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Abstract: Whether permafrost systematically alters the rate of riverbank erosion is a fundamental geomorphic question with significant importance to infrastructure, water quality, and biogeochemistry of high‐latitude watersheds. For over four decades, this question has remained unanswered due to a lack of data. Using remotely sensed imagery, we addressed this knowledge gap by quantifying riverbank erosion rates across the Arctic and subarctic. To compare these rates to non‐permafrost rivers, we assembled a global data set of published riverbank erosion rates. We found that erosion rates in rivers influenced by permafrost are on average nine times lower than non‐permafrost systems; erosion rate differences increase up to 40 times for the largest rivers. To test alternative hypotheses for the observed erosion rate difference, we examined differences in total water yield and erosional efficiency between these rivers and non‐permafrost rivers. Neither of these factors nor differences in river sediment loads provided compelling alternative explanations, leading us to conclude that permafrost limits riverbank erosion rates. This conclusion was supported by field investigations of rates and patterns of erosion along three rivers flowing through discontinuous permafrost in Alaska. Our results show that permafrost limits maximum bank erosion rates on rivers with stream powers greater than 900 Wm−1. On smaller rivers, however, hydrology rather than thaw rate may be the dominant control on bank erosion. Our findings suggest that Arctic warming and hydrological changes should increase bank erosion rates on large rivers but may reduce rates on rivers with drainage areas less than a few thousand km2.

Introduction: Although the clinical benefits of pelvic lymph node dissection (PLND) at the time of radical prostatectomy for prostate cancer remain uncertain, major guidelines recommend PLND based on risk profile. Thus, the objective of this study was to examine the association between PLND and survival among patients undergoing RP stratified by Gleason grade group (GG) with the aim of allowing patients and physicians to make more informed care decisions about the potential risks and benefits of PLND. Materials and methods: From the SEER-17 database, we examined overall (OS) and prostate cancer-specific (PCSS) survival of prostate cancer patients who underwent RP from 2010 to 2015 stratified by GG. We applied propensity score matching to balance pre-operative characteristics including race, age, PSA, household income, and housing status (urban/rural) between patients who did and did not undergo PLND for each GG. Statistical analyses included log-rank test and Kaplan-Meier curves. Results: We extracted a matched cohort from 80,287 patients with GG1-5 who underwent RP. The median PSA value was 6.0 ng/mL, and the median age was 62-years-old. 49,453 patients underwent PLND (61.60%), while 30,834 (38.40%) did not. There was no difference in OS and PCSS between patients who received PLND and those who did not for all Gleason GG (OS–GG1: P = 0.20, GG2: P = 0.34, GG3: P > 0.05, GG4: P = 0.55, GG5: P = 0.47; PCSS–GG1: P = 0.11, GG2: P = 0.96, GG3: P = 0.81, GG4: P = 0.22, GG5: P = 0.14). Conclusions: In this observational study, PLND at the time of RP was not associated with improved OS or PCSS among patients with cGS of 3 + 3, 3 + 4, 4 + 3, 4 + 4, 4 + 5, and 5 + 4. These findings suggest that until definitive clinical trials are completed, prostate cancer patients who have elected RP should be appropriately counseled on the potential risks and lack of proven survival benefit of PLND.

Abstract Permafrost influences 25% of land in the Northern Hemisphere, where it stabilizes the ground beneath communities and infrastructure and sequesters carbon. However, the coevolution of permafrost, river dynamics, and vegetation in Arctic environments remains poorly understood. As rivers meander, they erode the floodplain at cutbanks and build new land through bar deposition, creating sequences of landforms with distinct formation ages. Here we mapped these sequences along the Koyukuk River floodplain, Alaska, analyzing permafrost occurrence, and landform and vegetation types. We used radiocarbon and optically stimulated luminescence (OSL) dating to develop a floodplain age map. Deposit ages ranged from modern to 10 ka, with more younger deposits near the modern channel. Permafrost rapidly reached 50% areal extent in all deposits older than 200 years then gradually increased up to ∼85% extent for deposits greater than 4 Kyr old. Permafrost extent correlated with increases in black spruce and wetland abundance, as well as increases in permafrost extent within wetland, and shrub and scrub vegetation classes. We developed an inverse model to constrain permafrost formation rate as a function of air temperature. Permafrost extent initially increased by ∼25% per century, in pace with vegetation succession, before decelerating to

