Reply to comment by Karnauskas et al. on "Equatorial Pacific coral geochemical records show recent weakening of the Walker circulation"

In our paper describing a new coral record from Butaritari, we hypothesized that comparing the temporal trends in our records to coral records from farther east in the equatorial Pacific may support the evidence for a weakening of a Walker circulation, documented elsewhere in the literature [Power and Smith, 2007; Tokinaga et al., 2012]. Weakening of the Walker circulation is expected under global warming due to an imbalance in the rate of change in different aspects of the hydrological cycle [Vecchi and Soden, 2007]. We thank Karnauskas et al. [2015] for recognizing the value of our Butaritari coral climate reconstruction, and we appreciate their critique of our study. The Karnauskas et al. [2015] analyses strengthen our argument regarding the utility of interisland coral-proxy derived sea surface temperature (SST) gradients as a Walker circulation metric, but we disagree with their interpretation of decadal variability in our records. Here we provide additional analyses, which confirm that our reconstruction [Carilli et al., 2014] shows a long-term weakening of the Walker circulation over 1972-1998. We also document that significant decadal variations in Walker circulation strength, and for particular choices of start and end years over which trends are calculated, are able to show slight Walker strengthening. Overall, we conclude that Walker circulation variations are more nuanced than either our original publication [Carilli et al., 2014] or the subsequent Karnauskas et al. [2015] comment would suggest. Karnauskas et al. [2015] also provide a detailed analysis of Equatorial Undercurrent (EUC) activity near the Gilbert Islands and argue that the EUC does not strongly affect Butaritari. Our original publication did not claim to find significant EUC/Butaritari linkages, and we appreciate the diligence of Karnauskas et al. [2015] for ruling this out as a possibility

Equatorial Pacific coral geochemical records show recent weakening of the Walker Circulation

Equatorial Pacific ocean-atmosphere interactions affect climate globally, and a key component of the coupled system is the Walker Circulation, which is driven by sea surface temperature (SST) gradients across the equatorial Pacific. There is conflicting evidence as to whether the SST gradient and Walker Circulation have strengthened or weakened over the late twentieth century. We present new records of SST and sea surface salinity (SSS) spanning 1959-2010 based on paired measurements of Sr/Ca and δ18O in a massive Porites coral from Butaritari atoll in the Gilbert Islands, Republic of Kiribati, in the central western equatorial Pacific. The records show 2-7 year variability correlated with the El Niño-Southern Oscillation (ENSO) and corresponding shifts in the extent of the Indo-Pacific Warm Pool, and decadal-scale signals related to the Pacific Decadal Oscillation and the Pacific Warm Pool Index. In addition, the Butaritari coral records reveal a small but significant increase in SST (0.39°C) from 1959 to 2010 with no accompanying change in SSS, a trend that persists even when ENSO variability is removed. In contrast, larger increases in SST and SSS are evident in coral records from the equatorial Pacific Line Islands, located east of Butaritari. Taken together, the equatorial Pacific coral records suggest an overall reduction in the east-west SST and SSS gradient over the last several decades, and a recent weakening of the Walker Circulation

A before-after implementation trial of smoking cessation guidelines in hospitalized veterans

