Ten years of the International Patient Decision Aid Standards Collaboration: evolution of the core dimensions for assessing the quality of patient decision aids

In 2003, the International Patient Decision Aid Standards (IPDAS) Collaboration was established to enhance the quality and effectiveness of patient decision aids by establishing an evidence-informed framework for improving their content, development, implementation, and evaluation. Over this 10 year period, the Collaboration has established: a) the background document on 12 core dimensions to inform the original modified Delphi process to establish the IPDAS checklist (74 items); b) the valid and reliable IPDAS instrument (47 items); and c) the IPDAS qualifying (6 items), certifying (6 items + 4 items for screening), and quality criteria (28 items). The objective of this paper is to describe the evolution of the IPDAS Collaboration and discuss the standardized process used to update the background documents on the theoretical rationales, evidence and emerging issues underlying the 12 core dimensions for assessing the quality of patient decision aids. © 2013 Volk et al; licensee BioMed Central Ltd

First rotation biomass production and nutrient cycling within short-rotation coppice willow plantations in Saskatchewan, Canada

Although numerous studies have quantified different social, economic, energetic, and environmental benefits associated with short-rotation coppice (SRC) willow plantations, comprehensive assessments of nutrient cycling are rare. The objective of this study was to examine the biomass production and attendant biogeochemical cycling of nitrogen (N), phosphorus (P), potassium (K), sulphur (S), calcium (Ca), and magnesium (Mg) during the initial four-year rotation of six willow varieties grown at four locations along a 500 km north-south pedoclimatic gradient within Saskatchewan, Canada. Nutrient budgets consisted of quantifying various nutrient inputs (e.g., atmospheric deposition and soil mineral weathering), outputs (e.g., fine and coarse root biomass, leaf biomass, harvested biomass, leaching, and denitrification), and transfers (e.g., soil organic matter mineralization, canopy exchange, leaf litter decomposition, and fine root turnover) associated with the plant available soil nutrient pool. Total above- and below-ground production during the rotation was approximately 40 Mg ha-1, with calculated soil nutrient budget deficits (i.e., nutrient outputs > inputs + transfers) of 17, 39, 112, 271, and 74 kg ha-1 for N, P, K, Ca, and Mg, respectively, averaged across the varieties and sites, but a soil S surplus of 60 kg ha-1. While soil nutrient budget deficits varied among sites, there were no significant differences (P >0.05) among willow varieties. Despite the relatively low nutrient-demanding nature of willow and negligible leaching or denitrification losses, nutrient export in harvested biomass over multiple rotations will require soil nutrient amendments to maintain SRC willow productivity, particularly N and P, albeit a fraction of the amount required for annual agronomic crops

NGC 346 in The Small Magellanic Cloud. IV. Triggered Star Formation in the HII Region N66

Stellar feedback, expanding HII regions, wind-blown bubbles, and supernovae are thought to be important triggering mechanisms of star formation. Stellar associations, being hosts of significant numbers of early-type stars, are the loci where these mechanisms act. In this part of our photometric study of the star-forming region NGC346/N66 in the Small Magellanic Cloud, we present evidence based on previous and recent detailed studies, that it hosts at least two different events of triggered star formation and we reveal the complexity of its recent star formation history. In our earlier studies of this region (Papers I, III) we find that besides the central part of N66, where the bright OB stellar content of the association NGC346 is concentrated, an arc-like nebular feature, north of the association, hosts recent star formation. This feature is characterized by a high concentration of emission-line stars and Young Stellar Objects, as well as embedded sources seen as IR-emission peaks that coincide with young compact clusters of low-mass pre-main sequence stars. All these objects indicate that the northern arc of N66 encompasses the most current star formation event in the region. We present evidence that this star formation is the product of a different mechanism than that in the general area of the association, and that it is triggered by a wind-driven expanding HII region (or bubble) blown by a massive supernova progenitor, and possibly other bright stars, a few Myr ago. We propose a scenario according to which this mechanism triggered star formation away from the bar of N66, while in the bar of N66 star formation is introduced by the photo-ionizing OB stars of the association itself.Comment: Astrophysical Journal, In Press. 10 pages, 4 figures, emulateapj LaTeX style. Figures with Scaled-down resolution. Related Press Releases: http://www.nasa.gov/mission_pages/spitzer/news/spitzer-20081008.html and http://www.eso.org/public/outreach/press-rel/pr-2008/pr-34-08.htm

Delivering Patient Decision Aids on the Internet: Definitions, Theories, Current Evidence, and Emerging Research Areas

