The recent advances in Ku-band wind speed retrievals [Fore, 2014] in the presence of rain [Stiles and Dunbar, 2010] indicate that there is an opportunity to learn more about the physical relationship between the spatial variation of surface winds within a scatterometer resolution cell (wind vector cell; WVC) and the observed backscatter. There is a need for improvement in the ability of this type of scatterometer to estimate wind speed and direction, in the presence of rain. The wind vector products that are currently available, derived using these approaches and without a separate bias adjustment such as Stiles et al. [2014], often have relatively large errors in speed and direction [Bourassa, 2017]. In effect, the presence of rain frequently leads to erroneous solutions by these methods. This effort descried herein is engaged with data from the RapidScat scatterometer mission on the International Space Station. We are assessing the sub-footprint variability in wind and how rain contributes to the area averaged backscatter. The sub-footprint winds are from a new high-resolution wind vector product (hourly, 2.5 km spacing), for which data assimilation of NEXRAD observations should enhance the consistency with sub-footprint variability in rain contributions to the radar cross section. This product is the Real Time Mesoscale Analysis, from NOAA-NCEP. We are comparing the PO.DAAC NRCS products (after adjustment for rain) to the values estimated from the higher resolution wind product, transferred to backscatter, through the RapidScat geophysical model function (GMF). The rain data is available through a special RScat “RadRain” product created by Remote Sensing Systems using a variety of collocated, coincident satellite sensors.

In the coastal ocean, rivers provide a major source of biogeochemical, ecological, hydrographic and dynamical variability. Freshwater input by rivers produces buoyant low salinity plumes impacting ocean currents and stratification, which in turn influence air-sea heat exchange and oceanic vertical mixing. Rivers are also sources of nutrients and organic material, which can be transported far from the river mouth impacting marine ecosystems over large areas. As such, river plumes have long been an active area of study within the oceanographic scientific community. Despite their importance and vast study, there remains a striking lack of observations within regions influenced by river plumes that are suitable for characterizing the spatial and temporal scales and magnitudes of variability of their impacts on ocean salinity. Salinity measurements in the coastal region are difficult to make over long time periods due to the need for frequent servicing of instruments caused by biofouling and instrument drift. Because of this and the expense of moorings, time series of salinity measurements at fixed locations are not available at high enough density to capture the spatial variability in regions influenced by river plumes. The Aquarius mission helped pioneer the era of spaceborne sea surface salinity measurements [Lagerloef, et al; 2008]. Salinity estimates derived from its L-band radiometer provided an unprecedented view of the state of global ocean salinity and its dynamics, but its relatively low (100-150 km) resolution permitted only observations of very distant effects of the largest rivers (e.g., Mississippi and Amazon) on the ocean salinity [Gierach et al., 2013; Korosov et al, 2015]. The SMAP (Soil Moisture Active Passive) Mission was originally intended to observe land. Since Aquarius stopped working (June 10, 2015), the operational plan for SMAP now is to continue data collection over the oceans. The microwave sensors, the radar and radiometer, operate at the same frequency as those on Aquarius. SMAP instruments became the only NASA mission with the capability to monitor sea surface salinity. The combination of fully polarized, simultaneous active and passive L-band measurements, including their much higher spatial resolution than Aquarius, and with excellent radiometric precision, makes this satellite superior and unique. Due to a component failure, the radar instrument on SMAP became inoperable in early July 2015. The radiometer continues to collect valuable data for the application to sea surface salinity observation. This project is focused on improving methods of estimating salinity from SMAP data that will be applied to yield new information on salinity variability in regions impacted by river plumes. SMAP now allows salinity measurements at 40 km resolution, which allows observations of the salinity fields associated with smaller rivers (such as the Apalachicola River, with mean discharge rate approximately 5% that of the Mississippi River, but at times impacting the salinity field 200km from the coast; Morey et al., 2009).

