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Constraining landslide occurrence rates can help to generate landslide hazard models that predict the spatial and temporal occurrence of landslides. However, most landslide inventories do not include any temporal data due to the difficulties of dating landslide deposits. Here we introduce a method for estimating the mean landslide occurrence rate of deep‐seated rotational and translational slides derived solely from high‐resolution (≤3 m) elevation data and globally available estimates of the diffusion coefficient for sediment flux. The method applies a linear diffusion model to the roughest landslide deposits until they reach a representative non‐landslide roughness distribution. This estimates the time for a landslide deposit to be unrecognizable in high‐resolution digital elevation data, which we term the mean lifetime of the landslide. Using the mean lifetime and number of landslides within an area of interest, we can estimate the mean occurrence rate of landslides over that domain. We validate this approach using a comprehensive temporal inventory of landslides in western Oregon created using age‐roughness curves that are calibrated with high‐resolution elevation data and radiocarbon data. We find good agreement between our diffusion method and the existing age‐roughness‐derived estimates, producing mean lifetimes of 4500 and 5200 years (4% difference), respectively. Hazard maps produced using the two methodologies generally agree, with the maximum differences in landslide probability reaching 0.1. Due to the relative abundance of high‐resolution elevation data compared with age‐dated landslides, our method could help constrain landslide occurrence rates in areas previously considered unfeasible. Plain Language Summary: Estimating how often landslides occur over a given area can be helpful in reducing landslide damages in the future. Traditional methods of estimating how often landslides occur require complex methods for estimating landslide ages, which can be time consuming and expensive. As a result, age‐dated landslides are limited to a few locations around the world. Here, we present a method for estimating how often landslides occur using only widely available high‐resolution elevation data. We contrast our method with results using traditional age‐dating techniques and find good agreement. Using our method, we can estimate how often landslides occur in areas where it was previously impractical. Key Points: We present a method for constraining landslide occurrence rates without using traditional age‐dating techniquesThe method applies a diffusion model and only requires elevation data, a landslide inventory, and estimates of the diffusion coefficientEstimates of landslide occurrence rates using age‐dating and the diffusion method show good agreement [ABSTRACT FROM AUTHOR]

Hazard assessment for post‐wildfire debris flows, which are common in the steep terrain of the western United States, has focused on the susceptibility of upstream basins to generate debris flows. However, reducing public exposure to this hazard also requires an assessment of hazards in downstream areas that might be inundated during debris flow runout. Debris flow runout models are widely available, but their application to hazard assessment for post‐wildfire debris flows has not been extensively tested. Necessary inputs to these models include the total volume of the mobilized flow, flow properties (either inherent material properties or calibration coefficients), and site topography. Estimates of volume are possible in post‐event ("back calculation") studies, yet before an event, volume is an uncertain quantity. We simulated debris flow runout for the well‐constrained 9 January 2018 Montecito event using three models (RAMMS, FLO2D, and D‐Claw) to determine the relative importance of volume and flow properties. We broke the impacted area into three domains, and for each model‐domain combination, we performed a numerical sampling study in which volume and flow properties varied within a wide, but plausible range. We assessed model performance based on inundation patterns and peak flow depths. We found all models could simulate the event with comparable results. Simulation performance was most sensitive to flow volume and less sensitive to flow properties. Our results emphasize the importance of reducing uncertainty in pre‐event estimates of flow volume for hazard assessment. Plain Language Summary: Changes in soil properties after fire mean rain can more easily erode the surface and initiate debris flows—mixtures of water, soil, and rock that rapidly move from steep source areas to downstream regions. The combination of frequent fire, steep landscapes, dense population, and intense rain makes southern California prone to debris flows. The scientific community has established methods linking debris flow likelihood and volume to rainfall intensity and burned area characteristics. We presently lack a basis for understanding how flow volume, flow material properties, representation of flow physics, and site topography all combine to produce an inundation hazard. We begin to address this by using observations from the 9 January 2018 Montecito, California, debris flow event to test three candidate models for debris flow inundation. We found that all models can simulate the event and that the largest source of uncertainty in inundated area is the flow volume. Key Points: The 2018 Montecito event was successfully simulated with three debris flow inundation models that vary in model physicsModel performance was more sensitive to flow volume and site morphology than to flow propertiesEstimated volumes were lower than rainfall‐based predictions, and observed inundation areas were larger than volume‐based predictions [ABSTRACT FROM AUTHOR]

