses urban basin characteristics combined with rural discharges to estimate urban discharges. Annual peak discharges from 204 gaging stations, with drainage areas less than 7,770 square kilometers and at least 10 years of unregulated record, were used in the analysis. These data provide the basis for this analysis and are published in the Appendix of this report as supplemental data. Large rivers such as the Red, Arkansas, White, Black, St. Francis, Mississippi, and Ouachita Rivers have floodflow characteristics that differ from those of smaller tributary streams and were treated individually. Regional regression equations are not applicable to these large rivers. The magnitude and frequency of floods along these rivers are based on specific station data. This section is provided in the Appendix and has not been updated since the last Arkansas flood frequency report (1987b), but is included at the request of the cooperator.

Flood of June 22-24, 2006, in North-Central Ohio, With Emphasis on the Cuyahoga River Near Independence

USGS Publications Warehouse

Sherwood, James M.; Ebner, Andrew D.; Koltun, G.F.; Astifan, Brian M.

2007-01-01

Heavy rains caused severe flooding on June 22-24, 2006, and damaged approximately 4,580 homes and 48 businesses in Cuyahoga County. Damage estimates in Cuyahoga County for the two days of flooding exceed $47 million; statewide damage estimates exceed $150 million. Six counties (Cuyahoga, Erie, Huron, Lucas, Sandusky, and Stark) in northeast Ohio were declared Federal disaster areas. One death, in Lorain County, was attributed to the flooding. The peak streamflow of 25,400 cubic feet per second and corresponding peak gage height of 23.29 feet were the highest recorded at the U.S. Geological Survey (USGS) streamflow-gaging station Cuyahoga River at Independence (04208000) since the gaging station began operation in 1922, exceeding the previous peak streamflow of 24,800 cubic feet per second that occurred on January 22, 1959. An indirect calculation of the peak streamflow was made by use of a step-backwater model because all roads leading to the gaging station were inundated during the flood and field crews could not reach the station to make a direct measurement. Because of a statistically significant and persistent positive trend in the annual-peak-streamflow time series for the Cuyahoga River at Independence, a method was developed and applied to detrend the annual-peak-streamflow time series prior to the traditional log-Pearson Type III flood-frequency analysis. Based on this analysis, the recurrence interval of the computed peak streamflow was estimated to be slightly less than 100 years. Peak-gage-height data, peak-streamflow data, and recurrence-interval estimates for the June 22-24, 2006, flood are tabulated for the Cuyahoga River at Independence and 10 other USGS gaging stations in north-central Ohio. Because flooding along the Cuyahoga River near Independence and Valley View was particularly severe, a study was done to document the peak water-surface profile during the flood from approximately 2 miles downstream from the USGS streamflow-gaging station at Independence to approximately 2 miles upstream from the gaging station. High-water marks were identified and flagged in the field. Third-order-accuracy surveys were used to determine elevations of the high-water marks, and the data were tabulated and plotted.

Trigeminal neurons detect cellphone radiation: Thermal or nonthermal is not the question.

PubMed

Marino, Andrew A; Kim, Paul Y; Frilot Ii, Clifton

2017-01-01

Cellphone electromagnetic radiation produces temperature alterations in facial skin. We hypothesized that the radiation-induced heat was transduced by warmth-sensing trigeminal neurons, as evidenced by changes in cognitive processing of the afferent signals. Ten human volunteers were exposed on the right side of the face to 1 GHz radiation in the absence of acoustic, tactile, and low-frequency electromagnetic stimuli produced by cellphones. Cognitive processing manifested in the electroencephalogram (EEG) was quantitated by analysis of brain recurrence (a nonlinear technique). The theoretical temperature sensitivity of warmth-sensing neurons was estimated by comparing changes in membrane voltage expected as a result of heat transduction with membrane-voltage variance caused by thermal noise. Each participant underwent sixty 12-s trials. The recurrence variable r ("percent recurrence") was computed second by second for the ∆ band of EEGs from two bilaterally symmetric derivations (decussated and nondecussated). Percent recurrence during radiation exposure (first 4 s of each trial) was reduced in the decussated afferent signal compared with the control (last four seconds of each trial); mean difference, r = 1.1 ± 0.5%, p < 0.005. Mean relative ∆ power did not differ between the exposed and control intervals, as expected. Trigeminal neurons were capable of detecting temperature changes far below skin temperature increases caused by cellphone radiation. Simulated cellphone radiation affected brain electrical activity associated with nonlinear cognitive processing of radiation-induced thermal afferent signals. Radiation standards for cellphones based on a thermal/nonthermal binary distinction do not prevent neurophysiological consequences of cellphone radiation.

Risk of Recurrence and Mortality in a Multi-Ethnic Breast Cancer Population.

PubMed

Kabat, Geoffrey C; Ginsberg, Mindy; Sparano, Joseph A; Rohan, Thomas E

2017-12-01

Compared to non-Hispanic whites, African-American women tend to be diagnosed with breast cancer at an earlier age, to have less favorable tumor characteristics, and to have poorer outcomes from breast cancer. The extent to which differences in clinical characteristics account for the black/white disparity in breast cancer mortality is unclear. The purpose of this investigation was to examine the association of clinical, demographic, and treatment variables with total mortality and breast cancer recurrence by race/ethnicity in a cohort of women diagnosed with invasive breast cancer. To this end, we used data on 3890 invasive breast cancer cases diagnosed at a single medical center. Cox proportional hazards models were used to estimate hazard ratios (HR) and 95% confidence intervals (95% CI) for the association of tumor characteristics and treatment variables with mortality and recurrence. Compared to white women, black women with breast cancer presented with tumors that had worse prognostic factors, particularly higher stage, lower frequency of hormone-receptor positive tumors, and higher frequency of comorbidities. Hispanics also generally had less favorable prognostic factors compared to non-Hispanic whites. Among estrogen receptor-positive cases, blacks had roughly a two-fold increased risk of recurrence compared to non-Hispanic whites. However, ethnicity/race was not associated with total mortality. Tumor stage, tumor size, and Charlson comorbidity index were positively associated with mortality, and mammography and chemotherapy and hormone therapy were inversely associated with mortality. In spite of poorer prognostic factors among blacks compared whites, race/ethnicity was not associated with total mortality in our study.

Predictors of survival in patients with recurrent ovarian cancer undergoing secondary cytoreductive surgery based on the pooled analysis of an international collaborative cohort

PubMed Central

Zang, R Y; Harter, P; Chi, D S; Sehouli, J; Jiang, R; Tropé, C G; Ayhan, A; Cormio, G; Xing, Y; Wollschlaeger, K M; Braicu, E I; Rabbitt, C A; Oksefjell, H; Tian, W J; Fotopoulou, C; Pfisterer, J; du Bois, A; Berek, J S

2011-01-01

Background: This study aims to identify prognostic factors and to develop a risk model predicting survival in patients undergoing secondary cytoreductive surgery (SCR) for recurrent epithelial ovarian cancer. Methods: Individual data of 1100 patients with recurrent ovarian cancer of a progression-free interval at least 6 months who underwent SCR were pooled analysed. A simplified scoring system for each independent prognostic factor was developed according to its coefficient. Internal validation was performed to assess the discrimination of the model. Results: Complete SCR was strongly associated with the improvement of survival, with a median survival of 57.7 months, when compared with 27.0 months in those with residual disease of 0.1–1 cm and 15.6 months in those with residual disease of >1 cm, respectively (P<0.0001). Progression-free interval (⩽23.1 months vs >23.1 months, hazard ratio (HR): 1.72; score: 2), ascites at recurrence (present vs absent, HR: 1.27; score: 1), extent of recurrence (multiple vs localised disease, HR: 1.38; score: 1) as well as residual disease after SCR (R1 vs R0, HR: 1.90, score: 2; R2 vs R0, HR: 3.0, score: 4) entered into the risk model. Conclusion: This prognostic model may provide evidence to predict survival benefit from secondary cytoreduction in patients with recurrent ovarian cancer. PMID:21878937

Long-term Outcomes of Laparoscopic Versus Open Surgery for Clinical Stage II/III Gastric Cancer: A Multicenter Cohort Study in Japan (LOC-A Study).

PubMed

Kinoshita, Takahiro; Uyama, Ichiro; Terashima, Masanori; Noshiro, Hirokazu; Nagai, Eishi; Obama, Kazutaka; Tamamori, Yutaka; Nabae, Toshinaga; Honda, Michitaka; Abe, Takayuki

2018-04-24

A large-scale multicenter historical cohort study was conducted to investigate the efficacy of laparoscopic gastrectomy (LG) in comparison to open gastrectomy (OG) for locally advanced gastric cancer. LG is now practiced widely, but its applicability for advanced gastric cancer is still controversial. As oncologic outcomes of randomized trials are still pending, there is an urgent need for information that would be relevant to current practice. Through a consensus meeting involving surgeons and biostatisticians, 30 preoperative variables possibly influencing the choice of surgical approach and associated with outcome were identified to enable rigorous estimation of propensity scores. A total of 1948 consecutive patients who underwent gastrectomy for clinical stage II/III gastric adenocarcinoma between 2008 and 2014 were identified, and their clinical data were collected from 8 participating hospitals. After propensity score matching, 610 cases (OG = 305, LG = 305) were finally selected for comparison of long-term outcomes. In the propensity-matched OG and LG populations, the mean observation period was 3.5 and 3.4 years, and the 5-year overall survival was 53.0% and 54.2%, respectively. The hazard ratio (LG/OG) for overall survival was 1.01 (95% confidence interval, 0.80-1.29), and noninferiority of LG was demonstrated statistically as the upper 95% confidence limit was less than the prespecified margin (1.33). The recurrence rate was 30.8% and 29.8% for OG and LG, respectively, and the hazard ratio for recurrence was 0.98 (95% confidence interval, 0.74-1.31). The patterns of recurrence in the 2 groups were similar. This observational study strictly adjusted for confounding factors has provided evidence to suggest that LG is oncologically comparable to OG for locally advanced gastric cancer. The validity of this result will be examined in ongoing randomized trials.

The history of late holocene surface-faulting earthquakes on the central segments of the Wasatch fault zone, Utah

USGS Publications Warehouse

Duross, Christopher; Personius, Stephen; Olig, Susan S; Crone, Anthony J.; Hylland, Michael D.; Lund, William R; Schwartz, David P.

2017-01-01

The Wasatch fault (WFZ)—Utah’s longest and most active normal fault—forms a prominent eastern boundary to the Basin and Range Province in northern Utah. To provide paleoseismic data for a Wasatch Front regional earthquake forecast, we synthesized paleoseismic data to define the timing and displacements of late Holocene surface-faulting earthquakes on the central five segments of the WFZ. Our analysis yields revised histories of large (M ~7) surface-faulting earthquakes on the segments, as well as estimates of earthquake recurrence and vertical slip rate. We constrain the timing of four to six earthquakes on each of the central segments, which together yields a history of at least 24 surface-faulting earthquakes since ~6 ka. Using earthquake data for each segment, inter-event recurrence intervals range from about 0.6 to 2.5 kyr, and have a mean of 1.2 kyr. Mean recurrence, based on closed seismic intervals, is ~1.1–1.3 kyr per segment, and when combined with mean vertical displacements per segment of 1.7–2.6 m, yield mean vertical slip rates of 1.3–2.0 mm/yr per segment. These data refine the late Holocene behavior of the central WFZ; however, a significant source of uncertainty is whether structural complexities that define the segments of the WFZ act as hard barriers to ruptures propagating along the fault. Thus, we evaluate fault rupture models including both single-segment and multi-segment ruptures, and define 3–17-km-wide spatial uncertainties in the segment boundaries. These alternative rupture models and segment-boundary zones honor the WFZ paleoseismic data, take into account the spatial and temporal limitations of paleoseismic data, and allow for complex ruptures such as partial-segment and spillover ruptures. Our data and analyses improve our understanding of the complexities in normal-faulting earthquake behavior and provide geological inputs for regional earthquake-probability and seismic hazard assessments.

Results of revision anterior shoulder stabilization surgery in adolescent athletes.

PubMed

Blackman, Andrew J; Krych, Aaron J; Kuzma, Scott A; Chow, Roxanne M; Camp, Christopher; Dahm, Diane L

2014-11-01

The purpose of this study was to determine failure rates, functional outcomes, and risk factors for failure after revision anterior shoulder stabilization surgery in high-risk adolescent athletes. Adolescent athletes who underwent primary anterior shoulder stabilization were reviewed. Patients undergoing subsequent revision stabilization surgery were identified and analyzed. Failure rates after revision surgery were assessed by Kaplan-Meier analysis. Failure was defined as recurrent instability requiring reoperation. Functional outcomes included the Marx activity score; American Shoulder and Elbow Surgeons score; and University of California, Los Angeles score. The characteristics of patients who required reoperation for recurrent instability after revision surgery were compared with those of patients who required only a single revision to identify potential risk factors for failure. Of 90 patients who underwent primary anterior stabilization surgery, 15 (17%) had failure and underwent revision surgery (mean age, 16.6 years; age range, 14 to 18 years). The mean follow-up period was 5.5 years (range, 2 to 12 years). Of the 15 revision patients, 5 (33%) had recurrent dislocations and required repeat revision stabilization surgery at a mean of 50 months (range, 22 to 102 months) after initial revision. No risk factors for failure were identified. The Kaplan-Meier reoperation-free estimates were 86% (95% confidence interval, 67% to 100%) at 24 months and 78% (95% confidence interval, 56% to 100%) at 48 months after revision surgery. The mean final Marx activity score was 14.8 (range, 5 to 20); American Shoulder and Elbow Surgeons score, 82.1 (range, 33 to 100); and University of California, Los Angeles score, 30.8 (range, 16 to 35). At 5.5 years' follow-up, adolescent athletes had a high failure rate of revision stabilization surgery and modest functional outcomes. We were unable to convincingly identify specific risk factors for failure of revision surgery. Level IV, retrospective therapeutic case series. Copyright © 2014 Arthroscopy Association of North America. Published by Elsevier Inc. All rights reserved.

Limit on slip rate and timing of recent seismic ground-ruptures on the Jinghong fault, SE of the eastern Himalayan syntaxis

NASA Astrophysics Data System (ADS)

Shi, Xuhua; Weldon, Ray; Liu-Zeng, Jing; Wang, Yu; Weldon, Elise; Sieh, Kerry; Li, Zhigang; Zhang, Jinyu; Yao, Wenqian; Li, Zhanfei

2018-06-01

Quantifying slip rates and earthquake occurrence of active faults on the Shan Plateau, southeast of the eastern Himalayan syntaxis, is critical to assessing the seismic hazard and understanding the kinematics and geodynamics of this region. Most previous estimates of slip rates are averaged over either many millions of years using offset geological markers or decades using GPS. Well-constrained millennial slip rates of these faults remain sparse and constraints on recurrence rates of damaging earthquakes exist only for a few faults. Here we investigate the millennial slip rate and timing of recent earthquakes on the Jinghong fault, one of the geomorphically most significant sinistral-slip faults on the central Shan Plateau. We map and reconstruct fault offset (18 ± 5 m) of alluvial fan features at Manpa on the central Jinghong fault, using a 0.1 m-resolution digital surface model obtained from an unmanned aerial vehicle survey. We establish a slip rate, ≤2.5 ± 0.7 mm/yr over the past 7000 years, using pit-exposed stratigraphy. This millennial slip rate is consistent with rates averaged over both decadal and million-year timescales. Excavations at three sites near the town of Gelanghe on the northeastern Jinghong fault demonstrate 1) that the last seismic ground-rupture occurred between 482 and 889 cal yr BP, most likely in the narrower window 824-767 cal yr BP, if the lack of large earthquakes in the historical earthquake record is reliable, and 2) that multiple fault ruptures have occurred since 3618 cal yr BP. Combining this finding with a lack of large earthquakes in the 800-year-long Chinese historic record in this region, we suggest an average recurrence interval of seismic ground-ruptures on the order of 1000 years. This recurrence interval is consistent with the slip rate of the Jinghong fault and the size and earthquake frequency on other sinistral faults on the Shan Plateau.

Long-Term Survivors Using Intraoperative Radiotherapy for Recurrent Gynecologic Malignancies

DOE Office of Scientific and Technical Information (OSTI.GOV)

Tran, Phuoc T.; Su Zheng; Hara, Wendy

2007-10-01

Purpose: To analyze the outcomes of therapy and identify prognostic factors for patients treated with surgery followed by intraoperative radiotherapy (IORT) for gynecologic malignancies at a single institution. Methods and Materials: We performed a retrospective review of 36 consecutive patients treated with IORT to 44 sites with mean follow-up of 50 months. The primary site was the cervix in 47%, endometrium in 31%, vulva in 14%, vagina in 6%, and fallopian tubes in 3%. Previous RT had failed in 72% of patients, and 89% had recurrent disease. Of 38 IORT sessions, 84% included maximal cytoreductive surgery, including 18% exenterations. Themore » mean age was 52 years (range, 30-74), mean tumor size was 5 cm (range, 0.5-12), previous disease-free interval was 32 months (range, 0-177), and mean IORT dose was 1,152 cGy (range, 600-1,750). RT and systemic therapy after IORT were given to 53% and 24% of the cohort, respectively. The outcomes measured were locoregional control (LRC), distant metastasis-free survival (DMFS), disease-specific survival (DSS), and treatment-related complications. Results: The Kaplan-Meier 5-year LRC, DMFS, and DSS probability for the whole group was 44%, 51%, and 47%, respectively. For cervical cancer patients, the Kaplan-Meier 5-year LRC, DMFS, and DSS estimate was 45%, 60%, and 46%, respectively. The prognostic factors found on multivariate analysis (p {<=} 0.05) were the disease-free interval for LRC, tumor size for DMFS, and cervical primary, previous surgery, and locoregional relapse for DSS. Our cohort had 10 Grade 3-4 complications associated with treatment (surgery and IORT) and a Kaplan-Meier 5-year Grade 3-4 complication-free survival rate of 72%. Conclusions: Survival for pelvic recurrence of gynecologic cancer is poor (range, 0-25%). IORT after surgery seems to confer long-term local control in carefully selected patients.« less

Timing of late Holocene surface rupture of the Wairau Fault, Marlborough, New Zealand

USGS Publications Warehouse

Zachariasen, J.; Berryman, K.; Langridge, Rob; Prentice, C.; Rymer, M.; Stirling, M.; Villamor, P.

2006-01-01

Three trenches excavated across the central portion of the right-lateral strike-slip Wairau Fault in South Island, New Zealand, exposed a complex set of fault strands that have displaced a sequence of late Holocene alluvial and colluvial deposits. Abundant charcoal fragments provide age control for various stratigraphic horizons dating back to c. 5610 yr ago. Faulting relations from the Wadsworth trench show that the most recent surface rupture event occurred at least 1290 yr and at most 2740 yr ago. Drowned trees in landslide-dammed Lake Chalice, in combination with charcoal from the base of an unfaulted colluvial wedge at Wadsworth trench, suggest a narrower time bracket for this event of 1811-2301 cal. yr BP. The penultimate faulting event occurred between c. 2370 and 3380 yr, and possibly near 2680 ?? 60 cal. yr BP, when data from both the Wadsworth and Dillon trenches are combined. Two older events have been recognised from Dillon trench but remain poorly dated. A probable elapsed time of at least 1811 yr since the last surface rupture, and an average slip rate estimate for the Wairau Fault of 3-5 mm/yr, suggests that at least 5.4 m and up to 11.5 m of elastic shear strain has accumulated since the last rupture. This is near to or greater than the single-event displacement estimates of 5-7 m. The average recurrence interval for surface rupture of the fault determined from the trench data is 1150-1400 yr. Although the uncertainties in the timing of faulting events and variability in inter-event times remain high, the time elapsed since the last event is in the order of 1-2 times the average recurrence interval, implying that the Wairau Fault is near the end of its interseismic period. ?? The Royal Society of New Zealand 2006.

Selected Streamflow Statistics and Regression Equations for Predicting Statistics at Stream Locations in Monroe County, Pennsylvania

USGS Publications Warehouse

Thompson, Ronald E.; Hoffman, Scott A.

2006-01-01

A suite of 28 streamflow statistics, ranging from extreme low to high flows, was computed for 17 continuous-record streamflow-gaging stations and predicted for 20 partial-record stations in Monroe County and contiguous counties in north-eastern Pennsylvania. The predicted statistics for the partial-record stations were based on regression analyses relating inter-mittent flow measurements made at the partial-record stations indexed to concurrent daily mean flows at continuous-record stations during base-flow conditions. The same statistics also were predicted for 134 ungaged stream locations in Monroe County on the basis of regression analyses relating the statistics to GIS-determined basin characteristics for the continuous-record station drainage areas. The prediction methodology for developing the regression equations used to estimate statistics was developed for estimating low-flow frequencies. This study and a companion study found that the methodology also has application potential for predicting intermediate- and high-flow statistics. The statistics included mean monthly flows, mean annual flow, 7-day low flows for three recurrence intervals, nine flow durations, mean annual base flow, and annual mean base flows for two recurrence intervals. Low standard errors of prediction and high coefficients of determination (R2) indicated good results in using the regression equations to predict the statistics. Regression equations for the larger flow statistics tended to have lower standard errors of prediction and higher coefficients of determination (R2) than equations for the smaller flow statistics. The report discusses the methodologies used in determining the statistics and the limitations of the statistics and the equations used to predict the statistics. Caution is indicated in using the predicted statistics for small drainage area situations. Study results constitute input needed by water-resource managers in Monroe County for planning purposes and evaluation of water-resources availability.

Hurricane Agnes rainfall and floods, June-July 1972

USGS Publications Warehouse

Bailey, James F.; Patterson, James Lee; Paulhus, Joseph Louis Hornore

1975-01-01

Hurricane Agnes originated in the Caribbean Sea region in mid-June. Circulation barely reached hurricane intensity for a brief period in the Gulf of Mexico. The storm crossed the Florida Panhandle coastline on June 19, 1972, and followed an unusually extended overland trajectory combining with an extratropical system to bring very heavy rain from the Carolinas northward to New York. This torrential rain followed the abnormally wet May weather in the Middle Atlantic States and set the stage for the subsequent major flooding. The record-breaking floods occurred in the Middle Atlantic States in late June and early July 1972. Many streams in the affected area experienced peak discharges several times the previous maxima of record. Estimated recurrence intervals of peak flows at many gaging stations on major rivers and their tributaries exceeded 100 years. The suspended-sediment concentration and load of most flooded streams were also unusually high. The widespread flooding from this storm caused Agnes to be called the most destructive hurricane in United States history, claiming 117 lives and causing damage estimated at $3.1 billion in 12 States. Damage was particularly high in New York, Pennsylvania, Maryland, and Virginia. The detailed life history of Hurricane Agnes, including the tropical depression and tropical storm stages, is traced. Associated rainfalls are analyzed and compared with climatologic recurrence values. These are followed by a detailed description of the flood and streamflows of each affected basin. A summary of peak stages and discharges and comparison data for previous floods at 989 stations are presented. Deaths and flood damage estimates are compiled.

Development of Evidence Based Surveillance Intervals following Radiofrequency Ablation of Barrett's Esophagus.

PubMed

Cotton, Cary C; Haidry, Rehan; Thrift, Aaron P; Lovat, Laurence; Shaheen, Nicholas J

2018-04-12

Barrett's esophagus (BE) recurs in 25% or more of patients treated successfully with radiofrequency ablation (RFA), so surveillance endoscopy is recommended after complete eradication of intestinal metaplasia (CEIM). The frequency of surveillance is informed only by expert opinion. We aimed to model the incidence of neoplastic recurrence, validate the model in an independent cohort, and propose evidence-based surveillance intervals. We collected data from the United States Radiofrequency Ablation Registry (US RFA, 2004-2013) and the United Kingdom National Halo Registry (UK NHR, 2007-2015) to build and validate models to predict the incidence of neoplasia recurrence following initially successful RFA. We developed 3 categories of risk and modeled intervals to yield 0.1% risk of recurrence with invasive adenocarcinoma. We fit Cox proportional hazards models assessing discrimination by C statistic and 95% confidence limits (CL). The incidence of neoplastic recurrence was associated with most severe histologic grade prior to CEIM, age, endoscopic mucosal resection, sex, and baseline BE segment length. In multivariate analysis, a model based solely on most severe pre-CEIM histology predictied neoplastic recurrence with a C statistic 0.892 (95% CL, 0.863-0.921) in the US RFA registry. This model also performed well when we used data from the UK NHR. Our model divided patients into 3 risk groups based on baseline histologic grade: non-dysplastic BE or indefinite-for-dysplasia, low-grade dysplasia, and high-grade dysplasia or intramucosal adenocarcinoma. For patients with low-grade dysplasia, we propose surveillance endoscopy at 1 and 3 years after CEIM; for patients with high-grade dysplasia or intramucosal adenocarcinoma we propose surveillance endoscopy at 0.25, 0.5, and 1 year after CEIM, then annually. In analyses of data from the US RFA and UK NHR for BE, a much-attenuated schedule of surveillance endoscopy would provide protection from invasive adenocarcinoma. Adherence to the recommended surveillance intervals could decrease the number of endoscopies performed yet identify unresectable cancers at rates less than 1/1000 endoscopies. Copyright © 2018 AGA Institute. Published by Elsevier Inc. All rights reserved.

On the confounds among retest gains and age-cohort differences in the estimation of within-person change in longitudinal studies: a simulation study.

PubMed

Hoffman, Lesa; Hofer, Scott M; Sliwinski, Martin J

2011-12-01

Although longitudinal designs are the only way in which age changes can be directly observed, a recurrent criticism involves to what extent retest effects may downwardly bias estimates of true age-related cognitive change. Considerable attention has been given to the problem of retest effects within mixed effects models that include separate parameters for longitudinal change over time (usually specified as a function of age) and for the impact of retest (specified as a function of number of exposures). Because time (i.e., intervals between assessment) and number of exposures are highly correlated (and are perfectly correlated in equal interval designs) in most longitudinal studies, the separation of effects of within-person change from effects of retest gains is only possible given certain assumptions (e.g., age convergence). To the extent that cross-sectional and longitudinal effects of age differ, obtained estimates of aging and retest may not be informative. The current simulation study investigated the recovery of within-person change (i.e., aging) and retest effects from repeated cognitive testing as a function of number of waves, age range at baseline, and size and direction of age-cohort differences on the intercept and age slope in age-based models of change. Significant bias and Type I error rates in the estimated effects of retest were observed when these convergence assumptions were not met. These simulation results suggest that retest effects may not be distinguishable from effects of aging-related change and age-cohort differences in typical long-term traditional longitudinal designs.

Recurrences and fertility after endometrioma ablation in women with and without colorectal endometriosis: a prospective cohort study.

PubMed

Roman, Horace; Quibel, Solène; Auber, Mathieu; Muszynski, Hélène; Huet, Emmanuel; Marpeau, Loïc; Tuech, Jean Jacques

2015-03-01

What are the recurrence and pregnancy rates in women managed for ovarian endometrioma by ablation using plasma energy with and without associated surgery for colorectal endometriosis? Concomitant management of colorectal endometriosis does not impact either risk of recurrences or probability of pregnancy in women managed for endometrioma ablation using plasma energy. No consensus exists on how best to manage patients presenting with ovarian endometriomas and colorectal endometriosis, in terms of impact on fertility preservation and recurrence rates. A prospective series of consecutive patients managed for ovarian endometriomas by ablation using plasma energy, over a period of 48 consecutive months. The study included patients with associated colorectal endometriosis (n = 52) and those who were free of colorectal localizations of the disease (n = 72). No women were lost to follow-up. The 124 women included in this study were managed for either unilateral or bilateral ovarian endometriomas using plasma energy at a university tertiary care center. Recurrences and pregnancy rate were compared in patients with and without colorectal endometriosis. The minimum length of follow-up was 1 year. Cyst recurrences were assessed using pelvic ultrasound and magnetic resonance imaging. Kaplan-Meier and actuarial life-table analysis were used to estimate the recurrence-free survival curve and the probability of pregnancy. The Cox model was used to assess independent predictive factors for recurrences. Pregnancy likelihood and independent predictors were estimated using a regression logistic model. Mean follow-up was 32 ± 18 months. Forty-eight patients (40.3%) were presumed infertile and attended an assisted reproductive techniques (ART) center. Eighteen patients presented with a recurrence (14.5%). Bilateral localization of endometriomas was the only factor independently related to an increased risk of recurrences [hazard ratio 3.3, 95% confidence interval (CI) 1.2-9.4]. Of the 83 women wishing to conceive (66.9%), 51 became pregnant (61.4%) and 33 of these pregnancies were spontaneous (64.7%). The rates of pregnancy were 65.8% for the group of patients with associated colorectal endometriosis and 57.8% for controls (P = 0.50). Age over 35 years was the only independent factor for which association with pregnancy rates approached the significance threshold (adjusted odds ratio 0.35, 95% CI 0.12-1, P = 0.06). The study sample size may be insufficient to reveal statistically significant differences related to risk factors which have low impact on the probability of recurrence and pregnancy. Data on ovarian reserve before and after the procedure was not available in all patients, which would have added to our results and the discussion about treatment of endometrioma in general. Concomitant management of colorectal endometriosis does not impact either risk of recurrences or the probability of pregnancy in women having benefited from ovarian endometrioma ablation using plasma energy. Moreover, surgical management of colorectal and ovarian endometriosis may allow spontaneous conception in one out of three patients, thus reducing expenses related to ART management. No financial support was received for this study. Horace Roman reports personal fees for participating in a symposium and masterclass presenting his experience in the use of PlasmaJet. © The Author 2015. Published by Oxford University Press on behalf of the European Society of Human Reproduction and Embryology. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

Gamma-ray burster recurrence timescales

NASA Technical Reports Server (NTRS)

Schaefer, B. E.; Cline, T. L.

1984-01-01

Three optical transients have been found which are associated with gamma-ray bursters (GRBs). The deduced recurrence timescale for these optical transients (tau sub opt) will depend on the minimum brightness for which a flash would be detected. A detailed analysis using all available data of tau sub opt as a function of E(gamma)/E(opt) is given. For flashes similar to those found in the Harvard archives, the best estimate of tau sub opt is 0.74 years, with a 99% confidence interval from 0.23 years to 4.7 years. It is currently unclear whether the optical transients from GRBs also give rise to gamma-ray events. One way to test this association is to measure the recurrence timescale of gamma-ray events tau sub gamma. A total of 210 gamma-ray error boxes were examined and it was found that the number of observed overlaps is not significantly different from the number expected from chance coincidence. This observation can be used to place limits on tau sub gamma for an assumed luminosity function. It was found that tau sub gamma is approx. 10 yr if bursts are monoenergetic. However, if GRBs have a power law luminosity function with a wide dynamic range, then the limit is tau sub gamma 0.5 yr. Hence, the gamma-ray data do not require tau sub gamma and tau sub opt to be different.

Semiparametric modeling and estimation of the terminal behavior of recurrent marker processes before failure events.

PubMed

Chan, Kwun Chuen Gary; Wang, Mei-Cheng

2017-01-01

Recurrent event processes with marker measurements are mostly and largely studied with forward time models starting from an initial event. Interestingly, the processes could exhibit important terminal behavior during a time period before occurrence of the failure event. A natural and direct way to study recurrent events prior to a failure event is to align the processes using the failure event as the time origin and to examine the terminal behavior by a backward time model. This paper studies regression models for backward recurrent marker processes by counting time backward from the failure event. A three-level semiparametric regression model is proposed for jointly modeling the time to a failure event, the backward recurrent event process, and the marker observed at the time of each backward recurrent event. The first level is a proportional hazards model for the failure time, the second level is a proportional rate model for the recurrent events occurring before the failure event, and the third level is a proportional mean model for the marker given the occurrence of a recurrent event backward in time. By jointly modeling the three components, estimating equations can be constructed for marked counting processes to estimate the target parameters in the three-level regression models. Large sample properties of the proposed estimators are studied and established. The proposed models and methods are illustrated by a community-based AIDS clinical trial to examine the terminal behavior of frequencies and severities of opportunistic infections among HIV infected individuals in the last six months of life.

Silica precipitation potentially controls earthquake recurrence in seismogenic zones.

PubMed

Saishu, Hanae; Okamoto, Atsushi; Otsubo, Makoto

2017-10-17

Silica precipitation is assumed to play a significant role in post-earthquake recovery of the mechanical and hydrological properties of seismogenic zones. However, the relationship between the widespread quartz veins around seismogenic zones and earthquake recurrence is poorly understood. Here we propose a novel model of quartz vein formation associated with fluid advection from host rocks and silica precipitation in a crack, in order to quantify the timescale of crack sealing. When applied to sets of extensional quartz veins around the Nobeoka Thrust of SW Japan, an ancient seismogenic splay fault, our model indicates that a fluid pressure drop of 10-25 MPa facilitates the formation of typical extensional quartz veins over a period of 6.6 × 10 0 -5.6 × 10 1 years, and that 89%-100% of porosity is recovered within ~3 × 10 2 years. The former and latter sealing timescales correspond to the extensional stress period (~3 × 10 1 years) and the recurrence interval of megaearthquakes in the Nankai Trough (~3 × 10 2 years), respectively. We therefore suggest that silica precipitation in the accretionary wedge controls the recurrence interval of large earthquakes in subduction zones.

Impact of Visceral Metastasis on Efficacy of Fulvestrant in Patients with Hormone Receptor-positive Recurrent Breast Cancer.

