Search

ImportanceEach year, the National Cancer Database (NCDB) collects and analyzes data used in reports to support research, quality measures, and Commission on Cancer program accreditation. Because data models used to generate these reports have been historically stable, year-to-year variances have been attributed to changes within the cancer program rather than data modeling. Cancer submissions in 2020 were anticipated to be significantly different from prior years because of the COVID-19 pandemic. This study involved a validation analysis of the variances in observed to expected 2020 NCDB cancer data in comparison with 2019 and 2018.ObservationsThe NCDB captured a total of 1 223 221 overall cancer cases in 2020, a decrease of 14.4% (Δ = −206 099) compared with 2019. The early months of the COVID-19 pandemic (March-May 2020) coincided with a nadir of cancer cases in April 2020 that did not recover to overall prepandemic levels through the remainder of 2020. In the early months of the COVID-19 pandemic, the proportion of early-stage disease decreased sharply overall, while the proportion of late-stage disease increased. However, differences in observed to expected stage distribution in 2020 varied by primary disease site. Statistically significant differences in the overall observed to expected proportions of race and ethnicity, sex, insurance type, geographic location, education, and income were identified, but consistent patterns were not evident.Conclusions and RelevanceHistorically stable NCDB data models used for research, administrative, and quality improvement purposes were disrupted during the first year of the COVID-19 pandemic. NCDB data users will need to carefully interpret disease- and program-specific findings for years to come to account for pandemic year aberrations when running models that include 2020.

Global change is impacting the oceans in an unprecedented way, and multiple lines of evidence suggest that species distributions are changing in space and time. There is increasing evidence that multiple environmental stressors act together to constrain species habitat more than expected from warming alone. Here, we conducted a comprehensive study of how temperature and aragonite saturation state act together to limit Limacina helicina, globally distributed pteropods that are ecologically important pelagic calcifiers and an indicator species for ocean change. We co-validated three different approaches to evaluate the impact of ocean warming and acidification (OWA) on the survival and distribution of this species in the California Current Ecosystem. First, we used colocated physical, chemical, and biological data from three large-scale west coast cruises and regional time series; second, we conducted multifactorial experimental incubations to evaluate how OWA impacts pteropod survival; and third, we validated the relationships we found against global distributions of pteropods and carbonate chemistry. OWA experimental work revealed mortality increases under OWA, while regional habitat suitability indices and global distributions of L. helicina suggest that a multi-stressor framework is essential for understanding pteropod distributions. In California Current Ecosystem habitats, where pteropods are living close to their thermal maximum already, additional warming and acidification through unabated fossil fuel emissions (RCP 8.5) are expected to dramatically reduce habitat suitability.

Cancer care team attitudes towards distress screening are key to its success and sustainability. Previous qualitative research has interviewed staff mostly around the startup phase. We evaluate oncology teams' perspectives on psychosocial distress screening, including perceived strengths and challenges, in settings where it has been operational for years.We conducted, transcribed, and analyzed semi-structured interviews with 71 cancer care team members (e.g., MDs, RNs, MSWs) at 18 Commission on Cancer-accredited cancer programs including those serving underrepresented populations.Strengths of distress screening identified by participants included identifying patient needs and testing provider assumptions. Staff indicated it improved patient-provider communication and other aspects of care. Challenges to distress screening included patient barriers (e.g., respondent burden) and lack of electronic system interoperability. Participants expressed the strengths of distress screening (n = 291) more than challenges (n = 86). Suggested improvements included use of technology to collect data, report results, and make referrals; complete screenings prior to appointments; longitudinal assessment; additional staff training; and improve resources to address patient needs.Cancer care team members' perspectives on well-established distress screening programs largely replicate findings of previous studies focusing on the startup phase, but there are important differences: team members expressed more strengths than challenges, suggesting a positive attitude. While our sample described many challenges described previously, they did not indicate challenges with scoring and interpreting the distress screening questionnaire. The differences in attitudes expressed in response to mature versus startup implementations provide important insights to inform efforts to sustain and optimize distress screening.

