51 research outputs found

    The Budyko shape parameter as a descriptive index for streamflow loss

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    Increases in evapotranspiration (ET) from global warming are decreasing streamflow in headwater basins worldwide. However, these streamflow losses do not occur uniformly due to complex topography. To better understand the heterogeneity of streamflow loss, we use the Budyko shape parameter (Ļ‰) as a diagnostic tool. We fit Ļ‰ to 37-year of hydrologic simulation output in the Upper Colorado River Basin (UCRB), an important headwater basin in the US. We split the UCRB into two categories: peak watersheds with high elevation and steep slopes, and valley watersheds with lower elevation and gradual slopes. Our results demonstrate a relationship between streamflow loss and Ļ‰. The valley watersheds with greater streamflow loss have Ļ‰ higher than 3.1, while the peak watersheds with less streamflow loss have an average Ļ‰ of 1.3. This work highlights the use of Ļ‰ as an indicator of streamflow loss and could be generalized to other headwater basin systems

    Case-finding and genetic testing for familial hypercholesterolaemia in primary care

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    Objective: Familial Hypercholesterolaemia (FH) is a common inherited disorder causing premature heart disease and death. We have developed novel case-finding algorithms (FAMCAT version 1 & 2) for application in primary care, to improve detection of FH and have evaluated their performance, at 95% specificity, to detect genetically-confirmed FH in the general population. We also compared these algorithms to established clinical case-finding criteria. Methods: Prospective validation study, in 14 general practices, recruiting participants from the general adult population with cholesterol documented. For 260 participants with available health records, we determined possible FH cases based on FAMCAT thresholds, Dutch Lipid Clinic Network (DLCN) score, Simon-Broome criteria and national recommended cholesterol thresholds (total cholesterol > 9.0 mmol/L if ā‰„30 years or > 7.5 mmol/L i

    Alternative cascade-testing protocols for identifying and managing patients with familial hypercholesterolaemia: systematic reviews, qualitative study and cost-effectiveness analysis

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    BackgroundCascade testing the relatives of people with familial hypercholesterolaemia is an efficient approach to identifying familial hypercholesterolaemia. The cascade-testing protocol starts with identifying an index patient with familial hypercholesterolaemia, followed by one of three approaches to contact other relatives: indirect approach, whereby index patients contact their relatives; direct approach, whereby the specialist contacts the relatives; or a combination of both direct and indirect approaches. However, it is unclear which protocol may be most effective.ObjectivesThe objectives were to determine the yield of cases from different cascade-testing protocols, treatment patterns, and short- and long-term outcomes for people with familial hypercholesterolaemia; to evaluate the cost-effectiveness of alternative protocols for familial hypercholesterolaemia cascade testing; and to qualitatively assess the acceptability of different cascade-testing protocols to individuals and families with familial hypercholesterolaemia, and to health-care providers.Design and methodsThis study comprised systematic reviews and analysis of three data sets: PASS (PASS Software, Rijswijk, the Netherlands) hospital familial hypercholesterolaemia databases, the Clinical Practice Research Datalink (CPRD)ā€“Hospital Episode Statistics (HES) linked primaryā€“secondary care data set, and a specialist familial hypercholesterolaemia register. Cost-effectiveness modelling, incorporating preceding analyses, was undertaken. Acceptability was examined in interviews with patients, relatives and health-care professionals.ResultSystematic review of protocols: based on data from 4 of the 24 studies, the combined approach led to a slightly higher yield of relatives tested [40%, 95% confidence interval (CI) 37% to 42%] than the direct (33%, 95% CI 28% to 39%) or indirect approaches alone (34%, 95% CI 30% to 37%). The PASS databases identified that those contacted directly were more likely to complete cascade testing (p <ā€‰0.01); the CPRDā€“HES data set indicated that 70% did not achieve target treatment levels, and demonstrated increased cardiovascular disease risk among these individuals, compared with controls (hazard ratio 9.14, 95% CI 8.55 to 9.76). The specialist familial hypercholesterolaemia register confirmed excessive cardiovascular morbidity (standardised morbidity ratio 7.17, 95% CI 6.79 to 7.56). Cost-effectiveness modelling found a net health gain from diagnosis of ā€“0.27 to 2.51 quality-adjusted life-years at the willingness-to-pay threshold of Ā£15,000 per quality-adjusted life-year gained. The cost-effective protocols cascaded from genetically confirmed index cases by contacting first- and second-degree relatives simultaneously and directly. Interviews found a service-led direct-contact approach was more reliable, but combining direct and indirect approaches, guided by index patients and family relationships, may be more acceptable.LimitationsSystematic reviews were not used in the economic analysis, as relevant studies were lacking or of poor quality. As only a proportion of those with primary care-coded familial hypercholesterolaemia are likely to actually have familial hypercholesterolaemia, CPRD analyses are likely to underestimate the true effect. The cost-effectiveness analysis required assumptions related to the long-term cardiovascular disease risk, the effect of treatment on cholesterol and the generalisability of estimates from the data sets. Interview recruitment was limited to white English-speaking participants.ConclusionsBased on limited evidence, most cost-effective cascade-testing protocols, diagnosing most relatives, select index cases by genetic testing, with services directly contacting relatives, and contacting second-degree relatives even if first-degree relatives have not been tested. Combined approaches to contact relatives may be more suitable for some families.Future workEstablish a long-term familial hypercholesterolaemia cohort, measuring cholesterol levels, treatment and cardiovascular outcomes. Conduct a randomised study comparing different approaches to contact relatives.Study registrationThis study is registered as PROSPERO CRD42018117445 and CRD42019125775.FundingThis project was funded by the National Institute for Health and Care Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 27, No. 16. See the NIHR Journals Library website for further project information

