Background and Literature Review. Given both the importance of the topic, but also the diverse perspectives taken by different research communities, a plethora of relevant research has emerged over the past few decades looking broadly at issues of equality, poverty, and policy. This section summarizes six distinct research themes.
Background and Literature Review. Breast and Colorectal Cancer Cancer remains the second leading cause of death in the United States. It is estimated that 1,658,370 new cases of cancer will be diagnosed in 2015, including 231, 840 cases of invasive breast cancer, 93,090 cases of colon cancer, and 39,610 cases of rectal cancer (1). Breast cancer is the second leading cause of cancer death in women in the United States (1). Mortality rates decreased by about 1.9% between 2002-2011, however, breast cancer incidence remained stable at about 128 per 100,000 women (2), making it the most frequently diagnosed cancer in women, after skin cancer (1). Despite the overall decrease in cancer mortality, the burden of cancer is inequitably distributed across groups of women. For example, women who have been diagnosed with breast cancer that live in lower income areas have a significantly lower 5 year survival rate than women diagnosed living in areas with higher income (3, 4). Disparities also commonly exist by race/ethnicity. Despite having a lower incidence rate than White women, African American women have twice the risk of developing breast cancer and a 3 times higher risk of dying from breast cancer (5, 6). Colorectal cancer is the third most commonly diagnosed cancer, as well as the third leading cause of cancer death in both men and women (1). Similar to the trend seen in breast cancer, the burden of colorectal cancer is also unequally distributed. Incidence and mortality rates have decreased, however, African Americans continue to have the highest incidence and mortality rates when compared to Whites, Asian/ Pacific Islanders, American Indian/ Alaskan Natives, and Hispanic-Latinos (7). African Americans are also more likely to be diagnosed at later stages and earlier ages (8). Socioeconomic status is also associated with colorectal cancer risk. In a longitudinal study of American Association of Retired Persons (AARP) participants, investigators found that the rate of colorectal cancer was 1.19 (95% Confidence Interval [CI]: 1.07, 1.31) times higher in participants with less than 12 years of education than participants with postgraduate studies. In the same study, investigators concluded that neighborhood socioeconomic status was also associated with colorectal cancer risk in that the rate of colorectal cancer was 1.16 (95% CI: 1.05, 1.28) times higher in participants living in the most socioeconomically deprived neighborhoods than those living in the least deprived neighborhoods (9). Despite dec...
Background and Literature Review. While the United States has experienced a notable decline in infant mortality over the past several decades, infant death is still a considerable public health concern and an important indicator of the health and wellness of a society. In 2009 the infant mortality rate in the U.S. was 6.8 infant deaths per 1000 births (1), compared with 100 infant deaths per 1000 live births in 1900 (2). However, the U.S. infant mortality rate has seen very little decline since 2000 and remains high relative to other industrialized countries, with the U.S. ranking 29th in the world in infant mortality. The plateau in the U.S. infant mortality rate is the first sustained period without decline since the 1950s. Also of particular concern are the increasingly wide racial and socioeconomic disparities in infant mortality, suggesting a need for increased understanding of the risk factors related to infant death and effective means of prevention (2). Multiple risk factors for infant mortality have been identified and studied thoroughly. Among the 5 leading causes of infant death, preterm birth and maternal complications rank 2nd and 4th, respectively (3). The most significant maternal complication of pregnancy is maternal hypertension, which contributes heavily to conditions that increase infant mortality. Hypertensive disorders of pregnancy are classified as chronic hypertension, gestational hypertension, preeclampsia, and chronic hypertension with superimposed preeclampsia (4). Current epidemiologic evidence suggests that hypertensive disorders of pregnancy complicate approximately 5-10% of pregnancies worldwide, and pose significant risks to maternal, fetal, and neonatal health. Potential risks to infants of hypertensive mothers are related to two main etiologies: preterm birth and inadequate placental perfusion (7, 9). Preterm birth, defined as a delivery prior to 37 weeks gestation, causes up to 75% of perinatal, neonatal, and infant
Background and Literature Review. A background and literature review will be conducted at NHDHR and through electronic map repositories, where appropriate. File review using NHDHR’s GIS Enhanced Mapping & Management Information Tool (XXXXX) will collect data about prehistoric and historic archaeological sites, standing structures, and engineered features. Soils, topographic, historic maps, and technical cultural resources reports pertinent to the project area will be sourced through state and local repositories. Once the data are acquired and reviewed, pertinent information (known archaeological sites, historic districts, historic landmarks, etc.) will be graphically represented on project area maps. Archaeological site location data are considered confidential and not for public distribution. For planning purposes, however, such data are available to agencies for review. For this reason, the site location map will be marked “Not for Public Distribution.”
