Australia's nation-building: renegotiating the relationship between Indigenous peoples and the state

By the time of Australia's Federation in 1901, the colonies had established a long tradition of discrimination against Indigenous peoples. As a colonial country, racism was a founding value of Australian society - it justified the wholesale denial of Indigenous peoples' rights to retain their social, economic and political structures, while denying their rights to participate in the polity that was under construction. This beginning helped to establish the fundamental disrespect for Indigenous peoples that underpins Australia's legal and political development. Disrespect occurs not just in the relationship between the state and Indigenous peoples, but has engendered a more personal disrespect that is experienced by Indigenous people on a daily basis. It is the ongoing tolerance of disrespect that maintains racism as a core value of Australian society. Achieving justice for Indigenous peoples therefore requires fundamental change at every level. As Australia moves into its second century as an independent state, an examination of the vestiges of Australia's colonial origins should move us toward rectifying the fundamental injustices that continue to undermine the foundations of Australian nationhood. Nation-building is an ongoing process. It requires constant reinforcement of values and identity. It is not sufficient to relegate the failure to respect Indigenous peoples as equals to the vagaries of history, because that history constantly informs Australia's identity, values and governance. This paper looks back at those foundations but also at recent public policy debates concerning Indigenous peoples' rights. We identify the shortcomings of recent policies as stemming from the failure to approach Indigenous issues within the context of the structural relationship between Indigenous peoples and the colonial state. We suggest that Indigenous policy can no longer suffer the absence of a process that has the capacity to tear at the institutionalised racism and discrimination of the Australian state and build respect for Indigenous peoples as the first peoples of this land

Do ACE inhibitors prevent nephropathy in type 2 diabetes without proteinuria?

Angiotensin-converting enzyme (ACE) inhibitors make a significant difference for patients with diabetes as a whole. If patients both with and without microalbuminuria are included together, ACE inhibitors significantly reduce the progression of the albumin excretion rate (strength of recommendation [SOR]: A, based on multiple randomized controlled trials) and the development of overt nephropathy (SOR: A, based on 1 randomized controlled trial). However, studying diabetes without microalbuminuria separately, the effect of ACE inhibitors on progression to nephropathy does not reach statistical significance. This applies to both type 1 and 2 diabetes (SOR: A, based on randomized controlled trials with heterogenous results). Results are contradictory regarding whether ACE inhibition delays new onset of diabetic microalbuminuria

How Youth Are Put At Risk by Parents’ Low-Wage Jobs

In this report, we present a first-ever overview of what is known about the relationship between the status of youth and their parents’ low-wage jobs. Of the 20 million adolescents with working parents, 3.6 million (one out of every six) are in low-income families where parents have low-wage jobs. We identify several ways that young people are harmed by their parents’ low-wage, low-quality jobs that point to the urgency of this issue

Sexual Risk, Substance Use and Undiagnosed Seropositivity among Men Who Have Sex with Men and Women in Miami, Florida

This paper utilizes the National HIV Behavioral Surveillance data in Miami for the men who have sex with men cycle (NHBS-MSM2) in 2008. We analyzed sexual risk, substance use and undiagnosed seropositivity in a diverse sample of men who have sex with men and women (MSMW) and compared them with MSM. Of 152 MSMW, 15.1% tested HIV positive with 73.9% previously undiagnosed. Almost half (44.1%) of the MSMW reported unprotected sex with male and female partners in the past year. More MSMW than MSM had undiagnosed HIV infection, exchanged sex for money or drugs, used crack and cocaine, been high during sex, and had not received HIV treatment if HIV positive. Undiagnosed HIV infection among MSMW was associated with Black race, older age, non-alcohol use and Ecstasy use. Our findings indicate that MSMW represent a unique population at risk of acquiring and transmitting HIV in Miami

Trends in the HIV Epidemic among Men Who Have Sex with Men in Miami-Dade County, Florida, 2004-2014

Miami, Florida has a large population of Hispanic and black men who have sex with men (MSM), a population more likely to become HIV infected than white MSM. We present here HIV behavioral trends in this population that reflect the effects of public health prevention in Miami over a 10-year period. Using National HIV Behavioral Surveillance (NHBS) data of MSM in Miami-Dade County, Florida, in 2004-05, 2008, 2011 and 2014, chi-square trend analyses were used to assess the epidemiologic trends related to HIV infection rates, HIV testing rates, undiagnosed HIV infection, use antiretroviral therapy (ART) and access to HIV care. Of 258, 527, 511, and 536 MSM, HIV rates have remained steady between 22.5% (95% CI 17.4-27.6) in 2004-05 to a high of 25.9% (95% CI 22.2-29.6) in MSM4 in 2014, with no significant trend. There was an increase in HIV testing in the past six months between 2004 (48.4%;95% CI 41.8-55.0) and 2014 (55.8;95% CI 51.3-60.3), p \u3c .001; and a decrease in unrecognized HIV infection from 48.3% (95% CI 35.4- 61.2) in 2004 to 31.4% (95% CI 23.7-39.1) in 2014, p = .004, over the same period. Being currently on ART and knowledge of pre-exposure prophylaxis (PrEP) also increased significantly during this 10-year period. HIV surveillance is providing valuable information, notably, as HIV testing rates have gone up unrecognized infections have decreased. Continued use of the NHBS system should provide insights into the epidemic and assist in reaching public health goals for the control of HIV infections

