Endemic tuberculosis, the homeless, and public transportation: A merging of geographical information systems surveillance and the Houston Tuberculosis Initiative Surveillance project

To reach the goals established by the Institute of Medicine (IOM) and the Centers for Disease Control's (CDC) STOP TB USA, measures must be taken to curtail a future peak in Tuberculosis (TB) incidence and speed the currently stagnant rate of TB elimination. Both efforts will require, at minimum, the consideration and understanding of the third dimension of TB transmission: the location-based spread of an airborne pathogen among persons known and unknown to each other. This consideration will require an elucidation of the areas within the U.S. that have endemic TB. The Houston Tuberculosis Initiative (HTI) was a population-based active surveillance of confirmed Houston/Harris County TB cases from 1995–2004. Strengths in this dataset include the molecular characterization of laboratory confirmed cases, the collection of geographic locations (including home addresses) frequented by cases, and the HTI time period that parallels a decline in TB incidence in the United States (U.S.). The HTI dataset was used in this secondary data analysis to implement a GIS analysis of TB cases, the locations frequented by cases, and their association with risk factors associated with TB transmission. ^ This study reports, for the first time, the incidence of TB among the homeless in Houston, Texas. The homeless are an at-risk population for TB disease, yet they are also a population whose TB incidence has been unknown and unreported due to their non-enumeration. The first section of this dissertation identifies local areas in Houston with endemic TB disease. Many Houston TB cases who reported living in these endemic areas also share the TB risk factor of current or recent homelessness. Merging the 2004–2005 Houston enumeration of the homeless with historical HTI surveillance data of TB cases in Houston enabled this first-time report of TB risk among the homeless in Houston. The homeless were more likely to be US-born, belong to a genotypic cluster, and belong to a cluster of a larger size. The calculated average incidence among homeless persons was 411/100,000, compared to 9.5/100,000 among housed. These alarming rates are not driven by a co-infection but by social determinants. The unsheltered persons were hospitalized more days and required more follow-up time by staff than those who reported a steady housing situation. The homeless are a specific example of the increased targeting of prevention dollars that could occur if TB rates were reported for specific areas with known health disparities rather than as a generalized rate normalized over a diverse population. ^ It has been estimated that 27% of Houstonians use public transportation. The city layout allows bus routes to run like veins connecting even the most diverse of populations within the metropolitan area. Secondary data analysis of frequent bus use (defined as riding a route weekly) among TB cases was assessed for its relationship with known TB risk factors. The spatial distribution of genotypic clusters associated with bus use was assessed, along with the reported routes and epidemiologic-links among cases belonging to the identified clusters. ^ TB cases who reported frequent bus use were more likely to have demographic and social risk factors associated with poverty, immune suppression and health disparities. An equal proportion of bus riders and non-bus riders were cultured for Mycobacterium tuberculosis, yet 75% of bus riders were genotypically clustered, indicating recent transmission, compared to 56% of non-bus riders (OR=2.4, 95%CI(2.0, 2.8), p<0.001). Bus riders had a mean cluster size of 50.14 vs. 28.9 (p<0.001). Second order spatial analysis of clustered fingerprint 2 (n=122), a Beijing family cluster, revealed geographic clustering among cases based on their report of bus use. Univariate and multivariate analysis of routes reported by cases belonging to these clusters found that 10 of the 14 clusters were associated with use. Individual Metro routes, including one route servicing the local hospitals, were found to be risk factors for belonging to a cluster shown to be endemic in Houston. The routes themselves geographically connect the census tracts previously identified as having endemic TB. 78% (15/23) of Houston Metro routes investigated had one or more print groups reporting frequent use for every HTI study year. We present data on three specific but clonally related print groups and show that bus-use is clustered in time by route and is the only known link between cases in one of the three prints: print 22. (Abstract shortened by UMI.)^

