Breast cancer-related lymphedema is a syndrome of abnormal swelling coupled with multiple symptoms resulting from obstruction or disruption of the lymphatic system associated with cancer treatment. Research has demonstrated that with increased number of symptoms reported, breast cancer survivors’ limb volume increased. Lymphedema symptoms in the affected limb may indicate a latent stage of lymphedema in which changes cannot be detected by objective measures. The latent stage of lymphedema may exist months or years before overt swelling occurs. Symptom report may play an important role in detecting lymphedema in clinical practice. The purposes of this study were to: 1) examine the validity, sensitivity, and specificity of symptoms for detecting breast cancer-related lymphedema and 2) determine the best clinical cutoff point for the count of symptoms that maximized the sum of sensitivity and specificity. Data were collected from 250 women, including healthy female adults, breast cancer survivors with lymphedema, and those at risk for lymphedema. Lymphedema symptoms were assessed using a reliable and valid instrument. Validity, sensitivity, and specificity were evaluated using logistic regression, analysis of variance, and areas under receiver operating characteristic curves. Count of lymphedema symptoms was able to differentiate healthy adults from breast cancer survivors with lymphedema and those at risk for lymphedema. A diagnostic cutoff of three symptoms discriminated breast cancer survivors with lymphedema from healthy women with a sensitivity of 94% and a specificity of 97% (area under the curve =0.98). A diagnostic cutoff of nine symptoms discriminated at-risk survivors from survivors with lymphedema with a sensitivity of 64% and a specificity of 80% (area under the curve =0.72). In the absence of objective measurements capable of detecting latent stages of lymphedema, count of symptoms may be a cost-effective initial screening tool for detecting lymphedema.

Rising food, housing and energy demand of increasing population creates an immense pressure on water resources, especially on water quality. The water quality around the globe is degrading primarily due to intense agricultural activities associated with rapid urbanization. This study attributes to cause of water quality problem, indices to measure water quality, methods to identify proper explanatory variables to water quality and it's processing to capture the special effect, and finally modeling of water quality using identified explanatory variables to provide insights. This would help policymakers and watershed managers to take necessary steps to protect water quality for the future as well as current generation. Finally, some knowledge gaps are also discussed which need to be addressed in the future studies.

Background Advances in cancer treatments continue to reduce the incidence of lymphedema. Yet, many breast cancer survivors still face long-term post-operative challenges as a result of developing lymphedema. The purpose of this study was to preliminarily evaluate The-Optimal-Lymph-Flow program, a patient-centered education and behavioral program focusing on self-care strategies to enhance lymphedema risk reduction by promoting lymph flow and optimize body mass index. Methods A prospective, longitudinal, quasi-experimental design with repeated-measures was used. The study outcomes included lymph volume changes by infra-red perometer and body mass index by a bioimpedance device at pre-surgery baseline, 2-4 weeks after surgery, 6-month, and 12-month follow-up. A total of 140 patients were recruited and participated in The-Optimal-Lymph-Flow program; 134 patients completed the study with 4% attrition rate. Results Fifty-eight percent patients had axillary node dissection and 42% had sentinel lymph node biopsy. The majority (97%) of patients maintained and improved their preoperative limb volume and body mass index at the study endpoint of 12 months following cancer surgery. Cumulatively, 2 patients with sentinel lymph node biopsy and 2 patients with the axillary lymph node dissection had measurable lymphedema (>10% limb volume change). At 12-month follow-up, among the 4 patients with measurable lymphedema, 2 patients' limb volume returned to pre-operative level without compression therapy but by maintaining The-Optimal-Lymph-Flow exercises to promote daily lymph flow. Conclusions This educational and behavioral program is effective to enhance lymphedema risk reduction. The study provided initial evidence for emerging change in lymphedema care from treatment-focus to proactive risk reduction.

Abstract. Accurately predicting soil moisture patterns in the landscape is a persistent challenge. In humid regions, topographic wetness indices (TWIs) are widely used to approximate relative soil moisture patterns. However, there are many ways to calculate TWIs and very few field studies have evaluated the different approaches -especially in the US. We calculated TWIs using over 400 unique formulations that considered different digital elevation model (DEM) resolutions (cell size), vertical precision of DEM, flow direction and slope algorithms, smoothing via low-pass filtering, and the inclusion of relevant soil properties. We correlated each TWI with observed patterns of soil moisture at five agricultural fields in central NY, USA, with each field visited five to eight times between August and November 2012. Using a mixed effects modeling approach, we were able to identify optimal TWI formulations applicable to moderate relief agricultural settings that may provide guidance for practitioners and future studies. Overall, TWIs were moderately well correlated with observed soil moisture patterns; in the best case the relationship between TWI and soil moisture had an average R 2 and Spearman correlation value of 0.61 and 0.78, respectively. In all cases, fine-scale (3 m) lidar-derived DEMs worked better than USGS 10 m DEMs and, in general, including soil properties improved correlations.

A science-based geographic information system (GIS) approach is presented to target critical source areas in watersheds for conservation buffer placement. Critical source areas are the intersection of hydrologically sensitive areas and pollutant source areas in watersheds. Hydrologically sensitive areas are areas that actively generate runoff in the watershed and are derived using a modified topographic index approach based on variable source area hydrology. Pollutant source areas are the areas in watersheds that are actively and intensively used for such activities as agricultural production. The method is applied to the Neshanic River watershed in Hunterdon County, New Jersey. The capacity of the topographic index in predicting the spatial pattern of runoff generation and the runoff contribution to stream flow in the watershed is evaluated. A simple cost-effectiveness assessment is conducted to compare the conservation buffer placement scenario based on this GIS method to conventional riparian buffer scenarios for placing conservation buffers in agricultural lands in the watershed. The results show that the topographic index reasonably predicts the runoff generation in the watershed. The GIS-based conservation buffer scenario appears to be more cost-effective than the conventional riparian buffer scenarios.