Managing Culturally Significant Land: The Badger-Two Medicine Area as a Case Study

Located in Helena-Lewis and Clark National Forest, Badger-Two Medicine area (B2M) spans 130,000 acres and is situated on the Rocky Mountain Front. The area borders the Blackfeet Reservation, Glacier National Park, and Great Bear and Bob Marshall Wilderness areas. B2M possesses immense cultural and spiritual importance for the Blackfeet tribe, who have occupied the area since time immemorial. The area is also one of the last remaining refuges for vulnerable fish and wildlife species such as westslope cutthroat, grizzly bears, wolverines, and mountain goats. Altogether, B2M possesses vast spiritual, cultural, and ecological importance throughout. However, extractive development, disagreements over protection status, and varying tribal and federal interests have created management complications within its boundaries. Through an education-based project that focuses on communication and understanding, we explored current and future policy actions, opinions, and considerations for managing B2M’s culturally significant land. Our research involves interviewing tribal, federal, state, private, and non-profit stakeholders in the area to better understand where each group stands on current and future management actions in the area, and culturally significant land more broadly. Further, we will also host a Zoom panel in April consisting of individuals representing tribal, federal, conservation, and academic areas of expertise regarding B2M. In doing so, we hope to facilitate an informal yet informative discussion regarding management actions that inform the public and decision makers. We hope that our project will convey the complexities of managing culturally significant land, yet also inform others of the B2M’s management landscape. Communication between relevant groups and accessible information appears to be lacking, and this panel would help communicate the nuanced and broad distinctions between policy approaches to managing B2M. Through our case study, we also aim to provoke a wider discussion on policies pertaining to culturally significant land in other areas of the U.S. and globally

Expressions of climate perturbations in western Ugandan crater lake sediment records during the last 1000 yr

Equatorial East Africa has a complex, regional patchwork of climate regimes, with multiple interacting drivers. Recent studies have focussed on large lakes and reveal signals that are smoothed in both space and time, and, whilst useful at a continental scale, are of less relevance when understanding short-term, abrupt or immediate impacts of climate and environmental changes. Smaller-scale studies have highlighted spatial complexity and regional heterogeneity of tropical palaeoenvironments in terms of responses to climatic forcing (e.g. the Little Ice Age [LIA]) and questions remain over the spatial extent and synchroneity of climatic changes seen in East African records. Sediment cores from paired crater lakes in western Uganda were examined to assess ecosystem response to long-term climate and environmental change as well as testing responses to multiple drivers using redundancy analysis. These archives provide annual to sub-decadal records of environmental change. The records from the two lakes demonstrate an individualistic response to external (e.g. climatic) drivers, however, some of the broader patterns observed across East Africa suggest that the lakes are indeed sensitive to climatic perturbations such as a dry Mediaeval Climate Anomaly (MCA; 1000–1200 AD) and a relatively drier climate during the main phase of the LIA (1500–1800 AD); though lake levels in western Uganda do fluctuate. The relationship of Ugandan lakes to regional climate drivers breaks down c. 1800 AD, when major changes in the ecosystems appear to be a response to sediment and nutrient influxes as a result of increasing cultural impacts within the lake catchments. The data highlight the complexity of individual lake response to climate forcing, indicating shifting drivers through time. This research also highlights the importance of using multi-lake studies within a landscape to allow for rigorous testing of climate reconstructions, forcing and ecosystem response

Digital Authoring of Interactive Public Display Applications

HbbTV (Hybrid broadcast broadband TV) is an emerging force in the entertainment industry, and proper standarisation of technologies would be hugely beneficial for the creation of content. HbbTV aims to realise this vision and has been widely successful thus far. This paper introduces the MPAT (Multi Platform Application Toolkit) project, which is the result of multiple organisational entities effort and dedication to extend the capabilities and functionality of HbbTV, in order to ease the design and creation of interactive TV applications. The paper also showcases the versatility of MPAT, by describing a series of case studies which provide digital storytelling and visual authoring of interactive applications which transcend traditional TV use cases, and instead provide a gripping interactive experience via integration with public displays

Incidence of Tuberculosis in HIV-Infected Patients Before and After Starting Combined Antiretroviral Therapy in 8 Sub-Saharan African HIV Programs.

