Texas Groundwater: Reconciling the Rule of Capture with Environmental and Community Demands Comment.

In order to avert the depletion of water resources, many states have attempted to enact legislation aimed at promoting water conservation. Such legislation has been known to conflict with outdated principles of property ownership, namely the rule of capture. The rule of capture vests landowners with property rights in water located directly beneath their land. Texas categorizes water based on whether the water flows above or below the surface. Surface water is typically the property of the state, with property owners having no possessory interest in the surface water. Yet, the opposite is true for groundwater, where all rights to groundwater belong to the capturer or landowner. This allows landowners to use as much groundwater beneath their land as they choose. The Texas Legislature enacted the Edwards Aquifer Act (EAA) and Senate Bill 1 (S.B. 1) which limit the amount of water which may be pumped from the Edwards Aquifer and implemented research of groundwater districts. Despite the Legislature’s contentions that EAA and S.B. 1 are valid and reasonable, landowners have challenged the legislation, asserting it amounts to a taking under the state and federal constitutions. Additionally, both pieces of legislation abrogate strict application of the rule of capture. Yet, neither of them goes far enough. Thus, if the state of groundwater law remains the same, communities will be injured by individual landowners withdrawing unlimited amounts of groundwater. As early as 1917, the State of Texas recognized the need to protect natural resources. The antiquated doctrine of the rule of capture is incompatible with current water needs of the twenty-first century. The rule of capture must change if sustainability of water resources is a goal for the future. The Texas Legislature must enact comprehensive groundwater management programs which gives the State ultimately property rights to both ground and surface water

Health Disparities Across the Breast Cancer Continuum

To provide a brief overview of disparities across the spectrum of breast cancer incidence, treatment, and long-term care during the survivorship period

Oncology providers' perspectives on endocrine therapy prescribing and management.

Adjuvant endocrine therapy (ET) can reduce the risk of recurrence among females with hormone receptor-positive breast cancer. Overall, initiation and adherence to ET are suboptimal, though reasons are not well described. The study's objective was to better understand ET decision making, prescribing, and patient management from oncology providers' perspectives. Using purposive sampling, we recruited oncology providers who saw five or more breast cancer patients per week (n=20). We conducted 30-45-minute telephone interviews, using a semistructured guide to elicit perspectives on ET use. We used thematic content analysis to systematically identify categories of meaning and double-coded transcripts using Atlas.ti. Providers recommend ET to all eligible patients except those with contraindications or other risk factors. Providers base their ET prescribing decisions on the patient's menopausal status, side effects, and comorbidities. ET is typically discussed multiple times: at the onset of breast cancer treatment and in more detail after other treatment completion. Providers felt that the associated recurrence risk reduction is the most compelling argument for patients during ET decision making. While providers rarely perceived noninitiation as a problem, nonadherence was prevalent, often due to unresolvable side effects. From the clinicians' perspectives, side effects from ET are the dominant factor in nonadherence. Efforts to improve adherence should focus on strategies to minimize side effects and ensure clinicians and patients are well informed regarding optimal side effect management. This finding has important implications for novel endocrine regimens that offer improved outcomes through longer duration or more intensive therapy

Understanding racial differences in health-related quality of life in a population-based cohort of breast cancer survivors

Although racial disparities in health-related quality of life (HRQOL) among women with breast cancer (BC) are well documented, less is known about HRQOL changes over time among women of different races. Our objective was to assess racial differences in HRQOL during active treatment and survivorship phases of BC care

Patient-Centered Communication for Discussing Oncotype DX Testing

Oncotype DX testing (ODX), a tumor gene expression test, may improve breast cancer care, however communicating results remains challenging. We identified patient-centered communication strategies/gaps for discussing ODX results. We applied a patient-centered communication framework to analyze qualitative interviews with oncologists about how they communicate about ODX with patients, using template analysis in Atlas.ti. Overall, providers discussed four patient-centered communication domains: exchanging information, assessing uncertainty, making decisions and cross-cutting themes. Providers did not report discussing emotional aspects of managing uncertainty, assessing decision-making preferences, and evaluating decisions. A patient-centered approach may be a model for communicating about tumor gene expression tests