Journal of Palliative MedicineVol. 20, No. 2 Letters to the EditorAre We Making a Difference?David E. WeissmanDavid E. WeissmanSearch for more papers by this authorPublished Online:1 Feb 2017https://doi.org/10.1089/jpm.2016.0425AboutSectionsView articleView Full TextPDF/EPUB Permissions & CitationsPermissionsDownload CitationsTrack CitationsAdd to favorites Back To Publication ShareShare onFacebookTwitterLinked InRedditEmail View article"Are We Making a Difference?." Journal of Palliative Medicine, 20(2), p. 114FiguresReferencesRelatedDetails Volume 20Issue 2Feb 2017 InformationCopyright 2017, Mary Ann Liebert, Inc.To cite this article:David E. Weissman.Are We Making a Difference?.Journal of Palliative Medicine.Feb 2017.114-114.http://doi.org/10.1089/jpm.2016.0425Published in Volume: 20 Issue 2: February 1, 2017Online Ahead of Print:October 19, 2016PDF download

Rapid response teams (RRTs) can effectively foster discussions about appropriate goals of care and address other emergent palliative care needs of patients and families facing life-threatening illness on hospital wards. In this article, The Improving Palliative Care in the ICU (IPAL-ICU) Project brings together interdisciplinary expertise and existing data to address the following: special challenges for providing palliative care in the rapid response setting, knowledge and skills needed by RRTs for delivery of high-quality palliative care, and strategies for improving the integration of palliative care with rapid response critical care. We discuss key components of communication with patients, families, and primary clinicians to develop a goal-directed treatment approach during a rapid response event. We also highlight the need for RRT expertise to initiate symptom relief. Strategies including specific clinician training and system initiatives are then recommended for RRT care improvement. We conclude by suggesting that as evaluation of their impact on other outcomes continues, performance by RRTs in meeting palliative care needs of patients and families should also be measured and improved.

OBJECTIVES:To describe unique features of neurocritical illness that are relevant to provision of high-quality palliative care; to discuss key prognostic aids and their limitations for neurocritical illnesses; to review challenges and strategies for establishing realistic goals of care for patients in the neuro-ICU; and to describe elements of best practice concerning symptom management, limitation of life support, and organ donation for the neurocritically ill.DATA SOURCES:A search of PubMed and MEDLINE was conducted from inception through January 2015 for all English-language articles using the term "palliative care," "supportive care," "end-of-life care," "withdrawal of life-sustaining therapy," "limitation of life support," "prognosis," or "goals of care" together with "neurocritical care," "neurointensive care," "neurological," "stroke," "subarachnoid hemorrhage," "intracerebral hemorrhage," or "brain injury."DATA EXTRACTION AND SYNTHESIS:We reviewed the existing literature on delivery of palliative care in the neurointensive care unit setting, focusing on challenges and strategies for establishing realistic and appropriate goals of care, symptom management, organ donation, and other considerations related to use and limitation of life-sustaining therapies for neurocritically ill patients. Based on review of these articles and the experiences of our interdisciplinary/interprofessional expert advisory board, this report was prepared to guide critical care staff, palliative care specialists, and others who practice in this setting.CONCLUSIONS:Most neurocritically ill patients and their families face the sudden onset of devastating cognitive and functional changes that challenge clinicians to provide patient-centered palliative care within a complex and often uncertain prognostic environment. Application of palliative care principles concerning symptom relief, goal setting, and family emotional support will provide clinicians a framework to address decision making at a time of crisis that enhances patient/family autonomy and clinician professionalism.