A realistic numerical model is used to study the circulation and mixing of the Salish Sea, a large, complex estuarine system on the United States and Canadian west coast. The Salish Sea is biologically productive and supports many important fisheries but is threatened by recurrent hypoxia and ocean acidification, so a clear understanding of its circulation patterns and residence times is of value. The estuarine exchange flow is quantified at 39 sections over 3 years (2017–2019) using the Total Exchange Flow method. Vertical mixing in the 37 segments between sections is quantified as opposing vertical transports: the efflux and reflux. Efflux refers to the rate at which deep, landward-flowing water is mixed up to become part of the shallow, seaward-flowing layer. Similarly, reflux refers to the rate at which upper layer water is mixed down to form part of the landward inflow. These horizontal and vertical transports are used to create a box model to explore residence times in a number of different sub-volumes, seasons, and years. Residence times from the box model are generally found to be longer than those based on simpler calculations of flushing time. The longer residence times are partly due to reflux, and partly due to incomplete tracer homogenization in sub-volumes. The methods presented here are broadly applicable to other estuaries.

We present the outcome of a mission concept study that designed a small atmospheric entry probe and examined the feasibility and benefit of a future multi-probe mission to Uranus. We call our design the Small Next-generation Atmospheric Probe (SNAP). The primary scientific objective of a multi-probe mission is to reveal spatial variability of atmospheric conditions. This article first highlights that not all measurements must be repeated by multiple probes; some quantities, notably the noble gas abundances and elemental isotopic ratios, are not expected to be variable, and thus need to be performed only by a single large Primary Probe. Our study demonstrates that, by focusing its measurements on spatially variable quantities including atmospheric vapor concentrations, thermal stratification and wind speed, a viable atmospheric probe design is realized with an entry system with 50-cm heatshield diameter and 30-kg atmospheric entry mass. As a case study, we present a detailed analysis of adding SNAP to a notional Uranus Orbiter with Probe mission, which launches in 2031 and arrives at Uranus in 2043, designed by the NASA-funded Science Definition Team study in 2017. We demonstrate that, with minimal changes to the notional carrier mission, a large Primary Probe and SNAP can be delivered to the winter and summer hemispheres to examine seasonal atmospheric variabilities, and transmit data to the Orbiter, which in turn relays the data to Earth. The additional maneuvers needed to deliver SNAP totals a Delta-V of 84 m/s, and consumes 43 kg of propellant. The addition of SNAP is expected to cost $79.5 million in FY2018 dollars; thus, our study demonstrates that a multi-probe mission can be implemented with a 4% cost increase relative to the $2.0 billion cost estimate of the notional mission designed by NASA’s Ice Giant Flagship Science Definition Team study reported in 2017. The SNAP design incorporates several technologies that are currently under development at various Technology Readiness Levels (TRL) between TRL = 4 and TRL = 6. In particular, our study recommends targeted technology development in Thermal Protection System materials, advanced batteries, and miniaturized instruments to enable and enhance future small atmospheric probes like SNAP.

Observations from a single mooring site on the northern Chukchi Sea continental slope near the 1000-m isobath are presented. This site was occupied consecutively for three years (spanning September 2014–August 2017). Vertically the flow divides into three depth ranges: the upper ~200 m, ~200–~850 m and near-bottom flow. In the upper ~200 m, the mean flow was northwestward and strongest in the summer months. During winter months, currents decreased in magnitude, and in some years even reversed in direction. Satellite-tracked drifter trajectories (drogue depth ~30 m) show this along-slope flow persists at least from 156 to 165 °W, with an average velocity of ~17 cm s−1. This northwestward flowing current is the Chukchi Slope Current. From ~250 m to ~850 m, the flow reversed; this weak flow is the Arctic-wide cyclonic boundary current advecting Atlantic Water. The mean flow at ~900 m is weak and on an annual time scale not significantly different from 0 cm s−1. It consists of Arctic deep water. In the upper two layers, currents vary on the scale of days to seasons, with short-term reversals common. Currents below 40 m were not significantly correlated with local winds nor wind stress curl. We hypothesize that the northwestward flowing Chukchi Slope Current is a consequence of dynamics associated with the Beaufort Gyre.