PubMed

Koi, Yumiko; Koga, Chinami; Akiyoshi, Sayuri; Masuda, Takanobu; Ijichi, Hideki; Nakamura, Yoshiaki; Ishida, Mayumi; Ohno, Shinji; Tokunaga, Eriko

2018-03-01

Previous studies have suggested that the presence of visceral metastasis is a parameter useful in predicting the treatment efficacy of fulvestrant in patients with advanced breast cancer. We retrospectively examined the association between treatment efficacy and presence of visceral metastasis in 75 patients with hormone receptor-positive recurrent breast cancer who were treated with fulvestrant or no more than five lines of other endocrine monotherapy after recurrence. Nineteen patients received fulvestrant, 10 of whom had visceral metastasis. The median time to progression was 4 months for the overall study population; it was significantly longer for patients with non-visceral metastasis (5.4 months; 95% confidence interval=3.7-11.2 months) than for those with visceral metastasis (3.3 months; 95% confidence interval, 0.4-5.3 months; p=0.01). No differences in time to progression were found between the groups of patients with visceral metastasis and non-visceral metastasis who underwent other endocrine therapies. Fulvestrant is more effective for patients with non-visceral metastasis of recurrent breast cancer with than for those with visceral metastasis. Copyright© 2018, International Institute of Anticancer Research (Dr. George J. Delinasios), All rights reserved.

Incomplete surgery, local immunostimulation, and recurrence of some tumour types in dogs and cats.

PubMed

Misdorp, W

1987-07-01

Histologically confirmed inadequate treatment resulted in a lower than expected recurrence percentage in dogs with haemangiopericytoma (38%) and mastocytoma (30%). Clinical suspicion of inadequate tumour treatment did not always correlate with the histologically assessed inadequacy, nor with the appearance of local recurrence. Local recurrence did not seem to be correlated with histological grade of malignancy and tumour size. Local injection of C. parvum vaccine did not result in a lower percentage of local recurrence or longer recurrence-free intervals in any of the three tumour groups (canine haemangiopericytoma, canine mastocytoma, feline mammary carcinoma). Nor was palliative local adjuvant injection of Cp successful in dogs and cats with soft tissue sarcomas or in dogs with gingival melanoma. Re-operation of locally recurrent tumour was successful in some dogs with haemangiopericytoma, in a few with mastocytoma, but not in cats with mammary carcinoma. A trend toward histological progression of recurrences and metastases, when compared with the primary tumours, was not evident. The possible reasons for the relatively low recurrence rate of some tumour types and for the failure of Cp-treatment are discussed.

Temporal slip-rate stability and variations on the Hope Fault, New Zealand, during the late Quaternary

NASA Astrophysics Data System (ADS)

Khajavi, Narges; Nicol, Andrew; Quigley, Mark C.; Langridge, Robert M.

2018-07-01

The Hope Fault transfers slip from Hikurangi subduction to the Alpine Fault in the northern South Island of New Zealand. It accommodates mainly dextral strike slip and currently carries the highest slip rate in the Marlborough Fault System. Displacements, displacement rates and earthquake recurrence intervals have been determined using a combination of high resolution LiDAR for 59 dextral displacements ( 2.5-200 m) together with calibrated radiocarbon ages ( 130 yr to 13,000 yr) for abandoned stream channels, terrace risers and alluvial fans. Mean single-event displacement (SED) of 3 ± 0.6 m (2.2 to 4.6 m for 21 measurements) and mean recurrence interval of 266 ± 100 yr (range 128 to 560 yr) have been determined for the five most recent surface-rupturing earthquakes. On time scales ≥2300 yr the dextral slip rate is uniform at 12.2 ± 2.4 mm/yr, however, when averaged over time intervals of 230 to 1700 yr slip rates range from 4 to 46.4 mm/yr. This order-of-magnitude variability in slip rate over shorter timescales cannot be fully attributed to errors in displacement and age data, and is at least partly due to variations in earthquake recurrence interval and inferred SED. Short-term non-characteristic earthquake behaviour may be due to changes in fault loading arising from stress interactions between different segments of the Hope Fault and nearby faults.

Floods of February 1989 in Tennessee

USGS Publications Warehouse

Quinones, Ferdinand; Gamble, C.R.

1990-01-01

Rainfall amounts of over 5 inches the night of February 13 and the morning of February 14, 1989, caused flooding in areas of Middle and West Tennessee. The towns of Lebanon in Middle Tennessee and Obion in West Tennessee were most severely affected. Most of the business district in Lebanon and many residential areas in Obion were flooded. Recurrence intervals for 24-hour rainfall totals were as high as 25 years at some sites but most peak discharges had recurrence intervals of less than 10 years. Rainfall amounts for the period February 13-20, 1989, peak stages and discharges for this flood, the peak of record, and a list of discharge measurements made during the flood are documented. (USGS)

A 100-year average recurrence interval for the San Andreas fault at Wrightwood, California

USGS Publications Warehouse

Fumal, T.E.; Pezzopane, S.K.; Weldon, R.J.; Schwartz, D.P.

1993-01-01

Evidence for five large earthquakes during the past five centuries along the San Andreas fault zone 70 kilometers northeast of Los Angeles, California, indicates that the average recurrence interval and the temporal variability are significantly smaller than previously thought. Rapid sedimentation during the past 5000 years in a 150-meter-wide structural depression has produced a greater than 21-meter-thick sequence of debris flow and stream deposits interbedded with more than 50 datable peat layers. Fault scarps, colluvial wedges, fissure infills, upward termination of ruptures, and tilted and folded deposits above listric faults provide evidence for large earthquakes that occurred in A.D. 1857, 1812, and about 1700, 1610, and 1470.

Flood of December 1987 in central and eastern Arkansas

USGS Publications Warehouse

Neely, B.L.

1990-01-01

Heavy rain fell across Arkansas during December 24-28, 1987. During this period, 6 to 12 inches of rain fell in a 100-mile wide belt extending roughly from Texarkana to West Memphis, Arkansas. The intense rainfall produced flooding throughout much of central and eastern Arkansas. Peak discharges associated with the flood had recurrence intervals of 100 years at two gaging stations. Peak stages, discharges, and recurrence intervals for this flood are documented profiles for 41 gaging stations. Also included in this report are flood profiles for Bayou Meto, Bayou Two Prairie, Cache River, L'Anguille River, and flood hydrographs for gaging stations on Bayou Meto near Lonoke and Cache River at Patterson. (USGS)

Risk factors for recurrent symptomatic pigmented biliary stones after percutaneous transhepatic biliary extraction.

PubMed

Kim, Dong Won; Lee, Sang Yun; Cho, Jin-Han; Kang, Myong Jin; Noh, Myung Hwan; Park, Byeong-Ho

2010-07-01

To evaluate risk factors for the recurrence of biliary stones after a percutaneous transhepatic biliary stone extraction. The procedures were performed on 339 patients between July 2004 and December 2008 (54 months). Medical records and images were retrospectively reviewed for 135 patients (mean age, 66.4 years; 83 men and 52 women) who had undergone follow-up for a mean of 13.2 months (range, 3-37 months). To evaluate risk factors for the recurrence of biliary stones, variables were evaluated with univariate and multivariate analyses. Variables included sex, age, stone location, number of stones, stone size, presence of a peripapillary diverticulum, application of antegrade sphincteroplasty, presence of a biliary stricture, largest biliary diameter before the procedure, and gallbladder status. Thirty-three of the 135 patients (24%) had recurrent symptomatic biliary stones and underwent an additional extraction. The mean time to recurrence was 17.2 months +/- 8.7. Univariate analysis of risk factors for recurrence of biliary stones demonstrated that location, number of stones, stone size, application of antegrade sphincteroplasty, presence of a biliary stricture, and biliary diameter were significant factors (P < .05). With use of multivariate analysis, the number of stones (> or =6; relative risk, 64.8; 95% confidence interval: 5.8, 717.6) and stone size (> or =14 mm; relative risk, 3.8; 95% confidence interval: 1.138, 13.231) were determined to be significant risk factors. The independent risk factors for recurrence of symptomatic biliary stones after percutaneous transhepatic biliary stone extraction were a stone size of at least 14 mm and the presence of at least six stones. Copyright 2010 SIR. Published by Elsevier Inc. All rights reserved.

Surveillance of colorectal cancer: effectiveness of early detection of intraluminal recurrences on prognosis and survival of patients treated for cure.

PubMed

Barillari, P; Ramacciato, G; Manetti, G; Bovino, A; Sammartino, P; Stipa, V

1996-04-01

The authors evaluate the effectiveness of routine colonoscopy and marker evaluation in diagnosis of intraluminal recurrent cancer. Chart review was conducted on 481 patients who underwent curative resection for colorectal cancer between 1980 and 1990. Clinical visits were scheduled and carcinoembryonic antigen evaluation was performed every three months, and colonoscopy was performed preoperatively, 12 to 15 months after surgical treatment, and then with intervals of 12 to 24 months or when symptoms appeared. About 10 percent of patients developed intraluminal recurrences. More than one-half of metachronous lesions arose within the first 24 months, and median time to diagnosis was 25 months. Patients with left-sited tumors in the advanced stage had a higher risk of developing recurrent intraluminal disease. Twenty-nine patients underwent a second surgical operation, of which 17 cases were radical. In this group, the five-year survival was 70.6 percent, although no nonradically treated or nonresected patients survived longer than 31 months. Twenty-two patients were asymptomatic at time of diagnosis of recurrence, and of these, 12 patients underwent radical operation; on the other hand, of the 24 symptomatic patients, only 5 were treated radically. Carcinoembryonic antigen was the first sign of recurrence in eight cases. Colonoscopy must be performed within the first 12 to 15 months after operation, whereas an interval of 24 months between examinations seems sufficient to guarantee early detection of metachronous lesions. Serial tumor marker evaluation is of help in earlier diagnosis of local recurrences. Asymptomatic patients more frequently undergo another operation for cure and thus have a better survival rate.

Higher Bilirubin Levels of Healthy Living Liver Donors Are Associated With Lower Posttransplant Hepatocellular Carcinoma Recurrence.

PubMed

Han, Sangbin; Yang, Ju Dong; Sinn, Dong Hyun; Ko, Justin Sangwook; Kim, Jong Man; Shin, Jun Chul; Son, Hee Jeong; Gwak, Mi Sook; Joh, Jae-Won; Kim, Gaab Soo

2016-09-01

Serum bilirubin level, which may reflect the host defense against increased oxidative stress, is inversely associated with the risk of cancer development. In liver transplantation, the intrinsic bilirubin metabolism of donor liver is subsequently translated into recipient. Thus, we hypothesized that liver transplantation conducted with living donors with higher serum bilirubin reduces hepatocellular carcinoma (HCC) recurrence. Two hundred fifty recipients who underwent liver transplantation for treating HCC within the Milan criteria were included in the study. The association between donor preoperative total bilirubin concentration and the risk of HCC recurrence was analyzed using the Fine and Gray regression model with posttransplant death as a competing risk event with adjustment for tumor biology including α-fetoprotein, histological differentiation, and microvascular invasion. All donors were confirmed to have no underlying hepatobiliary diseases or hematological disorders. Donor preoperative total bilirubin concentration was 0.7 mg/dL in median and ranged from 0.2 to 2.7 mg/dL. Thirty-five (14.0%) recipients developed HCC recurrence. Multivariable analysis demonstrated that donor preoperative total bilirubin concentration was inversely associated with the recurrence risk (hazard ratio, 0.22; 95% confidence interval, 0.07-0.72; P = 0.013). The highest (≥1.0 mg/dL) versus lowest (≤0.6 mg/dL) tertile of donor preoperative total bilirubin showed a significant reduction of the recurrence risk (hazard ratio, 0.28; 95% confidence interval, 0.11-0.70; P = 0.006). Hepatocellular carcinoma recurrence risk decreases in relation to the increase in total serum bilirubin level of healthy living donors without underlying hepatobiliary or hematological disorders. Further validation of bilirubin as a potent anticancer substance against HCC is warranted.

Time to relapse after epilepsy surgery in children: AED withdrawal policies are a contributing factor.

PubMed

Boshuisen, Kim; Schmidt, Dieter; Uiterwaal, Cuno S P M; Arzimanoglou, Alexis; Braun, Kees P J; Study Group, TimeToStop

2014-09-01

It was recently suggested that early postoperative seizure relapse implicates a failure to define and resect the epileptogenic zone, that late recurrences reflect the persistence or re-emergence of epileptogenic pathology, and that early recurrences are associated with poor treatment response. Timing of antiepileptic drugs withdrawal policies, however, have never been taken into account when investigating time to relapse following epilepsy surgery. Of the European paediatric epilepsy surgery cohort from the "TimeToStop" study, all 95 children with postoperative seizure recurrence following antiepileptic drug (AED) withdrawal were selected. We investigated how time intervals from surgery to AED withdrawal, as well as other previously suggested determinants of (timing of) seizure recurrence, related to time to relapse and to relapse treatability. Uni- and multivariable linear and logistic regression models were used. Based on multivariable analysis, a shorter interval to AED reduction was the only independent predictor of a shorter time to relapse. Based on univariable analysis, incomplete resection of the epileptogenic zone related to a shorter time to recurrence. Timing of recurrence was not related to the chance of regaining seizure freedom after reinstallation of medical treatment. For children in whom AED reduction is initiated following epilepsy surgery, the time to relapse is largely influenced by the timing of AED withdrawal, rather than by disease or surgery-specific factors. We could not confirm a relationship between time to recurrence and treatment response. Timing of AED withdrawal should be taken into account when studying time to relapse following epilepsy surgery, as early withdrawal reveals more rapidly whether surgery had the intended curative effect, independently of the other factors involved.

Thyroid cancer outcomes in Filipino patients.

PubMed

Kus, Lukas H; Shah, Manish; Eski, Spiro; Walfish, Paul G; Freeman, Jeremy L

2010-02-01

To compare the outcomes of patients having thyroid cancer among Filipinos vs non-Filipinos. Retrospective medical record review. High-volume tertiary referral center in Toronto, Ontario, Canada. A total of 499 patients with thyroid cancer (36 Filipino and 463 non-Filipino) treated at Mount Sinai Hospital from January 1, 1984, to August 31, 2003, with a minimum 5-year follow-up period and a minimum 1.0-cm tumor size. Patients were identified from a thyroid cancer database. Data on patient, tumor, and treatment factors were collected along with outcomes. The presence of thyroid cancer recurrence, the rate of death from disease, and the time to recurrence. The 2 groups were similar for sex, age, history of head and neck radiation exposure, family history of thyroid cancer, follow-up time, tumor size, tumor pathologic findings, presence of tumor multifocality, stage of primary disease, type of thyroid surgery, use of postoperative radioactive iodine therapy, and use of external beam radiation therapy. Filipino patients experienced a thyroid cancer recurrence rate of 25% compared with 9.5% for non-Filipino patients (odds ratio, 3.20; 95% confidence interval, 1.23-7.49; P = .004). On multivariate analysis, the increased risk of thyroid cancer recurrence persisted for Filipino patients (odds ratio, 6.99; 95% confidence interval, 2.31-21.07; P < .001). No significant differences were noted between Filipino patients and non-Filipino patients regarding the rate of death from disease (5.6% vs 1.9%) and the time to recurrence (52.6 vs 53.1 months). Filipino patients have a significantly higher risk of thyroid cancer recurrence compared with non-Filipino patients. However, no significant difference was noted in the time to recurrence or the rate of death from disease. These findings justify a more aggressive initial management and follow-up regimen for Filipino patients with thyroid cancer.

Adjuvant Intrahepatic Injection Iodine-131-Lipiodol Improves Prognosis of Patients with Hepatocellular Carcinoma After Resection: a Meta-Analysis.

PubMed

Hong, Ye; Wu, Lu-Peng; Ye, Feng; Zhou, Yan-Ming

2015-12-01

High incidence of intrahepatic recurrence is a major surgical limitation following hepatectomy of hepatocellular carcinoma (HCC). This study was intended to investigate the effects of adjuvant intrahepatic injection of iodine-131-lipiodol on disease recurrence and survival in patients with HCC who underwent resection. A computerized literature search was performed to identify relevant articles. Data synthesis was performed using Review Manager 5.0 software, and results are presented as odds ratio (OR) with 95 % confidence intervals. Two randomized controlled trials and three case-control studies with a total of 334 participants were analyzed. Iodine-131-lipiodol treatment achieved significantly lower rates of intrahepatic recurrence (OR = 0.48, 95 % confidence interval (95 % CI) = 0.30-0.74; P = 0.001) and early recurrence (<2 year) (OR = 0.45, 95 % CI = 0.23-0.89; P = 0.02). Likewise, iodine-131-lipiodol treatment improved both the 5-year disease-free survival and overall survival significantly (OR = 1.85, 95 % CI = 1.13-3.03; P = 0.01; OR = 2.00, 95 % CI = 0.99-4.04; P = 0.05, respectively). Adjuvant intrahepatic injection of iodine-131-lipiodol resulted in a preventive effect on recurrence and improved survival after resection of HCC. Further larger, multi-centred, randomized prospective trial is warranted.

[The role of colonoscopy in early diagnosis of intraluminal recurrences in patients already treated for colorectal cancer].

PubMed

Barillari, P; Manetti, G; Bovino, A; Puce, Y; Piovanello, P; Cioè, I; Sammartino, P; Stipa, V

1996-11-01

It is a common opinion that the more often and the more rigorously the colon is examined, the more lesions will be discovered and diagnosed. However it has not been shown which methods of colonic examination and which regimen of surveillance should be used. Chart review was conducted on 481 patients who underwent curative resection for colorectal cancer between 1980 and 1990. Colonoscopy was performed preoperatively, after 12-15 months from surgical treatment, and then at an interval of 12-24 months, or when symptoms appeared. About ten percent of patients developed intraluminal recurrences, and more than 25% adenomatous polyps. More than one half of the metachronous lesions arise within the first 24 months. The median time to diagnosis was 25 months for intraluminal recurrences and 22 months for adenomatous polyps. Patients with left sited tumor at an advanced stage run a higher risk of developing recurrent intraluminal disease, and patients who presented associated polyps at the time of the operation for the index cancer have a higher risk of developing new polyps. About 50% of recurrences were detected when patients were asymptomatic. Colonoscopy must be performed within the first 12-15 months after operation, while an interval of 24 months between each examination seems sufficient to guarantee an early detection of metachronous lesion. Asymptomatic patients are more frequently reoperated for cure and thus have a better survival rate.

Flood characteristics of Oklahoma streams techniques for calculating magnitude and frequency of floods in Oklahoma, with compilations of flood data through 1971

USGS Publications Warehouse

Sauer, Vernon B.

1974-01-01

The 2-, 5-, 10-, 25-, 50-, and 100-year recurrence interval floods are related to basin and climatic parameters for natural streams in Oklahoma by multiple regression techniques through the mathematical model, Qx=aAbScPd,where Qx is peak discharge for recurrence interval x, A is contributing drainage area, S is main channel slope, P is mean annual precipitation, and a, b, c, and d are regression constants and coefficients. One equation for each recurrence interval applies statewide for all natural streams of less than 2,500 mil (6,500 km2), except where manmade works, such as dams, flood-detention structures, levees, channelization, and urban development, appreciably affect flood runoff. The equations can be used to estimate flood frequency of a stream at an ungaged site if drainage area size, main channel slope, and mean annual precipitation are known. At or near gaged sites, a weighted average of the regression results and the gaging station data is recommended.Individual relations of flood magnitude to contributing drainage area are given for all or parts of the main stems of the Arkansas, Salt Fork Arkansas, Cimarron, North Canadian, Canadian, Washita, North Fork Red, and Red Rivers. Parts of some of these streams, and all of the Neosho and Verdigris Rivers are not included because the effects of. major regulation from large reservoirs cannot be evaluated within the scope of the report. Graphical relations of maximum floods of record for eastern and western Oklahoma provide a guide to maximum probable floods. A random sampling of the seasonal occurrence of floods indicated about two-thirds of all annual floods in Oklahoma occur during. April through July. Less than one-half of one percent of annual floods occur in December. A compilation of flood records at all gaging sites in Oklahoma and some selected sites in adjacent States is given in an appendix. Basin and climatic parameters and log-Pearson Type III frequency data and statistics are given for most station records. A second appendix gives a reprint of the U.S. Water Resources Council Bulletin 15 which describes procedures for fitting a log-Pearson Type III distribution to gaging station data.

A reliable simultaneous representation of seismic hazard and of ground shaking recurrence

NASA Astrophysics Data System (ADS)

Peresan, A.; Panza, G. F.; Magrin, A.; Vaccari, F.

2015-12-01

Different earthquake hazard maps may be appropriate for different purposes - such as emergency management, insurance and engineering design. Accounting for the lower occurrence rate of larger sporadic earthquakes may allow to formulate cost-effective policies in some specific applications, provided that statistically sound recurrence estimates are used, which is not typically the case of PSHA (Probabilistic Seismic Hazard Assessment). We illustrate the procedure to associate the expected ground motions from Neo-deterministic Seismic Hazard Assessment (NDSHA) to an estimate of their recurrence. Neo-deterministic refers to a scenario-based approach, which allows for the construction of a broad range of earthquake scenarios via full waveforms modeling. From the synthetic seismograms the estimates of peak ground acceleration, velocity and displacement, or any other parameter relevant to seismic engineering, can be extracted. NDSHA, in its standard form, defines the hazard computed from a wide set of scenario earthquakes (including the largest deterministically or historically defined credible earthquake, MCE) and it does not supply the frequency of occurrence of the expected ground shaking. A recent enhanced variant of NDSHA that reliably accounts for recurrence has been developed and it is applied to the Italian territory. The characterization of the frequency-magnitude relation can be performed by any statistically sound method supported by data (e.g. multi-scale seismicity model), so that a recurrence estimate is associated to each of the pertinent sources. In this way a standard NDSHA map of ground shaking is obtained simultaneously with the map of the corresponding recurrences. The introduction of recurrence estimates in NDSHA naturally allows for the generation of ground shaking maps at specified return periods. This permits a straightforward comparison between NDSHA and PSHA maps.

What Factors Influence Women's Perceptions of their Systemic Recurrence Risk after Breast Cancer Treatment?

PubMed

Lee, Kamaria L; Janz, Nancy K; Zikmund-Fisher, Brian J; Jagsi, Reshma; Wallner, Lauren P; Kurian, Allison W; Katz, Steven J; Abrahamse, Paul; Hawley, Sarah T

2018-01-01

Breast cancer patients' misunderstanding of their systemic cancer recurrence risk has consequences on decision-making and quality of life. Little is known about how women derive their risk estimates. Using Los Angeles and Georgia's SEER registries (2014-2015), a random sample of early-stage breast cancer patients was sent surveys about 2 to 3 months after surgery ( N = 3930; RR, 68%). We conducted an inductive thematic analysis of open-ended responses about why women chose their risk estimates in a uniquely large sub-sample ( N = 1,754). Clinician estimates of systemic recurrence risk were provided for patient sub-groups with DCIS and with low-, intermediate-, and high-risk invasive disease. Women's perceived risk of systemic recurrence (0% to 100%) was categorized as overestimation, reasonably accurate estimation, or underestimation (0% for invasive disease) and was compared across identified factors and by clinical presentation. Women identified 9 main factors related to their clinical experience (e.g., diagnosis and testing; treatment) and non-clinical beliefs (e.g., uncertainty; spirituality). Women who mentioned at least one clinical experience factor were significantly less likely to overestimate their risk (12% v. 43%, P < 0.001). Most women who were influenced by "communication with a clinician" had reasonably accurate recurrence estimates (68%). "Uncertainty" and "family and personal history" were associated with overestimation, particularly for women with DCIS (75%; 84%). "Spirituality, religion, and faith" was associated with an underestimation of risk (63% v. 20%, P < 0.001). The quantification of our qualitative results is subject to any biases that may have occurred during the coding process despite rigorous methodology. Patient-clinician communication is important for breast cancer patients' understanding of their numeric risk of systemic recurrence. Clinician discussions about recurrence risk should address uncertainty and relevance of family and personal history.

A model-free characterization of recurrences in stationary time series

NASA Astrophysics Data System (ADS)

Chicheportiche, Rémy; Chakraborti, Anirban

2017-05-01

Study of recurrences in earthquakes, climate, financial time-series, etc. is crucial to better forecast disasters and limit their consequences. Most of the previous phenomenological studies of recurrences have involved only a long-ranged autocorrelation function, and ignored the multi-scaling properties induced by potential higher order dependencies. We argue that copulas is a natural model-free framework to study non-linear dependencies in time series and related concepts like recurrences. Consequently, we arrive at the facts that (i) non-linear dependences do impact both the statistics and dynamics of recurrence times, and (ii) the scaling arguments for the unconditional distribution may not be applicable. Hence, fitting and/or simulating the intertemporal distribution of recurrence intervals is very much system specific, and cannot actually benefit from universal features, in contrast to the previous claims. This has important implications in epilepsy prognosis and financial risk management applications.

Using recurrence plot for determinism analysis of EEG recordings in genetic absence epilepsy rats.

PubMed

Ouyang, Gaoxiang; Li, Xiaoli; Dang, Chuangyin; Richards, Douglas A

2008-08-01

Understanding the transition of brain activity towards an absence seizure is a challenging task. In this paper, we use recurrence quantification analysis to indicate the deterministic dynamics of EEG series at the seizure-free, pre-seizure and seizure states in genetic absence epilepsy rats. The determinism measure, DET, based on recurrence plot, was applied to analyse these three EEG datasets, each dataset containing 300 single-channel EEG epochs of 5-s duration. Then, statistical analysis of the DET values in each dataset was carried out to determine whether their distributions over the three groups were significantly different. Furthermore, a surrogate technique was applied to calculate the significance level of determinism measures in EEG recordings. The mean (+/-SD) DET of EEG was 0.177+/-0.045 in pre-seizure intervals. The DET values of pre-seizure EEG data are significantly higher than those of seizure-free intervals, 0.123+/-0.023, (P<0.01), but lower than those of seizure intervals, 0.392+/-0.110, (P<0.01). Using surrogate data methods, the significance of determinism in EEG epochs was present in 25 of 300 (8.3%), 181 of 300 (60.3%) and 289 of 300 (96.3%) in seizure-free, pre-seizure and seizure intervals, respectively. Results provide some first indications that EEG epochs during pre-seizure intervals exhibit a higher degree of determinism than seizure-free EEG epochs, but lower than those in seizure EEG epochs in absence epilepsy. The proposed methods have the potential of detecting the transition between normal brain activity and the absence seizure state, thus opening up the possibility of intervention, whether electrical or pharmacological, to prevent the oncoming seizure.

Long-term cardiovascular risk of nonsteroidal anti-inflammatory drug use according to time passed after first-time myocardial infarction: a nationwide cohort study.

PubMed

Olsen, Anne-Marie Schjerning; Fosbøl, Emil L; Lindhardsen, Jesper; Folke, Fredrik; Charlot, Mette; Selmer, Christian; Bjerring Olesen, Jonas; Lamberts, Morten; Ruwald, Martin H; Køber, Lars; Hansen, Peter R; Torp-Pedersen, Christian; Gislason, Gunnar H

2012-10-16

The cardiovascular risk after the first myocardial infarction (MI) declines rapidly during the first year. We analyzed whether the cardiovascular risk associated with using nonsteroidal anti-inflammatory drugs (NSAIDs) was associated with the time elapsed following first-time MI. We identified patients aged 30 years or older admitted with first-time MI in 1997 to 2009 and subsequent NSAID use by individual-level linkage of nationwide registries of hospitalization and drug dispensing from pharmacies in Denmark. We calculated the incidence rates of death and a composite end point of coronary death or nonfatal recurrent MIs associated with NSAID use in 1-year time intervals up to 5 years after inclusion and analyzed risk by using multivariable adjusted time-dependent Cox proportional hazards models. Of the 99 187 patients included, 43 608 (44%) were prescribed NSAIDs after the index MI. There were 36 747 deaths and 28 693 coronary deaths or nonfatal recurrent MIs during the 5 years of follow-up. Relative to noncurrent treatment with NSAIDs, the use of any NSAID in the years following MI was persistently associated with an increased risk of death (hazard ratio 1.59 [95% confidence interval, 1.49-1.69]) after 1 year and hazard ratio 1.63 [95% confidence interval, 1.52-1.74] after 5 years) and coronary death or nonfatal recurrent MI (hazard ratio, 1.30 [95% confidence interval,l 1.22-1.39] and hazard ratio, 1.41 [95% confidence interval, 1.28-1.55]). The use of NSAIDs is associated with persistently increased coronary risk regardless of time elapsed after first-time MI. We advise long-term caution in the use of NSAIDs for patients after MI.

Estimated probabilities, volumes, and inundation areas depths of potential postwildfire debris flows from Carbonate, Slate, Raspberry, and Milton Creeks, near Marble, Gunnison County, Colorado

USGS Publications Warehouse

Stevens, Michael R.; Flynn, Jennifer L.; Stephens, Verlin C.; Verdin, Kristine L.

2011-01-01

During 2009, the U.S. Geological Survey, in cooperation with Gunnison County, initiated a study to estimate the potential for postwildfire debris flows to occur in the drainage basins occupied by Carbonate, Slate, Raspberry, and Milton Creeks near Marble, Colorado. Currently (2010), these drainage basins are unburned but could be burned by a future wildfire. Empirical models derived from statistical evaluation of data collected from recently burned basins throughout the intermountain western United States were used to estimate the probability of postwildfire debris-flow occurrence and debris-flow volumes for drainage basins occupied by Carbonate, Slate, Raspberry, and Milton Creeks near Marble. Data for the postwildfire debris-flow models included drainage basin area; area burned and burn severity; percentage of burned area; soil properties; rainfall total and intensity for the 5- and 25-year-recurrence, 1-hour-duration-rainfall; and topographic and soil property characteristics of the drainage basins occupied by the four creeks. A quasi-two-dimensional floodplain computer model (FLO-2D) was used to estimate the spatial distribution and the maximum instantaneous depth of the postwildfire debris-flow material during debris flow on the existing debris-flow fans that issue from the outlets of the four major drainage basins. The postwildfire debris-flow probabilities at the outlet of each drainage basin range from 1 to 19 percent for the 5-year-recurrence, 1-hour-duration rainfall, and from 3 to 35 percent for 25-year-recurrence, 1-hour-duration rainfall. The largest probabilities for postwildfire debris flow are estimated for Raspberry Creek (19 and 35 percent), whereas estimated debris-flow probabilities for the three other creeks range from 1 to 6 percent. The estimated postwildfire debris-flow volumes at the outlet of each creek range from 7,500 to 101,000 cubic meters for the 5-year-recurrence, 1-hour-duration rainfall, and from 9,400 to 126,000 cubic meters for the 25-year-recurrence, 1-hour-duration rainfall. The largest postwildfire debris-flow volumes were estimated for Carbonate Creek and Milton Creek drainage basins, for both the 5- and 25-year-recurrence, 1-hour-duration rainfalls. Results from FLO-2D modeling of the 5-year and 25-year recurrence, 1-hour rainfalls indicate that the debris flows from the four drainage basins would reach or nearly reach the Crystal River. The model estimates maximum instantaneous depths of debris-flow material during postwildfire debris flows that exceeded 5 meters in some areas, but the differences in model results between the 5-year and 25-year recurrence, 1-hour rainfalls are small. Existing stream channels or topographic flow paths likely control the distribution of debris-flow material, and the difference in estimated debris-flow volume (about 25 percent more volume for the 25-year-recurrence, 1-hour-duration rainfall compared to the 5-year-recurrence, 1-hour-duration rainfall) does not seem to substantially affect the estimated spatial distribution of debris-flow material. Historically, the Marble area has experienced periodic debris flows in the absence of wildfire. This report estimates the probability and volume of debris flow and maximum instantaneous inundation area depths after hypothetical wildfire and rainfall. This postwildfire debris-flow report does not address the current (2010) prewildfire debris-flow hazards that exist near Marble.

The causes of recurrent geomagnetic storms

NASA Technical Reports Server (NTRS)

Burlaga, L. F.; Lepping, R. P.

1976-01-01

The causes of recurrent geomagnetic activity were studied by analyzing interplanetary magnetic field and plasma data from earth-orbiting spacecraft in the interval from November 1973 to February 1974. This interval included the start of two long sequences of geomagnetic activity and two corresponding corotating interplanetary streams. In general, the geomagnetic activity was related to an electric field which was due to two factors: (1) the ordered, mesoscale pattern of the stream itself, and (2) random, smaller-scale fluctuations in the southward component of the interplanetary magnetic field Bz. The geomagnetic activity in each recurrent sequence consisted of two successive stages. The first stage was usually the most intense, and it occurred during the passage of the interaction region at the front of a stream. These large amplitudes of Bz were primarily produced in the interplanetary medium by compression of ambient fluctuations as the stream steepened in transit to 1 A.U. The second stage of geomagnetic activity immediately following the first was associated with the highest speeds in the stream.

