Development and preliminary usability testing of an electronic conversation guide incorporating patient values and prognostic information in preparation for older people's decision-making near the end of life.

Initiating end-of-life conversations can be daunting for clinicians and overwhelming for patients and families. This leads to delays in communicating prognosis and preparing for the inevitable in old age, often generating potentially harmful overtreatment and poor-quality deaths. We aimed to develop an electronic resource, called Communicating Health Alternatives Tool (CHAT) that was compatible with hospital medical records software to facilitate preparation for shared decision-making across health settings with older adults deemed to be in the last year of life. The project used mixed methods including: literature review, user-directed specifications, web-based interface development with authentication and authorization; clinician and consumer co-design, iterative consultation for user testing; and ongoing developer integration of user feedback. An internet-based conversation guide to facilitate clinician-led advance care planning was co-developed covering screening for short-term risk of death, patient values and preferences, and treatment choices for chronic kidney disease and dementia. Printed summary of such discussion could be used to begin the process in hospital or community health services. Clinicians, patients, and caregivers agreed with its ease of use and were generally accepting of its contents and format. CHAT is available to health services for implementation in effectiveness trials to determine whether the interaction and documentation leads to formal decision-making, goal-concordant care, and subsequent reduction of unwanted treatments at the end of life.

Meteoritic dust from the atmospheric disintegration of a large meteoroid.

Much of the mass of most meteoroids entering the Earth's atmosphere is consumed in the process of ablation. Larger meteoroids (> 10 cm), which in some cases reach the ground as meteorites, typically have survival fractions near 1-25 per cent of their initial mass. The fate of the remaining ablated material is unclear, but theory suggests that much of it should recondense through coagulation as nanometre-sized particles. No direct measurements of such meteoric 'smoke' have hitherto been made. Here we report the disintegration of one of the largest meteoroids to have entered the Earth's atmosphere during the past decade, and show that the dominant contribution to the mass of the residual atmospheric aerosol was in the form of micrometre-sized particles. This result is contrary to the usual view that most of the material in large meteoroids is efficiently converted to particles of much smaller size through ablation. Assuming that our observations are of a typical event, we suggest that large meteoroids provide the dominant source of micrometre-sized meteoritic dust at the Earth's surface over long timescales.

Are there any natural resources?

Local and regional environments have for many centuries been seen as, or as being composed of, ''natural resources,'' which have generally been considered fully available for human use, irrespective of any use to which other species, purposefully or not, might put them. The global environment has more recently, though less routinely, been seen in this way. I examine full-human-use arguments in three widely credited philosophical traditions: the Judeo-Christian-liberal, the Aristotelian-Cartesian-rationalist, and the utilitarian or neoclassical economic. I find each tradition's full-human-use argument unsatisfactory. I then discuss, and ultimately recommend, an alternative, an all-species-use argument based on Albert Schweitzer's much admired but seldom adopted reverence-for-life ethic. I find revealed by this alternative argument a previously unnamed good, one worthy of honor, protection, and enlargement; I call this good ''the commonwealth of life.'' In conclusion, I consider important implications of accepting commonwealth-of-life reasoning, including foundational changes in ethics.