NOVEL PHANTOMS AND POST-PROCESSING FOR DIFFUSION SPECTRUM IMAGING

High Angular Resolution Diffusion Imaging (HARDI) techniques, including Diffusion Spectrum Imaging (DSI), have been proposed to resolve crossing and other complex fiber architecture in the human brain white matter. In these methods, directional information of diffusion is inferred from the peaks in the orientation distribution function (ODF). Extensive studies using histology on macaque brain, cat cerebellum, rat hippocampus and optic tracts, and bovine tongue are qualitatively in agreement with the DSI-derived ODFs and tractography. However, there are only two studies in the literature which validated the DSI results using physical phantoms and both these studies were not performed on a clinical MRI scanner. Also, the limited studies which optimized DSI in a clinical setting, did not involve a comparison against physical phantoms. Finally, there is lack of consensus on the necessary pre- and post-processing steps in DSI; and ground truth diffusion fiber phantoms are not yet standardized. Therefore, the aims of this dissertation were to design and construct novel diffusion phantoms, employ post-processing techniques in order to systematically validate and optimize (DSI)-derived fiber ODFs in the crossing regions on a clinical 3T MR scanner, and develop user-friendly software for DSI data reconstruction and analysis. Phantoms with a fixed crossing fiber configuration of two crossing fibers at 90° and 45° respectively along with a phantom with three crossing fibers at 60°, using novel hollow plastic capillaries and novel placeholders, were constructed. T2-weighted MRI results on these phantoms demonstrated high SNR, homogeneous signal, and absence of air bubbles. Also, a technique to deconvolve the response function of an individual peak from the overall ODF was implemented, in addition to other DSI post-processing steps. This technique greatly improved the angular resolution of the otherwise unresolvable peaks in a crossing fiber ODF. The effects of DSI acquisition parameters and SNR on the resultant angular accuracy of DSI on the clinical scanner were studied and quantified using the developed phantoms. With a high angular direction sampling and reasonable levels of SNR, quantification of a crossing region in the 90°, 45° and 60° phantoms resulted in a successful detection of angular information with mean ± SD of 86.93°±2.65°, 44.61°±1.6° and 60.03°±2.21° respectively, while simultaneously enhancing the ODFs in regions containing single fibers. For the applicability of these validated methodologies in DSI, improvement in ODFs and fiber tracking from known crossing fiber regions in normal human subjects were demonstrated; and an in-house software package in MATLAB which streamlines the data reconstruction and post-processing for DSI, with easy to use graphical user interface was developed. In conclusion, the phantoms developed in this dissertation offer a means of providing ground truth for validation of reconstruction and tractography algorithms of various diffusion models (including DSI). Also, the deconvolution methodology (when applied as an additional DSI post-processing step) significantly improved the angular accuracy of the ODFs obtained from DSI, and should be applicable to ODFs obtained from the other high angular resolution diffusion imaging techniques.

Dengue transmission risk maps of the continental United States

Dengue fever is a strictly human and non-human primate disease characterized by a high fever, thrombocytopenia, retro-orbital pain, and severe joint and muscle pain. Over 40% of the world population is at risk. Recent re-emergence of dengue outbreaks in Texas and Florida following the re-introduction of competent Aedes mosquito vectors in the United States have raised growing concerns about the potential for increased occurrences of dengue fever outbreaks throughout the southern United States. Current deficiencies in vector control, active surveillance and awareness among medical practitioners may contribute to a delay in recognizing and controlling a dengue virus outbreak. Previous studies have shown links between low-income census tracts, high population density, and dengue fever within the United States. Areas of low-income and high population density that correlate with the distribution of Aedes mosquitoes result in higher potential for outbreaks. In this retrospective ecologic study, nine maps were generated to model U.S. census tracts’ potential to sustain dengue virus transmission if the virus was introduced into the area. Variables in the model included presence of a competent vector in the county and census tract percent poverty and population density. Thirty states, 1,188 counties, and 34,705 census tracts were included in the analysis. Among counties with Aedes mosquito infestation, the census tracts were ranked high, medium, and low risk potential for sustained transmission of the virus. High risk census tracts were identified as areas having the vector, ≥20% poverty, and ≥500 persons per square mile. Census tracts with either ≥20% poverty or ≥500 persons per square mile and have the vector present are considered moderate risk. Census tracts that have the vector present but have <20% poverty and <500 persons per square mile are considered low risk. Furthermore, counties were characterized as moderate risk if 50% or more of the census tracts in that county were rated high or moderate risk, and high risk if 25% or greater were rated high risk. Extreme risk counties, which were primarily concentrated in Texas and Mississippi, were considered having 50% or greater of the census tracts ranked as high risk. Mapping of geographic areas with potential to sustain dengue virus transmission will support surveillance efforts and assist medical personnel in recognizing potential cases. ^

Correlation of tuberculosis and human immunodeficiency virus in Harris County, Texas from 2009 through 2010 using Geographic Information Systems

