Adolescents’ Attitudes Towards Direct-to-Consumer Genetic Testing

The direct-to-consumer (DTC) industry is about a decade old; however, recent years have seen an increase in visibility and uptake due to decreasing prices, television advertisements, and other factors. In the 2018 DNA Day Essay Contest, high school students were asked to research a genetic disorder and to formulate a stance on whether medical professionals should be required for all genetic testing or if consumers should have access to direct-to-consumer testing. Within the 400 coded essays, 80.5% said yes to having a medical professional required and 20.5% said no. Qualitative analysis of the essays revealed the following major themes: benefit of medical providers, consumer knowledge lacking, negative psychological effects, informed consumer, DTC testing companies knowledge lacking, accessibility of DTC testing, accessibility of medical professionals, DTC testing company can use information against the consumer, and insurance companies can use information against the consumer. Although most of the essays agreed to have a medical professional involved in DTC testing, many students cited similar reasons supporting their claims, regardless of their overall opinions of whether or not medical professionals should be involved

Ice tectonic deformation during the rapid in situ drainage of a supraglacial lake on the Greenland Ice Sheet.

We present detailed records of lake discharge, ice motion and passive seismicity capturing the behaviour and processes preceding, during and following the rapid drainage of a 4 km<sup>2</sup> supraglacial lake through 1.1-km-thick ice on the western margin of the Greenland Ice Sheet. Peak discharge of 3300 m<sup>3</sup> s<sup>−1</sup> coincident with maximal rates of vertical uplift indicates that surface water accessed the ice–bed interface causing widespread hydraulic separation and enhanced basal motion. The differential motion of four global positioning system (GPS) receivers located around the lake record the opening and closure of the fractures through which the lake drained. We hypothesise that the majority of discharge occurred through a 3-km-long fracture with a peak width averaged across its wetted length of 0.4 m. We argue that the fracture's kilometre-scale length allowed rapid discharge to be achieved by combining reasonable water velocities with sub-metre fracture widths. These observations add to the currently limited knowledge of in situ supraglacial lake drainage events, which rapidly deliver large volumes of water to the ice–bed interface

Greenland ice sheet annual motion insensitive to spatial variations in subglacial hydraulic structure

We present ice velocities observed with global positioning systems and TerraSAR-X/TanDEM-Xin a land-terminating region of the southwest Greenland ice sheet (GrIS) during the melt year 2012–2013, toexamine the spatial pattern of seasonal and annual ice motion. We find that while spatial variability in theconfiguration of the subglacial drainage system controls ice motion at short timescales, this configurationhas negligible impact on the spatial pattern of the proportion of annual motion which occurs duringsummer. While absolute annual velocities vary substantially, the proportional contribution of summermotion to annual motion does not. These observations suggest that in land-terminating margins of the GrIS,subglacial hydrology does not significantly influence spatial variations in net summer speedup.Furthermore, our findings imply that not every feature of the subglacial drainage system needs to beresolved in ice sheet models

North-east sector of the Greenland Ice Sheet to undergo the greatest inland expansion of supraglacial lakes during the 21st century

The formation and rapid drainage of supraglacial lakes (SGL) influences the mass balance and dynamics of the Greenland Ice Sheet (GrIS). Although SGLs are expected to spread inland during the 21st century due to atmospheric warming, less is known about their future spatial distribution and volume. We use GrIS surface elevation model and regional climate model outputs to show that at the end of the 21st century (2070-2099) approximately 9.8 ± 3.9 km3 (+113% compared to 1980-2009) and 12.6 ± 5 km3 (+174%) of meltwater could be stored in SGLs under moderate (RCP 4.5) and high (RCP 8.5) climate change scenarios respectively. The largest increase is expected in the north-eastern sector of the GrIS (191% in RCP 4.5 and 320% in RCP 8.5), whereas in west Greenland, where the most SGLs are currently observed, the future increase will be relatively moderate (55% in RCP 4.5 and 68% in RCP 8.5)

U.S. medical resident familiarity with national tuberculosis guidelines

<p>Abstract</p> <p>Background</p> <p>The ability of medical residents training at U.S. urban medical centers to diagnose and manage tuberculosis cases has important public health implications. We assessed medical resident knowledge about tuberculosis diagnosis and early management based on American Thoracic Society guidelines.</p> <p>Methods</p> <p>A 20-question tuberculosis knowledge survey was administered to 131 medical residents during a single routinely scheduled teaching conference at four different urban medical centers in Baltimore and Philadelphia. Survey questions were divided into 5 different subject categories. Data was collected pertaining to institution, year of residency training, and self-reported number of patients managed for tuberculosis within the previous year. The Kruskal-Wallis test was used to detect differences in median percent of questions answered correctly based on these variables.</p> <p>Results</p> <p>The median percent of survey questions answered correctly for all participating residents was 55%. Medical resident knowledge about tuberculosis did not improve with increasing post-graduate year of training or greater number of patients managed for tuberculosis within the previous year. Common areas of knowledge deficiency included the diagnosis and management of latent tuberculosis infection (median percent correct, 40.7%), as well as the interpretation of negative acid-fast sputum smear samples.</p> <p>Conclusion</p> <p>Many medical residents lack adequate knowledge of recommended guidelines for the management of tuberculosis. Since experience during training influences future practice pattterns, education of medical residents on guidelines for detection and early management of tuberculosis may be important for future improvements in national tuberculosis control strategies.</p

The National Adult Inpatient Survey conducted in the English National Health Service from 2002 to 2009: how have the data been used and what do we know as a result?