Moored observations are used to investigate the seasonal change in vertical structure of the cross-shelf circulation at a midshelf location in the northern California Current System. A streamwise–normal coordinate system is employed to eliminate meander- and eddy-induced biases in the cross-shelf flow that are unaccounted for with an alternative, commonly applied approach. The resulting flow structure develops an organized pattern midway through the upwelling season. In particular, under upwelling-favorable conditions an onshore return layer occurs just beneath the offshore surface flow, and a third offshore-directed layer exists at depth that does not appear to satisfy Ekman dynamics (to within 9 m of the bottom). Both subsurface layers strengthen in time over the upwelling season. Mechanisms to explain the mean structure are evaluated, and it is suggested that the timing of the development and strengthening of both the interior onshore return flow and the offshore near-bottom layer are consistent with the seasonally changing direction and magnitude of the large-scale alongshelf sea level gradient. The change to a poleward sea level gradient initiates a seasonal relaxation of upwelled isopycnals that likely leads to the near-bottom flow. Late-season enhancement of the interior onshore return flow is related to the alongshelf surface wind stress but appears to form as a consequence of offshore transport in the near-bottom layer and the need to satisfy coastal mass balance.

A coastwide bloom of the toxigenic diatom Pseudo‐nitzschia in spring 2015 resulted in the largest recorded outbreak of the neurotoxin, domoic acid, along the North American west coast. Elevated toxins were measured in numerous stranded marine mammals and resulted in geographically extensive and prolonged closures of razor clam, rock crab, and Dungeness crab fisheries. We demonstrate that this outbreak was initiated by anomalously warm ocean conditions. Pseudo‐nitzschia australis thrived north of its typical range in the warm, nutrient‐poor water that spanned the northeast Pacific in early 2015. The seasonal transition to upwelling provided the nutrients necessary for a large‐scale bloom; a series of spring storms delivered the bloom to the coast. Laboratory and field experiments confirming maximum growth rates with elevated temperatures and enhanced toxin production with nutrient enrichment, together with a retrospective analysis of toxic events, demonstrate the potential for similarly devastating ecological and economic disruptions in the future., Key Points The 2015 U.S. West Coast wide toxic Pseudo‐nitzschia australis bloom was facilitated by anomalous ocean conditionsThe seasonal transition to upwelling provided nutrients for the bloom, and spring storms delivered toxic cells to the nearshore environmentWest Coast toxic Pseudo‐nitzschia events are triggered by warm anomalies associated with El Niño and the Pacific Decadal Oscillation

34 Background: Since enactment of Healthy People 2000 (ODPHP.gov, nd), a focus has been to reduce disparity by achieving health equity across all people. We examined disparity for five cancer quality measures with high performance rates (PRs) ( > 85%). Methods: Five measures developed by the Commission on Cancer and endorsed by the National Quality Forum were evaluated for potential ethnicity, insurance, and Census Division disparities. Data from the National Cancer Database were used to examine hospital-level PRs on adjuvant chemotherapy for ER neg breast ca (MAC), hormone therapy for ER+ breast ca (HT), resection of at least 12 nodes in a colon resection (12RLN), and adjuvant chemotherapy for stage III colon ca (ACT) measures for patients diagnosed in 2015. Patients receiving radiation after breast conservation surgery (BCSRT) were diagnosed in 2014 to ensure complete treatment follow-up. Results: Significant disparities exist for all measures on ethnicity between non-Hispanic whites and Hispanics. The least variation of ethnicity occurred within 12RLN (non-significant). Variability within insurance was found most frequently with HT and BCSRT measures, not insured/Medicaid versus Medicare, and not insured/Medicaid versus Private respectively. Location disparity exists for all measures, with South Central states’ significantly lower PRs. Further investigation should focus on access, insurability, and delivery of care to better understand and eliminate disparities. Conclusions: Cancer quality measures, which show high performance nationally, show significant performance variability reflective of on-going disparities of care. [Table: see text]