A population based ecological study was conducted to identify areas with a high number of TB and HIV new diagnoses in Harris County, Texas from 2009 through 2010 by applying Geographic Information Systems to determine whether distinguished spatial patterns exist at the census tract level through the use of exploratory mapping. As of 2010, Texas has the fourth highest occurrence of new diagnoses of HIV/AIDS and TB.[31] The Texas Department of State Health Services (DSHS) has identified HIV infected persons as a high risk population for TB in Harris County.[29] In order to explore this relationship further, GIS was utilized to identify spatial trends. ^ The specific aims were to map TB and HIV new diagnoses rates and spatially identify hotspots and high value clusters at the census tract level. The potential association between HIV and TB was analyzed using spatial autocorrelation and linear regression analysis. The spatial statistics used were ArcGIS 9.3 Hotspot Analysis and Cluster and Outlier Analysis. Spatial autocorrelation was determined through Global Moran's I and linear regression analysis. ^ Hotspots and clusters of TB and HIV are located within the same spatial areas of Harris County. The areas with high value clusters and hotspots for each infection are located within the central downtown area of the city of Houston. There is an additional hotspot area of TB located directly north of I-10 and a hotspot area of HIV northeast of Interstate 610. ^ The Moran's I Index of 0.17 (Z score = 3.6 standard deviations, p-value = 0.01) suggests that TB is statistically clustered with a less than 1% chance that this pattern is due to random chance. However, there were a high number of features with no neighbors which may invalidate the statistical properties of the test. Linear regression analysis indicated that HIV new diagnoses rates (β=−0.006, SE=0.147, p=0.970) and census tracts (β=0.000, SE=0.000, p=0.866) were not significant predictors of TB new diagnoses rates. ^ Mapping products indicate that census tracts with overlapping hotspots and high value clusters of TB and HIV should be a targeted focus for prevention efforts, most particularly within central Harris County. While the statistical association was not confirmed, evidence suggests that there is a relationship between HIV and TB within this two year period.^

Neocortical hyperexcitability defect in a mutant mouse model of spike-wave epilepsy, {\it stargazer}

Single-locus mutations in mice can express epileptic phenotypes and provide critical insights into the naturally occurring defects that alter excitability and mediate synchronization in the central nervous system (CNS). One such recessive mutation (on chromosome (Chr) 15), stargazer(stg/stg) expresses frequent bilateral 6-7 cycles per second (c/sec) spike-wave seizures associated with behavioral arrest, and provides a valuable opportunity to examine the inherited lesion associated with spike-wave synchronization.^ The existence of distinct and heterogeneous defects mediating spike-wave discharge (SWD) generation has been demonstrated by the presence of multiple genetic loci expressing generalized spike-wave activity and the differential effects of pharmacological agents on SWDs in different spike-wave epilepsy models. Attempts at understanding the different basic mechanisms underlying spike-wave synchronization have focused on $\gamma$-aminobutyric acid (GABA) receptor-, low threshold T-type Ca$\sp{2+}$ channel-, and N-methyl-D-aspartate receptor (NMDA-R)-mediated transmission. It is believed that defects in these modes of transmission can mediate the conversion of normal oscillations in a trisynaptic circuit, which includes the neocortex, reticular nucleus and thalamus, into spike-wave activity. However, the underlying lesions involved in spike-wave synchronization have not been clearly identified.^ The purpose of this research project was to locate and characterize a distinct neuronal hyperexcitability defect favoring spike-wave synchronization in the stargazer brain. One experimental approach for anatomically locating areas of synchronization and hyperexcitability involved an attempt to map patterns of hypersynchronous activity with antibodies to activity-induced proteins.^ A second approach to characterizing the neuronal defect involved examining the neuronal responses in the mutant following application of pharmacological agents with well known sites of action.^ In order to test the hypothesis that an NMDA receptor mediated hyperexcitability defect exists in stargazer neocortex, extracellular field recordings were used to examine the effects of CPP and MK-801 on coronal neocortical brain slices of stargazer and wild type perfused with 0 Mg$\sp{2+}$ artificial cerebral spinal fluid (aCSF).^ To study how NMDA receptor antagonists might promote increased excitability in stargazer neocortex, two basic hypotheses were tested: (1) NMDA receptor antagonists directly activate deep layer principal pyramidal cells in the neocortex of stargazer, presumably by opening NMDA receptor channels altered by the stg mutation; and (2) NMDA receptor antagonists disinhibit the neocortical network by blocking recurrent excitatory synaptic inputs onto inhibitory interneurons in the deep layers of stargazer neocortex.^ In order to test whether CPP might disinhibit the 0 Mg$\sp{2+}$ bursting network in the mutant by acting on inhibitory interneurons, the inhibitory inputs were pharmacologically removed by application of GABA receptor antagonists to the cortical network, and the effects of CPP under 0 Mg$\sp{2+}$aCSF perfusion in layer V of stg/stg were then compared with those found in +/+ neocortex using in vitro extracellular field recordings. (Abstract shortened by UMI.) ^