This article provides a systematic decomposition of disparities in school funding by race and ethnicity using two new data resources. First, we use a national district level panel of data from the School Finance Indicators Database to evaluate recent (2012-2017) disparities in school revenue and spending by race in addition to poverty, across and within all states and within selected states. Next, we use data from the National Education Cost Model (NECM) to evaluate disparities in spending against estimates of "costs" of achieving national average student outcomes to determine racial differences in gaps between current spending and costs of equitable outcomes. As Latinx shares increase, per pupil spending and revenue decrease, respectively by about 4% to 7% for districts that are approximately 100% Latinx compared to those that have few or no Latinx students, controlling for poverty. More striking, when controlling for poverty, a district that is 100% Latinx is nearly 2.5 times as likely as a district that is 0% Latinx to be financially disadvantaged (have revenue <90% of labor market average, and poverty greater than 120%), when controlling for poverty and 28.5 times as likely when not controlling for poverty. Finally, spending is less adequate to achieve national average outcomes, across states, in districts serving larger shares of Latinx students.

BackgroundAlthough the Decipher genomic classifier has been validated as a prognostic tool for several prostate cancer endpoints, little is known about its role in assessing the risk of biopsy reclassification for patients on active surveillance, a key event that often triggers treatment.ObjectiveTo evaluate the association between Decipher genomic classifier scores and biopsy Gleason upgrading among patients on active surveillance.Design setting and participantsThis was a retrospective cohort study among patients with low- and favorable intermediate-risk prostate cancer on active surveillance who underwent biopsy-based Decipher testing as part of their clinical care.Outcome measurements and statistical analysisWe evaluated the association between the Decipher score and any increase in biopsy Gleason grade group (GG) using univariable and multivariable logistic regression. We compared the area under the receiver operating characteristic curve (AUC) for models comprising baseline clinical variables with or without the Decipher score.Results and limitationsWe identified 133 patients for inclusion with a median age of 67.7 yr and median prostate-specific of 5.6 ng/ml. At enrollment, 75.9% had GG1 and 24.1% had GG2 disease. Forty-three patients experienced biopsy upgrading. On multivariable logistic regression, the Decipher score was significantly associated with biopsy upgrading (odds ratio 1.37 per 0.10 unit increase, 95% confidence interval [CI] 1.05-1.79; p = 0.02). The Decipher score was associated with upgrading among patients with biopsy GG 1 disease, but not GG2 disease. The discriminative ability of a clinical model (AUC 0.63, 95% CI 0.51-0.74) was improved by integration of the Decipher score (AUC 0.69, 95% CI 0.58-0.80).ConclusionsThe Decipher genomic classifier score was associated with short-term biopsy Gleason upgrading among patients on active surveillance.Patient summaryThe results from this study indicate that among patients with prostate cancer undergoing active surveillance, those with higher Decipher scores were more likely to have higher-grade disease found over time. These findings indicate that the Decipher test might be useful for guiding the intensity of monitoring during active surveillance, such as more frequent biopsy for patients with higher scores.