Momentum balances in the near-field region of a large, tidally pulsed river plume are examined. The authors concentrate on a single ebb tide of the Columbia River plume, using the Regional Ocean Modeling System (ROMS) configured to hindcast flow conditions on the Washington and Oregon shelves and in the Columbia River estuary. During ebb, plume-interior streamwise balances are largely between advection, pressure gradient, and frictional forces. Stream-normal balances in this region reduce to centrifugal, cross-stream pressure gradient, and Coriolis terms (i.e., the “gradient wind” balance commonly assumed in river plume bulge investigations). Temporal derivatives are most important at the plume front and as the ebb progresses. Winds were light and contributed little to the force balance. Midebb stress and vertical salt flux were largest at a midplume depth, where stratification and vertical shear were also high, consistent with shear-induced mixing. Internal stress slows the spreading plume considerably. A kinematic description of the spreading process relates lateral spreading to the momentum dynamics and illustrates that plume spreading is largely a competition between the cross-stream pressure gradient and Coriolis forces. However, the very near-field dome of buoyant water is instrumental in setting initial flow pathways.

Background This manuscript describes an approach for analyzing large amounts of disparate clinical data to elucidate the most impactful factor(s) that relate to a meaningful clinical outcome, in this case, the quality of life of cancer patients. The relationships between clinical and quality of life variables were evaluated using the EORTC QLQ-C30 global health domain—a validated surrogate variable for overall cancer patient well-being. Methods A cross-sectional study design was used to evaluate the determinants of global health in cancer patients who initiated treatment at two regional medical centers between January 2001 and December 2009. Variables analyzed included 15 EORTC QLQ-C30 scales, age at diagnosis, gender, newly diagnosed/ recurrent disease status, and stage. The decision tree algorithm, perhaps unfamiliar to practicing clinicians, evaluates the relative contribution of individual parameters in classifying a clinically meaningful functional endpoint, such as the global health of a patient. Findings Multiple patient characteristics were identified as important contributors. Fatigue, in particular, emerged as the most prevalent indicator of cancer patients’ quality of life in 16/23 clinically relevant subsets. This analysis allowed results to be stated in a clinically-intuitive, rule set format using the language and quantities of the Quality of Life (QoL) tool itself. Interpretation By applying the classification algorithms to a large data set, identification of fatigue as a root factor in driving global health and overall QoL was revealed. The ability to practice mining of clinical data sets to uncover critical clinical insights that are immediately applicable to patient care practices is illustrated.

Patient-reported outcomes (PROs) measure quality of life, symptoms, patient functioning, and patient perceptions of care; they are essential for gaining a full understanding of cancer care and the impact of cancer on people's lives. Repeatedly captured facility-level and/or population-level PROs (PRO surveillance) could play an important role in quality monitoring and improvement, benchmarking, advocacy, policy making, and research. This article describes the rationale for PRO surveillance and the methods of the Patient Reported Outcomes Symptoms and Side Effects Study (PROSSES), which is the first PRO study to use the American College of Surgeons Commission on Cancer's Rapid Quality Reporting System to identify patients and manage study data flow. The American Cancer Society, the National Cancer Institute, the Commission on Cancer, and RTI International collaborated on PROSSES. PROSSES was conducted at 17 cancer programs that participated in the National Cancer Institute Community Cancer Centers Program among patients diagnosed with locoregional breast or colon cancer. The methods piloted in PROSSES were successful as demonstrated by high eligibility (93%) and response (61%) rates. Differences in clinical and demographic characteristics between respondents and nonrespondents were mostly negligible, with the exception that non-white individuals were somewhat less likely to respond. These methods were consistent across cancer centers and reproducible over time. If repeated and expanded, they could provide PRO surveillance data from patients with cancer on a national scale.