Journal of Palliative MedicineVol. 18, No. 3 Notes from the EditorImproving Care during a Time of Crisis: The Evolving Role of Specialty Palliative Care TeamsDavid E. WeissmanDavid E. WeissmanSearch for more papers by this authorPublished Online:2 Mar 2015https://doi.org/10.1089/jpm.2015.1014AboutSectionsView articleView Full TextPDF/EPUB Permissions & CitationsPermissionsDownload CitationsTrack CitationsAdd to favorites Back To Publication ShareShare onFacebookXLinked InRedditEmail View articleFiguresReferencesRelatedDetailsCited byPalliative Care Communication10 November 2022Implementation of an educational intervention pilot for residents on acute care general internal medicine wards around the ‘comfort measures strategy’ for end of life care17 November 2020 | Progress in Palliative Care, Vol. 29, No. 1Staffing a Specialist Palliative Care Service, a Team-Based Approach: Expert Consensus White Paper John David Henderson, Anne Boyle, Leonie Herx, Aleco Alexiadis, Doris Barwich, Stephanie Connidis, David Lysecki, and Aynharan Sinnarajah25 October 2019 | Journal of Palliative Medicine, Vol. 22, No. 11Dying in HospitalJournal of Hospice & Palliative Nursing, Vol. 18, No. 2 Volume 18Issue 3Mar 2015 InformationCopyright 2015, Mary Ann Liebert, Inc.To cite this article:David E. Weissman.Improving Care during a Time of Crisis: The Evolving Role of Specialty Palliative Care Teams.Journal of Palliative Medicine.Mar 2015.204-207.http://doi.org/10.1089/jpm.2015.1014Published in Volume: 18 Issue 3: March 2, 2015Online Ahead of Print:February 6, 2015PDF download

Scatterometer ocean surface winds have been providing very valuable information to researchers and operational weather forecasters for over 10 years. However, the scatterometer wind retrievals are compromised when rain is present. Merely flagging all rain-affected areas removes the most dynamic and interesting areas from the wind analysis. Fortunately, the Advanced Earth Observing Satellite II (ADEOS-II) mission carried a radiometer [the Advanced Microwave Scanning Radiometer (AMSR)] and a scatterometer, allowing for independent, collocated retrievals of rain. The authors developed an algorithm that uses AMSR observations to estimate the rain inside the scatterometer beam. This is the first in a series of papers that describe their approach to providing rain estimation and correction to scatterometer observations. This paper describes the retrieval algorithm and evaluates it using simulated data. Part II will present its validation when applied to AMSR observations. This passive microwave rain retrieval algorithm addresses the issues of nonuniform beam filling and hydrometeor uncertainty in a novel way by 1) using a large number of soundings to develop the retrieval database, thus accounting for the geographically varying atmospheric parameters; 2) addressing the spatial inhomogeneity of rain by developing multiple retrieval databases with different built-in inhomogeneity and rain intensity, along with a rain indicator to select the most appropriate database for each observed scene; 3) developing a new cloud-versus-rain partitioning that allows the use of a variety of drop size distribution assumptions to account for some of the natural variability diagnosed from the soundings; and 4) retrieving atmospheric and surface parameters just outside the rainy areas, thus providing information about the environment to help decrease the uncertainty of the rain estimates.

October 2013 • Volume 41 • Number 10 royalties from McGraw Hill and Wiley. Dr. Lustbader served as a board member of ABIM, provided expert testimony for MLMIC, and received grant support from the Department of Health ECRIP. Dr. Puntillo received grant support from NIHNINR (RO1 Dr. Puntillo’s institution receives indirects from this grant), royalties from Oxford University Press ( co-editor of "End of Life Care in ICU") and Elsevier (co-editor of "Critical Care Nursing Secret E2") , and support for travel for the 2012 European Society of Intensive Care Medicine meeting in Lisbon, Portugal (served as speaker). Dr. Bassett consulted for the VHA Critical Care Innovation Network. Dr. Weissman consulted for the Center for Advanced Palliative Care. The remaining authors have disclosed that they do not have any potential conflicts of interest. Address requests for reprints to: Judith E. Nelson, MD, JD, Division of Pulmonary, Critical Care and Sleep Medicine, Mount Sinai School of Medicine, 1 Gustave L. Levy Place, Box 1232, New York, NY 10029. E-mail: judith.nelson@mssm.edu

Specialist palliative care consultations, together with integration of palliative care principles into the care of all ICU patients, can improve the patient/family experience, reduce length of stay, improve ICU throughput without increasing mortality, and lower health care costs.

