Because of the unprecedented disruption of health care services caused by the COVID-19 pandemic, the American Society of Radiation Oncology (ASTRO) and the European Society for Radiotherapy and ...Oncology (ESTRO) identified an urgent need to issue practice recommendations for radiation oncologists treating head and neck cancer (HNC) in a time of limited resources and heightened risk for patients and staff.
A panel of international experts from ASTRO, ESTRO, and select Asia-Pacific countries completed a modified rapid Delphi process. Topics and questions were presented to the group, and subsequent questions were developed from iterative feedback. Each survey was open online for 24 hours, and successive rounds started within 24 hours of the previous round. The chosen cutoffs for strong agreement (≥80%) and agreement (≥66%) were extrapolated from the RAND methodology. Two pandemic scenarios, early (risk mitigation) and late (severely reduced radiation therapy resources), were evaluated. The panel developed treatment recommendations for 5 HNC cases.
In total, 29 of 31 of those invited (94%) accepted, and after a replacement 30 of 30 completed all 3 surveys (100% response rate). There was agreement or strong agreement across a number of practice areas, including treatment prioritization, whether to delay initiation or interrupt radiation therapy for intercurrent SARS-CoV-2 infection, approaches to treatment (radiation dose-fractionation schedules and use of chemotherapy in each pandemic scenario), management of surgical cases in event of operating room closures, and recommended adjustments to outpatient clinic appointments and supportive care.
This urgent practice recommendation was issued in the knowledge of the very difficult circumstances in which our patients find themselves at present, navigating strained health care systems functioning with limited resources and at heightened risk to their health during the COVID-19 pandemic. The aim of this consensus statement is to ensure high-quality HNC treatments continue, to save lives and for symptomatic benefit.
Because of the unprecedented disruption of health care services caused by the COVID-19 pandemic, the American Society of Radiation Oncology (ASTRO) and the European Society for Radiotherapy and ...Oncology (ESTRO) identified an urgent need to issue practice recommendations for radiation oncologists treating head and neck cancer (HNC) in a time of limited resources and heightened risk for patients and staff.
A panel of international experts from ASTRO, ESTRO, and select Asia-Pacific countries completed a modified rapid Delphi process. Topics and questions were presented to the group, and subsequent questions were developed from iterative feedback. Each survey was open online for 24 hours, and successive rounds started within 24 hours of the previous round. The chosen cutoffs for strong agreement (≥80%) and agreement (≥66%) were extrapolated from the RAND methodology. Two pandemic scenarios, early (risk mitigation) and late (severely reduced radiation therapy resources), were evaluated. The panel developed treatment recommendations for 5 HNC cases.
In total, 29 of 31 of those invited (94%) accepted, and after a replacement 30 of 30 completed all 3 surveys (100% response rate). There was agreement or strong agreement across a number of practice areas, including treatment prioritization, whether to delay initiation or interrupt radiation therapy for intercurrent SARS-CoV-2 infection, approaches to treatment (radiation dose-fractionation schedules and use of chemotherapy in each pandemic scenario), management of surgical cases in event of operating room closures, and recommended adjustments to outpatient clinic appointments and supportive care.
This urgent practice recommendation was issued in the knowledge of the very difficult circumstances in which our patients find themselves at present, navigating strained health care systems functioning with limited resources and at heightened risk to their health during the COVID-19 pandemic. The aim of this consensus statement is to ensure high-quality HNC treatments continue, to save lives and for symptomatic benefit.
To determine the relative efficacy of structured named diet and health behaviour programmes (dietary programmes) for prevention of mortality and major cardiovascular events in patients at increased ...risk of cardiovascular disease.
Systematic review and network meta-analysis of randomised controlled trials.
AMED (Allied and Complementary Medicine Database), CENTRAL (Cochrane Central Register of Controlled Trials), Embase, Medline, CINAHL (Cumulative Index to Nursing and Allied Health Literature), and ClinicalTrials.gov were searched up to September 2021.
Randomised trials of patients at increased risk of cardiovascular disease that compared dietary programmes with minimal intervention (eg, healthy diet brochure) or alternative programmes with at least nine months of follow-up and reporting on mortality or major cardiovascular events (such as stroke or non-fatal myocardial infarction). In addition to dietary intervention, dietary programmes could also include exercise, behavioural support, and other secondary interventions such as drug treatment.
All cause mortality, cardiovascular mortality, and individual cardiovascular events (stroke, non-fatal myocardial infarction, and unplanned cardiovascular interventions).
Pairs of reviewers independently extracted data and assessed risk of bias. A random effects network meta-analysis was performed using a frequentist approach and grading of recommendations assessment, development and evaluation (GRADE) methods to determine the certainty of evidence for each outcome.