Observational and model estimates of the form drag on Three Tree Point, a headland located in a tidal channel of Puget Sound, Washington, are presented. Subsurface, Three Tree Point is a sloping ridge. Tidal flow over this ridge gives rise to internal lee waves that lead to wave drag and enhanced mixing. At the same time, horizontal flow separation produces a headland eddy that distorts the surface height field in the lee of the point. Two observational methods for estimating the portion of the form drag associated with deformation of the surface height field, referred to here as the “external” form drag, are also introduced. Drogued drifters and ship-mounted acoustic current profiles from different days are used to indirectly map the flood-tide surface height field. Data are derived from a depth shallow enough that baroclinic pressure gradient forcing may be neglected, and yet deep enough that wind stress may also be ignored. This leaves an approximate balance between the acceleration and surface height pressure gradient, permitting, in this case, two independent estimates of the surface height (to within a constant). These fields are used to calculate the external form drag at the headland. Drag estimates from both observational datasets agree well. External form drag decreases offshore of the headland as expected, and is highly dependent on tidal phase, with maximum drag leading peak flood currents by 1–2 h at this location. Form drag is much larger than model estimates of the frictional drag, implying that it is the dominant mechanism extracting energy from the barotropic tide. A kinematic argument is also presented to show why the external form drag should increase in importance relative to the frictional drag as the topographic slope and tidal excursion increase.

173 Background: Many quality metrics of cancer care are process measures, based on whether a patient received recommended treatment for diagnosis and stage of their disease. Survival is dependent on patient characteristics, disease specifics, and care received (surgery, systemic therapies, radiation). Some argue survival is the ultimate measure of cancer care quality. Survival calculated from registry data may be a better indication of the real effects of new therapies as it contains a broad representation of patients who may not meet the eligibility criteria for clinical trials. Methods: The NCDB is composed of registry data from approximately 1,500 hospital based cancer programs, and includes stage, demographic data, co-morbidities, treatments, and vital status. Survival analyses were derived from NCDB data for all stages of breast cancer, non-small cell lung cancer (NSCLC), and pancreatic cancer. These diseases were selected because breast cancer has a high survival rate, whereas NSCLC and pancreatic cancer are diseases with a poor prognosis, but recent advances may have improved survival. Un-adjusted and risk adjusted survival were analyzed by socioeconomic, tumor, and hospital factors including stage, comorbidities, diagnosis year (to assess new treatment trends), and type of institution (academic, comprehensive community, and community cancer programs). Results: Results for these diseases and variables noted will be presented. Whereas better un-adjusted survival rates were often seen at academic cancer programs, differences disappeared after risk-adjustment. Improved survival was seen in more recent years, probably representing new treatment effects, though gains were modest and stage dependent. Conclusions: Measuring survival across hospitals and regions is critical to understanding the state of cancer treatment nationally and the effect of quality and therapy advances on patients across a variety of clinical settings. Methodologic challenges in analyzing and interpreting survival data must be realized, and continued innovation in the collection and analysis of data is needed.

Received 6 April 2011; revised 14 November 2011; accepted 3 January 2012; published 10 March 2012. [1] Simultaneous in situ measurements of waves, currents and turbulence are presented to describe dissipation rates of wave energy and turbulent kinetic energy in the windward coral reef-lagoon system at Lady Elliot Island (LEI), Australia. The dissipation of wave energy in the lagoon is tidally modulated and strongly correlates with frictional dissipation due to the presence of the extremely rough bottom boundary. The observed turbulent kinetic energy (TKE) dissipation rate, ɛ, in this wave-dominated lagoon is much larger than recently reported values for unidirectional flows over natural fringing coral reefs. The correlation between the wave dissipation and ɛ is examined. The average rate of dissipation induced by the rough turbulent flow was estimated directly from the observed ɛ coupled with both a depth-integrated approach and with a bottom boundary layer scaling. Rates of TKE dissipation estimated using the two approaches approximate well, within a factor of 1.5 to 2.4, to the surface-wave energy dissipation rate. The wave dissipation and friction factor in the lagoon can be described by a spectral wave-frictional model with a bottom roughness length scale that is approximately constant across the lagoon. We also present estimates of dissipation induced by the canopy drag force of the coral heads. The dissipation in this case is enhanced and becomes more significant for the total energy dissipation when the water depth in the lagoon is comparable to the height of the coral heads.

