Calibration Uncertainty in Ocean Color Satellite Sensors and Trends in Long-term Environmental Records

Launched in late 2011, the Visible Infrared Imaging Radiometer Suite (VIIRS) aboard the Suomi National Polar-orbiting Partnership (NPP) spacecraft is being evaluated by NASA to determine whether this sensor can continue the ocean color data record established through the Sea-Viewing Wide Field-of-view Sensor (SeaWiFS) and the MODerate resolution Imaging Spectroradiometer (MODIS). To this end, Goddard Space Flight Center generated evaluation ocean color data products using calibration techniques and algorithms established by NASA during the SeaWiFS and MODIS missions. The calibration trending was subjected to some initial sensitivity and uncertainty analyses. Here we present an introductory assessment of how the NASA-produced time series of ocean color is influenced by uncertainty in trending instrument response over time. The results help quantify the uncertainty in measuring regional and global biospheric trends in the ocean using satellite remote sensing, which better define the roles of such records in climate research

The Value of Admission Clinical Data for Diagnosing Heart Failure in Long-term Care

Background Heart failure (HF) is common in long-term care (LTC). Diagnostic uncertainty is important barrier to optimal HF management, stemming from inadequate health information transfer upon LTC admission. We determine the utility of admission clinical information to confirm a HF diagnosis in new LTC residents. Methods This was a prospective cohort study. From February 2004 to November 2006, information about new residents from 41 LTC homes in Ontario, Canada, was collected from residents and caregivers, and all available health records. A prior HF diagnosis was confirmed by consensus review of available data by two independent experts. Multivariate modelling was utilized to determine the utility of the admission clinical assessment in confirming a prior HF diagnosis. Results A total of 449 residents were included for analysis, aged84.3±6.5 years, and 21.6% had a prior HF diagnosis. The most useful clinical item for diagnosing HF was a “history of HF”. The final model included “history of HF’ (OR [odds ratio] 13.66, 95% CI 6.61–28.24), “fluid on the lungs” (OR 2.01, 95% CI 1.04–3.89), “orthopnea” (OR 1.76, 95% CI 0.93–3.33), “taking β-blocker” (OR 2.09, 95% CI 1.10– 3.94), “taking loop diuretics” (OR 2.11, 95% CI 1.12–3.98), and “history of coronary artery disease” (OR 2.83, 95% CI 1.42–5.64). Conclusion Elements of the clinical assessment for new LTC residents can help confirm a prior HF diagnosis. An admission history of HF is highly predictiveCanadian Institutes of Health Research (CIHR; Study ID 117947-BCA-CEBA-126289

Heart failure and cognitive impairment: Challenges and opportunities

As populations age, heart failure (HF) is becoming increasingly common, and in addition to a high burden of morbidity and mortality, HF has an enormous financial impact. Though disproportionately affected by HF, the elderly are less likely to receive recommended therapies, in part because clinical trials of HF therapy have ignored outcomes of importance to this population, including impaired cognitive function (ICF). HF is associated with ICF, manifested primarily as delirium in hospitalized patients, or as mild cognitive impairment or dementia in otherwise stable outpatients. This association is likely the result of shared risk factors, as well as perfusion and rheological abnormalities that occur in patients with HF. Evidence suggests that these abnormalities may be partially reversible with standard HF therapy. The clinical consequences of ICF in HF patients are significant. Clinicians should consider becoming familiar with screening instruments for ICF, including delirium and dementia, in order to identify patients at risk of nonadherence to HF therapy and related adverse consequences. Preliminary evidence suggests that optimal HF therapy in elderly patients may preserve or even improve cognitive function, though the impact on related outcomes remains to be determined

In Search Of The Royal Mausoleum At The Benedictine Abbey Of Dunfermline Fife: Medieval Liturgy, Antiquarianism, and a Ground-Penetrating Radar Pilot Survey, 2016-19 (2020)