Background and Literature Review. Vaccine hesitancy is a threat to combating vaccine-preventable diseases in the United States and in the world at large.1 Reports of outbreaks in the U.S. of vaccine-preventable diseases such as measles and pertussis have demonstrated the impact of parental vaccine hesitancy on vaccine-preventable diseases.19,21 Vaccine hesitancy, which dates back to as early as the time vaccines were invented, persists despite the overwhelming success of vaccines in reducing morbidity and mortality.21,22 Although most parents believe that vaccines protect their children from diseases,5,22 varying levels of vaccine hesitancy remain. Parents’ varying levels of resistance range from concerns about the safety and necessity of vaccines, to a lack of trust in vaccine manufacturers and advocates.5, 11, 12 Vaccine hesitancy should be prioritized if vaccine uptake is to be increased to allow continued control of vaccine-preventable diseases in the U.S. The World Health Organization (WHO) defines vaccine hesitancy as a “delay in acceptance or refusal of vaccines despite the availability of vaccine services,” and refers to the issue as being “complex and context specific, varying across time, place and vaccines.”24 WHO adds that vaccine hesitancy is influenced by factors such as complacency (not perceiving a need for, or not valuing, the vaccine), convenience (lack of access) and confidence (not trusting a vaccine or a provider).24 One of the major steps in addressing vaccine hesitancy, and improving and maintaining vaccine confidence, is the ability to identify vaccine hesitant parents, to understand the reasons for their decisions. It is, therefore, important to have a standardized tool (e.g., short questionnaire) for screening, identifying, and understanding parents’ attitudes towards immunizations available for use. Such a tool needs to be accessible and easily used by healthcare providers. This type of tool will also assist in addressing the specific vaccine concerns of these parents, thereby reducing vaccine hesitancy. Currently, there is no widely used, standardized tool for measuring vaccine hesitancy. However, there are ongoing efforts to develop a valid and reliable tool.19 Pediatricians and other healthcare providers have played a major role in promoting vaccine uptake in the U.S. in the past, but recently, the trend has changed. Parents who, until now, relied on healthcare providers for decisions about childhood immunizations, now seek to be actively involved in the decis...
Background and Literature Review. This study aimed to understand how to comprehensively assess the operational and financial sustainability of water purification plants and to apply that knowledge to an evaluation of LWW’s plants in Mexico. To do so, literature was reviewed to determine the current status and understanding of several different aspects of water supply and how they apply to LWW’s model. First, the status of worldwide access to safe drinking water and factors influencing it are discussed, followed by additional factors that are specific to Mexico and the Yucatán Peninsula. Next, the current understanding of and evidence from small water enterprises and faith-based social enterprises are discussed. Finally, suggestions on how to measure sustainability and the appropriateness of existing tools to do so are examined. Throughout, it becomes clear that much of the focus on the availability of safe drinking water and factors affecting it are specific to Africa, where the most dramatic gaps in access exist. However, there are still a significant number of people in Latin America, and Mexico specifically, that lack access to safe drinking water, and it is important to understand what can be done to improve access for them. Also, many of the problems facing water projects in Africa likely affect those in Mexico as well, although less information about the current state of water projects in Mexico is available. This is especially true of small water enterprises, even though there are a large number of small, non-state providers in Mexico. Finally, almost none of the information available on water supply projects and their sustainability is focused on faith-based enterprises, and faith may play an influential role in the sustainability of water projects. The current study will contribute to knowledge about factors affecting access to water in Mexico, the role of small water enterprises in Mexico and factors influencing their success, the role that faith plays in influencing the sustainability of faith-based enterprises, and will evaluate the sustainability of LWW’s plants using a tool that is specific to its model and appropriate for the Mexican context.
Background and Literature Review. 3.1.1 THE DEMOGRAPHICS OF THE INDIVIDUALS ENROLLED INTO THE PUBLISHED RIVAROXABAN TRIALS The principal clinical trials which led to the licensing of rivaroxaban were RECORD I, II and III and ENSTEIN- DVT, XXXXXXXX-PE and XXXXXXXX-ext. (refer to chapter 1.2.1). The trials were conducted in 39 countries at 336 sites. Exclusion criteria were: creatinine clearance <30 ml/min; clinically significant liver disease; active bleeding or high risk of bleeding; systolic blood pressure >180 mmHg; diastolic blood pressure >110 mmHg; pregnancy or breast feeding; use of P450 3A4 inhibitor or inducer; life expectancy < three months. The pooled demographic information from the EINSTEIN trials are shown in table 7. (Xx Xxxxx et al., 2016) TABLE 7 DEMOGRAPHIC CHARACTERISTICS OF THE POOLED EINSTEIN TRIALS, INVESTIGATING RIVAROXABAN VERSUS LOW MOLECULAR WEIGHT HEPARIN FOR VTE Characteristic Subjects taking rivaroxaban 20 mg once a day, n=4150 Age, median (range), y 58 (18-97) Female, % 44.5 Weight, mean (SD), kg 82.5 (18.9) BMI, mean (SD), kg/m2 28.1 (5.7) Creatinine clearance, % >80 ml/min 50-79 ml/min 30-49 ml/min <30 ml/min 66.8 25 7.8 0.2 Body weight, % <50 kg 50-100kg >100 kg 2 81 17 BMI, % <25 kg/m2 25-30 kg/m2 30-35 kg/m2 >35 kg/m2 30 40 20 10 It is important to note that 2 % of subjects in these trials weighed less than 50 kg, of whom only 10 % were male. 10 % had a BMI greater than 35 kg/m2. 40 % of those patients with BMI >35 kg/m2 were male and 50 % of those with BMI <25 kg/m2were male. The age distribution was evenly spread between the BMI categories. (Xx Xxxxx et al., 2016) Several phase I studies indicate that Cmax, volume of distribution and clearance of rivaroxaban remain consistent despite differences in ages.