A typology of drought decision making: Synthesizing across cases to understand drought preparedness and response actions

Drought is an inescapable reality in many regions, including much of the western United States. With climate change, droughts are predicted to intensify and occur more frequently, making the imperative for drought management even greater. Many diverse actors – including private landowners, business owners, scientists, non-governmental organizations (NGOs), and managers and policymakers within tribal, local, state, and federal government agencies – play multiple, often overlapping roles in preparing for and responding to drought. Managing water is, of course, one of the most important roles that humans play in both mitigating and responding to droughts; but, focusing only on “water managers” or “water management” fails to capture key elements related to the broader category of drought management. The respective roles played by those managing drought (as distinct from water managers), the interactions among them, and the consequences in particular contexts, are not well understood. Our team synthesized insights from 10 in-depth case studies to understand key facets of decision making about drought preparedness and response. We present a typology with four elements that collectively describe how decisions about drought preparedness and response are made (context and objective for a decision; actors responsible; choice being made or action taken; and how decisions interact with and influence other decisions). The typology provides a framework for system-level understanding of how and by whom complex decisions about drought management are made. Greater system-level understanding helps decision makers, program and research funders, and scientists to identify constraints to and opportunities for action, to learn from the past, and to integrate ecological impacts, thereby facilitating social learning among diverse participants in drought preparedness and response

Racial Variation in the Uptake of Onco type DX Testing for Early-Stage Breast Cancer

Oncotype DX (ODX) is a tumor gene-profiling test that aids in adjuvant chemotherapy decision-making. ODX has the potential to improve quality of care; however, if not equally accessible across racial groups, disparities in cancer care quality may persist or worsen. We examined racial disparities in ODX testing uptake

To be young, Black, and living with breast cancer: a systematic review of health-related quality of life in young Black breast cancer survivors

Compared with young White women, young Black women are more likely to present with aggressive breast cancer (BC) subtypes that are potentially linked to worse health-related quality of life (HRQOL); however, there is limited consensus regarding HRQOL needs among young Black BC survivors. Employing Ferrell's framework on QOL in BC (i.e., physical, psychological, social, and spiritual well-being), we conducted a systematic review on HRQOL among Black BC survivors aged <50 years and proposed recommendations for advancing HRQOL research and care for this population

Racial disparities in initiation of adjuvant endocrine therapy of early breast cancer

Endocrine therapy (ET) is the cornerstone of adjuvant therapy for hormone-receptor positive (HR+) breast cancer. The survival gap between African-American (AA) and white women with breast cancer is most pronounced in HR+ subtypes, and could be related to differences in ET use. The relationship between race and initiation of ET is not well defined. We investigated patterns of ET initiation by race in a diverse cohort of women covered by commercial health insurance. We identified 2,640 women with incident HR+ breast cancer in the North Carolina Central Cancer Registry whose records linked to commercial insurance claims using the Integrated Cancer Information and Surveillance System (ICISS) database. The sample included women age<65 years diagnosed with stage I–III HR+ cancers between 2004 and 2009. We used multivariate Poisson regression to examine the effect of race on likelihood of initiating ET. 14 % of women did not initiate ET within 12 months of diagnosis. AA women were 17 % less likely to initiate ET than whites (aRR 0.83, 95 % CI 0.74–0.93). When analyzed by subset, racial disparities persisted among women who received chemotherapy (aHR 0.67, 95 % CI 0.56–0.80) but not among women who did not receive chemotherapy (aHR 0.96, 95 % CI 0.76–1.21). AA women in our sample were less likely to initiate ET than whites, and this disparity was concentrated among chemotherapy-treated women. ET under-utilization may contribute to the racial survival gap in HR+ breast cancer, and represents an opportunity for intervention to reduce breast cancer disparities

Insurance-Based Differences in Time to Diagnostic Follow-up after Positive Screening Mammography

Insurance may lengthen or inhibit time to follow-up after positive screening mammography. We assessed the association between insurance status and time to initial diagnostic follow-up after a positive screening mammogram