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IOTA (International Ovarian Tumor Analysis) Simple Rules classifies adnexal masses as benign, malignant, or indeterminate based on sonographic features. We seek to determine if IOTA inappropriately directed women to surgery, or more aggressive surgery, than their final diagnosis warranted. This is a retrospective study of sonographically detected adnexal masses with known clinical outcomes from two institutions (n = 528). Surgically managed patients (n = 172) were categorized based on pathology and compared using Chi-square and t-test for categorical and continuous variables respectively. A logistic regression was used to predict characteristics that predicted surgery or imaging follow up of indeterminate masses. Of the 528 masses imaged, 29% (n = 155) underwent surgery for benign pathology. Only 1.9% (n = 10) underwent surgery after classification as malignant by IOTA for what was ultimately a benign mass. Surgical complications occurred in 10 cases (5.8%), all benign. Fifteen (3.2%) patients went into surgically induced menopause for benign masses, one of which was inaccurately classified by IOTA as malignant. Of the 41 IOTA indeterminate masses, the presence of soft tissue nodules on ultrasound was the only statistically significant predictor of the patient being triaged directly to surgery (OR 1.79, p = 0.04). Our findings support that the IOTA ultrasound classification system can provide clinical guidance without incurring unnecessary surgeries or surgical complications. [ABSTRACT FROM AUTHOR]

Classical estuary circulation theory states that in the longitudinal direction of an estuary there exists a single circulation with landward, near-bottom, and seaward, near-surface flows; however, the situation becomes complicated with the presence of a river mouth bar. Here we conducted tidal-cycle observations in the South Passage of the Yangtze Estuary during both the wet and dry seasons of 2018 (July and December, respectively). The simultaneous current velocity, temperature, and salinity profile data were obtained from anchored boats and base tripods at three stations along the channel in the mouth bar area. The results reveal two distinct longitudinal residual circulation patterns: a classic circulation which is formed on the seaward slope of the mouth bar during the wet season, and a double circulation system which is composed of two circulation cells over the landward and seaward slopes of the mouth bar during the dry season. The Simpson number (Si), mixing parameter (M), and salinity data were used to quantify the mixing intensity, which shows that horizontal baroclinic pressure gradient is the dominant factor in the formation of the longitudinal residual circulation. Furthermore, the double circulation pattern during the dry season is related to the mouth bar bathymetry, which affects saltwater intrusion. The double circulations can significantly influence the spatial and temporal evolution of the stagnation point in the estuarine channel, which in turn modifies the distribution patterns of suspended sediment concentration in the maximum turbidity zone. Evidently, the changes in the mouth bar sandbar bathymetry in response to human activities and river basin hydrographic conditions indirectly affect the occurrence and scale of the double circulations. [ABSTRACT FROM AUTHOR]

The vertical density gradients of salinity and suspended sediment concentration (SSC) cause stratification in estuaries, which play a vital role in the turbulence structure, water mixing, and sediment transport. To investigate the effect of stratification, especially SSC-induced stratification, on maintaining the estuarine turbidity maximum (ETM), we conducted in situ measurements on sediment dynamics at the upper and central ETM sites in the South Passage of Changjiang Estuary in July 2018. The gradient Richardson number was estimated as a proxy for the stratification that is attributable to salinity or/and SSC. We found that salinity-induced stratification was observed mainly on the surface and in the middle layers, whereas SSC-induced stratification occurred mainly in the near-bottom layers. Furthermore, at the central ETM, the baroclinic effect was enhanced during the neap tide when the salinity-induced stratification was stronger than that during the spring tide. In the early phase of floods with minimum velocity during the neap tide, salinity-induced stratification suppressed the turbulence and vertical diffusion of sediments. Moreover, the flocculation enhanced the settling process within the water column. Consequently, high concentrations of fine-grained sediments formed near the bottom and promoted SSC-induced stratification, thereby leading to the continuous accumulation and trapping of sediments. In conclusion, the interactions among the "salinity- and SSC-induced stratification" processes served as crucial constraints of the temporal and spatial variations of the ETM in the Changjiang Estuary. [ABSTRACT FROM AUTHOR]