Over the past eight hundred thousand years, glacial-interglacial cycles oscillated with a period of one hundred thousand years ('100k world'1). Ice core and ocean sediment data have shown that atmospheric carbon dioxide, Antarctic temperature, deep ocean temperature, and global ice volume correlated strongly with each other in the 100k world2-6. Between about 2.8 and 1.2 million years ago, glacial cycles were smaller in magnitude and shorter in duration ('40k world'7). Proxy data from deep-sea sediments suggest that the variability of atmospheric carbon dioxide in the 40k world was also lower than in the 100k world8-10, but we do not have direct observations of atmospheric greenhouse gases from this period. Here we report the recovery of stratigraphically discontinuous ice more than two million years old from the Allan Hills Blue Ice Area, East Antarctica. Concentrations of carbon dioxide and methane in ice core samples older than two million years have been altered by respiration, but some younger samples are pristine. The recovered ice cores extend direct observations of atmospheric carbon dioxide, methane, and Antarctic temperature (based on the deuterium/hydrogen isotope ratio δDice, a proxy for regional temperature) into the 40k world. All climate properties before eight hundred thousand years ago fall within the envelope of observations from continuous deep Antarctic ice cores that characterize the 100k world. However, the lowest measured carbon dioxide and methane concentrations and Antarctic temperature in the 40k world are well above glacial values from the past eight hundred thousand years. Our results confirm that the amplitudes of glacial-interglacial variations in atmospheric greenhouse gases and Antarctic climate were reduced in the 40k world, and that the transition from the 40k to the 100k world was accompanied by a decline in minimum carbon dioxide concentrations during glacial maxima.

Study objectiveThe transfusion of older packed RBCs may be harmful in critically ill patients. We seek to determine the association between packed RBC age and mortality among trauma patients requiring massive packed RBC transfusion.MethodsWe analyzed data from the Pragmatic, Randomized Optimal Platelet and Plasma Ratios trial. Subjects in the parent trial included critically injured adult patients admitted to 1 of 12 North American Level I trauma centers who received at least 1 unit of packed RBCs and were predicted to require massive blood transfusion. The primary exposure was volume of packed RBC units transfused during the first 24 hours of hospitalization, stratified by packed RBC age category: 0 to 7 days, 8 to 14 days, 15 to 21 days, and greater than or equal to 22 days. The primary outcome was 24-hour mortality. We evaluated the association between transfused volume of each packed RBC age category and 24-hour survival, using random-effects logistic regression, adjusting for total packed RBC volume, patient age, sex, race, mechanism of injury, Injury Severity Score, Revised Trauma Score, clinical site, and trial treatment group.ResultsThe 678 patients included in the analysis received a total of 8,830 packed RBC units. One hundred patients (14.8%) died within the first 24 hours. On multivariable analysis, the number of packed RBCs greater than or equal to 22 days old was independently associated with increased 24-hour mortality (adjusted odds ratio [OR] 1.05 per packed RBC unit; 95% confidence interval [CI] 1.01 to 1.08): OR 0.97 for 0 to 7 days old (95% CI 0.88 to 1.08), OR 1.04 for 8 to 14 days old (95% CI 0.99 to 1.09), and OR 1.02 for 15 to 21 days old (95% CI 0.98 to 1.06). Results of sensitivity analyses were similar only among patients who received greater than or equal to 10 packed RBC units.ConclusionIncreasing quantities of older packed RBCs are associated with increased likelihood of 24-hour mortality in trauma patients receiving massive packed RBC transfusion (≥10 units), but not in those who receive fewer than 10 units.

* Context.--Multiparametric magnetic resonance imaging (mpMRI) of prostate with targeted biopsy has enhanced detection of high-grade prostatic adenocarcinoma (HG PCa). However, utility of amount of HG PCa (Gleason pattern 4/5) in mpMRI-targeted biopsies versus standard 12-core biopsies in predicting adverse outcomes on radical prostatectomy (RP) is unknown. Objective.--To examine the utility of amount of HG PCa in mpMRI-targeted biopsies versus standard 12-core biopsies in predicting adverse RP outcomes. Design.--We performed a retrospective review of prostate biopsies that had corresponding RP, 1 or more mpMRI-targeted biopsy, and Grade Group 2 disease or higher. For the 169 cases identified, total millimeters of carcinoma and HG PCa and longest length HG PCa in a single core were recorded for 12-core biopsies and each set of mpMRI-targeted biopsies. For RP specimens, Gleason grade, extraprostatic extension, seminal vesicle involvement, and lymph node metastasis were recorded. The main outcome studied was prostate-confined disease at RP. A logistic regression model was used to test which pre-RP variables related to this outcome. Results.--Univariate analysis showed significant associations with adverse RP outcomes in 5 of 8 quantifiable variables; longest millimeter HG PCa in a single 12-core biopsy, highest Grade Group in any core, and total millimeter HG in mpMRI-targeted biopsies showed no statistical association (P = .54, P = .13, and P = .55, respectively). In multivariate analysis, total millimeter carcinoma in all cores, highest Grade Group in any core, and longest millimeter HG PCa in a single mpMRI-targeted core provided additional predictive value (P < .001, P = .004, and P = .03, respectively). Conclusions.--Quantitation of HG PCa in mpMRItargeted biopsies provides additional value over 12-core biopsies alone in predicting nonorgan confined prostate cancer at RP. Linear millimeters of HG PCa in mpMRItargeted biopsies is a significant parameter associated with higher pathologic stage and could be of value in risk models., Prostatic adenocarcinoma (PCa) is the leading cancer diagnosis among men in the United States and the second most common cause of cancer mortality. (1) At the same time, there has [...]

