Background/Problem Statement. The goal of this Cooperative Ecosystem Study is to learn how to make adaptive management a practical means to understanding ecosystem behavior given the current plans to manage Forest Service and other lands in the Sierra Nevada. We will explore strategies to integrate public involvement into this adaptive management framework and design field methods to capture ecosystem responses to landscape prescriptions. As noted in the Record of Decision (SNFPA 2004), the threat posed by catastrophic fire requires the modification of wildland fire behavior across broad landscapes (1,000’s of ha). An important scientific uncertainty is how this focus on mitigating potential wildfire through treatments will impact other forest resources such as wildlife habitat, water quality, and overall forest health. To date there is not enough information available to definitively assess the trade-offs implicit in this plan. Thus there is a need to develop “a refined and active multiparty adaptive management and monitoring system consistent with the Sierra Nevada Forest Plan Amendment.” In the course of our discussions, we identified five key elements that we believe are crucial to achieve this goal:
Background/Problem Statement. In the United States, breast cancer causes extensive health burden on women each year. It is second only to lung cancer as the leading cause of cancer death among women.1 According to the American Cancer Society, 207,090 women were diagnosed with breast cancer in 2010 in the United States and 39,840 died.2 Given the etiology of breast cancer, primary prevention strategies to reduce breast cancer mortality in the general population are not realistic. For this reason, prevention strategies traditionally focus on early detection.3 Routine screening mammography has been shown to reduce breast cancer mortality by as much as 40% in some trials.4 When identified and addressed at an early stage, the prognosis for breast cancer is much better and additionally far less costly to treat. Screening mammography is recommended as the means to detect breast cancer by all advocacy groups within the United States; however, there is currently disagreement as to when routine screening should begin. In November 2009, the United States Preventive Services Task Force (USPSTF) updated its recommendation statement by advising against routine mammograms in women aged 40 to 49 years and proposing biennial screening from ages 50 to 74 years.5 However, the methods used in the evaluation studies by the USPSTF are controversial, and several groups, including the American Cancer Society and the American College of Radiology, maintain their recommendations to initiate annual mammograms at age 40.4 Despite recommendations, the number of women receiving routine mammograms in the United States is inadequate. As part of the Healthy People 2010 campaign, the US Department of Health and Human Services set a goal of increasing to 70% the percentage of women over age 40 who have received a mammogram in the past two years. While this objective has been met in the general population (the national, age-adjusted prevalence of up-to-date mammography is 81.1%), women of a lower socioeconomic status, uninsured women, women without a regular source of care, and women who live in rural areas still have unacceptable rates of screening mammography.1, 6 Data from the 2008 Behavioral Risk Factor Surveillance System (BRFSS) revealed that only 56.3% of uninsured women aged 50-74 years had a mammogram in the past two years in comparison to 83.8% of insured women.1 There were also relatively low rates of up-to- date mammography screening among women in the annual household income bracket of less than $15,000 and ...
Background/Problem Statement. America has struggled with racial harmony and to fulfill the ambition of a “melting pot” society (Xxxxxx, 2009) since the Pilgrims first met American Indians at Plymouth Rock. From the beginning, racial divisions have flourished and were exhibited in institutions such as slavery, internment camps and reservations. America has attempted - from the Civil War to the Civil Rights movement – to remedy our divisions and ironically, has come to realize that the very concept of race is a construct without genetic basis (California Newsreel, 2003). Nonetheless, the concept of “race” is deeply entrenched and divisions based on race are still reflected in our society (Shoichet, 2015). This is true for almost every aspect of life governed by institutional and systemic structures from education to criminal justice. Despite good health being a basic necessity for sustaining all human life, the American healthcare system has not been immune to inequality in outcomes either. Healthy People 2020, our nation’s guide to health promotion and disease prevention, includes among its four “overarching goals,” the need to “ achieve health equity, eliminate disparities, and improve the health of all groups” (Department of Health and Human Services, 2010). Yet, this idea is in contrast to the statistics related to race based health disparities. According to a report by the Xxxxxx Family Foundation (KFF), it is estimated that “30% of direct medical costs for Blacks, Hispanics, and Asian Americans are excess costs due to health inequities” (Xxxxxx Family Foundation, 2012). In addition, in 2009 it was reported that “eliminating health disparities for minorities would have reduced direct medical care expenditures by $229.4 billion and reduced indirect costs associated with illness and premature death by approximately $1 trillion during 2003-2006” (Centers for Disease Control and Prevention, 2013). There is a plethora of published material acknowledging the reality and impact of race based health disparity and inequity though few discuss the role of racism in creating and maintaining disparity. Xxxxxx and Sharif (2015) say that avoiding the “explicit acknowledgement” of the “connection to racism” serves to “undermine or disguise the impact of racism on racialized health disparities” and “enables the perpetuation of these inequities.” Nonetheless, there is research and public health stakeholder recognition of the contributory role of racism in health inequity and disparity (Xxxxxx & Xxxxx...
