Enabling global clinical collaborations on identifiable patient data: The Minerva Initiative

The clinical utility of computational phenotyping for both genetic and rare diseases is increasingly appreciated; however, its true potential is yet to be fully realized. Alongside the growing clinical and research availability of sequencing technologies, precise deep and scalable phenotyping is required to serve unmet need in genetic and rare diseases. To improve the lives of individuals affected with rare diseases through deep phenotyping, global big data interrogation is necessary to aid our understanding of disease biology, assist diagnosis, and develop targeted treatment strategies. This includes the application of cutting-edge machine learning methods to image data. As with most digital tools employed in health care, there are ethical and data governance challenges associated with using identifiable personal image data. There are also risks with failing to deliver on the patient benefits of these new technologies, the biggest of which is posed by data siloing. The Minerva Initiative has been designed to enable the public good of deep phenotyping while mitigating these ethical risks. Its open structure, enabling collaboration and data sharing between individuals, clinicians, researchers and private enterprise, is key for delivering precision public health

Size-selective mortality during freshwater and marine life stages of steelhead related to freshwater growth in the Skagit River, Washington

Wild steelhead trout, Oncorhynchus mykiss, in the Puget Sound are currently in decline, and very little is known about the early life history of these threatened fish. This study evaluated consequences of early growth and survival to smolt or adult stages in different precipitation zones of the Skagit River Basin, Washington. The objectives of this study were to determine whether significant size-selective mortality (SSM) in wild steelhead could be detected between freshwater stages and returning adults; and if so, how the magnitude of SSM varied among juveniles rearing in different precipitation zones (snow and mixed rain-snow). Wild steelhead were sampled as juveniles, smolts, and adults, and scales were measured to compare back-calculated size distributions and growth rates of rearing juveniles with individuals that survived from an earlier life stage to the smolt and adult stages. Back-calculated size-at-annulus comparisons indicated that steelhead in the snow zone were significantly larger at annulus-1 than those in the mixed zone. Steelhead sampled as adults were significantly larger than those sampled as juveniles at annuli-1, -2, and -3, and larger than those sampled as smolts at annuli-2 and -3, Steelhead sampled as smolts were larger than those sampled as juveniles at annuli-1 and -2, but smolts and juveniles were the same size at annulus-3. The disparity in size-at-age-2 and -3 between steelhead sampled at earlier and later life stages suggested that fast growth during the second or third freshwater growing seasons was vitally important for survival to adulthood, and that both freshwater and marine survival could be attributed, in part, to size attained at earlier life stages in freshwater. Efforts for recovery of threatened Puget Sound steelhead could benefit by considering SSM in freshwater environments, and identifying factors that limit growth during early life stages

America's Rural Hospitals: A Selective Review of 1980s Research

We review 1980s research on American rural hospitals within the context of a decade of increasing restrictiveness in the reimbursement and operating environments. Areas addressed include rural hospital definitions, organizational and financial performance, and strategic management activities. The latter category consists of hospital closure, diversification and vertical integration, swing-bed conversion, sole community provider designation, horizontal integration and multihospital system affiliation, marketing, and patient retention. The review suggests several research needs, including: developing more meaningful definitions of rural hospitals, engaging in methodologically sound work on the effects of innovative programs and strategic management activities—including conversion of the facility itself—on rural hospital performance, and completing studies of the effects of rural hospital closure or conversion on the health of the communities served.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/74857/1/j.1748-0361.1990.tb00682.x.pd

Anuros da Reserva Natural Salto Morato, Guaraqueçaba, Paraná, Brasil

O objetivo do presente estudo é apresentar a lista de espécies de anfíbios da Reserva Natural Salto Morato (RNSM), uma reserva de Mata Atlântica no Estado do Paraná, sul do Brasil. O parque está localizado no litoral norte do Paraná, na divisa com o Estado de São Paulo. Nós amostramos ambientes lênticos e lóticos, bromélias e serrapilheira durante os meses de setembro de 2006 a março de 2007. Na RNSM foram registradas 42 espécies de anfíbios anuros, pertencentes a nove famílias, sendo uma espécie endêmica da área de estudo. Nós registramos 14 modos reprodutivos dos anuros na área de estudo. Na RNSM, 50% das espécies de anuros ocorreram em mais de 50% das amostragens, 26% das espécies foram registradas entre 25-50% das amostragens e 24% das espécies foram raras, ocorrendo em menos de 25% das amostragens. A RNSM até o presente momento é a área com a maior diversidade de anfíbios e de modos reprodutivos do Paraná. Esses fatores evidenciam a importância da RNSM para a conservação dos anfíbios.Here we present a survey of amphibian species of the Reserva Natural Salto Morato (RNSM), an Atlantic rainforest reserve in Paraná, southern Brazil. We sampled lentic and lotic water bodies, phytotelmata and leaf litter from September 2006 to March 2007. We found 42 species from nine families, one of which is endemic to the study area. Additionally, we recorded 14 reproductive modes. In the RNSM, 50% of anuran species occur in more than 50% of samples, 26% of species occurred between 25 and 50% of samples, and 24% were rare, occurring in less than 25% of samples. The reserve holds the highest diversity of amphibians and reproductive modes in Paraná. Our results emphasize the importance of RNSM for amphibian conservation.Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)Universidade Estadual Paulista - UNESP Instituto de Biociências, Letras e Ciências Exatas Departamento de Zoologia e BotânicaUniversidade Federal da Fronteira Sul - UFFSUniversidade Estadual Paulista - UNESP Instituto de Biociências, Letras e Ciências Exatas Departamento de Zoologia e Botânic