Primary Care Implementation of Genomic Population Health Screening Using a Large Gene Sequencing Panel.

To realize the promise of genomic medicine, harness the power of genomic technologies, and capitalize on the extraordinary pace of research linking genomic variation to disease risks, healthcare systems must embrace and integrate genomics into routine healthcare. We have implemented an innovative pilot program for genomic population health screening for any-health-status adults within the largest health system in Vermont, United States. This program draws on key research and technological advances to safely extract clinical value for genomics in routine health care. The program offers no-cost, non-research DNA sequencing to patients by their primary care providers as a preventive health tool. We partnered with a commercial clinical testing company for two next generation sequencing gene panels comprising 431 genes related to both high and low-penetrance common health risks and carrier status for recessive disorders. Only pathogenic or likely pathogenic variants are reported. Routine written clinical consultation is provided with a concise, clinical "action plan" that presents core messages for primary care provider and patient use and supports clinical management and health education beyond the testing laboratory's reports. Access to genetic counseling is free in most cases. Predefined care pathways and access to genetics experts facilitates the appropriate use of results. This pilot tests the feasibility of routine, ethical, and scalable use of population genomic screening in healthcare despite generally imperfect genomic competency among both the public and health care providers. This article describes the program design, implementation process, guiding philosophies, and insights from 2 years of experience offering testing and returning results in primary care settings. To aid others planning similar programs, we review our barriers, solutions, and perceived gaps in the context of an implementation research framework.

WMO World Record Lightning Extremes: Longest Reported Flash Distance and Longest Reported Flash Duration.

A World Meteorological Organization weather and climate extremes committee has judged that the world's longest reported distance for a single lightning flash occurred with a horizontal distance of 321 km (199.5 mi) over Oklahoma in 2007, while the world's longest reported duration for a single lightning flash is an event that lasted continuously for 7.74 seconds over southern France in 2012. In addition, the committee has unanimously recommended amendment of the AMS Glossary of Meteorology definition of lightning discharge as a "series of electrical processes taking place within 1 second" by removing the phrase "within one second" and replacing with "continuously." Validation of these new world extremes (a) demonstrates the recent and on-going dramatic augmentations and improvements to regional lightning detection and measurement networks, (b) provides reinforcement regarding the dangers of lightning, and

CLIMATE CHANGE. Possible artifacts of data biases in the recent global surface warming hiatus.

Much study has been devoted to the possible causes of an apparent decrease in the upward trend of global surface temperatures since 1998, a phenomenon that has been dubbed the global warming "hiatus." Here, we present an updated global surface temperature analysis that reveals that global trends are higher than those reported by the Intergovernmental Panel on Climate Change, especially in recent decades, and that the central estimate for the rate of warming during the first 15 years of the 21st century is at least as great as the last half of the 20th century. These results do not support the notion of a "slowdown" in the increase of global surface temperature.

Changes in weather and climate extremes: state of knowledge relevant to air and water quality in the United States.

Air and water quality are impacted by extreme weather and climate events on time scales ranging from minutes to many months. This review paper discusses the state of knowledge of how and why extreme events are changing and are projected to change in the future. These events include heat waves, cold waves, floods, droughts, hurricanes, strong extratropical cyclones such as nor'easters, heavy rain, and major snowfalls. Some of these events, such as heat waves, are projected to increase, while others, with cold waves being a good example, will decrease in intensity in our warming world. Each extreme's impact on air or water quality can be complex and can even vary over the course of the event.