iPrevent®: a tailored, web-based, decision support tool for breast cancer risk assessment and management

We aimed to develop a user-centered, web-based, decision support tool for breast cancer risk assessment and personalized risk management. Using a novel model choice algorithm, iPrevent(®) selects one of two validated breast cancer risk estimation models (IBIS or BOADICEA), based on risk factor data entered by the user. Resulting risk estimates are presented in simple language and graphic formats for easy comprehension. iPrevent(®) then presents risk-adapted, evidence-based, guideline-endorsed management options. Development was an iterative process with regular feedback from multidisciplinary experts and consumers. To verify iPrevent(®), risk factor data for 127 cases derived from the Australian Breast Cancer Family Study were entered into iPrevent(®), IBIS (v7.02), and BOADICEA (v3.0). Consistency of the model chosen by iPrevent(®) (i.e., IBIS or BOADICEA) with the programmed iPrevent(®) model choice algorithm was assessed. Estimated breast cancer risks from iPrevent(®) were compared with those attained directly from the chosen risk assessment model (IBIS or BOADICEA). Risk management interventions displayed by iPrevent(®) were assessed for appropriateness. Risk estimation model choice was 100 % consistent with the programmed iPrevent(®) logic. Discrepant 10-year and residual lifetime risk estimates of >1 % were found for 1 and 4 cases, respectively, none was clinically significant (maximal variation 1.4 %). Risk management interventions suggested by iPrevent(®) were 100 % appropriate. iPrevent(®) successfully integrates the IBIS and BOADICEA risk assessment models into a decision support tool that provides evidence-based, risk-adapted risk management advice. This may help to facilitate precision breast cancer prevention discussions between women and their healthcare providers.

Identifying and integrating patient and caregiver perspectives for clinical practice guidelines on the screening and management of infectious microorganisms in hemodialysis units

Introduction: The integration of patient and caregiver input into guideline development can help to ensure that clinical care addresses patient expectations, priorities, and needs. We aimed to identify topics and outcomes salient to patients and caregivers for inclusion in the Kidney Health Australia Caring for Australasians with Renal Impairment (KHA-CARI) clinical practice guideline on the screening and management of infectious microorganisms in hemodialysis units.

Methods: A facilitated workshop was conducted with 11 participants (patients [n = 8], caregivers [n = 3]). Participants identified and discussed potential topics for inclusion in the guidelines, which were compared to those developed by the guideline working group. The workshop transcript was thematically analyzed to identify and describe the reasons underpinning their priorities.

Findings: Patients and caregivers identified a range of topics already covered by the scope of the proposed guidelines and also suggested additional topics: privacy and confidentiality, psychosocial care during/after disease notification, quality of transportation, psychosocial treatment of patients in isolation, patient/caregiver education and engagement, and patient advocacy. Five themes characterized discussion and underpinned their choices: shock and vulnerability, burden of isolation, fear of infection, respect for privacy and confidentiality, and confusion over procedural inconsistencies.

Discussion: Patients and caregivers emphasized the need for guidelines to address patient education and engagement, and the psychosocial implications of communication and provision of care in the context of infectious microorganisms in hemodialysis units. Integrating patient and caregiver perspectives can help to improve the relevance of guidelines to enhance quality of care, patient experiences, and health and psychosocial outcomes.

Identifying knowledge gaps in seagrass research and management: An Australian perspective.

Seagrass species form important marine and estuarine habitats providing valuable ecosystem services and functions. Coastal zones that are increasingly impacted by anthropogenic development have experienced substantial declines in seagrass abundance around the world. Australia, which has some of the world's largest seagrass meadows and is home to over half of the known species, is not immune to these losses. In 1999 a review of seagrass ecosystems knowledge was conducted in Australia and strategic research priorities were developed to provide research direction for future studies and management. Subsequent rapid evolution of seagrass research and scientific methods has led to more than 70% of peer reviewed seagrass literature being produced since that time. A workshop was held as part of the Australian Marine Sciences Association conference in July 2015 in Geelong, Victoria, to update and redefine strategic priorities in seagrass research. Participants identified 40 research questions from 10 research fields (taxonomy and systematics, physiology, population biology, sediment biogeochemistry and microbiology, ecosystem function, faunal habitats, threats, rehabilitation and restoration, mapping and monitoring, management tools) as priorities for future research on Australian seagrasses. Progress in research will rely on advances in areas such as remote sensing, genomic tools, microsensors, computer modeling, and statistical analyses. A more interdisciplinary approach will be needed to facilitate greater understanding of the complex interactions among seagrasses and their environment.

