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The Automated Planet Finder (APF) is a facility purpose-built for the discovery and characterization of extrasolar planets through high-cadence Doppler velocimetry of the reflex barycentric accelerations of their host stars. Located atop Mount Hamilton, the APF facility consists of a 2.4 m telescope and its Levy spectrometer, an optical echelle spectrometer optimized for precision Doppler velocimetry. APF features a fixed-format spectral range from 374-970 nm, and delivers a \"throughput\" (resolution × slit width product) of 114,000″, with spectral resolutions up to 150,000. Overall system efficiency (fraction of photons incident on the primary mirror that are detected by the science CCD) on blaze at 560 nm in planet-hunting mode is 15%. First-light tests on the radial-velocity (RV) standard stars HD 185144 and HD 9407 demonstrate sub-meter-per-second precision (rms per observation) held over a 3 month period. This paper reviews the basic features of the telescope, dome, and spectrometer, and gives a brief summary of first-light performance.

The purpose of this position paper is to demonstrate that career planning is important for both the employer and employee. The employer and employee must plan for the future jointly and prepare how to deal with changes in the workplace. Employers are already looking at trends in future changes to develop their business strategy. Employees need to utilize this same information when creating career plans and there is an appendix at the end of this paper that demonstrates how to develop an individualized career management plan. Some of these areas of consideration include how employer/employee relate to each other, how individuals think, how people educate and learn, and how individuals understand and work within a global economy. One of the most important benefits from career planning is the recognition that employees control their destiny, thus increasing their self-confidence and self-direction.

The Automated Planet Finder (APF) is a facility purpose-built for the discovery and characterization of extrasolar planets through high-cadence Doppler velocimetry of the reflex barycentric accelerations of their host stars. Located atop Mt. Hamilton, the APF facility consists of a 2.4-m telescope and its Levy spectrometer, an optical echelle spectrometer optimized for precision Doppler velocimetry. APF features a fixed format spectral range from 374 nm - 970 nm, and delivers a \"Throughput\" (resolution * slit width product) of 114,000 arc-seconds, with spectral resolutions up to 150,000. Overall system efficiency (fraction of photons incident on the primary mirror that are detected by the science CCD) on blaze at 560 nm in planet-hunting mode is 15%. First-light tests on the RV standard stars HD 185144 and HD 9407 demonstrate sub-meter per second precision (RMS per observation) held over a 3-month period. This paper reviews the basic features of the telescope, dome, and spectrometer, and gives a brief summary of first-light performance.

Objective To provide an update to “Surviving Sepsis Campaign Guidelines for Management of Sepsis and Septic Shock: 2012”. Design A consensus committee of 55 international experts representing 25 international organizations was convened. Nominal groups were assembled at key international meetings (for those committee members attending the conference). A formal conflict-of-interest (COI) policy was developed at the onset of the process and enforced throughout. A stand-alone meeting was held for all panel members in December 2015. Teleconferences and electronic-based discussion among subgroups and among the entire committee served as an integral part of the development. Methods The panel consisted of five sections: hemodynamics, infection, adjunctive therapies, metabolic, and ventilation. Population, intervention, comparison, and outcomes (PICO) questions were reviewed and updated as needed, and evidence profiles were generated. Each subgroup generated a list of questions, searched for best available evidence, and then followed the principles of the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) system to assess the quality of evidence from high to very low, and to formulate recommendations as strong or weak, or best practice statement when applicable. Results The Surviving Sepsis Guideline panel provided 93 statements on early management and resuscitation of patients with sepsis or septic shock. Overall, 32 were strong recommendations, 39 were weak recommendations, and 18 were best-practice statements. No recommendation was provided for four questions. Conclusions Substantial agreement exists among a large cohort of international experts regarding many strong recommendations for the best care of patients with sepsis. Although a significant number of aspects of care have relatively weak support, evidence-based recommendations regarding the acute management of sepsis and septic shock are the foundation of improved outcomes for these critically ill patients with high mortality.

We aimed to estimate the prevalence, healthcare costs and number of deaths among people with chronic obstructive pulmonary disease (COPD) in England and Scotland 2011–2030. We adapted the Dutch COPD Model by using English and Scottish demographic, COPD incidence, COPD prevalence, smoking prevalence and mortality data to make projections. In England, the prevalence of COPD was estimated to be 1.79% (95% uncertainty interval 1.77–1.81) in 2011, increasing to 2.19% (1.85–2.33) by 2030. In Scotland, prevalence was 2.03% (1.96–2.10) in 2011 increasing to 2.20% (1.98–2.40) in 2030. These increases were driven by more women developing COPD. Annual direct healthcare costs of COPD in England were estimated to increase from £1.50 billon (1.18–2.50) in 2011 to £2.32 (1.85–3.08) billion in 2030. In Scotland, costs increased from £159 million (128–268) in 2011 to £207 (165–274) million in 2030. The deaths in England were estimated to increase from 99,200 (92,500–128,500) in 2011, to 129,400 (126,400–133,400) by 2030. In Scotland, in 2011 there were 9,700 (9,000–12,300) deaths and 13,900 (13,400–14,500) deaths in 2030. The number of people with COPD will increase substantially over the coming years in England and Scotland, particularly in females. Services need to adapt to this increasing demand.

