The Politics of Remembering and Forgetting: Native Title Law and Reconciliation in Australia

The post-Mabo era was to be the age of reconciliation and the end of unjust dispossession of indigenous peoples’ lands. However, as the more recent cases in native title show this vision did not become the reality. In this paper, I will examine Mabo in its historical context. In particular I will examine the claim that Mabo was a product of the “new history” movement in Australia. This movement developed in response to the silence that had shrouded the history of colonial relations between indigenous and non-indigenous peoples for most of the 19th and 20th centuries. Through the writing of these histories, new historians have raised awareness of the history of colonization in Australia and the impact it has had on indigenous peoples in particular. In the paper I will outline the ways in which Mabo is a product of this history. However, if Mabo did not bring to an end to the injustice and inequality facing indigenous peoples in the context of land law in Australia, it is because of the traces of another history informing that decision and the events that followed it. In this paper I will refer to this history as the “old history” of Australia. In this history indigenous peoples are placed in a paradoxical position: they are inferior, but still seen as threat to the colonial enterprise. The paper will explore how this “history” is repeated in Mabo and continues to inform the High Court’s approach to native title law

What are the reasons for clinical network success? A qualitative study

Background Clinical networks have been established to improve patient outcomes and processes of care by implementing a range of innovations and undertaking projects based on the needs of local health services. Given the significant investment in clinical networks internationally, it is important to assess their effectiveness and sustainability. This qualitative study investigated the views of stakeholders on the factors they thought were influential in terms of overall network success. Method Ten participants were interviewed using face-to-face, audio-recorded semi-structured interviews about critical factors for networks’ successes over the study period 2006–2008. Respondents were purposively selected from two stakeholder groups: i) chairs of networks during the study period of 2006–2008 from high- moderate- and low-impact networks (as previously determined by an independent review panel) and ii) experts in the clinical field of the network who had a connection to the network but who were not network members. Participants were blind to the performance of the network they were interviewed about. Transcribed data were coded and analysed to generate themes relating to the study aims. Results Themes relating to influential factors critical to network success were: network model principles; leadership; formal organisational structures and processes; nature of network projects; external relationships; profile and credibility of the network. Conclusions This study provides clinical networks with guidance on essential factors for maximising optimal network outcomes and that may assist networks to move from being a ’low-impact’ to ‘high-impact’ network. Important ingredients for successful clinical networks were visionary and strategic leadership with strong links to external stakeholders; and having formal infrastructure and processes to enable the development and management of work plans aligned with health priorities

Three discipline collaborative radiation therapy special debate: All head and neck cancer patients with intact tumors/nodes should have scheduled adaptive replanning performed at least once during the course of radiotherapy

Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/149241/1/acm212587_am.pdfhttps://deepblue.lib.umich.edu/bitstream/2027.42/149241/2/acm212587.pd

Responses to the 2017 ‘1 Million Gray Question’: ASTRO membership’s opinions on the most important research question facing radiation oncology

At the American Society for Radiation Oncology's (ASTRO's) 2017 annual meeting in San Diego, CA, attendees were asked, “What is the most important research question that needs to be answered in the next 3 to 5 years?” This request was meant to start a dialogue, promote thoughtful discussion within our professional community, and help inform topics for ASTRO workshops and focus meetings. Nearly 100 people responded while in attendance at the meeting, with questions that ranged from “How can we remove barriers so low- and middle-income countries can have radiation oncology facilities?” to “What is the exact role of radiation in stage IV disease in combination with immunotherapy or targeted agents to combat resistance development?” to “How can personalized care be better integrated into the oncology and radiation oncology clinical space?

Racial Differences in Treatments and Toxicity in Non-Small Cell Lung Cancer Patients Treated with Thoracic Radiation Therapy