Local Use and Management of Tasba (Senna obtusifolia) in the Traditional Food System of Sanguere Paul, North Cameroon

The purpose of this study is to examine the importance of the wild edible weed tasba (Senna obtusifolia) in Sanguéré Paul, Cameroon by examining how households use and manage the plant. This study found that local management of tasba is minimal compared to other traditional vegetables. Tasba was collected most frequently from en brousse or the communal, fallowed land which is often too degraded for traditional field crops to grow. Women subsistence farmers were closely involved with tasba as they are the ones responsible for food production within the family. Socioeconomic differences between women affects how they manage tasba and other vegetables to form a livelihood strategy to achieve food security within the family. Modifications and changes in management and use of tasba are influenced by time, proximity and income based on her perspective, preferences and resources available. Overall, tasba is an integral part of the traditional food system in Sanguéré Paul, and can play a role in the uncertain ecological and social setting of northern Cameroon.

Clinical diagnosis and management of suspicious pigmented skin lesions: A survey of GPs

BACKGROUND The ability of general practitioners to make important clinical decisions about the diagnosis and management of skin lesions is poorly understood.METHODS A questionnaire on the diagnosis and management of eight photographed skin lesions was sent to 150 GPs in southeast Queensland.RESULTS The questionnaire was completed by 114 GPs (response rate 77%). General practitioners’ provisional diagnoses and management of photographed skin lesions were mostly or always correct, and there was general high consistency between diagnosis and intended management. Pigmented seborrhoeic keratoses were the most difficult lesions for GPs to diagnose correctly. Whether a lesion was different to usual moles appears to have the strongest association with clinical diagnosis.DISCUSSION The high ability of GPs as measured in this artificial study is encouraging. The strong association between identifying moles that appear different to usual and correct clinical diagnoses suggest that unless GPs can increase the number of skin lesions they see as part of their typical workload, their clinical ability may not increase further. Article in Australian family physician 34(1) · January 2005

The effect of sample and sample matrix on DNA processing: Mechanisms for the detection and management of inhibition in forensic samples

The presence of inhibitory substances in biological forensic samples has, and continues to affect the quality of the data generated following DNA typing processes. Although the chemistries used during the procedures have been enhanced to mitigate the effects of these deleterious compounds, some challenges remain. Inhibitors can be components of the samples, the substrate where samples were deposited or chemical(s) associated to the DNA purification step. Therefore, a thorough understanding of the extraction processes and their ability to handle the various types of inhibitory substances can help define the best analytical processing for any given sample. A series of experiments were conducted to establish the inhibition tolerance of quantification and amplification kits using common inhibitory substances in order to determine if current laboratory practices are optimal for identifying potential problems associated with inhibition. DART mass spectrometry was used to determine the amount of inhibitor carryover after sample purification, its correlation to the initial inhibitor input in the sample and the overall effect in the results. Finally, a novel alternative at gathering investigative leads from samples that would otherwise be ineffective for DNA typing due to the large amounts of inhibitory substances and/or environmental degradation was tested. This included generating data associated with microbial peak signatures to identify locations of clandestine human graves. Results demonstrate that the current methods for assessing inhibition are not necessarily accurate, as samples that appear inhibited in the quantification process can yield full DNA profiles, while those that do not indicate inhibition may suffer from lowered amplification efficiency or PCR artifacts. The extraction methods tested were able to remove >90% of the inhibitors from all samples with the exception of phenol, which was present in variable amounts whenever the organic extraction approach was utilized. Although the results attained suggested that most inhibitors produce minimal effect on downstream applications, analysts should practice caution when selecting the best extraction method for particular samples, as casework DNA samples are often present in small quantities and can contain an overwhelming amount of inhibitory substances.^

A critical review of habitat use by feral cats and key directions for future research and management