Background: In 2005, the International Patient Decision Aids Standards Collaboration identified twelve quality dimensions to guide assessment of patient decision aids. One dimension — the delivery of patient decision aids on the Internet — is relevant when the Internet is used to provide some or all components of a patient decision aid. Building on the original background chapter, this paper provides an updated definition for this dimension, outlines a theoretical rationale, describes current evidence, and discusses emerging research areas. Methods: An international, multidisciplinary panel of authors examined the relevant theoretical literature and empirical evidence through 2012. Results: The updated definition distinguishes Internet-delivery of patient decision aids from online health information and clinical practice guidelines. Theories in cognitive psychology, decision psychology, communication, and education support the value of Internet features for providing interactive information and deliberative support. Dissemination and implementation theories support Internet-delivery for providing the right information (rapidly updated), to the right person (tailored), at the right time (the appropriate point in the decision making process). Additional efforts are needed to integrate the theoretical rationale and empirical evidence from health technology perspectives, such as consumer health informatics, user experience design, and human-computer interaction. Despite Internet usage ranging from 74% to 85% in developed countries and 80% of users searching for health information, it is unknown how many individuals specifically seek patient decision aids on the Internet. Among the 86 randomized controlled trials in the 2011 Cochrane Collaboration ’ s review of patient decision aids, only four studies focused on Internet-delivery. Given the limited number of published studies, this paper particularly focused on identifying gaps in the empirical evidence base and identifying emerging areas of research. Conclusions: As of 2012, the updated theoretical rationale and emerging evidence suggest potential benefits to delivering patient decision aids on the Internet. However, additional research is needed to identify best practices and quality metrics for Internet-based development, evaluation, and dissemination, particularly in the areas of interactivity, multimedia components, socially-generated information, and implementation strategies

Ultrathin Tropical Tropopause Clouds (UTTCs) : I. Cloud morphology and occurrence

Subvisible cirrus clouds (SVCs) may contribute to dehydration close to the tropical tropopause. The higher and colder SVCs and the larger their ice crystals, the more likely they represent the last efficient point of contact of the gas phase with the ice phase and, hence, the last dehydrating step, before the air enters the stratosphere. The first simultaneous in situ and remote sensing measurements of SVCs were taken during the APE-THESEO campaign in the western Indian ocean in February/March 1999. The observed clouds, termed Ultrathin Tropical Tropopause Clouds (UTTCs), belong to the geometrically and optically thinnest large-scale clouds in the Earth´s atmosphere. Individual UTTCs may exist for many hours as an only 200--300 m thick cloud layer just a few hundred meters below the tropical cold point tropopause, covering up to 105 km2. With temperatures as low as 181 K these clouds are prime representatives for defining the water mixing ratio of air entering the lower stratosphere

Screening a mushroom extract library for activity against Acinetobacter baumannii and Burkholderia cepacia and the identification of a compound with anti-Burkholderia activity

<p>Abstract</p> <p>Background</p> <p><it>Acinetobacter baumannii </it>and species within the <it>Burkholderia cepacia </it>complex (BCC) are significant opportunistic bacterial pathogens of humans. These species exhibit a high degree of antibiotic resistance, and some clinical isolates are resistant to all currently available antimicrobial drugs used for treatment. Thus, new drugs are needed to treat infections by these species. Mushrooms could be a potential source for new drugs to treat <it>A. baumannii </it>and BCC infections.</p> <p>Methods</p> <p>The aim of this study was to screen a library of crude extracts from 330 wild mushrooms by disk diffusion assays for antibacterial activity against <it>A. baumannii </it>and <it>Burkholderia cepacia </it>in the hope of identifying a novel natural drug that could be used to treat infections caused by these species. Once positive hits were identified, the extracts were subjected to bioassay-guided separations to isolate and identify the active drug molecules. MICs were performed to gauge the <it>in vitro </it>activity of the purified compounds.</p> <p>Results</p> <p>Only three crude extracts (0.9%) had activity against <it>A. baumannii </it>and <it>B. cepacia</it>. Compounds from two of these extracts had MICs greater than 128 μg/ml, and further analyses were not performed. From the third extract, prepared from <it>Leucopaxillus albissimus</it>, 2-aminoquinoline (2-AQ) was isolated. This compound exhibited a modest MIC <it>in vitro </it>against strains from nine different BCC species, including multi-drug resistant clinical isolates (MIC = 8-64 μg/ml), and a weak MIC (128 μg/ml) against <it>A baumannii</it>. The IC₅₀against a murine monocyte line was 1.5 mg/ml.</p> <p>Conclusion</p> <p>The small number of positive hits in this study suggests that finding a new drug from mushrooms to treat Gram-negative bacterial infections may be difficult. Although 2-AQ was identified in one mushroom, and it was shown to inhibit the growth of multi-drug resistant BCC isolates, the relatively high MICs (8-128 μg/ml) for both <it>A. baumannii </it>and BCC strains suggests that 2-AQ is not suitable for further drug development in its current form.</p

