Companies Positioned in the Middle:Municipal Wireless and Its Impact on Privacy and Free Speech

When a city institutes a municipal wireless system, it is building a new communications infrastructure on behalf of its residents. Like our rights to privacy in our public telephone communications, individuals have the right to a municipal wireless network that respects privacy and free speech, allowing users to explore all that the Internet offers without worrying where information about their online activities will end up or how it will be used or abused. Cities have a duty to protect the privacy and free speech rights of their residents, and safeguards for these rights must be priorities, not afterthoughts

Cloud Computing: Storm Warning for Privacy?

“Cloud computing” - the ability to create, store, and manipulate data through Web-based services - is growing in popularity. Cloud computing itself may not transform society; for most consumers, it is simply an appealing alternative tool for creating and storing the same records and documents that people have created for years. However, outdated laws and varying corporate practices mean that documents created and stored in the cloud may not have the same protections as the same documents stored in a filing cabinet or on a home computer. Can cloud computing services protect the privacy of their consumers? Do they? And what can we do to improve the situation? Cloud Computing: Storm Warning for Privacy? is the first in a series of issue papers by the ACLU of Northern California that discuss new technology trends and their consequences. This paper examines the current state of legal and technical privacy protections for consumers of cloud computing services and explores opportunities for consumers, businesses, and policymakers to work together to update and enhance these protections. Part I of this paper provides background information on cloud computing. Part II examines the privacy concerns that arise from the use of cloud computing services and Part III surveys the current state of privacy protections for consumers of these services. Finally, Part IV identifies opportunities for legal, technological, and social mechanisms to be reinforced so that Internet consumers are not forced to lose control of their information when they use cloud computing services

A Case Study on Professional Development: Improving STEM Teaching in K-12 Education

STEM Outreach Center is a non-profit educational center in southern New Mexico that supports K-12 STEM teachers and students by providing professional development, after school programs, summer camps, and field visits. This center has been organizing the Summer Institute Professional Development (SIPD) for more than ten years. The purpose of this research is to understand the effect of SIPD on teachers’ pedagogy to excite and engage students in STEM learning. This study contributes to the program evaluation by analyzing the experiences of teachers who participated in SIPD. This qualitative study uses the open-ended questionnaire as a method of data collection. The findings of this study show that teachers who attended the SIPD are eager to (i) integrate readings and arts in STEM teaching practices, (ii) improve their teaching pedagogies, and (iii) look for additional resources to support STEM teaching. Therefore, the authors recommend further research on how teachers transfer skills into their classrooms after attending SIPD

Location-Based Services: Time for a Privacy Check-In

Need to get directions when you are lost? Want to know if your friends are in the neighborhood? Location-based services – applications and websites that provide services based on your current location – can put this information and more in the palm of your hand. But outdated privacy laws and varying corporate practices could mean that sensitive information about who you are, where you go, what you do, and who you know end up being shared, sold, or turned over to the government. Can location-based services protect your privacy? Do they? And what can we do to improve the situation? Location-Based Services: Time for a Privacy Check-in is our new guide outlining privacy considerations for location-based services, including a side-by-side comparison of the privacy practices of several popular products. The guide highlights opportunities for consumers, businesses, and policymakers to work together to update and enhance privacy protections so that you are not forced to choose between using LBS and keeping control of your private information

Making Smart Decisions About Surveillance: A Guide for Communities

California communities are increasingly grappling with whether to deploy new surveillance technologies ranging from drones to license plate readers to facial recognition. This is understandable, since public safety budgets are tight, technology vendors promise the ability to do more with less, and federal agencies or industry sponsors may even offer funding. But surveillance can be both less effective and far more costly to local agencies and to the community at large than initially imagined, leaving communities saddled with long-term bills for surveillance that doesn\u27t end up making the community safer. Surveillance can also be easily misused, leading to the erosion of community trust, bad press, and even costly lawsuits. In the wake of the revelations about the National Security Agency’s rampant warrantless spying and the use of military equipment in Ferguson, Missouri to quell protests, communities are increasingly focused on the need for greater transparency, oversight, and accountability of surveillance and local policing. More than ever, people are aware of how billions of dollars in federal funding and equipment provided directly to law enforcement is circumventing normal democratic processes and preventing communities from thoroughly evaluating the costs and risks of surveillance. As a result, many community leaders and residents are no longer willing to heed local law enforcement’s call to “just trust us.” Instead, leaders and residents want to know when and why surveillance is being considered, what it is intended to do, and what it will really cost — both in dollars and in individual rights — before taking any steps to seek funding or acquire or deploy surveillance technology. They also want to craft robust rules to ensure proper use, oversight, and accountability if surveillance is used. Unfortunately, few resources exist to help communities make thoughtful decisions about surveillance. That’s where this document comes in. This first-of-its-kind guide provides step-by-step assistance to help communities ask and answer the right questions about surveillance. It includes case studies highlighting smart approaches and missteps to avoid. Because each community and each type of surveillance may present a different set of issues, there is no one-size-fits-all solution. Instead, this guide gives communities a flexible framework that policymakers, community members and law enforcement should use to properly evaluate a wide array of surveillance technologies and develop policies that provide transparency, oversight, and accountability. It also includes a Surveillance & Community Safety Ordinance that communities should adopt to ensure that the right process is followed every time

