Assessing the implementation efficacy of an ecosystem approach to Fisheries management in the South African sardine fishery

Includes bibliographical referencesAn Ecosystem Approach to Fisheries management (EAF) offers a holistic approach for sustainable fisheries management by extending the traditional target resources-orientated management (TROM) to include wider social-ecological dimensions of fisheries. An EAF requires balancing of multiple, often conflicting objectives, effectively dealing with complexity and uncertainty, and engaging with diverse groups of stakeholders. Various tools within the field of Multi-criteria Decision Analysis provide a formal approach which takes explicit account of multiple criteria, while effectively dealing with risk and uncertainty. A knowledge-based tool was developed in this thesis to assess the efficacy of EAF implementation for the ecological well-being dimension in the South Africa sardine fishery. An iterative, participatory approach was adopted for its implementation. The modelling philosophy applied a rapid prototyping approach, and an applied research perspective was employed to direct the research. A broad group of stakeholders participated in indicator selection, tool design, and interpretation. The knowledge-based tool provided a hierarchical framework for seven specific management objectives to which eleven ecological indicators were linked. Time series (1987-2009) were collated for each indicator, and a utility approach was used to transform indicators to a common scale. Weights for indicators and objectives were agreed to by stakeholders and combined through the objectives' hierarchy using weighted means. The resulting outputs were discussed in detail during focus group meetings to ensure that the tool was clearly presented and as intended helped improve the stakeholder's understanding of the process. It was confirmed that the 20 knowledge-based tool presents a transparent, repeatable and scientifically defensible approach, suitable to meet management requirements. The tool development process was useful in bringing diverse stakeholder groups together, and through applying the tool as a boundary object, has helped to bridge the boundary between the TROM and EAF research communities. Encouraging stakeholder interaction offers opportunities for social learning, which if carefully facilitated through the tool development process is likely to enhance the outcomes of this process and support more generally in bridging boundaries to EAF implementation. The combined focus on tool development and social processes supports effective implementation of an EAF in the South African small pelagic fishery and provide a model for other fisheries

The impact of blood donation deferral strategies on the eligibility of men who have sex with men and other sexual risk behavior in Australia

Background In Australia, a man cannot donate blood if he has had sex with another man within the past 3 months. However, this policy has been criticized as being discriminatory as it does not consider lower risk subgroups, and led to calls for modifications to the policy that more accurately distinguish risk among gay, bisexual, and other men who have sex with men (GBM). Study Design and Methods We used data from a nationally representative survey to estimate the proportion of GBM aged 18–74 years old who would be eligible to donate under current criteria and other scenarios. Results Among the 5178 survey participants, 155 (3.0%) were classified as GBM based on survey responses, Among the GBM, 40.2% (95% CI 28.0%–53.7%) were eligible to donate based on current criteria, and 21.0% (95% CI 14.5%–29.5%) were ineligible due to the 3 months deferral alone. Eligibility among GBM, all men, and the population increased as criteria were removed. Under the new Australian plasma donation criteria, 73.6% (95% CI 64.4%–81.1%) of GBM, 68.4% (95% CI 65.5%–71.2%) of all men, and 60.8% (95% CI 58.8%–62.8%) of the full population were estimated to be eligible. Only 16.1% (95% CI 8.6%–28.1%) of GBM knew that the male-to-male sex deferral period is 3 months. Discussion Changing the deferral criteria and sexual risk evaluation would lead to a higher proportion of GBM being eligible to donate blood. Knowledge of the current GBM deferral period is very low. Improved education about the current criteria and any future changes are required to improve blood donation rates

Strategies to improve control of sexually transmissible infections in remote Australian Aboriginal communities: a stepped-wedge, cluster-randomised trial