Background: Although the Decipher genomic classifier has been validated as a prognostic tool for several prostate cancer endpoints, little is known about its role in assessing the risk of biopsy reclassification for patients on active surveillance, a key event that often triggers treatment. Objective: To evaluate the association between Decipher genomic classifier scores and biopsy Gleason upgrading among patients on active surveillance. Design, setting, and participants: This was a retrospective cohort study among patients with low- and favorable intermediate-risk prostate cancer on active surveillance who underwent biopsy-based Decipher testing as part of their clinical care. Outcome measurements and statistical analysis: We evaluated the association between the Decipher score and any increase in biopsy Gleason grade group (GG) using univariable and multivariable logistic regression. We compared the area under the receiver operating characteristic curve (AUC) for models comprising baseline clinical variables with or without the Decipher score. Results and limitations: We identified 133 patients for inclusion with a median age of 67.7 yr and median prostate-specific of 5.6 ng/ml. At enrollment, 75.9% had GG1 and 24.1% had GG2 disease. Forty-three patients experienced biopsy upgrading. On multivariable logistic regression, the Decipher score was significantly associated with biopsy upgrading (odds ratio 1.37 per 0.10 unit increase, 95% confidence interval [CI] 1.05–1.79; p = 0.02). The Decipher score was associated with upgrading among patients with biopsy GG 1 disease, but not GG2 disease. The discriminative ability of a clinical model (AUC 0.63, 95% CI 0.51–0.74) was improved by integration of the Decipher score (AUC 0.69, 95% CI 0.58–0.80). Conclusions: The Decipher genomic classifier score was associated with short-term biopsy Gleason upgrading among patients on active surveillance. Patient summary: The results from this study indicate that among patients with prostate cancer undergoing active surveillance, those with higher Decipher scores were more likely to have higher-grade disease found over time. These findings indicate that the Decipher test might be useful for guiding the intensity of monitoring during active surveillance, such as more frequent biopsy for patients with higher scores.

In this report, the authors detail the evolution of voucher policies, from their roots in the Jim Crow Era to their modern-day applications, including the rise of “neovoucher” programs; the past legal challenges to vouchers; factors that may influence the legal justifications of vouchers, including the quality of education for students of color in voucher programs; key policy issues that arise from this shift toward greater public funding of private schools; and conclude with a set of recommendations focused on civil rights protections.

