Defining Advance Care Planning for Adults: A Consensus Definition From a Multidisciplinary Delphi Panel

Despite increasing interest in advance care planning (ACP) and prior ACP descriptions, a consensus definition does not yet exist to guide clinical, research, and policy initiatives

Validation of SO2 retrievals from the Ozone Monitoring Instrument (OMI) over NE China

The Ozone Monitoring Instrument (OMI) launched on the NASA Aura satellite in July 2004 offers unprecedented spatial resolution, coupled with contiguous daily global coverage, for space-based UV measurements of sulfur dioxide (SO2). We present a first validation of the OMI SO2 data with in-situ aircraft measurements in NE China in April 2005. The study demonstrates that OMI can distinguish between background SO2 conditions and heavy pollution on a daily basis. The noise (expressed as the standard deviation, σ) in the PBL SO2 data is ~1.5DU (Dobson Unit, 2.691016 molecules/cm2) for instantaneous field of view (IFOV) data. By looking at the pristine South Pacific under optimal conditions we have determined that temporal and spatial averaging can improve the resolution of the instrument to σ ~ 0.3 DU; the long term average over this remote location was within 0.1 DU of zero. Under polluted conditions, however, Collection 2 data are higher than aircraft measurements by a factor of two in most cases. Parameterization of the airmass factor (AMF) appears to enhance the accuracy of the SO2 data. Improved calibrations of the radiance and irradiance data (Collection 3) result in better agreement with aircraft measurements on polluted days. The re-processed and AMF-corrected Collection 3 data still show positive bias and sensitivity to UV absorbing aerosols. The difference between the in situ data and the OMI daily PBL SO2 measurements within 30 km of the aircraft profiles was about 1 DU, equivalent to ~5 ppb from 0 to 3000 m altitude. Quantifying the SO2 profile and spectral dependence of aerosol absorption between 310 and 330 nm are critical for accurate estimates of SO2 from satellite UV measurements

The implementation of a translational study involving a primary care based behavioral program to improve blood pressure control: The HTN-IMPROVE study protocol (01295)

<p>Abstract</p> <p>Background</p> <p>Despite the impact of hypertension and widely accepted target values for blood pressure (BP), interventions to improve BP control have had limited success.</p> <p>Objectives</p> <p>We describe the design of a 'translational' study that examines the implementation, impact, sustainability, and cost of an evidence-based nurse-delivered tailored behavioral self-management intervention to improve BP control as it moves from a research context to healthcare delivery. The study addresses four specific aims: assess the implementation of an evidence-based behavioral self-management intervention to improve BP levels; evaluate the clinical impact of the intervention as it is implemented; assess organizational factors associated with the sustainability of the intervention; and assess the cost of implementing and sustaining the intervention.</p> <p>Methods</p> <p>The project involves three geographically diverse VA intervention facilities and nine control sites. We first conduct an evaluation of barriers and facilitators for implementing the intervention at intervention sites. We examine the impact of the intervention by comparing 12-month pre/post changes in BP control between patients in intervention sites versus patients in the matched control sites. Next, we examine the sustainability of the intervention and organizational factors facilitating or hindering the sustained implementation. Finally, we examine the costs of intervention implementation. Key outcomes are acceptability and costs of the program, as well as changes in BP. Outcomes will be assessed using mixed methods (<it>e.g</it>., qualitative analyses--pattern matching; quantitative methods--linear mixed models).</p> <p>Discussion</p> <p>The study results will provide information about the challenges and costs to implement and sustain the intervention, and what clinical impact can be expected.</p

GPI Spectra of HR8799 C, D, and E in H-K Bands with KLIP Forward Modeling

We demonstrate KLIP forward modeling spectral extraction on Gemini Planet Imager coronagraphic data of HR8799, using PyKLIP. We report new and re-reduced spectrophotometry of HR8799 c, d, and e from H-K bands. We discuss a strategy for choosing optimal KLIP PSF subtraction parameters by injecting fake sources and recovering them over a range of parameters. The K1/K2 spectra for planets c and d are similar to previously published results from the same dataset. We also present a K band spectrum of HR8799e for the first time and show that our H-band spectra agree well with previously published spectra from the VLT/SPHERE instrument. We compare planets c, d, and e with M, L, and T-type field objects. All objects are consistent with low gravity mid-to-late L dwarfs, however, a lack of standard spectra for low gravity late L-type objects lead to poor fit for gravity. We place our results in context of atmospheric models presented in previous publications and discuss differences in the spectra of the three planets

Genome-wide association and Mendelian randomisation analysis provide insights into the pathogenesis of heart failure

Heart failure (HF) is a leading cause of morbidity and mortality worldwide. A small proportion of HF cases are attributable to monogenic cardiomyopathies and existing genome-wide association studies (GWAS) have yielded only limited insights, leaving the observed heritability of HF largely unexplained. We report results from a GWAS meta-analysis of HF comprising 47,309 cases and 930,014 controls. Twelve independent variants at 11 genomic loci are associated with HF, all of which demonstrate one or more associations with coronary artery disease (CAD), atrial fibrillation, or reduced left ventricular function, suggesting shared genetic aetiology. Functional analysis of non-CAD-associated loci implicate genes involved in cardiac development (MYOZ1, SYNPO2L), protein homoeostasis (BAG3), and cellular senescence (CDKN1A). Mendelian randomisation analysis supports causal roles for several HF risk factors, and demonstrates CAD-independent effects for atrial fibrillation, body mass index, and hypertension. These findings extend our knowledge of the pathways underlying HF and may inform new therapeutic strategies