Patient-Reported Outcomes Integrated Within an Electronic Medical Record in Patients With Head and Neck Cancer

PURPOSE: Patient-reported outcome (PRO) tools lead to clinical benefits, including improved overall survival for patients with cancer. However, routine implementation of PROs in clinical practice within the electronic medical record (EMR) by integrated health care delivery systems remains limited. We studied the use of a PRO tool for patients with head and neck cancer (HNC) integrated in an EMR at Kaiser Permanente in Northern California. METHODS: Between August 2017 and December 2019, patients with newly diagnosed HNC were surveyed at baseline, then every 3 months using the Functional Assessment of Cancer Therapy-General 7 and Functional Assessment of Cancer Therapy-Head and Neck (version 4). A medical assistant performed a baseline survey on diagnosis and then notified patients electronically per surveillance protocol. Patients who did not respond to online PRO surveys could complete them via telephone or in-person appointments with medical assistants. Abnormal findings on PRO surveys were referred to appropriate members of the care team or the treating Otolaryngology-Head and Neck Surgery physicians. RESULTS: Two hundred ninety patients received baseline surveys. Patients received up to a maximum of eight subsequent surveys. Of a total of 597 electronic surveys, 585 (97.9%) were completed. The percentage of patients completing each interval survey ranged from 92% to 100%. Multivariate Poisson regression analysis showed patients with English as their primary language and an online secure account were the most likely to complete surveys compared with those patients with non-English as a primary language and without an online account. CONCLUSION: PRO tools can be effectively used within the EMR for patients with HNC with a high response rate provided there is strong engagement from a dedicated member of the care team. This has important implications for designing clinical trials and symptom monitoring in clinical practices that incorporate EMRs

Systematic Conservation Planning in the Face of Climate Change: Bet-Hedging on the Columbia Plateau

Systematic conservation planning efforts typically focus on protecting current patterns of biodiversity. Climate change is poised to shift species distributions, reshuffle communities, and alter ecosystem functioning. In such a dynamic environment, lands selected to protect today's biodiversity may fail to do so in the future. One proposed approach to designing reserve networks that are robust to climate change involves protecting the diversity of abiotic conditions that in part determine species distributions and ecological processes. A set of abiotically diverse areas will likely support a diversity of ecological systems both today and into the future, although those two sets of systems might be dramatically different. Here, we demonstrate a conservation planning approach based on representing unique combinations of abiotic factors. We prioritize sites that represent the diversity of soils, topographies, and current climates of the Columbia Plateau. We then compare these sites to sites prioritized to protect current biodiversity. This comparison highlights places that are important for protecting both today's biodiversity and the diversity of abiotic factors that will likely determine biodiversity patterns in the future. It also highlights places where a reserve network designed solely to protect today's biodiversity would fail to capture the diversity of abiotic conditions and where such a network could be augmented to be more robust to climate-change impacts

An analysis-ready and quality controlled resource for pediatric brain white-matter research

We created a set of resources to enable research based on openly-available diffusion MRI (dMRI) data from the Healthy Brain Network (HBN) study. First, we curated the HBN dMRI data (N = 2747) into the Brain Imaging Data Structure and preprocessed it according to best-practices, including denoising and correcting for motion effects, susceptibility-related distortions, and eddy currents. Preprocessed, analysis-ready data was made openly available. Data quality plays a key role in the analysis of dMRI. To optimize QC and scale it to this large dataset, we trained a neural network through the combination of a small data subset scored by experts and a larger set scored by community scientists. The network performs QC highly concordant with that of experts on a held out set (ROC-AUC = 0.947). A further analysis of the neural network demonstrates that it relies on image features with relevance to QC. Altogether, this work both delivers resources to advance transdiagnostic research in brain connectivity and pediatric mental health, and establishes a novel paradigm for automated QC of large datasets

The Mirror of Anarchy: The Egoism of John Henry Mackay and Dora Marsden

The mirror of anarchy: the egoism of John Henry Mackay and Dora Marsde

Economic and Cultural Forces in the Child Labour Debate: Evidence from Urban Bangladesh

The relative influence of economic and cultural forces is a key area of debate amongst those exploring the causes of child work, and in wider discourse on household labour deployment. Data from Dhaka slums suggest that household poverty and income stability are important economic determinants of children's work. However, economic forces alone cannot explain child-work deployment. Evidence on the availability of adult household members to replace child contributions, and on gender and age differentials in household labour deployment, point towards the importance of cultural factors. Key cultural determinants of children's work include gender norms, age subordination and the cultural importance of avoiding idleness.Child-work, Economic Determinants, Cultural Determinants, Household Poverty, Income Stability, Bangladesh,

Computer Science Research Institute 2002 Annual Report of Activities

This report summarizes the activities of the Computer Science Research Institute (CSRI) at Sandia National Laboratories during the period January 1, 2002 to December 31, 2002. During this period the CSRI hosted 172 visitors representing 95 universities, companies or laboratories. Of these 56 were summer students or faculty. The CSRI also organized and hosted five workshops with 171 participants. Of these 94 attendees were from 64 universities, companies or laboratories, and 77 were from Sandia. Finally, the CSRI sponsored 14 long-term collaborative research projects

Computer Science Research Institute 2001 Annual Report of Activities

This report summarizes the activities of the Computer Science Research Institute at Sandia National Laboratories during the period January 1, 2001 to December 31, 2001

The graduating European dentist—domain II: safe and effective clinical practice

This position paper outlines the areas of competence and learning outcomes of “The Graduating European Dentist” that specifically relate to Safe and Effective Clinical Practice. Dentists are required to ensure that they are capable of providing appropriate care for their patients, whilst also effectively managing and leading the wider clinical team. The care that is provided should align to a contemporaneous evidence base wherever possible, and the quality of care and the management systems that underpin it should be regularly audited and improved