The emerging fungal pathogen Batrachochytrium salamandrivorans (Bsal) is a major threat to amphibian species worldwide with potential to infect many species if it invades salamander biodiversity hotspots in the Americas. Bsal can cause the disease chytridiomycosis, and it is important to assess the risk of Bsal‐induced chytridiomycosis to species in North America. We evaluated the susceptibility to Bsal of the common and widespread spotted salamander, Ambystoma maculatum, across life‐history stages and monitored the effect of Bsal exposure on growth rate and response of the stress hormone, corticosterone. We conclude that spotted salamanders appear resistant to Bsal because they showed no indication of disease or infection, and experienced minor effects on growth upon exposure. While we focused on a single population for this study, results were consistent across conditions of exposure including high or repeated doses of Bsal, life‐stage at exposure, environmental conditions including two temperatures and two substrates, and promoting pathogen infectivity by conditioning Bsal cultures with thyroid hormone. Exposure to high levels of Bsal elicited an acute but not chronic increase in corticosterone in spotted salamanders, and reduced growth. We hypothesize that the early acute increase in corticosterone facilitated mounting an immune response to the pathogen, perhaps through immunoredistribution to the skin, but further study is needed to determine immune responses to Bsal. These results will contribute to development of appropriate Bsal management plans to conserve species at risk of emerging disease. [ABSTRACT FROM AUTHOR]

Introduction: Sexual devices, including vibrators, are commonly used to enhance and aid in individual and partnered sexual experiences. Previous studies show that the use of vibratory stimulation can be an effective treatment of issues related to pelvic health and sexual function, but additional research is needed to further explore patient-related factors that may be taken into consideration when discussing this treatment modality. Objective: The purpose of this pilot study was to explore patient beliefs and experiences related to vibrator use as a treatment option for genital pain. Methods: This study was conducted in collaboration with a local sexual health practitioner who includes vibrators, or they refer to it in office as "vibe therapy," as part of their regular practice. Participants, women recommended vibe therapy for genital pain within the past 24 months, were recruited though the sexual health provider. Those who consented accessed an anonymous electronic questionnaire covering vibrator use and beliefs prior to recommended vibe therapy and specific to vibe therapy, as well as demographics and the Female Sexual Function Index (FSFI). The survey was conducted twice in a six month span and the current analysis included three cases who completed the survey during both rounds of data collection. Unique identifiers were created based on participant responses and utilized for the current analysis. Descriptive analysis was completed using SPSS and a comparison of vibe therapy beliefs and experiences were examined within and between cases. Results: The three current cases reported that their most recent visit to the medical clinic was due to various reasons including: dyspareunia, overactive pelvic floor, and/or vaginismus. While two participants reported previous masturbation behaviors, none of the participants reported vibrator use prior to their clinician including it as a treatment option. Responses varied for each of the participants between the initial and secondary survey. Two participants reported use of medication and/or pelvic rehab in combination with vibe therapy. For all cases, duration and frequency of vibe therapy increased between the two time points. Additionally, positive beliefs related to comfort of use, desire to engage in sexual behaviors, and reduced pain during sex were reported. Two participants who initially experienced pain during vibration reported that it was no longer painful by the second time point. Sexual partner communication and inclusion in vibrator use varied between participants. All participants reported increased sexual enjoyment, reduced sexual pain, and intentions to continue vibe therapy. Conclusions: While the use of genital vibrators for pain has been shown to be effective, patient experiences and beliefs related to this treatment option differ based on their individual situations. For all cases, responses remained consistent or became more favorable with continued use of vibe therapy. This information may be helpful for providers to consider when thinking about how they counsel patients who choose to use a vibrator as a form of treatment for sexual pain and other issues. Future studies may further explore how medical practitioner comfort and approach towards this treatment option may influence patient experiences. Disclosure: No. [ABSTRACT FROM AUTHOR]

