This article describes lessons learned from a pilot project that delivers Restorative Justice (RJ) to victims of crime referred by agencies supporting victims and victim self-referrals. The project ...involves a partnership of agencies in the Thames Valley, working as part of a wider European Collaboration, to extend RJ services to victims at the post-sentencing level. We provide access to RJ for victims, whilst protecting their rights and preventing re-victimisation, in accordance with EU directive 2012/29/EU (European Commission, 2012). The context and methodology of pilot project are explained. Lessons learned from practice through team case discussion and supervision are then identified and described. The cases are summarised in a table which outlines their key features and acts as a point of reference in relation to the lessons learned. Cases are ongoing at the time of writing. The lessons may not always be clear cut and finalised. We hope that this approach will demonstrate the process of learning from experience and practice as the project develops. Whilst ours is not a rigorously scientific approach, we hope it offers a chance to understand the dilemmas and issues presented by a model which starts from a victim's request for RJ. Independent evaluation, involving interviews with victims, referrers and offenders who have participated in the pilot project, follows at a later stage. Adapted from the source document.
Ovaj članak opisuje lekcije naučene iz pilot-projekta koji restorativnu pravdu omogućuje žrtvama zločina na koje upućuju agencije za pomoć žrtvama te žrtvama koje se same prijave za takav program. ...Projekt uključuje partnerstvo agencija u regiji Thames Valley, koje djeluju u sklopu šire europske suradnje, kako bi se usluge restorativne pravde za žrtve proširile na razini nakon izricanja kazne. Žrtvama omogućujemo pristup restorativnoj pravdi, dok štitimo njihova prava i sprečavamo ponovnu viktimizaciju, u skladu s Direktivom 2012/29/EU (Europska komisija 2012.).
Objašnjeni su kontekst i metodologija našeg pilot-projekta, a potom su kroz timske rasprave o slučajevima i nadzor identificirane i opisane lekcije naučene iz prakse. Slučajevi su zatim sažeti u tablici koja navodi njihove ključne značajke i djeluje kao referentna točka u vezi s naučenim lekcijama.
U vrijeme pisanja članka, slučajevi su u tijeku. Lekcije se ne mogu uvijek jasno definirati i finalizirati. Vjerujemo da će ovaj pristup pokazati proces učenja iz iskustva i prakse kako se projekt bude razvijao. Iako naš pristup nije strogo znanstven, nadamo se da čitateljima nudi priliku da razumiju dileme i pitanja predstavljene modelom koji počinje zahtjevom žrtve za restorativnom pravdom. Autori su voditelj projekta i voditelji restorativne pravde uključeni u izvršavanje usluga. Neovisna procjena, koja uključuje intervjue sa žrtvama, posrednicima i počiniteljima koji su sudjelovali u pilot-projektu, slijedi u kasnijoj fazi.
The prevalence of chronic kidney disease (CKD) is increasing worldwide; black patients have an increased risk of developing CKD and end stage kidney disease (ESKD) at significantly higher rates than ...other races. A cross sectional study was carried out on black patients with CKD attending the kidney outpatient clinic at Charlotte Maxeke Johannesburg Academic Hospital (CMJAH) in South Africa, between September 2019 to March 2020. Demographic and clinical data were extracted from the ongoing kidney outpatient clinic records and interviews, and were filled in a questionnaire. Patients provided blood and urine for laboratory investigations as standard of care, and data were descriptively and inferentially entered into REDcap and analysed using STATA version 17. Multivariable logistic regression analysis was used to identify demographic and clinical variables associated with advanced CKD. A total of 312 black patients with CKD were enrolled in the study with a median age of 58 (IQR 46-67) years; 58% patients had advanced CKD, 31.5% of whom had grossly increased proteinuria, 96.7% had hypertension, 38.7% had diabetes mellitus and 38.1% had both hypertension and diabetes mellitus. In patients with advanced CKD, the median age was 61 (IQR 51-69) years, eGFR 33 (30-39) mL/min/1.73 m.sup.2, serum bicarbonate 22 (IQR 20-24), haemoglobin 12.9 (IQR 11.5-14.0) g/dl and serum uric acid 0.43 (IQR 0.37-0.53). The prevalence of metabolic acidosis was 62.4%, anemia 46.4% and gout 30.9% among those with advanced CKD, while the prevalence of metabolic acidosis and anaemia was 46.6% and 25.9% respectively in those with early CKD. Variables with higher odds for advanced CKD after multivariable logistic regression analysis were hypertension (OR 3.3, 95% CI 1.2-9.2, P = 0.020), diabetes mellitus (OR 1.8, 95% CI 1.1-3.3, P = 0.024), severe proteinuria (OR 3.5, 95% CI 1.9-6.5, P = 0.001), angina (OR 2.5, 95% CI 1.2-5.1, P = 0.008), anaemia (OR 2.9, 95% CI 1.7-4.9, P = 0.001), hyperuricemia (OR 2.4, 95% CI 1.4-4.1, P = 0.001), and metabolic acidosis (OR 2.0, 95% CI 1.2-3.1, P = 0.005). Other associations with advanced CKD were loss of spouse (widow/widower) (OR 3.2, 95% CI 1.4-7.4, P = 0.006), low transferrin (OR 2.4, 95% CI 1.1-5.1, P = 0.028), hyperkalemia (OR 5.4, 95% CI 1.2-24.1, P = 0.029), use of allopurinol (OR 2.4, 95% CI 1.4-4.3, P = 0.005) and doxazosin (OR 1.9, 95% CI 1.2-3.1, P = 0.006). Hypertension and diabetes mellitus were strongly associated with advanced CKD, suggesting a need for primary and secondary population-based prevention measures. Metabolic acidosis, anemia with low transferrin levels, hyperuricemia and hyperkalemia were highly prevalent in our patients, including those with early CKD, and they were strongly associated with advanced CKD, requiring clinicians and dietitians to be proactive in supporting the needs of CKD patients in meeting their daily dietary requirements towards preventing and slowing the progression of CKD.
