Preferences for genetic testing to predict risk of developing hereditary cancer: A systematic review of discrete choice experiments

This is the final version. Available from SAGE Publications via the DOI in this record. Background. Understanding service user preferences is key to effective health care decision making and efficient resource allocation. It is of particular importance in the management of high-risk patients in whom predictive genetic testing can alter health outcomes. Purpose. This review aims to identify the relative importance and willingness to pay for attributes of genetic testing in hereditary cancer syndromes. Data Sources. Searches were conducted in Medline, Embase, PsycINFO, HMIC, Web of Science, and EconLit using discrete choice experiment (DCE) terms combined with terms related to hereditary cancer syndromes, malignancy synonyms, and genetic testing. Study Selection. Following independent screening by 3 reviewers, 7 studies fulfilled the inclusion criteria, being a DCE investigating patient or public preferences related to predictive genetic testing for hereditary cancer syndromes. Data Extraction. Extracted data included study and respondent characteristics, DCE attributes and levels, methods of data analysis and interpretation, and key study findings. Data Synthesis. Studies covered colorectal, breast, and ovarian cancer syndromes. Results were summarized in a narrative synthesis and the quality assessed using the Lancsar and Louviere framework. Limitations. This review focuses only on DCE design and testing for hereditary cancer syndromes rather than other complex diseases. Challenges also arose from heterogeneity in attributes and levels. Conclusions. Test effectiveness and detection rates were consistently important to respondents and thus should be prioritized by policy makers. Accuracy, cost, and wait time, while also important, showed variation between studies, although overall reduction in cost may improve uptake. Patients and the public would be willing to pay for improved detection and clinician over insurance provider involvement. Future studies should seek to contextualize findings by considering the impact of sociodemographic characteristics, health system coverage, and insurance policies on preferences

Uncertain pasts and risk-sensitive futures in sub-Saharan urban transformation

This chapter explores the status and the scope for transition of risk- sensitive and transformative urban development in diverse cities of sub-Saharan Africa. Sub-Saharan Africa is important because of its large proportions of urban populations with high vulnerability and growing exposure to risks. High rates of urban growth pose increasing risks as we go into the future, yet there is also opportunity to reduce risk through integrating risk management into development. However, this opportunity space is often constrained by limited capacities to plan and manage the rapid urbanisation process, particularly in informal settlements. Limited capacities to prevent processes of risk accumulation pose threats to poverty reduction and sustainable development. In this context, there is an increasingly urgent need for squarely recognising and addressing the underlying vulnerabilities of urban populations and their root causes. Transitioning towards such sustainable urban pathways will require the strengthening of capacities and accountability of city authorities and broader governance systems, both formal and informal

Community-Based Climate Change Adaptation Action Plans to Support Climate-Resilient Development in the Eastern African Highlands

Smallholder farmers in the Eastern African Highlands depend on rain-fed agriculture for their livelihoods. Climate adaptation and sustainable development goals must be targeted in an integrated way to better match farmers’ realities and address local priorities and vulnerabilities in these areas. To support climate-resilient development in the Eastern African Highlands, 224 local stakeholders were engaged in the development of community-based climate change adaptation action plans for the Jimma Highlands in Ethiopia, Taita Hills in Kenya and Mount Kilimanjaro in Tanzania. Participatory methods, high-resolution climate projections and the United Nations Development Programme’s (UNDP’s) guidelines were used in the design of these climate action plans with specific objectives to: 1) engage stakeholders to increase understanding of climate change impacts, adaptation options and their potential trade-offs, 2) build their capacities to design climate change adaptation projects, 3) empower stakeholders to identify existing vulnerabilities and enhance climate resilience and 4) strengthen networks to facilitate information access and sharing. Increased risk of water stress and reduction of agricultural productivity were the most frequently identified climate-change-induced problems in the three areas. The developed action plans target the underlying causes of these problems and describe sector-specific responses, activities, critical barriers and opportunities and support the National Adaptation Programmes of Action.Peer reviewe