1.Describe five primary palliative care services for hospitalized patients.2.Plan a primary palliative care initiative including needs assessment, staff education and quality improvement.3.List three necessary supporting elements necessary to complete a primary palliative care initiative. Long term projected shortages of palliative care specialists imply that it is not sustainable that palliative care specialists manage the palliative care needs of all seriously ill patients. The day-to-day care for seriously ill hospitalized patients should ideally be managed through provision of primary palliative care services by attending physicians, nursing staff, social workers, chaplains and other professionals involved with routine patient care. Thus, there is an urgent need to improve primary palliative care assessment and treatment skills among clinicians caring for seriously ill patients, with a goal of reserving specialty-level palliative care services for problems beyond their capabilities. Education alone is unlikely to substantially change practice patterns; but it should be one component of a comprehensive systems-change approach that seeks to address complex problems by combining evidence-based assessment and treatment algorithms, checklists of key tasks, quality improvement initiatives, provider and patient education. As a key first step, in 2011, the Center to Advance Palliative Care (CAPC) published suggested criteria for checklists to identify hospitalized patients with unmet palliative care needs. In this concurrent workshop, the authors will build from the CAPC checklists to provide a framework for helping palliative care specialists develop a strategy to improve primary palliative care services in their hospital. Key elements will include: (a) aligning unmet palliative care needs to larger hospital quality, mortality and cost initiatives; (b) completing a needs assessment; (c) forming a strategic work-group and gathering political intelligence; (d) developing a realistic action plan that includes standards of patient care; checklists for patient screening; staff/patient/family education; and (e) quality improvement. Learners will leave the session with a personalized Action Plan in which their palliative care expertise can be utilized to help to start their own local initiative to improve primary palliative care.

1.Describe common staffing models for small and large outpatient palliative care practices.2.Identify common services provided by outpatient palliative care services.3.Describe challenges faced by outpatient palliative care practices. While many healthcare organizations are interested in starting an outpatient palliative care practice, previous surveys of outpatient practices were brief and limited to cancer centers. To conduct an in-depth survey of outpatient palliative care practices. We used purposive sampling to obtain a diverse sample. The survey included a mixture of closed and open-ended questions about practice size, utilization, staffing, referrals, services offered, funding, impetus for starting, and challenges faced. Descriptive and thematic findings are presented. 20 of 22 (91%) practices responded. Practices varied in geographic location (West = 9, Northeast = 6, South = 2, and Midwest = 1), and affiliation: academic (9), hospital-based (7), within an oncology division/cancer center (8), part of an integrated health system (5), and hospice- or home-based (4). The top 3 non-cancer diagnoses were COPD, neurologic disorders, and CHF. 10 practices saw patients with chronic non-cancer pain. 7 practices operated a single half day/week, saw < 200 patients/year, and were staffed by a mixture of part-time physician or APN, with either a part time social worker or nurse (RN). 11 practices operated 3 or more half days/week, saw 200-350 patients/year, and were staffed by multiple part to full-time physicians, APNs, social workers, and RNs. 18 practices anticipate their practice will expand next year, 11 reported a staffing shortage, and 10 had wait times of a week or more for an appointment. All practices ranked “pain management” and “determining goals of care” as top reasons for referral. 12 practices provided 24/7 coverage. Billing and institutional support were the most common funding sources. Established practices (>4 years, n=11) described being overwhelmed with referrals. Established, growing practices face challenges of being overwhelmed with referrals, increased wait times, and funding for staffing.

