Conducting a Systematic Review of the Literature

This overview of the systematic review provides guidance regarding how and when to use this approach to a research question. High quality systematic reviews are essential to assist health care practitioners keep current with the large and rapidly growing body of scientific evidence. The systematic review is a transparent and reproducible synthesis of all the available evidence on a clearly defined research question or topic. Key stages in conducting a systematic review include clarification of aims and methods in a protocol, finding all of the relevant research, data collection, quality assessments, synthesizing evidence, and interpreting the findings. This short report provides examples for the various stages and steps of the systematic review research approach.

Narrative Reviews of the Literature: An overview

This short report guides the reader through the types of narrative reviews and describes the narrative review process from conception to completion. This report is an overview on the topic of literature reviews and serves to provide guidance regarding how and when to use a narrative review approach. Authors have many purposes for selecting the narrative review of the literature including introducing an original research manuscript, reviewing a critical topic for a scholarly journal, creating an introductory chapter for a thesis, or completing a classroom assignment. Each purpose may include a specific format and may require different components to be included in the research and writing process. This short report provides examples for each section of the narrative review research and writing process.

Barriers and strategies for recruiting participants who identify as racial minorities in musculoskeletal health research: a scoping review

Objective

Visible minorities are disproportionately affected by musculoskeletal disorders (MSD) and other diseases; yet are largely underrepresented in health research. The purpose of this scoping review was to identify barriers and strategies associated with increasing recruitment of visible minorities in MSD research.

Methods

Electronic databases (MEDLINE, EMBASE, CINAHL, and PsycInfo) were searched. Search strategies used terms related to the concepts of 'race/ethnicity', 'participation', 'research' and 'musculoskeletal'. All research designs were included. Two reviewers independently screened titles and abstracts, completed full-text reviews, and extracted data. Papers that did not focus on musculoskeletal research, include racial minorities, or focus on participation in research were excluded. Study characteristics (study location, design and methods; sample characteristics (size, age, sex and race); MSD of interest) as well as barriers and strategies to increasing participation of visible minorities in MSD research were extracted from each article and summarized in a table format.

Results

Of the 4,282 articles identified, 28 met inclusion criteria and were included. The majority were conducted in the United States (27 articles). Of the included studies, the groups of visible minorities represented were Black (25 articles), Hispanic (14 articles), Asian (6 articles), Indigenous (3 articles), Middle Eastern (1 article), and Multiracial (1 article). The most commonly cited barriers to research participation were mistrust, logistical barriers (e.g., transportation, inaccessible study location, financial constraints), and lack of awareness or understanding of research. Strategies for increasing diversity were ensuring benefit of participants, recruiting through sites serving the community of interest, and addressing logistical barriers.

Conclusion

Understanding the importance of diversity in MSD research, collaborating with communities of visible minorities, and addressing logistical barriers may be effective in reducing barriers to the participation of visible minorities in health research. This review presents strategies to aid researchers in increasing inclusion in MSD-related research.

Medicinal terpenoid UDP-glycosyltransferases in plants: recent advances and research strategies

Terpenoid glycosides have significant curative effects on many kinds of diseases. Most of these compounds are derived from medicinal plants. Glycosylation is a key step in the biosynthesis of medicinal terpenoids. In plants, UDP-dependent glycosyltransferases comprise a large family of enzymes that catalyze the transfer of sugars from donor to acceptor to form various bioactive glycosides. In recent years, numerous terpenoid UDP-glycosyltransferases (UGTs) have been cloned and characterized in medicinal plants. We review the typical characteristics and evolution of terpenoid-related UGTs in plants and summarize the advances and research strategies of terpenoid UGTs in medicinal plants over the past 20 years. We provide a reference for the study of glycosylation of terpenoid skeletons and the biosynthetic pathways for medicinal terpenoids in plants.

Research strategies for single-cell transcriptome analysis in plant leaves

The recent and continuous improvement in single-cell RNA sequencing (scRNA-seq) technology has led to its emergence as an efficient experimental approach in plant research. However, compared with single-cell research in animals and humans, the application of scRNA-seq in plant research is limited by several challenges, including cell separation, cell type annotation, cellular function analysis, and cell-cell communication networks. In addition, the unavailability of corresponding reliable and stable analysis methods and standards has resulted in the relative decentralization of plant single-cell research. Considering these shortcomings, this review summarizes the research progress in plant leaf using scRNA-seq. In addition, it describes the corresponding feasible analytical methods and associated difficulties and problems encountered in the current research. In the end, we provide a speculative overview of the development of plant single-cell transcriptome research in the future.

