An electronic registry to improve adherence to active surveillance monitoring among men with prostate cancer at a safety-net hospital: protocol for a pilot study.

BackgroundThe evidence-based practice of active surveillance to monitor men with favorable-risk prostate cancer in lieu of initial definitive treatment is becoming more common. However, there are barriers to effective implementation, particularly in low-resource settings. Our goal is to assess the efficacy and feasibility of a health information technology registry for men on active surveillance at a safety-net hospital to ensure patients receive guideline-recommended care.MethodsWe developed an electronic registry for urology clinic staff to monitor men on active surveillance. The health information technology tool was developed using the Systems Engineering Initiative for Patient Safety model and iteratively tailored to the needs of the clinic by engaging providers in a co-design process. We will enroll all men at Zuckerberg San Francisco General Hospital and Trauma Center who choose active surveillance as a treatment strategy. The primary outcomes to be assessed during this non-randomized, pragmatic evaluation are number of days delayed beyond recommended date of follow-up testing, the proportion of men who are lost to follow-up, the cancer stage at active treatment, and the feasibility and acceptability of the clinic-wide intervention with clinic staff. Secondary outcomes include appointment adherence within 30 days of the scheduled date.DiscussionUse of a customized electronic approach for monitoring men on active surveillance could improve patient outcomes. It may help reduce the number of men lost to follow-up and improve adherence to timely follow-up testing. Evaluating the adoption and efficacy of a customized registry in a safety-net setting may also demonstrate feasibility for implementation in diverse clinical contexts.Trial registrationClinicalTrials.gov identifier NCT03553732, An Electronic Registry to Improve Adherence to Active Surveillance Monitoring at a Safety-net Hospital. Registered 11 June 2018

Simulation of integrate-and-fire neuron circuits using HfO₂-based ferroelectric field effect transistors

Inspired by neurobiological systems, Spiking Neural Networks (SNNs) are gaining an increasing interest in the field of bio-inspired machine learning. Neurons, as central processing and short-term memory units of biological neural systems, are thus at the forefront of cutting-edge research approaches. The realization of CMOS circuits replicating neuronal features, namely the integration of action potentials and firing according to the all-or-nothing law, imposes various challenges like large area and power consumption. The non-volatile storage of polarization states and accumulative switching behavior of nanoscale HfO₂ - based Ferroelectric Field-Effect Transistors (FeFETs), promise to circumvent these issues. In this paper, we propose two FeFET-based neuronal circuits emulating the Integrate-and-Fire (I&F) behavior of biological neurons on the basis of SPICE simulations. Additionally, modulating the depolarization of the FeFETs enables the replication of a biology-based concept known as membrane leakage. The presented capacitor-free implementation is crucial for the development of neuromorphic systems that allow more complex features at a given area and power constraint

Influence of Castor canadensis on northern lower Michigan forest succession

General EcologyForests undergo a natural progression, called ecological succession, in which they experience a gradual change in community species composition (Luken 1990). As the tree community cycles through each stage of succession, the surrounding habitat cycles and transforms with it (Barnes and Wagner 2004). Our study focuses on how Castor canadensis (North American beaver) affects the direction of forest succession in northern lower Michigan. We counted, identified, and measured the diameter of standing and felled trees at four known beaver sites in the vicinity of Pellston, MI. In addition, we counted and identified 50 randomly selected juvenile trees at each site. Our results showed that C. Canadensis have a preference for Populus tremuloides (trembling aspen) (chi-square: p=0.008) and early successional tree species (chi-square: p=0.000) and show no foraging preference based on tree diameter (Mann-Whitney U: p=0.109). By comparing adult tree species to juvenile tree species, we also found that the species composition prior to and during beaver interference differs significantly from future forest species composition (chi-square: p=0.016). Given these results, we conclude that the foraging preferences of C. canadensis caused a premature progression of forest succession.http://deepblue.lib.umich.edu/bitstream/2027.42/78379/1/Breyer_Ruddy_Silver_2010.pd

Precautionary Regulation in Europe and the United States: A Quantitative Comparison

Much attention has been addressed to the question of whether Europe or the United States adopts a more precautionary stance to the regulation of potential environmental, health, and safety risks. Some commentators suggest that Europe is more risk-averse and precautionary, whereas the US is seen as more risk-taking and optimistic about the prospects for new technology. Others suggest that the US is more precautionary because its regulatory process is more legalistic and adversarial, while Europe is more lax and corporatist in its regulations. The flip-flop hypothesis claims that the US was more precautionary than Europe in the 1970s and early 1980s, and that Europe has become more precautionary since then. We examine the levels and trends in regulation of environmental, health, and safety risks since 1970. Unlike previous research, which has studied only a small set of prominent cases selected non-randomly, we develop a comprehensive list of almost 3,000 risks and code the relative stringency of regulation in Europe and the US for each of 100 risks randomly selected from that list for each year from 1970 through 2004. Our results suggest that: (a) averaging over risks, there is no significant difference in relative precaution over the period, (b) weakly consistent with the flip-flop hypothesis, there is some evidence of a modest shift toward greater relative precaution of European regulation since about 1990, although (c) there is a diversity of trends across risks, of which the most common is no change in relative precaution (including cases where Europe and the US are equally precautionary and where Europe or the US has been consistently more precautionary). The overall finding is of a mixed and diverse pattern of relative transatlantic precaution over the period