In this work, bio-inspired Au nanoparticles (NPs) were loaded through an ionic-liquid-enhanced-immobilization method onto TS-1 support, leading to efficient Au/TS-1 catalysts for gas-phase propylene epoxidation in the presence of O2 and H2. Specifically, the mesoporous TS-1 was synthesized by a hydrothermal method using nanosized TS-1 (size of ∼ 220 nm) as seeds, and the support was then etched with acid (HCl or HNO3). Both the pristine TS-1 and Au/TS-1 catalysts were fully characterized to understand the effects of preparation conditions on the catalytic performance in propylene epoxidation. Interestingly, it was found that the amount of Lewis acid sites in the seed-induced TS-1 was greater than that on the control sample formed without seed; more importantly, the size of the loaded Au NPs can be regulated by changing the amount of Lewis acid site. Furthermore, we have demonstrated that the post-treatment of TS-1 with appropriate acid sites could enhance the propylene conversion and propylene oxide (PO) selectivity. [ABSTRACT FROM AUTHOR]

The vertical distribution of suspended sediment concentration (SSC) plays a key role in the residual suspended sediment transport in the estuarine environments. A field measurement was carried out in the turbidity maximum zone (TMZ) of the Changjiang Estuary in 2012 to study the characteristics and formation mechanisms of SSC profile in the partially stratified estuary. Based on the observed data, we found that the vertical distribution of SSCs is mainly determined by the density stratification caused by the interactions between the river runoff and the saltwater intrusion. The vertical profiles of SSC were categorized into three types: (I) two-layer structure profile, (II) exponential profile, and (III) linear profile. Type I mainly occurred in condition of strong stratification, whereas types II and III mainly occurred in weak stratification and well-mixed conditions, respectively. We developed two new empirical equations to simulate the vertical profiles, which can accurately describe the observed exponential and linear profiles and reasonably/accurately describe the observed two-layer structure profiles. The two new equations can be easily used in other well-mixed or partially stratified estuaries given the surface and bottom SSC data, which can be obtained from many ways, for instance, the buoy and bottom tripod survey system, the remote-sensed images, and numerical models. [ABSTRACT FROM AUTHOR]

Every cancer survivor and his/her primary care provider should receive an individualized survivorship care plan (SCP) following curative treatment. Little is known regarding point-of-care utilization at primary care visits. We assessed SCP utilization in the clinical context of primary care visits. Primary care physicians and advanced practice providers (APPs) who had seen survivors following provision of an SCP were identified. Eligible primary care physicians and APPs were sent an online survey, evaluating SCP utilization and influence on decision-making at the point-of-care, accompanied by copies of the survivor's SCP and the clinic note. Eighty-eight primary care physicians and APPs were surveyed November 2016, with 40 (45%) responding. Most respondents (60%) reported discussing cancer or related issues during the visit. Information needed included treatment (66%) and follow-up visits, and the cancer team was responsible for (58%) vs primary care (58%). Respondents acquired this information by asking the patient (79%), checking oncology notes (75%), the SCP (17%), or online resources (8%). Barriers to SCP use included being unaware of the SCP (73%), difficulty locating it (30%), and finding needed information faster via another mechanism (15%). Despite largely not using the SCP for the visit (90%), most respondents (61%) believed one would be quite or very helpful for future visits. Most primary care visits included discussion of cancer or cancer-related issues. SCPs may provide the information necessary to deliver optimal survivor care but efforts are needed to reduce barriers and design SCPs for primary care use. [ABSTRACT FROM AUTHOR]

Survivorship care plans (SCPs) have been recommended as tools to improve care coordination and outcomes for cancer survivors. SCPs are increasingly being provided to survivors and their primary care providers. However, most primary care providers remain unaware of SCPs, limiting their potential benefit. Best practices for educating primary care providers regarding SCP existence and content are needed. We developed an education program to inform primary care providers of the existence, content, and potential uses for SCPs. The education program consisted of a 15-min presentation highlighting SCP basics presented at mandatory primary care faculty meetings. An anonymous survey was electronically administered via email (n = 287 addresses) to evaluate experience with and basic knowledge of SCPs pre- and post-education. A total of 101 primary care advanced practice providers (APPs) and physicians (35% response rate) completed the baseline survey with only 23% reporting prior receipt of a SCP. Only 9% could identify the SCP location within the electronic health record (EHR). Following the education program, primary care physicians and APPs demonstrated a significant improvement in SCP knowledge, including improvement in their ability to locate one within the EHR (9 vs 59%, p < 0.0001). A brief educational program containing information about SCP existence, content, and location in the EHR increased primary care physician and APP knowledge in these areas, which are prerequisites for using SCP in clinical practice. [ABSTRACT FROM AUTHOR]

