Access to breast prostheses via a government-funded service in Victoria, Australia

For many women, the only alternative to breast reconstruction following a mastectomy is to use external prostheses, which need replacing regularly at a cost of up to $395 per prosthesis. Commonwealth and state governments across Australia have responded to this need by providing subsidies to assist in the purchase of breast prostheses. However, current arrangements have been highly variable and sometimes difficult to access. As part of a larger review of breast pros-thesis services in Victoria, Australia, the aim of this research was to evaluate client satisfaction among Victorian women who accessed funds through the State Government\u27s Aids and Equipment Program, compare the responses of the program service providers with the experiences of clients accessing funding, and identify opportunities to improve service provision. <br /

A Proposal for Stewardship Support to Private Native Forests in NSW

The Southern Cross Group is proposing a completely new approach to private forest management in NSW based on stewardship support. This means that incentives will be used to encourage landholders to manage their forests in a way that maintains their environmental and other values for the community, without compromising their value as a resource to the farming community. Importantly, the Southern Cross Group system will foster good outcomes through innovation rather than through cumbersome and onerous prescriptions. Private forests in NSW are important as a source of timber as well as for the conservation values they provide to the general community. Landholders should be encouraged to manage them in a way that preserves their productive capacity and their conservation values for the long term. At present, however, neither the current regulatory regime, including the Private Native Forest legislation and proposed code of practice, nor the current market regime encourages sustainable management of the State's private timber resources. The Southern Cross Group has designed an effective and simple way of fostering and rewarding good stewardship of private native forests. Good stewardship may be viewed as a 'duty of care' responsibility that should be enforced by legislation, or as an environmental service that should be recognised and rewarded. The distinction is academic: the reality is that incentives are more effective than punitive regulations. Good environmental outcomes for most forests depend on active management and, especially in the case of private native forests, on incentives for continuing management. The challenge is to devise an equitable scheme that sends the right signals for forest management, is cost-effective to administer, and represents a worthwhile investment in terms of the public good generated. We believe the way forward is with simple, transparent indicators that provide an immediate and ongoing incentive. Under our proposal, landholders will receive an annual cash payment as a reward for progress towards specific outcomes. Rather than complicated targets, we are proposing a simple, two-tiered system that will give enough incentive to landholders to provide the environmental services desired by the community. The first tier rewards and encourages landholders to regenerate more forest, to retain big trees, and to stimulate tree growth on private land. The second tier rewards and encourages stewardship of endangered species and ecological communities. These incentives will be simple to apply and audit, and will encourage landholders to learn about and encourage biodiversity on their land, and to consider it part of their income portfolio. This system will contribute to farmers seeing forests as core business, both as part of their income stream and as part of their environmental stewardship responsibilities. When all farmers view forests in this way, Australia will reap the benefit of forests that are more diverse and productive, and a forest estate that no longer continues to shrink

The changing landscape of conservation science funding in the United States

To understand the changing role of funding sources in shaping conservation science in the United States, we analyzed acknowledgments from published studies, trends in research funding, and survey responses from conservation scientists. Although the U.S. federal government was the most frequently acknowledged source of support overall, U.S. foundations and NGOs were the predominant sources for tropical and socioeconomic research. Acknowledgments of foundation support for conservation research increased over the last two decades, while recognition of federal funds declined. Concordant trends in funding and acknowledgments indicated a changing landscape for conservation science, in which federal support has not kept pace with the growth in conservation research efforts or needs. Survey responses from conservation scientists about their funding sources were consistent with acknowledgment data, and most (64%) indicated that shifts in funding sources and amounts affected the type of research they conduct. Ongoing changes in the funding landscape shape the direction of conservation research and may make conservation science more vulnerable to economic recessions

Population-Based Pragmatic Trial of Advance Care Planning in Primary Care in the University of California Health System.

Introduction: Varying intensity of advance care planning (ACP) interventions at the population level has not been compared among seriously ill patients in primary care. This project will implement, test, and disseminate real-world scalable ACP interventions among primary care clinics across three University of California Health systems. The three ACP interventions are (1) distribution of an advance directive (AD) with targeted ACP messaging, (2) the AD, messaging, plus prompting patients to engage with the Prepare For Your Care website (PREPARE), and (3) the AD, messaging, PREPARE, plus Care Coordinator engagement with patients and clinicians. Methods: We will identify a population cohort of seriously ill primary care patients and implement the ACP interventions using electronic health record (EHR) patient portals and postal mailings. Forty-five clinics across the three health systems will be cluster randomized to one of the three ACP interventions. The primary outcome for the population cohort is AD or Physician Orders for Life-Sustaining Treatment documentation in the EHR. A subset of the population cohort will be surveyed to assess patient-centered outcomes, including care consistent with goals at baseline, 12 months, and 24 months. Caregivers will be interviewed if patients are unable to be surveyed or die. ACP documentation, goal concordant care, and among decedents, health care utilization will be compared among intervention arms. Study Implementation: Challenges and Contributions: The project is guided by a Study Advisory Group and Community Advisory Groups at each site to ensure rigorous patient-centered methods and consistency of implementation. Intervention fidelity will be evaluated using the Reach, Efficacy, Adoption, Implementation, and Maintenance (RE-AIM) framework. Challenges to implementation of this three-site health system trial and to intervention fidelity stem from site/clinic/system cultures, increasing attention to end-of-life care from payers and regulators, and growing pressures by health systems to implement ACP interventions. Stakeholder engagement is required to ensure consistent interventions across sites