Abstract Background Although most hospitalized smokers receive some form of cessation counseling during hospitalization, few receive outpatient cessation counseling and/or pharmacotherapy following discharge, which are key factors associated with long-term cessation. US Department of Veterans Affairs (VA) hospitals are challenged to find resources to implement and maintain the kind of high intensity cessation programs that have been shown to be effective in research studies. Few studies have applied the Chronic Care Model (CCM) to improve inpatient smoking cessation. Specific objectives The primary objective of this protocol is to determine the effect of a nurse-initiated intervention, which couples low-intensity inpatient counseling with sustained proactive telephone counseling, on smoking abstinence in hospitalized patients. Key secondary aims are to determine the impact of the intervention on staff nurses' attitudes toward providing smoking cessation counseling; to identify barriers and facilitators to implementation of smoking cessation guidelines in VA hospitals; and to determine the short-term cost-effectiveness of implementing the intervention. Design Pre-post study design in four VA hospitals Participants Hospitalized patients, aged 18 or older, who smoke at least one cigarette per day. Intervention The intervention will include: nurse training in delivery of bedside cessation counseling, electronic medical record tools (to streamline nursing assessment and documentation, to facilitate prescription of pharmacotherapy), computerized referral of motivated inpatients for proactive telephone counseling, and use of internal nursing facilitators to provide coaching to staff nurses practicing in non-critical care inpatient units. Outcomes The primary endpoint is seven-day point prevalence abstinence at six months following hospital admission and prolonged abstinence after a one-month grace period. To compare abstinence rates during the intervention and baseline periods, we will use random effects logistic regression models, which take the clustered nature of the data within nurses and hospitals into account. We will assess attitudes of staff nurses toward cessation counseling by questionnaire and will identify barriers and facilitators to implementation by using clinician focus groups. To determine the short-term incremental cost per quitter from the perspective of the VA health care system, we will calculate cessation-related costs incurred during the initial hospitalization and six-month follow-up period. Trial number NCT00816036http://deepblue.lib.umich.edu/bitstream/2027.42/112349/1/13012_2009_Article_190.pd

Country Concepts and the Rational Actor Trap: Limitations to Strategic Management of International NGOs

Growing criticism of inefficient development aid demanded new planning instruments of donors, including international NGOs (INGOs). A reorientation from isolated project-planning towards holistic country concepts and the increasing rationality of a result-orientated planning process were seen as answer. However, whether these country concepts - newly introduced by major INGOs too - have increased the efficiency of development cooperation is open to question. Firstly, there have been counteracting external factors, like the globalization of the aid business, that demanded structural changes in the composition of INGO portfolios towards growing short-term humanitarian aid; this was hardly compatible with the requirements of medium-term country planning. Secondly, the underlying vision of rationality as a remedy for the major ills of development aid was in itself a fallacy. A major change in the methodology of planning, closely connected with a shift of emphasis in the approach to development cooperation, away from project planning and service delivery, towards supporting the socio-cultural and political environment of the recipient communities, demands a reorientation of aid management: The most urgent change needed is by donors, away from the blinkers of result-orientated planning towards participative organizational cultures of learning.Des critiques croissantes de l'aide au développement inefficace exigent de nouveaux instruments de planification des bailleurs de fonds, y compris les ONG internationales (ONGI). Une réorientation de la planification des projets isolés vers des concepts holistiques de la planification de l’aide par pays ainsi que la rationalité croissante d'un processus de planification orientée vers les résultats ont été considérés comme réponse. Toutefois, si ces concepts de pays - nouvellement introduites par les grandes OING eux aussi - ont augmenté l'efficacité de la coopération au développement est ouvert à la question. Tout d'abord, il y a eu l’impact des facteurs externes, comme la mondialisation de l'entreprise de l'aide, qui a exigé des changements structurels dans la composition des portefeuilles des OING vers la croissance de l'aide humanitaire à court terme. Cela était difficilement compatible avec les exigences de l'aménagement du territoire à moyen terme. Deuxièmement, la vision sous-jacente de la rationalité accrue de la planification, concentré sur les resultats, comme un remède pour les grands maux de l'aide au développement était en soi une erreur. Un changement majeur dans la méthodologie de la planification, étroitement liée à un changement d'orientation dans l'approche de la coopération au développement, qui n’est pas concentrer sur planification du projet et la prestation de services, mais qui soutienne l'environnement socio-culturel et politique des communautés bénéficiaires, exige une réorientation de la gestion de l’aide: Le changement le plus urgent est un changement par les donateurs eux-mêmes, qui devrait implanter des cultures de collaboration étroit avec les partenaires et la population locale