Introduction: Pain is commonly experienced during Intrauterine device (IUD) insertion and a possible barrier to this form of contraception. Pharmacological methods and non-pharmacological techniques are available to reduce pain during this procedure, but the efficacy varies on a case-by-case basis and data is conflicting regarding doses. Additional techniques are needed to increase the likelihood of a more patient centered approach to address pain experienced during IUD placement. Objective: The purpose of the current project is to describe exploratory use of vibration and propose it as an innovative pain management technique during IUD insertion. Methods: Recognizing that the umbilicus and the distal third of the vagina are embryologically connected, the current clinician hypothesized that external vibration applied to the umbilicus by a patient during IUD placement may reduce pain. Starting in 2017 external umbilical vibration was added to a previously established list of pain reduction options available during IUD placement at one clinical practice. Patients were consulted prior to IUD insertion and the list of multiple options discussed as part of regular practice. Patients and the provider determined the methods of pain reduction that best fit the individual patient's needs based on their previous experiences, apprehension, and other concerns related to the procedure. Clinician observation and recall of response and reactions following the use of vibration will be shared. Results: A detailed description of the umbilical vibration technique will be provided. Provider recall and summary of anonymous patient responses will be discussed, as well as the possible implications for gynecological care. Verbal and non-verbal responses from patients who elected to use umbilical vibration, or a combination of umbilical vibration and other techniques, to reduce pain have been overwhelmingly positive. No negative experiences with this non-invasive technique have occurred. Conclusions: Umbilical vibration may serve as an effective, low-cost option to reduce pain during IUD placement. Providers considering this technique should be comfortable discussing vibration and open to this type of patient centered care. Umbilical vibration as a pain reduction technique for IUD insertion could be utilized in a trauma informed practice. A more in-depth study to further explore the intricacies of this technique is in preparation. Disclosure: No. [ABSTRACT FROM AUTHOR]

We evaluated the ability of three debris-flow runout models (RAMMS, FLO2D and D-Claw) to predict the number of damaged buildings in simulations of the 9 January 2019 Montecito, California, debrisflow event. Observations of building damage after the event were combined with OpenStreetMap building footprints to construct a database of all potentially impacted buildings. At the estimated event volume, all models overpredict the number of damaged buildings by a factor of 1.5–3.

In the semi-arid regions of the western United States, postfire debris flows are typically runoff generated. The U.S. Geological Survey has been studying the mechanisms of postfire debris-flow initiation for multiple decades to generate operational models for forecasting the timing, location, and magnitude of postfire debris flows. Here we discuss challenges and progress for extending operational capabilities to include modeling postfire debris-flow inundation extent. Analysis of volume and impacted area scaling relationships indicated that postfire debris flows do not conform to assumptions of geometric self-similarity. We documented sensitivity of impacted areas to rainfall intensity using a candidate methodology for generating inundation hazard assessments. Our results emphasize the importance of direct measurements of debris-flow volume, inundated area, and high temporal resolution rainfall intensity.

Since the approval of insulin as the first recombinant therapeutic protein, the prominence of biologic therapies in drug development has grown significantly. Many modalities beyond traditional biologics are now being developed or explored for various indications with significant unmet medical needs. From early traditional replacement proteins to more recent, highly engineered antibodies, oligonucleotides, fusion proteins, and gene constructs, biologic agents have delivered life-changing therapies, despite often having scientifically and technically challenging development programs. This brief review outlines some of the major biotherapeutic classes and identifies the advantages and challenges with the development of these products. [ABSTRACT FROM AUTHOR]