Using Videoconferencing Focus Groups in Sexual and Reproductive Health Research With Chinese Im/Migrants in Australia

Videoconferencing focus groups have emerged as a popular method for collecting qualitative data. However, its use in sexual and reproductive health research is still very much in its infancy. Based on participants' feedback and researchers' reflections on using videoconferencing focus groups to collect sexual and reproductive health data with 39 heterosexual and non-heterosexual Chinese im/migrants in Australia, we discuss some of the key lessons learned, and considerations involved in shifting from face-to-face to online focus groups. Overall, videoconferencing focus groups appeared to be a highly feasible and acceptable way to discuss "sensitive" topics with Chinese im/migrants. Importantly, researchers need to be both creative and reflexive during the research process and must not forget that the success of a study lies not only in troubleshooting technical issues but also in cultivating and maintaining a trusting relationship with research participants.

The Enigmatic Metallothioneins: A Case of Upward-Looking Research

In the mid-1950s, Bert Lester Vallee and his colleague Marvin Margoshes discovered a molecule referred to today as metallothionein (MT). Meanwhile, MTs have been shown to be common in many biological organisms. Despite their prevalence, however, it remains unclear to date what exactly MTs do and how they contribute to the biological function of an organism or organ. We investigate why biochemical research has not yet been able to pinpoint the function(s) of MTs. We shall systematically examine both the discovery of and recent research on Dr. Vallee's beloved family of MT proteins utilizing tools from philosophy of science. Our analysis highlights that Vallee's initial work exhibited features prototypical of a developing research tradition: it was upward-looking, exploratory, and utilized mere interactions. Since the 1960s, MT research has increasingly become intervention- and hypothesis-based while it remained largely upward-looking in character. Whilst there is no reason to think that upward-looking research cannot successfully yield structure-function mappings, it has not yet been successful in the case of MTs. Thus, we suggest it might be time to change track and consider other research strategies looking into the evolution of MTs. Recent studies in mollusks render research in this direction worthy of pursuit.

Long Non-Coding RNAs: The Regulatory Mechanisms, Research Strategies, and Future Directions in Cancers

The development and application of whole genome sequencing technology has greatly broadened our horizons on the capabilities of long non-coding RNAs (lncRNAs). LncRNAs are more than 200 nucleotides in length and lack protein-coding potential. Increasing evidence indicates that lncRNAs exert an irreplaceable role in tumor initiation, progression, as well as metastasis, and are novel molecular biomarkers for diagnosis and prognosis of cancer patients. Furthermore, lncRNAs and the pathways they influence might represent promising therapeutic targets for a number of tumors. Here, we discuss the recent advances in understanding of the specific regulatory mechanisms of lncRNAs. We focused on the signal, decoy, guide, and scaffold functions of lncRNAs at the epigenetic, transcription, and post-transcription levels in cancer cells. Additionally, we summarize the research strategies used to investigate the roles of lncRNAs in tumors, including lncRNAs screening, lncRNAs characteristic analyses, functional studies, and molecular mechanisms of lncRNAs. This review will provide a short but comprehensive description of the lncRNA functions in tumor development and progression, thus accelerating the clinical implementation of lncRNAs as tumor biomarkers and therapeutic targets.

Face-to-Face Compared With Online Collected Accounts of Health and Illness Experiences: A Scoping Review

Advocates of online alternatives to face-to-face interviewing suggest online approaches save money and time, whereas others have raised concerns about the quality and content of the resulting data. These issues affect researchers designing and costing their studies and application reviewers and research funders. We conducted a scoping review of English language articles describing the range of online alternative approaches. Furthermore, we systematically identified studies directly comparing online alternatives with face-to-face approaches. Synthesis of these 11 articles (565 participants) suggests that online alternatives should not be viewed as a straightforward replacement for face-to-face, a particularly important finding given the rapid communication changes occurring in the COVID-19 pandemic. When applied with consideration of the evolving evidence on their strengths and weaknesses, online methods may increase the likelihood of obtaining the desired sample, but responses are shorter, less contextual information is obtained, and relational satisfaction and consensus development are lower.