A Meta-Analysis of Global Urban Land Expansion

The conversion of Earth's land surface to urban uses is one of the most irreversible human impacts on the global biosphere. It drives the loss of farmland, affects local climate, fragments habitats, and threatens biodiversity. Here we present a meta-analysis of 326 studies that have used remotely sensed images to map urban land conversion. We report a worldwide observed increase in urban land area of 58,000 km2 from 1970 to 2000. India, China, and Africa have experienced the highest rates of urban land expansion, and the largest change in total urban extent has occurred in North America. Across all regions and for all three decades, urban land expansion rates are higher than or equal to urban population growth rates, suggesting that urban growth is becoming more expansive than compact. Annual growth in GDP per capita drives approximately half of the observed urban land expansion in China but only moderately affects urban expansion in India and Africa, where urban land expansion is driven more by urban population growth. In high income countries, rates of urban land expansion are slower and increasingly related to GDP growth. However, in North America, population growth contributes more to urban expansion than it does in Europe. Much of the observed variation in urban expansion was not captured by either population, GDP, or other variables in the model. This suggests that contemporary urban expansion is related to a variety of factors difficult to observe comprehensively at the global level, including international capital flows, the informal economy, land use policy, and generalized transport costs. Using the results from the global model, we develop forecasts for new urban land cover using SRES Scenarios. Our results show that by 2030, global urban land cover will increase between 430,000 km2 and 12,568,000 km2, with an estimate of 1,527,000 km2 more likely

Array-Based Whole-Genome Survey of Dog Saliva DNA Yields High Quality SNP Data

Background: Genome-wide association scans for genetic loci underlying both Mendelian and complex traits are increasingly common in canine genetics research. However, the demand for high-quality DNA for use on such platforms creates challenges for traditional blood sample ascertainment. Though the use of saliva as a means of collecting DNA is common in human studies, alternate means of DNA collection for canine research have instead been limited to buccal swabs, from which dog DNA is of insufficient quality and yield for use on most high-throughput array-based systems. We thus investigated an animal-based saliva collection method for ease of use and quality of DNA obtained and tested the performance of saliva-extracted canine DNA on genome-wide genotyping arrays. Methodology/Principal Findings: Overall, we found that saliva sample collection using this method was efficient. Extractions yielded high concentrations (,125 ng/ul) of high-quality DNA that performed equally well as blood-extracted DNA on the Illumina Infinium canine genotyping platform, with average call rates.99%. Concordance rates between genotype calls of saliva- versus blood-extracted DNA samples from the same individual were also.99%. Additionally, in silico calling of copy number variants was successfully performed and verified by PCR. Conclusions/Significance: Our findings validate the use of saliva-obtained samples for genome-wide association studies i

Testing the efficacy of voluntary urban greenhouse gas emissions inventories

Drawing from an original dataset of urban metropolitan carbon footprints, we explore the correlations between national level climate change commitments and subnational level inventories. We ask: Does voluntary reporting allow a city to perform better than national average? Does ambitiousness in commitment have an impact on performance in footprint reduction? Does having long-term commitments affect performance in footprint reduction? Do binding national level commitments (such as those under the Kyoto Protocol) affect performance at the city level in terms of footprint reduction? To provide answers, we synthesize data from the largest repository of voluntary sub-national commitments and actions towards footprint reduction and greenhouse gas inventories from around the world, the Carbonn platform. More than 500 cities report at least one action, commitment or inventory to this database. We find, using a subset of this database, perhaps counter intuitively that cities with more ambitious commitments do not necessarily have steeper reductions in emissions. Our data also suggest that having long-term self-reported goals does not make the cities perform better in terms of footprint reduction. This appears to be true for both government and community commitments reported. Lastly, and positively, our data did reveal a statistically significant effect for cities belonging to countries that had committed to the Kyoto Protocol, suggesting the necessity of binding national (and supranational) climate targets