Time series measurements were conducted on suspended sediment and current velocity from neap tide to spring tide in the South Branch of the upper Changjiang Estuary in the summer of 2011. Strong flood-ebb asymmetry in the current velocity was observed in the South Branch as a result of high river runoff and tide deformation, in which the magnitude and duration of ebb currents were significantly greater than those of flood currents. The suspended sediment concentration (SSC) and suspended median grain size also exhibited remarkable flood-ebb variation; these variables were considerably larger during the ebb than during the flood and increased from neap to spring tide. Affected by the strong asymmetry in the current velocity and SSC between the flood and ebb, suspended sediment flux during the ebb was notably larger than during the flood, and a seaward tidal net flux was observed in each tidal cycle. The balance of sediment flux illustrates that the seaward sediment transport was dominated by river flow and tidal trapping and the landward sediment transport was dominated by the Stokes drift and the shear effect. Notable resuspension occurred during the spring and moderate tides. The critical velocity for the resuspension of bed sediments was estimated based on the correlation between current velocity with SSC and suspended median grain size. The results show that the critical velocity was approximately 40 cm/s during the flood phases and approximately 80 cm/s during the ebb phases because the surficial flood bed sediments located in the lower reach are much finer than the surficial ebb bed sediments located in the upper reach. The flood-ebb variation in the critical erosion velocity has significant effect on the intratidal variation of SSC and sediment transport process, and it is a common phenomenon in many estuaries of the world due to the complicated spatial distribution of bed sediments. [ABSTRACT FROM AUTHOR]

The aim of this study is to determine the effects of early intravenous (IV) infusion later followed by transendocardial (TE) injection of allogeneic mesenchymal stem cells (MSCs) following myocardial infarction (MI). Twenty-four swine underwent balloon occlusion reperfusion MI and were randomized into 4 groups: IV MSC (or placebo) infusion (post-MI day 2) and TE MSC (or placebo) injection targeting the infarct border with 2D X-ray fluoroscopy fused to 3D magnetic resonance (XFM) co-registration (post-MI day 14). Continuous ECG recording, MRI, and invasive pressure-volume analyses were performed. IV MSC plus TE MSC treated group was superior to other groups for contractility reserve ( p = 0.02) and freedom from VT ( p = 0.03) but had more lymphocytic foci localized to the peri-infarct region ( p = 0.002). No differences were observed in post-MI remodeling parameters. IV followed by XFM targeted TE MSC therapy improves contractility reserve and suppresses VT but does not affect post-MI remodeling and may cause an immune response. [ABSTRACT FROM AUTHOR]

Profiles of tidal current and suspended sediment concentration (SSC) were measured in the North Branch of the Changjiang Estuary from neap tide to spring tide in April 2010. The measurement data were analyzed to determine the characteristics of intratidal and neap-spring variations of SSC and suspended sediment transport. Modulated by tidal range and current speed, the tidal mean SSC increased from 0.5 kg/m in neap tide to 3.5 kg/m in spring tide. The intratidal variation of the depth-mean SSC can be summarized into three types: V-shape variation in neap tide, M-shape and mixed M-V shape variation in medium and spring tides. The occurrence of these variation types is controlled by the relative intensity and interaction of resuspension, settling and impact of water exchange from the rise and fall of tide. In neap tide the V-shape variation is mainly due to the dominant effect of the water exchange from the rise and fall of tide. During medium and spring tides, resuspension and settling processes become dominant. The interactions of these processes, together with the sustained high ebb current and shorter duration of low-tide slack, are responsible for the M-shape and M-V shape SSC variation. Weakly consolidated mud and high current speed cause significant resuspension and remarkable flood and ebb SSC peaks. Settling occurs at the slack water periods to cause SSC troughs and formation of a thin fluff layer on the bed. Fluxes of water and suspended sediment averaged over the neap-spring cycle are all seawards, but the magnitude and direction of tidal net sediment flux is highly variable. [ABSTRACT FROM AUTHOR]

Some patients experience reduced bone mineral density (BMD) despite bisphosphonate therapy. We performed a retrospective chart review study to detect factors associated with decreased BMD in men prescribed alendronate. Two investigators reviewed eligible medical records and used a standardized form to record potential characteristics predicting men's response to alendronate. We analyzed patient characteristics associated with annualized change in hip and spine BMD (D-BMD). Among 115 eligible men, 19 (17 %) experienced significantly decreased BMD at the hip or spine, defined as a change exceeding precision error. Eleven men (10 %) fractured during therapy. Spine D-BMD was positively associated with adherence to alendronate ( R = 0.23, p = 0.02) and inversely associated with baseline body weight ( R = −0.21, p = 0.03). Hip D-BMD was positively associated with annualized weight change ( R = 0.19, p = 0.0498) and negatively associated with patient age and number of concomitant medications ( R = −0.21, p = 0.03; R = −0.20, p = 0.03, respectively). In stepwise linear models, spine D-BMD was associated positively with alendronate adherence and multivitamin use and negatively with baseline body weight. Hip D-BMD was negatively associated with age. Fracture during treatment was associated with fracture prior to therapy ( p = 0.03). In this small study of men prescribed alendronate, BMD response showed a positive association with adherence to therapy, weight gain, and use of a multivitamin. By contrast, older age, higher baseline body weight, and higher number of medications were each associated with a decrease in BMD. Larger studies are needed to confirm and extend these findings. [ABSTRACT FROM AUTHOR]

