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BACKGROUND & AIMS: Previous studies have shown an increasing incidence of pancreatic cancer (PC), especially in younger women; however, this has not been externally validated. In addition, there are limited data about contributing factors to this trend. We report age and sex-specific time-trend analysis of PC age-adjusted incidence rates (aIRs) using the National Program of Cancer Registries database without Surveillance Epidemiology and End Results data. METHODS: PC aIR, mortality rates, annual percentage change, and average annual percentage change (AAPC) were calculated and assessed for parallelism and identicalness. Age-specific analyses were conducted in older (≥55 years) and younger (200% difference), and it did not show slowing down.

Science, technology, engineering, and mathematics (STEM) career barriers persist for individuals from marginalized communities due to financial and educational inequality, unconscious bias, and other disadvantaging factors. To evaluate differences in plans and interests between historically underrepresented (UR) and well-represented (WR) groups, we surveyed more than 3000 undergraduates enrolled in chemistry courses. Survey responses showed all groups arrived on campus with similar interests in learning more about science research. Over the 4 years of college, WR students maintained their interest levels, but UR students did not, creating a widening gap between the groups. Without intervention, UR students participated in lab research at lower rates than their WR peers. A case study pilot program, Biosciences Collaborative for Research Engagement (BioCoRE), encouraged STEM research exploration by undergraduates from marginalized communities. BioCoRE provided mentoring and programming that increased community cohesion and cultivated students' intrinsic scientific mindsets. Our data showed that there was no statistical significant difference between BioCoRE WR and UR students when surveyed about plans for a medical profession, graduate school, and laboratory scientific research. In addition, BioCoRE participants reported higher levels of confidence in conducting research than non-BioCoRE Scholars. We now have the highest annual number of UR students moving into PhD programs in our institution's history.

The emergence of ecosystem-based fisheries management (EBFM) has broadened the policy scope of fisheries management by accounting for the biological and ecological connectivity of fisheries. Less attention, however, has been given to the economic connectivity of fisheries. If fishers consider multiple fisheries when deciding where, when, and how much to fish, then management changes in one fishery can generate spillover impacts in other fisheries. Catch-share programs are a popular fisheries management framework that may be particularly prone to generating spillovers given that they typically change fishers' incentives and their subsequent actions. We use data from Alaska fisheries to examine spillovers from each of the main catch-share programs in Alaska. We evaluate changes in participation-a traditional indicator in fisheries economics-in both the catch-share and non-catch-share fisheries. Using network analysis, we also investigate whether catch-share programs change the economic connectivity of fisheries, which can have implications for the socioeconomic resilience and robustness of the ecosystem, and empirically identify the set of fisheries impacted by each Alaska catch-share program. We find that cross-fishery participation spillovers and changes in economic connectivity coincide with some, but not all, catch-share programs. Our findings suggest that economic connectivity and the potential for cross-fishery spillovers deserve serious consideration, especially when designing and evaluating EBFM policies.

[This corrects the article DOI: 10.1038/s41746-017-0002-4.].

Despite growing interest in remote patient monitoring, limited evidence exists to substantiate claims of its ability to improve outcomes. Our aim was to evaluate randomized controlled trials (RCTs) that assess the effects of using wearable biosensors (e.g. activity trackers) for remote patient monitoring on clinical outcomes. We expanded upon prior reviews by assessing effectiveness across indications and presenting quantitative summary data. We searched for articles from January 2000 to October 2016 in PubMed, reviewed 4,348 titles, selected 777 for abstract review, and 64 for full text review. A total of 27 RCTs from 13 different countries focused on a range of clinical outcomes and were retained for final analysis; of these, we identified 16 high-quality studies. We estimated a difference-in-differences random effects meta-analysis on select outcomes. We weighted the studies by sample size and used 95% confidence intervals (CI) around point estimates. Difference-in-difference point estimation revealed no statistically significant impact of remote patient monitoring on any of six reported clinical outcomes, including body mass index (-0.73; 95% CI: -1.84, 0.38), weight (-1.29; -3.06, 0.48), waist circumference (-2.41; -5.16, 0.34), body fat percentage (0.11; -1.56, 1.34), systolic blood pressure (-2.62; -5.31, 0.06), and diastolic blood pressure (-0.99; -2.73, 0.74). Studies were highly heterogeneous in their design, device type, and outcomes. Interventions based on health behavior models and personalized coaching were most successful. We found substantial gaps in the evidence base that should be considered before implementation of remote patient monitoring in the clinical setting.

