HRS white paper on clinical utilization of digital health technology.

This collaborative statement from the Digital Health Committee of the Heart Rhythm Society provides everyday clinical scenarios in which wearables may be utilized by patients for cardiovascular health and arrhythmia management. We describe herein the spectrum of wearables that are commercially available for patients, and their benefits, shortcomings and areas for technological improvement. Although wearables for rhythm diagnosis and management have not been examined in large randomized clinical trials, undoubtedly the usage of wearables has quickly escalated in clinical practice. This document is the first of a planned series in which we will update information on wearables as they are revised and released to consumers

Strategic Operational Redesign Improves Prior Authorization Access: A Validation Study

Purpose: Obtaining prior authorization (PA) before treatment is becoming increasingly burdensome in oncology, especially in radiation oncology. Here, we describe the impact of a strategic novel operational PA redesign to shorten authorization time and to improve patient access to cancer care at a large United States academic proton therapy center. We ask whether such a redesign may be replicable and adoptable across oncology centers. Materials and Methods: Our PA redesign strategy was based on a 3-tiered approach. Specifically, we (1) held payors accountable to legally backed timelines, (2) leveraged expertise on insurance policies and practices, and (3) updated the submission, appeal writing, and planning procedures for PA. Metrics were compared at the following 3 time points: 6 months before, at phase-in, and at 6 months after intervention. Results: In analyzing the impact of improving PA access to care, the percentage of approvals for commercial proton beam therapy improved by an absolute 30.6% postintervention (P < .001). The proportion of commercially insured patients treated with proton beam therapy also increased by 6.2%, and the number of new starts rose by 11.7 patients/mo. Overall patient census increased by 13 patients/d. Median authorization time was 1 week, and 90% of surveyed providers reported reduced PA burden and improved patient care. Conclusion: This is the first validated, comprehensive operational strategy to improve access to cancer therapy while reducing the burden of PA. This novel approach may be helpful for addressing barriers to PA in medical and surgical oncology because the redesign is predicated on laws that regulate PA across disciplines

Abundance signals of amphibians and reptiles indicate strong edge effects in Neotropical fragmented forest landscapes

Fragmentation and habitat loss contribute considerably to global declines of amphibians and reptiles. However, few studies focus on forest edges, created during the fragmentation process, as proximate drivers of the local demographic structure of populations. Here, we use abundance data of amphibians and reptiles to study their responses to forest edges in nine fragmented forested landscapes of the Neotropics. Species-specific abundance data were collected in plots established at varying distances from their respective nearest forest edge. We tested for edge effects on the abundance of species, and used curve clustering techniques to group species with similar edge responses, i.e. species with either increasing or decreasing abundance from the matrix towards the forest interior. We also grouped species that showed no change in abundance with respect to the nearest forest edge and those whose abundance response was unimodal, peaking in either forest habitat or the surrounding matrix habitat. We found that 96% of all amphibians and 90% of all reptiles showed an edge response, with the abundance of 74.5% of amphibians and 57.3% of reptiles decreasing with increasing proximity to forest edges. However, species-specific edge effects were not always consistent, with some species having opposite edge responses when measured in different landscapes. The depth of edge effects exhibited by forest species, i.e. species that increased in abundance in the forest interior, extended up to one kilometre away from forest edges. We show that the median edge effect on forest species extends to 250 m within the forest interior, indicating that tropical forest patches with a mean diameter < 500 m (minimum area ≈ 78 ha) are unsuitable for half of forest-dependent species considered in this study

Global protected area expansion is compromised by projected land-use and parochialism

Peer reviewe

Tumor Volumes and Prognosis in Laryngeal Cancer

Tumor staging systems for laryngeal cancer (LC) have been developed to assist in estimating prognosis after treatment and comparing treatment results across institutions. While the laryngeal TNM system has been shown to have prognostic information, varying cure rates in the literature have suggested concern about the accuracy and effectiveness of the T-classification in particular. To test the hypothesis that tumor volumes are more useful than T classification, we conducted a retrospective review of 78 patients with laryngeal cancer treated with radiation therapy at our institution. Using multivariable analysis, we demonstrate the significant prognostic value of anatomic volumes in patients with previously untreated laryngeal cancer. In this cohort, primary tumor volume (GTVP), composite nodal volumes (GTVN) and composite total volume (GTVP + GTVN = GTVC) had prognostic value in both univariate and multivariate cox model analysis. Interestingly, when anatomic volumes were measured from CT scans after a single cycle of induction chemotherapy, all significant prognosticating value for measured anatomic volumes was lost. Given the literature findings and the results of this study, the authors advocate the use of tumor anatomic volumes calculated from pretreatment scans to supplement the TNM staging system in subjects with untreated laryngeal cancer. The study found that tumor volume assessment after induction chemotherapy is not of prognostic significance