Allocating Groundwater Among Nations, States and Tribes

70 pages

Factors Influencing Breast Cancer Genetic Testing Among High Risk African American Women: A Systematic Review

African American women are disproportionately impacted by breast cancer and its associated effects. They have the highest breast cancer mortality rate of all racial and ethnic groups in the U.S., yet, many high risk African American women do not follow-up with genetic testing despite, having a shorter survival rate and more likely to develop malignancies or aggressive forms of breast cancer than white women. Purpose: This review explored breast cancer genetic follow up and barriers among African American women and made recommendations for designing tailored high risk breast cancer programs. Method: The Integrative Model of Behavioral Prediction framework provided the framework for the review. PubMed, PSYINFO, CINAHL and Cochrane Collection Plus databases were searched for articles published from 2007 to 2017 that focused on attitude and beliefs that influenced genetic testing follow up among African American women. Three reviewers independently reviewed and appraised articles. The quality of the articles was assessed to determine the evidence level and overall recommendations using the Joanna Bridge Institute grading criteria. Results: Sixteen of the 2275 articles reviewed met the inclusion criteria of which, seven showed statistically significance changes related to family concerns, medical mistrust and cost barriers; decreases in breast cancer worry and perceived risk after genetic counseling; and higher education level and diagnosed early increased genetic testing. Conclusions: This systematic review provides greater understanding of how the social determinants of health influence decisions about genetic testing and treatment to determine why African American women who are at risk for breast cancer, do not progress to genetic testing. It provided recommendations for designing sensitive curriculum content for African American women and providers to increase genetic follow-up and reduce breast cancer disparity. The results of this review could be used to design comprehensive, tailored interventions to address the identified barriers, increase breast cancer awareness and early detection, and help minority women make informed, value decisions about genetic testing and treatment options. Recommendations: Future research is required to examine the role communities, agencies and policy makers play in improving clinical outcomes for minorities

A respectful design framework: incorporating indigenous knowledge in the design process

To stay within the planetary boundaries, we have to take responsibility, and this includes designers. This requires new perspectives on design. In this work, we focus on a co-design project with indigenous communities. Within such communities, indigenous knowledge is central. Indigenous knowledge acknowledges that the world is alive and that we, as humans, are merely a small part. Central in our approach is Sheehan’s respectful design, which ensures a central place for indigenous knowledge in the design process. However, Sheehan’s approach does not state in pragmatic terms how such a design approach can be achieved. Some of the co-design processes we engaged in led to respectful design spaces, others did not. This helped us to identify patterns of dynamics that are essential for respectful design. At the core of our findings lies the observation that in order to reach a respectful design space, in which indigenous knowledge is embedded, a shared dialogical space between community and designer is essential

The blood–brain barrier significantly limits eflornithine entry into Trypanosoma brucei brucei infected mouse brain1

Drugs to treat African trypanosomiasis are toxic, expensive and subject to parasite resistance. New drugs are urgently being sought. Although the existing drug, eflornithine, is assumed to reach the brain in high concentrations, little is known about how it crosses the healthy and infected blood–brain barrier. This information is essential for the design of drug combinations and new drugs. This study used novel combinations of animal models to address these omissions. Eflornithine crossed the healthy blood–CNS interfaces poorly, but this could be improved by co-administering suramin, but not nifurtimox, pentamidine or melarsoprol. Work using a murine model of sleeping sickness demonstrated that Trypanosoma brucei brucei crossed the blood–CNS interfaces, which remained functional, early in the course of infection. Concentrations of brain parasites increased during the infection and this resulted in detectable blood–brain barrier, but not choroid plexus, dysfunction at day 28 post-infection with resultant increases in eflornithine brain delivery. Barrier integrity was never restored and the animals died at day 37.9 ± 1.2. This study indicates why an intensive treatment regimen of eflornithine is required (poor blood–brain barrier penetration) and suggests a possible remedy (combining eflornithine with suramin). The blood–brain barrier retains functionality until a late, possibly terminal stage, of trypanosoma infection