Today, visitors to the Benedictine Abbey of Dunfermline, Fife, find a church of two halves. To the west the surviving medieval Catholic abbey nave which also served as the original parish church of Dunfermline; to the east the modern Protestant Abbey Church of Dunfermline, built in 1818-21 atop the ruins of the abbey’s medieval choir. The lost east-end of this great church had been the focus of the cult shrine of Queen/St Margaret (d.1093) and the site of multiple royal and aristocratic burials down to 1420 before it was sacked at the Reformation of 1560. Thereafter it fell into successive generations of neglect and reuse as a town stone-source and then burial ground, the ‘Psalter churchyard’. As a result, little to no evidence survives – either written or material – to enable us to recreate the overall evolving layout and spiritual life of the lost abbey choir, not least the position and form of the many royal burials within this mausoleum and cult church. What discussion there has been of these important features has been dominated by a focus on the tomb and remains of King Robert Bruce/I (1306-29) whose grave was believed to have been found in 1818 when the choir ruins were cleared to make way for the new Abbey Church build. Medieval Scottish chroniclers had briefly reported Bruce as being buried at the abbey ‘in the middle of the choir.’ However, such evidence that this grave and skeleton did indeed belong to Bruce remains, in several important ways, quite ambivalent and open to differing interpretation. Nor does a focus on the 1818 grave tell us anything of the larger living medieval church. It was in this context that the project outlined in the following report sought to apply Ground-Penetrating Radar [GPR] to the lost choir site. We planned to scan down both through the modern interior floor of the Abbey Church to the medieval depths, and in search of similar archaeology beneath accessible exterior ground atop the choir ruins. We hoped this would provide some fresh evidence which could in turn be used to reassess the surviving medieval written and material evidence, in combination with the many antiquarian finds and observations about the abbey, its choir and tombs reported in the eighteenth and nineteenth centuries. Once brought together, this evidence might allow us to paint a fuller picture of the architectural and liturgical nature of the choir with a focus on the period from c.1250-1, when St Margaret was moved to her new east-end shrine and the choir expanded, down to c.1560. Our pilot stage GPR scans of 2016, 2017 and 2019 can be said, cautiously, to have been successful thanks to the application of a tailored method of scanning for buried and overbuilt medieval ecclesiastical remains. This report (and its three accompanying technical field reports by GPR expert Erica Utsi) will summarise those scans’ key findings of: - Multiple potential elite burials at the likely medieval depths in the northern Transept/Lady aisle area of the choir, perhaps in pairs down the east-west axis of that aisle adjacent to the fourteenth-century Lady Chapel extension. - Potential evidence for a large north-south architectural feature running across the overbuilt choir presbytery space, perhaps the medieval sanctuary steps. - Evidence for multiple potential burials beneath the floor of the Abbey Church’s east-end vestry, thus beneath the sanctuary pavement and ambulatory of the mid-thirteenth-century feretory shrine extension for St Margaret. As these burials lie west of the surviving fossiliferous marble base of Margaret’s shrine they may, however, also belong to the period of ‘Psalter’ churchyard interments of Protestant townsfolk c.1560-c.1818. - Evidence for potential burials or, more likely, the foundations of architectural or liturgical fittings to the east of the 1818 ‘Bruce grave’ and thus around the likely site of the medieval high altar of the abbey and its chancel/altar screens. - Evidence for the footings of the walls of the east and west ends of the northern Lady Chapel extension of the choir and, perhaps, of some liturgical fittings or tombs within that Chapel’s interior which can be scanned through the ground outside the Abbey Church’s North Transept. - Likely evidence for a southern choir chapel dedicated to St John the Baptist and of a shape and scale matching that of the northern Lady Chapel. This possible finding will require testing and verification in drier weather better suited to GPR work but, if confirmed, allows us to envisage a full symmetrical form for the late medieval choir at Dunfermline and its pilgrimage cult ambulatory and evolving royal mausoleum. The report then combines these initial GPR findings with previously unnoticed or overlooked medieval and antiquarian evidence to make the case for: - A focus for royal and aristocratic burials in the Lady aisle as well as in the northern Lady Chapel in the fourteenth and fifteenth centuries, with a likely concentration of couples, perhaps as double tombs; earlier royal burials would have been focussed in the central monks’ choir/presbytery area. - A second possible location for the tomb of Robert Bruce. This was reported by an antiquarian investigator as lying a ‘few yards to the south west’ of the site of six slabs within the Lady Chapel long believed by locals to cover royal burials, and thus within the northern edge of the medieval presbytery or along its boundary with the Lady aisle (perhaps between columns). - A reassessment of our understanding of the cruciform axes of this great church as running both east-west and north-south, not simply east-west with a focus on the high altar. This should mean that a wider and larger central ‘presbytery’ space in the choir could be the site of royal burials like that of Bruce and his queen, Elizabeth de Burgh, alongside the shrine of Margaret’s son, David I (1124-53), who had elevated the house to a full abbey and, like both his parents, was believed by the monks to be a saint. - A possible double tomb for Robert Bruce and Elizabeth, like such royal couples’ marble monuments to be found in the French royal mausoleum in the contemporary Benedictine abbey of St Denis, outside medieval Paris. - Recreating the position and basic physical form of the medieval high altar and eastern sanctuary/chancel of the choir, and thus to question both the dating of the 1818 ‘Bruce grave’ as pre-Reformation and that it did actually belong to that king. Recreating the high altar and sanctuary space also provides possible evidence for the nature of the access points into the post-1250 shrine chapel of St Margaret. - A growing interest after the Reformation among local families in securing ‘Psalter churchyard’ burial close to the shrine of St Margaret, particularly in the retro-choir/vestry area. - The potential existence of a matching south-side transept aisled chapel, dedicated to St John the Baptist, thus confirming both the accuracy of the ground-plan of the surviving medieval walls recorded by the Abbey Church’s architect-builder in 1818, William Burn (but one which modern heritage plans of the abbey have ignored since then), and the fully symmetrical cruciform shape of the late medieval choir thus with an extensive circuitous pilgrimage ambulatory. - The possibility that for liturgical reasons Alexander III (1249-86) was buried in this St John aisle or chapel. - The possibility that the previously overlooked evidence of both the anthropomorphic (body-shaped) lead coffin and the crude, shallow stone crypt of the 1818 ‘Bruce grave’ actually point to this being a late sixteenth/seventeenth century burial and thus perhaps a post-Reformation rescue burial of a medieval body or a later ‘Psalter’ intrusion. - The lost late medieval choir with all its key chapels, altars, tombs and inter-related liturgical spaces can be cautiously reimagined in all its evolving complexity as very much a Scottish mirror-image of the English and French royal mausoleums at Westminster and St Denis (both also Benedictine houses dedicated to the Trinity and royal saints) and with its own unique liturgical setting and meanings. The report closes with some proposals for further GPR and allied research which could make an important contribution to the fresh (re-)interpretation of Dunfermline Abbey planned for the immediate future. Not least, this closes with the possibility of locating evidence for further potential royal graves and liturgical settings within the central (and western) choir/presbytery and aisles/chapels of the Abbey’s lost east end.This is the end pilot stage interpretive report of an interdisciplinary project undertaken c.2016-20 to combine historical research and ground-penetrating radar in search of greater understanding of the form, liturgy and overall significance of the lost, overbuilt choir of the Benedictine abbey of Dunfermline, Fife, home to the cult shrine of St Margaret and the burials of at least seven kings of Scots, many of their women-folk and great noble subjects