Background and Literature Review. The SOW states:
Background and Literature Review. In the United States, testicular cancer accounts for 1% of all cancers in men and for 5% of male genitourinary malignancies (1, 2). Testes, the pair of male sex glands located behind the penis within a pouch of skin called the scrotum, are the main source of testosterone and the site of sperm production and storage (2). Testicular carcinomas are the most common solid tumor among men 15 to 34 years of age (2). According to estimates from the American Cancer Society, among U.S. men in 2010 there were 8,480 new cases of testicular cancer and 350 deaths from the disease (3). While the incidence of testicular cancer is lower among African-American men compared to U.S. men of other races and ethnicities, African-American testicular cancer patients have poorer survival (4-9). Delayed presentation, differences in adherence to follow-up, socioeconomic status, access to healthcare, education, culture, and lifestyle have been proposed as explanations that may account for this observed disparity in outcomes (3, 4, 8-11). However, biological tumor characteristics such as levels of prognostic tumor markers have not previously been compared across racial and ethnic groups on a population level. Testicular cancer can occur in one or both testicles (2). This form of cancer is commonly detected via self-examination or during physical examination by a physician. Risk factors for testicular cancer include cryptorchidism, in which one or both testicles do not descend from the abdomen into the scrotum, and Xxxxxxxxxxx'x syndrome, a genetic disorder in which males have at least one additional X-chromosome (2, 12). Other risk factors include family history, infertility, testicular atrophy, hypogonadism, testicular dysgenesis syndromes, and inguinal hernias (2, 12, 13). Ninety-five percent of testicular cancers arise in germ cells, the cells that give rise to sperm, while the other 5% are non- germinal tumors (2). Carcinoma in situ, intratubular germ cell neoplasia (ITGCN), precedes the majority of invasive germ cell tumors in adults (12). Progression from ITGCN to invasive cancer occurs after a median of approximately 5 years (12). The two major types of germ cell carcinomas are seminomas and nonseminomas (2). Seminomas are slow-growing cells that are sensitive to radiation and chemotherapy (2, 13). These carcinomas account for 50% of germ cell tumors and are most common during the 4th decade of life (12). Nonseminomas can be purely one cell type or mixed tumors comprised of tw...
Background and Literature Review. Reading is an ability upon which many life skills depend in modern, industrialized societies (Xxxxx, 1999). It is a skill that must be explicitly taught (NRP, 2000), and a failure to master the foundational skills of reading early in life significantly decreases the likelihood of learning them at all (Xxxxx, 1999). It is a complex task that involves word recognition processing in both the auditory (i.e., hearing word forms) and visual (i.e., recognizing printed word forms) modalities (Xxxxxxxxxx & Xxxxxxxxx, 1993), as well as mapping between them. Although most children learn to read, many fail to become proficient readers. In fact, according to the Nation’s Assessment of Educational Progress (2015), only 36% of fourth graders are reading at a level of “proficient” or higher, and approximately 10% of children in America have difficulty learning to read at all and will require intervention (Xxxxx & Xxxxx, 2003). Collaborative research efforts spearheaded by Congress sought to investigate the components that comprise skilled reading (National Reading Panel, 2000) in an effort to identify best practices in reading instruction. Based on findings from this initiative, the Panel identified five components of reading that should receive emphasis in reading instruction. Referred to as “The Five Big Ideas”, the following competencies comprise skilled reading: phonemic awareness, alphabetic principle, fluency, vocabulary, and comprehension. Phonemic awareness is the ability to identify and manipulate individual sounds within words, but does not necessarily imply an understanding of sound- grapheme mappings. The alphabetic principle, also known as phonics, refers to the ability to map speech sounds onto graphemes and use this knowledge to decode text and to spell. Fluency refers to the ease with which one reads connected text with speed, accuracy, and expression. Vocabulary, or the ability to understand and use words, is connected to comprehension, the ability to gain meaning from text. The “Five Big Ideas” provides a framework for recommendations and best-practices for optimal reading instruction delivery. Nonetheless, the panel also recommended that additional research efforts should be aimed toward studying the development of skilled reading (NRP, 2000). In an attempt to address this need, the National Early Literacy Panel (NELP) was convened in 2002 to research best practices in the intervention, assessment, instruction, and development of pre- reading skills in ...