ObjectivesAcute pancreatitis has a highly variable course. Currently there is no widely accepted method to measure disease activity in patients hospitalized for acute pancreatitis. We aimed to develop a clinical activity index that incorporates routine clinical parameters to assist in the measurement, study, and management of acute pancreatitis.MethodsWe used the UCLA/RAND appropriateness method to identify items for inclusion in the disease activity instrument. We conducted a systematic literature review followed by two sets of iterative modified Delphi meetings including a panel of international experts between November 2014 and November 2015. The final instrument was then applied to patient data obtained from five separate study cohorts across Southern California to assess profiles of disease activity.ResultsFrom a list of 35 items comprising 6 domains, we identified 5 parameters for inclusion in the final weighted clinical activity scoring system: organ failure, systemic inflammatory response syndrome, abdominal pain, requirement for opiates and ability to tolerate oral intake. We applied the weighted scoring system across the 5 study cohorts comprising 3,123 patients. We identified several distinct patterns of disease activity: (i) overall there was an elevated score at baseline relative to discharge across all study cohorts, (ii) there were distinct patterns of disease activity related to duration of illness as well as (iii) early and persistent elevation of disease activity among patients with severe acute pancreatitis defined as persistent organ failure.ConclusionsWe present the development and initial validation of a clinical activity score for real-time assessment of disease activity in patients with acute pancreatitis.

The Cook Inlet beluga whale (CIBW) is an endangered whale found in waters off the state of Alaska that is protected under the U.S. Endangered Species Act. The federal recovery plan estimates recovery costs will total $73 million (in 2013 dollars). In this study, we use data from a stated preference discrete choice experiment (CE) study to estimate the aggregate benefits of recovering the CIBW and generally for improving its conservation status and reducing extinction risk. Estimated CE models account and test for utility scale heterogeneity, attribute non-attendance, self-selection bias, and demographic effects. Aggregation methods that differ in adjustments made to the mean household welfare and/or to the number of population units are compared by assessing their impact on the resulting aggregate (population-level) welfare estimates. Alaska households are willing to pay between $34 million (95% CI of [$25 million, $44 million]) and $103 million ([$74 million, $131 million]) for full recovery of the CIBW, depending upon the model and aggregation assumptions. While some of the state-level recovery value estimates are below the total cost of combined federal and state recovery actions, accounting for welfare benefits beyond the state of Alaska justifies recovery actions by the benefit–cost criterion. [ABSTRACT FROM AUTHOR]

Many fishers own a portfolio of permits across multiple fisheries, creating an opportunity for fishing effort to adjust across fisheries and enabling impacts from a policy change in one fishery to spill over into other fisheries. In regions with a large and diverse number of permits and fisheries, joint-permitting can result in a complex system, making it difficult to understand the potential for cross-fishery substitution. In this study, we construct a network representation of permit ownership to characterize interconnectedness among Alaska commercial fisheries due to cross-fishery permitting. The Alaska fisheries network is highly connected, suggesting that most fisheries are vulnerable to cross-fishery spillovers from network shocks, such as changes to policies or fish stocks. We find that fisheries with similar geographic proximity are more likely to be a part of a highly connected cluster of susceptible fisheries. We use a case study to show that preexisting network statistics can be useful for identifying the potential scope of policy-induced spillovers. Our results demonstrate that network analysis can improve our understanding of the potential for policy-induced cross-fishery spillovers.De nombreux pecheurs detiennent un portefeuille de permis pour differentes peches, ce qui offre la possibility d'ajuster l'effort de peche sur differentes peches et fait en sorte que les impacts de changements de politiques concernant une peche peuvent se propager a d'autres peches. Dans les regions caracterisees par un grand nombre de permis et de peches varies, les permis conjoints peuvent se traduire par un systeme complexe qui rend difficile la comprehension du potentiel de substitution entre peches. Nous elaborons une representation en reseau de la propriete de permis pour caracteriser l'interconnexion entre les peches commerciales en Alaska decoulant de la delivrance de permis pour differentes peches. Le reseau des peches en Alaska est hautement connecte, ce qui donne a penser que la plupart des peches sont vulnerables a la propagation d'impacts decoulant de chocs sur le reseau, comme des changements de politiques ou aux stocks de poissons. Nous constatons que les peches caracterisees par une proximite geographique similaire sont plus susceptibles de faire partie d'un groupement hautement connecte de peches vulnerables. Nous employons une etude de case pour demontrer que des statistiques preexistantes sur le reseau peuvent etre utiles pour etablir la portee potentielle d'effets de propagation induits par des changements de politiques. Nos resultats demontrent que l'analyse de reseau peut ameliorer la comprehension du potentiel d'effets de propagation entre peches decoulant des politiques. [Traduit par la Redaction], IntroductionMost commercial fishery policies are directed towards a single species in a particular region and caught by a certain gear, even though fishers participate in multiple regions, catch multiple species, [...]