STUDY QUESTION: Is salpingotomy cost effective compared with salpingectomy in women with tubal pregnancy and a healthy contralateral tube? SUMMARY ANSWER: Salpingotomy is not cost effective over salpingectomy as a surgical procedure for tubal pregnancy, as its costs are higher without a better ongoing pregnancy rate while risks of persistent trophoblast are higher. WHAT IS KNOWN ALREADY: Women with a tubal pregnancy treated by salpingotomy or salpingectomy in the presence of a healthy contralateral tube have comparable ongoing pregnancy rates by natural conception. Salpingotomy bears the risk of persistent trophoblast necessitating additional medical or surgical treatment. Repeat ectopic pregnancy occurs slightly more often after salpingotomy compared with salpingectomy. Both consequences imply potentially higher costs after salpingotomy. STUDY DESIGN, SIZE, DURATION: We performed an economic evaluation of salpingotomy compared with salpingectomy in an international multicentre randomized controlled trial in women with a tubal pregnancy and a healthy contralateral tube. Between 24 September 2004 and 29 November 2011, women were allocated to salpingotomy (n = 215) or salpingectomy (n = 231). Fertility follow-up was done up to 36 months post-operatively. PARTICIPANTS/MATERIALS, SETTINGS, METHODS: We performed a cost-effectiveness analysis from a hospital perspective. We compared the direct medical costs of salpingotomy and salpingectomy until an ongoing pregnancy occurred by natural conception within a time horizon of 36 months. Direct medical costs included the surgical treatment of the initial tubal pregnancy, readmissions including reinterventions, treatment for persistent trophoblast and interventions for repeat ectopic pregnancy. The analysis was performed according to the intention -to-treat principle. MAIN RESULTS AND THE ROLE OF CHANCE: Mean directmedical costs per woman in the salpingotomy group and in the salpingectomy group were €3319 versus €2958, respectively, with a mean difference of €361 (95%confidence interval €217 to €515). Salpingotomy resulted in a marginally higher ongoing pregnancy rate by natural conception compared with salpingectomy leading to an incremental cost-effectiveness ratio €40 982 (95% confidence interval 2 €130 319 to €145 491) per ongoing pregnancy. Since salpingotomy resulted in more additional treatments for persistent trophoblast and interventions for repeat ectopic pregnancy, the incremental cost-effectiveness ratio was not informative. † The ESEP Group members are listed in the Appendix. & 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 Human Reproduction, Vol.30, No.9 pp. 2038-2047, 2015 Advanced Access publication on July 13, 2015 doi: LIMITATIONS, REASONS FOR CAUTION: Costs of any subsequent IVF cycles were not included in this analysis. The analysis was limited to the perspective of the hospital. WIDER IMPLICATIONS OF THE FINDINGS: However, a small treatment benefit of salpingotomy might be enough to cover the costs of subsequent IVF. This uncertainty should be incorporated in shared decision-making. Whether salpingotomy should be offered depends on society's willingness to pay for an additional child. STUDY FUNDING/COMPETING INTEREST(S): Netherlands Organisation for Health Research and Development, Region Västra Götaland Health & Medical Care Committee. TRIAL REGISTRATION NUMBER: ISRCTN37002267. [ABSTRACT FROM AUTHOR]

Sea ice limits the interaction of the land and ocean water in the Arctic winter and influences this interaction in the summer by governing the fetch. In many parts of the Arctic, the open-water season is increasing in duration and summertime sea-ice extents are decreasing. Sea ice provides a first-order control on the physical vulnerability of Arctic coasts to erosion, inundation, and damage to settlements and infrastructures by ocean water. We ask how the changing sea-ice cover has influenced coastal erosion over the satellite record. First, we present a pan-Arctic analysis of satellite-based sea-ice concentration specifically along the Arctic coasts. The median length of the 2012 open-water season, in comparison to 1979, expanded by between 1.5 and 3-fold by Arctic Sea sector, which allows for open water during the stormy Arctic fall. Second, we present a case study of Drew Point, Alaska, a site on the Beaufort Sea, characterized by ice-rich permafrost and rapid coastal-erosion rates, where both the duration of the open-water season and distance to the sea-ice edge, particularly towards the northwest, have increased. At Drew Point, winds from the northwest result in increased water levels at the coast and control the process of submarine notch incision, the rate-limiting step of coastal retreat. When open-water conditions exist, the distance to the sea ice edge exerts control on the water level and wave field through its control on fetch. We find that the extreme values of water-level setup have increased consistently with increasing fetch. [ABSTRACT FROM AUTHOR]