40 eligible trials were identified with 35 548 participants across seven named dietary programmes (low fat, 18 studies; Mediterranean, 12; very low fat, 6; modified fat, 4; combined low fat and low sodium, 3; Ornish, 3; Pritikin, 1). At last reported follow-up, based on moderate certainty evidence, Mediterranean dietary programmes proved superior to minimal intervention for the prevention of all cause mortality (odds ratio 0.72, 95% confidence interval 0.56 to 0.92; patients at intermediate risk: risk difference 17 fewer per 1000 followed over five years), cardiovascular mortality (0.55, 0.39 to 0.78; 13 fewer per 1000), stroke (0.65, 0.46 to 0.93; 7 fewer per 1000), and non-fatal myocardial infarction (0.48, 0.36 to 0.65; 17 fewer per 1000). Based on moderate certainty evidence, low fat programmes proved superior to minimal intervention for prevention of all cause mortality (0.84, 0.74 to 0.95; 9 fewer per 1000) and non-fatal myocardial infarction (0.77, 0.61 to 0.96; 7 fewer per 1000). The absolute effects for both dietary programmes were more pronounced for patients at high risk. There were no convincing differences between Mediterranean and low fat programmes for mortality or non-fatal myocardial infarction. The five remaining dietary programmes generally had little or no benefit compared with minimal intervention typically based on low to moderate certainty evidence.
Moderate certainty evidence shows that programmes promoting Mediterranean and low fat diets, with or without physical activity or other interventions, reduce all cause mortality and non-fatal myocardial infarction in patients with increased cardiovascular risk. Mediterranean programmes are also likely to reduce stroke risk. Generally, other named dietary programmes were not superior to minimal intervention.
PROSPERO CRD42016047939.
•Links between hydrodynamics and ecological responses via a multi-disciplinary study.•Functional representation of bacterial mineralisation improves chlorophyll-a predictions.•Model boundary ...conditions are critical in driving biophysical system response.•Net transport rates and net growth rates affect model's response sensitivity.•Hydrodynamics are important in designing microbial field sampling programs.
Eutrophication due to excess anthropogenic nutrients in waterways is a significant issue worldwide. The pressure-stressor-response of a waterway to excessive nutrient loading is reliant on numerous physical and biological factors, including hydrodynamics and microbial processing. While substantial progress has been made towards simulating these mechanisms there are limited multi-disciplinary studies that relate the physical hydrodynamics of a site with the ecological response from linked laboratory and field studies. This paper presents the development of a coupled hydrodynamic and aquatic ecosystem response model, expanded to include an integrated microbial loop, that allows the explicit representation of heterotrophic bacteria growth and dissolved organic nutrient mineralisation. A unique long-term water quality dataset at an estuary in south-eastern Australia was used to validate and assess the model's sensitivity to complex biophysical processes driving the observed water quality variability. Results indicate that explicit time-varying bacterial mineralisation rates provide a substantially improved understanding of the broader aquatic ecosystem response than assigned fixed bulk rate parameter values, which are typically derived from non-local literature. Implementation of a microbial loop at the study site indicated that the model is sensitive to the boundary conditions, in particular catchment loads, with both net transport rates and the net growth rates of heterotrophic bacteria demonstrating different responses. Under average flow conditions, a smaller net transport and reduced nutrient availability has a pronounced effect of lowering net growth rates through the applied limitation factors. During high flow conditions, freshwater inflows increased net transport and nutrient loads, which resulted in higher net growth rates. Further, temporal variability in water temperature had a compounding effect on the model's response sensitivity. This approach has broader application in other riverine systems subject to eutrophication, and in interrogating linkages in hydrodynamic and microbial mediated processes (e.g., productivity). Future studies are recommended to better understand the sensitivity of aquatic ecosystem response models to microbial net growth rate kinetics at different temperatures and from top-down predation (e.g., zooplankton grazing).
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ABSTRACT
HATS-18 b is a transiting planet with a large mass and a short orbital period, and is one of the best candidates for the detection of orbital decay induced by tidal effects. We present ...extensive photometry of HATS-18 from which we measure 27 times of mid-transit. Two further transit times were measured from data from the Transiting Exoplanet Survey Satellite (TESS) and three more taken from the literature. The transit timings were fitted with linear and quadratic ephemerides and an upper limit on orbital decay was determined. This corresponds to a lower limit on the modified stellar tidal quality factor of $Q_\star ^{\, \prime } \gt 10^{5.11 \pm 0.04}$. This is at the cusp of constraining the presence of enhanced tidal dissipation due to internal gravity waves. We also refine the measured physical properties of the HATS-18 system, place upper limits on the masses of third bodies, and compare the relative performance of TESS and the 1.54 m Danish Telescope in measuring transit times for this system.