BACKGROUND: Remote Australian Aboriginal communities have among the highest diagnosed rates of sexually transmissible infections (STIs) in the world. We did a trial to assess whether continuous improvement strategies related to sexual health could reduce infection rates. METHODS: In this stepped-wedge, cluster-randomised trial (STIs in remote communities: improved and enhanced primary health care [STRIVE]), we recruited primary health-care centres serving Aboriginal communities in remote areas of Australia. Communities were eligible to participate if they were classified as very remote, had a population predominantly of Aboriginal people, and only had one primary health-care centre serving the population. The health-care centres were grouped into clusters on the basis of geographical proximity to each other, population size, and Aboriginal cultural ties including language connections. Clusters were randomly assigned into three blocks (year 1, year 2, and year 3 clusters) using a computer-generated randomisation algorithm, with minimisation to balance geographical region, population size, and baseline STI testing level. Each year for 3 years, one block of clusters was transitioned into the intervention phase, while those not transitioned continued usual care (control clusters). The intervention phase comprised cycles of reviewing clinical data and modifying systems to support improved STI clinical practice. All investigators and participants were unmasked to the intervention. Primary endpoints were community prevalence and testing coverage in residents aged 16–34 years for Chlamydia trachomatis, Neisseria gonorrhoeae, and Trichomonas vaginalis . We used Poisson regression analyses on the final dataset and compared STI prevalences and testing coverage between control and intervention clusters. All analyses were by intention to treat and models were adjusted for time as an independent covariate in overall analyses. This study was registered with the Australia and New Zealand Clinical Trials Registry, ACTRN12610000358044. FINDINGS: Between April, 2010, and April, 2011, we recruited 68 primary care centres and grouped them into 24 clusters, which were randomly assigned into year 1 clusters (estimated population aged 16–34 years, n=11 286), year 2 clusters (n=10 288), or year 3 clusters (n=13 304). One primary health-care centre withdrew from the study due to restricted capacity to participate. We detected no difference in the relative prevalence of STIs between intervention and control clusters (adjusted relative risk [RR] 0·97, 95% CI 0·84–1·12; p=0·66). However, testing coverage was substantially higher in intervention clusters (22%) than in control clusters (16%; RR 1·38; 95% CI 1·15–1·65; p=0·0006). INTERPRETATION: Our intervention increased STI testing coverage but did not have an effect on prevalence. Additional interventions that will provide increased access to both testing and treatment are required to reduce persistently high prevalences of STIs in remote communities.James Ward, Rebecca J Guy, Alice R Rumbold, Skye McGregor, Handan Wand, Hamish McManus, Amalie Dyda, Linda Garton, Belinda Hengel, Bronwyn J Silver, Debbie Taylor-Thomson, Janet Knox, Basil Donovan, Matthew Law, Lisa Maher, Christopher K Fairley, Steven Skov, Nathan Ryder, Elizabeth Moore, Jacqueline Mein, Carole Reeve, Donna Ah Chee, John Boffa and John M Kaldo

Targeting DNA Damage Response and Replication Stress in Pancreatic Cancer

Background and aims: Continuing recalcitrance to therapy cements pancreatic cancer (PC) as the most lethal malignancy, which is set to become the second leading cause of cancer death in our society. The study aim was to investigate the association between DNA damage response (DDR), replication stress and novel therapeutic response in PC to develop a biomarker driven therapeutic strategy targeting DDR and replication stress in PC. Methods: We interrogated the transcriptome, genome, proteome and functional characteristics of 61 novel PC patient-derived cell lines to define novel therapeutic strategies targeting DDR and replication stress. Validation was done in patient derived xenografts and human PC organoids. Results: Patient-derived cell lines faithfully recapitulate the epithelial component of pancreatic tumors including previously described molecular subtypes. Biomarkers of DDR deficiency, including a novel signature of homologous recombination deficiency, co-segregates with response to platinum (P < 0.001) and PARP inhibitor therapy (P < 0.001) in vitro and in vivo. We generated a novel signature of replication stress with which predicts response to ATR (P < 0.018) and WEE1 inhibitor (P < 0.029) treatment in both cell lines and human PC organoids. Replication stress was enriched in the squamous subtype of PC (P < 0.001) but not associated with DDR deficiency. Conclusions: Replication stress and DDR deficiency are independent of each other, creating opportunities for therapy in DDR proficient PC, and post-platinum therapy

Health research capacity building in low and middle income countries

Health improvement in low- and middle-income countries (LMICs) depends on locally relevant research that meets the priority needs of populations and translates into policy change. However many LMICs have historically had limited capacity to conduct health research. While capacity building has become an objective of development programs, it is often unclear what impact it has had, both in terms of improved ability to conduct research, and health outcomes.There is extensive literature discussing evaluation of research capacity building; however there are no standard metrics for measurement. Evaluations have tended to focus on programs with explicit research capacity building objectives, and largely on determination of short and medium-term outcomes. To better understand capacity building activities, we undertook a series of projects aimed at evaluating health research capacity building. We focused on opportunities for evaluation of non-specific capacity building activities, in the context of academic and research endeavours at theUniversity of New South Wales, Australia.The first project used a bibliometric methodology to analyse trends and predictors in authorship in peer-reviewed HIV research conducted in LMICs. Our findings demonstrate an increase in capacity in the field but suggest there is still progress required in research leadership. The second project evaluated the impact on research involvement of attendance at an international conference. The analysis provides evidence of increased research engagement and skills of LMIC attendees. The thirdproject followed up LMIC public health graduates from an Australian university, to determine predictors of research careers and analyse research output, highlighting challenges in engaging with alumni. The fourth project undertook a bibliometric analysis of the same population, revealing a fifth of graduates had authorship on a peer-reviewed publication following completion of studies. The fifth project examined how health research priorities are set in LMICs, taking into consideration issues ofhealth research capacity. The systematic review found numerous initiatives had been completed, however use of an established strategy was rare and few provided evidence of evaluation or follow-up.Together the five projects provide insight into the process of research capacity building in LMICs, different ways of measuring progress, and outcomes in a number of areas