Return volatility interval analysis of stock indexes during a financial crash

NASA Astrophysics Data System (ADS)

Li, Wei-Shen; Liaw, Sy-Sang

2015-09-01

We investigate the interval between return volatilities above a certain threshold q for 10 countries data sets during the 2008/2009 global financial crisis, and divide these data into several stages according to stock price tendencies: plunging stage (stage 1), fluctuating or rebounding stage (stage 2) and soaring stage (stage 3). For different thresholds q, the cumulative distribution function always satisfies a power law tail distribution. We find the absolute value of the power-law exponent is lowest in stage 1 for various types of markets, and increases monotonically from stage 1 to stage 3 in emerging markets. The fractal dimension properties of the return volatility interval series provide some surprising results. We find that developed markets have strong persistence and transform to weaker correlation in the plunging and soaring stages. In contrast, emerging markets fail to exhibit such a transformation, but rather show a constant-correlation behavior with the recurrence of extreme return volatility in corresponding stages during a crash. We believe this long-memory property found in recurrence-interval series, especially for developed markets, plays an important role in volatility clustering.

Burden of Clostridium difficile infection in the United States.

PubMed

Lessa, Fernanda C; Mu, Yi; Bamberg, Wendy M; Beldavs, Zintars G; Dumyati, Ghinwa K; Dunn, John R; Farley, Monica M; Holzbauer, Stacy M; Meek, James I; Phipps, Erin C; Wilson, Lucy E; Winston, Lisa G; Cohen, Jessica A; Limbago, Brandi M; Fridkin, Scott K; Gerding, Dale N; McDonald, L Clifford

2015-02-26

The magnitude and scope of Clostridium difficile infection in the United States continue to evolve. In 2011, we performed active population- and laboratory-based surveillance across 10 geographic areas in the United States to identify cases of C. difficile infection (stool specimens positive for C. difficile on either toxin or molecular assay in residents ≥ 1 year of age). Cases were classified as community-associated or health care-associated. In a sample of cases of C. difficile infection, specimens were cultured and isolates underwent molecular typing. We used regression models to calculate estimates of national incidence and total number of infections, first recurrences, and deaths within 30 days after the diagnosis of C. difficile infection. A total of 15,461 cases of C. difficile infection were identified in the 10 geographic areas; 65.8% were health care-associated, but only 24.2% had onset during hospitalization. After adjustment for predictors of disease incidence, the estimated number of incident C. difficile infections in the United States was 453,000 (95% confidence interval [CI], 397,100 to 508,500). The incidence was estimated to be higher among females (rate ratio, 1.26; 95% CI, 1.25 to 1.27), whites (rate ratio, 1.72; 95% CI, 1.56 to 2.0), and persons 65 years of age or older (rate ratio, 8.65; 95% CI, 8.16 to 9.31). The estimated number of first recurrences of C. difficile infection was 83,000 (95% CI, 57,000 to 108,900), and the estimated number of deaths was 29,300 (95% CI, 16,500 to 42,100). The North American pulsed-field gel electrophoresis type 1 (NAP1) strain was more prevalent among health care-associated infections than among community-associated infections (30.7% vs. 18.8%, P<0.001). C. difficile was responsible for almost half a million infections and was associated with approximately 29,000 deaths in 2011. (Funded by the Centers for Disease Control and Prevention.).

Modest familial risks for multiple sclerosis: a registry-based study of the population of Sweden

PubMed Central

Westerlind, Helga; Ramanujam, Ryan; Uvehag, Daniel; Kuja-Halkola, Ralf; Boman, Marcus; Bottai, Matteo; Lichtenstein, Paul

2014-01-01

Data on familial recurrence rates of complex diseases such as multiple sclerosis give important hints to aetiological factors such as the importance of genes and environment. By linking national registries, we sought to avoid common limitations of clinic-based studies such as low numbers, poor representation of the population and selection bias. Through the Swedish Multiple Sclerosis Registry and a nationwide hospital registry, a total of 28 396 patients with multiple sclerosis were identified. We used the national Multi-Generation Registry to identify first and second degree relatives as well as cousins, and the Swedish Twin Registry to identify twins of patients with multiple sclerosis. Crude and age corrected familial risks were estimated for cases and found to be in the same range as previously published figures. Matched population-based controls were used to calculate relative risks, revealing lower estimates of familial multiple sclerosis risks than previously reported, with a sibling recurrence risk (λs = 7.1; 95% confidence interval: 6.42–7.86). Surprisingly, despite a well-established lower prevalence of multiple sclerosis amongst males, the relative risks were equal among maternal and paternal relations. A previously reported increased risk in maternal relations could thus not be replicated. An observed higher transmission rate from fathers to sons compared with mothers to sons suggested a higher transmission to offspring from the less prevalent sex; therefore, presence of the so-called ‘Carter effect’ could not be excluded. We estimated the heritability of multiple sclerosis using 74 757 twin pairs with known zygosity, of which 315 were affected with multiple sclerosis, and added information from 2.5 million sibling pairs to increase power. The heritability was estimated to be 0.64 (0.36–0.76), whereas the shared environmental component was estimated to be 0.01 (0.00–0.18). In summary, whereas multiple sclerosis is to a great extent an inherited trait, the familial relative risks may be lower than usually reported. PMID:24441172

An Estimate of North Atlantic Basin Tropical Cyclone Activity for 2008

NASA Technical Reports Server (NTRS)

Wilson, Robert M.

2008-01-01

The statistics of North Atlantic basin tropical cyclones for the interval 1945-2007 are examined and estimates are given for the frequencies of occurrence of the number of tropical cyclones, number of hurricanes, number of major hurricanes, number of category 4/5 hurricanes, and number of U.S. land-falling hurricanes for the 2008 hurricane season. Also examined are the variations of peak wind speed, average peak wind speed per storm, lowest pressure, average lowest pressure per storm, recurrence rate and duration of extreme events (El Nino and La Nina), the variation of 10-yr moving averages of parametric first differences, and the association of decadal averages of frequencies of occurrence of North Atlantic basin tropical cyclones against decadal averages of Armagh Observatory, Northern Ireland, annual mean temperature (found to be extremely important for number of tropical cyclones and number of hurricanes). Because the 2008 hurricane season seems destined to be one that is non-El Nino-related and is a post-1995 season, estimates of the frequencies of occurrence for the various subsets of storms should be above long-term averages.

Low-flow frequency analyses for streams in west-central Florida

USGS Publications Warehouse

Hammett, K.M.

1985-01-01

The log-Pearson type III distribution was used for defining low-flow frequency at 116 continuous-record streamflow stations in west-central Florida. Frequency distributions were calculated for 1, 3, 7, 14, 30, 60, 90, 120, and 183 consecutive-day periods for recurrence intervals of 2, 5, 10, and 20 years. Discharge measurements at more than 100 low-flow partial-record stations and miscellaneous discharge-measurement stations were correlated with concurrent daily mean discharge at continuous-record stations. Estimates of the 7-day, 2-year; 7-day, 10-year; 30-day, 2-year; and 30-day, 10-year discharges were made for most of the low-flow partial-record and miscellaneous discharge-measurement stations based on those correlations. Multiple linear-regression analysis was used in an attempt to mathematically relate low-flow frequency data to basin characteristics. The resulting equations showed an apparent bias and were considered unsatisfactory for use in estimating low-flow characteristics. Maps of the 7-day, 10-year and 30-day, 10-year low flows are presented. Techniques that can be used to estimate low-flow characteristics at an ungaged site are also provided. (USGS)

Peak-flow characteristics of Wyoming streams

USGS Publications Warehouse

Miller, Kirk A.

2003-01-01

Peak-flow characteristics for unregulated streams in Wyoming are described in this report. Frequency relations for annual peak flows through water year 2000 at 364 streamflow-gaging stations in and near Wyoming were evaluated and revised or updated as needed. Analyses of historical floods, temporal trends, and generalized skew were included in the evaluation. Physical and climatic basin characteristics were determined for each gaging station using a geographic information system. Gaging stations with similar peak-flow and basin characteristics were grouped into six hydrologic regions. Regional statistical relations between peak-flow and basin characteristics were explored using multiple-regression techniques. Generalized least squares regression equations for estimating magnitudes of annual peak flows with selected recurrence intervals from 1.5 to 500 years were developed for each region. Average standard errors of estimate range from 34 to 131 percent. Average standard errors of prediction range from 35 to 135 percent. Several statistics for evaluating and comparing the errors in these estimates are described. Limitations of the equations are described. Methods for applying the regional equations for various circumstances are listed and examples are given.

Second operation after the failure of previous resection for epilepsy.

PubMed

Awad, I A; Nayel, M H; Lüders, H

1991-04-01

We present our surgical experience with second operations in 15 patients with recurrent intractable partial seizures after resection for epilepsy. The interval from the first operation until the first recurrence of seizures ranged from 1 day to 7 months (mean, 62 days). The interval between the first and second operations ranged from 3 months to 12 years (mean, 38 months). Detailed video-electroencephalographic interictal and ictal recording was performed in all patients (invasive electrodes were used in 11 patients). Ictal onset was shown to be remote from the zone of previous resection in 3 of 15 cases (all 3 extratemporal and in the ipsilateral hemisphere). Recurrent seizures arose from the area of previous extratemporal resection in 2 of 15 patients, and from the area of previous temporal resection in 10 of 15 patients. Both cases of extratemporal recurrences and 3 of the 10 cases of temporal lobe recurrences in the area of previous resection were associated with residual unresected structural lesion. Of the 10 patients with local temporal recurrence, 6 had proven epileptogenicity in the residual mesial structures, and 4 had residual epileptogenicity in the unresected lateral temporal lobe. The patients have been monitored for 8 to 82 months (mean, 18 months) after the second operation: 7 patients (47%) have remained seizure-free and another 5 (33%) have achieved a reduction in seizure frequency of more than 90%. There was no mortality or significant morbidity in this series. We conclude that the extent and distribution of residual epileptogenicity after failed epilepsy surgery are highly variable.(ABSTRACT TRUNCATED AT 250 WORDS)

The Wasatch fault zone, utah-segmentation and history of Holocene earthquakes

USGS Publications Warehouse

Machette, M.N.; Personius, S.F.; Nelson, A.R.; Schwartz, D.P.; Lund, W.R.

1991-01-01

The Wasatch fault zone (WFZ) forms the eastern boundary of the Basin and Range province and is the longest continuous, active normal fault (343 km) in the United States. It underlies an urban corridor of 1.6 million people (80% of Utah's population) representing the largest earthquake risk in the interior of the western United States. We have used paleoseismological data to identify 10 discrete segments of the WFZ. Five are active, medial segments with Holocene slip rates of 1-2 mm a-1, recurrence intervals of 2000-4000 years and average lengths of about 50 km. Five are less active, distal segments with mostly pre-Holocene surface ruptures, late Quaternary slip rates of 6.5 have occurred since 1860. Although the time scale of the clustering is different-130 years vs 1100 years-we consider the central Nevada-eastern California Seismic Belt to be a historic analog for movement on the WFZ during the past 1500 years. We have found no evidence that surface-rupturing events occurred on the WFZ during the past 400 years, a time period which is twice the average intracluster recurrence interval and equal to the average Holocene recurrence interval. In particular, the Brigham City segment (the northernmost medial segment) has not ruptured in the past 3600 years-a period that is about three times longer than this segment's average recurrence interval during the early and middle Holocene. Although the WFZ's seismological record is one of relative quiescence, a comparison with other historic surface-rupturing earthquakes in the region suggests that earthquakes having moment magnitudes of 7.1-7.4 (or surface-wave magnitudes of 7.5-7.7)-each associated with tens of kilometers of surface rupture and several meters of normal dip slip-have occurred about every four centuries during the Holocene and should be expected in the future. ?? 1991.

Cholesterol, Cholesterol-Lowering Medication Use, and Breast Cancer Outcome in the BIG 1-98 Study.

PubMed

Borgquist, Signe; Giobbie-Hurder, Anita; Ahern, Thomas P; Garber, Judy E; Colleoni, Marco; Láng, István; Debled, Marc; Ejlertsen, Bent; von Moos, Roger; Smith, Ian; Coates, Alan S; Goldhirsch, Aron; Rabaglio, Manuela; Price, Karen N; Gelber, Richard D; Regan, Meredith M; Thürlimann, Beat

2017-04-10

Purpose Cholesterol-lowering medication (CLM) has been reported to have a role in preventing breast cancer recurrence. CLM may attenuate signaling through the estrogen receptor by reducing levels of the estrogenic cholesterol metabolite 27-hydroxycholesterol. The impact of endocrine treatment on cholesterol levels and hypercholesterolemia per se may counteract the intended effect of aromatase inhibitors. Patients and Methods The Breast International Group (BIG) conducted a randomized, phase III, double-blind trial, BIG 1-98, which enrolled 8,010 postmenopausal women with early-stage, hormone receptor-positive invasive breast cancer from 1998 to 2003. Systemic levels of total cholesterol and use of CLM were measured at study entry and every 6 months up to 5.5 years. Cumulative incidence functions were used to describe the initiation of CLM in the presence of competing risks. Marginal structural Cox proportional hazards modeling investigated the relationships between initiation of CLM during endocrine therapy and outcome. Three time-to-event end points were considered: disease-free-survival, breast cancer-free interval, and distant recurrence-free interval. Results Cholesterol levels were reduced during tamoxifen therapy. Of 789 patients who initiated CLM during endocrine therapy, the majority came from the letrozole monotherapy arm (n = 318), followed by sequential tamoxifen-letrozole (n = 189), letrozole-tamoxifen (n = 176), and tamoxifen monotherapy (n = 106). Initiation of CLM during endocrine therapy was related to improved disease-free-survival (hazard ratio [HR], 0.79; 95% CI, 0.66 to 0.95; P = .01), breast cancer-free interval (HR, 0.76; 95% CI, 0.60 to 0.97; P = .02), and distant recurrence-free interval (HR, 0.74; 95% CI, 0.56 to 0.97; P = .03). Conclusion Cholesterol-lowering medication during adjuvant endocrine therapy may have a role in preventing breast cancer recurrence in hormone receptor-positive early-stage breast cancer. We recommend that these observational results be addressed in prospective randomized trials.

Streambed scour of salmon spawning habitat in a regulated river influenced by management of peak discharge

USGS Publications Warehouse

Gendaszek, Andrew S.; Burton, Karl D.; Magirl, Christopher S.; Konrad, Christopher P.

2017-01-01

In the Pacific Northwest of the United States, salmon eggs incubating within streambed gravels are susceptible to scour during floods. The threat to egg-to-fry survival by streambed scour is mitigated, in part, by the adaptation of salmon to bury their eggs below the typical depth of scour. In regulated rivers globally, we suggest that water managers consider the effect of dam operations on scour and its impacts on species dependent on benthic habitats.We instrumented salmon-spawning habitat with accelerometer scour monitors (ASMs) at 73 locations in 11 reaches of the Cedar River in western Washington State of the United States from Autumn 2013 through the Spring of 2014. The timing of scour was related to the discharge measured at a nearby gage and compared to previously published ASM data at 26 locations in two reaches of the Cedar River collected between Autumn 2010 and Spring 2011.Thirteen percent of the recovered ASMs recorded scour during a peak-discharge event in March 2014 (2-to 3-year recurrence interval) compared to 71% of the recovered ASMs during a higher peak-discharge event in January 2011 (10-year recurrence interval). Of the 23 locations where ASMs recorded scour during the 2011 and 2014 deployments, 35% had scour when the discharge was ≤87.3 m3/s (3,082 ft3/s) (2-year recurrence interval discharge) with 13% recording scour at or below the 62.3 m3/s (2,200 ft3/s) operational threshold for peak-discharge management during the incubation of salmon eggs.Scour to the depth of salmon egg pockets was limited during peak discharges with frequent (1.25-year or less) recurrence intervals, which managers can regulate through dam operations on the Cedar River. Pairing novel measurements of the timing of streambed scour with discharge data allows the development of peak-discharge management strategies that protect salmon eggs incubating within streambed gravels during floods.

Cost comparison of continued anticoagulation with rivaroxaban versus placebo based on the 1-year EINSTEIN-Extension trial efficacy and safety results.

PubMed

Wells, Philip S; Lensing, Anthonie W A; Haskell, Lloyd; Levitan, Bennett; Laliberté, François; Durkin, Michael; Ashton, Veronica; Xiao, Yongling; Crivera, Concetta; Lejeune, Dominique; Schein, Jeff; Lefebvre, Patrick

2018-06-01

The EINSTEIN-Extension trial (EINSTEIN-EXT) found that continued treatment with rivaroxaban for an additional 6 or 12 months (vs placebo) after 6-12 months of initial anticoagulation significantly reduced the risk of recurrent venous thromboembolism (VTE) with a small non-significant increased risk of major bleeding (none fatal or in critical site). This study aimed to compare total healthcare cost between rivaroxaban and placebo, based on the EINSTEIN-EXT event rates. Total healthcare cost was calculated as the sum of treatment and clinical event costs from a US managed care perspective. Treatment duration and event rates were obtained from the EINSTEIN-EXT study. Adjustment on treatment duration was made by assuming a 10% non-adherence rate. Drug costs were based on wholesale acquisition costs. Cost estimates for clinical events (i.e. recurrent deep vein thrombosis [DVT], recurrent pulmonary embolism, major bleeding, clinically relevant non-major bleeding) were determined from the literature. Results were examined over a ±20% range of each cost component and over 95% confidence intervals (CIs) of event rate differences in deterministic (one-way) and probabilistic sensitivity analyses (PSA). Total healthcare cost was $1,454 lower for rivaroxaban-treated (vs placebo-treated) patients in the base-case, with a lower clinical event cost fully offsetting drug cost. The cost savings of recurrent DVT alone (-$3,102) was greater than drug cost ($2,723). Total healthcare cost remained lower for rivaroxaban in the majority (73%) of PSA (cost difference [95% CI] = -$1,454 [-$2,396, $1,231]). This study was conducted over the 1-year observation period of the EINSTEIN-EXT trial, which limited "real-world" applicability and examination of long-term economic impact. Assumptions on drug and clinical event costs were US-based and, thus, not applicable to other healthcare systems. Total healthcare costs were estimated to be lower for patients continuing rivaroxaban therapy compared to those receiving placebo in VTE patients who had completed 6-12 months of VTE treatment.

Association between atherogenic dyslipidemia and recurrent stroke risk in patients with different subtypes of ischemic stroke.

PubMed

Zhao, Lu; Wang, Ruihao; Song, Bo; Tan, Song; Gao, Yuan; Fang, Hui; Lu, Jie; Xu, Yuming

2015-07-01

The association between atherogenic dyslipidemia and stroke recurrence remains unclear, and may be influenced by different subtypes of ischemic stroke. We aimed to investigate whether atherogenic dyslipidemia contributed to stroke recurrence in ischemic stroke patients and in those with certain subtypes of ischemic stroke. We conducted a prospective hospital-based study enrolling patients with acute ischemic stroke. Atherogenic dyslipidemia was defined as high-density lipoprotein cholesterol <40 mg/dl and triglycerides ≥200 mg/dl. Ischemic stroke subtypes were classified according to the Trial of Org 10172 in Acute Stroke Treatment criteria. The patients were followed up at 3, 6, 12 and 24 months after stroke onset. The association between atherogenic dyslipidemia and stroke recurrence was analyzed by using multivariable Cox regression model. In the 510 ischemic stroke patients, 64 patients (12·5%) had atherogenic dyslipidemia, and 66 patients (12·9%) experienced stroke recurrence events within 24 months. Kaplan-Meier analysis revealed that stroke recurrence rate was significantly higher in patients with atherogenic dyslipidemia than those without in all the stroke patients (20·3% vs. 11·9%; P = 0·048), and more evident in those of large-artery atherosclerosis subtype (31·0% vs. 14·1%; P = 0·014), but not in the other subtypes. Multivariable Cox regression analysis revealed that atherogenic dyslipidemia was associated with higher stroke recurrence risk among stroke patients of large-artery atherosclerosis subtype (hazard ratio, 2·79; 95% confidence interval, 1·24-6·28), but not significant in all the stroke patients (hazard ratio, 1·69; 95% confidence interval, 0·85-3·37). Atherogenic dyslipidemia is associated with higher risk of stroke recurrence in ischemic stroke patients. Such association might be more pronounced in large-artery atherosclerosis subtype and needs further investigation to establish such relationship. © 2015 World Stroke Organization.

Clinical outcomes and response of patients applying topical therapy for pyoderma gangrenosum: A prospective cohort study.

PubMed

Thomas, Kim S; Ormerod, Anthony D; Craig, Fiona E; Greenlaw, Nicola; Norrie, John; Mitchell, Eleanor; Mason, James M; Johnston, Graham A; Wahie, Shyamal; Williams, Hywel C

2016-11-01

Pyoderma gangrenosum (PG) is an uncommon dermatosis with a limited evidence base for treatment. We sought to estimate the effectiveness of topical therapies in the treatment of patients with PG. This was a prospective cohort study of UK secondary care patients with a clinical diagnosis of PG that was suitable for topical treatment (recruited between July 2009 and June 2012). Participants received topical therapy after normal clinical practice (primarily topical corticosteroids [classes I-III] and tacrolimus 0.03% or 0.1%). The primary outcome was speed of healing at 6 weeks. Secondary outcomes included the following: proportion healed by 6 months; time to healing; global assessment; inflammation; pain; quality of life; treatment failure; and recurrence. Sixty-six patients (22-85 years of age) were enrolled. Clobetasol propionate 0.05% was the most commonly prescribed therapy. Overall, 28 of 66 (43.8%) ulcers healed by 6 months. The median time to healing was 145 days (95% confidence interval, 96 days to ∞). Initial ulcer size was a significant predictor of time to healing (hazard ratio, 0.94 [95% confidence interval, 0.88-1.00); P = .043). Four patients (15%) had a recurrence. Our study did not include a randomized comparator. Topical therapy is potentially an effective first-line treatment for PG that avoids the possible side effects associated with systemic therapy. It remains unclear whether more severe disease will respond adequately to topical therapy alone. Crown Copyright © 2016. Published by Elsevier Inc. All rights reserved.

Drought analysis and water resource availability using standardised precipitation evapotranspiration index

NASA Astrophysics Data System (ADS)

Hui-Mean, Foo; Yusop, Zulkifli; Yusof, Fadhilah

2018-03-01

Trend analysis for potential evapotranspiration (PET) and climatic water balance (CWB) is critical in identifying the wetness or dryness episodes with respect to the water surplus or deficit. The PET is computed based on the monthly average temperature for the entire Peninsular Malaysia using Thornthwaite parameterization. The trends and slope's magnitude for the PET and CWB were then investigated using Mann-Kendall, Spearman's rho tests and Thiel-Sen estimator. The 1-, 3-, 6- and 12-month standardised precipitation evapotranspiration index (SPEI) is applied to determine the drought episodes and the average recurrence interval are calculated based on the SPEI. The results indicate that most of the stations show an upward trend in annual and monthly PET while majority of the regions show an upward trend in annual CWB except for the Pahang state. The increasing trends detected in the CWB describe water is in excess especially during the northeast monsoons while the decreasing trends imply water insufficiency. The excess water is observed mostly in January especially in the west coast, east coast and southwest regions that suggest more water is available for crop requirement. The average recurrence interval for drought episodes is almost the same for the smaller severity with various time scale of SPEI and high probability of drought occurrence is observed for some regions. The findings are useful for policymakers and practitioners to improve water resources planning and management, in particular to minimise drought effects in the future. Future research shall address the influence of topography on drought behaviour using more meteorological stations and to include east Malaysia in the analysis.

Regression equations to estimate seasonal flow duration, n-day high-flow frequency, and n-day low-flow frequency at sites in North Dakota using data through water year 2009

USGS Publications Warehouse

Williams-Sether, Tara; Gross, Tara A.

2016-02-09

Seasonal mean daily flow data from 119 U.S. Geological Survey streamflow-gaging stations in North Dakota; the surrounding states of Montana, Minnesota, and South Dakota; and the Canadian provinces of Manitoba and Saskatchewan with 10 or more years of unregulated flow record were used to develop regression equations for flow duration, n-day high flow and n-day low flow using ordinary least-squares and Tobit regression techniques. Regression equations were developed for seasonal flow durations at the 10th, 25th, 50th, 75th, and 90th percent exceedances; the 1-, 7-, and 30-day seasonal mean high flows for the 10-, 25-, and 50-year recurrence intervals; and the 1-, 7-, and 30-day seasonal mean low flows for the 2-, 5-, and 10-year recurrence intervals. Basin and climatic characteristics determined to be significant explanatory variables in one or more regression equations included drainage area, percentage of basin drainage area that drains to isolated lakes and ponds, ruggedness number, stream length, basin compactness ratio, minimum basin elevation, precipitation, slope ratio, stream slope, and soil permeability. The adjusted coefficient of determination for the n-day high-flow regression equations ranged from 55.87 to 94.53 percent. The Chi2 values for the duration regression equations ranged from 13.49 to 117.94, whereas the Chi2 values for the n-day low-flow regression equations ranged from 4.20 to 49.68.

Late Holocene earthquakes on the Toe Jam Hill fault, Seattle fault zone, Bainbridge Island, Washington

USGS Publications Warehouse

Nelson, A.R.; Johnson, S.Y.; Kelsey, H.M.; Wells, R.E.; Sherrod, B.L.; Pezzopane, S.K.; Bradley, L.A.; Koehler, R. D.; Bucknam, R.C.

2003-01-01

Five trenches across a Holocene fault scarp yield the first radiocarbon-measured earthquake recurrence intervals for a crustal fault in western Washington. The scarp, the first to be revealed by laser imagery, marks the Toe Jam Hill fault, a north-dipping backthrust to the Seattle fault. Folded and faulted strata, liquefaction features, and forest soil A horizons buried by hanging-wall-collapse colluvium record three, or possibly four, earthquakes between 2500 and 1000 yr ago. The most recent earthquake is probably the 1050-1020 cal. (calibrated) yr B.P. (A.D. 900-930) earthquake that raised marine terraces and triggered a tsunami in Puget Sound. Vertical deformation estimated from stratigraphic and surface offsets at trench sites suggests late Holocene earthquake magnitudes near M7, corresponding to surface ruptures >36 km long. Deformation features recording poorly understood latest Pleistocene earthquakes suggest that they were smaller than late Holocene earthquakes. Postglacial earthquake recurrence intervals based on 97 radiocarbon ages, most on detrital charcoal, range from ???12,000 yr to as little as a century or less; corresponding fault-slip rates are 0.2 mm/yr for the past 16,000 yr and 2 mm/yr for the past 2500 yr. Because the Toe Jam Hill fault is a backthrust to the Seattle fault, it may not have ruptured during every earthquake on the Seattle fault. But the earthquake history of the Toe Jam Hill fault is at least a partial proxy for the history of the rest of the Seattle fault zone.

Using Low-Frequency Earthquake Families on the San Andreas Fault as Deep Creepmeters

NASA Astrophysics Data System (ADS)

Thomas, A. M.; Beeler, N. M.; Bletery, Q.; Burgmann, R.; Shelly, D. R.

2018-01-01

The central section of the San Andreas Fault hosts tectonic tremor and low-frequency earthquakes (LFEs) similar to subduction zone environments. LFEs are often interpreted as persistent regions that repeatedly fail during the aseismic shear of the surrounding fault allowing them to be used as creepmeters. We test this idea by using the recurrence intervals of individual LFEs within LFE families to estimate the timing, duration, recurrence interval, slip, and slip rate associated with inferred slow slip events. We formalize the definition of a creepmeter and determine whether this definition is consistent with our observations. We find that episodic families reflect surrounding creep over the interevent time, while the continuous families and the short time scale bursts that occur as part of the episodic families do not. However, when these families are evaluated on time scales longer than the interevent time these events can also be used to meter slip. A straightforward interpretation of episodic families is that they define sections of the fault where slip is distinctly episodic in well-defined slow slip events that slip 16 times the long-term rate. In contrast, the frequent short-term bursts of the continuous and short time scale episodic families likely do not represent individual creep events but rather are persistent asperities that are driven to failure by quasi-continuous creep on the surrounding fault. Finally, we find that the moment-duration scaling of our inferred creep events are inconsistent with the proposed linear moment-duration scaling. However, caution must be exercised when attempting to determine scaling with incomplete knowledge of scale.

Streamflow and Erosion Response to Prolonged Intense Rainfall of November 1-2, 2000, Island of Hawaii, Hawaii

USGS Publications Warehouse

Fontaine, Richard A.; Hill, Barry R.

2002-01-01

A combination of several meteorologic and topographic factors produced extreme rainfall over the eastern part of the island of Hawaii on November 1-2, 2000. Storm rainfall was concentrated in two distinct areas, the Waiakea and Kapapala areas, where maximum rainfall totals of 32.47 and 38.97 inches were recorded. Resultant flooding caused damages in excess of 70 million dollars, among the highest totals associated with flooding in the State's history. Storm rainfall had recurrence intervals that ranged from 10 years or less for maximum 1-hour totals to 100 years or more for maximum 24-hour totals As part of this study, peak flow and/or erosion data were collected at 41 sites. Analyses of these data indicated that peak discharges of record occurred at 6 of 12 sites where historic data were available. Peak flows with estimated recurrence intervals from 50 to over 100 years were recorded at 4 of 11 sites. Peak flows were poorly correlated with total storm rainfall. Critical rainfall durations associated with peak flows ranged from 1 to 12 hours and were about 3 hours at most sites. Rainfall-runoff computations and field observations indicated that infiltration-excess overland flow alone was not sufficient to have caused the observed flood peaks and therefore saturation-excess overland flow and subsurface flow probably contributed to peak flows at most sites Most hillslope erosion associated with the storm took place along or near the Kaoiki Pali in the Kapapala area. Hillslope erosion was predominately caused by overland flow.

Antiplatelet Regimen for Patients With Breakthrough Strokes While on Aspirin: A Systematic Review and Meta-Analysis.

PubMed

Lee, Meng; Saver, Jeffrey L; Hong, Keun-Sik; Rao, Neal M; Wu, Yi-Ling; Ovbiagele, Bruce

2017-09-01

Optimal antiplatelet therapy after an ischemic stroke or transient ischemic attack while on aspirin is uncertain. We, therefore, conducted a systematic review and meta-analysis. We searched PubMed (1966 to August 2016) and bibliographies of relevant published original studies to identify randomized trials and cohort studies reporting patients who were on aspirin at the time of an index ischemic stroke or transient ischemic attack and reported hazard ratio for major adverse cardiovascular events or recurrent stroke associated with a switch to or addition of another antiplatelet agent versus maintaining aspirin monotherapy. Estimates were combined using a random effects model. Five studies with 8723 patients with ischemic stroke or transient ischemic attack were identified. Clopidogrel was used in 4 cohorts, and ticagrelor was used in 1 cohort. Pooling results showed that addition of or a switch to another antiplatelet agent, versus aspirin monotherapy, was associated with reduced risks of major adverse cardiovascular events (hazard ratio, 0.68; 95% confidence interval, 0.54-0.85) and recurrent stroke (hazard ratio, 0.70; 95% confidence interval, 0.54-0.92). Each of the strategies of addition of and switching another antiplatelet agent showed benefit versus continued aspirin monotherapy, and studies with regimen initiation in the first days after index event showed more homogenous evidence of benefit. Among patients who experience an ischemic stroke or transient ischemic attack while on aspirin monotherapy, the addition of or a switch to another antiplatelet agent, especially in the first days after index event, is associated with fewer future vascular events, including stroke. © 2017 American Heart Association, Inc.

A linear recurrent kernel online learning algorithm with sparse updates.

PubMed

Fan, Haijin; Song, Qing

2014-02-01

In this paper, we propose a recurrent kernel algorithm with selectively sparse updates for online learning. The algorithm introduces a linear recurrent term in the estimation of the current output. This makes the past information reusable for updating of the algorithm in the form of a recurrent gradient term. To ensure that the reuse of this recurrent gradient indeed accelerates the convergence speed, a novel hybrid recurrent training is proposed to switch on or off learning the recurrent information according to the magnitude of the current training error. Furthermore, the algorithm includes a data-dependent adaptive learning rate which can provide guaranteed system weight convergence at each training iteration. The learning rate is set as zero when the training violates the derived convergence conditions, which makes the algorithm updating process sparse. Theoretical analyses of the weight convergence are presented and experimental results show the good performance of the proposed algorithm in terms of convergence speed and estimation accuracy. Copyright © 2013 Elsevier Ltd. All rights reserved.

Recurrent craniopharyngioma after conformal radiation in children and the burden of treatment.

PubMed

Klimo, Paul; Venable, Garrett T; Boop, Frederick A; Merchant, Thomas E

2015-05-01

In this paper the authors present their experience treating children with recurrent craniopharyngioma who were initially managed with surgery followed by conformal radiation therapy (CRT). A departmental oncology information system was queried to identify all children (< 18 years old) who received CRT for a craniopharyngioma between 1998 and 2010 (inclusive) and specifically those who experienced tumor progression. For each patient, the authors recorded the type of recurrence (solid, cystic, or both), the time interval to first progression and each subsequent progression, the associated treatment complications, and disease status at last follow-up evaluation. Among the 97 patients that met criteria for entry into this study, 18 (18.6%) experienced tumor progression (9 cystic, 3 solid, 6 cystic and solid). The median time to first recurrence was 4.62 years (range 1.81-9.11 years). The subgroup included 6 female and 12 male patients with a median age of 7.54 years (range 3.61-13.83 years). Ten patients experienced first progression within 5 years of CRT. The 5- and 10-year treatment-free survival rates for the entire cohort were 89.0% (95% confidence interval [CI] 80.5%-93.9%) and 76.2% (95% CI 64%-85%), respectively. Seven patients had a single episode of progression and 11 had more than 1. The time interval between each subsequent progression was progressively shorter. The 18 patients underwent 38 procedures. The median follow-up duration for this group was 9.32 years (range 4.04-19.0 years). Three patients died, including 1 from perioperative complications. Craniopharyngioma progression after prior irradiation is exceedingly difficult to treat and local control is challenging despite repeated surgical procedures. Given our results, gross-total resection may need to be the surgical goal at the time of first recurrence, if possible. Decompressing new cyst formation alone has a low rate of long-term success.

