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Background: Cigarette smoking remains the leading cause of preventable disease and death in the United States. Primary care offers an ideal setting to reach adults who smoke cigarettes and improve uptake of evidence-based cessation treatment. Although U.S. Preventive Services Task Force Guidelines recommend the 5As model (Ask, Advise, Assess, Assist, Arrange) in primary care, there are many barriers to its implementation. Automated, comprehensive, and proactive tools are needed to overcome barriers. Our team developed and preliminarily evaluated a proactive electronic visit (e-visit) delivered via the Electronic Health Record patient portal to facilitate evidence-based smoking cessation treatment uptake in primary care, with promising initial feasibility and efficacy. This paper describes the rationale, design, and protocol for an ongoing Hybrid Type I effectiveness-implementation trial that will simultaneously assess effectiveness of the e-visit intervention for smoking cessation as well as implementation potential across diverse primary care settings. Methods: The primary aim of this remote five-year study is to examine the effectiveness of the e-visit intervention vs. treatment as usual (TAU) for smoking cessation via a clinic-randomized clinical trial. Adults who smoke cigarettes are recruited across 18 primary care clinics. Clinics are stratified based on their number of primary care providers and randomized 2:1 to either e-visit or TAU. An initial baseline e-visit gathers information about patient smoking history and motivation to quit, and a clinical decision support algorithm determines the best evidence-based cessation treatment to prescribe. E-visit recommendations are evaluated by a patient's own provider, and a one-month follow-up e-visit assesses cessation progress. Main outcomes include: (1) cessation treatment utilization (medication, psychosocial cessation counseling), (2) reduction in cigarettes per day, and (3) biochemically verified 7-day point prevalence abstinence (PPA) at six-months. We hypothesize that patients randomized to the e-visit condition will have better cessation outcomes (vs. TAU). A secondary aim evaluates e-visit implementation potential at patient, provider, and organizational levels using a mixed-methods approach. Implementation outcomes include acceptability, adoption, fidelity, implementation cost, penetration, and sustainability. Discussion: This asynchronous, proactive e-visit intervention could provide substantial benefits for patients, providers, and primary care practices and has potential to widely improve reach of evidence-based cessation treatment. Trial registration: NCT05493254. [ABSTRACT FROM AUTHOR]

During the summer of 2018, the upward-pointing Wyoming Cloud Lidar (WCL) was deployed on board the University of Wyoming King Air (UWKA) research aircraft for the Biomass Burning Flux Measurements of Trace Gases and Aerosols (BB-FLUX) field campaign. This paper describes the generation of calibrated attenuated backscatter coefficients and aerosol extinction coefficients from the WCL measurements. The retrieved aerosol extinction coefficients at the flight level strongly correlate (correlation coefficient, rr > 0.8) with in situ aerosol concentration and carbon monoxide (CO) concentration, providing a first-order estimate for converting WCL extinction coefficients into vertically resolved CO and aerosol concentration within wildfire smoke plumes. The integrated CO column concentrations from the WCL data in nonextinguished profiles also correlate (rr = 0.7) with column measurements by the University of Colorado Airborne Solar Occultation Flux instrument, indicating the validity of WCL-derived extinction coefficients. During BB-FLUX, the UWKA sampled smoke plumes from more than 20 wildfires during 35 flights over the western United States. Seventy percent of flight time was spent below 3 km above ground level (AGL) altitude, although the UWKA ascended up to 6 km AGL to sample the top of some deep smoke plumes. The upward-pointing WCL observed a nearly equal amount of thin and dense smoke below 2 km and above 5 km due to the flight purpose of targeted fresh fire smoke. Between 2 and 5 km, where most of the wildfire smoke resided, the WCL observed slightly more thin smoke than dense smoke due to smoke spreading. Extinction coefficients in dense smoke were 2–10 times stronger, and dense smoke tended to have larger depolarization ratio, associated with irregular aerosol particles. [ABSTRACT FROM AUTHOR]