Decadal changes in vegetation cover within coastal dunes at the regional scale in Victoria, SE Australia.

Vegetation is a critical boundary condition for the stability of coastal dunes. Globally, vegetation cover is increasing on the coast with many dunes being stabilised in the past decades. This pattern is driven by site-specific (e.g., coastal management) and global (e.g., climatic changes) factors. This study examines changes in dune vegetation during the past six decades at the regional scale along the southeast coast of Australia to understand the relative importance of the climate and human interventions in vegetation cover change. A total area of >31,000 ha, comprising 53% of the open coast of Victoria was studied. Since the 1960's, a general trend of dune stabilisation and coastal greening has occurred with total vegetation cover increasing from 61% to 84% coverage until 2020. At the regional scale, the increase in vegetation cover has been primarily driven by both climatic-related drivers, such as rising temperature, elevating CO2 concentrations and declining windiness, and state-wide coastal management interventions (e.g., marram grass planting, fencing, fire control, grazing removal). The only areas where there was a decline in total area of vegetation was where substantial coastal recession had occurred. The decrease in vegetation is a result of a loss of land area rather than a loss of plant biomass over the dunefields. Therefore, it is considered that the overall decadal changes in both climate and coastal management are forcing the dunes toward a more stabilised state at the regional scale. At the same time, compelling local drivers (e.g., storms and local sediment deficiency) can be the most crucial factor to regulate vegetation change and shift dune mobility at the site-specific scale.

Examining the Benefits of the 340b Drug Discount Program.

The 340B Drug Discount Program required drug manufacturers to provide discounted outpatient drugs to health care organizations serving vulnerable patient populations to allow these institutions to offer more services to more people. As the 340B program expanded, controversy centered on which entities have benefited from the program. Many health care organizations sold 340B drugs to well-insured patients at full price and have thus been financially rewarded. Amendments to the program have permitted 340B providers to use contract pharmacies to dispense 340B medications, furthering the debate over which stakeholders are benefiting from the program. The purpose of this study was to determine which stakeholders benefited because of the 340B Drug Discount Program and what have been the drivers of recent changes to the program. The study used a literature review. One database aggregator and six academic databases were used to collect 70 total sources. These sources were reviewed and reduced to 39 sources, which were used in the written research. Of these, 20 sources were used in the Results section. Research showed that 340B eligible entities and contract pharmacies have financially benefited from the 340B program. Patient benefit has been indirect, as qualified providers have expanded service offerings and increased access to health care services. Regulatory reform, as well as profit potential, has driven the expansion of 340B as more providers have expanded eligible service lines. Although the goal of the 340B program has often been misconstrued, direct financial benefits to eligible providers have allowed for this expansion of access.