(Table 2) Organic residue at DSDP Hole 76-534A

The kind, sedimentation rate, and diagenesis of organic particles delivered to the North Atlantic seafloor during the Middle Jurassic-Early Cretaceous were responsible for the presence of carbonaceous sediments in Hole 534A. Organic-rich black clays formed from the rapid supply of organic matter; this organic matter was composed of either abundant, well-preserved, and poorly sorted particles of land plants deposited in clays and silty clays within terrigenous turbiditic sequences (tracheal facies) or abundant amorphous debris (xenomorphic facies) generated through the digestive tracts of marine zooplankton and sedimented as fecal pellets. Evidence for the fecal-pellet origin of xenomorphic debris is illustrated. Black clays were also produced in sediments containing less organic matter as a result of the black color of carbonized particles composing all or most of the residues (micrinitic facies). Slowly sedimented hematitic Aptian clays contain very little carbonized, organic debris that survived diagenetic oxidation. In the red calcareous clay sequence of the Late Jurassic, larger amounts of this oxidized debris turned several clay layers black or blackish red. Carbonized debris also dominates the residues recovered in interbedded black and green Albian clays. Carbonization of organic matter in these sediments either turned them black or provided the diagenetic environment for reduced iron. Carbonized debris is also appreciable in burrow-mottled black-green Kimmeridgian clay. The study of Hole 534A organic matter indicates that during the middle Callovian there was a rapid supply of terrigenous organic matter, followed by a late Callovian episode of rapidly supplied xenomorphic debris deposited as fecal pellets. The Late Jurassic-Berriasian was a time of slower sedimentation of organic matter, primarily of a marine dinoflagellate flora in a poorly preserved xenomorphic facies variously affected by diagenetic oxidation. Several intervals of carbonized tracheal tissue in the Oxfordian and Kimmeridgian suggest episodes of oxidized terrigenous matter. The same sequence of Callovian organic events is evident in much of the Early Cretaceous

Detección de Ralstonia solanacearum en Solanum tuberosum L. en el Estado de Sonora, México

Ralstonia solanacearum (Rs) produce la enfermedad cuarentenaria denominada marchitez bacteriana en papa. México es un país importador de semilla de Estados Unidos de América y Canadá, aspecto significante para provocar una eventual introducción de esta enfermedad en áreas con amplias extensiones de papa. Sonora es una región importante en relación con la producción de este cultivo. Por lo anteriormente expuesto, se realizó la presente investigación, teniendo como objetivos: a) la producción de antisuero para la bacteria Rs; b) diagnosticar Rs en tubérculos de importación que se utilizan para siembra, y en tubérculos de procedencia mexicana para consumo humano, que son utilizados como semilla; c) la detección de la bacteria durante el desarrollo vegetativo de lotes de papa en Sonora, México. Se analizó tubérculo semilla de importación, de consumo humano, plantas de papa, hojas y tubérculos de producción; los métodos de detección utilizados fueron medios de cultivos específicos, ELISA, antisuero producido y pruebas de patogenicidad. Los resultados mostraron positiva la presencia de Rs en tubérculos de consumo; en tubérculos de importación y en etapas vegetativas fue negativa. Cada prueba de detección por separado no debe ser utilizada como método único; la presencia de Rs representa un riesgo de eventual manifestación de la enfermedad, por lo que es necesario que las áreas productoras realicen actividades de control preventivo fitosanitario.