Feminist-Informed Protective Factors for Subthreshold Eating Disorders

Despite knowledge that the larger sociocultural context contributes to the development of eating disorders, few studies have examined protective factors for women with subthreshold eating disorders. Using feminist-informed constructivist grounded theory methodology, 15 women (ages 18-25 years) with subthreshold eating disorders were interviewed. Results suggest that participants spoke of their subthreshold eating disorders in an externalized way and used protective factors to guide decision making toward their preferred values. A grounded theory model was developed to illustrate this process. Protective factors included (a) people who provide emotional and tangible support, (b) support people who challenge the eating disorder, (c) personal sense of agency, and (d) community activism and involvement. Participants experiencing subthreshold eating disorders demonstrated a capacity to distinguish their own thoughts and values from those of the "eating disorder voice," and protective factors facilitated this process. Implications for future research and practice are discussed.

Managing Uncertainty During the Communication of Diagnostic Test Information Between Patients and Clinicians in Australian Emergency Care

We sought (a) an inductive understanding of patient and clinician perspectives and experiences of the communication of diagnostic test information and (b) a normative understanding of the management of uncertainty that occurs during the clinical encounter in emergency care. Between 2016 and 2018, 58 interviews were conducted with patients and nursing, medical, and managerial staff. Interview data were sequentially analyzed through an inductive thematic analysis, then a normative theory of uncertainty management. Themes of "Ideals," "Service Efficiency," and "Managing Uncertainty" were inductively identified as influencing the communication of diagnostic test information. A normative theory of uncertainty management highlighted (a) how these themes reflected the interaction's sociocultural context, encapsulated various criteria by which clinicians and patients evaluated the appropriateness and effectiveness of their communication, and represented competing goals during the clinical encounter, and (b) how systemic tensions between themes accounted for when diagnostic test information communication occurred, was deferred or avoided.

What Contributions, if Any, Can Non-Indigenous Researchers Offer Toward Decolonizing Health Research?

Four non-Indigenous academics share lessons learned through our reflective processes while working with Indigenous Australian partners on a health research project. We foregrounded reflexivity in our work to raise consciousness regarding how colonizing mindsets-that do not privilege Indigenous ways of knowing or recognize Indigenous land and sovereignty-exist within ourselves and the institutions within which we operate. We share our self-analyses and invite non-Indigenous colleagues to also consider socialized, unquestioned, and possibly unconscious assumptions about the dominance of Western paradigms, asking what contributions, if any, non-Indigenous researchers can offer toward decolonizing health research. Our processes comprise of three iterative features-prioritizing attempts to decolonize ourselves, acknowledging the necessary role of discomfort in doing so, and moving through nonbinary and toward nondualistic thinking. With a nondual lens, working to decolonize ourselves may itself be seen as one contribution non-Indigenous researchers may offer to the collective project of decolonizing health research.

New Methodologies for Global Health Research: Improving the Knowledge, Attitude, and Practice Survey Model Through Participatory Research in Haiti

Knowledge, attitude, and practice (KAP) survey models are a common tool used by researchers and global health practitioners to reveal insights necessary for health program design and implementation. We explore how an interdisciplinary team of medical practitioners, researchers, designers, and community members improved the KAP survey tool in Haiti by drawing on participatory research methods. The overall objective of the project was to build a new approach to investigating and meeting community health needs and specifically the challenges faced by women with breast and cervical cancer in Haiti. The research findings were used to design an education tool kit for health care providers as well as create a community-based engagement strategy to better connect people to cancer screening and treatment facilities. By infusing the KAP survey model with participatory approaches to knowledge production, the advisory board designed a survey tool that generated more relevant and in-depth knowledge with the community while maintaining the study's simplicity and complying with a time-limited budget.

Using a Flexible Diary Method Rigorously and Sensitively With Family Carers

Health and social science researchers are increasingly interested in the range of new possibilities and benefits associated with diary methods, particularly using digital devices. In this article, we explore how a flexible diary method, which enables participants to choose the device (i.e., paper notebook, tablet, or computer) and medium (i.e., text, photographs, sketches) through which they narrate their experiences, can be used to promote sensitive and rigorous research engagement with family carers to people with dementia. We used a diary interview method with 10 carers over the course of 6 weeks to explore how they experience and interpret the changing behaviors of their cognitively impaired kin. We reflect on how the quality of diary data can be enhanced alongside the ethical dimensions of research with carer populations, through different forms of diary keeping, regular interaction with participants, reflexive practice, and follow-up interviews.