Blood Pressure Reduction and Secondary Stroke Prevention: A Systematic Review and Metaregression Analysis of Randomized Clinical Trials.

PubMed

Katsanos, Aristeidis H; Filippatou, Angeliki; Manios, Efstathios; Deftereos, Spyridon; Parissis, John; Frogoudaki, Alexandra; Vrettou, Agathi-Rosa; Ikonomidis, Ignatios; Pikilidou, Maria; Kargiotis, Odysseas; Voumvourakis, Konstantinos; Alexandrov, Anne W; Alexandrov, Andrei V; Tsivgoulis, Georgios

2017-01-01

Current recommendations do not specifically address the optimal blood pressure (BP) reduction for secondary stroke prevention in patients with previous cerebrovascular events. We conducted a systematic review and metaregression analysis on the association of BP reduction with recurrent stroke and cardiovascular events using data from randomized controlled clinical trials of secondary stroke prevention. For all reported events during each eligible study period, we calculated the corresponding risk ratios to express the comparison of event occurrence risk between patients randomized to antihypertensive treatment and those randomized to placebo. On the basis of the reported BP values, we performed univariate metaregression analyses according to the achieved BP values under the random-effects model (Method of Moments) for those adverse events reported in ≥10 total subgroups of included randomized controlled clinical trials. In pairwise meta-analyses, antihypertensive treatment lowered the risk for recurrent stroke (risk ratio, 0.73; 95% confidence interval, 0.62-0.87; P<0.001), disabling or fatal stroke (risk ratio, 0.71; 95% confidence interval, 0.59-0.85; P<0.001), and cardiovascular death (risk ratio, 0.85; 95% confidence interval, 0.75-0.96; P=0.01). In metaregression analyses, systolic BP reduction was linearly related to the lower risk of recurrent stroke (P=0.049), myocardial infarction (P=0.024), death from any cause (P=0.001), and cardiovascular death (P<0.001). Similarly, diastolic BP reduction was linearly related to a lower risk of recurrent stroke (P=0.026) and all-cause mortality (P=0.009). Funnel plot inspection and Egger statistical test revealed no evidence of publication bias. The extent of BP reduction is linearly associated with the magnitude of risk reduction in recurrent cerebrovascular and cardiovascular events. Strict and aggressive BP control seems to be essential for effective secondary stroke prevention. © 2016 American Heart Association, Inc.

Clinical and microbiologic characteristics of adult patients with recurrent bacteraemia caused by extended-spectrum β-lactamase-producing Escherichia coli or Klebsiella pneumoniae.

PubMed

Lee, C-H; Su, L-H; Chen, F-J; Tang, Y-F; Chien, C-C; Liu, J-W

2015-12-01

The characteristics of patients with recurrent bacteraemia caused by extended-spectrum β-lactamase (ESBL)-producing Escherichia coli or Klebsiella pneumoniae (EK) are rarely described. Flomoxef belongs to the cephamycins group and demonstrates in vitro activity against ESBL-producing organisms. Whether flomoxef may be used for the treatment of such infections remains controversial. This retrospective case-control study enrolled adult patients who had bacteraemia caused by ESBL-EK during 2005-2011. Case patients were those who had more than one episode of ESBL-EK bacteraemia. Controls were those who were matched for age and interval time of blood sampling and had only one episode of ESBL-EK bacteraemia with subsequent bacteraemia episodes caused by other non-ESBL-EK bacteria. Pulsed-field gel electrophoresis and microbiologic profiles of the initial and subsequent ESBL-EK isolates were analysed. During the study period, 424 patients were found to have at least one positive blood culture after the first ESBL-EK bacteraemia episode, and 67 (15.8%) had a second episode of ESBL-EK bacteraemia. Bacteraemia resulting from vascular catheter-related infection (odds ratio, 3.24; 95% confidence interval, 1.31-8.05), and definitive therapy with flomoxef (odds ratio, 2.99; 95% confidence interval, 1.10-8.15) were both independent risk factors for the recurrence. Among the 56 patients with available ESBL-EK isolates for analysis, 38 (67.8%) were infected by genetically similar strains. In three of these 38 recurrent ESBL-EK bacteraemia cases caused by an identical strain, the minimum inhibitory concentrations of carbapenem for the subsequent K. pneumoniae isolates were fourfold or higher than the initial isolates. Recurrent bacteraemia was not uncommon in our patients with ESBL-EK bacteraemia, and most of the episodes were caused by identical strains. Copyright © 2015 European Society of Clinical Microbiology and Infectious Diseases. Published by Elsevier Ltd. All rights reserved.

Clinical analysis of patients with hepatocellular carcinoma recurrence after living-donor liver transplantation

PubMed Central

Na, Gun Hyung; Hong, Tae Ho; You, Young Kyoung; Kim, Dong Goo

2016-01-01

AIM: To evaluated patterns and outcomes of hepatocellular carcinoma (HCC) recurrence after living donor liver transplantation (LDLT). METHODS: From 2001 to 2014, 293 patients underwent LDLT for HCC at our transplant center. We retrospectively reviewed 54 (18.4%) patients with HCC recurrence after LDLT. We evaluated patterns and outcomes of HCC recurrence after LDLT, with particular attention to the Milan criteria at transplantation, treatments for HCC-recurrent patients, and factors related to survival after HCC recurrence. Furthermore, we evaluated the efficacy of combination treatment of sorafenib and an mTOR inhibitor. RESULTS: The 1-, 2-, and 3-year overall survival rates after HCC recurrence were 41.1%, 20.5%, and 15.4%, respectively. The median time interval between LDLT and HCC recurrence was 6.5 mo. Although recurrence rates according to the Milan criteria at LDLT were significantly different, HCC recurrence patterns and survival rates after HCC recurrence were not significantly different between the two groups. Time to recurrence < 12 mo (P = 0.048), multiple recurrences at HCC recurrence (P = 0.038), and palliative treatment for recurrent tumors (P = 0.003) were significant independent prognostic factors for poor survival after HCC recurrence in a multivariate analysis. The combination treatment of sorafenib and sirolimus showed survival benefits in the palliative treatment group (P = 0.005). CONCLUSION: Curative treatment for recurrent HCC after LDLT is the most important factor in survival rates after HCC recurrence and combination treatments of sorafenib and an mTOR inhibitor could have survival benefits in patients with HCC recurrence after LT in the palliative treatment group. PMID:27433092

Clinical analysis of patients with hepatocellular carcinoma recurrence after living-donor liver transplantation.

PubMed

Na, Gun Hyung; Hong, Tae Ho; You, Young Kyoung; Kim, Dong Goo

2016-07-07

To evaluated patterns and outcomes of hepatocellular carcinoma (HCC) recurrence after living donor liver transplantation (LDLT). From 2001 to 2014, 293 patients underwent LDLT for HCC at our transplant center. We retrospectively reviewed 54 (18.4%) patients with HCC recurrence after LDLT. We evaluated patterns and outcomes of HCC recurrence after LDLT, with particular attention to the Milan criteria at transplantation, treatments for HCC-recurrent patients, and factors related to survival after HCC recurrence. Furthermore, we evaluated the efficacy of combination treatment of sorafenib and an mTOR inhibitor. The 1-, 2-, and 3-year overall survival rates after HCC recurrence were 41.1%, 20.5%, and 15.4%, respectively. The median time interval between LDLT and HCC recurrence was 6.5 mo. Although recurrence rates according to the Milan criteria at LDLT were significantly different, HCC recurrence patterns and survival rates after HCC recurrence were not significantly different between the two groups. Time to recurrence < 12 mo (P = 0.048), multiple recurrences at HCC recurrence (P = 0.038), and palliative treatment for recurrent tumors (P = 0.003) were significant independent prognostic factors for poor survival after HCC recurrence in a multivariate analysis. The combination treatment of sorafenib and sirolimus showed survival benefits in the palliative treatment group (P = 0.005). Curative treatment for recurrent HCC after LDLT is the most important factor in survival rates after HCC recurrence and combination treatments of sorafenib and an mTOR inhibitor could have survival benefits in patients with HCC recurrence after LT in the palliative treatment group.

Vitamin D intake and survival and recurrence in head and neck cancer patients.

PubMed

Yokosawa, Eva B; Arthur, Anna E; Rentschler, Katie M; Wolf, Gregory T; Rozek, Laura S; Mondul, Alison M

2018-05-14

With an unacceptably low 5-year survival rate and few identified modifiable factors that affect head and neck cancer (HNC) outcomes, HNC survival remains an important public health problem. Vitamin D has been shown to be associated with immune reactivity and improved outcomes for some cancer sites, but findings are mixed, and few studies have examined vitamin D in relation to HNC. This study aimed to assess the association between vitamin D intake and survival outcomes in HNC patients. Prospective cohort study. This study utilized data on 434 HNC patients with valid pretreatment food frequency questionnaire data who participated in the University of Michigan Head and Neck Specialized Program of Research Excellence epidemiology project. Cox proportional hazard models were used to estimate the associations between total, dietary, and supplemental vitamin D intake and HNC outcomes, while adjusting for other known prognostic factors. After multivariable adjustment, we found a statistically significant inverse trend between total vitamin D intake and recurrence (Q4 vs. Q1 hazard ratio: 0.47, 95% confidence interval: 0.20-1.10, P trend = .048). We observed no association with dietary or supplemental intake separately, and no association was observed with all-cause or HNC-specific mortality. These findings suggest that HNC patients with lower levels of vitamin D intake are at higher risk of recurrence. If borne out in future studies, our results suggest that increased vitamin D intake through dietary intervention or the use of supplements may be a feasible intervention for prevention of recurrence in HNC patients. 2b. Laryngoscope, 2018. © 2018 The American Laryngological, Rhinological and Otological Society, Inc.

Olfactory groove meningioma: discussion of clinical presentation and surgical outcomes following excision via the subcranial approach.

PubMed

Pepper, Jon-Paul; Hecht, Sarah L; Gebarski, Stephen S; Lin, Erin M; Sullivan, Stephen E; Marentette, Lawrence J

2011-11-01

To describe surgical outcomes and radiographic features of olfactory groove meningiomas treated by excision through the subcranial approach. Special emphasis is placed on paranasal sinus and orbit involvement. Retrospective review of a series of patients. Nineteen patients underwent excision of olfactory groove meningioma (OGM) via the transglabellar/subcranial approach between December 1995 and November 2009. Nine patients had previously undergone prior resection at outside institutions, and four had prior radiotherapy in addition to a prior excision. Transglabellar/subcranial surgical approach to the anterior skull base was performed. Tumor histology included three World Health Organization (WHO) grade III lesions, one WHO grade II lesion, and 15 WHO grade I lesions. Fourteen patients had evidence of extension into the paranasal sinuses, with the ethmoid sinus being most commonly involved. Kaplan-Meier estimates of mean overall and disease-free survival were 121.45 months and 93.03 months, respectively. The mean follow-up interval was 41.0 months, and at the time of data analysis three patients had recurrent tumors. Seven (36.8%) patients experienced a major complication in the perioperative period; there were no perioperative mortalities. Orbit invasion was observed in four patients, with optic nerve impingement in 11 patients. Of these, three patients had long-term diplopia. No patients experienced worsening of preoperative visual acuity. Olfactory groove meningiomas demonstrate a propensity to spread into the paranasal sinuses, particularly in recurrent cases. Given a tendency for infiltrative recurrence along the skull base, this disease represents an important area of collaboration between neurosurgery and otolaryngology. The subcranial approach offers excellent surgical access for excision, particularly for recurrences that involve the paranasal sinuses and optic apparatus. Copyright © 2011 The American Laryngological, Rhinological, and Otological Society, Inc.

Recurrent Guillain-Barré syndrome, Miller Fisher syndrome and Bickerstaff brainstem encephalitis.

PubMed

Ishii, Junko; Yuki, Nobuhiro; Kawamoto, Michi; Yoshimura, Hajime; Kusunoki, Susumu; Kohara, Nobuo

2016-05-15

Guillain-Barré syndrome (GBS), Miller Fisher syndrome (MFS), and Bickerstaff brainstem encephalitis (BBE) are usually monophasic, but some patients experience recurrences after long asymptomatic intervals. We aimed to investigate clinical features of recurrent GBS, MFS, and BBE at a single hospital. Records from 97 consecutive patients with GBS, MFS or BBE who were admitted to a tertiary hospital between 2001 and 2013 were reviewed. Clinical and laboratory features of patients with recurrent GBS, MFS, or BBE were investigated. Patients included 55 (32 males) with GBS, 34 (22 males) with MFS, and 8 (6 males) with BBE. Recurrent cases occurred in 2 (4%) of the 55 patients with GBS, 4 (12%) of the 34 patients with MFS, and 2 (25%) of the 8 patients with BBE. Patients with recurrent MFS had a tendency to be younger at the first episode than patients with non-recurrent MFS (median, 22 versus 37years old). Symptoms and signs were less severe during relapses than during the initial episode in recurrent patients. Recurrences occurred more frequently in patients with MFS or BBE compared with those with GBS. Patients with recurrent MFS might be younger than those with non-recurrent MFS. Copyright © 2016 Elsevier B.V. All rights reserved.

The early detection of antral malignancy in the postmaxillectomy patient

DOE Office of Scientific and Technical Information (OSTI.GOV)

Som, P.M.; Shugar, J.M.; Biller, H.F.

1982-05-01

A protocol was developed for the radiographic evaluation of the postmaxillectomy patient that called for a six- to eight-week postoperative, baseline computed tomography (CT) scan, followed by CT scans at four- to six-month intervals for at least three years. This protocol allowed for an early, more complete assessment of clinically discovered recurrences and the detection of clinically occult recurrences in three out of 18 patients who followed the protocol. The CT appearance of the normal partial and total maxillectomy is discussed, as well as the focal nodular soft-tissue findings suggestive of recurrent disease.

Risk of Recurrence or Contralateral Breast Cancer More than 5 Years After Diagnosis of Hormone Receptor-Positive Early-Stage Breast Cancer.

PubMed

Wilson, Sheridan; Speers, Caroline; Tyldesley, Scott; Chia, Stephen; Kennecke, Hagen; Ellard, Susan; Lohrisch, Caroline

2016-08-01

Three large studies have shown a survival benefit from 10 years of adjuvant hormone therapy (AHT). We evaluated the risk of an event 5 years after the initial breast cancer (BC) diagnosis and identified the prognostic factors to assist clinicians considering extended AHT. Patients newly referred to the BC Cancer Agency with stage I to III estrogen receptor-positive BC diagnosed from 1989 to 2004 who had undergone AHT were identified by the BC Cancer Agency's Breast Cancer Outcomes Unit. Cases with recurrence, death, or contralateral BC occurring within the first 5 years were excluded. The 10-year event-free survival (EFS) and 95% confidence intervals (CIs) were calculated using the Kaplan-Meier method. This provided estimates of recurrence risk after the fifth year following the diagnosis. The histopathologic and age variables were examined for prognostic value by univariate analysis. Within our cohort, 6615 women were postmenopausal and 1886 were premenopausal at the BC diagnosis. The median follow-up period was 11 years. The 10-year EFS for women aged < 50 years with stage I, II, and III disease was 94.8% (95% CI, 92.8%-96.3%), 88.3% (95% CI, 86.0%-90.2%), and 80.4% (95% CI, 73.6%-85.6%), respectively. Among women aged ≥ 50 years, the corresponding EFS rates were 94.8% (95% CI, 93.8%-95.6%), 86.3% (95% CI, 85.0%-87.5%), and 73.8% (95% CI, 69.1%-77.8%). EFS varied significantly by grade. The 10-year recurrence risk was < 10% with stage I cancer (any grade) and for stage II (node-negative and node-positive), grade I cancer. Our data have identified BCs associated with a very low recurrence risk 5 to 10 years after diagnosis, providing women with such cancers confidence about a decision to discontinue AHT after 5 years. Copyright © 2015 Elsevier Inc. All rights reserved.

Associations between short-term exposure to particulate matter and ultrafine particles and myocardial infarction in Augsburg, Germany.

PubMed

Wolf, Kathrin; Schneider, Alexandra; Breitner, Susanne; Meisinger, Christa; Heier, Margit; Cyrys, Josef; Kuch, Bernhard; von Scheidt, Wolfgang; Peters, Annette

2015-08-01

Short-term exposure to increased particulate matter (PM) concentration has been reported to trigger myocardial infarction (MI). However, the association with ultrafine particles remains unclear. We aimed to assess the effects of short-term air pollution and especially ultrafine particles on registry-based MI events and coronary deaths in the area of Augsburg, Germany. Between 1995 and 2009, the MONICA/KORA myocardial infarction registry recorded 15,417 cases of MI and coronary deaths. Concentrations of PM<10μm (PM10), PM<2.5μm (PM2.5), particle number concentration (PNC) as indicator for ultrafine particles, and meteorological parameters were measured in the study region. Quasi-Poisson regression adjusting for time trend, temperature, season, and weekday was used to estimate immediate, delayed and cumulative effects of air pollutants on the occurrence of MI. The daily numbers of total MI, nonfatal and fatal events as well as incident and recurrent events were analysed. We observed a 1.3% risk increase (95%-confidence interval: [-0.9%; 3.6%]) for all events and a 4.4% [-0.4%; 9.4%] risk increase for recurrent events per 24.3μg/m(3) increase in same day PM10 concentrations. Nonfatal events indicated a risk increase of 3.1% [-0.1%; 6.5%] with previous day PM10. No association was seen for PM2.5 which was only available from 1999 on. PNC showed a risk increase of 6.0% [0.6%; 11.7%] for recurrent events per 5529 particles/cm(3) increase in 5-day average PNC. Our results suggested an association between short-term PM10 concentration and numbers of MI, especially for nonfatal and recurrent events. For ultrafine particles, risk increases were notably high for recurrent events. Thus, persons who already suffered a MI seemed to be more susceptible to air pollution. Copyright © 2015 Elsevier GmbH. All rights reserved.

Randomized, Double-Blind, Placebo-Controlled Trial of Asenapine Maintenance Therapy in Adults With an Acute Manic or Mixed Episode Associated With Bipolar I Disorder.

PubMed

Szegedi, Armin; Durgam, Suresh; Mackle, Mary; Yu, Sung Yun; Wu, Xiao; Mathews, Maju; Landbloom, Ronald P

2018-01-01

The authors determined the efficacy and safety of asenapine in preventing recurrence of any mood episode in adults with bipolar I disorder. Adults with an acute manic or mixed episode per DSM-IV-TR criteria were enrolled in this randomized, placebo-controlled trial consisting of an initial 12- to 16-week open-label period and a 26-week double-blind randomized withdrawal period. The target asenapine dosage was 10 mg b.i.d. in the open-label period but could be titrated down to 5 mg b.i.d. After completing the open-label period, subjects meeting stabilization/stable-responder criteria were randomized to asenapine or placebo treatment in the double-blind period. The primary efficacy endpoint was time to recurrence of any mood event during the double-blind period. Kaplan-Meier estimation was performed, and 95% confidence intervals were determined. Safety was assessed throughout. A total of 549 subjects entered the open-label period, of whom 253 enrolled in the double-blind randomized withdrawal period (127 in the placebo group; 126 in the asenapine group). Time to recurrence of any mood episode was statistically significantly longer for asenapine- than placebo-treated subjects. In post hoc analyses, significant differences in favor of asenapine over placebo were seen in time to recurrence of manic and depressive episodes. The most common treatment-emergent adverse events were somnolence (10.0%), akathisia (7.7%), and sedation (7.7%) in the open-label period and mania (11.9% of the placebo group compared with 4.0% of the asenapine group) and bipolar I disorder (6.3% compared with 1.6%) in the double-blind period. Long-term treatment with asenapine was more effective than placebo in preventing recurrence of mood events in adults with bipolar I disorder and was generally well-tolerated.

Recurrence relations for orthogonal polynomials for PDEs in polar and cylindrical geometries.

PubMed

Richardson, Megan; Lambers, James V

2016-01-01

This paper introduces two families of orthogonal polynomials on the interval (-1,1), with weight function [Formula: see text]. The first family satisfies the boundary condition [Formula: see text], and the second one satisfies the boundary conditions [Formula: see text]. These boundary conditions arise naturally from PDEs defined on a disk with Dirichlet boundary conditions and the requirement of regularity in Cartesian coordinates. The families of orthogonal polynomials are obtained by orthogonalizing short linear combinations of Legendre polynomials that satisfy the same boundary conditions. Then, the three-term recurrence relations are derived. Finally, it is shown that from these recurrence relations, one can efficiently compute the corresponding recurrences for generalized Jacobi polynomials that satisfy the same boundary conditions.

Temporal coherence of phenological and climatic rhythmicity in Beijing

NASA Astrophysics Data System (ADS)

Chen, Xiaoqiu; Zhang, Weiqi; Ren, Shilong; Lang, Weiguang; Liang, Boyi; Liu, Guohua

2017-10-01

Using woody plant phenological data in the Beijing Botanical Garden from 1979 to 2013, we revealed three levels of phenology rhythms and examined their coherence with temperature rhythms. First, the sequential and correlative rhythm shows that occurrence dates of various phenological events obey a certain time sequence within a year and synchronously advance or postpone among years. The positive correlation between spring phenophase dates is much stronger than that between autumn phenophase dates and attenuates as the time interval between two spring phenophases increases. This phenological rhythm can be explained by positive correlation between above 0 °C mean temperatures corresponding to different phenophase dates. Second, the circannual rhythm indicates that recurrence interval of a phenophase in the same species in two adjacent years is about 365 days, which can be explained by the 365-day recurrence interval in the first and last dates of threshold temperatures. Moreover, an earlier phenophase date in the current year may lead to a later phenophase date in the next year through extending recurrence interval. Thus, the plant phenology sequential and correlative rhythm and circannual rhythm are interacted, which mirrors the interaction between seasonal variation and annual periodicity of temperature. Finally, the multi-year rhythm implies that phenophase dates display quasi-periodicity more than 1 year. The same 12-year periodicity in phenophase and threshold temperature dates confirmed temperature controls of the phenology multi-year rhythm. Our findings provide new perspectives for examining phenological response to climate change and developing comprehensive phenology models considering temporal coherence of phenological and climatic rhythmicity.

Patients with recurrent falls attending Accident & Emergency benefit from multifactorial intervention--a randomised controlled trial.

PubMed

Davison, John; Bond, John; Dawson, Pamela; Steen, I Nicholas; Kenny, Rose Anne

2005-03-01

To determine the effectiveness of multifactorial intervention to prevent falls in cognitively intact older persons with recurrent falls. Randomised controlled trial of multifactorial (medical, physiotherapy and occupational therapy) post-fall assessment and intervention compared with conventional care. Accident & Emergency departments in a university teaching hospital and associated district general hospital. 313 cognitively intact men and women aged over 65 years presenting to Accident & Emergency with a fall or fall-related injury and at least one additional fall in the preceding year; 159 randomised to assessment and intervention and 154 to conventional care. primary outcome was the number of falls and fallers in 1 year after recruitment. Secondary outcomes included injury rates, fall-related hospital admissions, mortality and fear of falling. There were 36% fewer falls in the intervention group (relative risk 0.64, 95% confidence interval 0.46-0.90). The proportion of subjects continuing to fall (65% (94/144) compared with 68% (102/149) relative risk 0.95, 95% confidence interval 0.81-1.12), and the number of fall-related attendances and hospital admissions was not different between groups. Duration of hospital admission was reduced (mean difference admission duration 3.6 days, 95% confidence interval 0.1-7.6) and falls efficacy was better in the intervention group (mean difference in Activities Specific Balance Confidence Score of 7.5, 95% confidence interval 0.72-14.2). Multifactorial intervention is effective at reducing the fall burden in cognitively intact older persons with recurrent falls attending Accident & Emergency, but does not reduce the proportion of subjects still falling.

Temporal and spatial climatic controls on Holocene fire-related erosion and sedimentation, Jemez Mountains, New Mexico

NASA Astrophysics Data System (ADS)

Fitch, Erin P.; Meyer, Grant A.

2016-01-01

In the Jemez Mountains, tree-ring data indicate that low-severity fires characterized the 400 yr before Euro-American settlement, and that subsequent fire suppression promoted denser forests, recent severe fires, and erosion. Over longer timescales, climate change may alter fire regimes; thus, we used fire-related alluvial deposits to assess the timing of moderate- to high-severity fires, their geomorphic impact, and relation to climate over the last 4000 yr. Fire-related sedimentation does not clearly follow millennial-scale climatic changes, but probability peaks commonly correspond with severe drought, e.g., within the interval 1700-1400 cal yr BP, and ca. 650 and ca. 410 cal yr BP. The latter episodes were preceded by prolonged wet intervals that could promote dense stands. Estimated recurrence intervals for fire-related sedimentation are 250-400 yr. Climatic differences with aspect influenced Holocene post-fire response: fire-related deposits constitute 77% of fan sediments from north-facing basins but only 39% of deposits from drier southerly aspects. With sparser vegetation and exposed bedrock, south aspects can generate runoff and sediment when unburned, whereas soil-mantled north aspects produce minor sediment unless severely burned. Recent channel incision appears unprecedented over the last 2300 yr, suggesting that fuel loading and extreme drought produced an anomalously severe burn in 2002.

Predecessors of the giant 1960 Chile earthquake

USGS Publications Warehouse

Cisternas, M.; Atwater, B.F.; Torrejon, F.; Sawai, Y.; Machuca, G.; Lagos, M.; Eipert, A.; Youlton, C.; Salgado, I.; Kamataki, T.; Shishikura, M.; Rajendran, C.P.; Malik, J.K.; Rizal, Y.; Husni, M.

2005-01-01

It is commonly thought that the longer the time since last earthquake, the larger the next earthquake's slip will be. But this logical predictor of earthquake size, unsuccessful for large earthquakes on a strike-slip fault, fails also with the giant 1960 Chile earthquake of magnitude 9.5 (ref. 3). Although the time since the preceding earthquake spanned 123 years (refs 4, 5), the estimated slip in 1960, which occurred on a fault between the Nazca and South American tectonic plates, equalled 250-350 years' worth of the plate motion. Thus the average interval between such giant earthquakes on this fault should span several centuries. Here we present evidence that such long intervals were indeed typical of the last two millennia. We use buried soils and sand layers as records of tectonic subsidence and tsunami inundation at an estuary midway along the 1960 rupture. In these records, the 1960 earthquake ended a recurrence interval that had begun almost four centuries before, with an earthquake documented by Spanish conquistadors in 1575. Two later earthquakes, in 1737 and 1837, produced little if any subsidence or tsunami at the estuary and they therefore probably left the fault partly loaded with accumulated plate motion that the 1960 earthquake then expended. ?? 2005 Nature Publishing Group.

Incidence, recurrence and cost of hyperglycaemic crises requiring emergency treatment in Andalusia, Spain.

PubMed

Barranco, R J; Gomez-Peralta, F; Abreu, C; Delgado-Rodriguez, M; Moreno-Carazo, A; Romero, F; de la Cal, M A; Barranco, J M; Pasquel, F J; Umpierrez, G E

2017-07-01

Hyperglycaemic crises (diabetic ketoacidosis and hyperosmolar hyperglycaemic state) are medical emergencies in people with diabetes. We aimed to determine their incidence, recurrence and economic impact. An observational study of hyperglycaemic crises cases using the database maintained by the out-of-hospital emergency service, the Healthcare Emergency Public Service (EPES) during 2012. The EPES provides emergency medical services to the total population of Andalusia, Spain (8.5 million inhabitants) and records data on the incidence, resource utilization and cost of out-of-hospital medical care. Direct costs were estimated using public prices for health services updated to 2012. Among 1 137 738 emergency calls requesting medical assistance, 3157 were diagnosed with hyperglycaemic crises by an emergency coordinator, representing 2.9 cases per 1000 persons with diabetes [95% confidence intervals (CI) 2.8 to 3.0]. The incidence of diabetic ketoacidosis was 2.5 cases per 1000 persons with diabetes (95% CI 2.4 to 2.6) and the incidence of hyperosmolar hyperglycaemic state was 0.4 cases per 1000 persons with diabetes (95% CI 0.4 to 0.5). In total, 17.7% (n = 440) of people had one or more hyperglycaemic crisis. The estimated total direct cost was €4 662 151, with a mean direct cost per episode of €1476.8 ± 217.8. Hyperglycaemic crises require high resource utilization of emergency medical services and have a significant economic impact on the health system. © 2017 Diabetes UK.

Quantifying the Impact of Natural Immunity on Rotavirus Vaccine Efficacy Estimates: A Clinical Trial in Dhaka, Bangladesh (PROVIDE) and a Simulation Study.

PubMed

Rogawski, Elizabeth T; Platts-Mills, James A; Colgate, E Ross; Haque, Rashidul; Zaman, K; Petri, William A; Kirkpatrick, Beth D

2018-03-05

The low efficacy of rotavirus vaccines in clinical trials performed in low-resource settings may be partially explained by acquired immunity from natural exposure, especially in settings with high disease incidence. In a clinical trial of monovalent rotavirus vaccine in Bangladesh, we compared the original per-protocol efficacy estimate to efficacy derived from a recurrent events survival model in which children were considered naturally exposed and potentially immune after their first rotavirus diarrhea (RVD) episode. We then simulated trial cohorts to estimate the expected impact of prior exposure on efficacy estimates for varying rotavirus incidence rates and vaccine efficacies. Accounting for natural immunity increased the per-protocol vaccine efficacy estimate against severe RVD from 63.1% (95% confidence interval [CI], 33.0%-79.7%) to 70.2% (95% CI, 44.5%-84.0%) in the postvaccination period, and original year 2 efficacy was underestimated by 14%. The simulations demonstrated that this expected impact increases linearly with RVD incidence, will be greatest for vaccine efficacies near 50%, and can reach 20% in settings with high incidence and low efficacy. High rotavirus incidence leads to predictably lower vaccine efficacy estimates due to the acquisition of natural immunity in unvaccinated children, and this phenomenon should be considered when comparing efficacy estimates across settings. NCT01375647.

Storm and flood of July 5, 1989, in northern New Castle County, Delaware

USGS Publications Warehouse

Paulachok, G.N.; Simmons, R.H.; Tallman, A.J.

1995-01-01

On July 5, 1989, intense rainfall from the remnants of Tropical Storm Allison caused severe flooding in northern New Castle County, Delaware. The flooding claimed three lives, and damage was estimated to be $5 million. Flood conditions were aggravated locally by rapid runoff from expansive urban areas. Record- breaking floods occurred on many streams in northern New Castle County. Peak discharges at three active, continuous-record streamflow-gaging stations, one active crest-stage station, and at two discontinued streamflow-gaging stations exceeded previously recorded maximums. Estimated recurrence intervals for peak flow at the three active, continuous-record streamflow stations exceeded 100 years. The U.S. Geological Survey conducted comprehensive post-flood surveys to determine peak water-surface elevations that occurred on affected streams and their tributaries during the flood of July 5, 1989. Detailed surveys were performed near bridge crossings to provide additional information on the extent and severity of the flooding and the effects of hydraulic constrictions on floodwaters.

Flood of June 4, 2002, in the Indian Creek Basin, Linn County, Iowa

USGS Publications Warehouse

Eash, David A.

2004-01-01

Severe flooding occurred on June 4, 2002, in the Indian Creek Basin in Linn County, Iowa, following thunderstorm activity over east-central Iowa. The rain gage at Cedar Rapids, Iowa, recorded a 24-hour rainfall of 4.76 inches at 6:00 p.m. on June 4th. Radar indications estimated as much as 6 inches of rain fell in the headwaters of the Indian Creek Basin. Peak discharges on Indian Creek of 12,500 cubic feet per second at County Home Road north of Marion, Iowa, and 24,300 cubic feet per second at East Post Road in southeast Cedar Rapids, were determined for the flood. The recurrence interval for these peak discharges both exceed the theoretical 500-year flood as computed using flood-estimation equations developed by the U.S. Geological Survey. Information about the basin and flood history, the 2002 thunderstorms and associated flooding, and a profile of high-water marks are presented for selected reaches along Indian and Dry Creeks.

Chaotic behaviour of the short-term variations in ozone column observed in Arctic

NASA Astrophysics Data System (ADS)

Petkov, Boyan H.; Vitale, Vito; Mazzola, Mauro; Lanconelli, Christian; Lupi, Angelo

2015-09-01

The diurnal variations observed in the ozone column at Ny-Ålesund, Svalbard during different periods of 2009, 2010 and 2011 have been examined to test the hypothesis that they could be a result of a chaotic process. It was found that each of the attractors, reconstructed by applying the time delay technique and corresponding to any of the three time series can be embedded by 6-dimensional space. Recurrence plots, depicted to characterise the attractor features revealed structures typical for a chaotic system. In addition, the two positive Lyapunov exponents found for the three attractors, the fractal Hausdorff dimension presented by the Kaplan-Yorke estimator and the feasibility to predict the short-term ozone column variations within 10-20 h, knowing the past behaviour make the assumption about their chaotic character more realistic. The similarities of the estimated parameters in all three cases allow us to hypothesise that the three time series under study likely present one-dimensional projections of the same chaotic system taken at different time intervals.