Apropriaçâo da terra e formaçâo de grandes patimônios fundiários na fronteira sul do Brasil, através dos inventários post mortem (1800-1860)

This article is dedicated to the study the ways of appropriation of land in the south border of Brazil, in the first half of the century XIX. The historiography has, for tradition, associated the appropriation of large tracts of land, in Rio Grande do Sul, with royal donations. That would have been made, mainly, in the form of 'sesmarias' donations. However, a more detained study shows than the public concessions were just one among other forms of appropriation of the land used by families that accomplished a voracious accumulation of lands. Among other sources, inventories post mortem, registrations of concessions of lands and official correspondences are used. The main analysis focus relapses on the municipal district of Alegrete, between 1800 and 1870

Apropriaçâo da terra e formaçâo de grandes patimônios fundiários na fronteira sul do Brasil, através dos inventários post mortem (1800-1860)

This article is dedicated to the study the ways of appropriation of land in the south border of Brazil, in the first half of the century XIX. The historiography has, for tradition, associated the appropriation of large tracts of land, in Rio Grande do Sul, with royal donations. That would have been made, mainly, in the form of 'sesmarias' donations. However, a more detained study shows than the public concessions were just one among other forms of appropriation of the land used by families that accomplished a voracious accumulation of lands. Among other sources, inventories post mortem, registrations of concessions of lands and official correspondences are used. The main analysis focus relapses on the municipal district of Alegrete, between 1800 and 1870

Sediment thickness and distribution of facies types in the Kara Sea

We studied the impact of the last glacial (late Weichselian) sea level cycle on sediment architecture in the inner Kara Sea using high-resolution acoustic sub-bottom profiling. The acoustic lines were ground-truthed with dated sediment cores. Furthermore we refined the location of the eastern LGM ice margin, by new sub bottom profiles. New model results of post-Last Glacial Maximum (LGM) isostatic rebound for this area allow a well-constrained interpretation of acoustic units in terms of sequence stratigraphy. The lowstand (or regressive) system tract sediments are absent but are represented by an unconformity atop of Pleistocene sediments on the shelf and by a major incised dendritic paleo-river network. The subsequent transgressive and highstand system tracts are best preserved in the incised channels and the recent estuaries while only minor sediment accumulation on the adjacent shelf areas is documented. The Kara Sea can be subdivided into three areas: estuaries (A), the shelf (B) and (C) deeper lying areas that accumulated a total of 114 * 10**10 t of Holocene sediments.

Apropriaçâo da terra e formaçâo de grandes patimônios fundiários na fronteira sul do Brasil, através dos inventários post mortem (1800-1860)

This article is dedicated to the study the ways of appropriation of land in the south border of Brazil, in the first half of the century XIX. The historiography has, for tradition, associated the appropriation of large tracts of land, in Rio Grande do Sul, with royal donations. That would have been made, mainly, in the form of 'sesmarias' donations. However, a more detained study shows than the public concessions were just one among other forms of appropriation of the land used by families that accomplished a voracious accumulation of lands. Among other sources, inventories post mortem, registrations of concessions of lands and official correspondences are used. The main analysis focus relapses on the municipal district of Alegrete, between 1800 and 1870

Average dip directions from intervals of dipmeter log in drill hole CRP-2A

Bedding dips in the CRP-2A drillhole were determined in two ways (1) analysis of a dipmeter log, and (2) identification of bed boundaries on digital images of the outer core surface. The two methods document the downhole increase in structural dip, to a maximum of 15° in the lowest 150 m of the hole. Dipmeter data, which are azimuthally oriented, indicate a 75° azimuth for structural tilting, in agreement with seismic reflection profiles. Core and log dips indicate that structural dip increases by 5-7° between 325 and 480 mbsf. Both, however, also exhibit high dip inhomogeneity because of depositional (e.g., cross bedding) and post-depositional (e.g., softsediment deformation) processes. This variability adds ambiguity to the search for angular unconformities within the CRP-2A drillhole. Dip directions of different lithologies are generally similar, as are dip directions for the four kinds of systems tracts. Downdip azimuths of sands and muds are slightly different from those of diamicts, possibly reflecting the divergence between ENE offshore dip and ESE glacial advance.

Shallow water foraminifera of ODP Hole 133-821A

Reworked shallow-water foraminifers that settled on the upper slope of the central Great Barrier Reef at Site 821 (water depth, 212.6 m) were used as indicators of the paleoclimatic and paleoenvironmental conditions that have controlled the Pleistocene evolution of the adjacent platform. Throughout the 400-m-thick sequence drilled, the nature, composition, and distribution of the shallow-water foraminiferal assemblages studied indicate that (1) all the species recorded are at present living in diverse tropical, reef-related areas of the Indo-Pacific and Atlantic provinces; (2) the composition of the microfaunal taphocoenoses is almost identical between the different stratigraphic intervals studied and the modern Great Barrier Reef environments; (3) inner-neritic, tropical environments have continued to develop since the middle Pleistocene; (4) high- to moderate-energy platform edges occurred repeatedly throughout Pleistocene time. These factors may suggest that, since the beginning of the Pleistocene, several reef-like tracts have grown successively on the central area of the northeastern Australian shelf edge. These tracts probably had a sufficiently evolved morphological zonation to act as shelters for foraminiferal biocoenoses of high species diversity.