Feral cats (Felis catus) have a wide global distribution and cause significant damage to native fauna. Reducing their impacts requires an understanding of how they use habitat and which parts of the landscape should be the focus of management. We reviewed 27 experimental and observational studies conducted around the world over the last 35 years that aimed to examine habitat use by feral and unowned cats. Our aims were to: (1) summarise the current body of literature on habitat use by feral and unowned cats in the context of applicable ecological theory (i.e. habitat selection, foraging theory); (2) develop testable hypotheses to help fill important knowledge gaps in the current body of knowledge on this topic; and (3) build a conceptual framework that will guide the activities of researchers and managers in reducing feral cat impacts. We found that feral cats exploit a diverse range of habitats including arid deserts, shrublands and grasslands, fragmented agricultural landscapes, urban areas, glacial valleys, equatorial to sub-Antarctic islands and a range of forest and woodland types. Factors invoked to explain habitat use by cats included prey availability, predation/competition, shelter availability and human resource subsidies, but the strength of evidence used to support these assertions was low, with most studies being observational or correlative.Wetherefore provide a list of key directions that will assist conservation managers and researchers in better understanding and ameliorating the impact of feral cats at a scale appropriate for useful management and research. Future studies will benefit from employing an experimental approach and collecting data on the relative abundance and activity of prey and other predators. This might include landscape-scale experiments where the densities of predators, prey or competitors are manipulated and then the response in cat habitat use is measured. Effective management of feral cat populations could target high-use areas, such as linear features and structurally complex habitat. Since our review shows often-divergent outcomes in the use of the same habitat components and vegetation types worldwide, local knowledge and active monitoring of management actions is essential when deciding on control programs.

Priorities in policy and management when existing biodiversity stressors interact with climate-change

There are three key drivers of the biodiversity crisis: (1) the well known existing threats to biodiversity such as habitat loss, invasive pest species and resource exploitation; (2) direct effects of climate-change, such as on coastal and high elevation communities and coral reefs; and (3) the interaction between existing threats and climate-change. The third driver is set to accelerate the biodiversity crisis beyond the impacts of the first and second drivers in isolation. In this review we assess these interactions, and suggest the policy and management responses that are needed to minimise their impacts. Renewed management and policy action that address known threats to biodiversity could substantially diminish the impacts of future climate-change. An appropriate response to climate-change will include a reduction of land clearing, increased habitat restoration using indigenous species, a reduction in the number of exotic species transported between continents or between major regions of endemism, and a reduction in the unsustainable use of natural resources. Achieving these measures requires substantial reform of international, national and regional policy, and the development of new or more effective alliances between scientists, government agencies, non-government organisations and land managers. Furthermore, new management practices and policy are needed that consider shifts in the geographic range of species, and that are responsive to new information acquired from improved research and monitoring programs. The interactions of climate-change with existing threats to biodiversity have the potential to drive many species to extinction, but there is much that can be done now to reduce this risk.

Impacts and management of feral cats Felis catus in Australia

Feral cats are among the most damaging invasive species worldwide, and are implicated in many extinctions, especially in Australia, New Zealand and other islands. Understanding and reducing their impacts is a global conservation priority. We review knowledge about the impacts and management of feral cats in Australia, and identify priorities for research and management. In Australia, the most well understood and significant impact of feral cats is predation on threatened mammals. Other impacts include predation on other vertebrates, resource competition, and disease transmission, but knowledge of these impacts remains limited. Lethal control is the most common form of management, particularly via specifically designed poison baits. Non-lethal techniques include the management of fire, grazing, food, and trophic cascades. Managing interactions between these processes is key to success. Given limitations on the efficacy of feral cat management, conservation of threatened mammals has required the establishment of insurance populations on predator-free islands and in fenced mainland enclosures. Research and management priorities are to: prevent feral cats from driving threatened species to extinction; assess the efficacy of new management tools; trial options for control via ecosystem management; and increase the potential for native fauna to coexist with feral cats.

Conservation and management of exploited shark populations based on reproductive value

Several life history traits of sharks result in juveniles being particularly vulnerable to exploitation. However, population level impacts of harvests on juvenile sharks have not been well quantified. This paper examines a range of harvest strategies, including those targeting juveniles. Reproductive value and yield per recruit are used to compare the harvests, which are represented by Leslie matrix models with a harvest matrix. Two species are used as examples: the short-lived Rhizoprionodon taylori and the long-lived Squalus acanthias. Harvests that maintain a stationary population size cause reproductive values to change in opposing ways, but they remove equal fractions of the population's reproductive potential. A new theorem gives population growth as a function of the fraction of reproductive potential removed by a harvest, a relationship useful for comparing harvests on juveniles and adults. Stochastic projections indicate that the risk of depletion is associated with the fraction of reproductive potential removed annually, a measure which encompasses the information in both the selectivity and the rate of fishing mortality. These results indicate the value of focusing conservation efforts on preserving reproductive potential.