The Degree of t-System Remodeling Predicts Negative Force-Frequency Relationship and Prolonged Relaxation Time in Failing Human Myocardium

The normally positive cardiac force-frequency relationship (FFR) becomes flat or negative in chronic heart failure (HF). Here we explored if remodeling of the cardiomyocyte transverse tubular system (t-system) is associated with alterations in FFR and contractile kinetics in failing human myocardium. Left-ventricular myocardial slices from 13 failing human hearts were mounted into a biomimetic culture setup. Maximum twitch force (F), 90% contraction duration (CD90), time to peak force (TTP) and time to relaxation (TTR) were determined at 37 degrees C and 0.2-2 Hz pacing frequency. F-1(Hz)/F-0.(5)(Hz) and F-2(Hz)/F-0.(5)(Hz) served as measures of FFR, intracellular cardiomyocyte t-tubule distance (Delta TT) as measure of t-system remodeling. Protein levels of SERCA2, NCX1, and PLB were quantified by immunoblotting. F-1(Hz)/F-0.(5)(Hz) (R-2 = 0.82) and F-2(Hz)/F-0.(5)(Hz) (R-2 = 0.5) correlated negatively with Delta TT, i.e., samples with severe t-system loss exhibited a negative FFR and reduced myocardial wall tension at high pacing rates. PLB levels also predicted F-1(Hz)/F-0.(5)(Hz), but to a lesser degree (R-2 = 0.49), whereas NCX1 was not correlated (R-2 = 0.02). CD90 correlated positively with Delta TT (R-2 = 0.39) and negatively with SERCA2/PLB (R-2 = 0.42), indicating that both the t-system and SERCA activity are important for contraction kinetics. Surprisingly, Delta TT was not associated with TTP (R-2 = 0) but rather with TTR (R-2 = 0.5). This became even more pronounced when interaction with NCX1 expression was added to the model (R-2 = 0.79), suggesting that t-system loss impairs myocardial relaxation especially when NCX1 expression is low. The degree of t-system remodeling predicts FFR inversion and contraction slowing in failing human myocardium. Moreover, together with NCX, the t-system may be important for myocardial relaxation

2006 SQ372: A Likely Long-Period Comet from the Inner Oort Cloud

We report the discovery of a minor planet (2006 SQ372) on an orbit with a perihelion of 24 AU and a semimajor axis of 796 AU. Dynamical simulations show that this is a transient orbit and is unstable on a timescale of 200 Myrs. Falling near the upper semimajor axis range of the scattered disk and the lower semimajor axis range of the Oort Cloud, previous membership in either class is possible. By modeling the production of similar orbits from the Oort Cloud as well as from the scattered disk, we find that the Oort Cloud produces 16 times as many objects on SQ372-like orbits as the scattered disk. Given this result, we believe this to be the most distant long-period comet ever discovered. Furthermore, our simulation results also indicate that 2000 OO67 has had a similar dynamical history. Unaffected by the "Jupiter-Saturn Barrier," these two objects are most likely long-period comets from the inner Oort Cloud

W51 IRS 2: A Massive Jet Emerging from a Molecular Cloud into an H II Region

We have mapped [Ne II] (12.8um) and [S IV] (10.5um) emission from W51 IRS 2 with TEXES on Gemini North, and we compare these data to VLA free-free observations and VLT near-infrared images. With 0.5" spatial and 4 km/s spectral resolution we are able to separate the ionized gas into several components: an extended H II region on the front surface of the molecular cloud, several embedded compact H II regions, and a streamer of high velocity gas. We interpret the high velocity streamer as a precessing or fan-like jet, which has emerged from the molecular cloud into an OB star cluster where it is being ionized.Comment: 3 pages, 4 figures, 2 movie

Taxonomic revision of true morels (Morchella) in Canada and the United States

Recent molecular phylogenetic studies have revealed the existence of at least 50 species of Morchella worldwide and demonstrated a high degree of continental endemism within the genus. Here we describe 19 phylogenetic species of Morchella from North America, 14 of which are new (M. diminutiva, M. virginiana, M. esculentoides, M. prava, M. cryptica, M. frustrata, M. populiphila, M. sextelata, M. septimelata, M. capitata, M. importuna, M. snyderi, M. brunnea and M. septentrionalis). Existing species names (M. rufobrunnea, M. tomentosa, M. punctipes and M. angusticeps) are applied to four phylogenetic species, and formal description of one species (M. sp. Mel-8 ) is deferred pending study of additional material. Methods for assessing morphological features in Morchella are delineated, and a key to the known phylogenetic species of Morchella in North America is provided. Type studies of M. crassistipa, M. hotsonii, M. angusticeps and M. punctipes are provided. Morchella crassistipa is designated nomen dubium