“My Future is Now”: A Qualitative Study of Persons Living With Advanced Cancer

Objectives: Advance care planning (ACP) enables individuals to deliberate about future preferences for care based upon their values and beliefs about what is important in life. For many patients with advanced cancer, however, these critical conversations do not occur. A growing body of literature has examined the end-of-life wishes of seriously ill patients. Few studies have explored what is important to persons as they live with advanced cancer. The aim of the current study was to address this gap and to understand how clinicians can support patients’ efforts to live in the present and plan for the future. Methods: Transcriptions of interviews conducted with 36 patients diagnosed with advanced cancer were analyzed using immersion–crystallization, a qualitative research technique. Results: Four overarching themes were identified: (I) living in the face of death, (II) who I am, (III) my experience of cancer, and (IV) impact of my illness on others. Twelve subthemes are also reported. Significance of Results: These findings have significant implications for clinicians as they partner with patients to plan for the future. Our data suggest that clinicians consider the following 4 prompts: (1) “What is important to you now, knowing that you will die sooner than you want or expected?” (2) “Tell me about yourself.” (3) “Tell me in your own words about your experience with cancer care and treatment.” (4) “What impact has your illness had on others?” In honoring patients’ lived experiences, we may establish the mutual understanding necessary to providing high-quality care that supports patients’ priorities for life

Discussions of Life Expectancy Moderate Relationships between Prognosis and Anxiety or Depression in Men with Advanced Cancer

Purpose: Oncologists avoid prognostic discussions due to concerns about increasing patients' anxiety or depression. We sought to determine if perceived prognosis or extent of prognostic discussions predicted anxiety or depression and whether prognostic discussions moderated the relationship between prognosis and anxiety or depression. Methods: Men with advanced cancer and their oncologists estimated the likelihood of survival at 6 months and reported extent of prognostic discussions. Anxiety and depression were measured by the Hospital Anxiety and Depression Scale (HADS). Results: Men who died within 6 months reported higher scores on depression but not anxiety. Men who estimated a lower (10%–75%) likelihood of surviving at least 6 months were more depressed and anxious than men who estimated a higher (>90%) likelihood of survival. A similar relationship was seen with oncologists' prognostications. Men who reported having had full prognostic discussions with their oncologist had less depression compared with men who reported having had brief or no discussions. Men for whom the oncologists reported a full discussion had greater anxiety. The relationships between patient-perceived prognosis and depression or anxiety were moderated by extent of prognostic discussions as reported by the patient or oncologist, respectively. Conclusion: Full prognostic discussions are associated with less depression among men who perceive a poor prognosis. Anxiety is increased in men if the oncologists report a full discussion. Oncologists should engage in prognostic discussions but assess for increased anxiety to facilitate coping with advanced cancer

The Academics Athletics Trade-off: Universities and Intercollegiate Athletics

This analysis focuses on several key issues in the Football Bowl Subdivision (FBS). The intrinsic benefits of athletic programs are discussed in the first section. Trends in graduation rates and academic performance among athletes and how they correlate with the general student body are discussed in the second section. Finally, an overview of the revenues and expenses of athletic department budgets are discussed in an effort to gain a better understanding of the allocation of funds to athletics. In spite of recent growth in revenues and expenses, the athletic department budget comprises on average only 5 percent of the entire university budget at an FBS school, though spending and revenues have increased dramatically in recent years. In the grand scheme of things, American higher education faces several other, arguably more pressing, areas of reform. However, athletics is a significant and growing dimension of higher education that warrants in-depth examination

Broadband reduction of quantum radiation pressure noise via squeezed light injection

The Heisenberg uncertainty principle states that the position of an object cannot be known with infinite precision, as the momentum of the object would then be totally uncertain. This momentum uncertainty then leads to position uncertainty in future measurements. When continuously measuring the position of an object, this quantum effect, known as back-action, limits the achievable precision1,2. In audio-band, interferometer-type gravitational-wave detectors, this back-action effect manifests as quantum radiation pressure noise (QRPN) and will ultimately (but does not yet) limit sensitivity3. Here, we present the use of a quantum engineered state of light to directly manipulate this quantum back-action in a system where it dominates the sensitivity in the 10–50 kHz range. We observe a reduction of 1.2 dB in the quantum back-action noise. This experiment is a crucial step in realizing QRPN reduction for future interferometric gravitational-wave detectors and improving their sensitivity

FIRE Arctic Clouds Experiment

An overview is given of the First ISCCP Regional Experiment (FIRE) Arctic Clouds Experiment that was conducted in the Arctic during April through July, 1998. The principal goal of the field experiment was to gather the data needed to examine the impact of arctic clouds on the radiation exchange between the surface, atmosphere, and space, and to study how the surface influences the evolution of boundary layer clouds. The observations will be used to evaluate and improve climate model parameterizations of cloud and radiation processes, satellite remote sensing of cloud and surface characteristics, and understanding of cloud-radiation feedbacks in the Arctic. The experiment utilized four research aircraft that flew over surface-based observational sites in the Arctic Ocean and Barrow, Alaska. In this paper we describe the programmatic and science objectives of the project, the experimental design (including research platforms and instrumentation), conditions that were encountered during the field experiment, and some highlights of preliminary observations, modelling, and satellite remote sensing studies

First narrow-band search for continuous gravitational waves from known pulsars in advanced detector data

Spinning neutron stars asymmetric with respect to their rotation axis are potential sources of continuous gravitational waves for ground-based interferometric detectors. In the case of known pulsars a fully coherent search, based on matched filtering, which uses the position and rotational parameters obtained from electromagnetic observations, can be carried out. Matched filtering maximizes the signalto- noise (SNR) ratio, but a large sensitivity loss is expected in case of even a very small mismatch between the assumed and the true signal parameters. For this reason, narrow-band analysis methods have been developed, allowing a fully coherent search for gravitational waves from known pulsars over a fraction of a hertz and several spin-down values. In this paper we describe a narrow-band search of 11 pulsars using data from Advanced LIGO’s first observing run. Although we have found several initial outliers, further studies show no significant evidence for the presence of a gravitational wave signal. Finally, we have placed upper limits on the signal strain amplitude lower than the spin-down limit for 5 of the 11 targets over the bands searched; in the case of J1813-1749 the spin-down limit has been beaten for the first time. For an additional 3 targets, the median upper limit across the search bands is below the spin-down limit. This is the most sensitive narrow-band search for continuous gravitational waves carried out so far