Heritable Variation, With Little or No Maternal Effect, Accounts for Recurrence Risk to Autism Spectrum Disorder in Sweden.

PubMed

Yip, Benjamin Hon Kei; Bai, Dan; Mahjani, Behrang; Klei, Lambertus; Pawitan, Yudi; Hultman, Christina M; Grice, Dorothy E; Roeder, Kathryn; Buxbaum, Joseph D; Devlin, Bernie; Reichenberg, Abraham; Sandin, Sven

2018-04-01

Autism spectrum disorder (ASD) has both genetic and environmental origins, including potentially maternal effects. Maternal effects describe the association of one or more maternal phenotypes with liability to ASD in progeny that are independent of maternally transmitted risk alleles. While maternal effects could play an important role, consistent with association to maternal traits such as immune status, no study has estimated maternal, additive genetic, and environmental effects in ASD. Using a population-based sample consisting of all children born in Sweden from 1998 to 2007 and their relatives, we fitted statistical models to family data to estimate the variance in ASD liability originating from maternal, additive genetic, and shared environmental effects. We calculated sibling and cousin family recurrence risk ratio as a direct measure of familial, genetic, and environmental risk factors and repeated the calculations on diagnostic subgroups, specifically autistic disorder (AD) and spectrum disorder (SD), which included Asperger's syndrome and/or pervasive developmental disorder not otherwise specified. The sample consisted of 776,212 children of whom 11,231 had a diagnosis of ASD: 4554 with AD, 6677 with SD. We found support for large additive genetic contribution to liability; heritability (95% confidence interval [CI]) was estimated to 84.8% (95% CI: 73.1-87.3) for ASD, 79.6% (95% CI: 61.2-85.1) for AD, and 76.4% (95% CI: 63.0-82.5) for SD. There was modest, if any, contribution of maternal effects to liability for ASD, including subtypes AD and SD, and there was no support for shared environmental effects. These results show liability to ASD arises largely from additive genetic variation. Copyright © 2017 Society of Biological Psychiatry. Published by Elsevier Inc. All rights reserved.

Mean annual runoff and peak flow estimates based on channel geometry of streams in southeastern Montana

USGS Publications Warehouse

Omang, R.J.; Parrett, Charles; Hull, J.A.

1983-01-01

Equations using channel-geometry measurements were developed for estimating mean runoff and peak flows of ungaged streams in southeastern Montana. Two separate sets of esitmating equations were developed for determining mean annual runoff: one for perennial streams and one for ephemeral and intermittent streams. Data from 29 gaged sites on perennial streams and 21 gaged sites on ephemeral and intermittent streams were used in these analyses. Data from 78 gaged sites were used in the peak-flow analyses. Southeastern Montana was divided into three regions and separate multiple-regression equations for each region were developed that relate channel dimensions to peak discharge having recurrence intervals of 2, 5, 10, 25, 50, and 100 years. Channel-geometery relations were developed using measurements of the active-channel width and bankfull width. Active-channel width and bankfull width were the most significant channel features for estimating mean annual runoff for al types of streams. Use of this method requires that onsite measurements be made of channel width. The standard error of estimate for predicting mean annual runoff ranged from about 38 to 79 percent. The standard error of estimate relating active-channel width or bankfull width to peak flow ranged from about 37 to 115 percent. (USGS)

Epidemiology and Heritability of Major Depressive Disorder, Stratified by Age of Onset, Sex, and Illness Course in Generation Scotland: Scottish Family Health Study (GS:SFHS).

PubMed

Fernandez-Pujals, Ana Maria; Adams, Mark James; Thomson, Pippa; McKechanie, Andrew G; Blackwood, Douglas H R; Smith, Blair H; Dominiczak, Anna F; Morris, Andrew D; Matthews, Keith; Campbell, Archie; Linksted, Pamela; Haley, Chris S; Deary, Ian J; Porteous, David J; MacIntyre, Donald J; McIntosh, Andrew M

2015-01-01

The heritability of Major Depressive Disorder (MDD) has been estimated at 37% based largely on twin studies that rely on contested assumptions. More recently, the heritability of MDD has been estimated on large populations from registries such as the Swedish, Finnish, and Chinese cohorts. Family-based designs utilise a number of different relationships and provide an alternative means of estimating heritability. Generation Scotland: Scottish Family Health Study (GS:SFHS) is a large (n = 20,198), family-based population study designed to identify the genetic determinants of common diseases, including Major Depressive Disorder. Two thousand seven hundred and six individuals were SCID diagnosed with MDD, 13.5% of the cohort, from which we inferred a population prevalence of 12.2% (95% credible interval: 11.4% to 13.1%). Increased risk of MDD was associated with being female, unemployed due to a disability, current smokers, former drinkers, and living in areas of greater social deprivation. The heritability of MDD in GS:SFHS was between 28% and 44%, estimated from a pedigree model. The genetic correlation of MDD between sexes, age of onset, and illness course were examined and showed strong genetic correlations. The genetic correlation between males and females with MDD was 0.75 (0.43 to 0.99); between earlier (≤ age 40) and later (> age 40) onset was 0.85 (0.66 to 0.98); and between single and recurrent episodic illness course was 0.87 (0.72 to 0.98). We found that the heritability of recurrent MDD illness course was significantly greater than the heritability of single MDD illness course. The study confirms a moderate genetic contribution to depression, with a small contribution of the common family environment (variance proportion = 0.07, CI: 0.01 to 0.15), and supports the relationship of MDD with previously identified risk factors. This study did not find robust support for genetic differences in MDD due to sex, age of onset, or illness course. However, we found an intriguing difference in heritability between recurrent and single MDD illness course. These findings establish GS:SFHS as a valuable cohort for the genetic investigation of MDD.

Stoppage in Autism Spectrum Disorders

ERIC Educational Resources Information Center

Grønborg, Therese K.; Hansen, Stefan N.; Nielsen, Svend V.; Skytthe, Axel; Parner, Erik T.

2015-01-01

Stoppage refers to changes in reproductive behavior following the birth of a child with a severe disease. The presence of stoppage can bias estimates of sibling recurrence risk if not properly addressed. If stoppage occurs non-randomly (differential stoppage), it is possibly an additional source of bias in sibling recurrence risk estimation. This…

More than one-third of successfully nonoperatively treated patients with complicated appendicitis experienced recurrent appendicitis: Is interval appendectomy necessary?

PubMed

Tanaka, Yujiro; Uchida, Hiroo; Kawashima, Hiroshi; Fujiogi, Michimasa; Suzuki, Keisuke; Takazawa, Shinya; Deie, Kyoichi; Amano, Hizuru; Iwanaka, Tadashi

2016-12-01

Although nonoperative treatment (non-OPT) for complicated appendicitis is performed widely, the long-term outcomes and merits of interval appendectomy (IA) need to be evaluated. Between April 2007 and December 2013, all appendicitis patients with well-circumscribed abscess or phlegmon were required to select either laparoscopic surgery (OPT) or non-OPT with optional IA on admission. Optional IA was planned at ≥3months after non-OPT. For non-OPT, intravenous injection of antibiotics was continued until the serum C-reactive protein concentration decreased to <0.5mg/dL, with occasional drainage of abscesses. Thirty-three patients chose OPT, and 55 chose non-OPT. Among non-OPT patients, 16 selected IA. The success rate of non-OPT was 98.2%. Recurrence occurred in 13 (34.2%) of the 38 non-IA group patients. Although the non-IA group patients frequently had perforated appendicitis at recurrence, they visited the hospital earlier than at the initial appendicitis and had less inflammation. Readmission rate or complications in patients undergoing IA were not different compared with those of the patients in the non-IA group, who had recurrence at ≥3months, or with those of patients in the OPT group. Although many patients experienced recurrent appendicitis after successful nonoperative treatment, IA may not be necessary after non-OPT. Prospective comparative study, level II. Copyright © 2016 Elsevier Inc. All rights reserved.

Effects of an early referral system on liver transplantation for hepatoblastoma at Texas Children's Hospital.

PubMed

Kueht, Michael; Thompson, Patrick; Rana, Abbas; Cotton, Ronald; O'Mahony, Christine; Goss, John

2016-06-01

The purposes of this study were to analyze the effects of an ERS on time to transplantation and to describe our center's experience with OLT for HB. Patients who received OLT for HB between 2000 and 2013 were included. Patient and allograft characteristics, chemotherapy regimens, and prior surgical therapies were examined. The interval between diagnosis and OLT prior to and following the institution of an ERS for transplant was compared. Survival and tumor recurrence were analyzed. Nineteen patients received OLT for HB (mean age 33 months). All children received grafts from deceased donors. Two patients underwent prior resections. Tumor recurred in four patients (21.1%). Both patients who received salvage transplants experienced post-OLT recurrence. Three of the four recurrences occurred in spite of adjuvant chemotherapy. There were three deaths: two from metastatic disease. One- and five-yr survivals were 86.1% and 73.8%. After the institution of the ERS, the mean interval between tissue diagnosis and OLT was significantly reduced. Our series of 19 patients demonstrates a 21% recurrence of HB following OLT despite chemotherapy. Five-yr survival reached 73.8%. A system of early referral can effectively reduce times between diagnosis and transplant. © 2016 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

Hospital Utilization and Characteristics of Patients Experiencing Recurrent Readmissions Within Children’s Hospitals

PubMed Central

Berry, Jay G.; Hall, David E.; Kuo, Dennis Z.; Cohen, Eyal; Agrawal, Rishi; Feudtner, Chris; Hall, Matt; Kueser, Jacqueline; Kaplan, William; Neff, John

2011-01-01

Context Early hospital readmission is emerging as an indicator of care quality. Some children with chronic illnesses may be readmitted on a recurrent basis, but there are limited data describing their rehospitalization patterns and impact. Objectives To describe the inpatient resource utilization, clinical characteristics, and admission reasons of patients recurrently readmitted to children’s hospitals. Design, Setting, and Patients Retrospective cohort analysis of 317 643 patients (n=579 504 admissions) admitted to 37 US children’s hospitals in 2003 with follow-up through 2008. Main Outcome Measure Maximum number of readmissions experienced by each child within any 365-day interval during the 5-year follow-up period. Results In the sample, 69 294 patients (21.8%) experienced at least 1 readmission within 365 days of a prior admission. Within a 365-day interval, 9237 patients (2.9%) experienced 4 or more readmissions; time between admissions was a median 37 days (interquartile range [IQR], 21–63). These patients accounted for 18.8% (109 155 admissions) of all admissions and 23.2% ($3.4 billion) of total inpatient charges for the study cohort during the entire follow-up period. Tests for trend indicated that as the number of readmissions increased from 0 to 4 or more, the prevalences increased for a complex chronic condition (from 22.3% [n=55 382/248 349] to 89.0% [n=8225/9237]; P <.001), technology assistance (from 5.3% [n = 13 163] to 52.6% [n=4859]; P <.001), public insurance use (from 40.9% [n = 101 575] to 56.3% [n=5202]; P <.001), and non-Hispanic black race (from 21.8% [n=54 140] to 34.4% [n=3181]; P <.001); and the prevalence decreased for readmissions associated with an ambulatory care–sensitive condition (from 23.1% [62 847/272 065] to 14.0% [15 282/109 155], P<.001). Of patients readmitted 4 or more times in a 365-day interval, 2633 (28.5%) were rehospitalized for a problem in the same organ system across all admissions during the interval. Conclusions Among a group of pediatric hospitals, 18.8% of admissions and 23.2% of inpatient charges were accounted for by the 2.9% of patients with frequent recurrent admissions. Many of these patients were rehospitalized recurrently for a problem in the same organ system. PMID:21325184

Recurrence and interoccurrence behavior of self-organized complex phenomena

NASA Astrophysics Data System (ADS)

Abaimov, S. G.; Turcotte, D. L.; Shcherbakov, R.; Rundle, J. B.

2007-08-01

The sandpile, forest-fire and slider-block models are said to exhibit self-organized criticality. Associated natural phenomena include landslides, wildfires, and earthquakes. In all cases the frequency-size distributions are well approximated by power laws (fractals). Another important aspect of both the models and natural phenomena is the statistics of interval times. These statistics are particularly important for earthquakes. For earthquakes it is important to make a distinction between interoccurrence and recurrence times. Interoccurrence times are the interval times between earthquakes on all faults in a region whereas recurrence times are interval times between earthquakes on a single fault or fault segment. In many, but not all cases, interoccurrence time statistics are exponential (Poissonian) and the events occur randomly. However, the distribution of recurrence times are often Weibull to a good approximation. In this paper we study the interval statistics of slip events using a slider-block model. The behavior of this model is sensitive to the stiffness α of the system, α=kC/kL where kC is the spring constant of the connector springs and kL is the spring constant of the loader plate springs. For a soft system (small α) there are no system-wide events and interoccurrence time statistics of the larger events are Poissonian. For a stiff system (large α), system-wide events dominate the energy dissipation and the statistics of the recurrence times between these system-wide events satisfy the Weibull distribution to a good approximation. We argue that this applicability of the Weibull distribution is due to the power-law (scale invariant) behavior of the hazard function, i.e. the probability that the next event will occur at a time t0 after the last event has a power-law dependence on t0. The Weibull distribution is the only distribution that has a scale invariant hazard function. We further show that the onset of system-wide events is a well defined critical point. We find that the number of system-wide events NSWE satisfies the scaling relation NSWE ∝(α-αC)δ where αC is the critical value of the stiffness. The system-wide events represent a new phase for the slider-block system.

Effect of autotransfusion system on tumor recurrence and survival in hepatocellular carcinoma patients

PubMed Central

Akbulut, Sami; Kayaalp, Cuneyt; Yilmaz, Mehmet; Ince, Volkan; Ozgor, Dincer; Karabulut, Koray; Eris, Cengiz; Toprak, Huseyin Ilksen; Aydin, Cemalettin; Yilmaz, Sezai

2013-01-01

AIM: To investigate the therapeutic efficacy and safety of continuous autotransfusion system (CATS) during liver transplantation of hepatocellular carcinoma patients. METHODS: Eighty-three hepatocellular carcinoma (HCC) patients who underwent liver transplantation with intraoperative CATS (n = 24, CATS group) and without (n = 59, non-CATS group) between April 2006 and November 2011 at the Liver Transplant Institute of Inonu University were analyzed retrospectively. Postoperative HCC recurrence was monitored by measuring alpha-fetoprotein (AFP) levels at 3-mo intervals and performing imaging analysis by thoracoabdominal multidetector computed tomography at 6-month intervals. Inter-group differences in recurrence and correlations between demographic, clinical, and pathological data were assessed by ANOVA and χ2 tests. Overall and disease-free survivals were calculated by the univariate Kaplan-Meier method. RESULTS: Of the 83 liver transplanted HCC patients, 89.2% were male and the overall mean age was 51.3 ± 8.9 years (range: 18-69 years). The CATS and non-CATS groups showed no statistically significant differences in age, sex ratio, body mass index, underlying disease, donor type, graft-to-recipient weight ratio, Child-Pugh and Model for End-Stage Liver Disease scores, number of tumors, tumor size, AFP level, Milan and University of California San Francisco selection criteria, tumor differentiation, macrovascular invasion, median hospital stay, recurrence rate, recurrence site, or mortality rate. The mean follow-up time of the non-CATS group was 17.9 ± 12.8 mo, during which systemic metastasis and/or locoregional recurrence developed in 25.4% of the patients. The mean follow-up time for the CATS group was 25.8 ± 15.1 mo, during which systemic metastasis and/or locoregional recurrence was detected in 29.2% of the patients. There was no significant difference between the CATS and non-CATS groups in recurrence rate or site. Additionally, no significant differences existed between the groups in overall or disease-free survival. CONCLUSION: CATS is a safe procedure and may decrease the risk of tumor recurrence in HCC patients. PMID:23538988

Salvage radiotherapy in patients with recurrent esophageal carcinoma.

PubMed

Fakhrian, K; Gamisch, N; Schuster, T; Thamm, R; Molls, M; Geinitz, H

2012-02-01

The feasibility and effectiveness of radiotherapy in the management of recurrent esophageal carcinoma (REC) is reported. A consecutive cohort of 54 patients with rcT1-4, rcN0-1, or cM0 recurrent esophageal carcinoma (69% squamous cell carcinoma, 31% adenocarcinoma) was treated between 1988 and 2010. The initial treatment for these patients was definitive radiochemotherapy, surgery alone, or neoadjuvant radiochemotherapy + surgical resection in 8 (15%), 33 (61%), and 13 (24%) patients, respectively. The median time to recurrence from initial treatment was 19 months (range 4-79 months). The site of the recurrence was anastomotic or local, nodal, or both in 63%, 30%, and 7% of patients, respectively. Salvage radio(chemo)therapy was carried out with a median dose of 45 Gy (range 30-68 Gy). Median follow-up time for surviving patients from the start of R(C)T was 38 months (range 10-105 months). Relief of symptoms was achieved in 19 of 28 symptomatic patients (68%). The median survival time was 12 months (95% confidence interval (CI) 7-17 months) and the median recurrence-free interval was 8 months (95% CI 4-12 months). The survival rates at 1, 2, and 3 years were 55 ± 7%, 29 ± 6%, and 19 ± 5%, respectively. The recurrence-free survival rates at 1, 2, and 3 years were 44 ± 7%, 22 ± 6%, and 15 ± 5%, respectively. A radiation dose ≥ 45 Gy and conformal RT were associated with a better prognosis. RT is feasible and effective in the management of recurrent esophageal carcinoma, especially for relief of symptoms. Toxicity is in an acceptable range. The outcome of REC is poor; however, long-term survival of patients with recurrent esophageal carcinoma after radiochemotherapy might be possible, even with a previous history of radiotherapy in the initial treatment. If re-irradiation of esophageal carcinoma is contemplated, three-dimensional conformal techniques and a minimum total dose of 45 Gy are recommended.

Regional curve development and selection of a reference reach in the non-urban, lowland sections of the Piedmont physiographic province, Pennsylvania and Maryland

USGS Publications Warehouse

White, Kirk E.

2001-01-01

Stream-restoration projects utilizing naturalstream designs frequently are based on the bankfull- channel characteristics of a stream reach that is accommodating streamflow and sediment transport without excessive erosion or deposition. The bankfull channel is identified by the use of field indicators and confirmed with tools such as regional curves. Channel dimensions were surveyed at six streamflow-measurement stations operated by the U.S. Geological Survey in the Gettysburg-Newark Lowlands Section and Piedmont Lowlands Section of the Piedmont Physiographic Province in Pennsylvania and Maryland. Regional curves were developed from regression analyses of the relation between drainage area and cross-sectional area, mean depth, width, and streamflow of the bankfull channel. Regional curves were used to confirm the identification of the bankfull channel at a reference reach. Stream dimensions and characteristics of the reference reach were measured for extrapolation into the design of a steam-restoration project on Bermudian Creek in Adams County, Pa.Dimensions for cross-sectional area, mean depth, width, and computed streamflow of the bankfull channel in all surveyed riffle cross sections in the reference reach were within the 95-percent confidence interval bounding the regression line representing bankfull channel geometry in the Lowland Sections of the Piedmont Physiographic Province. The average bankfull cross-sectional area, bankfull mean depth, and computed bankfull discharge for riffle cross sections in the reference reach ranged from 15.4 to 16.5 percent less than estimates determined from the lowland regional curves. Average bankfull channel width was about 2 percent greater than estimates. Cross-sectional area, mean depth, and computed streamflow corresponding to the bankfull stage at the reference reach were 31.4, 44.4, and 9.6 percent less, respectively, than estimates derived from the regional curves developed by Dunne and Leopold in 1978. Average bankfull channel width at the reference reach was 16.7 percent greater than the Dunne and Leopold estimate.The concepts of regional curves and reference reaches can be valuable tools to support efforts in stream restoration. Practitioners of stream restoration need to recognize them as such and realize their limitations. The small number of stations available for analysis is a major limiting factor in the strength of the results of this investigation. Subjective selection criteria may have unnecessarily eliminated streamflow-measurement stations that could have been included in the regional curves. A bankfull discharge with a recurrence interval within the 1- to 2-year range was used as a criteria for confirmation of the bankfull stage at each streamflow-measurement station. Many researchers accept this range for recurrence interval of the bankfull discharge; however, literature provides contradictory evidence. The use of channel-characteristics data from a reference reach without any monitoring data to document the stability of the reference reach over time is a topic of debate.

Calcium supplementation for the prevention of colorectal adenomas: A systematic review and meta-analysis of randomized controlled trials.

PubMed

Bonovas, Stefanos; Fiorino, Gionata; Lytras, Theodore; Malesci, Alberto; Danese, Silvio

2016-05-14

To determine the efficacy of calcium supplementation in reducing the recurrence of colorectal adenomas. We conducted a systematic review and meta-analysis of published studies. We searched PubMed, Scopus, the Cochrane Library, the WHO International Clinical Trials Registry Platform, and the ClinicalTrials.gov website, through December 2015. Randomized, placebo-controlled trials assessing supplemental calcium intake for the prevention of recurrence of adenomas were eligible for inclusion. Two reviewers independently selected studies based on predefined criteria, extracted data and outcomes (recurrence of colorectal adenomas, and advanced or "high-risk" adenomas), and rated each trial's risk-of-bias. Between-study heterogeneity was assessed, and pooled risk ratio (RR) estimates with their 95% confidence intervals (95%CI) were calculated using fixed- and random-effects models. To express the treatment effect in clinical terms, we calculated the number needed to treat (NNT) to prevent one adenoma recurrence. We also assessed the quality of evidence using GRADE. Four randomized, placebo-controlled trials met the eligibility criteria and were included. Daily doses of elemental calcium ranged from 1200 to 2000 mg, while the duration of treatment and follow-up of participants ranged from 36 to 60 mo. Synthesis of intention-to-treat data, for participants who had undergone follow-up colonoscopies, indicated a modest protective effect of calcium in prevention of adenomas (fixed-effects, RR = 0.89, 95%CI: 0.82-0.96; random-effects, RR = 0.87, 95%CI: 0.77-0.98; high quality of evidence). The NNT was 20 (95%CI: 12-61) to prevent one colorectal adenoma recurrence within a period of 3 to 5 years. On the other hand, the association between calcium treatment and advanced adenomas did not reach statistical significance (fixed-effects, RR = 0.92, 95%CI: 0.75-1.13; random-effects, RR = 0.92, 95%CI: 0.71-1.18; moderate quality of evidence). Our results suggest a modest chemopreventive effect of calcium supplements against recurrent colorectal adenomas over a period of 36 to 60 mo. Further research is warranted.

Calcium supplementation for the prevention of colorectal adenomas: A systematic review and meta-analysis of randomized controlled trials

PubMed Central

Bonovas, Stefanos; Fiorino, Gionata; Lytras, Theodore; Malesci, Alberto; Danese, Silvio

2016-01-01

AIM: To determine the efficacy of calcium supplementation in reducing the recurrence of colorectal adenomas. METHODS: We conducted a systematic review and meta-analysis of published studies. We searched PubMed, Scopus, the Cochrane Library, the WHO International Clinical Trials Registry Platform, and the ClinicalTrials.gov website, through December 2015. Randomized, placebo-controlled trials assessing supplemental calcium intake for the prevention of recurrence of adenomas were eligible for inclusion. Two reviewers independently selected studies based on predefined criteria, extracted data and outcomes (recurrence of colorectal adenomas, and advanced or “high-risk” adenomas), and rated each trial’s risk-of-bias. Between-study heterogeneity was assessed, and pooled risk ratio (RR) estimates with their 95% confidence intervals (95%CI) were calculated using fixed- and random-effects models. To express the treatment effect in clinical terms, we calculated the number needed to treat (NNT) to prevent one adenoma recurrence. We also assessed the quality of evidence using GRADE. RESULTS: Four randomized, placebo-controlled trials met the eligibility criteria and were included. Daily doses of elemental calcium ranged from 1200 to 2000 mg, while the duration of treatment and follow-up of participants ranged from 36 to 60 mo. Synthesis of intention-to-treat data, for participants who had undergone follow-up colonoscopies, indicated a modest protective effect of calcium in prevention of adenomas (fixed-effects, RR = 0.89, 95%CI: 0.82-0.96; random-effects, RR = 0.87, 95%CI: 0.77-0.98; high quality of evidence). The NNT was 20 (95%CI: 12-61) to prevent one colorectal adenoma recurrence within a period of 3 to 5 years. On the other hand, the association between calcium treatment and advanced adenomas did not reach statistical significance (fixed-effects, RR = 0.92, 95%CI: 0.75-1.13; random-effects, RR = 0.92, 95%CI: 0.71-1.18; moderate quality of evidence). CONCLUSION: Our results suggest a modest chemopreventive effect of calcium supplements against recurrent colorectal adenomas over a period of 36 to 60 mo. Further research is warranted. PMID:27182169

Adjuvant ovarian suppression in premenopausal breast cancer.

PubMed

Francis, Prudence A; Regan, Meredith M; Fleming, Gini F; Láng, István; Ciruelos, Eva; Bellet, Meritxell; Bonnefoi, Hervé R; Climent, Miguel A; Da Prada, Gian Antonio; Burstein, Harold J; Martino, Silvana; Davidson, Nancy E; Geyer, Charles E; Walley, Barbara A; Coleman, Robert; Kerbrat, Pierre; Buchholz, Stefan; Ingle, James N; Winer, Eric P; Rabaglio-Poretti, Manuela; Maibach, Rudolf; Ruepp, Barbara; Giobbie-Hurder, Anita; Price, Karen N; Colleoni, Marco; Viale, Giuseppe; Coates, Alan S; Goldhirsch, Aron; Gelber, Richard D

2015-01-29

Suppression of ovarian estrogen production reduces the recurrence of hormone-receptor-positive early breast cancer in premenopausal women, but its value when added to tamoxifen is uncertain. We randomly assigned 3066 premenopausal women, stratified according to prior receipt or nonreceipt of chemotherapy, to receive 5 years of tamoxifen, tamoxifen plus ovarian suppression, or exemestane plus ovarian suppression. The primary analysis tested the hypothesis that tamoxifen plus ovarian suppression would improve disease-free survival, as compared with tamoxifen alone. In the primary analysis, 46.7% of the patients had not received chemotherapy previously, and 53.3% had received chemotherapy and remained premenopausal. After a median follow-up of 67 months, the estimated disease-free survival rate at 5 years was 86.6% in the tamoxifen-ovarian suppression group and 84.7% in the tamoxifen group (hazard ratio for disease recurrence, second invasive cancer, or death, 0.83; 95% confidence interval [CI], 0.66 to 1.04; P=0.10). Multivariable allowance for prognostic factors suggested a greater treatment effect with tamoxifen plus ovarian suppression than with tamoxifen alone (hazard ratio, 0.78; 95% CI, 0.62 to 0.98). Most recurrences occurred in patients who had received prior chemotherapy, among whom the rate of freedom from breast cancer at 5 years was 82.5% in the tamoxifen-ovarian suppression group and 78.0% in the tamoxifen group (hazard ratio for recurrence, 0.78; 95% CI, 0.60 to 1.02). At 5 years, the rate of freedom from breast cancer was 85.7% in the exemestane-ovarian suppression group (hazard ratio for recurrence vs. tamoxifen, 0.65; 95% CI, 0.49 to 0.87). Adding ovarian suppression to tamoxifen did not provide a significant benefit in the overall study population. However, for women who were at sufficient risk for recurrence to warrant adjuvant chemotherapy and who remained premenopausal, the addition of ovarian suppression improved disease outcomes. Further improvement was seen with the use of exemestane plus ovarian suppression. (Funded by Pfizer and others; SOFT ClinicalTrials.gov number, NCT00066690.).

The partly Aalen's model for recurrent event data with a dependent terminal event.

PubMed

Chen, Chyong-Mei; Shen, Pao-Sheng; Chuang, Ya-Wen

2016-01-30

Recurrent event data are commonly observed in biomedical longitudinal studies. In many instances, there exists a terminal event, which precludes the occurrence of additional repeated events, and usually there is also a nonignorable correlation between the terminal event and recurrent events. In this article, we propose a partly Aalen's additive model with a multiplicative frailty for the rate function of recurrent event process and assume a Cox frailty model for terminal event time. A shared gamma frailty is used to describe the correlation between the two types of events. Consequently, this joint model can provide the information of temporal influence of absolute covariate effects on the rate of recurrent event process, which is usually helpful in the decision-making process for physicians. An estimating equation approach is developed to estimate marginal and association parameters in the joint model. The consistency of the proposed estimator is established. Simulation studies demonstrate that the proposed approach is appropriate for practical use. We apply the proposed method to a peritonitis cohort data set for illustration. Copyright © 2015 John Wiley & Sons, Ltd.

Nonparametric methods for analyzing recurrent gap time data with application to infections after hematopoietic cell transplant.

PubMed

Lee, Chi Hyun; Luo, Xianghua; Huang, Chiung-Yu; DeFor, Todd E; Brunstein, Claudio G; Weisdorf, Daniel J

2016-06-01

Infection is one of the most common complications after hematopoietic cell transplantation. Many patients experience infectious complications repeatedly after transplant. Existing statistical methods for recurrent gap time data typically assume that patients are enrolled due to the occurrence of an event of interest, and subsequently experience recurrent events of the same type; moreover, for one-sample estimation, the gap times between consecutive events are usually assumed to be identically distributed. Applying these methods to analyze the post-transplant infection data will inevitably lead to incorrect inferential results because the time from transplant to the first infection has a different biological meaning than the gap times between consecutive recurrent infections. Some unbiased yet inefficient methods include univariate survival analysis methods based on data from the first infection or bivariate serial event data methods based on the first and second infections. In this article, we propose a nonparametric estimator of the joint distribution of time from transplant to the first infection and the gap times between consecutive infections. The proposed estimator takes into account the potentially different distributions of the two types of gap times and better uses the recurrent infection data. Asymptotic properties of the proposed estimators are established. © 2015, The International Biometric Society.

Nonparametric methods for analyzing recurrent gap time data with application to infections after hematopoietic cell transplant

PubMed Central

Lee, Chi Hyun; Huang, Chiung-Yu; DeFor, Todd E.; Brunstein, Claudio G.; Weisdorf, Daniel J.

2015-01-01

Summary Infection is one of the most common complications after hematopoietic cell transplantation. Many patients experience infectious complications repeatedly after transplant. Existing statistical methods for recurrent gap time data typically assume that patients are enrolled due to the occurrence of an event of interest, and subsequently experience recurrent events of the same type; moreover, for one-sample estimation, the gap times between consecutive events are usually assumed to be identically distributed. Applying these methods to analyze the post-transplant infection data will inevitably lead to incorrect inferential results because the time from transplant to the first infection has a different biological meaning than the gap times between consecutive recurrent infections. Some unbiased yet inefficient methods include univariate survival analysis methods based on data from the first infection or bivariate serial event data methods based on the first and second infections. In this paper, we propose a nonparametric estimator of the joint distribution of time from transplant to the first infection and the gap times between consecutive infections. The proposed estimator takes into account the potentially different distributions of the two types of gap times and better uses the recurrent infection data. Asymptotic properties of the proposed estimators are established. PMID:26575402

Emergency Assessment of Postfire Debris-Flow Hazards for the 2009 Station Fire, San Gabriel Mountains, Southern California

USGS Publications Warehouse

Cannon, Susan H.; Gartner, Joseph E.; Rupert, Michael G.; Michael, John A.; Staley, Dennis M.; Worstell, Bruce B.

2009-01-01

This report presents an emergency assessment of potential debris-flow hazards from basins burned by the 2009 Station fire in Los Angeles County, southern California. Statistical-empirical models developed for postfire debris flows are used to estimate the probability and volume of debris-flow production from 678 drainage basins within the burned area and to generate maps of areas that may be inundated along the San Gabriel mountain front by the estimated volume of material. Debris-flow probabilities and volumes are estimated as combined functions of different measures of basin burned extent, gradient, and material properties in response to both a 3-hour-duration, 1-year-recurrence thunderstorm and to a 12-hour-duration, 2-year recurrence storm. Debris-flow inundation areas are mapped for scenarios where all sediment-retention basins are empty and where the basins are all completely full. This assessment provides critical information for issuing warnings, locating and designing mitigation measures, and planning evacuation timing and routes within the first two winters following the fire. Tributary basins that drain into Pacoima Canyon, Big Tujunga Canyon, Arroyo Seco, West Fork of the San Gabriel River, and Devils Canyon were identified as having probabilities of debris-flow occurrence greater than 80 percent, the potential to produce debris flows with volumes greater than 100,000 m3, and the highest Combined Relative Debris-Flow Hazard Ranking in response to both storms. The predicted high probability and large magnitude of the response to such short-recurrence storms indicates the potential for significant debris-flow impacts to any buildings, roads, bridges, culverts, and reservoirs located both within these drainages and downstream from the burned area. These areas will require appropriate debris-flow mitigation and warning efforts. Probabilities of debris-flow occurrence greater than 80 percent, debris-flow volumes between 10,000 and 100,000 m3, and high Combined Relative Debris-Flow Hazard Rankings were estimated in response to both short recurrence-interval (1- and 2-year) storms for all but the smallest basins along the San Gabriel mountain front between Big Tujunga Canyon and Arroyo Seco. The combination of high probabilities and large magnitudes determined for these basins indicates significant debris-flow hazards for neighborhoods along the mountain front. When the capacity of sediment-retention basins is exceeded, debris flows may be deposited in neighborhoods and streets and impact infrastructure between the mountain front and Foothill Boulevard. In addition, debris flows may be deposited in neighborhoods immediately below unprotected basins. Hazards to neighborhoods and structures at risk from these events will require appropriate debris-flow mitigation and warning efforts.

