The role of tributary relative timing and sequencing in controlling large floods

Hydrograph convolution is a product of tributary inputs from across the watershed. The time-space distribution of precipitation, the biophysical processes that control the conversion of precipitation to runoff and channel flow conveyance processes, are heterogeneous and different areas respond to rainfall in different ways. We take a subwatershed approach to this and account for tributary flow magnitude, relative timing, and sequencing. We hypothesize that as the scale of the watershed increases so we may start to see systematic differences in subwatershed hydrological response. We test this hypothesis for a large flood (T >100 years) in a large watershed in northern England. We undertake a sensitivity analysis of the effects of changing subwatershed hydrological response using a hydraulic model. Delaying upstream tributary peak flow timing to make them asynchronous from downstream subwatersheds reduced flood magnitude. However, significant hydrograph adjustment in any one subwatershed was needed for meaningful reductions in stage downstream, although smaller adjustments in multiple tributaries resulted in comparable impacts. For larger hydrograph adjustments, the effect of changing the timing of two tributaries together was lower than the effect of changing each one separately. For smaller adjustments synergy between two subwatersheds meant the effect of changing them together could be greater than the sum of the parts. Thus, this work shows that while the effects of modifying biophysical catchment properties diminishes with scale due to dilution effects, their impact on relative timing of tributaries may, if applied in the right locations, be an important element of flood management.

Code Generator for Key Management Protocols - Design and Implementation

Key management has a fundamental role in secure communications. Designing and testing of key management protocols is tricky. These protocols must work flawlessly despite of any abuse. The main objective of this work was to design and implement a tool that helps to specify the protocol and makes it possible to test the protocol while it is still under development. This tool generates compile-ready java code from a key management protocol model. A modelling method for these protocols, which uses Unified Modeling Language (UML) was also developed. The protocol is modelled, exported as an XMI and read by the code generator tool. The code generator generates java code that is immediately executable with a test software after compilation.

Capturing diagnosis-timing in ICD-coded hospital data: recommendations from the WHO ICD-11 topic advisory group on quality and safety.

PURPOSE: To develop a consensus opinion regarding capturing diagnosis-timing in coded hospital data. METHODS: As part of the World Health Organization International Classification of Diseases-11th Revision initiative, the Quality and Safety Topic Advisory Group is charged with enhancing the capture of quality and patient safety information in morbidity data sets. One such feature is a diagnosis-timing flag. The Group has undertaken a narrative literature review, scanned national experiences focusing on countries currently using timing flags, and held a series of meetings to derive formal recommendations regarding diagnosis-timing reporting. RESULTS: The completeness of diagnosis-timing reporting continues to improve with experience and use; studies indicate that it enhances risk-adjustment and may have a substantial impact on hospital performance estimates, especially for conditions/procedures that involve acutely ill patients. However, studies suggest that its reliability varies, is better for surgical than medical patients (kappa in hip fracture patients of 0.7-1.0 versus kappa in pneumonia of 0.2-0.6) and is dependent on coder training and setting. It may allow simpler and more precise specification of quality indicators. CONCLUSIONS: As the evidence indicates that a diagnosis-timing flag improves the ability of routinely collected, coded hospital data to support outcomes research and the development of quality and safety indicators, the Group recommends that a classification of 'arising after admission' (yes/no), with permitted designations of 'unknown or clinically undetermined', will facilitate coding while providing flexibility when there is uncertainty. Clear coding standards and guidelines with ongoing coder education will be necessary to ensure reliability of the diagnosis-timing flag.

Early Recurrence and Cerebral Bleeding in Patients With Acute Ischemic Stroke and Atrial Fibrillation: effect of Anticoagulation and Its Timing: the RAF Study.

BACKGROUND AND PURPOSE: The best time for administering anticoagulation therapy in acute cardioembolic stroke remains unclear. This prospective cohort study of patients with acute stroke and atrial fibrillation, evaluated (1) the risk of recurrent ischemic event and severe bleeding; (2) the risk factors for recurrence and bleeding; and (3) the risks of recurrence and bleeding associated with anticoagulant therapy and its starting time after the acute stroke. METHODS: The primary outcome of this multicenter study was the composite of stroke, transient ischemic attack, symptomatic systemic embolism, symptomatic cerebral bleeding and major extracranial bleeding within 90 days from acute stroke. RESULTS: Of the 1029 patients enrolled, 123 had 128 events (12.6%): 77 (7.6%) ischemic stroke or transient ischemic attack or systemic embolism, 37 (3.6%) symptomatic cerebral bleeding, and 14 (1.4%) major extracranial bleeding. At 90 days, 50% of the patients were either deceased or disabled (modified Rankin score ≥3), and 10.9% were deceased. High CHA2DS2-VASc score, high National Institutes of Health Stroke Scale, large ischemic lesion and type of anticoagulant were predictive factors for primary study outcome. At adjusted Cox regression analysis, initiating anticoagulants 4 to 14 days from stroke onset was associated with a significant reduction in primary study outcome, compared with initiating treatment before 4 or after 14 days: hazard ratio 0.53 (95% confidence interval 0.30-0.93). About 7% of the patients treated with oral anticoagulants alone had an outcome event compared with 16.8% and 12.3% of the patients treated with low molecular weight heparins alone or followed by oral anticoagulants, respectively (P=0.003). CONCLUSIONS: Acute stroke in atrial fibrillation patients is associated with high rates of ischemic recurrence and major bleeding at 90 days. This study has observed that high CHA2DS2-VASc score, high National Institutes of Health Stroke Scale, large ischemic lesions, and type of anticoagulant administered each independently led to a greater risk of recurrence and bleedings. Also, data showed that the best time for initiating anticoagulation treatment for secondary stroke prevention is 4 to 14 days from stroke onset. Moreover, patients treated with oral anticoagulants alone had better outcomes compared with patients treated with low molecular weight heparins alone or before oral anticoagulants.

Improving the performance of the single-dish Cherenkov telescope MAGIC through the use of signal timing

The Cherenkov light flashes produced by Extensive Air Showers are very short in time. A high bandwidth and fast digitizing readout, therefore, can minimize the influence of the background from the light of the night sky, and improve the performance in Cherenkov telescopes. The time structure of the Cherenkov image can further be used in single-dish Cherenkov telescopes as an additional parameter to reduce the background from unwanted hadronic showers. A description of an analysis method which makes use of the time information and the subsequent improvement on the performance of the MAGIC telescope (especially after the upgrade with an ultra fast 2 GSamples/s digitization system in February 2007) will be presented. The use of timing information in the analysis of the new MAGIC data reduces the background by a factor two, which in turn results in an enhancement of about a factor 1.4 of the flux sensitivity to point-like sources, as tested on observations of the Crab Nebula.