Design and baseline characteristics of the finerenone in reducing cardiovascular mortality and morbidity in diabetic kidney disease trial

Background: Among people with diabetes, those with kidney disease have exceptionally high rates of cardiovascular (CV) morbidity and mortality and progression of their underlying kidney disease. Finerenone is a novel, nonsteroidal, selective mineralocorticoid receptor antagonist that has shown to reduce albuminuria in type 2 diabetes (T2D) patients with chronic kidney disease (CKD) while revealing only a low risk of hyperkalemia. However, the effect of finerenone on CV and renal outcomes has not yet been investigated in long-term trials. Patients and Methods: The Finerenone in Reducing CV Mortality and Morbidity in Diabetic Kidney Disease (FIGARO-DKD) trial aims to assess the efficacy and safety of finerenone compared to placebo at reducing clinically important CV and renal outcomes in T2D patients with CKD. FIGARO-DKD is a randomized, double-blind, placebo-controlled, parallel-group, event-driven trial running in 47 countries with an expected duration of approximately 6 years. FIGARO-DKD randomized 7,437 patients with an estimated glomerular filtration rate >= 25 mL/min/1.73 m(2) and albuminuria (urinary albumin-to-creatinine ratio >= 30 to <= 5,000 mg/g). The study has at least 90% power to detect a 20% reduction in the risk of the primary outcome (overall two-sided significance level alpha = 0.05), the composite of time to first occurrence of CV death, nonfatal myocardial infarction, nonfatal stroke, or hospitalization for heart failure. Conclusions: FIGARO-DKD will determine whether an optimally treated cohort of T2D patients with CKD at high risk of CV and renal events will experience cardiorenal benefits with the addition of finerenone to their treatment regimen. Trial Registration: EudraCT number: 2015-000950-39; ClinicalTrials.gov identifier: NCT02545049

Impact of opioid-free analgesia on pain severity and patient satisfaction after discharge from surgery: multispecialty, prospective cohort study in 25 countries

Background: Balancing opioid stewardship and the need for adequate analgesia following discharge after surgery is challenging. This study aimed to compare the outcomes for patients discharged with opioid versus opioid-free analgesia after common surgical procedures.Methods: This international, multicentre, prospective cohort study collected data from patients undergoing common acute and elective general surgical, urological, gynaecological, and orthopaedic procedures. The primary outcomes were patient-reported time in severe pain measured on a numerical analogue scale from 0 to 100% and patient-reported satisfaction with pain relief during the first week following discharge. Data were collected by in-hospital chart review and patient telephone interview 1 week after discharge.Results: The study recruited 4273 patients from 144 centres in 25 countries; 1311 patients (30.7%) were prescribed opioid analgesia at discharge. Patients reported being in severe pain for 10 (i.q.r. 1-30)% of the first week after discharge and rated satisfaction with analgesia as 90 (i.q.r. 80-100) of 100. After adjustment for confounders, opioid analgesia on discharge was independently associated with increased pain severity (risk ratio 1.52, 95% c.i. 1.31 to 1.76; P &lt; 0.001) and re-presentation to healthcare providers owing to side-effects of medication (OR 2.38, 95% c.i. 1.36 to 4.17; P = 0.004), but not with satisfaction with analgesia (beta coefficient 0.92, 95% c.i. -1.52 to 3.36; P = 0.468) compared with opioid-free analgesia. Although opioid prescribing varied greatly between high-income and low- and middle-income countries, patient-reported outcomes did not.Conclusion: Opioid analgesia prescription on surgical discharge is associated with a higher risk of re-presentation owing to side-effects of medication and increased patient-reported pain, but not with changes in patient-reported satisfaction. Opioid-free discharge analgesia should be adopted routinely