Healthcare Resource Utilization and Costs Associated with Recurrent Episodes of Atrial Fibrillation: The FRACTAL Registry

PubMed Central

REYNOLDS, MATTHEW R.; ESSEBAG, VIDAL; ZIMETBAUM, PETER; COHEN, DAVID J.

2007-01-01

Cost of Recurrent AF Introduction Drivers of cost in the atrial fibrillation (AF) population are not fully understood. We sought to characterize the resource utilization and costs of treating new-onset AF, with emphasis on the incremental costs associated with recurrent episodes of AF over time. Methods and Results An inception cohort of 973 AF patients was followed at 3–6 month intervals in an observational registry over a mean of 24 ± 9 months. AF therapies, clinical outcomes, and both inpatient and outpatient medical resource utilization were tracked at each follow-up interval. Registry patients were managed primarily with cardioversion and pharmacological therapy. Direct healthcare costs were calculated from a U.S. perspective by multiplying measures of resource utilization by representative price weights. Costs were compared among patients in whom the initial episode of AF became permanent and patients who initially achieved sinus rhythm and had either 0, 1–2, or ≥3 documented recurrences during follow-up. Mean annual costs for these four groups were $2,372, $3,385, $6,331, and $10,312 per patient per year, respectively (P < 0.001 for trend), with the largest variation related to hospital costs. In multivariable analysis controlling for demographic characteristics and baseline cardiac and comorbid conditions, each documented recurrence of AF was found to increase annual healthcare costs by ∼$1,600. Conclusion Following initial diagnosis, patients with AF treated with traditional therapies incur $4,000–$5,000 in annual direct healthcare costs. Costs are markedly higher in patients with multiple AF recurrences. These data may be helpful in evaluating the economic impact of new technologies for treating AF. PMID:17451468

Is race a determinant of stillbirth recurrence?

PubMed

Sharma, Puza P; Salihu, Hamisu M; Oyelese, Yinka; Ananth, Cande V; Kirby, Russell S

2006-02-01

A history of stillbirth may result in an increased risk for recurrence, although information regarding this remains scanty. It is also uncertain whether race is a determinant of stillbirth recurrence given that the risk of stillbirth varies across racial and ethnic populations. The Missouri maternally linked cohort data set containing births from 1978 through 1997 was used. We identified the study group (women who experienced a stillbirth in the first pregnancy) and a comparison group (women who delivered a live birth in their first pregnancy) and compared the outcome (stillbirth) in the second pregnancy between the 2 groups. We analyzed 404,180 women with information on first and second pregnancies (1,979 [0.5%] in the study arm, and 402,201 [99.5%] in the comparison arm). Of the 1,929 cases of stillbirths in the second pregnancy, 45 cases occurred in mothers with a history of stillbirth (stillbirth rate = 22.7/1000) and 1,884 in the comparison group (stillbirth rate 4.7/1,000, P < .001). The adjusted risk of stillbirth was almost 5-fold as high in women with a prior stillbirth (odds ratio 4.7, 95% confidence interval 3.3-6.6). Analysis across racial groups revealed that whites had lower absolute risk for stillbirth recurrence than African Americans (19.1/1,000 compared with 35.9/1,000, P < .05). The elevated stillbirth recurrence risk was confirmed after adjusting for potential confounders (odds ratio 2.6, 95% confidence interval 1.2-5.7). History of stillbirth is associated with a 5-fold increase for subsequent stillbirth. The recurrence of stillbirth is almost tripled in African Americans as compared with whites. II-2.

Patterns of Recurrence in Electively Irradiated Lymph Node Regions After Definitive Accelerated Intensity Modulated Radiation Therapy for Head and Neck Squamous Cell Carcinoma

DOE Office of Scientific and Technical Information (OSTI.GOV)

Bosch, Sven van den, E-mail: sven.vandenbosch@radboudumc.nl; Dijkema, Tim; Verhoef, Lia C.G.

Purpose: To provide a comprehensive risk assessment on the patterns of recurrence in electively irradiated lymph node regions after definitive radiation therapy for head and neck cancer. Methods and Materials: Two hundred sixty-four patients with stage cT2-4N0-2M0 squamous cell carcinoma of the oropharynx, larynx, or hypopharynx treated with accelerated intensity modulated radiation therapy between 2008 and 2012 were included. On the radiation therapy planning computed tomography (CT) scans from all patients, 1166 lymph nodes (short-axis diameter ≥5 mm) localized in the elective volume were identified and delineated. The exact sites of regional recurrences were reconstructed and projected on the initial radiationmore » therapy planning CT scan by performing coregistration with diagnostic imaging of the recurrence. Results: The actuarial rate of recurrence in electively irradiated lymph node regions at 2 years was 5.1% (95% confidence interval 2.4%-7.8%). Volumetric analysis showed an increased risk of recurrence with increasing nodal volume. Receiver operating characteristic analysis demonstrated that the summed long- and short-axis diameter is a good alternative for laborious volume calculations, using ≥17 mm as cut-off (hazard ratio 17.8; 95% confidence interval 5.7-55.1; P<.001). Conclusions: An important risk factor was identified that can help clinicians in the pretreatment risk assessment of borderline-sized lymph nodes. Not overtly pathologic nodes with a summed diameter ≥17 mm may require a higher than elective radiation therapy dose. For low-risk elective regions (all nodes <17 mm), the safety of dose de-escalation below the traditional 45 to 50 Gy should be investigated.« less

Botulinum Toxin for the Management of Sjögren Syndrome-Associated Recurrent Parotitis.

PubMed

O'Neil, Luke M; Palme, Carsten E; Riffat, Faruque; Mahant, Neil

2016-12-01

Recurrent parotitis is a rare manifestation of Sjögren syndrome. The management of recurrent parotitis is challenging because conservative methods may be of limited efficacy and invasive approaches carry the risk of complications. Botulinum toxin has been shown to reduce salivary flow, and consequently, the results of its use in the management of recurrent parotitis have been encouraging. A 65-year-old female patient with recurrent parotitis due to Sjögren syndrome was referred to us, complaining of weekly bouts of inflammation. She required a course of antibiotics monthly to control bacterial superinfections. We treated her with onabotulinumtoxinA injections into both parotid glands at regular intervals. After her second injection cycle, she denied further inflammatory bouts, has not required antibiotics in more than 36 months, and denied any side effects. Botulinum toxin may be a safe and effective method of treating Sjögren syndrome-associated recurrent parotitis. Copyright © 2016 American Association of Oral and Maxillofacial Surgeons. Published by Elsevier Inc. All rights reserved.

Exclusion of deep vein thrombosis using the Wells rule in clinically important subgroups: individual patient data meta-analysis.

PubMed

Geersing, G J; Zuithoff, N P A; Kearon, C; Anderson, D R; Ten Cate-Hoek, A J; Elf, J L; Bates, S M; Hoes, A W; Kraaijenhagen, R A; Oudega, R; Schutgens, R E G; Stevens, S M; Woller, S C; Wells, P S; Moons, K G M

2014-03-10

To assess the accuracy of the Wells rule for excluding deep vein thrombosis and whether this accuracy applies to different subgroups of patients. Meta-analysis of individual patient data. Authors of 13 studies (n = 10,002) provided their datasets, and these individual patient data were merged into one dataset. Studies were eligible if they enrolled consecutive outpatients with suspected deep vein thrombosis, scored all variables of the Wells rule, and performed an appropriate reference standard. Multilevel logistic regression models, including an interaction term for each subgroup, were used to estimate differences in predicted probabilities of deep vein thrombosis by the Wells rule. In addition, D-dimer testing was added to assess differences in the ability to exclude deep vein thrombosis using an unlikely score on the Wells rule combined with a negative D-dimer test result. Overall, increasing scores on the Wells rule were associated with an increasing probability of having deep vein thrombosis. Estimated probabilities were almost twofold higher in patients with cancer, in patients with suspected recurrent events, and (to a lesser extent) in males. An unlikely score on the Wells rule (≤ 1) combined with a negative D-dimer test result was associated with an extremely low probability of deep vein thrombosis (1.2%, 95% confidence interval 0.7% to 1.8%). This combination occurred in 29% (95% confidence interval 20% to 40%) of patients. These findings were consistent in subgroups defined by type of D-dimer assay (quantitative or qualitative), sex, and care setting (primary or hospital care). For patients with cancer, the combination of an unlikely score on the Wells rule and a negative D-dimer test result occurred in only 9% of patients and was associated with a 2.2% probability of deep vein thrombosis being present. In patients with suspected recurrent events, only the modified Wells rule (adding one point for the previous event) is safe. Combined with a negative D-dimer test result (both quantitative and qualitative), deep vein thrombosis can be excluded in patients with an unlikely score on the Wells rule. This finding is true for both sexes, as well as for patients presenting in primary and hospital care. In patients with cancer, the combination is neither safe nor efficient. For patients with suspected recurrent disease, one extra point should be added to the rule to enable a safe exclusion.

Historical changes in annual peak flows in Maine and implications for flood-frequency analyses

USGS Publications Warehouse

Hodgkins, Glenn A.

2010-01-01

Flood-frequency analyses use statistical methods to compute peak streamflows for selected recurrence intervals— the average number of years between peak flows that are equal to or greater than a specified peak flow. Analyses are based on annual peak flows at a stream. It has long been assumed that the annual peak streamflows used in these computations were stationary (non-changing) over very long periods of time, except in river basins subject to direct effects of human activities, such as urbanization and regulation. Because of the potential effects of global warming on peak flows, the assumption of peak-flow stationarity has recently been questioned. Maine has many streamgages with 50 to 105 years of recorded annual peak streamflows. In this study, this long-term record has been tested for historical flood-frequency stationarity, to provide some insight into future flood frequency. Changes over time in annual instantaneous peak streamflows at 28 U.S. Geological Survey streamgages with long-term data (50 or more years) and relatively complete records were investigated by examining linear trends for each streamgage’s period of record. None of the 28 streamgages had more than 5 years of missing data. Eight streamgages have substantial streamflow regulation. Because previous studies have suggested that changes over time may have occurred as a step change around 1970, step changes between each streamgage’s older record (start year to 1970) and newer record (1971 to 2006) also were computed. The median change over time for all 28 streamgages is an increase of 15.9 percent based on a linear change and an increase of 12.4 percent based on a step change. The median change for the 20 unregulated streamgages is slightly higher than for all 28 streamgages; it is 18.4 percent based on a linear change and 15.0 percent based on a step change. Peak flows with 100- and 5-year recurrence intervals were computed for the 28 streamgages using the full annual peak-flow record and multiple sub-periods of that record using the guidelines (Bulletin 17B) of the Interagency Advisory Committee on Water Data. Magnitudes of 100- and 5-year peak flows computed from sub-periods then were compared to those computed from the full period. Sub-periods of 30 years with starting years staggered by 10 years were evaluated (1907–36, 1917–46, 1927–56, 1937–66, 1947–76, 1957–86, 1967–96, and 1977–2006). Two other sub-periods were evaluated using older data (start-of-record to 1970) and newer data (1971 to 2006). The 5-year peak flow is used to represent small and relatively frequent flood flows in Maine, whereas the 100-year peak flow is used to represent large flood flows. The 1967–96 sub-period generated the highest 100- and 5-year peak flows overall when compared to peak flows based on the full period of record; the median difference for all 28 streamgages is 8 percent for 100- and 5-year peak flows. The 1977–2006 and 1971–2006 sub-periods also generated 100- and 5-year peak flows higher than peak flows based on the full period of record, but not as high as the peak flows based on the 1967–96 sub-period. The 1937–66 sub-period generated the lowest 100- and 5-year peak flows overall. The median difference from full-period peak flows is -11 percent for 100-year peak flows and -8 percent for 5-year peak flows. Overall, differences between peak flows based on the sub-periods and those based on the full periods, generated using the 20 unregulated streamgages, are similar to differences using all 28 streamgages. Increases in the 5- and 100-year peak flows based on recent years of record are, in general, modest when compared to peak flows based on complete periods of record. The highest peak flows are based on the 1967–96 sub-period rather than the most recent sub-period (1977-2006). Peak flows for selected recurrence intervals are sensitive to very high peak flows that may occur once in a century or even less frequently. It is difficult, therefore, to determine which approach will produce the most reliable future estimates of peak flows for selected recurrence intervals, using only recent years of record or the traditional method using the entire historical period. One possible conservative approach to computing peak flows of selected recurrence intervals would be to compute peak flows using recent annual peak flows and the entire period of record, then choose the higher computed value. Whether recent or entire periods of record are used to compute peak flows of selected recurrence intervals, the results of this study highlight the importance of using recent data in the computation of the peak flows. The use of older records alone could result in underestimation of peak flows, particularly peak flows with short recurrence intervals, such as the 5-year peak flows.

Aneurysm Recurrence Volumetry Is More Sensitive than Visual Evaluation of Aneurysm Recurrences.

PubMed

Schönfeld, M H; Schlotfeldt, V; Forkert, N D; Goebell, E; Groth, M; Vettorazzi, E; Cho, Y D; Han, M H; Kang, H-S; Fiehler, J

2016-03-01

Considerable inter-observer variability in the visual assessment of aneurysm recurrences limits its use as an outcome parameter evaluating new coil generations. The purpose of this study was to compare visual assessment of aneurysm recurrences and aneurysm recurrence volumetry with an example dataset of HydroSoft coils (HSC) versus bare platinum coils (BPC). For this retrospective study, 3-dimensional time-of-flight magnetic resonance angiography datasets acquired 6 and 12 months after endovascular therapy using BPC only or mainly HSC were analyzed. Aneurysm recurrence volumes were visually rated by two observersas well as quantified by subtraction of the datasets after intensity-based rigid registration. A total of 297 aneurysms were analyzed (BPC: 169, HSC: 128). Recurrences were detected by aneurysm recurrence volumetry in 9 of 128 (7.0 %) treated with HSC and in 24 of 169 (14.2 %) treated with BPC (odds ratio: 2.39, 95 % confidence interval: 1.05-5.48; P = 0.039). Aneurysm recurrence volumetry revealed an excellent correlation between observers (Cronbach's alpha = 0.93). In contrast, no significant difference in aneurysm recurrence was found for visual assessment (3.9 % in HSC cases and 4.7 % in BPC cases). Recurrences were observed in aneurysms smaller than the sample median in 10 of 33 (30.3 %) by aneurysm recurrence volumetry and in 1 of 13 (7.7 %) by visual assessment. Aneurysm recurrences were detected more frequently by aneurysm recurrence volumetry when compared with visual assessment. By using aneurysm recurrence volumetry, differences between treatment groups were detected with higher sensitivity and inter-observer validity probably because of the higher detection rate of recurrences in small aneurysms.

DOE Office of Scientific and Technical Information (OSTI.GOV)

Tinkle, Christopher L.; Weinberg, Vivian; Chen, Lee-May

Purpose: Evaluate the efficacy and toxicity of image guided brachytherapy using inverse planning simulated annealing (IPSA) high-dose-rate brachytherapy (HDRB) boost for locoregionally advanced cervical cancer. Methods and Materials: From December 2003 through September 2009, 111 patients with primary cervical cancer were treated definitively with IPSA-planned HDRB boost (28 Gy in 4 fractions) after external radiation at our institution. We performed a retrospective review of our experience using image guided brachytherapy. Of the patients, 70% had a tumor size >4 cm, 38% had regional nodal disease, and 15% had clinically evident distant metastasis, including nonregional nodal disease, at the time of diagnosis. Surgicalmore » staging involving pelvic lymph node dissection was performed in 15% of patients, and 93% received concurrent cisplatin-based chemotherapy. Toxicities are reported according to the Common Terminology Criteria for Adverse Events version 4.0 guidelines. Results: With a median follow-up time of 42 months (range, 3-84 months), no acute or late toxicities of grade 4 or higher were observed, and grade 3 toxicities (both acute and late) developed in 8 patients (1 constitutional, 1 hematologic, 2 genitourinary, 4 gastrointestinal). The 4-year Kaplan-Meier estimate of late grade 3 toxicity was 8%. Local recurrence developed in 5 patients (4 to 9 months after HDRB), regional recurrence in 3 (6, 16, and 72 months after HDRB), and locoregional recurrence in 1 (4 months after HDR boost). The 4-year estimates of local, locoregional, and distant control of disease were 94.0%, 91.9%, and 69.1%, respectively. The overall and disease-free survival rates at 4 years were 64.3% (95% confidence interval [CI] of 54%-73%) and 61.0% (95% CI, 51%-70%), respectively. Conclusions: Definitive radiation by use of inverse planned HDRB boost for locoregionally advanced cervical cancer is well tolerated and achieves excellent local control of disease. However, overall survival continues to be limited by the high rates of distant metastasis.« less

Reirradiation of tumors in cats and dogs.

PubMed

Turrel, J M; Théon, A P

1988-08-15

Fifty-one cats and dogs with tumor recurrence after irradiation were treated with a second course of radiotherapy, using either teletherapy or brachytherapy. Eighty-six percent of the tumors had partial or complete response at 2 months after reirradiation. Tumor response was significantly (P = 0.041) affected when the interval between the 2 courses of irradiation was greater than 5 months. The estimated local tumor control rate was 38% at 1 year after reirradiation. Of all the factors examined, complete response at 2 months, reirradiation field size less than or equal to 10 cm2, and reirradiation dose greater than 40 gray emerged as predictors of local tumor control. The estimated overall survival rate was 47% at 2 years. Tumor location had a significant (P = 0.001) influence on overall survival; animals with cutaneous tumors had the longest survival times, and those with oral tumors had the shortest survival times. The other significant (P = 0.001) factor affecting overall survival time was the field size of the reirradiated site. Estimated survival time after reirradiation was 41% at 1 year. Favorable prognostic indicators were complete response at 2 months and location of tumor; animals with skin tumors had a favorable prognosis. The acute effects of reirradiation on normal tissues were acceptable, but 12% of the animals had severe delayed complications. Significant risk of complications after reirradiation was associated with squamous cell carcinoma (P = 0.015) and reirradiated field size greater than 30 cm2 (P = 0.056). When the interval between irradiations was greater than 5 months, the risk of complications was significantly (P = 0.022) lower.(ABSTRACT TRUNCATED AT 250 WORDS)

Development of Final A-Fault Rupture Models for WGCEP/ NSHMP Earthquake Rate Model 2

USGS Publications Warehouse

Field, Edward H.; Weldon, Ray J.; Parsons, Thomas; Wills, Chris J.; Dawson, Timothy E.; Stein, Ross S.; Petersen, Mark D.

2008-01-01

This appendix discusses how we compute the magnitude and rate of earthquake ruptures for the seven Type-A faults (Elsinore, Garlock, San Jacinto, S. San Andreas, N. San Andreas, Hayward-Rodgers Creek, and Calaveras) in the WGCEP/NSHMP Earthquake Rate Model 2 (referred to as ERM 2. hereafter). By definition, Type-A faults are those that have relatively abundant paleoseismic information (e.g., mean recurrence-interval estimates). The first section below discusses segmentation-based models, where ruptures are assumed be confined to one or more identifiable segments. The second section discusses an un-segmented-model option, the third section discusses results and implications, and we end with a discussion of possible future improvements. General background information can be found in the main report.

Magnitude and frequency of floods in western Oregon

USGS Publications Warehouse

Harris, David Dell; Hubbard, Larry L.; Hubbard, Lawrence E.

1979-01-01

A method for estimating the magnitude and frequency of floods is presented for unregulated streams in western Oregon. Equations relating flood magnitude to basin characteristics were developed for exceedance probabilities of 0.5 to 0.01 (2- to 100-year recurrence intervals). Separate equations are presented for four regions: Coast, Willamette, Rogue-Umpqua, and High Cascades. Also presented are values of flood discharges for selected exceedance probabilities and of basin characteristics for all gaging stations used in the analysis. Included are data for 230 stations in Oregon, 6 stations in southwestern Washington, and 3 stations in northwestern California. Drainage areas used in the analysis range from 0.21 to 7,280 square miles. Also included are maximum discharges for all western Oregon stations used in the analysis. (Woodard-USGS)

Flood of May 6, 2007, Willow Creek, west-central Iowa

USGS Publications Warehouse

Fischer, Edward E.; Eash, David A.

2008-01-01

Major flooding occurred May 6, 2007, in the Willow Creek drainage basin in Harrison County following severe thunderstorm activity over west-central Iowa. More than 7 inches of rain were recorded for the 72-hour period ending 7 a.m., May 6, at the Logan, Iowa weather station. The peak discharge in Willow Creek at Medford Avenue near Missouri Valley, Iowa, was 17,000 cubic feet per second. The recurrence interval of the flood is 160 years, which was estimated using regional regression equations. Information about the basin, the storms, the flooding, and a profile of high-water marks measured at 10 locations along Willow Creek between the mouth at the Boyer River and State Highway 37 in Monona County, a distance of almost 33 river miles, are presented in this report.

Multi-state models for colon cancer recurrence and death with a cured fraction.

PubMed

Conlon, A S C; Taylor, J M G; Sargent, D J

2014-05-10

In cancer clinical trials, patients often experience a recurrence of disease prior to the outcome of interest, overall survival. Additionally, for many cancers, there is a cured fraction of the population who will never experience a recurrence. There is often interest in how different covariates affect the probability of being cured of disease and the time to recurrence, time to death, and time to death after recurrence. We propose a multi-state Markov model with an incorporated cured fraction to jointly model recurrence and death in colon cancer. A Bayesian estimation strategy is used to obtain parameter estimates. The model can be used to assess how individual covariates affect the probability of being cured and each of the transition rates. Checks for the adequacy of the model fit and for the functional forms of covariates are explored. The methods are applied to data from 12 randomized trials in colon cancer, where we show common effects of specific covariates across the trials. Copyright © 2013 John Wiley & Sons, Ltd.

Outcome and risk factors of recurrence after thoracoscopic bullectomy in young adults with primary spontaneous pneumothorax.

PubMed

Nakayama, Takashi; Takahashi, Yusuke; Uehara, Hirofumi; Matsutani, Noriyuki; Kawamura, Masafumi

2017-07-01

To investigate the risk factors of recurrence of pneumothorax following thoracoscopic bullectomy in young adults. Between January, 2005 and September, 2015, 167 patients aged ≤40 years underwent initial thoracoscopic bullectomy for primary spontaneous pneumothorax (PSP) at our hospital. Recurrence-free probability was calculated from the date of surgery to recurrence or last follow-up, using the Kaplan-Meier method. Sixteen (9.6%) of the 167 patients suffered a recurrence (collective total, 16 recurrences). The recurrence-free intervals were 3-107 months (median 25.8 months), and the 5-year recurrence-free probability was 85.9%. Multivariate Cox analysis demonstrated that age ≤23 years (p = 0.029) and a history of ipsilateral pneumothorax before surgery (p = 0.029) were significantly associated with higher risk of recurrence. The 5-year recurrence-free probability was 72.3% for patients aged ≤23 years and a history of ipsilateral pneumothorax before surgery and 94.1% for those with neither of these factors (p = 0.001). Recurrence developed within 3 years after surgery in 14 of the 16 patients. Patients ≤23 years of age with a history of ipsilateral pneumothorax before surgery are at significantly high risk of its recurrence, frequently within 3 years; thus, the risk of postoperative recurrence of a pneumothorax must be kept in mind.

Flood of February 1980 along the Agua Fria River, Maricopa County, Arizona

USGS Publications Warehouse

Thomsen, B.W.

1980-01-01

The flood of February 20, 1980, along the Agua Fria River below Waddell Dam, Maricopa County, Ariz., was caused by heavy rains during February 13-20. The runoff filled Lake Pleasant and resulted in the largest release--66,600 cubic feet per second--from the reservoir since it was built in 1927; the maximum inflow to the reservoir was about 73,300 cubic feet per second. The area inundated by the releases includes about 28 miles along the channel from the mouth of the Agua Fria River to the Beardsley Canal flume crossing 5 miles downstream from Waddell Dam. The flood of 1980 into Lake Pleasant has a recurrence interval of about 47 years, whereas the flood of record (1919) has a recurrence interval of about 100 years. (USGS)

A population-based study of tumor gene expression and risk of breast cancer death among lymph node-negative patients.

PubMed

Habel, Laurel A; Shak, Steven; Jacobs, Marlena K; Capra, Angela; Alexander, Claire; Pho, Mylan; Baker, Joffre; Walker, Michael; Watson, Drew; Hackett, James; Blick, Noelle T; Greenberg, Deborah; Fehrenbacher, Louis; Langholz, Bryan; Quesenberry, Charles P

2006-01-01

The Oncotype DX assay was recently reported to predict risk for distant recurrence among a clinical trial population of tamoxifen-treated patients with lymph node-negative, estrogen receptor (ER)-positive breast cancer. To confirm and extend these findings, we evaluated the performance of this 21-gene assay among node-negative patients from a community hospital setting. A case-control study was conducted among 4,964 Kaiser Permanente patients diagnosed with node-negative invasive breast cancer from 1985 to 1994 and not treated with adjuvant chemotherapy. Cases (n = 220) were patients who died from breast cancer. Controls (n = 570) were breast cancer patients who were individually matched to cases with respect to age, race, adjuvant tamoxifen, medical facility and diagnosis year, and were alive at the date of death of their matched case. Using an RT-PCR assay, archived tumor tissues were analyzed for expression levels of 16 cancer-related and five reference genes, and a summary risk score (the Recurrence Score) was calculated for each patient. Conditional logistic regression methods were used to estimate the association between risk of breast cancer death and Recurrence Score. After adjusting for tumor size and grade, the Recurrence Score was associated with risk of breast cancer death in ER-positive, tamoxifen-treated and -untreated patients (P = 0.003 and P = 0.03, respectively). At 10 years, the risks for breast cancer death in ER-positive, tamoxifen-treated patients were 2.8% (95% confidence interval [CI] 1.7-3.9%), 10.7% (95% CI 6.3-14.9%), and 15.5% (95% CI 7.6-22.8%) for those in the low, intermediate and high risk Recurrence Score groups, respectively. They were 6.2% (95% CI 4.5-7.9%), 17.8% (95% CI 11.8-23.3%), and 19.9% (95% CI 14.2-25.2%) for ER-positive patients not treated with tamoxifen. In both the tamoxifen-treated and -untreated groups, approximately 50% of patients had low risk Recurrence Score values. In this large, population-based study of lymph node-negative patients not treated with chemotherapy, the Recurrence Score was strongly associated with risk of breast cancer death among ER-positive, tamoxifen-treated and -untreated patients.

A population-based study of tumor gene expression and risk of breast cancer death among lymph node-negative patients

PubMed Central

Habel, Laurel A; Shak, Steven; Jacobs, Marlena K; Capra, Angela; Alexander, Claire; Pho, Mylan; Baker, Joffre; Walker, Michael; Watson, Drew; Hackett, James; Blick, Noelle T; Greenberg, Deborah; Fehrenbacher, Louis; Langholz, Bryan; Quesenberry, Charles P

2006-01-01

Introduction The Oncotype DX assay was recently reported to predict risk for distant recurrence among a clinical trial population of tamoxifen-treated patients with lymph node-negative, estrogen receptor (ER)-positive breast cancer. To confirm and extend these findings, we evaluated the performance of this 21-gene assay among node-negative patients from a community hospital setting. Methods A case-control study was conducted among 4,964 Kaiser Permanente patients diagnosed with node-negative invasive breast cancer from 1985 to 1994 and not treated with adjuvant chemotherapy. Cases (n = 220) were patients who died from breast cancer. Controls (n = 570) were breast cancer patients who were individually matched to cases with respect to age, race, adjuvant tamoxifen, medical facility and diagnosis year, and were alive at the date of death of their matched case. Using an RT-PCR assay, archived tumor tissues were analyzed for expression levels of 16 cancer-related and five reference genes, and a summary risk score (the Recurrence Score) was calculated for each patient. Conditional logistic regression methods were used to estimate the association between risk of breast cancer death and Recurrence Score. Results After adjusting for tumor size and grade, the Recurrence Score was associated with risk of breast cancer death in ER-positive, tamoxifen-treated and -untreated patients (P = 0.003 and P = 0.03, respectively). At 10 years, the risks for breast cancer death in ER-positive, tamoxifen-treated patients were 2.8% (95% confidence interval [CI] 1.7–3.9%), 10.7% (95% CI 6.3–14.9%), and 15.5% (95% CI 7.6–22.8%) for those in the low, intermediate and high risk Recurrence Score groups, respectively. They were 6.2% (95% CI 4.5–7.9%), 17.8% (95% CI 11.8–23.3%), and 19.9% (95% CI 14.2–25.2%) for ER-positive patients not treated with tamoxifen. In both the tamoxifen-treated and -untreated groups, approximately 50% of patients had low risk Recurrence Score values. Conclusion In this large, population-based study of lymph node-negative patients not treated with chemotherapy, the Recurrence Score was strongly associated with risk of breast cancer death among ER-positive, tamoxifen-treated and -untreated patients. PMID:16737553

[Inactivated herpes simplex virus types 1 and 2 divaccine as an agent for effective immunoprophylaxis of recurrent genital herpes].

PubMed

Barinskiĭ, I F; Makhmudov, F R

2010-01-01

Prevention of recurrent genital herpes with the inactivated herpetic divaccine Vitaherpavac against herpes simplex virus types 1 and 2 has a number of advantages over the most commonly used symptomatic therapy: it ceases or significantly reduces the number of recurrences and accordingly prolongs a relapse-free interval, abolishes viremia and the manifestations of clinical symptoms of recurrences, induces no dependence to the vaccine. Coadministration of the Vitaherpavac vaccine and the immunomodulator Giaferon has been shown to have some advantage over vaccination only. The new formulation of the agent as suppositories (per rectum) not only enhances the immunogenicity and protective properties of the vaccine, but also reduces the frequency of its application and makes more convenient for patients to use.

Complicated Sporadic Cardiac Myxomas: A Second Recurrence and Myxomatous Cerebral Aneurysms in One Patient

PubMed Central

Iskandar, Mazen E.; Dimitrova, Kamellia; Geller, Charles M.; Hoffman, Darryl M.; Tranbaugh, Robert F.

2013-01-01

A second recurrence of an excised nonfamilial cardiac myxoma is rare. Myxomatous cerebral aneurysms as a complication of cardiac myxomas are equally rare. A unique case of a patient with a total of 4 myxomas over a 20-year interval is presented. Her most recent presentation was a second recurrence of a left atrial myxoma, a de novo right atrial myxoma, and multiple cerebral myxomatous aneurysms. The challenging reconstruction of the normal anatomy was achieved with the use of porcine extracellular matrix patches. A diagnostic cerebral angiogram was later performed, and the aneurysms will be monitored for growth and possible intervention. PMID:24455387

Complicated sporadic cardiac myxomas: a second recurrence and myxomatous cerebral aneurysms in one patient.

PubMed

Iskandar, Mazen E; Dimitrova, Kamellia; Geller, Charles M; Hoffman, Darryl M; Tranbaugh, Robert F

2013-01-01

A second recurrence of an excised nonfamilial cardiac myxoma is rare. Myxomatous cerebral aneurysms as a complication of cardiac myxomas are equally rare. A unique case of a patient with a total of 4 myxomas over a 20-year interval is presented. Her most recent presentation was a second recurrence of a left atrial myxoma, a de novo right atrial myxoma, and multiple cerebral myxomatous aneurysms. The challenging reconstruction of the normal anatomy was achieved with the use of porcine extracellular matrix patches. A diagnostic cerebral angiogram was later performed, and the aneurysms will be monitored for growth and possible intervention.

Management of Mediastinal Relapse after Treatment with Stereotactic Body Radiotherapy or Accelerated Hypofractionated Radiotherapy for Stage I/II Non–Small-Cell Lung Cancer

PubMed Central

Kilburn, Jeremy M.; Lester, Scott C.; Lucas, John T.; Soike, Michael H.; Blackstock, A. William; Kearns, William T.; Hinson, William H.; Miller, Antonius A.; Petty, William J.; Munley, Michael T.; Urbanic, James J.

2014-01-01

Purpose/Objective(s) Regional failures occur in up to 15% of patients treated with stereotactic body radiotherapy (SBRT) for stage I/II lung cancer. This report focuses on the management of the unique scenario of isolated regional failures. Methods Patients treated initially with SBRT or accelerated hypo-fractionated radiotherapy were screened for curative intent treatment of isolated mediastinal failures (IMFs). Local control, regional control, progression-free survival, and distant control were estimated from the date of salvage treatment using the Kaplan–Meier method. Results Among 160 patients treated from 2002 to 2012, 12 suffered IMF and were amenable to salvage treatment. The median interval between treatments was 16 months (2–57 mo). Median salvage dose was 66 Gy (60–70 Gy). With a median follow-up of 10 months, the median overall survival was 15 months (95% confidence interval, 5.8–37 mo). When estimated from original treatment, the median overall survival was 38 months (95% confidence interval, 17–71 mo). No subsequent regional failures occurred. Distant failure was the predominant mode of relapse following salvage for IMF with a 2-year distant control rate of 38%. At the time of this analysis, three patients have died without recurrence while four are alive and no evidence of disease. High-grade toxicity was uncommon. Conclusions To our knowledge, this is first analysis of salvage mediastinal radiation after SBRT or accelerated hypofractionated radiotherapy in lung cancer. Outcomes appear similar to stage III disease at presentation. Distant failures were common, suggesting a role for concurrent or sequential chemotherapy. A standard full course of external beam radiotherapy is advisable in this unique clinical scenario. PMID:24736084

Flood-frequency analyses from paleoflood investigations for Spring, Rapid, Boxelder, and Elk Creeks, Black Hills, western South Dakota

USGS Publications Warehouse

Harden, Tessa M.; O'Connor, Jim E.; Driscoll, Daniel G.; Stamm, John F.

