A Global Repository for Planet-Sized Experiments and Observations

Working across U.S. federal agencies, international agencies, and multiple worldwide data centers, and spanning seven international network organizations, the Earth System Grid Federation (ESGF) allows users to access, analyze, and visualize data using a globally federated collection of networks, computers, and software. Its architecture employs a system of geographically distributed peer nodes that are independently administered yet united by common federation protocols and application programming interfaces (APIs). The full ESGF infrastructure has now been adopted by multiple Earth science projects and allows access to petabytes of geophysical data, including the Coupled Model Intercomparison Project (CMIP)—output used by the Intergovernmental Panel on Climate Change assessment reports. Data served by ESGF not only include model output (i.e., CMIP simulation runs) but also include observational data from satellites and instruments, reanalyses, and generated images. Metadata summarize basic information about the data for fast and easy data discovery.This work was supported by the U.S. Department of Energy Office of Science/Office of Biological and Environmental Research under Contract DE-AC52-07NA27344 at Lawrence Livermore National Laboratory. VB is supported by the Cooperative Institute for Climate Science, Princeton University, under Award NA08OAR4320752 from the National Oceanic and Atmospheric Administration, U.S. Department of Commerce. Part of this work was undertaken with the assistance of resources from the National Computational Infrastructure (NCI), which is supported by the Australian Government. Part of this activity was performed on behalf of the Jet Propulsion Laboratory, California Institute of Technology, under a contract with NASA. Part of this activity was performed on behalf of the Goddard Space Flight Center, under a contract with NASA. This work was supported by ANR Convergence project (Grant Agreement ANR-13-MONU-0008). This work was supported by FP7 IS-ENES2 project (Grant Agreement 312979)

Clinical evidence continuous medical education: a randomised educational trial of an open access e-learning program for transferring evidence-based information – ICEKUBE (Italian Clinical Evidence Knowledge Utilization Behaviour Evaluation) – study protocol

<p>Abstract</p> <p>Background</p> <p>In an effort to ensure that all physicians have access to valid and reliable evidence on drug effectiveness, the Italian Drug Agency sponsored a free-access e-learning system, based on <it>Clinical Evidence</it>, called ECCE. Doctors have access to an electronic version and related clinical vignettes. Correct answers to the interactive vignettes provide Continuing Medical Education credits. The aims of this trial are to establish whether the e-learning program (ECCE) increases physicians' basic knowledge about common clinical scenarios, and whether ECCE is superior to the passive diffusion of information through the printed version of <it>Clinical Evidence</it>.</p> <p>Design</p> <p>All Italian doctors naïve to ECCE will be randomised to three groups. Group one will have access to ECCE for <it>Clinical Evidence </it>chapters and vignettes lot A and will provide control data for <it>Clinical Evidence </it>chapters and vignettes lot B; group two vice versa; group three will receive the concise printed version of <it>Clinical Evidence</it>. There are in fact two designs: a before and after pragmatic trial utilising a two by two incomplete block design (group one versus group two) and a classical design (group one and two versus group three). The primary outcome will be the retention of <it>Clinical Evidence </it>contents assessed from the scores for clinical vignettes selected from ECCE at least six months after the intervention. To avoid test-retest effects, we will randomly select vignettes out of lot A and lot B, avoiding repetitions. In order to preserve the comparability of lots, we will select vignettes with similar, optimal psychometric characteristics.</p> <p>Trial registration</p> <p>ISRCTN27453314</p

Benefits and Harms of Lung Cancer Screening by Chest Computed Tomography: A Systematic Review and Meta-Analysis

PURPOSE This meta-analysis aims to combine and analyze randomized clinical trials comparing computed tomography lung screening (CTLS) versus either no screening (NS) or chest x-ray (CXR) in subjects with cigarette smoking history, to provide a precise and reliable estimation of the benefits and harms associated with CTLS. MATERIALS AND METHODS Data from all published randomized trials comparing CTLS versus either NS or CXR in a highly tobacco-exposed population were collected, according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Subgroup analyses by comparator (NS or CXR) were performed. Pooled risk ratio (RR) and relative 95% CIs were calculated for dichotomous outcomes. The certainty of the evidence was assessed using the GRADE approach. RESULTS Nine eligible trials (88,497 patients) were included. Pooled analysis showed that CTLS is associated with: a significant reduction of lung cancer-related mortality (overall RR, 0.87; 95% CI, 0.78 to 0.98; NS RR, 0.80; 95% CI, 0.69 to 0.92); a significant increase of early-stage tumors diagnosis (overall RR, 2.84; 95% CI 1.76 to 4.58; NS RR, 3.33; 95% CI, 2.27 to 4.89; CXR RR, 1.52; 95% CI, 1.04 to 2.23); a significant decrease of late-stage tumors diagnosis (overall RR, 0.75; 95% CI, 0.68 to 0.83; NS RR, 0.67; 95% CI, 0.56 to 0.80); a significant increase of resectability rate (NS RR, 2.57; 95% CI, 1.76 to 3.74); a nonsignificant reduction of all-cause mortality (overall RR, 0.99; 95% CI, 0.94 to 1.05); and a significant increase of overdiagnosis rate (NS, 38%; 95% CI, 14 to 63). The analysis of lung cancer-related mortality by sex revealed nonsignificant differences between men and women (P = .21; I-squared = 33.6%). CONCLUSION Despite there still being uncertainty about overdiagnosis estimate, this meta-analysis suggested that the CTLS benefits outweigh harms, in subjects with cigarette smoking history, ultimately supporting the systematic implementation of lung cancer screening worldwide