Roadmap for Creating an Accelerated Three-Year Medical Education Program

Medical education is undergoing significant transformation. Many medical schools are moving away from the concept of seat time to competency-based education and introducing flexibility in the curriculum that allows individualization. In response to rising student debt and the anticipated physician shortage, 35% of US medical schools are considering the development of accelerated pathways. The roadmap described in this paper is grounded in the experiences of the Consortium of Accelerated Medical Pathway Programs (CAMPP) members in the development, implementation, and evaluation of one type of accelerated pathway: the three-year MD program. Strategies include developing a mission that guides curricular development – meeting regulatory requirements, attaining institutional buy-in and resources necessary to support the programs, including student assessment and mentoring – and program evaluation. Accelerated programs offer opportunities to innovate and integrate a mission benefitting students and the public

White Matter Plasticity in Reading-Related Pathways Differs in Children Born Preterm and at Term: A Longitudinal Analysis

Children born preterm (PT) are at risk for white matter injuries based on complications of prematurity. They learn to read but on average perform below peers born full term (FT). Studies have yet to establish whether properties of white matter pathways at the onset of learning to read are associated with individual variation later in reading development in PT children. Here, we asked whether fractional anisotropy (FA) at age 6 years is associated with reading outcome at age 8 years in PT children in the same pathways as previously demonstrated in a sample of FT children. PT (n = 34, mean gestational age = 29.5 weeks) and FT children (n = 37) completed diffusion MRI and standardized measures of non-verbal IQ, language, and phonological awareness at age 6 years. Reading skills were assessed at age 8 years. Mean tract-FA was extracted from pathways that predicted reading outcome in children born FT: left arcuate fasciculus (Arc), bilateral superior longitudinal fasciculus (SLF), and left inferior cerebellar peduncle (ICP). We explored associations in additional pathways in the PT children: bilateral inferior fronto-occipital fasciculus, inferior longitudinal fasciculus, and uncinate fasciculus. Linear regression models examined whether the prediction of reading outcome at age 8 years based on mean tract-FA at age 6 years was moderated by birth group. Children born PT and FT did not differ significantly in tract-FA at age 6 years or in reading at age 8 years. Sex, socioeconomic status, and non-verbal IQ at age 6 years were associated with reading outcome and were included as covariates in all models. Birth group status significantly moderated associations between reading outcome and mean tract-FA only in the left Arc, right SLF, and left ICP, before and after consideration of pre-literacy skills. Microstructural properties of these cerebral and cerebellar pathways predicted later reading outcome in FT but not in PT children. Children born PT may rely on alternative pathways to achieve fluent reading. These findings have implications for plasticity of neural organization after early white matter injury

Discovering cancer vulnerabilities using high-throughput micro-RNA screening

© 2017 The Author(s). Micro-RNAs (miRNAs) are potent regulators of gene expression and cellular phenotype. Each miRNA has the potential to target hundreds of transcripts within the cell thus controlling fundamental cellular processes such as survival and proliferation. Here, we exploit this important feature of miRNA networks to discover vulnerabilities in cancer phenotype, and map miRNA-target relationships across different cancer types. More specifically, we report the results of a functional genomics screen of 1280 miRNA mimics and inhibitors in eight cancer cell lines, and its presentation in a sophisticated interactive data portal. This resource represents the most comprehensive survey of miRNA function in oncology, incorporating breast cancer, prostate cancer and neuroblastoma. A user-friendly web portal couples this experimental data with multiple tools for miRNA target prediction, pathway enrichment analysis and visualization. In addition, the database integrates publicly available gene expression and perturbation data enabling tailored and context-specific analysis of miRNA function in a particular disease. As a proof-of-principle, we use the database and its innovative features to uncover novel determinants of the neuroblastoma malignant phenotype

Analytical validation of a standardised scoring protocol for Ki67 immunohistochemistry on breast cancer excision whole sections: an international multicentre collaboration

Aims The nuclear proliferation marker Ki67 assayed by immunohistochemistry has multiple potential uses in breast cancer, but an unacceptable level of interlaboratory variability has hampered its clinical utility. The International Ki67 in Breast Cancer Working Group has undertaken a systematic programme to determine whether Ki67 measurement can be analytically validated and standardised among laboratories. This study addresses whether acceptable scoring reproducibility can be achieved on excision whole sections. Methods and results Adjacent sections from 30 primary ER+ breast cancers were centrally stained for Ki67 and sections were circulated among 23 pathologists in 12 countries. All pathologists scored Ki67 by two methods: (i) global: four fields of 100 tumour cells each were selected to reflect observed heterogeneity in nuclear staining; (ii) hot-spot: the field with highest apparent Ki67 index was selected and up to 500 cells scored. The intraclass correlation coefficient (ICC) for the global method [confidence interval (CI) = 0.87; 95% CI = 0.799-0.93] marginally met the prespecified success criterion (lower 95% CI >= 0.8), while the ICC for the hot-spot method (0.83; 95% CI = 0.74-0.90) did not. Visually, interobserver concordance in location of selected hot-spots varies between cases. The median times for scoring were 9 and 6 min for global and hot-spot methods, respectively. Conclusions The global scoring method demonstrates adequate reproducibility to warrant next steps towards evaluation for technical and clinical validity in appropriate cohorts of cases. The time taken for scoring by either method is practical using counting software we are making publicly available. Establishment of external quality assessment schemes is likely to improve the reproducibility between laboratories further