Audio feedback design: principles and emerging practice

This paper considers the design of audio feedback as experienced in several faculties of a UK university and as identified in the literature. Several adaptable models are presented, including: 'personal tutor monologue' recorded at the PC by the tutor as part of the marking process; 'personal feedback conversations', recorded by the tutor or student(s) in the lab or studio to capture project discussions or studio 'crits'; 'broadcast feedback' targeted at large groups; 'peer audio feedback', in which students learn as they assess each other's work; 'tutor conversations', a 'common room conversation' approach designed to model critical thinking; and 'personal audio interventions', targeted at individuals to address emerging issues. The methods are introduced and evaluated according to their potential to formatively affect learning. Audio feedback design factors are outlined and practical recommendations are offered. The paper concludes that the use of audio feedback can promote a culture of dialogic engagement

Alternative to welfare: the Milwaukee Jobs Commitment

The central theme of the paper is that although the only solution to poverty is income, this income must be obtained through a fair wage and package of benefits received in return for labor. Jobs, alone, can not eradicate poverty. They must offer benefits at least comparable to the benefits received while on welfare. This includes a package of sufficient income to support a family, including health care, child care, transportation and some type of career ladder so that a worker can see an opportunity for growth in his or her job. This paper examines the strengths and weaknesses of a pilot project which has been designed for two target neighborhoods in Milwaukee. Known as The New Hope Project: The Milwaukee Jobs Commitment, the goal of this project is to provide jobs and benefits that offer the poor an incentive to voluntarily choose employment over welfare. One of the central tenets of the project is that all who work full-time and year-round should be entitled to a wage and package of benefits that puts them above the official poverty level

Pan-Cancer Analysis of lncRNA Regulation Supports Their Targeting of Cancer Genes in Each Tumor Context

Long noncoding RNAs (lncRNAs) are commonly dys-regulated in tumors, but only a handful are known toplay pathophysiological roles in cancer. We inferredlncRNAs that dysregulate cancer pathways, onco-genes, and tumor suppressors (cancer genes) bymodeling their effects on the activity of transcriptionfactors, RNA-binding proteins, and microRNAs in5,185 TCGA tumors and 1,019 ENCODE assays.Our predictions included hundreds of candidateonco- and tumor-suppressor lncRNAs (cancerlncRNAs) whose somatic alterations account for thedysregulation of dozens of cancer genes and path-ways in each of 14 tumor contexts. To demonstrateproof of concept, we showed that perturbations tar-geting OIP5-AS1 (an inferred tumor suppressor) andTUG1 and WT1-AS (inferred onco-lncRNAs) dysre-gulated cancer genes and altered proliferation ofbreast and gynecologic cancer cells. Our analysis in-dicates that, although most lncRNAs are dysregu-lated in a tumor-specific manner, some, includingOIP5-AS1, TUG1, NEAT1, MEG3, and TSIX, synergis-tically dysregulate cancer pathways in multiple tumorcontexts

Genomic, Pathway Network, and Immunologic Features Distinguishing Squamous Carcinomas

This integrated, multiplatform PanCancer Atlas study co-mapped and identified distinguishing molecular features of squamous cell carcinomas (SCCs) from five sites associated with smokin

Pan-cancer Alterations of the MYC Oncogene and Its Proximal Network across the Cancer Genome Atlas

Although theMYConcogene has been implicated incancer, a systematic assessment of alterations ofMYC, related transcription factors, and co-regulatoryproteins, forming the proximal MYC network (PMN),across human cancers is lacking. Using computa-tional approaches, we define genomic and proteo-mic features associated with MYC and the PMNacross the 33 cancers of The Cancer Genome Atlas.Pan-cancer, 28% of all samples had at least one ofthe MYC paralogs amplified. In contrast, the MYCantagonists MGA and MNT were the most frequentlymutated or deleted members, proposing a roleas tumor suppressors.MYCalterations were mutu-ally exclusive withPIK3CA,PTEN,APC,orBRAFalterations, suggesting that MYC is a distinct onco-genic driver. Expression analysis revealed MYC-associated pathways in tumor subtypes, such asimmune response and growth factor signaling; chro-matin, translation, and DNA replication/repair wereconserved pan-cancer. This analysis reveals insightsinto MYC biology and is a reference for biomarkersand therapeutics for cancers with alterations ofMYC or the PMN