Afghanistan - transition to transformation

Presents various approaches for Australia to play a role in shaping Afghanistan’s future, both unilaterally and by working with other nations. Summary: On 31 December 2014, Afghanistan will move from a UN-led period of ‘transition’ (2001–2014) to an Afghan-led and -owned ‘transformation decade’ (2015–2024). The transformation decade will seek to consolidate and build on the outcomes of transition to ensure Afghanistan’s future as a functional, stable and durable state. The Afghanistan National Security Forces (ANSF) will have the lead responsibility for national security during transformation. Although transition still has nearly a year to go, the end-of-2014 scorecard is expected to be a mix of positives and negatives. Unless a major turn-around occurs, most national and foreign interlocutors interviewed for this report view Afghanistan’s short and longer term future with varying degrees of pessimism. There’s a role for Australia including working unilaterally and with other nations, to help shape Afghanistan’s future. We’ve already publicly committed, on a bipartisan basis, to the long-term security, trade and development of Afghanistan after 2014. This report details other approaches including lobbying Afghan politicians; improving the effectiveness of aid; supporting multinational, regional and donor countries initiatives to promote political, security and economic cooperation and development; utilising other means and opportunities as they arise by using the resources and influence derived from our current membership of the UN Security Council. A longer background paper, which includes a more thorough exploration of the topic, is available for further reading

Effective strategies to strengthen the mental health and wellbeing of Aboriginal and Torres Strait Islander people

Introduction: The purpose of this paper is to draw on Aboriginal and Torres Strait Islander (Indigenous) perspectives, theoretical understandings, and available evidence to answer questions about what is required to effectively address Indigenous people’s mental health and social and emotional wellbeing. Social and emotional wellbeing is a multifaceted concept. Although the term is often used to describe issues of ‘mental health’ and ‘mental illness’, it has a broader scope in that Indigenous culture takes a holistic view of health. It recognises the importance of connection to land, culture, spirituality, ancestry, family and community, how these connections have been shaped across generations, and the processes by which they affect individual wellbeing. It is a whole-of-life view, and it includes the interdependent relationships between families, communities, land, sea and spirit and the cyclical concept of life–death–life. Importantly, these concepts and understandings of maintaining and restoring health and social and emotional wellbeing differ markedly to those in many non-Indigenous-specific (or mainstream) programs that tend to emphasise an individual’s behavioural and emotional strengths and ability to adapt and cope with the challenges of life. This paper explores the central question of ‘what are culturally appropriate mental health and social and emotional wellbeing programs and services for Indigenous people, and how are these best delivered?’. It identifies Indigenous perspectives of what is required for service provision and program delivery that align with Indigenous beliefs, values, needs and priorities. It explores the evidence and consensus around the principles of best practice in Indigenous mental health programs and services. It discusses these principles of best practice with examples of programs and research that show how these values and perspectives can be achieved in program design and delivery. This paper seeks to provide an evidence-based, theoretically coherent discussion of the factors that influence the effective development, implementation and outcomes of initiatives to address Indigenous mental health and wellbeing issues. It seeks to assess whether the current investment in Indigenous people’s mental health is aligned with available evidence on what works. To this end, the paper reviews Australian literature and government health, mental health and social and emotional wellbeing policies and programs. The scope of programs and their criteria for inclusion in this paper are informed by the Key Result Area 4, Social and Emotional Wellbeing objectives, within the National Strategic Framework for Aboriginal and Torres Strait Islander Health 2003–13: Australian Government Implementation Plan 2007–2013. This paper acknowledges the holistic nature of health, mental health and wellbeing, and the effects of Australia’s colonial history and legacy on the contemporary state of Indigenous social and emotional wellbeing. It recognises that there is a complex relationship between social and emotional wellbeing, harmful substance misuse, suicide, and a range of social and economic factors. Although this paper encompasses the broad priorities identified within the key Indigenous mental health policies and frameworks, it does not provide a detailed discussion of programs and resources that, although relevant here, are covered in a number of existing Closing the Gap Clearinghouse resource sheets and issues papers (see Appendix 1). These interweavings and overlaps are not surprising given the complexity and interconnectedness of the issues and determinants that are being addressed to strengthen Indigenous mental health and wellbeing

Australia and Cyberwarfare

This book explores Australia’s prospective cyber-warfare requirements and challenges. It describes the current state of planning and thinking within the Australian Defence Force with respect to Network Centric Warfare, and discusses the vulnerabilities that accompany the use by Defence of the National Information Infrastructure (NII), as well as Defence’s responsibility for the protection of the NII. It notes the multitude of agencies concerned in various ways with information security, and argues that mechanisms are required to enhance coordination between them. It also argues that Australia has been laggard with respect to the development of offensive cyber-warfare plans and capabilities. Finally, it proposes the establishment of an Australian Cyber-warfare Centre responsible for the planning and conduct of both the defensive and offensive dimensions of cyber-warfare, for developing doctrine and operational concepts, and for identifying new capability requirements. It argues that the matter is urgent in order to ensure that Australia will have the necessary capabilities for conducting technically and strategically sophisticated cyber-warfare activities by the 2020s. The Foreword has been contributed by Professor Kim C. Beazley, former Minister for Defence (1984–90), who describes it as ‘a timely book which transcends old debates on priorities for the defence of Australia or forward commitments, [and] debates about globalism and regionalism’, and as ‘an invaluable compendium’ to the current process of refining the strategic guidance for Australia’s future defence policies and capabilities