Trends in Prescribing Oral Anticoagulants in Canada, 2008–2014

AbstractPurposeThe non–vitamin K antagonist oral anticoagulants (NOACs), dabigatran, rivaroxaban, and apixaban, provide several advantages over vitamin K antagonists, such as warfarin. Little is known about the trends of prescribing OACs in Canada. In this study we analyzed changes in prescription volumes for OAC drugs since the introduction of the NOACs in Canada overall, by province and by physician specialty.MethodsCanadian prescription volumes for warfarin, dabigatran, rivaroxaban, and apixaban from January 2008 to June 2014 were obtained from the Canadian Compuscript Audit of IMS Health Canada Inc and were analyzed by physician specialty at the national and provincial levels. Total prescriptions by indication were calculated based on data from the Canadian Disease and Therapeutic Index for all OAC indications and for each commonly prescribed dose of dabigatran (75, 110, and 150 mg), rivaroxaban (10, 15, and 20 mg), and apixaban (2.5 and 5 mg).FindingsThe overall number of OAC prescriptions in Canada has increased annually since 2008. With the availability of the NOACs, the proportion of total OAC prescriptions attributable to warfarin has steadily decreased, from 99% in 2010 to 67% by June 2014, and the absolute number of warfarin prescriptions has been decreasing since February 2011. The greatest decline in proportionate warfarin prescriptions was in Ontario. In general, the increase of NOAC prescriptions coincided with the introduction of provinces’ reimbursement of NOAC prescription costs. The proportion of total OAC prescriptions represented by the NOACs varied by specialty, with the greatest proportionate prescribing found among orthopedic surgeons, cardiologists, and neurologists.ImplicationsSince their approval, the NOACs have represented a growing share of total OAC prescriptions in Canada. This trend is expected to continue because the NOACs are given preference over warfarin in guidelines on stroke prevention in patients with atrial fibrillation, because of growing physician experience, and due to the emergence of potential new indications. An understanding of the current prescribing patterns will help to encourage knowledge translation and possibly influence policy/reimbursement strategies

Causes of death in patients with atrial fibrillation anticoagulated with rivaroxaban:a pooled analysis of XANTUS