Major sudden stratospheric warmings (SSWs), vortex formation, and final breakdown dates are key highlight points of the stratospheric polar vortex. These phenomena are relevant for ...stratosphere‐troposphere coupling, which explains the interest in understanding their future changes. However, up to now, there is not a clear consensus on which projected changes to the polar vortex are robust, particularly in the Northern Hemisphere, possibly due to short data record or relatively moderate CO2 forcing. The new simulations performed under the Coupled Model Intercomparison Project, Phase 6, together with the long daily data requirements of the DynVarMIP project in preindustrial and quadrupled CO2 (4xCO2) forcing simulations provide a new opportunity to revisit this topic by overcoming the limitations mentioned above. In this study, we analyze this new model output to document the change, if any, in the frequency of SSWs under 4xCO2 forcing. Our analysis reveals a large disagreement across the models as to the sign of this change, even though most models show a statistically significant change. As for the near‐surface response to SSWs, the models, however, are in good agreement as to this signal over the North Atlantic: There is no indication of a change under 4xCO2 forcing. Over the Pacific, however, the change is more uncertain, with some indication that there will be a larger mean response. Finally, the models show robust changes to the seasonal cycle in the stratosphere. Specifically, we find a longer duration of the stratospheric polar vortex and thus a longer season of stratosphere‐troposphere coupling.
Key Points
The tropospheric signal of sudden stratospheric warming (SSWs) in the North Atlantic does not change under 4xCO2 forcing
There is high uncertainty in changes of SSW frequency under 4xCO2 forcing; single models show the rate to be significantly halved or doubled
The boreal polar vortex will form earlier and disappear later under increased CO2, extending the season of stratosphere‐troposphere coupling
The Thresher: Lucky imaging without the waste Hitchcock, J A; Bramich, D M; Foreman-Mackey, D ...
Monthly notices of the Royal Astronomical Society,
03/2022, Letnik:
511, Številka:
4
Journal Article
Recenzirano
Odprti dostop
ABSTRACT
In traditional lucky imaging (TLI), many consecutive images of the same scene are taken with a high frame-rate camera, and all but the sharpest images are discarded before constructing the ...final shift-and-add image. Here, we present an alternative image analysis pipeline – The Thresher – for these kinds of data, based on online multi-frame blind deconvolution. It makes use of all available data to obtain the best estimate of the astronomical scene in the context of reasonable computational limits; it does not require prior estimates of the point-spread functions in the images, or knowledge of point sources in the scene that could provide such estimates. Most importantly, the scene it aims to return is the optimum of a justified scalar objective based on the likelihood function. Because it uses the full set of images in the stack, The Thresher outperforms TLI in signal-to-noise ratio; as it accounts for the individual-frame PSFs, it does this without loss of angular resolution. We demonstrate the effectiveness of our algorithm on both simulated data and real Electron-Multiplying CCD images obtained at the Danish 1.54-m telescope (hosted by ESO, La Silla). We also explore the current limitations of the algorithm, and find that for the choice of image model presented here, non-linearities in flux are introduced into the returned scene. Ongoing development of the software can be viewed at https://github.com/jah1994/TheThresher.
The world has changed drastically over the past decade. The Internet has had a huge part in that, as it has made the world more accessible to anyone of any age, race, or gender. Used for ...entertainment, education, shopping, dating and more, the internet has provided a whole new virtual world for everyone to enjoy. But with the good also comes the bad -- and for kids and teens these days, the bad has becomes a constant threat from cyberbullies and cyberstalking. J.A. Hitchcock began to have an interest in cyberstalking and cyberbullies in 1996 when she blew the whistle on a literary agency scam. They stole her identity and began posting messages online pretending to be her and that was only the beginning of a barrage of threats. When she contacted local police they had never had an internet-related case and couldn't help her, so she taught herself how to track down online criminals, how to handle the situation, and how to stay safer online. After 10 years of being a victim, her cyberstalkers were brought to justice. Unfortunately, not all internet crime stories end with a happy ending. Really, anyone of any age can become the target of a cyberbully. And quite honestly, victims are getting younger and younger every year when it comes to being cyberbullied. Throughout this book, Hitchcock explains how someone can become victim to cyberbullying and how they can stay safer online. Offering victims, and parents, the chance to be able to relate to and truly understand the unfortunate reality of cyberbullying through real-life examples of what happened to someone who had been through a similar situation.
ABSTRACT
We present the results of 14 nights of I-band photometric monitoring of the nearby brown dwarf binary, ϵ Indi Ba and Bb. Observations were acquired over 2 months, with a total of close to ...42 h of coverage at a typically high cadence of 1.4 min. At a separation of just 0.7 arcsec, we do not resolve the individual components, and so effectively treat the binary as if it were a single object. However, ϵ Indi Ba (spectral type T1) is the brightest known T-type brown dwarf, and is expected to dominate the photometric signal. We typically find no strong variability associated with the target during each individual night of observing, but see significant changes in mean brightness – by as much as 0.10 mag – over the 2 months of the campaign. This strong variation is apparent on a time-scale of at least 2 d. We detect no clear periodic signature, which suggests that we may be observing the T1 brown dwarf almost pole-on, and the days-long variability in mean brightness is caused by changes in the large-scale structure of the cloud coverage. Dynamic clouds will very likely produce lightning, and complementary high-cadence V-band and H α images were acquired to search for the emission signatures associated with stochastic ‘strikes’. We report no positive detections for the target in either of these passbands.
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