Increasing access to integrated ESKD care as part of Universal Health Coverage

The global nephrology community recognizes the need for a cohesive strategy to address the growing problem of end-stage kidney disease (ESKD). In March 2018, the International Society of Nephrology hosted a summit on integrated ESKD care, including 92 individuals from around the globe with diverse expertise and professional backgrounds. The attendees were from 41 countries, including 16 participants from 11 low- and lower-middle–income countries. The purpose was to develop a strategic plan to improve worldwide access to integrated ESKD care, by identifying and prioritizing key activities across 8 themes: (i) estimates of ESKD burden and treatment coverage, (ii) advocacy, (iii) education and training/workforce, (iv) financing/funding models, (v) ethics, (vi) dialysis, (vii) transplantation, and (viii) conservative care. Action plans with prioritized lists of goals, activities, and key deliverables, and an overarching performance framework were developed for each theme. Examples of these key deliverables include improved data availability, integration of core registry measures and analysis to inform development of health care policy; a framework for advocacy; improved and continued stakeholder engagement; improved workforce training; equitable, efficient, and cost-effective funding models; greater understanding and greater application of ethical principles in practice and policy; definition and application of standards for safe and sustainable dialysis treatment and a set of measurable quality parameters; and integration of dialysis, transplantation, and comprehensive conservative care as ESKD treatment options within the context of overall health priorities. Intended users of the action plans include clinicians, patients and their families, scientists, industry partners, government decision makers, and advocacy organizations. Implementation of this integrated and comprehensive plan is intended to improve quality and access to care and thereby reduce serious health-related suffering of adults and children affected by ESKD worldwide

Large expert-curated database for benchmarking document similarity detection in biomedical literature search

Document recommendation systems for locating relevant literature have mostly relied on methods developed a decade ago. This is largely due to the lack of a large offline gold-standard benchmark of relevant documents that cover a variety of research fields such that newly developed literature search techniques can be compared, improved and translated into practice. To overcome this bottleneck, we have established the RElevant LIterature SearcH consortium consisting of more than 1500 scientists from 84 countries, who have collectively annotated the relevance of over 180 000 PubMed-listed articles with regard to their respective seed (input) article/s. The majority of annotations were contributed by highly experienced, original authors of the seed articles. The collected data cover 76% of all unique PubMed Medical Subject Headings descriptors. No systematic biases were observed across different experience levels, research fields or time spent on annotations. More importantly, annotations of the same document pairs contributed by different scientists were highly concordant. We further show that the three representative baseline methods used to generate recommended articles for evaluation (Okapi Best Matching 25, Term Frequency-Inverse Document Frequency and PubMed Related Articles) had similar overall performances. Additionally, we found that these methods each tend to produce distinct collections of recommended articles, suggesting that a hybrid method may be required to completely capture all relevant articles. The established database server located at https://relishdb.ict.griffith.edu.au is freely available for the downloading of annotation data and the blind testing of new methods. We expect that this benchmark will be useful for stimulating the development of new powerful techniques for title and title/abstract-based search engines for relevant articles in biomedical research.Peer reviewe

The Ethical Public Scholar

As scholars, we have a critical responsibility to uphold principles such as intellectual honesty, rigour, and open communication. Those who work outside the academy, or whose scholarship spans the academic and non-academic realms, have additional responsibilities and often face more complex or different ethical dilemmas and conflicting moral imperatives in their work. This workshop will feature three experts speaking to the ethical dimensions of scholarship in different contexts: in work involving community engagement or partnership, in the health field, and in the work of ‘public intellectuals’ from any sector.Arts, Faculty ofGraduate and Postdoctoral StudiesNon UBCAnthropology, Department ofGeography, Department ofUnreviewedFacultyGraduat

Water worries : What is the state of our most valuable resource?

We often hear about the possibility of future water wars as populations can’t survive without adequate and safe supplies of fresh water. In recent years, the effects of climate change have led to a global redistribution of water reserves, and agricultural and industrial uses are further straining our supplies of clean fresh water. California is in the midst of a devastating drought and in recent months areas of British Columbia have been hit by drought-like conditions. What steps do we need to take to protect the quality and quantity of our water supplies for decades to come? What lengths will governments go to in order to secure fresh water sources? Who “owns” the planet’s water and how can we ensure there’s enough to go around?Arts, Faculty ofNon UBCGender, Race, Sexuality and Social Justice, Institute forGeography, Department ofLiu Institute for Global IssuesResources, Environment and Sustainability (IRES), Institute forUnreviewedFacultyOthe