Getting It Quite Wrong: Van Manen and Smith on Phenomenology

Max van Manen and Jonathan Smith have recently had an exchange in Qualitative Health Research concerning their respective use of phenomenology. I welcome the attempt to get clearer on what phenomenology amounts to and I agree with van Manen that an overly arbitrary use of the term will lead to an erosion of the reputation of phenomenology. However, I think both of them are to blame for promoting various confusions concerning the nature of phenomenology. The aim of my article is to make some critical remarks concerning van Manen's and Smith's understanding of phenomenology and to suggest alternative resources for qualitative researchers interested in phenomenology.

A Critique of O'Byrne's Understanding of Ethnography and the Politics of Public Health Research

Patrick O'Byrne criticizes the use of ethnography in public health research focused on cultural groups. His main argument is that ethnography disciplines marginalized populations that do not respect the imperative of health. In this article, I argue that O'Byrne has an erroneous understanding of ethnography and the politics of scientific research. My main argument is that a methodology itself cannot discipline individuals. I argue that if data are used as a basis to develop problematic public health policies, the issue is the policies themselves and not the methodology used to collect the data. While O'Byrne discourages researchers from conducting health research like ethnography focused on cultural groups, I argue the exact opposite. This has to do with justice and equity for marginalized communities and the obligation to tailor health services for their specific needs, which may not be the same as those of the general population.

Harnessing Energies, Resolving Tensions: Acknowledging a Dual Heritage for Qualitative Evidence Synthesis

Qualitative evidence synthesis (QES) encompasses more than 20 methods for synthesizing qualitative accounts of research phenomena documenting real-life contexts. However, tensions frequently arise from the different heritages that shape QES methodology: namely, systematic reviews of effectiveness and primary qualitative research. Methodological innovations either derive from each heritage or are stimulated when both are in juxtaposition; it is important to broker a rapprochement. This article draws on practical experience from a range of syntheses and methodological development work conducted with the Cochrane Qualitative and Implementation Methods Group. The legacy of both heritages is briefly characterized. Three stages of the QES process offer exemplars: searching/sampling, quality assessment, and data synthesis. Rather than an antagonistic clash of research paradigms, this dual heritage offers an opportunity to harness the collective energies of both paradigms. Future methodological research is needed to identify further applications by which this dual heritage might be optimally harnessed.

An Ounce of Prevention: Identifying Cues to (In)Action for Maternal Vaccine Refusal

Recent increases in childhood vaccine exemption rates are a source of concern within the public health community. Drawing from the health belief model and in-depth interviews with 50 mothers ( n = 50) who refused one or more vaccine, the aim of this study was to identify the specific reasons and the broader decision context(s) that underscored participants' vaccine refusal. Results indicate that the vast majority of participants supported vaccination until a particular cue motivated them to consider otherwise, and qualitative analysis identified three main categories into which these cues fell: perceived adverse reactions, endorsements from health care professionals, and perceived contradiction among expert-endorsed messages. These categories point to the central role of health communication in motivating vaccine refusal. Better understanding these cues can inform vaccine communication scholarship and practice, and also lend theoretical insight into the intertextual nature of controversial health messages and decisions.

'Quality in, quality out', a stepwise approach to EBM for rare diseases promoted by MEN1

Rare diseases pose specific challenges in the field of medical research to provide physicians with evidence based guidelines derived from studies with sufficient quality. An example of these rare diseases is multiple endocrine neoplasia type 1 (MEN1), which is an autosomal dominant endocrine tumor syndrome with an estimated occurrence rate of 2-3 per 100.000. For this complex disease, characterized by multiple endocrine tumors, it proves difficult to perform both adequate and feasible studies. The opinion of patients themselves is of utmost importance to identify the gaps in the evidence based medicine regarding clinical care. In the search for scientific answers to clinical research questions, the aim for best available evidence is obvious. Observational studies within patient cohorts, although prone to bias, seem the most feasible study design regarding the disease prevalence. Knowledge and adaptation to all types of bias is demanded in the strive for answers. Guided by our research on MEN1 patients, we elaborate on strategies to identify sufficient patients, to maximize and maintain patient enrollment and to standardize the data collection process. Preferably, data collection is performed prospectively, however, under certain conditions data storage in a longitudinal retrospective database with a disease-specific framework is suitable. Considering the global challenges on observational research on rare diseases, we propose a stepwise approach from clinical research questions to scientific answers.

