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ISCCP continues to quantify the global distribution and diurnal-to-interannual variations of cloud properties in a revised version. This paper summarizes assessments of the previous version, describes refinements of the analysis and enhanced features of the product design, discusses the few notable changes in the results, and illustrates the long-term variations of global mean cloud properties and differing high cloud changes associated with ENSO. The new product design includes a global, pixel-level product on a 0.1° grid, all other gridded products at 1.0°-equivalent equal area, separate satellite products with ancillary data for regional studies, more detailed, embedded quality information, and all gridded products in netCDF format. All the data products including all input data, expanded documentation, the processing code, and an operations guide are available online. Notable changes are 1) a lowered ice–liquid temperature threshold, 2) a treatment of the radiative effects of aerosols and surface temperature inversions, 3) refined specification of the assumed cloud microphysics, and 4) interpolation of the main daytime cloud information overnight. The changes very slightly increase the global monthly mean cloud amount with a little more high cloud and a little less middle and low cloud. Over the whole period, total cloud amount slowly decreases caused by decreases in cumulus/altocumulus; consequently, average cloud-top temperature and optical thickness have increased. The diurnal and seasonal cloud variations are very similar to earlier versions. Analysis of the whole record shows that high cloud variations, but not low clouds, exhibit different patterns in different ENSO events. Significance Statement: This paper reports on the evolution of the research goals and satellite cloud data products produced by ISCCP, a long-term international project, which is now fully operational. The growing length of record with 10-km and 3-h sampling makes possible studies of cloud variations from diurnal-to-weather scale (cloud process scale) to climate variation scale. In particular the length of record includes many examples of ENSO and is beginning to encompass the slower modes of ocean variation, allowing studies of the role of cloud feedbacks in coupling the atmosphere and ocean circulations. [ABSTRACT FROM AUTHOR]

Cervical cancer screening aims to detect cervical intraepithelial neoplasia grade 3 or higher (CIN 3+) to reduce morbidity and mortality from cervical cancer.1 This strategy has evolved from vaginal to cervical specimens in the 1960s, from cytology alone to cytology with human papillomavirus (HPV) triage in the 1990s, and from cotesting using both cytology and HPV testing in the 2010s to, most recently, primary HPV testing. Primary HPV testing is an effective screening modality for cervical cancer in average-risk individuals (eTable A), can decrease the total number of screenings a patient needs, and can decrease inequities in cervical cancer screening and follow-up testing. [ABSTRACT FROM AUTHOR]

This paper describes the new global long-term, International Satellite Cloud Climatology Project (ISCCP) H-Series climate data record (CDR). The H-Series data contains a suite of level 2 and level 3 products for monitoring the distribution and variation of cloud and surface properties to better understand the effects of clouds on climate, the radiation budget, and the global hydrologic cycle. This product is currently available for public use and is derived from both geostationary and polar orbiting satellite imaging radiometers with common visible and infrared (IR) channels. The H-Series data spans from July 1983 to Dec 2009 with plans for continued production to extend the record to the present with regular updates. The H-series data are the longest combined geostationary and polar orbiter satellite based CDR of cloud properties. Access to the data is provided in network Common Data Form (netCDF) and archived by NOAA's National Centers for Environmental Information (NCEI) under the satellite Climate Data Record Program (https://doi.org/10.7289/V5QZ281S). The basic characteristics, history, and evolution of the dataset are presented herein with particular emphasis on and discussion of product changes between the H-Series and the widely used predecessor D-Series product which spans from July 1983 through December 2009. Key refinements included to the ISCCP H-Series CDR are based on improved quality control measures, modified ancillary inputs, higher spatial resolution input and output products, calibration refinements, and updated documentation and metadata to bring the H-Series product into compliance with existing standards for climate data records. [ABSTRACT FROM AUTHOR]

Pancreatic cancer remains the fourth leading cause of cancer-related deaths in the United States. Risk factors include family history, smoking, chronic pancreatitis, obesity, diabetes mellitus, heavy alcohol use, and possible dietary factors. Because more than two-thirds of adenocarcinomas occur in the head of the pancreas, abdominal pain, jaundice, pruritus, dark urine, and acholic stools may be presenting symptoms. In symptomatic patients, the serum tumor marker cancer antigen 19-9 can be used to confirm the diagnosis and to predict prognosis and recurrence after resection. Pancreas protocol computed tomography is considered standard for the diagnosis and staging of pancreatic cancer. Although surgical resection is the only potentially curative treatment for pancreatic ductal adenocarcinomas, less than 20% of surgical candidates survive five years. The decision on resectability requires multidisciplinary consultation. Pancreatic resections should be performed at institutions that complete at least 15 of the surgeries annually. Postoperatively, use of gemcitabine or fluorouracil/leucovorin as adjuvant chemotherapy improves overall survival by several months. However, more than 80% of patients present with disease that is not surgically resectable. For patients with locally advanced or metastatic disease, chemoradiotherapy with gemcitabine or irinotecan provides clinical benefit and modest survival improvement. Palliation should address pain control, biliary and gastric outlet obstruction, malnutrition, thromboembolic disease, and depression. [ABSTRACT FROM AUTHOR]