Never before COVID-19 had Canadians faced making health-related decisions in a context of significant uncertainty. However, little is known about which type of decisions and the types of difficulties that they faced. We sought to identify the health-related decisions and decisional needs of Canadians. Our study was codesigned by researchers and knowledge users (eg, patients, clinicians). Informed by the CHERRIES (the Checklist for Reporting Results of Internet E-Surveys) reporting guideline, we conducted 2 online surveys of random samples drawn from the Leger consumer panel of 400,000 Canadians. Eligible participants were adults (≥18 years) who received or were receiving any health services in the past 12 months for themselves (adults) or for their child (parent) or senior with cognitive impairment (caregiver). We assessed decisions and decisional needs using questions informed by the Ottawa Decision Support Framework, including decisional conflict and decision regret using the Decision Conflict Scale (DCS) and the Decision Regret Scale (DRS), respectively. Descriptive statistics were conducted for adults who had decided for themselves or on behalf of someone else. Significant decisional conflict (SDC) was defined as a total DCS score of >37.5 out of 100, and significant decision regret was defined as a total DRS score of >25 out of 100. From May 18 to June 4, 2021, 14,459 adults and 6542 parents/caregivers were invited to participate. The invitation view rate was 15.5% (2236/14,459) and 28.3% (1850/6542); participation rate, 69.3% (1549/2236) and 28.7% (531/1850); and completion rate, 97.3% (1507/1549) and 95.1% (505/531), respectively. The survey was completed by 1454 (97.3%) adults and 438 (95.1%) parents/caregivers in English (1598/1892, 84.5%) or French (294/1892, 15.5%). Respondents from all 10 Canadian provinces and the northern territories represented a range of ages, education levels, civil statuses, ethnicities, and annual household income. Of 1892 respondents, 541 (28.6%) self-identified as members of marginalized groups. The most frequent decisions were (adults vs parents/caregivers) as follows: COVID-19 vaccination (490/1454, 33.7%, vs 87/438, 19.9%), managing a health condition (253/1454, 17.4%, vs 47/438, 10.7%), other COVID-19 decisions (158/1454, 10.9%, vs 85/438, 19.4%), mental health care (128/1454, 8.8%, vs 27/438, 6.2%), and medication treatments (115/1454, 7.9%, vs 23/438, 5.3%). Caregivers also reported decisions about moving family members to/from nursing or retirement homes (48/438, 11.0%). Adults (323/1454, 22.2%) and parents/caregivers (95/438, 21.7%) had SDC. Factors making decisions difficult were worrying about choosing the wrong option (557/1454, 38.3%, vs 184/438, 42.0%), worrying about getting COVID-19 (506/1454, 34.8%, vs 173/438, 39.5%), public health restrictions (427/1454, 29.4%, vs 158/438, 36.1%), information overload (300/1454, 20.6%, vs 77/438, 17.6%), difficulty separating misinformation from scientific evidence (297/1454, 20.4%, vs 77/438, 17.6%), and difficulty discussing decisions with clinicians (224/1454, 15.4%, vs 51/438, 11.6%). For 1318 (90.6%) adults and 366 (83.6%) parents/caregivers who had decided, 353 (26.8%) and 125 (34.2%) had significant decision regret, respectively. In addition, 1028 (50%) respondents made their decision alone without considering the opinions of clinicians. During COVID-19, Canadians who responded to the survey faced several new health-related decisions. Many reported unmet decision-making needs, resulting in SDC and decision regret. Interventions can be designed to address their decisional needs and support patients facing new health-related decisions.

Public and school library collaboration offers mutually beneficial opportunities that became increasingly important during the global health crisis. The purpose of this paper is to provide insights into the collaborative efforts of the Jamaica Library Sendee (JLS) during the COVID-19 pandemic. The main goal of the study is to highlight what constitutes collaboration, showcase collaborative strategies implemented and to assess the opportunities gained and challenges associated with executing these collaborative initiatives during the pandemic. This study is grounded in the Teacher and Librarian Collaboration (TLC) model and employed a mixed method research design to collect data from schools and librarians directly involved in collaborative activities. The findings revealed that public and school collaboration played an integral role in teaching and learning activities during the pandemic while also increasing awareness of the resources and services offered by the public library.

A strategy of mechanical ventilation that places limits on airway pressure and tidal volume has been recommended for patients with the acute respiratory distress syndrome. 1 – 4 This recommendation is based on the observation that mechanical ventilation, although life-sustaining, can cause marked lung injury in both animals 5 – 9 and humans 10 if lung overdistention occurs. Patients with the acute respiratory distress syndrome are particularly prone to overdistention, especially when conventional tidal volumes are used (10 to 15 ml per kilogram of body weight), because the number of lung units available for ventilation is markedly reduced as a result of fluid accumulation, consolidation, . . .