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Australia's dispersed population in rural areas contributes to poor access to therapy services and the inability of the existing rural therapy workforce to meet demand. As a result, rural children with a developmental delay wait a long time for therapy. This paper describes participant perceptions of a therapy facilitation service model that has worked to improve access to therapy for children in these circumstances. The model, given the pseudonym 'Outback', operates in rural and remote areas of western New South Wales. 'Outback' employs local people to work under the guidance of therapists based in larger centres to provide preschool children with developmental delays with access to therapy interventions they might not otherwise receive. A two‐stage case study design involving focus groups and interviews with the director, four therapy facilitators, nine therapists, and seven carers was used. Three themes were identified as central to the service model: 1) being part of the local community; 2) developing therapy facilitator knowledge and skills; 3) improving access to therapy intervention for children in rural and remote areas. The 'Outback' model demonstrates that appropriately supported, local therapy facilitators provide a flexible workforce adjunct that expands the reach of therapists into rural and remote communities and enhances service access for children and their families.

AbstractThroughout their lives, all people, including those who have a disability, use a broad range of community services. Community services are important in assisting people with a range of impairments to participate in their communities. Vast geographic distances and a lack of therapists in rural and remote regions of Australia pose significant barriers for implementing policy aimed at supporting people with a disability. The aim of this study was to investigate the extent to which metropolitan‐formulated policy encompassed the unique geographic, demographic, and sociocultural challenges experienced by rural therapists and people with a disability in New South Wales (NSW). Twenty‐seven policy documents were reviewed and categorized into tier 1 (higher level strategic policies) and tier 2 (specific operational policies). Tier 1 policy documents provided consistent messages about the need to develop strategies and service delivery options to address geographic, cultural, and age‐related barriers facing all people in NSW including those who have a disability. Tier 2 documents revealed a lack of attention to the practical differences between implementing the policy principles in metropolitan compared with rural areas. Study findings identify that the implementation of metropolitan‐formulated policy does not always encompass the unique challenges experienced by therapists providing services to rural people with a disability and their carers. This study highlights the importance of "rural proofing" policy to consider people who live and work in rural areas.

AbstractWorldwide health and social outcomes of Indigenous people are poorer than those of non‐Indigenous. In Australia, the Indigenous population experience disability at more than twice the rate of the non‐Indigenous population, and a quarter live in geographically remote areas. The challenges associated with accessing services and supports in remote communities can impact on a good life for Aboriginal people with disability. Interviews were conducted with Aboriginal people (Anangu) with disability and family carers from remote Central Australian communities and service workers. Thematic data analysis determined factors Anangu viewed as essential to living a good life: connection to their Lands, being with family and engaging in cultural activities. Workers' support for a good life involves "Proper Way" help and an understanding of Anangu culture. Three culturally relevant strengths‐based concepts are important in supporting Anangu with disability to live a good life: being connected to the Lands and family, sharing together and working together.

Genome-wide association studies (GWAS) have identified more than 50,000 unique associations with common human traits. While this represents a substantial step forward, establishing the biology underlying these associations has proven extremely difficult. Even determining which cell types and which particular gene(s) are relevant continues to be a challenge. Here, we conduct a cell-specific pathway analysis of the latest GWAS in multiple sclerosis (MS), which had analyzed a total of 47,351 cases and 68,284 healthy controls and found more than 200 non-MHC genome-wide associations. Our analysis identifies pan immune cell as well as cell-specific susceptibility genes in T cells, B cells and monocytes. Finally, genotype-level data from 2,370 patients and 412 controls is used to compute intra-individual and cell-specific susceptibility pathways that offer a biological interpretation of the individual genetic risk to MS. This approach could be adopted in any other complex trait for which genome-wide data is available. ; This investigation was supported in part by the following sources: NIH/NINDS awards R01NS088155 and 1R01NS099240, the Valhalla Charitable Foundation, and the Heidrich Family and Friends Foundation (Sergio E. Baranzini). US National Multiple Sclerosis Society (TA 3056-A-2), the Harvard NeuroDiscovery Center and an Intel Parallel Computing Center award (Nikolaos A. Patsopoulos). Swedish Medical Research Council; Swedish Research Council for Health, Working Life and Welfare, Knut and Alice Wallenberg Foundation, AFA insurance, Swedish Brain Foundation, the Swedish Association for Persons with Neurological Disabilities. Cambridge NIHR Biomedical Research Centre, UK Medical Research Council (G1100125) and the UK MS society (861/07). NIH/NINDS: R01 NS049477, NIH/NIAID: R01 AI059829, NIH/NIEHS: R01 ES0495103. Research Council of Norway grant 196776 and 240102. NINDS/NIH R01NS088155. Oslo MS association. Research Council KU Leuven, Research Foundation Flanders. AFM, AFM-Généthon, CIC, ARSEP, ANR-10-INBS-01 and ANR-10-IAIHU-06. Research Council KU Leuven, Research Foundation Flanders. Inserm ATIP-Avenir Fellowship and Connect-Talents Award. German Ministry for Education and Research, German Competence Network MS (BMBF KKNMS). Oslo MS association, Research Council of Norway grant 196776 and 240102. Dutch MS Research Foundation. TwinsUK is funded by the Wellcome Trust, Medical Research Council, European Union, the National Institute for Health Research (NIHR)-funded BioResource, Clinical Research Facility and Biomedical Research Centre based at Guy's and St Thomas' NHS Foundation Trust in partnership with King's College London. German Ministry for Education and Research, German Competence Network MS (BMBF KKNMS). Italian Foundation of Multiple Sclerosis (FISM). NMSS (RG 4680A1/1). German Ministry for Education and Research, German Competence Network MS (BMBF KKNMS). Lundbeck Foundation and Benzon Foundation. ; updatedVersion