Bridging the age gap in breast cancer: evaluation of decision support interventions for older women with operable breast cancer: protocol for a cluster randomised controlled trial.

While breast cancer outcomes are improving steadily in younger women due to advances in screening and improved therapies, there has been little change in outcomes among the older age group. It is inevitable that comorbidities/frailty rates are higher, which may increase the risks of some breast cancer treatments such as surgery and chemotherapy, many older women are healthy and may benefit from their use. Adjusting treatment regimens appropriately for age/comorbidity/frailty is variable and largely non-evidence based, specifically with regard to rates of surgery for operable oestrogen receptor-positive disease and rates of chemotherapy for high-risk disease. This multicentre, parallel group, pragmatic cluster randomised controlled trial (RCT) (2015-18) reported here is nested within a larger ongoing 'Age Gap Cohort Study' (2012-18RP-PG-1209-10071), aims to evaluate the effectiveness of a complex intervention of decision support interventions to assist in the treatment decision making for early breast cancer in older women. The interventions include two patient decision aids (primary endocrine therapy vs surgery/antioestrogen therapy and chemotherapy vs no chemotherapy) and a clinical treatment outcomes algorithm for clinicians. National and local ethics committee approval was obtained for all UK participating sites. Results from the trial will be submitted for publication in international peer-reviewed scientific journals. 115550. European Union Drug Regulating Authorities Clinical Trials (EudraCT) number 2015-004220-61;Pre-results. Sponsor's Protocol Code Number Sheffield Teaching Hospitals STH17086. ISRCTN 32447*. [Abstract copyright: © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

Mediation and immediacy. Sensational forms, semiotic ideologies and the question of the medium

Taking as a starting point the paradox that immediacy is not prior to, but rather a product of mediation, this article argues that the negotiation of newly available media technologies is key to the transformation of religion. Invoked to authorise sensations of spiritual powers as immediate and real, media are prone to 'disappear' or become 'hyper-apparent' in the act of mediation. I argue that a view of media as intrinsic to religion requires a fundamental critique of approaches of both religion and media that posit an opposition between media and immediacy. © 2011 European Association of Social Anthropologists

Policy Comparison of Lead Hunting Ammunition Bans and Voluntary Nonlead Programs for California Condors

The endangered California condor (Gymnogyps californianus) is negatively affected by lead poisoning from spent lead‐based hunting ammunition. Because lead poisoning is the primary mortality factor affecting condors, the California Fish and Game Commission banned lead hunting ammunition during 2008 in the southern California condor range followed by a statewide ban implemented in 2019. In contrast, the Arizona Game and Fish Department instituted an outreach and awareness program encouraging voluntary use of nonlead hunting ammunition in the northern portion of the state during 2005 and a similar program was launched in Utah during 2012. The juxtaposition of policy tools provided a unique opportunity to evaluate the intended efforts to mitigate lead exposure in condors and their respective positive and negative effects. Herein we reflect upon the effectiveness of lead policy actions in the 3‐state region on the basis of condor blood‐lead levels, population status, and hunter awareness of the issue and use of nonlead hunting ammunition

Desorption of alkali atoms from 4He nanodroplets

The dynamics following the photoexcitation of Na and Li atoms located on the surface of helium nanodroplets has been investigated in a joint experimental and theoretical study. Photoelectron spectroscopy has revealed that excitation of the alkali atoms via the (n+1) -> ns transition leads to the desorption of these atoms. The mean kinetic energy of the desorbed atoms, as determined by ion imaging, shows a linear dependence on excitation frequency. These experimental findings are analyzed within a three-dimensional, time-dependent density functional approach for the helium droplet combined with a Bohmian dynamics description of the desorbing atom. This hybrid method reproduces well the key experimental observables. The dependence of the observables on the impurity mass is discussed by comparing the results obtained for the 6Li and 7Li isotopes. The calculations show that the desorption of the excited alkali atom is accompanied by the creation of highly non-linear density waves in the helium droplet that propagate at supersonic velocities

Neutrino masses from clustering of red and blue galaxies: a test of astrophysical uncertainties