Background: Racial disparities are of particular concern for lung cancer patients given historical differences in surgery rates for African-American lung cancer patients that resulted in lower overall survival and higher recurrence rates compared with rates in White patients. Objectives: The overall objective of this study was to examine racial differences in thoracic radiation therapy (RT) treatments and toxicities in a large cohort of patients from a multi-institutional consortium database of non-small cell lung cancer (NSCLC) patients. Methods: A large multi-institutional statewide prospectively collected patient-level database of locally advanced (stage II or III) NSCLC patients who received thoracic RT from March 2012 to November 2019 was analyzed to assess the associations between race and treatment and toxicity variables. Race (White or African-American) was defined by patient self-report or if not available then by the electronic medical record system classification. Race categories other than White or African-American comprised a small minority of patients and were excluded from this analysis. Patient-reported toxicity was determined by validated tools including the Functional Assessment of Cancer Therapy-Lung (FACT-L) quality of life instrument. Provider-reported toxicity was determined by the Common Terminology Criteria for Adverse Events (CTCAE) version 4.0. Uni-variable and multi-variable regression models were then fitted to assess relationships between primary outcomes by race and indicators of high-quality treatment and secondary analysis of symptoms. Spearman rank correlation coefficients were calculated between provider reported toxicity and similar patient reported outcomes for each race category. Results: A total of 1441 patients from 24 institutions with mean age of 68 years (range 38-94) were evaluated; 226 patients were African-American, of whom 61% were treated at three facilities. Race was not significantly associated with RT treatment approach, use of concurrent chemotherapy, or the dose to the planning target volume (PTV) or organs at risk including the heart and lungs. However, there was increased patient-reported general pain in African-American patients (compared with White patients) at several time points including pre-RT (22% (vs 15%), P=0.02) and at the end of RT (30% (vs 17%), P=0.001). African-American patients were significantly less likely to have provider-reported grade 2+ radiation pneumonitis (odds ratio (OR) 0.36, P=0.03), despite similar levels of patient-reported respiratory toxicities such as cough and shortness of breath and even after controlling for known patient and treatment-related factors. Correlation coefficients between provider- and patient-reported toxicities were generally similar across race categories. Conclusions: In this large multi-institutional observational study, we reassuringly found no evidence of differences in radiation treatment or chemotherapy approaches by race, in contrast to historical differences by race in surgical care that led to worse survival and outcomes in minority race patients. However, we did unexpectedly find that African-American race was associated with lower odds of provider-reported grade 2+ radiation pneumonitis despite similar patient-reported toxicities of shortness of breath and cough. There are several possibilities for this finding including that pneumonitis is a multifactorial diagnosis that relies on clinical as well as radiologic information and clinical information alone may be insufficient. The Spearman correlation analysis also revealed stronger correlations between patient- and provider-reported toxicities in White patients compared with African-American patients, particularly for trouble swallowing/esophagitis. These findings together for pneumonitis and esophagitis discouragingly suggest possible under-recognition of symptoms in black patients. Further investigation is now warranted to better understand how these findings impact the care of racially diverse lung cancer patients

Cardiac and Pulmonary Dosimetric Parameters in Lung Cancer Patients Undergoing Post-Operative Radiation Therapy in the Real-World Setting

Purpose/Objective(s): The recently published Lung ART trial reported increased rates of cardiac and pulmonary toxicity in the post-operative radiation therapy arm. It remains unknown whether the dosimetric parameters reported in Lung ART are representative of real-world practice. The purpose of this study is to examine heart and lung dose exposure in patients receiving post-operative radiation therapy for non-small cell lung cancer (NSCLC) across a statewide consortium. Materials/Methods: From 2012 to 2020, 377 patients at 27 academic and community centers within the Michigan Radiation Oncology Quality Consortium (MROQC) underwent surgical resection followed by post-operative radiation therapy for non-metastatic NSCLC. Demographic and dosimetric data were prospectively collected for these patients. Rates of 3D-CRT and IMRT use were analyzed. Mean heart dose (MHD), heart V5, heart V35, mean lung dose (MLD), lung V20, target volume and minimum dose to 95% PTV were calculated for these patients and the reported dosimetric parameters were stratified by treatment modality. Results: 51% of patients in this cohort had N2 disease at the time of surgery, 18% had a positive margin. 65.8% of patients were treated with IMRT compared to 32.1% treated with 3D-CRT. Average MHD for all patients was 10.3 Gy, mean Heart V5 was 40.3% and mean heart V35 was 12.6%. Average MLD was 11.2 Gy and mean lung V20 was 18.9%. These dosimetric parameters did not significantly differ based on treatment modality, with MHD and MLD 9.9 Gy and 10.1 Gy, respectively, for patients treated with 3D-CRT compared to 10.6 Gy and 11.8 Gy for patients treated with IMRT. Conclusion: Cardiac and lung dosimetric parameters for patients receiving post-operative radiation therapy for NSCLC are similar to the dosimetric characteristics reported in Lung ART. The mean heart and mean lung doses observed are slightly lower (MHD 10.3 Gy, MLD 11.2 Gy) compared to Lung ART (MHD 13 Gy, MLD 13 Gy), possibly owing to increased use of IMRT. These data support application of Lung ART\u27s findings outside of the clinical trial setting