Characteristics and stomach contents of Greenland sharks (Somniosus microcephalus) caught in Svalbard during June 2008-2009

Harbour seals in Svalbard have short longevity, despite being protected from human hunting and having limited terrestrial predation at their haulout sites, low contaminant burdens and no fishery by-catch issues. This led us to explore the diet of Greenland sharks (Somniosus microcephalus) in this region as a potential seal predator. We examined gastrointestinal tracts (GITs) from 45 Greenland sharks in this study. These sharks ranged from 229 to 381 cm in fork length and 136-700 kg in body mass; all were sexually immature. Seal and whale tissues were found in 36.4 and 18.2%, respectively, of the GITs that had contents (n = 33). Based on genetic analyses, the dominant seal prey species was the ringed seal (Pusa hispida); bearded seal (Erignathus barbatus) and hooded seal (Cystophora cristata) tissues were each found in a single shark. The sharks had eaten ringed seal pups and adults based on the presence of lanugo-covered prey (pups) and age determinations based on growth rings on claws (<1 year and adults). All of the whale tissue was from minke whale (Balenoptera acutorostrata) offal, from animals that had been harvested in the whale fishery near Svalbard. Fish dominated the sharks' diet, with Atlantic cod (Gadus morhua), Atlantic wolffish (Anarhichas lupus) and haddock (Melanogrammus aeglefinus) being the most important fish species. Circumstantial evidence suggests that these sharks actively prey on seals and fishes, in addition to eating carrion such as the whale tissue. Our study suggests that Greenland sharks may play a significant predatory role in Arctic food webs.

Sediment composition and sedimentation rates of four Holes in ODP Leg 166

To date, work on the Great Bahama Bank's western, leeward margin has centred chiefly on seismic-scale expressions of carbonate sequences and systems tracts. However, periplatform, slope sediments also exhibit very well developed cyclicity on scales of decimetres to several metres. It is these small-scale, high-frequency cycles within the larger-scale facies successions of the Quaternary which form the main topic of this paper. Previous studies have shown that the small-scale cycles correlate to the orbitally forced, high-frequency sea-level changes. Therefore these cycles should indicate how sea level has affected the slope development and thus platform-margin evolution during this period. Through detailed, high-resolution sequence stratigraphy of the Great Bahama Bank's leeward margin, obtained via delta18O isotope and mineralogical (XRD) analyses, confined by U/Th dating and nannofossil bioevents, a greater understanding of the bedding geometries within the Pleistocene-Holocene seismic sequences and clues as to the nature of the slope development has been achieved. The high-resolution seismic profiles indicate that since the Plio-Pleistocene change in geometry, in which the Great Bahama Bank developed into a rimmed platform, continued steepening and subsequent progradation of the leeward margin has typified slope development during the Quaternary, which is described as an accretionary slope. However, on the basis of our observations we conclude that only the early to lower middle Pleistocene section (isotope stages 45-20) and the Holocene (isotope stage 1) of the leeward margin is accretionary. This indicates that a degree of erosion and/or by-passing has occurred on the leeward margin since the lower middle Pleistocene (isotope stage 19). During the first part of this period (isotope stages 19-12) erosion and/or by-passing occurred in the middle to lower slope regions and toe-of-slope. By the end of the upper middle to late Pleistocene phase (isotope stages 11-2) erosion also occurred on the upper slope. This erosion by currents at the toe-of-slope and oversteepening of the upper and middle slopes have led to back-cutting upslope and resulted in the progressive retreat of the toe-of-slope towards the platform to the east. However, the rise in sea level since the Last Glacial Maximum to its present-day level has allowed high productivity on the platform top during the Holocene and the deposition of a thick sediment wedge on the slope and sedimentation across the entire leeward flanks. This has led to the redevelopment of an accretionary slope and continued westward progradation of the Great Bahama Bank's western, leeward margin.