1.Describe key elements of ED practice/culture that PC consultants need to be aware of.2.Review 10 steps of effective palliative care consultations in the ED.3.List three methods for improving Palliative Care-ED relationships. Palliative care and emergency department partnerships can be key in the growth of a palliative care program. Palliative care consultants can assist the ED in (a) attempting to rapidly achieve consensus about goals of care, (b) assisting with challenging symptom management problems, (c) developing creative disposition plans, and (d) freeing up the ED staff to attend to other patients. When interacting in the emergency department the palliative care consultant should be aware of key considerations regarding interacting with emergency department staff with respect to issues of patient movement and medicolegal concerns. as well as be able to rapidly categorize the type of consultation request by the ED clinician to effectively achieve patient-centered outcomes in a short time frame. This session will explore elements of a successful consultation and focus on strategies to assist palliative care consultants in optimizing consultation interactions for successful partnerships.

The ADVANCED Wind Scatterometer (ASCAT) instrument is now the principal resource for oceanographers and meteorologists needing timely observations of ocean vector winds across the globe, using an active microwave sensor. This is one of the instruments operated by the European Space Agency (ESA)/European Organization for the Exploitation of Meteorological Satellites (EUMETSAT), on the METOP-A satellite. This is a six-antenna beam radar which operates with vertical polarization at 5.3 Ghz. The retrieval of wind speed and direction for each surface cell area requires the accurate estimation of the radar cross section (RCS) from three antenna beams. The processed returned signals result in an operational product with 50 km resolution on a 25 km grid. When a rain event is being observed by ASCAT, these 50 km cells will contain a wide range of spatial variability of the precipitation. This circumstance creates a challenge for a quantitative assessment of the effect of the rain on the measured radar cross section as a function of surface wind speed, and for then utilizing this knowledge for more accurate wind speed and direction estimation.

Journal of Palliative MedicineVol. 13, No. 1 Fast Facts and ConceptsHypercalcemia of Malignancy #151Fareeha Siddiqui and David E. WeissmanFareeha SiddiquiSearch for more papers by this author and David E. WeissmanSearch for more papers by this authorPublished Online:5 Jan 2010https://doi.org/10.1089/jpm.2010.9894AboutSectionsView articleView Full TextPDF/EPUB Permissions & CitationsPermissionsDownload CitationsTrack CitationsAdd to favorites Back To Publication ShareShare onFacebookTwitterLinked InRedditEmail View article"Hypercalcemia of Malignancy #151." , 13(1), pp. 77–78FiguresReferencesRelatedDetailsCited byRecurrent Nephrolithiasis Leading to Renal Failure: A Neglected Primary Hyperparathyroidism19 February 2018 | Nephro-Urology Monthly, Vol. 10, No. 2Current World LiteratureCurrent Opinion in Endocrinology, Diabetes & Obesity, Vol. 17, No. 6Electrolyte Disturbances and Acute Kidney Injury in Patients With CancerSeminars in Nephrology, Vol. 30, No. 6Pathologic Fractures: A Neglected Clinical Feature of Parathyroid AdenomaCase Reports in Medicine, Vol. 2010 Volume 13Issue 1Jan 2010 InformationCopyright 2009, Mary Ann Liebert, Inc.To cite this article:Fareeha Siddiqui and David E. Weissman.Hypercalcemia of Malignancy #151.Journal of Palliative Medicine.Jan 2010.77-78.http://doi.org/10.1089/jpm.2010.9894Published in Volume: 13 Issue 1: January 5, 2010PDF download

High-altitude, airborne, L-band synthetic aperture radar (SAR) data were collected in Hurricane Gloria on 28 and 30 September 1976. The backscattered power levels (proportional to the surface scattering coefficient) averaged over a few square kilometers of surface area were found to vary with surface wind speed and the angle of the wind relative to the radar. Comparisons between the backscatter from the eye and eye-wall regions of the hurricane were made with low-level aircraft wind measurements that were nearly coincident in space and time. The SAR has the potential advantage over other radar types because of its higher spatial resolution. It also appears to have the ability to penetrate rainfall, with a reduction in the echo from the surface. One difference when compared with higher frequency microwave radars is a decrease in the sensitivity of the backscatter to changes in wind speed. This dependence of L-band radar backscatter on surface winds suggests that the winds associated with hurricanes can be measured with airborne or spaceborne radars.