Practitioner Feedback on Lung Cancer Practice Guidelines in Ontario

Purpose:Practitioner feedback (PF) surveys are sent to practitioners who care for lung cancer patients as each new practice guideline is completed. In this study, the PF was reviewed to assess the frequency of response to the surveys, the respondents’ characteristics, the nature of the feedback, and the intention to adopt the guideline in practice.Methods:Fourteen practice guidelines (PGs) were sent to Ontario practitioners treating lung cancer, and feedback on the PGs was obtained through either an eight- or 21-item survey.Results:Between 1995 and 2002, 1198 surveys were sent to 223 practitioners. The overall response rate was 58.9% but varied by specialty (radiation and medical oncologists, 67%; thoracic surgeons, 46%; respirologists, 38%), by location of practice (cancer center, 65%; community-based practice, 55%), by geographic region of the province (highest, 72%; lowest, 42%), and by PG topic (chemotherapy, 60%; radiotherapy, 63%; combined modality therapy, 52%). The response rate to the PF surveys did not decline over time. Eighty-six percent of respondents agreed with the lung cancer guidelines and indicated that they were likely or very likely to use the PGs in their practice.Conclusion:The results suggest that practitioners view the guideline development process as credible and useful to guide practice. Whether the stated intention to use the guidelines will actually translate into practice requires further study

Northern Hemisphere atmospheric stilling accelerates lake thermal responses to a warming world

Climate change, in particular the increase in air temperature, has been shown to influence lake thermal dynamics, with climatic warming resulting in higher surface temperatures, stronger stratification, and altered mixing regimes. Less-studied is the influence on lake thermal dynamics of atmospheric stilling, the decrease in near-surface wind speed observed in recent decades. Here we use a lake model to assess the influence of atmospheric stilling, on lake thermal dynamics across the Northern Hemisphere. From 1980-2016, lake thermal responses to warming have accelerated as a result of atmospheric stilling. Lake surface temperatures and thermal stability have changed at respective rates of 0.33 and 0.38°C decade-1, with atmospheric stilling contributing 15 and 27% of the calculated changes, respectively. Atmospheric stilling also resulted in a lengthening of stratification, contributing 23% of the calculated changes. Our results demonstrate that atmospheric stilling has influenced lake thermal responses to warming

Interacting impacts of hydrological changes and air temperature warming on lake temperatures highlight the potential for adaptive management

Globally, climate warming is increasing air temperatures and changing river flows, but few studies have explicitly considered the consequences for lake temperatures of these dual effects, or the potential to manage lake inflows to mitigate climate warming impacts. Using a one-dimensional model, we tested the sensitivity of lake temperatures to the separate and interacting effects of changes in air temperature and inflow on a small, short-residence time (annual average ≈ 20 days), temperate lake. Reducing inflow by 70% increased summer lake surface temperatures 1.0–1.2 °C and water column stability by 11–19%, equivalent to the effect of 1.2 °C air temperature warming. Conversely, similar increases in inflow could result in lake summer cooling, sufficient to mitigate 0.75 °C air temperature rise, increasing to more than 1.1 °C if inflow temperature does not rise. We discuss how altering lake inflow volume and temperature could be added to the suite of adaptation measures for lakes

Three-weekly doses of azithromycin for Indigenous infants hospitalized with bronchiolitis: a multicentre, randomized, placebo-controlled trial

Background: Bronchiolitis is a major health burden in infants globally, particularly among Indigenous populations. It is unknown if 3 weeks of azithromycin improve clinical outcomes beyond the hospitalization period. In an international, double-blind randomized controlled trial, we determined if 3 weeks of azithromycin improved clinical outcomes in Indigenous infants hospitalized with bronchiolitis.Methods: Infants aged ≤24 months were enrolled from three centers and randomized to receive three once-weekly doses of either azithromycin (30 mg/kg) or placebo. Nasopharyngeal swabs were collected at baseline and 48 h later. Primary endpoints were hospital length of stay (LOS) and duration of oxygen supplementation monitored every 12 h until judged ready for discharge. Secondary outcomes were: day-21 symptom/signs, respiratory rehospitalizations within 6 months post-discharge and impact upon nasopharyngeal bacteria and virus shedding at 48 h.Results: Two hundred nineteen infants were randomized (n = 106 azithromycin, n = 113 placebo). No significant between-group differences were found for LOS (median 54 h for each group, difference = 0 h, 95% CI: −6, 8; p = 0.8), time receiving oxygen (azithromycin = 40 h, placebo = 35 h, group difference = 5 h, 95% CI: −8, 11; p = 0.7), day-21 symptom/signs, or rehospitalization within 6 months (azithromycin n = 31, placebo n = 25 infants, p = 0.2). Azithromycin reduced nasopharyngeal bacterial carriage (between-group difference 0.4 bacteria/child, 95% CI: 0.2, 0.6; p < 0.001), but had no significant effect upon virus detection rates.Conclusion: Despite reducing nasopharyngeal bacterial carriage, three large once-weekly doses of azithromycin did not confer any benefit over placebo during the bronchiolitis illness or 6 months post hospitalization. Azithromycin should not be used routinely to treat infants hospitalized with bronchiolitis.Clinical trial registration: The trial was registered with the Australian and New Zealand Clinical Trials Register: Clinical trials number: ACTRN1261000036099