Aims: Anticoagulation can prevent stroke and prolong lives in patients with atrial fibrillation (AF). However, anticoagulated patients with AF remain at risk of death. The aim of this study was to investigate the causes of death and factors associated with all-cause and cardiovascular death in the XANTUS population. Methods and results: Causes of death occurring within a year after rivaroxaban initiation in patients in the XANTUS programme studies were adjudicated by a central adjudication committee and classified following international guidance. Baseline characteristics associated with all-cause or cardiovascular death were identified. Of 11 040 patients, 187 (1.7%) died. Almost half of these deaths were due to cardiovascular causes other than bleeding (n = 82, 43.9%), particularly heart failure (n = 38, 20.3%) and sudden or unwitnessed death (n = 24, 12.8%). Fatal stroke (n = 8, 4.3%), which was classified as a type of cardiovascular death, and fatal bleeding (n = 17, 9.1%) were less common causes of death. Independent factors associated with all-cause or cardiovascular death included age, AF type, body mass index, left ventricular ejection fraction, hospitalization at baseline, rivaroxaban dose, and anaemia. Conclusion: The overall risk of death due to stroke or bleeding was low in XANTUS. Anticoagulated patients with AF remain at risk of death due to heart failure and sudden death. Potential interventions to reduce cardiovascular deaths in anticoagulated patients with AF require further investigation, e.g. early rhythm control therapy and AF ablation. Trial registration numbers: NCT01606995, NCT01750788, NCT0180000

Assessment of the conservation priority status of South African estuaries for use in management and water allocation

The future health and productivity of South Africa's approximately 250 estuaries is dependent on two main factors: management and freshwater inputs. Both management and water allocation decisions involve trade-offs between conservation and various types of utilisation. In order to facilitate decision-making in both of these spheres, it is necessary to understand the relative conservation importance of different estuaries. This study devises a method for prioritising South African estuaries on the basis of conservation importance, and presents the results of a ranking based on the collation of existing data for all South African estuaries. Estuaries are scored in terms of their size, type and biogeographical zone, habitats and biota (plants, invertebrates, fish and birds). Thirtythree estuaries are currently under formal protection, but they are not representative of all estuarine biodiversity. We performed a complementarity analysis, incorporating data on abundance where available, to determine the minimum set of estuaries that includes all known species of plants, invertebrates, fishes and birds. In total, 32 estuaries were identified as 'required protected areas', including 10 which are already protected. An estuary's importance status (including 'required protected area' status) will influence the choice of management class and hence freshwater allocation under the country's new Water Act, and can be used to assist the development of a new management strategy for estuaries, which is currently underway. WaterSA Vol.28(2) 2002: 191-20

Suomi NPP VIIRS Ocean Color Data Product Early Mission Assessment

Following the launch of the Visible Infrared Imaging Radiometer Suite (VIIRS) aboard the Suomi National Polarorbiting Partnership (NPP) spacecraft, the NASA NPP VIIRS Ocean Science Team (VOST) began an evaluation of ocean color data products to determine whether they could continue the existing NASA ocean color climate data record (CDR). The VOST developed an independent evaluation product based on NASA algorithms with a reprocessing capability. Here we present a preliminary assessment of both the operational ocean color data products and the NASA evaluation data products regarding their applicability to NASA science objectives

Molecular basis for effects of carcinogenic heavy metals on inducible gene expression.

Certain forms of the heavy metals arsenic and chromium are considered human carcinogens, although they are believed to act through very different mechanisms. Chromium(VI) is believed to act as a classic and mutagenic agent, and DNA/chromatin appears to be the principal target for its effects. In contrast, arsenic(III) is considered nongenotoxic, but is able to target specific cellular proteins, principally through sulfhydryl interactions. We had previously shown that various genotoxic chemical carcinogens, including chromium (VI), preferentially altered expression of several inducible genes but had little or no effect on constitutive gene expression. We were therefore interested in whether these carcinogenic heavy metals might target specific but distinct sites within cells, leading to alterations in gene expression that might contribute to the carcinogenic process. Arsenic(III) and chromium(VI) each significantly altered both basal and hormone-inducible expression of a model inducible gene, phosphoenolpyruvate carboxykinase (PEPCK), at nonovertly toxic doses in the chick embryo in vivo and rat hepatoma H411E cells in culture. We have recently developed two parallel cell culture approaches for examining the molecular basis for these effects. First, we are examining the effects of heavy metals on expression and activation of specific transcription factors known to be involved in regulation of susceptible inducible genes, and have recently observed significant but different effects of arsenic(III) and chromium(VI) on nuclear transcription factor binding. Second, we have developed cell lines with stably integrated PEPCK promoter-luciferase reporter gene constructs to examine effects of heavy metals on promoter function, and have also recently seen profound effects induced by both chromium(VI) and arsenic(III) in this system. These model systems should enable us to be able to identify the critical cis (DNA) and trans (protein) cellular targets of heavy metal exposure leading to alterations in expression of specific susceptible genes. It is anticipated that such information will provide valuable insight into the mechanistic basis for these effects as well as provide sensitive molecular biomarkers for evaluating human exposure