* Context.--Pathologist interobserver discordance is significant in grading of prostate cancer, limiting reliability. Diagnostic reproducibility may be improved with digital images, but adoption faces workflow, cost, and quality challenges. A novel digital method using an alternative tissue processing approach and novel laser microscopy system potentially addresses these issues. Objective.--To evaluate the capability of this new method for primary diagnostic interpretation in clinical prostate biopsy specimens. Design.--Forty patients with a high likelihood of prostate cancer based on magnetic resonance imaging consented to investigational core biopsy. A subset of samples was used for direct comparison of physical slide preparation effects and time-tracking determination with multiphoton microscopy. Twenty samples were processed for diagnostic comparison between multilevel digital slides and subsequently produced physical slides. A reference diagnosis based on all data was established using grade groups. Level of diagnostic match and requests for immunohistochemistry were compared between physical and digital diagnoses. Immunohistochemical staining and length measurements were secondary outcomes. Results.--Interpretations based on direct multiphoton imaging yielded diagnoses that were at least as accurate as standard histology; cancer diagnosis correlation was 89% (51 of 57) by physical slides and 95% (53 of 56) by multiphoton microscopy. Grade-level concordance was 73% (44 of 60) by either method. Immunohistochemistry for routine prostate cancer-associated markers on these alternatively processed tissues was unaffected. Alternatively processed tissues resulted in longer measured core and cancer lengths, suggestive of improved orientation and visualization. Conclusions.--Findings support high potential for complete interpretation of prostate core biopsies using solely multiphoton microscopy of intact specimens, with potential diagnostic benefits as well as reduced processing time and reduced processing complexity. doi: 10.5858/arpa.2020-0037-OA, Increasing adoption of digital pathology promises marked improvements in reproducibility, efficiency, and accuracy of tissue-based diagnostics by facilitating routine remote expert consultation and enabling computerized image analysis for clinical use. [...]

BackgroundAltered coagulation function after trauma can contribute to development of venous thromboembolism (VTE). Severe trauma impairs coagulation function, but the trajectory for recovery is not known. We hypothesized that enhanced, early recovery of coagulation function increases VTE risk in severely injured trauma patients.Study designSecondary analysis was performed on data from the Pragmatic Randomized Optimal Platelet and Plasma Ratio (PROPPR) trial, excluding patients who died within 24 hours or were on pre-injury anticoagulants. Patient characteristics, adverse outcomes, and parameters of platelet function and coagulation (thromboelastography) were compared from admission to 72 hours between VTE (n = 83) and non-VTE (n = 475) patients. A p value < 0.05 indicates significance.ResultsDespite similar patient demographics, VTE patients exhibited hypercoagulable thromboelastography parameters and enhanced platelet function at admission (p < 0.05). Both groups exhibited hypocoagulable thromboelastography parameters, platelet dysfunction, and suppressed clot lysis (low clot lysis at 30 minutes) 2 hours after admission (p < 0.05). The VTE patients exhibited delayed coagulation recovery (a significant change compared with 2 hours) of K-value (48 vs 24 hours), α-angle (no recovery), maximum amplitude (24 vs 12 hours), and clot lysis at 30 minutes (48 vs 12 hours). Platelet function recovery mediated by arachidonic acid (72 vs 4 hours), ADP (72 vs 12 hours), and collagen (48 vs 12 hours) was delayed in VTE patients. The VTE patients had lower mortality (4% vs 13%; p < 0.05), but fewer hospital-free days (0 days [interquartile range 0 to 8 days] vs 10 days [interquartile range 0 to 20 days]; p < 0.05) and higher complication rates (p < 0.05).ConclusionsRecovery from platelet dysfunction and coagulopathy after severe trauma were delayed in VTE patients. Suppressed clot lysis and compensatory mechanisms associated with altered coagulation that can potentiate VTE formation require additional investigation.

Introduction: The knowledge of British and Irish bryophytes has been summarised at intervals since 1690 in national floras and checklists. The number of species and varieties recognised in these works can be used to track the discovery of British and Irish bryophytes. Methods: The main floras and checklists were identified, and the taxa recognised in twenty of them counted and their identity assessed in relation to the current (2021) checklist. Key results: The number of known bryophytes increased rapidly after the publication of Ray's Synopsis (1690). Dillenius's (1741) Historia muscorum brought together all previous reports. His polynomials were the main source for Linnaeus's binomial names in Species plantarum (1753). Linnaeus cut the number of British and Irish species from 179 to 119, omitting those that seemed to him obscure. It was clumsily done, and William Hudson (1762), in Flora Anglica, increased the number to 139, with 51 varieties, of which 37 are now treated as species. His contemporary Richard Pulteney made an early attempt to trace first records in a manuscript compiled ca. 1789. We agree with 134 of Pulteney's first records, but disagree with 88. All the historic lists contain redundancies – species that were then thought distinct but are now lumped together, the maximum being Smith's (1804) Flora Britannica, with 62. From 1855 to 1930 numerous varieties were recognised. These peaked at 309 moss varieties in Duncan's (1926) checklist and 117 liverworts in Wilson's (1930) checklist. In 2021 they have shrunk to 33 moss varieties and 9 liverworts. [ABSTRACT FROM AUTHOR]