"It's Not Much of a Life": The Benefits and Ethics of Using Life History Methods With People Who Inject Drugs in Qualitative Harm Reduction Research

A life history approach enables study of how risk or health protection is shaped by critical transitions and turning points in a life trajectory and in the context of social environment and time. We employed visual and narrative life history methods with people who inject drugs to explore how hepatitis C protection was enabled and maintained over the life course. We overview our methodological approach, with a focus on the ethics in practice of using life history timelines and life-grids with 37 participants. The life-grid evoked mixed emotions for participants: pleasure in receiving a personalized visual history and pain elicited by its contents. A minority managed this pain with additional heroin use. The methodological benefits of using life history methods and visual aids have been extensively reported. Crucial to consider are the ethical implications of this process, particularly for people who lack socially ascribed markers of a "successful life."

"I Never Would Have Caught That Before": Pharmacist Perceptions of Using Clinical Decision Support for Antimicrobial Stewardship in the United States

To systematically improve the appropriateness of antibiotic prescribing, antimicrobial stewardship programs have been developed. There is a paucity of literature examining how pharmacists perform antimicrobial stewardship using a clinical decision support system in a hospital setting. The purpose of this qualitative study was to develop a model exploring how pharmacists perform antimicrobial stewardship to identify areas for programmatic improvement. Semistructured interviews were conducted across a health care system until saturation of themes was reached. Pharmacists identified that self-efficacy and time were vital for antimicrobial stewardship to be performed, while culture of the hospital and attitude facilitated the process of stewardship. Antimicrobial stewardship programs using clinical decision support tools should ensure pharmacists have adequate time to address rules, provide easy-to-use resources and training to support self-efficacy, and engage influential physicians to support a culture of collaboration.

Photovoice Ethics: Critical Reflections From Men's Mental Health Research

As photovoice continues to grow as a method for researching health and illness, there is a need for rigorous discussions about ethical considerations. In this article, we discuss three key ethical issues arising from a recent photovoice study investigating men's depression and suicide. The first issue, indelible images, details the complexity of consent and copyright when participant-produced photographs are shown at exhibitions and online where they can be copied and disseminated beyond the original scope of the research. The second issue, representation, explores the ethical implications that can arise when participants and others have discordant views about the deceased. The third, vicarious trauma, offers insights into the potenial for triggering mental health issues among researchers and viewers of the participant-produced photographs. Through a discussion of these ethical issues, we offer suggestions to guide the work of health researchers who use, or are considering the use of, photovoice.

Translating Knowledge From a Family Systems Approach to Clinical Practice: Insights From Knowledge Translation Research Experiences

While there has been continued growth in family nursing knowledge, the complex process of implementing and sustaining family nursing in health care settings continues to be a challenge for family nursing researchers and clinicians alike. Developing knowledge and skills about how to translate family nursing theory to practice settings is a global priority to make family nursing more visible. There is a critical need for more research methods and research evidence about how to best move family nursing knowledge into action. Enhancing health care practice is a multifactorial process that calls for a systemic perspective to ensure its efficacy and sustainability. This article presents insights derived from lessons learned through recent research experiences of using a knowledge translation model to promote practice changes in health care settings. These insights aim to optimize (a) knowledge translation of a Family Systems Approach (FSA) in practice settings; (b) knowledge translation research processes; and

The Fate of Unused Embryos: Discourses, Action Possibilities, and Subject Positions

Although in vitro fertilization (IVF) has offered hope to those struggling with infertility, it has also had some unintended consequences, including the fate of embryos that may be "surplus" to requirement following IVF treatment. The number of embryos in storage across the world is high, creating a dilemma for patients who need to make disposal decisions, as well as presenting an administrative and practical dilemma for clinics. Research has suggested that patients' views of the status of their embryo/s may affect their disposal decisions, and yet the nature of the links between views of the embryo and decisions to either donate or discard remain unclear. In this article, we engage in a discursive analysis of literature on disposal decisions. We discuss the range of ways in which embryos may be constructed, and demonstrate how these discourses make available or constrain particular action possibilities, and offer particular subject positions for patients. The analysis highlights the complexity of the relationship between embryo status and decision making, and may assist clinicians in supporting and guiding patients' decisions.