<p>Abstract</p> <p>Background</p> <p>When it was initiated in 2001, England's national patient survey programme was one of the first in the world and has now been widely emulated in other healthcare systems. The aim of the survey programme was to make the National Health Service (NHS) more "patient centred" and more responsive to patient feedback. The national inpatient survey has now been running in England annually since 2002 gathering data from over 600,000 patients. The aim of this study is to investigate how the data have been used and to summarise what has been learned about patients' evaluation of care as a result.</p> <p>Methods</p> <p>Two independent researchers systematically gathered all research that included analyses of the English national adult inpatient survey data. Journals, databases and relevant websites were searched. Publications prior to 2002 were excluded. Articles were also identified following consultation with experts. All documents were then critically appraised by two co-authors both of whom have a background in statistical analysis.</p> <p>Results</p> <p>We found that the majority of the studies identified were reports produced by organisations contracted to gather the data or co-ordinate the data collection and used mainly descriptive statistics. A few articles used the survey data for evidence based reporting or linked the survey to other healthcare data. The patient's socio-demographic characteristics appeared to influence their evaluation of their care but characteristics of the workforce and the. At a national level, the results of the survey have been remarkably stable over time. Only in those areas where there have been co-ordinated government-led campaigns, targets and incentives, have improvements been shown. The main findings of the review are that while the survey data have been used for different purposes they seem to have incited little academic interest.</p> <p>Conclusions</p> <p>The national inpatient survey has been a useful resource for many authors and organisations but the full potential inherent in this large, longitudinal publicly available dataset about patients' experiences has not as yet been fully exploited.</p> <p>This review suggests that the presence of survey results alone is not enough to improve patients' experiences and further research is required to understand whether and how the survey can be best used to improve standards of care in the NHS.</p

Recent Advances in Our Understanding of the Role of Meltwater in the Greenland Ice Sheet System

Nienow, Sole and Cowton’s Greenland research has been supported by a number of UK NERC research grants (NER/O/S/2003/00620; NE/F021399/1; NE/H024964/1; NE/K015249/1; NE/K014609/1) and Slater has been supported by a NERC PhD studentshipPurpose of the review:  This review discusses the role that meltwater plays within the Greenland ice sheet system. The ice sheet’s hydrology is important because it affects mass balance through its impact on meltwater runoff processes and ice dynamics. The review considers recent advances in our understanding of the storage and routing of water through the supraglacial, englacial, and subglacial components of the system and their implications for the ice sheet Recent findings:   There have been dramatic increases in surface meltwater generation and runoff since the early 1990s, both due to increased air temperatures and decreasing surface albedo. Processes in the subglacial drainage system have similarities to valley glaciers and in a warming climate, the efficiency of meltwater routing to the ice sheet margin is likely to increase. The behaviour of the subglacial drainage system appears to limit the impact of increased surface melt on annual rates of ice motion, in sections of the ice sheet that terminate on land, while the large volumes of meltwater routed subglacially deliver significant volumes of sediment and nutrients to downstream ecosystems. Summary:  Considerable advances have been made recently in our understanding of Greenland ice sheet hydrology and its wider influences. Nevertheless, critical gaps persist both in our understanding of hydrology-dynamics coupling, notably at tidewater glaciers, and in runoff processes which ensure that projecting Greenland’s future mass balance remains challenging.Publisher PDFPeer reviewe

Greenland ice sheet surface mass loss: recent developments in observation and modeling

Surface processes currently dominate Greenland ice sheet (GrIS) mass loss. We review recent developments in the observation and modelling of GrIS surface mass balance (SMB), published after the July 2012 deadline for the Fifth Assessment Report of the Intergovernmental Panel on Climate Change (IPCC AR5). Since IPCC AR5 our understanding of GrIS SMB has further improved, but new observational and model studies have also revealed that temporal and spatial variability of many processes are still poorly quantified and understood, e.g. bio-albedo, the formation of ice lenses and their impact on lateral meltwater transport, heterogeneous vertical meltwater transport (‘piping’), the impact of atmospheric circulation changes and mixed-phase clouds on the surface energy balance and the magnitude of turbulent heat exchange over rough ice surfaces. As a result, these processes are only schematically or not at all included in models that are currently used to assess and predict future GrIS surface mass loss