SETTIN

Validation of the myocardial-ischaemic-injury-index machine learning algorithm to guide the diagnosis of myocardial infarction in a heterogenous population: a prespecified exploratory analysis

BACKGROUND: Diagnostic pathways for myocardial infarction rely on fixed troponin thresholds, which do not recognise that troponin varies by age, sex, and time within individuals. To overcome this limitation, we recently introduced a machine learning algorithm that predicts the likelihood of myocardial infarction. Our aim was to evaluate whether this algorithm performs well in routine clinical practice and predicts subsequent events. METHODS: The myocardial-ischaemic-injury-index (MI3) algorithm was validated in a prespecified exploratory analysis using data from a multi-centre randomised trial done in Scotland, UK that included consecutive patients with suspected acute coronary syndrome undergoing serial high-sensitivity cardiac troponin I measurement. Patients with ST-segment elevation myocardial infarction were excluded. MI3 incorporates age, sex, and two troponin measurements to compute a value (0-100) reflecting an individual's likelihood of myocardial infarction during the index visit and estimates diagnostic performance metrics (including area under the receiver-operating-characteristic curve, and the sensitivity, specificity, negative predictive value, and positive predictive value) at the computed score. Model performance for an index diagnosis of myocardial infarction (type 1 or type 4b), and for subsequent myocardial infarction or cardiovascular death at 1 year was determined using the previously defined low-probability threshold (1·6) and high-probability MI3 threshold (49·7). The trial is registered with ClinicalTrials.gov, NCT01852123. FINDINGS: In total, 20 761 patients (64 years [SD 16], 9597 [46%] women) enrolled between June 10, 2013, and March 3, 2016, were included from the High-STEACS trial cohort, of whom 3272 (15·8%) had myocardial infarction. MI3 had an area under the receiver-operating-characteristic curve of 0·949 (95% CI 0·946-0·952) identifying 12 983 (62·5%) patients as low-probability for myocardial infarction at the pre-specified threshold (MI3 score <1·6; sensitivity 99·3% [95% CI 99·0-99·6], negative predictive value 99·8% [99·8-99·9]), and 2961 (14·3%) as high-probability at the pre-specified threshold (MI3 score ≥49·7; specificity 95·0% [94·6-95·3], positive predictive value 70·4% [68·7-72·0]). At 1 year, subsequent myocardial infarction or cardiovascular death occurred more often in high-probability patients than low-probability patients (520 [17·6%] of 2961 vs 197 [1·5%] of 12 983], p<0·0001). INTERPRETATION: In consecutive patients undergoing serial cardiac troponin measurement for suspected acute coronary syndrome, the MI3 algorithm accurately estimated the likelihood of myocardial infarction and predicted subsequent adverse cardiovascular events. By providing individual probabilities the MI3 algorithm could improve the diagnosis and assessment of risk in patients with suspected acute coronary syndrome. FUNDING: Medical Research Council, British Heart Foundation, National Institute for Health Research, and NHSX

The Effectiveness of Embedded Values Analysis Modules in Computer Science Education: An Empirical Study

Embedding ethics modules within computer science courses has become a popular response to the growing recognition that CS programs need to better equip their students to navigate the ethical dimensions of computing technologies like AI, machine learning, and big data analytics. However, the popularity of this approach has outpaced the evidence of its positive outcomes. To help close that gap, this empirical study reports positive results from Northeastern's program that embeds values analysis modules into CS courses. The resulting data suggest that such modules have a positive effect on students' moral attitudes and that students leave the modules believing they are more prepared to navigate the ethical dimensions they will likely face in their eventual careers. Importantly, these gains were accomplished at an institution without a philosophy doctoral program, suggesting this strategy can be effectively employed by a wider range of institutions than many have thought