    ngVLA Key Science Goal 5 Understanding the Formation and Evolution of Black Holes in the Era of Multi-Messenger Astronomy

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    The next-generation Very Large Array (ngVLA) will be a powerful telescope for finding and studying black holes across the entire mass range. High-resolution imaging abilities will allow the separation of low-luminosity black holes in the local Universe from background sources, thereby providing critical constraints on the mass function, formation, and growth of black holes. Its combination of sensitivity and angular resolution will provide new constraints on the physics of black hole accretion and jet formation. Combined with facilities across the spectrum and gravitational wave observatories, the ngVLA will provide crucial constraints on the interaction of black holes with their environments, with specific implications for the relationship between evolution of galaxies and the emission of gravitational waves from in-spiraling supermassive black holes and potential implications for stellar mass and intermediate mass black holes. The ngVLA will identify the radio counterparts to transient sources discovered by electromagnetic, gravitational wave, and neutrino observatories, and its high-resolution, fast-mapping capabilities will make it the preferred instrument to pinpoint electromagnetic counterparts to events such as supermassive black hole mergers. The National Radio Astronomy Observatory is a facility of the National Science Foundation operated under cooperative agreement by Associated Universities, Inc. Part of this research was carried out at the Jet Propulsion Laboratory, California Institute of Technology, under a contract with the National Aeronautics and Space Administration

    Models of classroom assessment for course-based research experiences

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    Course-based research pedagogy involves positioning students as contributors to authentic research projects as part of an engaging educational experience that promotes their learning and persistence in science. To develop a model for assessing and grading students engaged in this type of learning experience, the assessment aims and practices of a community of experienced course-based research instructors were collected and analyzed. This approach defines four aims of course-based research assessmentā€”(1) Assessing Laboratory Work and Scientific Thinking; (2) Evaluating Mastery of Concepts, Quantitative Thinking and Skills; (3) Appraising Forms of Scientific Communication; and (4) Metacognition of Learningā€”along with a set of practices for each aim. These aims and practices of assessment were then integrated with previously developed models of course-based research instruction to reveal an assessment program in which instructors provide extensive feedback to support productive student engagement in research while grading those aspects of research that are necessary for the student to succeed. Assessment conducted in this way delicately balances the need to facilitate studentsā€™ ongoing research with the requirement of a final grade without undercutting the important aims of a CRE education
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