Trophic signatures of small-scale fishing gears: implications for conservation and management

We quantified the ecosystem effects of small-scale gears operating in southern European waters (Portugal, Spain, Greece), based on a widely accepted ecosystem measure and indicator, the trophic level (TL). We used data from experimental fishing trials during 1997 to 2000. We studied a wide range of gear types and sizes: (1) gill nets of 8 mesh sizes, ranging from 44 to 80 mm; (2) trammel nets of 9 inner panel mesh sizes, ranging from 40 to 140 mm; and (3) longlines of 8 hook sizes, ranging from Nos. 15 (small) to 5 (large). We used the number of species caught per TL class for constructing trophic signatures (i.e. cumulative TL distributions), and estimated the TL at 25, 50 and 75% cumulative frequency (TL25, TL50, TL75) and the slopes using the logistic function. We also estimated the mean weighted TL of the catches (TLW). Our analyses showed that the TL characteristics of longlines varied much more than those of gill and trammel nets. The longlines of large hooks (Nos. 10, 9, 7, 5) were very TL selective, and their trophic signatures had very steep slopes, the highest mean TL50 values, very narrow mean TL25 to TL75 ranges and mean TLW > 4. In addition, the mean number of TL classes exploited was smaller and the mean TL50 and TLW were larger for the longlines of small hooks (Nos. 15, 13, 12, 11) in Greek than in Portuguese waters. Trammel and gill nets caught more TL classes, and the mean slopes of their trophic signatures were significantly smaller than those of longlines as a group. In addition, the mean number of TL classes exploited, the mean TL50 and the TLW of gill nets were significantly smaller than those of trammel nets. We attribute the differences between longlines of small hooks to bait type, and the differences between all gear types to their characteristic species and size-selectivity patterns. Finally, we showed how the slope and the TL50 Of the trophic signatures can be used to characterise different gears along the ecologically 'unsustainable-sustainable' continuum.

Unexpectedly high catch-and-release rates in European marine recreational fisheries: implications for science and management

While catch-and-release (C&R) is a well-known practice in several European freshwater recreational fisheries, studies on the magnitude and impact of this practice in Europeanmarine recreational fisheries are limited. To provide an overview of the practice andmagnitude of C&R among marine recreational anglers in Europe, the existing knowledge of C&R and its potential associated release mortality was collected andsummarized. The present study revealed that in several European countries over half of the total recreational catch is released by marine anglers. High release proportions of > 60% were found for Atlantic cod (Gadus morhua), European sea bass (Dicentrarchus labrax), pollack (Pollachius pollachius), and sea trout (Salmo trutta) in at least one of the studied European countries. In the case of the German recreational Baltic Sea cod fishery, release proportions varied considerably between years, presumably tracking a strong year class ofundersized fish. Reasons for release varied between countries and species, and included legal restrictions (e.g. minimumlanding sizes and daily bag limits) and voluntary C&R. Considering the magnitude of C&R practice among European marine recreational anglers, post-release mortalities of released fish may need to be accounted for in estimated fishingmortalities.However, as the survival rates of Europeanmarine species aremostly unknown, there is a need to conduct post-release survival studies and to identify factors affecting post-release survival. Such studies could also assist in developing species-specific, best-practice guidelines to minimize the impacts of C&R on released marine fish in Europe.

Biology and management of dogfish sharks

This book comprises 34 chapters (35 including the initial keynote paper), each written as a stand-alone scientific paper, that are grouped in functional categories. The keynote paper is followed by 11 papers addressing Distribution and Abundance, 6 papers on Age, Growth and Reproduction, 6 papers on Ecology and Physiology, and 10 papers on Fisheries, Assessment and Management, and Conservation. Some of the papers are based upon presentations that were given at the First International Symposium on the Management and Biology of Dogfish Sharks, held in Seattle, WA in 2005.