Combining measurements of the galaxy power spectrum and the cosmic microwave background (CMB) is a powerful means of constraining the summed mass of neutrino species sum(m_nu), but is subject to systematic uncertainties due to non-linear structure formation, redshift-space distortions and galaxy bias. We empirically test the robustness of neutrino mass results to these effects by separately analyzing power spectra of red and blue galaxies from the Sloan Digital Sky Survey (SDSS-II) Data Release 7 (DR7), combined with the CMB five-year Wilkinson Microwave Anisotropy Probe (WMAP5) data. We consider fitting for a range of maximum wavenumber k using twelve different galaxy bias models. For example, using a new model based on perturbation theory and including redshift space distortions (Saito et al. 2009), the all-galaxy power spectrum combined with WMAP5 for a wavenumber range of k<0.2 Mpc/h yields 95% CL sum(m_nu)<0.46 eV. The red and blue galaxy power spectra give 0.41 and 0.63 eV respectively for this model. Using mock catalogues, we find the expected difference in these limits assuming a true neutrino mass of zero is 0.10 + or - 0.14 eV. Thus the difference of 0.22 eV between upper limits on neutrino mass for red and blue galaxies is approximately 1 sigma from the expected value. We find similar results for the other models and k ranges tested. This indicates good agreement for current data but hints at possible issues for next-generation surveys. Being able to perform such systematic tests is advantageous, and future surveys would benefit by including broad galaxy populations and luminosities that enable such a decomposition.Comment: 15 pages, 6 figures, matches version published in MNRA

Beyond the Social Determinants of Learning™ A Walden University Position Paper

The Social Determinants of Health (SDOH), presented by the World Health Organization (WHO) and a cross-organizational global commission in the early 2000s, provide an understanding of health status of individuals and communities. SDOH consider societal forces and conditions such as housing, work conditions, environment, and education (Braveman & Gottlieb, 2014; WHO, 2021). The U.S. Department of Health and Human Services (n.d.) launched a “Healthy People 2030” initiative, addressing five key social determinants of health and offering a framework from which organizations can build strategy: 1. Healthcare access and quality 2. Education access and quality 3. Social and community context 4. Economic stability 5. Neighborhood and built environment As leaders in preparing provisioners of healthcare, Walden’s nursing and healthcare programs operate from the Social Determinants of Health & Healthcare (SDOH&H) framework (emphasizing both health and healthcare) and address the SDOH&H in every course

Study protocol: developing a decision system for inclusive housing: applying a systematic, mixed-method quasi-experimental design

Background Identifying the housing preferences of people with complex disabilities is a much needed, but under-developed area of practice and scholarship. Despite the recognition that housing is a social determinant of health and quality of life, there is an absence of empirical methodologies that can practically and systematically involve consumers in this complex service delivery and housing design market. A rigorous process for making effective and consistent development decisions is needed to ensure resources are used effectively and the needs of consumers with complex disability are properly met. Methods/Design This 3-year project aims to identify how the public and private housing market in Australia can better respond to the needs of people with complex disabilities whilst simultaneously achieving key corporate objectives. First, using the Customer Relationship Management framework, qualitative (Nominal Group Technique) and quantitative (Discrete Choice Experiment) methods will be used to quantify the housing preferences of consumers and their carers. A systematic mixed-method, quasi-experimental design will then be used to quantify the development priorities of other key stakeholders (e.g., architects, developers, Government housing services etc.) in relation to inclusive housing for people with complex disabilities. Stakeholders randomly assigned to Group 1 (experimental group) will participate in a series of focus groups employing Analytical Hierarchical Process (AHP) methodology. Stakeholders randomly assigned to Group 2 (control group) will participate in focus groups employing existing decision making processes to inclusive housing development (e.g., Risk, Opportunity, Cost, Benefit considerations). Using comparative stakeholder analysis, this research design will enable the AHP methodology (a proposed tool to guide inclusive housing development decisions) to be tested. Discussion It is anticipated that the findings of this study will enable stakeholders to incorporate consumer housing preferences into commercial decisions. Housing designers and developers will benefit from the creation of a parsimonious set of consumer-led housing preferences by which to make informed investments in future housing and contribute to future housing policy. The research design has not been applied in the Australian research context or elsewhere, and will provide a much needed blueprint for market investment to develop viable, consumer directed inclusive housing options for people with complex disability

Intermanifold similarities in partial photoionization cross sections of helium

Using the eigenchannel R-matrix method we calculate partial photoionization cross sections from the ground state of the helium atom for incident photon energies up to the N=9 manifold. The wide energy range covered by our calculations permits a thorough investigation of general patterns in the cross sections which were first discussed by Menzel and co-workers [Phys. Rev. A {\bf 54}, 2080 (1996)]. The existence of these patterns can easily be understood in terms of propensity rules for autoionization. As the photon energy is increased the regular patterns are locally interrupted by perturber states until they fade out indicating the progressive break-down of the propensity rules and the underlying approximate quantum numbers. We demonstrate that the destructive influence of isolated perturbers can be compensated with an energy-dependent quantum defect.Comment: 10 pages, 10 figures, replacement with some typos correcte