An Assessment of the Representation of Ecosystems in Global Protected Areas Using New Maps of World Climate Regions and World Ecosystems

Representation of ecosystems in protected area networks and conservation strategies is a core principle of global conservation priority setting approaches and a commitment in Aichi Target 11 of the Convention on Biological Diversity. The 2030 Sustainable Development Goals (SDGs) explicitly call for the conservation of terrestrial, freshwater, and marine ecosystems. Accurate ecosystem distribution maps are required to assess representation of ecosystems in protected areas, but standardized, high spatial resolution, and globally comprehensive ecosystem maps have heretofore been lacking. While macroscale global ecoregions maps have been used in global conservation priority setting exercises, they do not identify distinct localized ecosystems at the occurrence (patch) level, and instead describe large ecologically meaningful areas within which additional conservation planning and management are necessary. We describe a new set of maps of globally consistent climate regions and ecosystems at a much finer spatial resolution (250 m) than existing ecological regionalizations. We then describe a global gap analysis of the representation of these ecosystems in protected areas. The new map of terrestrial World Ecosystems was derived from the objective development and integration of 1) global temperature domains, 2) global moisture domains, 3) global landforms, and 4) 2015 global vegetation and land use. These new terrestrial World Ecosystems do not include either freshwater or marine ecosystems, but analog products for the freshwater and marine domains are in development. A total of 431 World Ecosystems were identified, and of these a total of 278 units were natural or semi-natural vegetation/environment combinations, including different kinds of forestlands, shrublands, grasslands, bare areas, and ice/snow regions. The remaining classes were different kinds of croplands and settlements. Of the 278 natural and semi-natural classes, 9 were not represented in global protected areas with a strict biodiversity conservation management objective (IUCN management categories I-IV), and an additional 206 were less than 8.5% protected (half way to the 17% Aichi Target 11 goal). Forty four classes were between 8.5% and 17% protected (more than half way towards the Aichi 17% target), and only 19 classes exceeded the 17% Aichi target. However, when all protected areas (IUCN management categories I-VI plus protected areas with no IUCN designation) were included in a separate global gap analysis, representation of ecosystems increases substantially, with a third of the ecosystems exceeding the 17% Aichi target, and another third between 8.5% and 17%. The overall protection (representation) of global ecosystems in protected areas is considerably less when assessed using only strictly conserved protected areas, and more if all protected areas are included in the analysis. Protected area effectiveness should be included in further evaluations of global ecosystem protection. The ecosystems with the highest representation in protected areas were often bare or sparsely vegetated and found in inhospitable environments (e.g. cold mountains, deserts), and the eight most protected ecosystems were all snow and ice ecosystems. In addition to the global gap analysis of World Ecosystems in protected areas, we report on the representation results for the ecosystems in each biogeographic realm (Neotropical, Nearctic, Afrotropical, Palearctic, Indomalayan, Australasian, and Oceania)

A Proposed Process for Managing the First Amendment Aspects of Campus Hate Speech

For public institutions, attempts to regulate hate speech raise substantial legal issues under the First Amendment of the U.S. Constitution. For private institutions, which may not be bound by the First Amendment, attempts to regulate hate speech raise sensitive policy questions concerning the role of free expression on campus. Numerous articles (many of which are listed in the references below) have undertaken substantive analysis of these constitutional issues and policy questions. In contrast, this article explores a preliminary and overarching concern: the process by which a college or university addresses the problem of hate speech, and in particular the process by which the institution manages the First Amendment aspects of the problem. In other words, this article focuses on the decision-making process rather than on the decisions themselves; it is the journey, not the destination, that is of primary concern

Prediction of Dengue Incidence Using Search Query Surveillance

Improvements in surveillance, prediction of outbreaks and the monitoring of the epidemiology of dengue virus in countries with underdeveloped surveillance systems are of great importance to ministries of health and other public health decision makers who are often constrained by budget or man-power. Google Flu Trends has proven successful in providing an early warning system for outbreaks of influenza weeks before case data are reported. We believe that there is greater potential for this technique for dengue, as the incidence of this pathogen can vary by a factor of ten in some settings, making prediction all the more important in public health planning. In this paper, we demonstrate the utility of Google search terms in predicting dengue incidence in Singapore and Bangkok, Thailand using several regression techniques. Incidence data were provided by the Singapore Ministry of Health and the Thailand Bureau of Epidemiology. We find our models predict incident cases well (correlation greater than 0.8) and periods of high incidence equally well (AUC greater than 0.95). All data and analysis code used in our study are available free online and can be adapted to other settings