[1] Temperature data collected in the shallow, tidally isolated reef flat/lagoon of Lady Elliot Island off Queensland, Australia, show marked variability under solar and tidal forcing. Sea level drops below the height of the protective lagoon rim for a few hours during low tide, effectively isolating the remaining water. Because the lagoon is shallow, its temperature change (from diurnal solar forcing and cooling) is amplified. We develop a simple analytical model to predict the time evolution of mean lagoon temperature, beginning with a well-mixed control volume. This approach highlights the asymmetric flood/ebb physics of tidally isolated lagoons. After discussing the response of this model, we compare it with results from two idealized numerical simulations that illustrate differing aspects of lagoon temperature variability under “potential flow” and “prevailing current” situations. The conceptual model captures the essence of lagoon temperature variability and underscores the importance of solar-lunar phasing. However, because of the well-mixed assumption, it cannot reproduce sudden temperature transitions associated with new incoming water masses. Observations show that a slowly progressing thermal wave inundates the lagoon on rising tides. This wave is similar to our “potential flow” simulation in that it is approximately radially symmetric. On the other hand, it appears to advectively replace resident lagoon water, similar to our “prevailing current” simulations. We attempt to account for this behavior with a simple “frontal” modification to our conceptual model. Results show that this frontal model is able to capture the sudden temperature transitions present in the data and offers improved predictive capabilities over the well-mixed model.

[1] Large rivers represent gateways for the transport of terrigenous and anthropogenic material to the coastal ocean. Here we document a ∼700 km2 recirculation or bulge associated with the Columbia River plume that retains recently discharged river water sufficiently to create a regional bioreactor. Fueled by a fluvial nitrate source, this feature stimulated growth across three trophic levels and may buffer this gateway system during periods of increased warming and stratification that lead to decreased ocean productivity, potentially enhancing production at multiple trophic levels and enriching surface waters far from the river mouth.

[1] River Influences on Shelf Ecosystems (RISE) is the first comprehensive interdisciplinary study of the rates and dynamics governing the mixing of river and coastal waters in an eastern boundary current system, as well as the effects of the resultant plume on phytoplankton standing stocks, growth and grazing rates, and community structure. The RISE Special Volume presents results deduced from four field studies and two different numerical model applications, including an ecosystem model, on the buoyant plume originating from the Columbia River. This introductory paper provides background information on variability during RISE field efforts as well as a synthesis of results, with particular attention to the questions and hypotheses that motivated this research. RISE studies have shown that the maximum mixing of Columbia River and ocean water occurs primarily near plume liftoff inside the estuary and in the near field of the plume. Most plume nitrate originates from upwelled shelf water, and plume phytoplankton species are typically the same as those found in the adjacent coastal ocean. River-supplied nitrate can help maintain the ecosystem during periods of delayed upwelling. The plume inhibits iron limitation, but nitrate limitation is observed in aging plumes. The plume also has significant effects on rates of primary productivity and growth (higher in new plume water) and microzooplankton grazing (lower in the plume near field and north of the river mouth); macrozooplankton concentration (enhanced at plume fronts); offshelf chlorophyll export; as well as the development of a chlorophyll ‘‘shadow zone’’ off northern Oregon.

[1] The northern California Current System is impacted by two primary freshwater sources: the Strait of Juan de Fuca and the Columbia River. The Columbia is frequently bidirectional in summer, with branches both north and south of the river mouth simultaneously. We describe the interaction of these two warm Columbia plumes with each other and with the colder plume originating from the strait. The interactions occurred when a period of strong downwelling-favorable winds and high Columbia River discharge was followed by persistent and strong upwelling-favorable winds. The northward plume that developed under the downwelling winds extended over 200 km along the coast to the Strait of Juan de Fuca and into the strait. The plume subsequently wrapped around Juan de Fuca Strait water in the counterclockwise seasonal eddy just offshore of the strait. Inspection for similar wind and outflow conditions (>0.15 N m−2 and 104 m3 s−1, respectively) suggest that these events might have occurred in roughly half the years since 1994. Surface drifters deployed in the Columbia plume near its origin tracked this plume water northward along the coast, then reversed direction at the onset of upwelling-favorable winds, tracking plume water southward past the river mouth once again. “Recent” (∼1–2 day old) and “Aged” (>14 day old) plume water folded around the newly emerging southwest tending Columbia plume, forming a distinctive “sock” shaped plume. This plume was a mixture of ∼10% “New” (

