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Purpose The core needle biopsy (CNB) procedure is an essential part of breast cancer diagnosis. Current CNB devices on the market are not suitable for low-resource settings, which makes early breast cancer diagnosis inaccessible for women in these areas. Disposable CNB devices are the gold standard of breast cancer diagnostic tools in high-income countries, but the single-use cost—approximately $40 to $200—is unaffordable in low- and middle-income countries. Existing reusable devices are susceptible to internal contamination as blood travels back through the coaxial needle into the driver and thus requires laborious cleaning procedures. Methods After conducting more than 100 interviews with stakeholders at 18 hospitals in the United States, South Africa, and Peru, we devised criteria for the device. The device must prevent internal driver contamination and match the standard tissue sample size. We report the design and development of a reusable CNB device with disposable needles that trap contamination. To demonstrate where blood travels in current reusable devices and prove that internal contamination can be completely eliminated, we created an external attachment that interfaces with the Bard Magnum, an existing reusable driver that yields internal contamination. To prove our concept, we evaluated contamination rates by placing water-indicating tape inside the Bard driver and firing the device into a plastic test tube that was filled with blood-mimicking solutions and covered with a latex glove. Results When we fired the existing Bard Magnum device without our attachment, contaminants entered the internal compartment of the device both times, as shown by the water-indicating tape; however, when the device was fired with our external needle attachment, the water-indicating tape was completely clean, which verified that there was no internal contamination. Conclusion We can conclude from our contamination testing that blood enters the device as a result of contaminants traveling back between the faces of the needle and sheath into the device’s driver and that our external attachment eliminates this risk. Using these insights, we are currently developing a full reusable driver device with novel disposable needles that trap contamination to remove safety concerns associated with reusable devices, lower procedural cost, and increase access to breast cancer diagnostic tools in low-resource settings. AUTHORS' DISCLOSURES OF POTENTIAL CONFLICTS OF INTEREST The following represents disclosure information provided by authors of this manuscript. All relationships are considered compensated. Relationships are self-held unless noted. I = Immediate Family Member, Inst = My Institution. Relationships may not relate to the subject matter of this manuscript. For more information about ASCO's conflict of interest policy, please refer to www.asco.org/rwc or ascopubs.org/jco/site/ifc . Megan Callanan Employment: Stryker Spine Patents, Royalties, Other Intellectual Property: Ithemba LLC Laura Hinson Patents, Royalties, Other Intellectual Property: Ithemba LLC Madeline Lee Patents, Royalties, Other Intellectual Property: Ithemba LLC Sophia Triantis Patents, Royalties, Other Intellectual Property: Ithemba LLC Amir Manbachi Research Funding: Siemens Healthineers (Inst) Susan Harvey Honoraria: Hologic Inc, IBM Watson Imaging Consulting or Advisory Role: IBM Watson, Hologic Inc Research Funding: IBM Watson

This document contains an analysis of interviews, focus groups, and relevant background information on the homeless community in Alamance County. The data were compiled by a group of five graduate students from the University of North Carolina at Chapel Hill���s School of Public Health, as part of a community assessment, also known as Action-Oriented Community Diagnosis (AOCD). An AOCD is a process through which a student team works with a community to identify strengths and challenges, presents the findings at a community forum, and facilitates the development of tangible action steps to help the community address the identified challenges. The process involves both research and practice. Bill Adams, executive director of the Allied Churches of Alamance County, and Karen Webb, of the Alamance-Caswell-Rockingham Local Management Entity (formerly the Alamance-Caswell Area Mental Health Program), requested the AOCD in order to learn more about homelessness in the county. Another goal of the assessment was to examine the assets and challenges of service providers who work with individuals experiencing homelessness. The information presented in this document is intended for use as a reference and a resource, and may inform program planning, grant writing, and future community forums. The first section of this report contains background information on homelessness and Alamance County. The second part of the document contains a description of the AOCD methods and a summary of community strengths and challenges, including eight domains that emerged from interviews and focus groups with service providers and individuals experiencing homelessness. These eight domains are: mental health, employment, housing, transportation, substance abuse, reentry from prison or psychiatric facilities, perceptions of homelessness, and communication among service providers or between service providers and homeless individuals. The third part of the document contains a description of the community forum, planned by the community and student team, during which project findings were presented and tangible action steps were generated to address the challenges that emerged during the AOCD process. Finally, the student team���s recommendations conclude the report. The scope of this report is limited to the adult homeless community in Graham and Burlington because that is where most services are concentrated. For the purposes of this AOCD, the homeless population is defined broadly, but most interviewees are shelter guests and many are new residents of Alamance County. The student team presented their findings at a community forum, called Homelessness: Creating Community Change, held on April 27, 2007 at the First Christian United Church of Christ in Burlington. The event brought together more than 160 homeless and formerly homeless individuals, service providers and general community members with an interest in homelessness, to identify and discuss action steps related to the identified themes. The action steps and key discussion points from the forum are listed in Appendix C, and a general presentation of the forum planning process and schedule of events is contained in the body of this document. To conclude, this document describes the AOCD process and analyzes the experiences, perceptions, and frustrations of people experiencing homelessness, and the people who serve them, in Alamance County. The primary data, secondary data, recommendations, and action steps contained in this report may be used to guide future program planning and grant-writing. The student team thanks the people of Alamance County for the challenging work they have done already, and the action steps they have committed to take in the future, to improve the lives of people experiencing homelessness.