Explorations, Vol. 4, No. 3

Articles include: Cover: Trophy: MooseHorn, from the Trophy Series, by Caellaigh B. Desrosiers. Editorial Reflections, by Carole J. Bombard North Cascade Glacier Climate Project, by Mauri Pelto Stained Glass Molecules, by Anne P. Sherblom Lobsters Inside-Out: A Guide to the Maine Lobster Community Forestry: UMaine Cooperative Extension Service, by Nancy E. Coverstone and William D. Lilley Where Are They Now? — Robert F. LaPrade, M.D. ’81 Little Critters with a Big Job: Ciliated Protozoa and the Gulf of Maine Food Chain, by Marcia Gauvin from a paper by Charles Gregory The Innovation of Tradition: Low-Cost, Low-Input Alternatives for Maine Farmers, by Marcia Gauvin Just What IS An Animal? Preschoolers Investigate Merging Two Cultures: Our Cover Artist, by Caellaigh Bennett Derosiers Freezing and Photosynthesis, by Steven R. Dudgeon, Ian R. Davison, and Robert L. Vada

Pitfalls in assessing stromal tumor infiltrating lymphocytes (sTILs) in breast cancer

Abstract: Stromal tumor-infiltrating lymphocytes (sTILs) are important prognostic and predictive biomarkers in triple-negative (TNBC) and HER2-positive breast cancer. Incorporating sTILs into clinical practice necessitates reproducible assessment. Previously developed standardized scoring guidelines have been widely embraced by the clinical and research communities. We evaluated sources of variability in sTIL assessment by pathologists in three previous sTIL ring studies. We identify common challenges and evaluate impact of discrepancies on outcome estimates in early TNBC using a newly-developed prognostic tool. Discordant sTIL assessment is driven by heterogeneity in lymphocyte distribution. Additional factors include: technical slide-related issues; scoring outside the tumor boundary; tumors with minimal assessable stroma; including lymphocytes associated with other structures; and including other inflammatory cells. Small variations in sTIL assessment modestly alter risk estimation in early TNBC but have the potential to affect treatment selection if cutpoints are employed. Scoring and averaging multiple areas, as well as use of reference images, improve consistency of sTIL evaluation. Moreover, to assist in avoiding the pitfalls identified in this analysis, we developed an educational resource available at www.tilsinbreastcancer.org/pitfalls

Report on computational assessment of Tumor Infiltrating Lymphocytes from the International Immuno-Oncology Biomarker Working Group

Funder: U.S. Department of Health & Human Services | NIH | National Cancer Institute (NCI)Funder: National Center for Research Resources under award number 1 C06 RR12463-01, VA Merit Review Award IBX004121A from the United States Department of Veterans Affairs Biomedical Laboratory Research and Development Service, the DOD Prostate Cancer Idea Development Award (W81XWH-15-1-0558), the DOD Lung Cancer Investigator-Initiated Translational Research Award (W81XWH-18-1-0440), the DOD Peer Reviewed Cancer Research Program (W81XWH-16-1-0329), the Ohio Third Frontier Technology Validation Fund, the Wallace H. Coulter Foundation Program in the Department of Biomedical Engineering and the Clinical and Translational Science Award Program (CTSA) at Case Western Reserve University.Funder: Susan G Komen Foundation (CCR CCR18547966) and a Young Investigator Grant from the Breast Cancer Alliance.Funder: The Canadian Cancer SocietyFunder: Breast Cancer Research Foundation (BCRF), Grant No. 17-194Abstract: Assessment of tumor-infiltrating lymphocytes (TILs) is increasingly recognized as an integral part of the prognostic workflow in triple-negative (TNBC) and HER2-positive breast cancer, as well as many other solid tumors. This recognition has come about thanks to standardized visual reporting guidelines, which helped to reduce inter-reader variability. Now, there are ripe opportunities to employ computational methods that extract spatio-morphologic predictive features, enabling computer-aided diagnostics. We detail the benefits of computational TILs assessment, the readiness of TILs scoring for computational assessment, and outline considerations for overcoming key barriers to clinical translation in this arena. Specifically, we discuss: 1. ensuring computational workflows closely capture visual guidelines and standards; 2. challenges and thoughts standards for assessment of algorithms including training, preanalytical, analytical, and clinical validation; 3. perspectives on how to realize the potential of machine learning models and to overcome the perceptual and practical limits of visual scoring

Application of a risk-management framework for integration of stromal tumor-infiltrating lymphocytes in clinical trials

Funder: Breast Cancer Research Foundation (BCRF); doi: https://doi.org/10.13039/100001006Abstract: Stromal tumor-infiltrating lymphocytes (sTILs) are a potential predictive biomarker for immunotherapy response in metastatic triple-negative breast cancer (TNBC). To incorporate sTILs into clinical trials and diagnostics, reliable assessment is essential. In this review, we propose a new concept, namely the implementation of a risk-management framework that enables the use of sTILs as a stratification factor in clinical trials. We present the design of a biomarker risk-mitigation workflow that can be applied to any biomarker incorporation in clinical trials. We demonstrate the implementation of this concept using sTILs as an integral biomarker in a single-center phase II immunotherapy trial for metastatic TNBC (TONIC trial, NCT02499367), using this workflow to mitigate risks of suboptimal inclusion of sTILs in this specific trial. In this review, we demonstrate that a web-based scoring platform can mitigate potential risk factors when including sTILs in clinical trials, and we argue that this framework can be applied for any future biomarker-driven clinical trial setting