[1] Observational estimates of entrainment and vertical salt flux into the tidally pulsed Columbia River plume are presented. Drifting buoys deployed in ebbing plume water downstream of the lift-off region are used to make measurements of velocity, salinity, and horizontal divergence in the surface layer. Drifters released near the river mouth, shoreward of the propagating ocean-plume front, catch up to the front, consistent with classical models of plume front circulation. During their offshore transit, drifter streamwise velocities decrease while salinities increase. Assuming drifter-measured quantities are representative of plume-averaged quantities, conservation equations evaluated between adjacent spreading drifters are used to determine the plume depth and entrainment velocity throughout the experiment. This approach provides knowledge of the mixing involved between the active lift-off region and the offshore ocean-plume front as the flow evolves. Because the surface drifters do not downwell at the ocean-plume front, we do not estimate mixing in that region. We find that entrainment and vertical salt flux are largest near the river mouth, as expected, with typical values of O(10−3 m s−1) and O(10−2 practical salinity units (psu) m s−1), respectively, and that these quantities steadily decrease as the drifters move offshore. Profiles of water properties following the drifters provide knowledge of vertical stratification (0.5–4 psu m−1 at the plume base) allowing for discrete estimates of the eddy diffusivity of salt KS. Typical plume values of KS are O(10−3 m2 s−1), similar to estimates made in other plume systems and 2 orders of magnitude larger than open ocean eddy diffusivity estimates.

[1] The lifespan of a barotropic tidal eddy generated by flow around a coastal headland in deep (∼200 m) stratified water is examined. Field observations recorded the evolution of the flood tide eddy from its generation, through the eddy release at the turn of the tide, until its dissipation during subsequent tidal cycles. Ship-based acoustic profiling reveals vortical structure that extends throughout the flow depth. Tracks from subsurface drifters from successive days indicated that flow structure was repeatable. Vorticity decay times, estimated from combined set of drifter tracks, are less than a tidal period. These are significantly shorter than simple estimates using boundary friction would imply, and it is suggested that baroclinic mechanisms associated with tilted vorticity in the deep stratified flow over the sloping headland may play a significant role in the dissipation of vorticity.

The lifespan of a tidal eddy generated by flow around a coastal headland is examined. Field observations of a tidal headland eddy at Three Tree Point, WA (USA) are presented that examine the temporal evolution of the flood tide separation eddy from its generation, through the eddy release at the turn of the tide, until its dissipation during subsequent tidal cycles. Ship-based acoustic profiling examines the vertical structure of the velocity field and subsurface drogued drifters are used to track the horizontal motion of the flow structure. Drifter tracks from successive days at similar phases of the tide indicate that flow structure is repeatable. The combined set of drifter tracks is used to obtain an estimate of eddy lifetime. Time scales for vorticity decay of less than a tidal period are significantly shorter than simple estimates using boundary friction would imply. This finding suggests that the internal wave response of the stratified flow over the sloping headland plays a significant role in the dissipation of vorticity. Field observations are compared with results from numerical modeling that also suggest that baroclinic effects are significant.Copyright © 2002 by ASME