Wide-spread inconsistency in estimation of lake mixed depth impacts interpretation of limnological processes

The mixed layer, or epilimnion, is a physical concept referring to an isothermal layer at the surface of a water body. This concept is ubiquitous within limnology, is fundamental to our understanding of chemical and ecological processes, and is an important metric for water body monitoring, assessment and management. Despite its importance as a metric, many different approaches to approximating mixed depth currently exist. Using data from field campaigns in a small meso-eutrophic lake in the UK in 2016 and 2017 we tested whether different definitions of mixed depth resulted in comparable estimates and whether variables other than temperature could be assumed to be mixed within the layer. Different methods resulted in very different estimates for the mixed depth and ecologically important variables were not necessarily homogenously spread through the epilimnion. Furthermore, calculation of simple ecologically relevant metrics based on mixed depth showed that these metrics were highly dependent on the definition of mixed depth used. The results demonstrate that an idealised concept of a well-defined fully mixed layer is not necessarily appropriate. The widespread use of multiple definitions for mixed depth impairs the comparability of different studies while associated uncertainty over the most appropriate definition limits the confirmability of studies utilising the mixed depths

Adaptive forecasting of phytoplankton communities

The global proliferation of harmful algal blooms poses an increasing threat to water resources, recreation and ecosystems. Predicting the occurrence of these blooms is therefore needed to assist water managers in making management decisions to mitigate their impact. Evaluation of the potential for forecasting of algal blooms using the phytoplankton community model PROTECH was undertaken in pseudo-real-time. This was achieved within a data assimilation scheme using the Ensemble Kalman Filter to allow uncertainties and model nonlinearities to be propagated to forecast outputs. Tests were made on two mesotrophic lakes in the English Lake District, which differ in depth and nutrient regime. Some forecasting success was shown for chlorophyll a, but not all forecasts were able to perform better than a persistence forecast. There was a general reduction in forecast skill with increasing forecasting period but forecasts for up to four or five days showed noticeably greater promise than those for longer periods. Associated forecasts of phytoplankton community structure were broadly consistent with observations but their translation to cyanobacteria forecasts was challenging owing to the interchangeability of simulated functional species

Modelling frontal discontinuities in wind fields

A Bayesian procedure for the retrieval of wind vectors over the ocean using satellite borne scatterometers requires realistic prior near-surface wind field models over the oceans. We have implemented carefully chosen vector Gaussian Process models; however in some cases these models are too smooth to reproduce real atmospheric features, such as fronts. At the scale of the scatterometer observations, fronts appear as discontinuities in wind direction. Due to the nature of the retrieval problem a simple discontinuity model is not feasible, and hence we have developed a constrained discontinuity vector Gaussian Process model which ensures realistic fronts. We describe the generative model and show how to compute the data likelihood given the model. We show the results of inference using the model with Markov Chain Monte Carlo methods on both synthetic and real data

Modelling lake cyanobacterial blooms: disentangling the climate‐driven impacts of changing mixed depth and water temperature

1. Climate change is already having profound impacts upon the state and dynamics of lake ecosystems globally. A specific concern is that climate change will continue to promote the growth of phytoplankton, particularly blooms of toxic cyanobacteria, via lake physical processes including warming surface waters and shallowing of the mixed layer. These two mechanisms will have different impacts on lake phytoplankton communities, but their inter‐connectedness has made it difficult to disentangle their independent effects. 2. We fill this knowledge gap by performing 1666 numerical modelling experiments with the phytoplankton community model, PROTECH, in which we separated the independent effects on lake phytoplankton of temperature change and changes in the depth of the surface mixed layer. Given the large global abundance of small lakes (<1 km2) and the importance of their ecosystems in global processes and budgets, we used a small meso‐eutrophic lake as an example study site for the modelling experiments. 3. Increasing the lake temperature and positioning the mixed layer at a shallower depth had different ecological impacts, with warming typically resulting in more biomass and a dominance of cyanobacteria. 4. The response to mixed depth shallowing depended on the original depth where mixing occurred. As anticipated, where the original mixed depth was moderate (4–6 m) and there was a simultaneous increase in water temperature, cyanobacterial biomass increased. However, when the same absolute difference in shallowing and temperature increase were applied to a deeper mixed depth (9–13 m), lower cyanobacterial biomass resulted, owing to poorer conditions for low‐light tolerant cyanobacteria. 5. Our study shows that the response of cyanobacterial blooms to climate‐induced warming and shallowing of mixed layers in lakes around the world will not be universal, but rather will be system‐specific, depending upon the average mixed layer depth of the lake in question and the light affinity of the dominant cyanobacteria species