Omecamtiv mecarbil in chronic heart failure with reduced ejection fraction, GALACTIC‐HF: baseline characteristics and comparison with contemporary clinical trials

Aims: The safety and efficacy of the novel selective cardiac myosin activator, omecamtiv mecarbil, in patients with heart failure with reduced ejection fraction (HFrEF) is tested in the Global Approach to Lowering Adverse Cardiac outcomes Through Improving Contractility in Heart Failure (GALACTIC‐HF) trial. Here we describe the baseline characteristics of participants in GALACTIC‐HF and how these compare with other contemporary trials. Methods and Results: Adults with established HFrEF, New York Heart Association functional class (NYHA) ≥ II, EF ≤35%, elevated natriuretic peptides and either current hospitalization for HF or history of hospitalization/ emergency department visit for HF within a year were randomized to either placebo or omecamtiv mecarbil (pharmacokinetic‐guided dosing: 25, 37.5 or 50 mg bid). 8256 patients [male (79%), non‐white (22%), mean age 65 years] were enrolled with a mean EF 27%, ischemic etiology in 54%, NYHA II 53% and III/IV 47%, and median NT‐proBNP 1971 pg/mL. HF therapies at baseline were among the most effectively employed in contemporary HF trials. GALACTIC‐HF randomized patients representative of recent HF registries and trials with substantial numbers of patients also having characteristics understudied in previous trials including more from North America (n = 1386), enrolled as inpatients (n = 2084), systolic blood pressure &lt; 100 mmHg (n = 1127), estimated glomerular filtration rate &lt; 30 mL/min/1.73 m2 (n = 528), and treated with sacubitril‐valsartan at baseline (n = 1594). Conclusions: GALACTIC‐HF enrolled a well‐treated, high‐risk population from both inpatient and outpatient settings, which will provide a definitive evaluation of the efficacy and safety of this novel therapy, as well as informing its potential future implementation

The evolving SARS-CoV-2 epidemic in Africa: Insights from rapidly expanding genomic surveillance

INTRODUCTION Investment in Africa over the past year with regard to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) sequencing has led to a massive increase in the number of sequences, which, to date, exceeds 100,000 sequences generated to track the pandemic on the continent. These sequences have profoundly affected how public health officials in Africa have navigated the COVID-19 pandemic. RATIONALE We demonstrate how the first 100,000 SARS-CoV-2 sequences from Africa have helped monitor the epidemic on the continent, how genomic surveillance expanded over the course of the pandemic, and how we adapted our sequencing methods to deal with an evolving virus. Finally, we also examine how viral lineages have spread across the continent in a phylogeographic framework to gain insights into the underlying temporal and spatial transmission dynamics for several variants of concern (VOCs). RESULTS Our results indicate that the number of countries in Africa that can sequence the virus within their own borders is growing and that this is coupled with a shorter turnaround time from the time of sampling to sequence submission. Ongoing evolution necessitated the continual updating of primer sets, and, as a result, eight primer sets were designed in tandem with viral evolution and used to ensure effective sequencing of the virus. The pandemic unfolded through multiple waves of infection that were each driven by distinct genetic lineages, with B.1-like ancestral strains associated with the first pandemic wave of infections in 2020. Successive waves on the continent were fueled by different VOCs, with Alpha and Beta cocirculating in distinct spatial patterns during the second wave and Delta and Omicron affecting the whole continent during the third and fourth waves, respectively. Phylogeographic reconstruction points toward distinct differences in viral importation and exportation patterns associated with the Alpha, Beta, Delta, and Omicron variants and subvariants, when considering both Africa versus the rest of the world and viral dissemination within the continent. Our epidemiological and phylogenetic inferences therefore underscore the heterogeneous nature of the pandemic on the continent and highlight key insights and challenges, for instance, recognizing the limitations of low testing proportions. We also highlight the early warning capacity that genomic surveillance in Africa has had for the rest of the world with the detection of new lineages and variants, the most recent being the characterization of various Omicron subvariants. CONCLUSION Sustained investment for diagnostics and genomic surveillance in Africa is needed as the virus continues to evolve. This is important not only to help combat SARS-CoV-2 on the continent but also because it can be used as a platform to help address the many emerging and reemerging infectious disease threats in Africa. In particular, capacity building for local sequencing within countries or within the continent should be prioritized because this is generally associated with shorter turnaround times, providing the most benefit to local public health authorities tasked with pandemic response and mitigation and allowing for the fastest reaction to localized outbreaks. These investments are crucial for pandemic preparedness and response and will serve the health of the continent well into the 21st century