Background: Neoadjuvant chemotherapy is used to help downstage cancer, and is widely used in locally-advanced breast cancer. Studies of Ki67 proliferation index in breast cancer have been fairly extensively evaluated. Comparison of core and surgical specimens in breast cancers without exposure to chemo- or radiotherapy revealed technical variation of up to 20% in the Ki67 index score. In non-small cell lung cancer (NSCLC), however, little is known about the association of rate of change of Ki67 after neoadjuvant chemotherapy +/- radiotherapy with radiographic response and clinical outcomes. We surveyed NSCLC from patients treated with neoadjuvant chemotherapy +/- radiotherapy. Methods: NSCLC patients treated with neoadjuvant chemotherapy were identified from 3 Hungarian hospitals and 1 community hospital in the United States. Matched pre-chemotherapy and post-surgical resection formalin-fixed, paraffin-embedded (FFPE) tumor specimens were collected and the Ki67 index was scored under an IRB exemption. We set an absolute difference of 20% between pre-chemotherapy and post-resection Ki67 scores as “meaningful” to avoid possible technical variation reported in the literature (1). Radiographic response to neoadjuvant chemotherapy by RECIST 1.0 criteria was also measured. Fisher's exact test was used to measure the relationship between gender, histology, and type of chemo with “meaningful” Ki67 index. Logistic regression was used to test the relationship between Ki67 index decline rate and outcome subgroup (response/no response). Decline rate was defined as a ratio of decrease of Ki67 to its level at baseline. For univariate analysis, Kaplan-Meier method was used to estimate the survival probability and the log rank test was used to assess the difference in survival between groups. For multivariate analysis, the Cox proportional hazards regression was used. P-values were adjusted for multiple comparison. Results: 63 matched cases were identified. 46 cases were analyzable for pre-chemotherapy and post-operative Ki67, and chemotherapy regimen; 40 cases also had response criteria by RECIST (Table I). Of the 46 cases, the median patient age was 59 years (range 40-77), 24 were men, and 30 of 34 had a smoking history. There were 24 adenocarcinomas and 22 squamous cell carcinomas. Stages I, II, III, and IV were 2, 9, 31, and 4; respectively. All but two patients received a platinum-doublet, with 24 containing gemcitabine. 5 patients also received neoadjuvant radiotherapy. 22 are deceased as of last follow-up. Median overall survival (OS) is 28.5 months (range 7.4-107.7 months). The mean Ki67 index scores were 35% (range 1-100%) pre-chemotherapy and 32% (0-100%) post-resection (see representative example in Figure 1). 9 patients (19.6%) had a paradoxical “meaningful” increase in Ki67 index after neoadjuvant chemotherapy. Of the 40 patients with RECIST response data, there was 1 complete response, 34 partial responses, 4 stable diseases, and 1 disease progression. There were no statistically significant differences between gender, histology subtype, or type of platinum doublet administered associated with this paradoxical increase. There was no statistically significant difference in Ki67 decline rate between responders and non-responders. Additionally, there was no statistically significant association by univariate or multivariate analysis with gender, histology, chemo type (gemcitabine vs. other), paradoxical Ki67 increase, or RECIST response and OS. Conclusion: In this cohort of patients, there was a paradoxical “meaningful” increase in Ki67 index after neoadjuvant chemotherapy in ~20% of patients, without a clear association between histology or platinum doublet administered. For patients receiving neoadjuvant chemotherapy, the Ki67 index decline rate was not associated with radiographic response or OS. Approximately 1/5 of NSCLC may have selection of tumor cells for a higher proliferative index when undergoing neoadjuvant platinum-based chemotherapy, though this does not appear to impact OS. Citation Format: Glen J. Weiss, Judit Moldvay, Balazs Dome, Katalin Fabian, Eszter Podmaniczky, Judit Papay, Marton Gyulai, Jozsef Furak, Ildiko Szirtes, Jizhou Ai, Ryan McCabe, Janine LoBello, Balazs Hegedus. Ki67 proliferation index score paradoxical increase after neoadjuvant therapy in resected NSCLC. [abstract]. In: Proceedings of the AACR-IASLC Joint Conference on Molecular Origins of Lung Cancer; 2014 Jan 6-9; San Diego, CA. Philadelphia (PA): AACR; Clin Cancer Res 2014;20(2Suppl):Abstract nr B29.