Background: Achieving negative surgical margins is critical to minimizing the risk of tumor recurrence in patients undergoing breast conservation surgery (BCS) for a breast malignancy. Our objective was to perform a systematic review comparing reexcision rates, sensitivity and specificity of the intraoperative use of the margin assessment techniques of imprint cytology (IC) and frozen section analysis (FSA), against permanent histopathologic section (PS). Methods: The databases PubMed, Web of Knowledge, Cochrane Library and CINAHL Plus were searched for literature published from 1997 to 2011. Original investigations of patients who underwent BCS for breast cancer that evaluated margin assessment with PS and/or IC or FSA were included. Of 182 titles identified, 41 patient cohorts from 37 articles met inclusion criteria: PS ( n = 19), IC ( n = 7) and FSA ( n = 15). Studies were summarized qualitatively using the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) checklist for cohort studies and the Strength of Recommendation Taxonomy (SORT) numerical scale for diagnostic studies. Results: The final reexcision rates after primary BCS were 35 % for PS, 11 % for IC ( p = 0.001 vs. PS) and 10 % for FSA ( p < 0.0001 vs. PS). For IC, reexcision rates decreased from 26 to 4 % ( p = 0.18) and for FSA, reexcision rates decreased from 27 to 6 % ( p < 0.0001). The pooled sensitivity of IC and FSA were 72 and 83 %. The pooled specificity of IC and FSA were 97 and 95 %. The average length of each technique was 13 min for IC and 27 min for FSA. Conclusions: Patients who underwent BCS with intraoperative IC or FSA to assess negative surgical margins had significantly fewer secondary surgical procedures for excision of their breast malignancies. [ABSTRACT FROM AUTHOR]

The seven long tunnels of Jinping II hydropower station are deeply buried. The width and evolution characteristics of excavation damaged zone (EDZ) are the key problem to the design of tunnels excavation and supports. In order to study this problem, several specific experimental tunnels with different overburden and geometric sizes were excavated at this site. Digital borehole camera, sliding micrometer, cross-hole acoustic wave equipment and acoustic emission apparatus were adopted. This paper introduced the comprehensive in situ experimental methods through pre-installed facilities and pre-drilled boreholes. Typical properties of the surrounding rock mass, including cracks, deformation, elastic wave and micro fractures, were measured during the whole process of the tunnel excavation. The width and characteristics of formation and evolution of tunnels EDZ were analyzed under different construction methods involving of TBM and drilling and blasting, the test tunnels were excavated by full-face or two benches. The relationships between EDZ and tunnel geometry sizes, overburden and excavation method were described as well. The results will not only contribute a great deal to the analysis of rock mass behavior in deeply buried rock mass, but also provide direct data for support design and rockburst prediction. [ABSTRACT FROM AUTHOR]

A MIDAS-400 customized data acquisition system has been used for the high-resolution sediment dynamic measurements over the Dafeng intertidal flats of northern Jiangsu during 6 tidal cycles from July 3 to July 10, 2003. The bed shear stress and bedload transport rates, in response to wave-current interactions, are calculated, which indicate that wind waves enhance the bottom shear stress and bedload transport rates. At the station for measurements, bedload transport was directed to seaward, with a sediment discharge of 30-150 kg·m-1 per tidal cycle. The surficial sediment samples were collected from a grid with 10 m spatial intervals over a rectangle 2 × 104 m² experimental area, near the MIDAS-400 during the spring tide of July 4, 2003, and the neap tide of July 9, 2003. In addition, leveling survey was undertaken to obtain the detailed topography of the sampling area. Grain-size trend analysis of the sediment samples shows that the bedload transport patterns are complex, mainly controlled by the hydrodynamics and local geomorphology (e.g. tidal creeks) over the intertidal flats. Furthermore, the grain-size trends pattern during the neap tide rather than during the spring tide is consistent with the calculated bedload transport, and the grain-size trend vectors for the spring tide are larger than those for [ABSTRACT FROM AUTHOR]

The following are errors in the original article: Ya Ping Wang's first name was incorrect. It is correct as shown here. There is an error in Eq. 2. Following is the corrected equation. [ABSTRACT FROM AUTHOR]