Intentional Nonadherence as a Means to Exert Control

Medication adherence is a major issue for patients with a chronic illness, who sometimes rationally choose temporary nonadherence. This study aims at better understanding intentional nonadherence and especially why it seems to fluctuate over time. It is based on 48 semi-structured interviews conducted in a hospital in the Netherlands with patients who had been prescribed a medication for a chronic disease for at least 1 year, and who had either type 2 diabetes, hypertension, Parkinson's disease, inflammatory bowel disease, or chronic myeloid leukemia. The analysis uses a simplified version of the failure modes and effects analysis (FMEA) method. Intentional nonadherence appeared to be the result of the respondents' desire (a) to exert control over the treatment and its effects on their body, and (b) to control the hold of the treatment on their daily life. This result provides a rationale for the fluctuation of intentional nonadherence behavior.

Strategies for enrollment of African Americans into cancer genetic studies

The enrollment of ethnically diverse populations in genetic and genomic research is vital to the parity of benefits resulting from research with biological specimens. Herein, we discuss strategies that may effectively improve the recruitment of African Americans into genetics studies. Specifically, we show that engaging physicians, genetic counselors, and community members is essential to enrolling participants into genetic studies. We demonstrate the impact of utilizing African American genetic counselors on study enrollment rates and implementing a two-page consent form that improved on a lengthy and inefficient consenting process. Lastly, we provided participants with the option of donating saliva instead of blood for study purposes. Descriptive statistics were used. Using the aforementioned strategies, recruitment goals for the Genetic Basis of Breast Cancer Subtype Study at Howard University (HU) were met. Our overall results yielded 182 participants in 18 months. Recruitment strategies that involve the engagement of physicians, genetic counselors, and community members may help researchers increase the enrollment of ethnically diverse and hard-to-reach participants into genetic studies.

Innovating alongside designers

Building alliances with industrial designers offers health innovators a unique pathway to create new modes to serve their patients. Cross-pollination of ideas from the earliest stages of development in interdisciplinary research and development teams including major stakeholders and designers can lead to more meaningful and impactful innovations.A shift in future healthcare from cure to prevention will rely more heavily upon the individual. The home environment will house consumer medical devices that will carry out basic monitoring of the individual. While technologies are currently being developed to support this trend, there is a gulf that exists between the often-complex interfaces required by the highly specific functionality of products and the emotional needs of the target user. If a target user 'feels' a product was designed 'just for them' they are more likely to develop an emotional bond with that product. This manifests itself in the user engaging and interacting with the product. If a product, regardless of its high functionality, does not resonate with the user, this tends to result in product underuse, misuse and possible abandonment. When those products are related to a course of medical rehabilitation or treatment, these results could be translated to 'more compliant' and 'less compliant' and ultimately can impact upon how a person heals.Industrial designers focus on ensuring that both the functional and emotional needs of mainstream users as well as technical-expert-users are met. Design research provides the opportunity to bridge the gap between the functional requirements and the less tangible unmet needs of the user by exploring authentic human behaviour.This paper presents case studies of collaborative, interdisciplinary teams employing human-centred design and empathic research strategies (incorporating shared language, collaboration, ethnography, empathy and empathic modelling) to create real solutions that are responding to real needs of real users.The future is interdisciplinary. The future is bright.

Empathic design: Research strategies

This paper explores the role of empathy within new product development from the perspective of human-centred design. The authors have developed a range of empathic design tools and strategies that help to identify authentic human needs.For products and services to be effective, they need to satisfy both functional and emotional needs of individuals. In addition, the individual user needs to feel that the product and/or service has been designed 'just for them', otherwise they may misuse, underuse or abandon the product/service. This becomes critical with a product such as a Zimmer frame (walker), when it fails to resonate with the patient due to any stigma the patient may perceive, and thus remains unused.When training young designers to consider the wider community (people unlike themselves) during the design process, it has proven extremely valuable to take them outside their comfort zones, by seeking to develop empathy with the end user for whom they are designing. Empathic modelling offers designers the opportunity to develop greater insight and understanding, in order to support more effective design outcomes. Sensitising designers to the different ways that individuals complete daily tasks has helped to diminish the gap between themselves and others (e.g. people with disabilities).The authors intend for this paper to resonate with health care providers. Human-centred design can help to refocus the designer, by placing the individual end user's needs at the heart of their decision-making.

Future possibilities in the prevention of breast cancer: fat and fiber and breast cancer research

The potential for a reduction in dietary fat or for an increase in dietary fiber to reduce breast cancer risk has been debated for some years. It is argued here that available research data, even though extensive, leave open hypotheses ranging from little or no potential to major public health potential for breast cancer prevention by means of these dietary maneuvers. Some elements of a research strategy for testing these and other dietary breast cancer prevention hypotheses are described.