Product/Brand co-creation methodology crossing marketing, design thinking, creativity and management: ideas(r)evolution

This thesis introduce a new innovation methodology called IDEAS(R)EVOLUTION that was developed according to an on-going experimental research project started in 2007. This new approach to innovation has initial based on Design thinking for innovation theory and practice. The concept of design thinking for innovation has received much attention in recent years. This innovation approach has climbed from the design and designers knowledge field towards other knowledge areas, mainly business management and marketing. Human centered approach, radical collaboration, creativity and breakthrough thinking are the main founding principles of Design thinking that were adapted by those knowledge areas due to their assertively and fitness to the business context and market complexity evolution. Also Open innovation, User-centered innovation and later on Living Labs models emerge as answers to the market and consumers pressure and desire for new products, new services or new business models. Innovation became the principal business management focus and strategic orientation. All this changes had an impact also in the marketing theory. It is possible now to have better strategies, communications plans and continuous dialogue systems with the target audience, incorporating their insights and promoting them to the main dissemination ambassadors of our innovations in the market. Drawing upon data from five case studies, the empirical findings in this dissertation suggest that companies need to shift from Design thinking for innovation approach to an holistic, multidimensional and integrated innovation system. The innovation context it is complex, companies need deeper systems then the success formulas that “commercial “Design thinking for innovation “preaches”. They need to learn how to change their organization culture, how to empower their workforce and collaborators, how to incorporate external stakeholders in their innovation processes, hoe to measure and create key performance indicators throughout the innovation process to give them better decision making data, how to integrate meaning and purpose in their innovation philosophy. Finally they need to understand that the strategic innovation effort it is not a “one shot” story it is about creating a continuous flow of interaction and dialogue with their clients within a “value creation chain“ mindset; RESUMO: Metodologia de co-criação de um produto/marca cruzando Marketing, Design Thinking, Criativity and Management - IDEAS(R)EVOLUTION. Esta dissertação apresenta uma nova metodologia de inovação chamada IDEAS(R)EVOLUTION, que foi desenvolvida segundo um projecto de investigação experimental contínuo que teve o seu início em 2007. Esta nova abordagem baseou-se, inicialmente, na teoria e na práctica do Design thinking para a inovação. Actualmente o conceito do Design Thinking para a inovação “saiu” do dominio da area de conhecimento do Design e dos Designers, tendo despertado muito interesse noutras áreas como a Gestão e o Marketing. Uma abordagem centrada na Pessoa, a colaboração radical, a criatividade e o pensamento disruptivo são principios fundadores do movimento do Design thinking que têm sido adaptados por essas novas áreas de conhecimento devido assertividade e adaptabilidade ao contexto dos negócios e à evolução e complexidade do Mercado. Também os modelos de Inovação Aberta, a inovação centrada no utilizador e mais tarde os Living Labs, emergem como possiveis soluções para o Mercado e para a pressão e desejo dos consumidores para novos productos, serviços ou modelos de negócio. A inovação passou a ser o principal foco e orientação estratégica na Gestão. Todas estas mudanças também tiveram impacto na teoria do Marketing. Hoje é possivel criar melhores estratégias, planos de comunicação e sistemas continuos de diálogo com o público alvo, incorporando os seus insights e promovendo os consumidores como embaixadores na disseminação da inovação das empresas no Mercado Os resultados empiricos desta tese, construídos com a informação obtida nos cinco casos realizados, sugerem que as empresas precisam de se re-orientar do paradigma do Design thinking para a inovação, para um sistema de inovação mais holistico, multidimensional e integrado. O contexto da Inovação é complexo, por isso as empresas precisam de sistemas mais profundos e não apenas de “fórmulas comerciais” como o Design thinking para a inovação advoga. As Empresas precisam de aprender como mudar a sua cultura organizacional, como capacitar sua força de trabalho e colaboradores, como incorporar os públicos externos no processo de inovação, como medir o processo de inovação criando indicadores chave de performance e obter dados para um tomada de decisão mais informada, como integrar significado e propósito na sua filosofia de inovação. Por fim, precisam de perceber que uma estratégia de inovação não passa por ter “sucesso uma vez”, mas sim por criar um fluxo contínuo de interação e diálogo com os seus clientes com uma mentalidade de “cadeia de criação de valor”