Prevalence, treatment and correlates of depression in multiple sclerosis

BackgroundThe prevalence of depression in Multiple Sclerosis (MS) is often assessed by administering patient reported outcome measures (PROMs) examining depressive symptomatology to population cohorts; a recent review summarised 12 such studies, eight of which used the Hospital Anxiety and Depression Scale-Depression (HADS-D). In clinical practice, depression is diagnosed by an individual structured clinical interview; diagnosis often leads to treatment options including antidepressant medication. It follows that an MS population will include those whose current depressive symptoms meet threshold for depression diagnosis, plus those who previously met diagnostic criteria for depression and have been treated such that depressive symptoms have improved below that threshold. We examined a large MS population to establish a multi-attribute estimate of depression, taking into account probable depression on HADS-D, as well as anti-depressant medication use and co-morbidity data reporting current treatment for depression. We then studied associations with demographic and health status measures and the trajectories of depressive symptoms over time.MethodsParticipants were recruited into the UK-wide Trajectories of Outcome in Neurological Conditions-MS (TONiC-MS) study, with demographic and disease data from clinical records, PROMs collected at intervals of at least 9 months, as well as co-morbidities and medication. Interval level conversions of PROM data followed Rasch analysis. Logistic regression examined associations of demographic characteristics and symptoms with depression. Finally, a group-based trajectory model was applied to those with depression.ResultsBaseline data in 5633 participants showed the prevalence of depression to be 25.3% (CI: 24.2-26.5). There were significant differences in prevalence by MS subtype: relapsing 23.2% (CI: 21.8- 24.5), primary progressive 25.8% (CI: 22.5-29.3), secondary progressive 31.5% (CI: 29.0-34.0); disability: EDSS 0-4 19.2% (CI: 17.8-20.6), EDSS ≥4.5 31.9% (CI: 30.2-33.6); and age: 42-57 years 27.7% (CI: 26.0-29.3), above or below this range 23.1% (CI: 21.6-24.7). Fatigue, disability, self-efficacy and self esteem correlated with depression with a large effect size (&gt;.8) whereas sleep, spasticity pain, vision and bladder had an effect size &gt;.5. The logistic regression model (N=4938) correctly classified 80% with 93% specificity: risk of depression was increased with disability, fatigue, anxiety, more comorbidities or current smoking. Higher self-efficacy or self esteem and marriage reduced depression. Trajectory analysis of depressive symptoms over 40 months in those with depression (N=1096) showed three groups: 19.1% with low symptoms, 49.2% with greater symptoms between the threshold of possible and probable depression, and 31.7% with high depressive symptoms. 29.9% (CI: 27.6-32.3) of depressed subjects were untreated, conversely of those treated, 26.1% still had a symptom level consistent with a probable case (CI: 23.5-28.9).ConclusionA multi-attribute estimate of depression in MS is essential because using only screening questionnaires, diagnoses or antidepressant medication all under-estimate the true prevalence. Depression affects 25.3% of those with MS, almost half of those with depression were either untreated or still had symptoms indicating probable depression despite treatment. Services for depression in MS must be pro-active and flexible, recognising the heterogeneity of outcomes and reaching out to those with ongoing symptoms

Coronary CT Angiography and 5-Year Risk of Myocardial Infarction.

BACKGROUND: Although coronary computed tomographic angiography (CTA) improves diagnostic certainty in the assessment of patients with stable chest pain, its effect on 5-year clinical outcomes is unknown. METHODS: In an open-label, multicenter, parallel-group trial, we randomly assigned 4146 patients with stable chest pain who had been referred to a cardiology clinic for evaluation to standard care plus CTA (2073 patients) or to standard care alone (2073 patients). Investigations, treatments, and clinical outcomes were assessed over 3 to 7 years of follow-up. The primary end point was death from coronary heart disease or nonfatal myocardial infarction at 5 years. RESULTS: The median duration of follow-up was 4.8 years, which yielded 20,254 patient-years of follow-up. The 5-year rate of the primary end point was lower in the CTA group than in the standard-care group (2.3% [48 patients] vs. 3.9% [81 patients]; hazard ratio, 0.59; 95% confidence interval [CI], 0.41 to 0.84; P=0.004). Although the rates of invasive coronary angiography and coronary revascularization were higher in the CTA group than in the standard-care group in the first few months of follow-up, overall rates were similar at 5 years: invasive coronary angiography was performed in 491 patients in the CTA group and in 502 patients in the standard-care group (hazard ratio, 1.00; 95% CI, 0.88 to 1.13), and coronary revascularization was performed in 279 patients in the CTA group and in 267 in the standard-care group (hazard ratio, 1.07; 95% CI, 0.91 to 1.27). However, more preventive therapies were initiated in patients in the CTA group (odds ratio, 1.40; 95% CI, 1.19 to 1.65), as were more antianginal therapies (odds ratio, 1.27; 95% CI, 1.05 to 1.54). There were no significant between-group differences in the rates of cardiovascular or noncardiovascular deaths or deaths from any cause. CONCLUSIONS: In this trial, the use of CTA in addition to standard care in patients with stable chest pain resulted in a significantly lower rate of death from coronary heart disease or nonfatal myocardial infarction at 5 years than standard care alone, without resulting in a significantly higher rate of coronary angiography or coronary revascularization. (Funded by the Scottish Government Chief Scientist Office and others; SCOT-HEART ClinicalTrials.gov number, NCT01149590 .)