Rethinking Rewriting: Tribal Constitutional Amendment And Reform

This Essay examines the recent wave of American Indian tribal constitutional change through the framework of subnational constitutional theory. When tribes rewrite their constitutions, they not only address internal tribal questions and communicate tribal values, but also engage with other subnational entities, i.e. states, and the federal government. This Essay applies that framework to a study of tribal constitutional amendment and reform procedures. Focusing on the processes of constitutional change produces insight into tribes' status as “domestic dependent sovereigns” in the contemporary era of self-determination, a status reflected in the opportunities, and limitations, inherent in tribal constitutions. In so doing, this Essay aims to highlight an aspect of tribal constitution writing that enables successful reform and communicates the significance and goals of constitutionalism within the tribal context

GeneChip analysis of human embryonic stem cell differentiation into hemangioblasts: an in silico dissection of mixed phenotypes

Transcriptional profiling of human embryonic stem cells differentiating into blast cells reveals that erythroblasts are the predominant cell type in the blast cell population. In silico comparisons with publicly available data sets revealed the presence of endothelia, cardiomyocytes and hematopoietic lineages

Urban park use during the COVID-19 pandemic:Are socially vulnerable communities disproportionately impacted?

The COVID-19 pandemic altered human behavior around the world. To maintain mental and physical health during periods of lockdown and quarantine, people often engaged in outdoor, physically distanced activities such as visits to parks and greenspace. However, research tracking outdoor recreation patterns during the pandemic has yielded inconsistent results, and few studies have explored the impacts of COVID-19 on park use across diverse neighborhoods. We used a mixed methods approach to examine changes in park use patterns in cities across North Carolina, USA, during the COVID-19 pandemic, with an emphasis on impacts in socially vulnerable communities (based on racial/ethnic composition and socioeconomic status). First, we surveyed a demographically representative sample of 611 urban residents during August 2020 to assess their use of outdoor park spaces before and during the pandemic. Second, we used cell phone location (i.e., geo-tracking) data to document changes in park visits within 605 socioeconomically diverse urban census tracts before (July 2019) and during (July 2020) the pandemic. Data from both methods revealed urban park use declined during the pandemic; 56% of survey respondents said they stopped or reduced park use, and geo-tracked park visits dropped by 15%. Park users also became more homogenous, with visits increasing the most for past park visitors and declining the most in socially vulnerable communities and among individuals who were BIPOC or lower-income. Our results raise concerns about urban park use during the COVID-19 pandemic and suggest pre-existing health disparities in socially vulnerable communities might be exacerbated by inequitable access and utilization of parks and greenspace

Human-Centered Tools for Coping with Imperfect Algorithms during Medical Decision-Making

Machine learning (ML) is increasingly being used in image retrieval systems for medical decision making. One application of ML is to retrieve visually similar medical images from past patients (e.g. tissue from biopsies) to reference when making a medical decision with a new patient. However, no algorithm can perfectly capture an expert's ideal notion of similarity for every case: an image that is algorithmically determined to be similar may not be medically relevant to a doctor's specific diagnostic needs. In this paper, we identified the needs of pathologists when searching for similar images retrieved using a deep learning algorithm, and developed tools that empower users to cope with the search algorithm on-the-fly, communicating what types of similarity are most important at different moments in time. In two evaluations with pathologists, we found that these refinement tools increased the diagnostic utility of images found and increased user trust in the algorithm. The tools were preferred over a traditional interface, without a loss in diagnostic accuracy. We also observed that users adopted new strategies when using refinement tools, re-purposing them to test and understand the underlying algorithm and to disambiguate ML errors from their own errors. Taken together, these findings inform future human-ML collaborative systems for expert decision-making

Microscope 2.0: An Augmented Reality Microscope with Real-time Artificial Intelligence Integration

The brightfield microscope is instrumental in the visual examination of both biological and physical samples at sub-millimeter scales. One key clinical application has been in cancer histopathology, where the microscopic assessment of the tissue samples is used for the diagnosis and staging of cancer and thus guides clinical therapy. However, the interpretation of these samples is inherently subjective, resulting in significant diagnostic variability. Moreover, in many regions of the world, access to pathologists is severely limited due to lack of trained personnel. In this regard, Artificial Intelligence (AI) based tools promise to improve the access and quality of healthcare. However, despite significant advances in AI research, integration of these tools into real-world cancer diagnosis workflows remains challenging because of the costs of image digitization and difficulties in deploying AI solutions. Here we propose a cost-effective solution to the integration of AI: the Augmented Reality Microscope (ARM). The ARM overlays AI-based information onto the current view of the sample through the optical pathway in real-time, enabling seamless integration of AI into the regular microscopy workflow. We demonstrate the utility of ARM in the detection of lymph node metastases in breast cancer and the identification of prostate cancer with a latency that supports real-time workflows. We anticipate that ARM will remove barriers towards the use of AI in microscopic analysis and thus improve the accuracy and efficiency of cancer diagnosis. This approach is applicable to other microscopy tasks and AI algorithms in the life sciences and beyond