Limited empirical evidence is available regarding the uptake and effectiveness of school-based mental health and wellbeing programs implemented in Australian schools. This study aimed to characterise ...the delivery of programs in primary (elementary) schools across New South Wales, Australia, and to assess this information against published ratings of program effectiveness. Delivery of programs in four health-promoting domains - creating a positive school community; teaching social and emotional skills; engaging the parent community; and supporting students experiencing mental health difficulties - were reported by 597 school principals/leaders via online survey. Although three quarters of principals reported implementing at least one program, many of these programs were supported by little or no evidence of effectiveness. There was also variability in the use of evidence-based programs across the four domains. Findings indicate a need to provide educators with improved support to identify, implement, and evaluate effective evidenced-based programs that promote student mental health. Author abstract
Pembrolizumab is active in head and neck squamous cell carcinoma (HNSCC), with programmed cell death ligand 1 (PD-L1) expression associated with improved response.
KEYNOTE-048 was a randomised, phase ...3 study of participants with untreated locally incurable recurrent or metastatic HNSCC done at 200 sites in 37 countries. Participants were stratified by PD-L1 expression, p16 status, and performance status and randomly allocated (1:1:1) to pembrolizumab alone, pembrolizumab plus a platinum and 5-fluorouracil (pembrolizumab with chemotherapy), or cetuximab plus a platinum and 5-fluorouracil (cetuximab with chemotherapy). Investigators and participants were aware of treatment assignment. Investigators, participants, and representatives of the sponsor were masked to the PD-L1 combined positive score (CPS) results; PD-L1 positivity was not required for study entry. The primary endpoints were overall survival (time from randomisation to death from any cause) and progression-free survival (time from randomisation to radiographically confirmed disease progression or death from any cause, whichever came first) in the intention-to-treat population (all participants randomly allocated to a treatment group). There were 14 primary hypotheses: superiority of pembrolizumab alone and of pembrolizumab with chemotherapy versus cetuximab with chemotherapy for overall survival and progression-free survival in the PD-L1 CPS of 20 or more, CPS of 1 or more, and total populations and non-inferiority (non-inferiority margin: 1·2) of pembrolizumab alone and pembrolizumab with chemotherapy versus cetuximab with chemotherapy for overall survival in the total population. The definitive findings for each hypothesis were obtained when statistical testing was completed for that hypothesis; this occurred at the second interim analysis for 11 hypotheses and at final analysis for three hypotheses. Safety was assessed in the as-treated population (all participants who received at least one dose of allocated treatment). This study is registered at ClinicalTrials.gov, number NCT02358031.