Introduction: We examine the discovery of British and Irish bryophytes, based on a database of their first records. For 1140 taxa in the current (2021) checklist we have compiled information on the place and date of the first record, the finder and the author and place of its publication. The full database is posted on the Zenodo repository. Here we analyse changes over time in the attributes (e.g. size) of newly discovered species, their location and the main finders. Methods: We checked first records reported in bryological publications, extracting the relevant details for our database. Most are supported by herbarium specimens. To check on these we have relied mainly on the expertise of others, examining only a few specimens ourselves. Key results: Unlike flowering plants, very few bryophytes were known until ca. 1690 and the first to be discovered tended to be widespread, large species with frequent sporophytes, growing in lowland England. After Dillenius's Historia muscorum (1741) there was a major trough in activity, extending to the 1780s. Thereafter there was a surge in records from the Highlands of Scotland (from 1790) and western Ireland (from 1809). The flood of new moss records in the early nineteenth century culminated in the 1850s, with William Wilson making an outstanding contribution. New liverwort records increased later in the century and peaked between 1900 and 1909. There followed a further trough for both groups from 1920 to 1949. Since then the rate of discovery has remained steady at about 2.8 species per year. [ABSTRACT FROM AUTHOR]

A single early prostate-specific antigen (PSA) level has been correlated with a higher likelihood of prostate cancer diagnosis and death in younger men. PSA testing in older men has been considered of limited utility. We evaluated prostate cancer death in relation to age and PSA level immediately prior to prostate cancer diagnosis. Using the Veterans Affairs database, we identified 230,081 men aged 50-89 years diagnosed with prostate cancer and at least one prior PSA test between 1999 and 2009. Prostate cancer-specific death over time was calculated for patients stratified by age group (e.g., 50-59 years, through 80-89 years) and PSA range at diagnosis (10 ranges) using Kaplan-Meier methods. Risk of 10-year prostate cancer mortality across age and PSA was compared using log-rank tests with a Bonferroni adjustment for multiple testing. 10.5% of men diagnosed with prostate cancer died of cancer during the 10-year study period (mean follow-up = 3.7 years). Higher PSA values prior to diagnosis predict a higher risk of death in all age groups (p

In this article, we explain how overly prescriptive, rigid state statutory and regulatory policy frameworks regarding teacher evaluation, tenure and employment decisions outstrip the statistical reliability and validity of proposed measures of teaching effectiveness. We begin with a discussion of the emergence of highly prescriptive state legislation regarding the use of student testing data within teacher evaluation systems, specifically for purposes of making employment decisions. Next, we explain the most problematic features of those policies, which include a) requirements that test-based measures constitute fixed, non-negotiable weight in final decisions, b) that test-based measures are used to place teachers into categories of effectiveness by applying numerical cutoffs beyond the precision or accuracy of the available data, and c) that professional judgment is removed from personnel decisions by legislating (or regulating) specific actions be taken when teachers fall into certain performance categories. In the subsequent section, we point out that different types of measures are being developed and implemented across states, and we explain that while value-added metrics in particular are, in fact designed to estimate a teacher's effect on student outcomes, descriptive growth percentile measures are not designed for making such inference and thus have no place in making determinations regarding teacher effectiveness. We also explain that, due to the properties of value-added estimates, they have no place in making high-stakes decisions based on rigid policy frameworks like those described herein. We evaluate the legal implications of rigid reliance on measures of teaching effectiveness that a) lack reliability and b) may be entirely invalid. (Contains 32 tables and 13 footnotes.)