Prescribing Time in Nature for Human Health and Well-Being: Study Protocol for Tailored Park Prescriptions

BackgroundeHealth technologies offer an efficient method to integrate park prescriptions into clinical practice by primary health care (PHC) providers to help patients improve their health via tailored, nature-based health behavior interventions. This paper describes the protocol of the GoalRx Prescription Intervention (GPI) which was designed to leverage community resources to provide tailored park prescriptions for PHC patients.MethodsThe GPI study was designed as a 3-arm, multi-site observational study. We enrolled low-income, rural adults either at-risk of or living with hypertension or diabetes (n = 75) from Federally Qualified Health Centers (FQHC) in two counties in North Carolina, USA into the 3-month intervention. Eligible participants self-selected to receive (1) a tailored park prescription intervention; (2) a tailored home/indoor PA prescription intervention; or (3) a healthy eating prescription (with no PA prescription beyond standard PA counseling advice that is already routinely provided in PHC) as the comparison group. The GPI app paired patient health data from the electronic health record with stated patient preferences and triggered app-integrated SMS motivation and compliance messaging directly to the patient. Patients were assessed at baseline and at a 3-month follow-up upon the completion of the intervention. The primary outcome (mean difference in weekly physical activity from baseline (T0) to post-intervention (T1) as measured by the Fitbit Flex 2) was assessed at 3 months. Secondary outcomes included assessment of the relationship between the intervention and biological markers of health, including body mass index (BMI), systolic and diastolic blood pressure, HbA1c or available glucose test (if applicable), and a depression screen score using the Patient Health Questionnaire 9. Secondary outcomes also included the total number of SMS messages sent, number of SMS messages responded to, number of SMS messages ignored, and opt-out rate.DiscussionThe goal was to create a protocol utilizing eHealth technologies that addressed the specific needs of rural low-income communities and fit into the natural rhythms and processes of the selected FQHC clinics in North Carolina. This protocol offered a higher standard of health care by connecting patients to their PHC teams and increasing patient motivation to make longer-lasting health behavior changes

Identification of unique expression signatures and therapeutic targets in esophageal squamous cell carcinoma

<p>Abstract</p> <p>Background</p> <p>Esophageal squamous cell carcinoma (ESCC), the predominant histological subtype of esophageal cancer, is characterized by high mortality. Previous work identified important mRNA expression differences between normal and tumor cells; however, to date there are limited <it>ex vivo </it>studies examining expression changes occurring during normal esophageal squamous cell differentiation versus those associated with tumorigenesis. In this study, we used a unique tissue microdissection strategy and microarrays to measure gene expression profiles associated with cell differentiation versus tumorigenesis in twelve cases of patient-matched normal basal squamous epithelial cells (NB), normal differentiated squamous epithelium (ND), and squamous cell cancer. Class comparison and pathway analysis were used to compare NB versus tumor in a search for unique therapeutic targets.</p> <p>Results</p> <p>As a first step towards this goal, gene expression profiles and pathways were evaluated. Overall, ND expression patterns were markedly different from NB and tumor; whereas, tumor and NB were more closely related. Tumor showed a general decrease in differentially expressed genes relative to NB as opposed to ND that exhibited the opposite trend. FSH and IgG networks were most highly dysregulated in normal differentiation and tumorigenesis, respectively. DNA repair pathways were generally elevated in NB and tumor relative to ND indicating involvement in both normal and pathological growth. PDGF signaling pathway and 12 individual genes unique to the tumor/NB comparison were identified as therapeutic targets, and 10 associated ESCC gene-drug pairs were identified. We further examined the protein expression level and the distribution patterns of four genes: ODC1, POSTN, ASPA and IGF2BP3. Ultimately, three genes (ODC1, POSTN, ASPA) were verified to be dysregulated in the same pattern at both the mRNA and protein levels.</p> <p>Conclusions</p> <p>These data reveal insight into genes and molecular pathways mediating ESCC development and provide information potentially useful in designing novel therapeutic interventions for this tumor type.</p