Between April 20, 2015, and Jan 17, 2017, 882 participants were allocated to receive pembrolizumab alone (n=301), pembrolizumab with chemotherapy (n=281), or cetuximab with chemotherapy (n=300); of these, 754 (85%) had CPS of 1 or more and 381 (43%) had CPS of 20 or more. At the second interim analysis, pembrolizumab alone improved overall survival versus cetuximab with chemotherapy in the CPS of 20 or more population (median 14·9 months vs 10·7 months, hazard ratio HR 0·61 95% CI 0·45–0·83, p=0·0007) and CPS of 1 or more population (12·3 vs 10·3, 0·78 0·64–0·96, p=0·0086) and was non-inferior in the total population (11·6 vs 10·7, 0·85 0·71–1·03). Pembrolizumab with chemotherapy improved overall survival versus cetuximab with chemotherapy in the total population (13·0 months vs 10·7 months, HR 0·77 95% CI 0·63–0·93, p=0·0034) at the second interim analysis and in the CPS of 20 or more population (14·7 vs 11·0, 0·60 0·45–0·82, p=0·0004) and CPS of 1 or more population (13·6 vs 10·4, 0·65 0·53–0·80, p<0·0001) at final analysis. Neither pembrolizumab alone nor pembrolizumab with chemotherapy improved progression-free survival at the second interim analysis. At final analysis, grade 3 or worse all-cause adverse events occurred in 164 (55%) of 300 treated participants in the pembrolizumab alone group, 235 (85%) of 276 in the pembrolizumab with chemotherapy group, and 239 (83%) of 287 in the cetuximab with chemotherapy group. Adverse events led to death in 25 (8%) participants in the pembrolizumab alone group, 32 (12%) in the pembrolizumab with chemotherapy group, and 28 (10%) in the cetuximab with chemotherapy group.
Based on the observed efficacy and safety, pembrolizumab plus platinum and 5-fluorouracil is an appropriate first-line treatment for recurrent or metastatic HNSCC and pembrolizumab monotherapy is an appropriate first-line treatment for PD-L1-positive recurrent or metastatic HNSCC.
Merck Sharp & Dohme.
There is ample evidence that anthropogenic aerosols have important effects on climate in the Northern Hemisphere but little such evidence in the Southern Hemisphere. Observations of Australian ...rainfall and cloudiness since 1950 show increases over much of the continent. We show that including anthropogenic aerosol changes in 20th century simulations of a global climate model gives increasing rainfall and cloudiness over Australia during 1951–1996, whereas omitting this forcing gives decreasing rainfall and cloudiness. The pattern of increasing rainfall when aerosols are included is strongest over northwestern Australia, in agreement with the observed trends. The strong impact of aerosols is primarily due to the massive Asian aerosol haze, as confirmed by a sensitivity test in which only Asian anthropogenic aerosols are included. The Asian haze alters the meridional temperature and pressure gradients over the tropical Indian Ocean, thereby increasing the tendency of monsoonal winds to flow toward Australia. Anthropogenic aerosols also make the simulated pattern of surface‐temperature change in the tropical Pacific more like La Niña, since they induce a cooling of the surface waters in the extratropical North Pacific, which are then transported to the tropical eastern Pacific via the deep ocean. Transient climate model simulations forced only by increased greenhouse gases have generally not reproduced the observed rainfall increase over northwestern and central Australia. Our results suggest that a possible reason for this failure was the omission of forcing by Asian aerosols. Further research is essential to more accurately quantify the role of Asian aerosols in forcing Australian climate change.
Few studies have linked high levels of plasma C-terminal fibroblast growth factor 23 (FGF23) with poor clinical outcomes in patients on maintenance haemodialysis (MHD), while the association between ...intact FGF23 and mortality in this group of patients remains inconclusive. Therefore, the aim of this study was to evaluate the association between plasma levels of intact FGF23 and mortality in dialysis patients.
A prospective multicenter study involving patients undergoing dialysis at three dialysis centers in Johannesburg was undertaken between 1st October 2014 and 31st December 2017.
The study comprised 165 chronic dialysis patients (111 blacks, 54 whites) with a mean age of 46.6 ±14.2 years. During a three year follow up period, there were 46 deaths (1.03 per 100 person-years). The median plasma FGF 23 level was 382 pg/ml (interquartile range IQR, 145-2977). In adjusted multivariable analyses, there was a non-statistically significant increase in the risk of mortality with higher quartiles of FGF 23 levels: the adjusted hazard ratios (HR) for the second, third and fourth quantiles were HR 3.20 (95% CI, 0.99-10.35; P = 0.052), HR 2.43(95% CI,0.65-9.09; P = 0.19), and HR 2.09 (95% CI, 0.66-7.32; P = 0.25),respectively. Corrected serum calcium 2.38-2.5 mmol/l HR 2.98 (95% CI, 1.07-8.29; P = 0.04 and > 2.50 mmol/l HR 5.50 (95% CI, 1.84-16.48; P = 0.002 were independently associated with increased risk of death. Likewise, patients with intact parathyroid hormone > 600 pg/ml had a 3.46-fold higher risk of death (HR 3.46, 95% CI, 1.22-9.82 P = 0.019). These findings persisted in time -dependent analyses.
Higher levels of intact FGF 23 appear not to be independently associated with all-cause mortality in our dialysis patients, while hypercalcaemia and severe hyperparathyroidism were found to be independent predictors of mortality in this cohort of patients.
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