2011-01-01

Flood-frequency analyses for the Black Hills area are important because of severe flooding of June 9-10, 1972, that was caused by a large mesoscale convective system and caused at least 238 deaths. Many 1972 peak flows are high outliers (by factors of 10 or more) in observed records that date to the early 1900s. An efficient means of reducing uncertainties for flood recurrence is to augment gaged records by using paleohydrologic techniques to determine ages and magnitudes of prior large floods (paleofloods). This report summarizes results of paleoflood investigations for Spring Creek, Rapid Creek (two reaches), Boxelder Creek (two subreaches), and Elk Creek. Stratigraphic records and resulting long-term flood chronologies, locally extending more than 2,000 years, were combined with observed and adjusted peak-flow values (gaged records) and historical flood information to derive flood-frequency estimates for the six study reaches. Results indicate that (1) floods as large as and even substantially larger than 1972 have affected most of the study reaches, and (2) incorporation of the paleohydrologic information substantially reduced uncertainties in estimating flood recurrence. Canyons within outcrops of Paleozoic rocks along the eastern flanks of the Black Hills provided excellent environments for (1) deposition and preservation of stratigraphic sequences of late-Holocene flood deposits, primarily in protected slack-water settings flanking the streams; and (2) hydraulic analyses for determination of associated flow magnitudes. The bedrock canyons ensure long-term stability of channel and valley geometry, thereby increasing confidence in hydraulic computations of ancient floods from modern channel geometry. Stratigraphic records of flood sequences, in combination with deposit dating by radiocarbon, optically stimulated luminescence, and cesium-137, provided paleoflood chronologies for 29 individual study sites. Flow magnitudes were estimated from elevations of flood deposits in conjunction with hydraulic calculations based on modern channel and valley geometry. Reach-scale paleoflood chronologies were interpreted for each study reach, which generally entailed correlation of flood evidence among multiple sites, chiefly based on relative position within stratigraphic sequences, unique textural characteristics, or results of age dating and flow estimation. The FLDFRQ3 and PeakfqSA analytical models (assuming log-Pearson Type III frequency distributions) were used for flood-frequency analyses for as many as four scenarios: (1) analysis of gaged records only; (2) gaged records with historical information; (3) all available data including gaged records, historical flows, paleofloods, and perception thresholds; and (4) the same as the third scenario, but ?top fitting? the distribution using only the largest 50 percent of gaged peak flows. The PeakfqSA model is most consistent with procedures adopted by most Federal agencies for flood-frequency analysis and thus was (1) used for comparisons among results for study reaches, and (2) considered by the authors as most appropriate for general applications of estimating low-probability flood recurrence. The detailed paleoflood investigations indicated that in the last 2,000 years all study reaches have had multiple large floods substantially larger than in gaged records. For Spring Creek, stratigraphic records preserved a chronology of at least five paleofloods in approximately (~) 1,000 years approaching or exceeding the 1972 flow of 21,800 cubic feet per second (ft3/s). The largest was ~700 years ago with a flow range of 29,300-58,600 ft3/s, which reflects the uncertainty regarding flood-magnitude estimates that was incorporated in the flood-frequency analyses. In the lower reach of Rapid Creek (downstream from Pactola Dam), two paleofloods in ~1,000 years exceeded the 1972 flow of 31,200 ft3/s. Those occurred ~440 and 1,000 years ago, with flows of 128,000-256,000 and 64,000-128,000 ft3/s, respectively. Five smaller paleofloods of 9,500-19,000 ft3/s occurred between ~200 and 400 years ago. In the upper reach of Rapid Creek (above Pactola Reservoir), the largest recorded floods are substantially smaller than for lower Rapid Creek and all other study reaches. Paleofloods of ~12,900 and 12,000 ft3/s occurred ~1,000 and 1,500 years ago. One additional paleoflood (~800 years ago) was similar in magnitude to the largest gaged flow of 2,460 ft3/s Boxelder Creek was treated as having two subreaches because of two tributaries that affect peak flows. During the last ~1,000 years, paleofloods of ~39,000-78,000 ft3/s and 40,000-80,000 ft3/s in the upstream subreach have exceeded the 1972 peak flow of 30,800 ft3/s. One other paleoflood was similar to the second largest gaged flow (16,400 ft3/s in 1907). For the downstream subreach, paleofloods of 61,300-123,000 ft3/s and 52,500-105,000 ft3/s in the last ~1,000 years have substantially exceeded the 1972 flood (50,500 ft3/s). Four additional paleofloods had flows between 14,200 and 33,800 ft3/s. The 1972 flow on Elk Creek (10,400 ft3/s) has been substantially exceeded at least five times in the last 1,900 years. The largest paleoflood (41,500-124,000 ft3/s) was ~900 years ago. Three other paleofloods between 37,500 and 120,000 ft3/s occurred between 1,100 and 1,800 years ago. A fifth paleoflood of 25,500-76,500 ft3/s was ~750 years ago. Considering analyses for all available data (PeakfqSA model) for all six study reaches, the 95-percent confidence intervals about the low-probability quantile estimates (100-, 200-, and 500-year recurrence intervals) were reduced by at least 78 percent relative to those for the gaged records only. In some cases, 95-percent uncertainty intervals were reduced by 99 percent or more. For all study reaches except the two Boxelder Creek subreaches, quantile estimates for these long-term analyses were larger than for the short-term analyses. The 1972 flow for the Spring Creek study reach (21,800 ft3/s) corresponds with a recurrence interval of ~400 years. Recurrence intervals are ~500 years for the 1972 flood magnitudes along the lower Rapid Creek reach and the upstream subreach of Boxelder Creek. For the downstream subreach of Boxelder Creek, the large 1972 flood magnitude (50,500 ft3/s) exceeds the 500-year quantile estimate by about 35 percent. The recurrence interval of ~100 years for 1972 flooding along the Elk Creek study reach is small relative to other study reaches along the eastern margin of the Black Hills. All of the paleofloods plot within the bounds of a national envelope curve, indicating that the national curve represents exceedingly rare floods for the Black Hills area. Elk Creek, lower Rapid Creek, and the downstream subreach of Boxelder Creek all have paleofloods that plot above a regional envelope curve; in the case of Elk Creek, by a factor of nearly two. The Black Hills paleofloods represent some of the largest known floods, relative to drainage area, for the United States. Many of the other largest known United States floods are in areas with physiographic and climatologic conditions broadly similar to the Black Hills-semiarid and rugged landscapes that intercept and focus heavy precipitation from convective storm systems. The 1972 precipitation and runoff patterns, previous analyses of peak-flow records, and the paleoflood investigations of this study support a hypothesis of distinct differences in flood generation within the central Black Hills study area. The eastern Black Hills are susceptible to intense orographic lifting associated with convective storm systems and also have high relief, thin soils, and narrow and steep canyons-factors favoring generation of exceptionally heavy rain-producing thunderstorms and promoting runoff and rapid concentration of flow into stream channels. In contrast, storm potential is smaller in and near the Limestone Plateau area, and storm runoff is further reduced by substantial infiltration into the limestone, gentle topography, and extensive floodplain storage. Results of the paleoflood investigations are directly applicable only to the specific study reaches and in the case of Rapid Creek, only to pre-regulation conditions. Thus, approaches for broader applications were developed from inferences of overall flood-generation processes, and appropriate domains for application of results were described. Example applications were provided by estimating flood quantiles for selected streamgages, which also allowed direct comparison with results of at-site flood-frequency analyses from a previous study. Several broad issues and uncertainties were examined, including potential biases associated with stratigraphic records that inherently are not always complete, uncertainties regarding statistical approaches, and the unknown applicability of paleoflood records to future watershed conditions. The results of the paleoflood investigations, however, provide much better physically based information on low-probability floods than has been available previously, substantially improving estimates of the magnitude and frequency of large floods in these basins and reducing associated uncertainty.

Potential of two submontane broadleaved species (Acer opalus, Quercus pubescens) to reveal spatiotemporal patterns of rockfall activity

NASA Astrophysics Data System (ADS)

Favillier, Adrien; Lopez-Saez, Jérôme; Corona, Christophe; Trappmann, Daniel; Toe, David; Stoffel, Markus; Rovéra, Georges; Berger, Frédéric

2015-10-01

Long-term records of rockfalls have proven to be scarce and typically incomplete, especially in increasingly urbanized areas where inventories are largely absent and the risk associated with rockfall events rises proportionally with urbanization. On forested slopes, tree-ring analyses may help to fill this gap, as they have been demonstrated to provide annually-resolved data on past rockfall activity over long periods. Yet, the reconstruction of rockfall chronologies has been hampered in the past by the paucity of studies that include broadleaved tree species, which are, in fact, quite common in various rockfall-prone environments. In this study, we test the sensitivity of two common, yet unstudied, broadleaved species - Quercus pubescens Willd. (Qp) and Acer opalus Mill. (Ao) - to record rockfall impacts. The approach is based on a systematic mapping of trees and the counting of visible scars on the stem surface of both species. Data are presented from a site in the Vercors massif (French Alps) where rocks are frequently detached from Valanginian limestone and marl cliffs. We compare recurrence interval maps obtained from both species and from two different sets of tree structures (i.e., single trees vs. coppice stands) based on Cohen's k coefficient and the mean absolute error. A total of 1230 scars were observed on the stem surface of 847 A. opalus and Q. pubescens trees. Both methods yield comparable results on the spatial distribution of relative rockfall activity with similar downslope decreasing recurrence intervals. Yet recurrence intervals vary significantly according to tree species and tree structure. The recurrence interval observed on the stem surface of Q. pubescens exceeds that of A. opalus by > 20 years in the lower part of the studied plot. Similarly, the recurrence interval map derived from A. opalus coppice stands, dominant at the stand scale, does not exhibit a clear spatial pattern. Differences between species may be explained by the bark thickness of Q. pubescens, which has been demonstrated to grow at twice the rate of A. opalus, thus constituting a mechanical barrier that is able to buffer low energy rockfalls and thus can avoid damage to the underlying tissues. The reasons for differences between tree structures are related to the clustered coppice-specific spatial stem distribution in clumps that could result on one hand in bigger gaps between clumps, which in turn decreases the probability of tree impacts for traveling blocks. On the other hand, data also indicate that several scars on the bark of coppice stands may stem from the same impact and thus may lead to an overestimation of rockfall activity.

AMERICAN ASSOCIATION OF CLINICAL ENDOCRINOLOGISTS AND AMERICAN COLLEGE OF ENDOCRINOLOGY DISEASE STATE CLINICAL REVIEW: DIAGNOSIS OF RECURRENCE IN CUSHING DISEASE.

PubMed

Fleseriu, Maria; Hamrahian, Amir H; Hoffman, Andrew R; Kelly, Daniel F; Katznelson, Laurence

2016-12-01

Recurrence of hypercortisolemia after initial treatment of Cushing disease (CD) is more common than previously thought, with a third of patients suffering a recurrence over their lifetime. Awareness of this high rate and delayed timeline (sometimes decades) of potential recurrence is critical and patients with CD should be monitored at regular intervals throughout their lives. In this manuscript, we review the complex evaluation needed for defining CD remission versus persistent disease after surgery, and focus on challenges in diagnosing early recurrent hypercortisolemia. Late night salivary cortisol appears to be an earlier predictor of recurrence when compared with urinary free cortisol (UFC) excretion. We also review the criteria suggested to define recurrence of hypercortisolemia in patients treated with medical therapy. Further research is needed to determine the optimal way to evaluate a patient with CD recurrence as well as the riskbenefit ratio of treatment in early, mild recurrent disease. ACTH = adrenocorticotropic hormone AI = adrenal insufficiency CD = Cushing disease CDDT = coupled dexamethasone desmopressin test CR = circadian rhythm CRH = corticotropin-releasing hormone GC = glucocorticoid GCR = global clinical response HPA = hypothalamic-pituitary-adrenal LDDST = low-dose dexamethasone suppression test LNSC = late-night salivary cortisol ODST = overnight dexamethasone suppression test TSS = trans-sphenoidal surgery.

Eribulin mesylate (halichondrin B Analog E7389) in platinum-resistant and platinum-sensitive ovarian cancer: a two-cohort, phase II study

PubMed Central

Hensley, Martee L.; Kravetz, Sara; Jia, Xiaoyu; Iasonos, Alexia; Tew, William; Pereira, Lauren; Sabbatini, Paul; Whalen, Christin; Aghajanian, Carol A.; Zarwan, Corinne; Berlin, Suzanne

2011-01-01

Background Eribulin mesylate is a tubulin inhibitor with activity superior to paclitaxel in NIH:OVCAR-3 human epithelial ovarian cancer xenograft models. We sought to assess the efficacy of eribulin in platinum-resistant and platinum-sensitive recurrent ovarian cancer. Methods Patients with recurrent measurable epithelial ovarian cancer, ≤2 prior cytotoxic regimens, and adequate organ function were enrolled into two separate cohorts: 1) Platinum resistant (progression-free interval from last platinum-based therapy <6 months); and 2) Platinum sensitive (progression-free interval from last platinum-based therapy ≥6 months). Treatment: Eribulin 1.4 mg/m2 over 15 minutes by vein on days 1 and 8, every 21 days. Efficacy was determined by objective response by computed tomography. Results Platinum-resistant cohort: Thirty-seven patients enrolled. Thirty-six patients were evaluable for response and toxicity. Two patients achieved partial response (PR, 5.5%). Sixteen (44%) had a best response of stable disease. Median progression-free survival was 1.8 months (95% confidence interval, 1.4–2.8 months). Platinum-sensitive cohort: Thirty-seven patients enrolled, and all were evaluable for response. Seven patients achieved partial response (PR, 19%). Median progression-free survival was 4.1 months (95% confidence interval, 2.8–5.8 months). The major toxicity was grade 3 or 4 neutropenia (42% in platinum-resistant patients; 54% in platinum-sensitive patients). Conclusions Eribulin achieved objective response in 5.5% of women with platinum-resistant recurrent ovarian cancer and in 19% of women with platinum-sensitive disease. Median progression-free survival was 1.8 months in the platinum-resistant group and 4.1 months in the platinum-sensitive group. PMID:21935916

Patterns of Recurrence After Low-Dose-Rate Prostate Brachytherapy: A Population-Based Study of 2223 Consecutive Low- and Intermediate-Risk Patients

DOE Office of Scientific and Technical Information (OSTI.GOV)

Lo, Andrea C.; Morris, W. James, E-mail: JMorris@bccancer.bc.ca; Pickles, Tom

Objectives: This study examined patterns of recurrence after low–dose-rate prostate brachytherapy (LDR-PB), estimated local recurrence rate and compared that rate to the estimated local recurrence rate after radical prostatectomy (RP). Methods and Materials: A prospective database was maintained with clinical, dosimetric, and outcome data for all LDR-PB implantation procedures performed at our institution. From 1998 to 2008, 2223 patients with prostate cancer received LDR-PB without supplemental external beam radiation therapy. Patients who developed Phoenix-defined biochemical failure were reviewed for sites of relapse and investigations completed. Results: At a median follow-up of 5 years, 108 of 2223 patients (4.8%) developed biochemical relapse.more » In 1 additional patient, local relapse was found on transurethral prostate resection, but his prostate-specific antigen concentration was well short of triggering Phoenix-defined failure. Of the 109 patients with disease relapse, 18 of 2223 (0.8%) had a proven local recurrence, and 30 of 2223 (1.3%) had a proven distant recurrence. The remaining 61 of 2223 patients (2.7%) had unidentified sites of recurrence; of these, 57 patients (93%) had digital rectal examinations (DREs), 18 (30%) had post-treatment biopsies, 45 (74%) had bone scans, and 34 (56%) had computed tomography imaging of the abdomen and pelvis. If every biochemical failure were local, the local recurrence rate would be as high as 4.9%; however, by excluding those with proven distant failure and those with both a negative DRE and biopsy, we estimate that the local recurrence rate is 2.7% or less. Conclusions: In the context of limitations of the study design, our population-based analysis indicates that the local recurrence rate after LDR-PB is as low or lower than that after RP in our jurisdiction.« less

Estimating peak discharges, flood volumes, and hydrograph shapes of small ungaged urban streams in Ohio

USGS Publications Warehouse

Sherwood, J.M.

1986-01-01

Methods are presented for estimating peak discharges, flood volumes and hydrograph shapes of small (less than 5 sq mi) urban streams in Ohio. Examples of how to use the various regression equations and estimating techniques also are presented. Multiple-regression equations were developed for estimating peak discharges having recurrence intervals of 2, 5, 10, 25, 50, and 100 years. The significant independent variables affecting peak discharge are drainage area, main-channel slope, average basin-elevation index, and basin-development factor. Standard errors of regression and prediction for the peak discharge equations range from +/-37% to +/-41%. An equation also was developed to estimate the flood volume of a given peak discharge. Peak discharge, drainage area, main-channel slope, and basin-development factor were found to be the significant independent variables affecting flood volumes for given peak discharges. The standard error of regression for the volume equation is +/-52%. A technique is described for estimating the shape of a runoff hydrograph by applying a specific peak discharge and the estimated lagtime to a dimensionless hydrograph. An equation for estimating the lagtime of a basin was developed. Two variables--main-channel length divided by the square root of the main-channel slope and basin-development factor--have a significant effect on basin lagtime. The standard error of regression for the lagtime equation is +/-48%. The data base for the study was established by collecting rainfall-runoff data at 30 basins distributed throughout several metropolitan areas of Ohio. Five to eight years of data were collected at a 5-min record interval. The USGS rainfall-runoff model A634 was calibrated for each site. The calibrated models were used in conjunction with long-term rainfall records to generate a long-term streamflow record for each site. Each annual peak-discharge record was fitted to a Log-Pearson Type III frequency curve. Multiple-regression techniques were then used to analyze the peak discharge data as a function of the basin characteristics of the 30 sites. (Author 's abstract)

Long-term outcome of patients with acute cholecystitis receiving antibiotic treatment: a retrospective cohort study.

PubMed

Wang, Chih-Hung; Chou, Hao-Chang; Liu, Kao-Lang; Lien, Wan-Ching; Wang, Hsiu-Po; Wu, Yao-Ming

2014-02-01

Few studies have followed patients who received antibiotic treatment for acute cholecystitis (AC). The present retrospective study investigated recurrence rates of AC and analyzed factors associated with recurrence after antibiotic treatment in adult AC patients. We analyzed patients treated with antibiotics for AC between October 1, 2004, and November 30, 2010. A Cox proportional hazards model was used to identify factors associated with early recurrence. Generalized additive models were applied to detect the nonlinear effects of continuous covariates. The study included 226 patients (mean age: 62.2 years; 144 men [63.7 %]). The average duration of parenteral antibiotics was 8.0 days. Second-generation cephalosporins were administered to 199 patients (88.1 %). The Kaplan-Meier plot indicated that recurrences were more frequent within 100 days of AC; these were defined as early recurrences. The recurrence rate was 13.7 % (31/226) at a median follow-up of 308.5 days (early recurrences: 19/226 [8.4 %]). The duration of parenteral antibiotic use significantly correlated with early recurrence (hazard ratio: 0.83; 95 % confidence interval, 0.73-0.95; p = 0.005). Generalized additive models revealed that patients using parenteral antibiotics longer than 8 days were less likely to suffer from early recurrence. The rate of recurrence of AC in patients who received antibiotics alone was low. The recurrence rate was higher within 100 days of AC. Because of the inherent limitations of a retrospective study, further research is needed to identify factors associated with early recurrence.

Late quaternary paleoseismology of the southern Steens fault zone, northern Nevada

USGS Publications Warehouse

Personius, S.F.; Crone, A.J.; Machette, M.N.; Mahan, S.A.; Kyung, J.B.; Cisneros, H.; Lidke, D.J.

2007-01-01

The 192-km-long Steens fault zone is the most prominent normal fault system in the northern Basin and Range province of western North America. We use trench mapping and radiometric dating to estimate displacements and timing of the last three surface-rupturing earthquakes (E1-E3) on the southern part of the fault south of Denio, Nevada. Coseismic displacements range from 1.1 to 2.2 ?? 0.5 m, and radiometric ages indicate earthquake times of 11.5 ?? 2.0 ka (E3), 6.1 ?? 0.5 ka (E2), and 4.6 ?? 1.0 ka (E1). These data yield recurrence intervals of 5.4 ?? 2.1 k.y. between E3 and E2, 1.5 ?? 1.1 k.y. between E2 and E1, and an elapsed time of 4.6 ?? 1.0 k.y. since E1. The recurrence data yield variable interval slip rates (between 0.2 ?? 0.22 and 1.5 ?? 2.3 mm/yr), but slip rates averaged over the past ???18 k.y. (0.24 ?? 0.06 mm/year) are similar to long-term (8.5-12.5 Ma) slip rates (0.2 ?? 0.1 mm /yr) measured a few kilometers to the north. We infer from the lack of significant topographic relief across the fault in Bog Hot Valley that the fault zone is propagating southward and may now be connected with a fault at the northwestern end of the Pine Forest Range. Displacements documented in the trench and a rupture length of 37 km indicate a history of three latest Quaternary earthquakes with magnitudes of M 6.6-7.1 on the southern part of the Steens fault zone.

Flood of July 12-13, 2004, Burlington and Camden Counties, South-Central New Jersey

USGS Publications Warehouse

Protz, Amy R.; Reed, Timothy J.

2006-01-01

Intense rainfall inundated south-central New Jersey on July 12-13, 2004, causing major flooding with heavy property, road, and bridge damage in Burlington and Camden Counties. Forty-five dams were topped or damaged, or failed completely. The affected areas were in the Rancocas Creek, Cooper River, and Pennsauken Creek Basins. The U.S. Geological Survey (USGS) documented peak stream elevations and flows at 56 selected sites within the affected area. With rainfall totals averaging more than 6 inches throughout the three basins, peak-of-record flood elevations and streamflows occurred at all but one USGS stream gage, where the previous record was tied. Flood-frequency recurrence-intervals ranged from 30 to greater than 100 years and maximum streamflow per square mile ranged from 13.9 to 263 cubic feet per second per square mile (ft3/s/mi2). Peak streamflow at USGS stream gages surrounding the affected basins are associated with considerably lower recurrence intervals and demonstrate the limited extent of the flood. A high tide of about 1 foot above monthly mean high tide did not contribute to high-water conditions. Low ground-water levels prior to the rainfall helped to mitigate flooding in the affected basins. Compared with historical floods in the Rancocas Creek Basin during 1938-40, the July 2004 flood had greater streamflow, but lower stream elevations. Property damage from the event was estimated at $50 million. Governor James E. McGreevy declared a State of Emergency in Burlington and Camden Counties on July 13, 2004. After assessment of the damage by the Federal Emergency Management Agency (FEMA), President George W. Bush declared Burlington and Camden Counties disaster areas on July 16, 2004.

Low-flow characteristics of streams in South Carolina

USGS Publications Warehouse

Feaster, Toby D.; Guimaraes, Wladmir B.

2017-09-22

An ongoing understanding of streamflow characteristics of the rivers and streams in South Carolina is important for the protection and preservation of the State’s water resources. Information concerning the low-flow characteristics of streams is especially important during critical flow periods, such as during the historic droughts that South Carolina has experienced in the past few decades.Between 2008 and 2016, the U.S. Geological Survey, in cooperation with the South Carolina Department of Health and Environmental Control, updated low-flow statistics at 106 continuous-record streamgages operated by the U.S. Geological Survey for the eight major river basins in South Carolina. The low-flow frequency statistics included the annual minimum 1-, 3-, 7-, 14-, 30-, 60-, and 90-day mean flows with recurrence intervals of 2, 5, 10, 20, 30, and 50 years, depending on the length of record available at the streamflow-gaging station. Computations of daily mean flow durations for the 5-, 10-, 25-, 50-, 75-, 90-, and 95-percent probability of exceedance also were included.This report summarizes the findings from publications generated during the 2008 to 2016 investigations. Trend analyses for the annual minimum 7-day average flows are provided as well as trend assessments of long-term annual precipitation data. Statewide variability in the annual minimum 7-day average flow is assessed at eight long-term (record lengths from 55 to 78 years) streamgages. If previous low-flow statistics were available, comparisons with the updated annual minimum 7-day average flow, having a 10-year recurrence interval, were made. In addition, methods for estimating low-flow statistics at ungaged locations near a gaged location are described.

Pathologic Response, When Increased by Longer Interval, Is a Marker but Not the Cause of Good Prognosis in Rectal Cancer: 17-year Follow-up of the Lyon R90-01 Randomized Trial

DOE Office of Scientific and Technical Information (OSTI.GOV)

Cotte, Eddy, E-mail: eddy.cotte@chu-lyon.fr; Lyon 1 University, EMR 3738, Lyon-Sud/Charles Mérieux Medical University, Oullins; Passot, Guillaume

Purpose: The Lyon R90-01 randomized trial investigated whether the interval between preoperative radiation therapy and surgery influenced rectal cancer outcome. Long-term results are reported here after a median follow-up of 17 years. Methods and Materials: Between February 1991 and December 1995, 210 patients from 29 French centers were randomly assigned (ratio of 1:1) to groups that waited either 2 weeks (short interval [SI]) or 6 to 8 weeks (long interval [LI]) between neoadjuvant radiation therapy and surgery. The primary endpoint was sphincter-preserving surgery. Results: LI group showed a better pathologic response (complete response or few residual cells) after radiation therapy than the SImore » group (26% vs 10.3%, P=.015). A better pathologic response was associated in multivariate analysis with significant improvement of overall survival (pT: P=.0293 and pN: P=.0048) but it was irrespective of the interval duration. The median follow-up was 17.2 years. The 5-, 10-, 15-, and 17-year overall survival rates were, respectively, 66.8%, 48.7%, 40.0%, and 34.0% for the SI group and, respectively, 67.1%, 53.5%, 41.9%, and 34.0% for the LI group. There were no significant differences between groups in terms of survival (P=.7656) or local recurrence rates (SI: 14.4% vs LI: 12.1%, respectively; P=.6202). Of 24 local disease recurrences, 20 (83%) occurred during the first 2 postoperative years, and all but one (96%) occurred during the first 5 postoperative years. The rate of second new malignancies was 9.4% (19 patients). Conclusions: The radiation-induced sterilization rate of the preoperative cancer specimen was a marker of good prognosis. The interval duration (the treatment being the same) although it is modifying the sterilization rate has no impact on survival. Radiation therapy did not postpone local recurrence, because the rate of local relapse after 5 years was low. Radiation-induced cancers after radiation therapy were unusual and should not influence treatment decisions in adults.« less

Joint scale-change models for recurrent events and failure time.

PubMed

Xu, Gongjun; Chiou, Sy Han; Huang, Chiung-Yu; Wang, Mei-Cheng; Yan, Jun

2017-01-01

Recurrent event data arise frequently in various fields such as biomedical sciences, public health, engineering, and social sciences. In many instances, the observation of the recurrent event process can be stopped by the occurrence of a correlated failure event, such as treatment failure and death. In this article, we propose a joint scale-change model for the recurrent event process and the failure time, where a shared frailty variable is used to model the association between the two types of outcomes. In contrast to the popular Cox-type joint modeling approaches, the regression parameters in the proposed joint scale-change model have marginal interpretations. The proposed approach is robust in the sense that no parametric assumption is imposed on the distribution of the unobserved frailty and that we do not need the strong Poisson-type assumption for the recurrent event process. We establish consistency and asymptotic normality of the proposed semiparametric estimators under suitable regularity conditions. To estimate the corresponding variances of the estimators, we develop a computationally efficient resampling-based procedure. Simulation studies and an analysis of hospitalization data from the Danish Psychiatric Central Register illustrate the performance of the proposed method.

Geology and radiocarbon ages of Tláloc, Tlacotenco, Cuauhtzin, Hijo del Cuauhtzin, Teuhtli, and Ocusacayo monogenetic volcanoes in the central part of the Sierra Chichinautzin, México

NASA Astrophysics Data System (ADS)

Siebe, Claus; Arana-Salinas, Lilia; Abrams, Michael

2005-03-01

Tláloc, Tlacotenco, Cuauhtzin, Hijo del Cuauhtzin, Teuhtli, and Ocusacayo monogenetic volcanoes located within the Sierra del Chichinautzin Volcanic Field (SCVF) at the southern margin of Mexico City were studied to further refine attendant volcanic hazards in this heavily populated region. Based on fieldwork and Landsat imagery interpretation, a geologic map was produced, morphometric parameters characterizing the cones and lava flows were determined, and the areal extent and volumes of erupted products were estimated. The longest lava flow was produced by Tlacotenco and reached 9.5 km from its source; total areas covered by lava flows from each eruption range between 12.8 km 2 (Tlacotenco) and 54.4 km 2 (Tláloc); and total erupted volumes range between 0.26 and 1.36 km 3 per volcano. Radiocarbon measurements of a paleosol underneath an ash layer from the Tláloc scoria cone yielded an age of 6200 years BP, while charcoal found within block-and-ash flow and lahar deposits from Cuauhtzin dome yielded ages of 7360 and 8225 years BP, respectively. The Tlacotenco dacite lava flow overlies Popocatépetl's Tutti Frutti Plinian pumice fall deposit dated at 14,000 years BP and is therefore younger than this prominent stratigraphic marker. On the other hand, Teuhtli and Hijo del Cuauhtzin scoria cones and the Ocusacayo andesite lava flows are overlain by the Tutti Frutti and therefore older than 14,000 years BP. These new dates together with other published dates for scoria cones in the SCVF imply that the previously determined recurrence interval during the Holocene for monogenetic eruptions in the SCVF of <1700 years [Siebe, C., Rodríguez-Lara, V., Schaaf, P., Abrams, M., 2004a. Radiocarbon ages of Holocene Pelado, Guespalapa, and Chichinautzin scoria cones, south of Mexico_City: implications for archaeology and future hazards. Bull. Volcanol. 66, 203-225.] needs to be corrected to <1250 years. This means that the time of quiescence since the last eruption of the SCVF (1670 years BP) exceeds that of the estimated recurrence interval during the Holocene.

Subaqueous Tsunami Deposits from Ohtsuchi Bay of Sanriku Coast, North Eastern Japan

NASA Astrophysics Data System (ADS)

Haraguchi, T.; Fujiwara, O.; Shimazaki, K.

2005-12-01

Holocene tsunami history was analyzed by using a drilling core obtained from the Ohtsuchi Bay on the Sanriku coast, Pacific side of NE Japan. The saw-tooth Sanriku coast line, facing the Japan Trench, is well known for repeated suffers from the historical great tsunamis. The worst tsunami damage in Japanese history, more than 20,000 fatalities, by the AD1896 Meiji Sanriku Tsunami (M 8 1/2) centered off Sanriku was recorded from this coast. However, the geological records of ancient tsunami such as tsunami deposits have been rarely reported from the Sanriku coast.Reconstruction of the pale-tsunami history including the recurrence interval is fundamental data for the tsunami disaster mitigation on the coast. The core, 24-meter long, obtained from a bay center of 10 m-deep is mainly composed of sandy mud excluding the basal gravel bed (core bottom reached SL-34 m). Sand and gravelly sand beds ranging from several to 200 cm-thick are intercalated in the core and denoted TS-22 to TS-1 in ascending order. Most of these coarse-grained beds have evidences of deposition from high-energy and density currents, basal erosion surface, rip-up clasts mixed mulluscan shells, inverse- and normal grading, and generally upward-fining sequence.Most likely origin of these event deposits is great tsunami, because the coring site is a deep and low energy bay floor isolated from major river mouth. Low sediment supply by river floods and small disturbance by wind waves at the drilling site are favorable for the preservation of tsunami deposits. Depositional ages of TS-1 to TS-22 were estimated from a depositional curve of the core based on ten 14C ages of marine shells. Recurrence interval of 13 sand and gravel beds in the lower part of the core, TS22 (ca. 7800 cal BP) to TS-10 (AD1660-1700), is 400 to 500 years.The number of event beds in the upper part of the core, deposited during the last 400 years (TS-9 to TS-1), approximates to that of historic large tsunamis recorded around the Ohtsuchi Bay (13-14 times).Remarkable differences of the recurrence intervals of event deposits between the lower and upper parts of the core reflects the change of sediment supply system and preservation potential of the event deposits.Identification of tsunami deposits from other deposits such as river flood and storm deposits is problem to be solved for reconstructing the accurate tsunami history on the Sanriku coast.

Low-flow frequency and flow duration of selected South Carolina streams in the Savannah and Salkehatchie River Basins through March 2014

USGS Publications Warehouse

Feaster, Toby D.; Guimaraes, Wladmir B.