Emerging in situ sensors and distributed network technologies have the potential to monitor dynamic hydrological and environmental processes more effectively than traditional monitoring and data acquisition techniques by sampling at greater spatial and temporal resolutions. Since sensor networks supply data with little or no delay, applications exist where automatic or real-time assimilation of this data would be useful, for example, during smart remediation procedures where tracking of the plume response will reinforce real-time decisions. As a foray into this new data context, we consider the estimation of hydraulic conductivity when incorporating subsurface plume concentration data. Current practice optimizes the model in the time domain, which is often slow and very nonlinear. Instead, we perform model inversion in Laplace space and are able to do so because data gathered using new technologies can be sampled densely in time. An intermediate-scale synthetic aquifer is used to illustrate the developed technique. [ABSTRACT FROM AUTHOR]

Objective: To estimate whether a gel containing the spermicide C31G was noninferior to a commercially available product containing nonoxynol-9.Methods: Participants were healthy, sexually active women aged 18-40 years. Measured outcomes included pregnancy rates, continuation rates, adverse events, and acceptability. The primary study outcome was contraceptive efficacy. Sample size was calculated at a 2.5% significance level using a one-sided test based on assumed 6-month pregnancy probability of 15% in the nonoxynol-9 group. Sample size was sufficient to reject, with 80% power, the null hypothesis that pregnancy probability in the C31G arm would be more than 5% higher.Results: Nine hundred thirty-two women were randomized in the C31G group and 633 in the nonoxynol-9 group. For randomized patients with at least one episode of coitus (modified intent-to-treat group), 6-month pregnancy probabilities were 12.0% (95% confidence interval [CI] 9.3-14.7%) and 12.0% (95% CI 8.7-15.3%) for C31G and nonoxynol-9,respectively. Twelve-month pregnancy probabilities were 13.8% (95% CI 7.6-20%) for C31G and 19.8% (95% CI 10.9-28.7%) for nonoxynol-9. Two serious adverse events were deemed possibly related to study product and neither occurred in the C31G group. Three fourths of users in either group reported that they liked their assigned study product. Approximately 40% of patients discontinued prematurely for reasons other than pregnancy with 11% lost to follow-up.Conclusion: C31G demonstrated noninferior contraceptive efficacy compared with nonoxynol-9. C31G may provide another marketable option for women seeking spermicidal contraception.Clinical Trial Registration: ClinicalTrials.gov, www.ClinicalTrials.gov, NCT00274261. [ABSTRACT FROM AUTHOR]

Background: A logistic regression model (M4) was developed in the UK to predict the outcome for women with a pregnancy of unknown location (PUL) based on the initial two human chorionic gonadotrophin (hCG) values, 48 h apart. The purpose of this paper was to assess the utility of this model to predict the outcome for a woman (PUL) in a US population.Methods: Diagnostic variables included log-transformed serum hCG average of two measurements, and linear and quadratic hCG ratios. Outcomes modeled were failing PUL, intrauterine pregnancy (IUP) and ectopic pregnancy (EP). This model was applied to a US cohort of 604 women presenting with symptomatic first-trimester pregnancies, who were followed until a definitive diagnosis was made. The model was applied before and after correcting for differences in terminology and diagnostic criteria.Results: When retrospectively applied to the adjusted US population, the M4 model demonstrated lower areas under the curve compared with the UK population, 0.898 versus 0.988 for failing PUL/spontaneous miscarriage, 0.915 versus 0.981 for IUP and 0.831 versus 0.904 for EP. Whereas the model had 80% sensitivity for EP using UK data, this decreased to 49% for the US data, with similar specificities. Performance only improved slightly (55% sensitivity) when the US population was adjusted to better match the UK diagnostic criteria.Conclusions: A logistic regression model based on two hCG values performed with modest decreases in predictive ability in a US cohort for women at risk for EP compared with the original UK population. However, the sensitivity for EP was too low for the model to be used in clinical practice in its present form. Our data illustrate the difficulties of applying algorithms from one center to another, where the definitions of pathology may differ. [ABSTRACT FROM AUTHOR]