Properties of starch as related to the characteristics of starch-structured breads

The purpose of the research was to investigate the chemical composition of five starches and the physical characteristics of their respective starch pastes as these properties relate to the characteristics of starch-structured breads. Starch-structured breads were prepared with five starches, corn, wheat, potato, arrowroot and waxy maize, used as granular starch with and without addition of 5% freshly prepared or retrograded pastes. All bread characteristics, analyzed by the analysis of variance, were different due to starch or treatment at the 1% or 5% level of significance. Amylose content and performance when heated in water were determined for the starches. All measurements, analyzed by analysis of variance, were different due to starch at the 1% or 5% level of significance. When temperature was a variable, differences were significant at the 1% or 5% level for amylose versus starch characteristics of temperature at maximum viscosity and viscosity of retrograded pastes, and for amylose versus all granular starch bread characteristics and grain and springiness of breads made with 5% retrograded pastes

Reunion ; Sixteen ; June of the year ; The stakes four short stories

The deviled eggs, covered with a napkin, were on a corner of the table; and the beaten biscuits were stacked in a neat pile in a box. Everything had been done, it seemed. Annie inspected the kitchen carefully, the full wood-box, the clean bread board, the shelves covered with fresh paper. They would be eating in the yard, but Emily might bring little Emily in for a drink of water; and she wanted everything to be like a pin. "This is silly," she scolded herself. "Forty years, and I'm behaving like I've just married into the family." It had always been that way when they came, and they were conscious of it as much as she. As soon as one of them set foot in her hall, an odd sort of pride took hold of her; and hard as she tried to conceal it, it showed in everything she said or did

Qualitative research to inform hypothesis testing for fidelity-based sub-group analysis in clinical trials : lessons learnt from the process evaluation of a multifaceted podiatry intervention for falls prevention

Background: Ensuring fidelity to complex interventions is a challenge when conducting pragmatic randomised controlled trials. We explore fidelity through a qualitative process evaluation, which was conducted alongside a pragmatic, multicentre, two-arm cohort randomised controlled trial: the REFORM (Reducing Falls with Orthoses and a Multifaceted podiatry intervention) trial. The paper aims, through a qualitative process evaluation, to explore some of the factors that may have affected the delivery of the REFORM intervention and highlight how project-specific fidelity can be assessed using a truly mixed-methods approach when informed by qualitative insights. Design: Semi-structured qualitative interviews carried out as part of a process evaluation. Interviews were analysed thematically. Setting: Seven NHS trusts in the UK and a University podiatry school in Ireland. Interviews were undertaken face-toface or over the telephone. Participants: Twenty-one REFORM trial participants and 14 podiatrists who delivered the REFORM intervention. Results: Factors affecting fidelity included: how similar the intervention was to routine practice; the challenges of delivering a multifaceted intervention to a heterogeneous older population; and practical issues with delivery such as time and training. Trial participants’ views of the intervention, whether falls prevention is a personal priority, their experience of being part of a trial and individual factors such as medical conditions may also have affected intervention fidelity. Conclusions: Our process evaluation highlighted factors that were perceived to have affected the fidelity of the REFORM intervention and in doing so demonstrates the importance of considering fidelity when designing and evaluating pragmatic trials. We propose a number of recommendations of how important project-specific insights from qualitative work can be incorporated into the design of fidelity measurement of future trials, which build on existing conceptual fidelity frameworks. In particular, we encourage adopting a mixed-methods approach whereby qualitative insights can be used to suggest ways to enhance quantitative data collection facilitating integration through hypothesis generation, hypothesis testing and seeking explanation for trial findings. This will provide a framework of enabling measures of fidelity to be incorporated into the understanding of trial results which has been relatively neglected by existing literature. Trial registration: ISRCTN Registry: ISRCTN68240461. Registered on 01/07/2011. Keywords: Process evaluation, Randomised controlled trials, Fidelity, Mixed methods, Falls, Elderly, Ageing, Qualitativ