2016-07-14

An ongoing understanding of streamflow characteristics of the rivers and streams in South Carolina is important for the protection and preservation of the State’s water resources. Information concerning the low-flow characteristics of streams is especially important during critical flow periods, such as during the historic droughts that South Carolina has experienced in the past few decades.In 2008, the U.S. Geological Survey, in cooperation with the South Carolina Department of Health and Environmental Control, initiated a study to update low-flow statistics at continuous-record streamgaging stations operated by the U.S. Geological Survey in South Carolina. This report presents the low-flow statistics for 28 selected streamgaging stations in the Savannah and Salkehatchie River Basins in South Carolina. The low-flow statistics include daily mean flow durations for the 5-, 10-, 25-, 50-, 75-, 90-, and 95-percent probability of exceedance and the annual minimum 1-, 3-, 7-, 14-, 30-, 60-, and 90-day mean flows with recurrence intervals of 2, 5, 10, 20, 30, and 50 years, depending on the length of record available at the streamgaging station. The low-flow statistics were computed from records available through March 31, 2014.Low-flow statistics are influenced by length of record, hydrologic regime under which the data were collected, analytical techniques used, and other factors, such as urbanization, diversions, and droughts that may have occurred in the basin. To assess changes in the low-flow statistics from the previously published values, a comparison of the low-flow statistics for the annual minimum 7-day average streamflow with a 10-year recurrence interval (7Q10) from this study was made with the most recently published values. Of the 28 streamgaging stations for which recurrence interval computations were made, 14 streamgaging stations were suitable for comparing to low-flow statistics that were previously published in U.S. Geological Survey reports. These comparisons indicated that seven of the streamgaging stations had values lower than the previous values, two streamgaging stations had values higher than the previous values, and two streamgaging stations had values that were unchanged from previous values. The remaining three stations for which previous 7Q10 values were computed, which are located on the main stem of the Savannah River, were not compared with current estimates because of differences in the way the pre-regulation and regulated flow data were analyzed.

Intraperitoneal chemotherapy for advanced ovarian and peritoneal cancers in patients following interval debulking surgery or primary cytoreductive surgery: Tom Baker Cancer Centre experience from 2006 to 2009.

PubMed

Nelson, Gregory; Lucero, Carlos Aspe; Chu, Pamela; Nation, Jill; Ghatage, Prafull

2010-03-01

To describe our experience with cisplatin- and paclitaxel-based IP chemotherapy in patients treated initially with either neoadjuvant chemotherapy and interval debulking surgery (IDS) or primary cytoreductive surgery (PCRS). We performed a retrospective review of the records of 67 patients (38 IDS, 29 PCRS) enrolled in the intraperitoneal (IP) chemotherapy program at the Tom Baker Cancer Centre between 2006 and 2009. Information pertaining to patient demographics, IP chemotherapy toxicity, and catheter complications was extracted, and the median time to recurrence was calculated. Most patients in the study were aged 50 to 70 years and had a diagnosis of stage III serous ovarian cancer. Overall, 295/393 IP cycles (75%) were successfully administered. The proportion of patients completing six cycles of chemotherapy in the IDS and PCRS groups was 53% and 59%, respectively. Frequent (> 25%) Grade 1 to 2 chemotherapy toxicities included fatigue, peripheral neuropathy, and nausea. Catheter complications were observed in 34% of patients (23/67). The recurrence rates for patients completing four or more cycles of IP chemotherapy in the IDS and PCRS groups were 58% and 35%, respectively, with the median time to recurrence approximately one year. Although IP chemotherapy is well tolerated in both IDS and PCRS patients, the median time to recurrence is shorter than expected.

Meta-analysis of randomized controlled trials comparing 17α-hydroxyprogesterone caproate and vaginal progesterone for the prevention of recurrent spontaneous preterm delivery.

PubMed

Oler, Elizabeth; Eke, Ahizechukwu C; Hesson, Ashley

2017-07-01

Vaginal progesterone and 17α-hydroxyprogesterone (17α-OHP) are both used to prevent preterm delivery in women who have experienced spontaneous preterm delivery (SPTD) previously. Randomized trial data of the comparative effectiveness of these interventions have been mixed. To compare the efficacy of intramuscular 17α-OHP and vaginal progesterone in the prevention of recurrent SPTD. Cochrane Central Register of Controlled Trials, African Journals Online, Embase, Google Scholar, ISI Web of Science, LILACS, CINAHL, PubMed, and registers of ongoing trials were searched using keywords related to 17α-OHP, vaginal progesterone, and preterm delivery. Randomized controlled trials published between January 1, 1966, and November 30, 2016, comparing 17α-OHP and vaginal progesterone for the prevention of recurrent SPTD during singleton pregnancies were included. Study data were extracted and meta-analyses were performed when outcomes were comparable. The meta-analyses included data from three randomized trials. Lower rates of SPTD before 34 weeks (relative risk 0.71, 95% confidence interval 0.53-0.95) and before 32 weeks (relative risk 0.62, 95% confidence interval 0.40-0.94) of pregnancy were observed among patients treated with vaginal progesterone. Vaginal progesterone and 17α-OHP were comparable for the prevention of recurrent SPTD in singleton pregnancies; vaginal progesterone could be superior. © 2017 International Federation of Gynecology and Obstetrics.

Assessment of catchments' flooding potential: a physically-based analytical tool

NASA Astrophysics Data System (ADS)

Botter, G.; Basso, S.; Schirmer, M.

2016-12-01

The assessment of the flooding potential of river catchments is critical in many research and applied fields, ranging from river science and geomorphology to urban planning and the insurance industry. Predicting magnitude and frequency of floods is key to prevent and mitigate the negative effects of high flows, and has therefore long been the focus of hydrologic research. Here, the recurrence intervals of seasonal flow maxima are estimated through a novel physically-based analytic approach, which links the extremal distribution of streamflows to the stochastic dynamics of daily discharge. An analytical expression of the seasonal flood-frequency curve is provided, whose parameters embody climate and landscape attributes of the contributing catchment and can be estimated from daily rainfall and streamflow data. Only one parameter, which expresses catchment saturation prior to rainfall events, needs to be calibrated on the observed maxima. The method has been tested in a set of catchments featuring heterogeneous daily flow regimes. The model is able to reproduce characteristic shapes of flood-frequency curves emerging in erratic and persistent flow regimes and provides good estimates of seasonal flow maxima in different climatic regions. Performances are steady when the magnitude of events with return times longer than the available sample size is estimated. This makes the approach especially valuable for regions affected by data scarcity.

Carotid recurrent stenosis and risk of ipsilateral stroke: a systematic review of the literature.

PubMed

Frericks, H; Kievit, J; van Baalen, J M; van Bockel, J H

1998-01-01

The main goal of follow-up after carotid endarterectomy is to prevent new strokes caused by recurrent stenosis. To determine the most cost-effective follow-up schedule, it is necessary to know the incidence of recurrent stenosis and the risk of stroke it carries. A systematic review of the literature was performed using standard meta-analytical techniques. Incidence of recurrent stenosis: The data were very heterogeneous. The risk of recurrent stenosis was 10% in the first year, 3% in the second, and 2% in the third. Long-term risk of recurrent stenosis is about 1% per year. Risk of stroke: The reported relative risks of stroke in patients with recurrent stenosis compared with patients without recurrent stenosis showed extreme heterogeneity and ranged from 10 to 0.10. The random effects summary estimator of relative risk was 1.88. The data were very heterogeneous, and much better data are needed to arrive at truly reliable estimates of these important parameters of follow-up. It is clear, though, that the risk of recurrent stenosis is highest in the first few years after carotid endarterectomy and very low in later years. By use of general decision-analytic arguments, it can be argued that, given the test characteristics of carotid ultrasound, a small number of tests can be done in the first few years and that testing for restenosis should not be done after 4 years.

Comparing interval estimates for small sample ordinal CFA models

PubMed Central

Natesan, Prathiba

2015-01-01

Robust maximum likelihood (RML) and asymptotically generalized least squares (AGLS) methods have been recommended for fitting ordinal structural equation models. Studies show that some of these methods underestimate standard errors. However, these studies have not investigated the coverage and bias of interval estimates. An estimate with a reasonable standard error could still be severely biased. This can only be known by systematically investigating the interval estimates. The present study compares Bayesian, RML, and AGLS interval estimates of factor correlations in ordinal confirmatory factor analysis models (CFA) for small sample data. Six sample sizes, 3 factor correlations, and 2 factor score distributions (multivariate normal and multivariate mildly skewed) were studied. Two Bayesian prior specifications, informative and relatively less informative were studied. Undercoverage of confidence intervals and underestimation of standard errors was common in non-Bayesian methods. Underestimated standard errors may lead to inflated Type-I error rates. Non-Bayesian intervals were more positive biased than negatively biased, that is, most intervals that did not contain the true value were greater than the true value. Some non-Bayesian methods had non-converging and inadmissible solutions for small samples and non-normal data. Bayesian empirical standard error estimates for informative and relatively less informative priors were closer to the average standard errors of the estimates. The coverage of Bayesian credibility intervals was closer to what was expected with overcoverage in a few cases. Although some Bayesian credibility intervals were wider, they reflected the nature of statistical uncertainty that comes with the data (e.g., small sample). Bayesian point estimates were also more accurate than non-Bayesian estimates. The results illustrate the importance of analyzing coverage and bias of interval estimates, and how ignoring interval estimates can be misleading. Therefore, editors and policymakers should continue to emphasize the inclusion of interval estimates in research. PMID:26579002

Comparing interval estimates for small sample ordinal CFA models.

PubMed

Natesan, Prathiba

2015-01-01

Robust maximum likelihood (RML) and asymptotically generalized least squares (AGLS) methods have been recommended for fitting ordinal structural equation models. Studies show that some of these methods underestimate standard errors. However, these studies have not investigated the coverage and bias of interval estimates. An estimate with a reasonable standard error could still be severely biased. This can only be known by systematically investigating the interval estimates. The present study compares Bayesian, RML, and AGLS interval estimates of factor correlations in ordinal confirmatory factor analysis models (CFA) for small sample data. Six sample sizes, 3 factor correlations, and 2 factor score distributions (multivariate normal and multivariate mildly skewed) were studied. Two Bayesian prior specifications, informative and relatively less informative were studied. Undercoverage of confidence intervals and underestimation of standard errors was common in non-Bayesian methods. Underestimated standard errors may lead to inflated Type-I error rates. Non-Bayesian intervals were more positive biased than negatively biased, that is, most intervals that did not contain the true value were greater than the true value. Some non-Bayesian methods had non-converging and inadmissible solutions for small samples and non-normal data. Bayesian empirical standard error estimates for informative and relatively less informative priors were closer to the average standard errors of the estimates. The coverage of Bayesian credibility intervals was closer to what was expected with overcoverage in a few cases. Although some Bayesian credibility intervals were wider, they reflected the nature of statistical uncertainty that comes with the data (e.g., small sample). Bayesian point estimates were also more accurate than non-Bayesian estimates. The results illustrate the importance of analyzing coverage and bias of interval estimates, and how ignoring interval estimates can be misleading. Therefore, editors and policymakers should continue to emphasize the inclusion of interval estimates in research.

Malignant melanoma of the skin: long-term follow-up and time to first recurrence.

PubMed

Hohnheiser, Annika M; Gefeller, Olaf; Göhl, Jonas; Schuler, Gerold; Hohenberger, Werner; Merkel, Susanne

2011-03-01

Surgical excision can cure most patients with malignant melanoma of the skin. However, the risk of recurrence remains for years. The aim of our study was to identify factors that influence time to recurrence and survival after the first recurrence with a special interest in late recurrences. Data from 2487 patients with malignant melanoma and primary treatment between 1978 and 1997 at the Department of Surgery or the Department of Dermatology, University Hospital Erlangen, Germany, were prospectively collected in the Melanoma Registry of the University Hospital Erlangen. After a median follow-up period of 13 years, overall survival, the time to first recurrence and survival after the first relapse were examined in univariate and multivariate analyses. Overall survival was found to be significantly worse in older patients, men, melanoma of the head or trunk, and melanoma with high pT and pN categories. In 523 patients, relapse from malignant melanoma was observed after a median of 24 months. Among patients with recurrences, young age and low pT and pN categories proved to be independent factors that prolonged the disease-free interval. Advanced age at the time of the recurrence diagnosis, male sex, high pN category, and distant metastases as the first manifestation of recurrence were associated with a poor prognosis after the first recurrence. Although thin lesions have a favorable prognosis, among a cohort with recurrences they showed a relatively high rate of late recurrences. These late recurrences have an extremely poor prognosis when they present with distant metastases.

Techniques for estimating peak-streamflow frequency for unregulated streams and streams regulated by small floodwater retarding structures in Oklahoma

USGS Publications Warehouse

Tortorelli, Robert L.

1997-01-01

Statewide regression equations for Oklahoma were determined for estimating peak discharge and flood frequency for selected recurrence intervals from 2 to 500 years for ungaged sites on natural unregulated streams. The most significant independent variables required to estimate peak-streamflow frequency for natural unregulated streams in Oklahoma are contributing drainage area, main-channel slope, and mean-annual precipitation. The regression equations are applicable for watersheds with drainage areas less than 2,510 square miles that are not affected by regulation from manmade works. Limitations on the use of the regression relations and the reliability of regression estimates for natural unregulated streams are discussed. Log-Pearson Type III analysis information, basin and climatic characteristics, and the peak-stream-flow frequency estimates for 251 gaging stations in Oklahoma and adjacent states are listed. Techniques are presented to make a peak-streamflow frequency estimate for gaged sites on natural unregulated streams and to use this result to estimate a nearby ungaged site on the same stream. For ungaged sites on urban streams, an adjustment of the statewide regression equations for natural unregulated streams can be used to estimate peak-streamflow frequency. For ungaged sites on streams regulated by small floodwater retarding structures, an adjustment of the statewide regression equations for natural unregulated streams can be used to estimate peak-streamflow frequency. The statewide regression equations are adjusted by substituting the drainage area below the floodwater retarding structures, or drainage area that represents the percentage of the unregulated basin, in the contributing drainage area parameter to obtain peak-streamflow frequency estimates.

Natural History of the Post-ablation Esophagus.

PubMed

Reed, Craig C; Shaheen, Nicholas J

2018-04-18

Endoscopic ablative therapy including radiofrequency ablation (RFA) represents the preferred management strategy for dysplastic Barrett's esophagus (BE) and appears to diminish the risk of developing esophageal adenocarcinoma (EAC). Limited data describe the natural history of the post-ablation esophagus. Recent findings demonstrate that recurrent intestinal metaplasia (IM) following RFA is relatively frequent. However, dysplastic BE and EAC subsequent to the complete eradication of intestinal metaplasia (CEIM) are uncommon. Moreover, data suggest that the risk of recurrent disease is probably highest in the first year following CEIM. Recurrent IM and dysplasia are usually successfully eradicated with repeat RFA. Future studies may refine surveillance intervals and inform the length of time surveillance should be conducted following RFA with CEIM. Further data will also be necessary to understand the utility of chemopreventive strategies, including NSAIDs, in reducing the risk of recurrent disease.

Active, capable, and potentially active faults - a paleoseismic perspective

USGS Publications Warehouse

Machette, M.N.

2000-01-01

Maps of faults (geologically defined source zones) may portray seismic hazards in a wide range of completeness depending on which types of faults are shown. Three fault terms - active, capable, and potential - are used in a variety of ways for different reasons or applications. Nevertheless, to be useful for seismic-hazards analysis, fault maps should encompass a time interval that includes several earthquake cycles. For example, if the common recurrence in an area is 20,000-50,000 years, then maps should include faults that are 50,000-100,000 years old (two to five typical earthquake cycles), thus allowing for temporal variability in slip rate and recurrence intervals. Conversely, in more active areas such as plate boundaries, maps showing faults that are <10,000 years old should include those with at least 2 to as many as 20 paleoearthquakes. For the International Lithosphere Programs' Task Group II-2 Project on Major Active Faults of the World our maps and database will show five age categories and four slip rate categories that allow one to select differing time spans and activity rates for seismic-hazard analysis depending on tectonic regime. The maps are accompanied by a database that describes evidence for Quaternary faulting, geomorphic expression, and paleoseismic parameters (slip rate, recurrence interval and time of most recent surface faulting). These maps and databases provide an inventory of faults that would be defined as active, capable, and potentially active for seismic-hazard assessments.

Transverse and longitudinal variation in woody riparian vegetation along a montane river

USGS Publications Warehouse

Friedman, J.M.; Auble, G.T.; Andrews, E.D.; Kittel, G.; Madole, R.F.; Griffin, E.R.; Allred, Tyler M.

2006-01-01

This study explores how the relationship between flow and riparian vegetation varies along a montane river. We mapped occurrence of woody riparian plant communities along 58 km of the San Miguel River in southwestern Colorado. We determined the recurrence interval of inundation for each plant community by combining step-backwater hydraulic modeling at 4 representative reaches with Log-Pearson analysis of 4 stream gaging stations. Finally, we mapped bottomland surficial geology and used a Geographic Information System to overlay the coverages of geology and vegetation. Plant communities were distinctly arrayed along the hydrologic gradient. The Salix exigua Nuttall (sand-bar willow) community occurred mostly on surfaces with a recurrence interval of inundation shorter than 2.2 years; the Betula occidentalis Hooker (river birch) community peaked on sites with recurrence intervals of inundation between 2.2 and 4.6 years. The hydrologic position occupied by communities dominated by Populus angustifolia James (narrowleaf cottonwood) was strongly related to age of trees and species composition of understory shrubs. The fraction of riparian vegetation on surfaces historically inundated by the river decreased in the upstream direction from almost 100% near Uravan to <50% along the South Fork of the San Miguel River. In upstream reaches much of the physical disturbance necessary to maintain riparian vegetation is provided by valley-side processes including debris flows, floods from minor tributaries, landslides, and beaver activity. Where valley-side processes are important, prediction of riparian vegetation change based on alterations of river flow will be incomplete.

Flood of September 7-9, 1987, in Lexington and Richland counties in the vicinity of Saint Andrews Road and Irmo, South Carolina

USGS Publications Warehouse

Guimaraes, W.B.

1989-01-01

Localized heavy rainfall on September 7, 1987, in Lexington and Richland Counties, South Carolina, caused severe flooding in the basins of Kinley Creek, Rawls Creek, and Stoop Creek, in the vicinity of Saint Andrews Road and the town of Irmo, South Carolina. The flooding damaged homes, furnishings, and landscaping. Rainfall, peak discharges, high-water elevations, and frequency relations of rainfall and discharge are tabulated and plotted for selected streams. The rain was most intense in the area along Rawls Creek, R-2 (tributary to Rawls Creek), Koon Branch (tributary to Rawls Creek), and the upper part of Kinley Creek. A rainfall of about 5.5 inches in 3 hours, which has a recurrence interval in excess of 100 years, was reported by local residents along these streams. High-water marks are presented in this report for Stoop Creek, Kinley Creek, K-1 (tributary to Kinley Creek), K-2 (tributary to Kinley Creek), unnamed tributary to Kinley Creek, Lowery Creek (tributary to Kinley Creek), Rawls Creek, R-2 (tributary to Rawls Creek), and Koon Branch (tributary to Rawls Creek). Peak discharges at the most downstream sites on Rawls Creek and Koon Branch had recurrence intervals of 75 years and 60 years, respectively. Peak discharges on Kinley Creek varied from 20 to 25 years north of K-1 basin to less than 10 years at K-1. The Stoop Creek basin had a recurrence interval of 10 years. (USGS)

Medically Treated Diverticular Abscess Associated With High Risk of Recurrence and Disease Complications.

PubMed

Devaraj, Bikash; Liu, Wendy; Tatum, James; Cologne, Kyle; Kaiser, Andreas M

2016-03-01

The best management for diverticulitis with abscess formation remains unknown. The purpose of this study was to determine the natural course and outcomes of patients with medically treated diverticular abscess. We conducted a retrospective review of all patients at our institution with diverticular abscess confirmed by CT from 2004 to 2014. This study was conducted in a tertiary referral hospital. A total of 1194 patients were treated for acute diverticulitis in 10 years; 210 patients with CT-documented diverticular abscess were analyzed (140 men (66.7%) and 70 women (33.3%); median age 45 years; range, 23-84 years). Overall recurrence and disease complication rates, as well as the need for subsequent operation after initial successful nonsurgical management, were measured, along with analysis of the whole cohort and the subgroup of patients with percutaneous drainage for diverticular abscess. During the initial presentation, 25 patients failed nonoperative management and required an urgent operation. A total of 185 patients were initially successfully managed without surgery and were discharged from the hospital. Of these, recurrent diverticulitis developed in 112 (60.5%) after an average time interval of 5.3 months (range, 0.8-20.0 months); 47 patients (42%) experienced more than 1 episode. The modified Hinchey stage at time of recurrence (compared with index stay) increased in 51 patients (45.6%). Seventy one (63%) of 112 recurrences showed local disease complications (recurrent abscess, fistula, stricture, or peritonitis). Fistula formation (colovesicular/colovaginal/colocutaneous) and recurrent abscess were the 2 most frequent complications. Twenty nine (26%) of 112 recurrences required an urgent operation; overall, 66 (59%) of 112 patients eventually underwent surgery at our institution. The original abscess size in patients who later developed recurrences was significantly larger than in patients who did not develop recurrence (5.3 vs 3.2 cm; p < 0.001). Paradoxically, larger abscesses also had a higher chance of successful CT-guided drainage (average size, 6.5 cm; range, 1.1-14 cm), yet CT-guided drainage did not change the overall outcome. Of 65 (31.0%) of 210 patients with CT-guided drainage, 45 (73.8%) of 61 after initial success experienced a recurrence. Furthermore, local disease complications at the time of recurrence were noted in 32 of 61 patients (52.5% of all CT-guided drainage, 71.1% of post-CT-guided drainage recurrences), and 13 (29.2%) of 45 patients with recurrence after successful CT-guided drainage subsequently required an urgent operation. The study was limited by its retrospective noncomparative design. Diverticular abscesses represent complicated diverticulitis and are associated with a high risk of recurrences and disease complications. Recurrences (contrary to other series) were often more severe than the index presentation. The successful CT-guided drainage of a diverticular abscess does not appear to lower the risks of future recurrence or complication rates and frequently is only a bridge to surgery. After initial successful nonoperative management, patients with diverticular abscess should be offered interval elective colectomy (see Video, Supplemental Digital Content 1, http://links.lww.com/DCR/A216).

Scoliosis may increase the risk of recurrence of lumbar disc herniation after microdiscectomy.

PubMed

Chang, Hsuan-Kan; Chang, Huang-Chou; Wu, Jau-Ching; Tu, Tsung-Hsi; Fay, Li-Yu; Chang, Peng-Yuan; Wu, Ching-Lan; Huang, Wen-Cheng; Cheng, Henrich

2016-04-01

The aim of this paper was to investigate the risk of recurrence of lumbar disc herniation (LDH) in patients with scoliosis who underwent microdiscectomy. A series of consecutive patients who underwent microdiscectomy for LDH was retrospectively reviewed. The inclusion criteria were young adults younger than 40 years who received microdiscectomy for symptomatic 1-level LDH. An exclusion criterion was any previous spinal surgery, including fusion or correction of scoliosis. The patients were divided into 2 groups: those with scoliosis and those without scoliosis. The demographic data in the 2 groups were similar. All medical records and clinical and radiological evaluations were reviewed. A total of 58 patients who underwent 1-level microdiscectomy for LDH were analyzed. During the mean follow-up of 24.6 months, 6 patients (10.3%) experienced a recurrence of LDH with variable symptoms. The recurrence rate was significantly higher among the scoliosis group than the nonscoliosis group (33.3% vs. 2.3%, p = 0.001). Furthermore, the recurrence-free interval in the scoliosis group was short. Young adults (< 40 years) with uncorrected scoliosis are at higher risk of recurrent LDH after microdiscectomy.

Methods for estimating selected spring and fall low-flow frequency statistics for ungaged stream sites in Iowa, based on data through June 2014

USGS Publications Warehouse

Eash, David A.; Barnes, Kimberlee K.; O'Shea, Padraic S.

2016-09-19

A statewide study was led to develop regression equations for estimating three selected spring and three selected fall low-flow frequency statistics for ungaged stream sites in Iowa. The estimation equations developed for the six low-flow frequency statistics include spring (April through June) 1-, 7-, and 30-day mean low flows for a recurrence interval of 10 years and fall (October through December) 1-, 7-, and 30-day mean low flows for a recurrence interval of 10 years. Estimates of the three selected spring statistics are provided for 241 U.S. Geological Survey continuous-record streamgages, and estimates of the three selected fall statistics are provided for 238 of these streamgages, using data through June 2014. Because only 9 years of fall streamflow record were available, three streamgages included in the development of the spring regression equations were not included in the development of the fall regression equations. Because of regulation, diversion, or urbanization, 30 of the 241 streamgages were not included in the development of the regression equations. The study area includes Iowa and adjacent areas within 50 miles of the Iowa border. Because trend analyses indicated statistically significant positive trends when considering the period of record for most of the streamgages, the longest, most recent period of record without a significant trend was determined for each streamgage for use in the study. Geographic information system software was used to measure 63 selected basin characteristics for each of the 211streamgages used to develop the regional regression equations. The study area was divided into three low-flow regions that were defined in a previous study for the development of regional regression equations.Because several streamgages included in the development of regional regression equations have estimates of zero flow calculated from observed streamflow for selected spring and fall low-flow frequency statistics, the final equations for the three low-flow regions were developed using two types of regression analyses—left-censored and generalized-least-squares regression analyses. A total of 211 streamgages were included in the development of nine spring regression equations—three equations for each of the three low-flow regions. A total of 208 streamgages were included in the development of nine fall regression equations—three equations for each of the three low-flow regions. A censoring threshold was used to develop 15 left-censored regression equations to estimate the three fall low-flow frequency statistics for each of the three low-flow regions and to estimate the three spring low-flow frequency statistics for the southern and northwest regions. For the northeast region, generalized-least-squares regression was used to develop three equations to estimate the three spring low-flow frequency statistics. For the northeast region, average standard errors of prediction range from 32.4 to 48.4 percent for the spring equations and average standard errors of estimate range from 56.4 to 73.8 percent for the fall equations. For the northwest region, average standard errors of estimate range from 58.9 to 62.1 percent for the spring equations and from 83.2 to 109.4 percent for the fall equations. For the southern region, average standard errors of estimate range from 43.2 to 64.0 percent for the spring equations and from 78.1 to 78.7 percent for the fall equations.The regression equations are applicable only to stream sites in Iowa with low flows not substantially affected by regulation, diversion, or urbanization and with basin characteristics within the range of those used to develop the equations. The regression equations will be implemented within the U.S. Geological Survey StreamStats Web-based geographic information system application. StreamStats allows users to click on any ungaged stream site and compute estimates of the six selected spring and fall low-flow statistics; in addition, 90-percent prediction intervals and the measured basin characteristics for the ungaged site are provided. StreamStats also allows users to click on any Iowa streamgage to obtain computed estimates for the six selected spring and fall low-flow statistics.

Estimating the Magnitude and Frequency of Floods in Small Urban Streams in South Carolina, 2001

USGS Publications Warehouse

Feaster, Toby D.; Guimaraes, Wladimir B.

2004-01-01

The magnitude and frequency of floods at 20 streamflowgaging stations on small, unregulated urban streams in or near South Carolina were estimated by fitting the measured wateryear peak flows to a log-Pearson Type-III distribution. The period of record (through September 30, 2001) for the measured water-year peak flows ranged from 11 to 25 years with a mean and median length of 16 years. The drainage areas of the streamflow-gaging stations ranged from 0.18 to 41 square miles. Based on the flood-frequency estimates from the 20 streamflow-gaging stations (13 in South Carolina; 4 in North Carolina; and 3 in Georgia), generalized least-squares regression was used to develop regional regression equations. These equations can be used to estimate the 2-, 5-, 10-, 25-, 50-, 100-, 200-, and 500-year recurrence-interval flows for small urban streams in the Piedmont, upper Coastal Plain, and lower Coastal Plain physiographic provinces of South Carolina. The most significant explanatory variables from this analysis were mainchannel length, percent impervious area, and basin development factor. Mean standard errors of prediction for the regression equations ranged from -25 to 33 percent for the 10-year recurrence-interval flows and from -35 to 54 percent for the 100-year recurrence-interval flows. The U.S. Geological Survey has developed a Geographic Information System application called StreamStats that makes the process of computing streamflow statistics at ungaged sites faster and more consistent than manual methods. This application was developed in the Massachusetts District and ongoing work is being done in other districts to develop a similar application using streamflow statistics relative to those respective States. Considering the future possibility of implementing StreamStats in South Carolina, an alternative set of regional regression equations was developed using only main channel length and impervious area. This was done because no digital coverages are currently available for basin development factor and, therefore, it could not be included in the StreamStats application. The average mean standard error of prediction for the alternative equations was 2 to 5 percent larger than the standard errors for the equations that contained basin development factor. For the urban streamflow-gaging stations in South Carolina, measured water-year peak flows were compared with those from an earlier urban flood-frequency investigation. The peak flows from the earlier investigation were computed using a rainfall-runoff model. At many of the sites, graphical comparisons indicated that the variance of the measured data was much less than the variance of the simulated data. Several statistical tests were applied to compare the variances and the means of the measured and simulated data for each site. The results indicated that the variances were significantly different for 11 of the 13 South Carolina streamflow-gaging stations. For one streamflow-gaging station, the test for normality, which is one of the assumptions of the data when comparing variances, indicated that neither the measured data nor the simulated data were distributed normally; therefore, the test for differences in the variances was not used for that streamflow-gaging station. Another statistical test was used to test for statistically significant differences in the means of the measured and simulated data. The results indicated that for 5 of the 13 urban streamflowgaging stations in South Carolina there was a statistically significant difference in the means of the two data sets. For comparison purposes and to test the hypothesis that there may have been climatic differences between the period in which the measured peak-flow data were measured and the period for which historic rainfall data were used to compute the simulated peak flows, 16 rural streamflow-gaging stations with long-term records were reviewed using similar techniques as those used for the measured an

Seasonality in malaria transmission: implications for case-management with long-acting artemisinin combination therapy in sub-Saharan Africa.

PubMed

Cairns, Matthew E; Walker, Patrick G T; Okell, Lucy C; Griffin, Jamie T; Garske, Tini; Asante, Kwaku Poku; Owusu-Agyei, Seth; Diallo, Diadier; Dicko, Alassane; Cisse, Badara; Greenwood, Brian M; Chandramohan, Daniel; Ghani, Azra C; Milligan, Paul J

2015-08-19

Long-acting artemisinin-based combination therapy (LACT) offers the potential to prevent recurrent malaria attacks in highly exposed children. However, it is not clear where this advantage will be most important, and deployment of these drugs is not rationalized on this basis. To understand where post-treatment prophylaxis would be most beneficial, the relationship between seasonality, transmission intensity and the interval between malaria episodes was explored using data from six cohort studies in West Africa and an individual-based malaria transmission model. The total number of recurrent malaria cases per 1000 child-years at risk, and the fraction of the total annual burden that this represents were estimated for sub-Saharan Africa. In settings where prevalence is less than 10 %, repeat malaria episodes constitute a small fraction of the total burden, and few repeat episodes occur within the window of protection provided by currently available drugs. However, in higher transmission settings, and particularly in high transmission settings with highly seasonal transmission, repeat malaria becomes increasingly important, with up to 20 % of the total clinical burden in children estimated to be due to repeat episodes within 4 weeks of a prior attack. At a given level of transmission intensity and annual incidence, the concentration of repeat malaria episodes in time, and consequently the protection from LACT is highest in the most seasonal areas. As a result, the degree of seasonality, in addition to the overall intensity of transmission, should be considered by policy makers when deciding between ACT that differ in their duration of post-treatment prophylaxis.

Conditional survival analysis of hepatocellular carcinoma patients treated with radiofrequency ablation.

PubMed

Facciorusso, Antonio; Del Prete, Valentina; Antonino, Matteo; Neve, Viviana; Amoruso, Annabianca; Crucinio, Nicola; Di Leo, Alfredo; Barone, Michele

2015-10-01

Survival estimates are commonly reported as survival from the first observation, but future survival probability changes based on the survival time already accumulated after therapy, otherwise known as conditional survival (CS). The aim of the study was to describe CS according to different prognostic variables in hepatocellular carcinoma (HCC) patients treated with radiofrequency ablation (RFA). Data on 125 very early/early HCC patients treated with RFA between 1999 and 2007 were analyzed. Actuarial survival estimates were computed by means of Kaplan-Meier method and compared by log-rank test. The 5-year CS was calculated with stratification by several predictors for patients who had already survived up to 5 years from diagnosis. Median overall survival (OS) was 72 months (95% confidence interval [CI], 58-86). Age, Child-Pugh (CP), α-fetoprotein (AFP), Cancer of the Liver Italian Program (CLIP) score and type of recurrence (early vs late) were significant predictors of OS. The 5-year CS rates of the entire study cohort assessed at 1, 2, 3 and 5 years from the treatment were 49%, 48%, 30% and 34%, respectively. Subgroup analysis confirmed age and CP as significant predictors of CS at all time points, while the CS of subgroups stratified by AFP and CLIP did not differ significantly from the 3rd year after RFA onward, as more advanced patients had probably escaped early recurrence. CS analysis showed that the impact of different variables influencing OS is not linear over time after RFA. Information derived from the study can improve the current management of HCC patients. © 2014 The Japan Society of Hepatology.