Practising social justice: Community organisations, what matters and what counts

This thesis investigates the situated knowing-in-practice of locally-based community organisations, and studies how this practice knowledge is translated and contested in inter-organisational relations in the community services field of practices. Despite participation in government-led consultation processes, community organisations express frustration that the resulting policies and plans inadequately take account of the contributions from their practice knowledge. The funding of locally-based community organisations is gradually diminishing in real terms and in the competitive tendering environment, large nationally-based organisations often attract the new funding sources. The concern of locally-based community organisations is that the apparent lack of understanding of their distinctive practice knowing is threatening their capacity to improve the well-being of local people and their communities. In this study, I work with practitioners, service participants and management committee members to present an account of their knowing-in-practice, its character and conditions of efficacy; and then investigate what happens when this local practice knowledge is translated into results-based accountability (RBA) planning with diverse organisations and institutions. This thesis analyses three points of observation: knowing in a community of practitioners; knowing in a community organisation and knowing in the community services field of practices. In choosing these points of observation, the inquiry explores some of the relations and intra-actions from the single organisation to the institutional at a time when state government bureaucracy has mandated that community organisations implement RBA to articulate outcomes that can be measured by performance indicators. A feminist, performative, relational practice-based approach employs participatory action research to achieve an enabling research experience for the participants. It aims to intervene strategically to enhance recognition of the distinctive contributions of community organisations’ practice knowledge. This thesis reconfigures understandings of the roles, contributions and accountabilities of locally-based community organisations. Observations of situated practices together with the accounts of workers and service participants demonstrate how community organisations facilitate service participants’ struggles over social justice. A new topology for rethinking social justice as processual and practice-based is developed. It demonstrates how these struggles are a dynamic complex of iteratively-enfolded practices of respect and recognition, redistribution and distributive justice, representation and participation, belonging and inclusion. The focus on the practising of social justice in this thesis offers an alternative to the neo-liberal discourse that positions community organisations as sub-contractors accountable to government for delivering measurable outputs, outcomes and efficiencies in specified service provision contracts. The study shows how knowing-in-practice in locally-based community organisations contests the representational conception of knowledge inextricably entangled with accountability and performance measurement apparatus such as RBA. Further, it suggests that practitioner and service participant contributions are marginalised and diminished in RBA through the privileging of knowledge that takes an ‘expert’, quantifiable and calculative form. Thus crucially, harnessing local practice knowing requires re-imagining and enacting knowledge spaces that assemble and take seriously all relevant stakeholder perspectives, diverse knowledges and methods

The preoperative prognostic nutritional index is an independent predictor of survival in patients with renal cell carcinoma.

OBJECTIVE: Accurate postoperative stratification of patients with renal cell carcinoma (RCC) in distinct prognostic groups is essential for tailoring follow-up, medical therapy, and inclusion in clinical trials. Increasing evidence suggests that Onodera׳s prognostic nutritional index (PNI) is a stage- and grade-independent predictor of poor outcomes in patients with cancer, but there are no data in RCC. MATERIALS AND METHODS: We reviewed medical records of 1,344 patients with RCC who underwent radical or partial nephrectomy at the Medical University of Vienna and the University of California-Los Angeles between 1991 and 2012. Associations with cancer-specific survival were assessed with univariable and multivariable Cox proportional hazards models. Discrimination was measured with the C-index. RESULTS: The median postoperative follow-up was 40 months. An increase of PNI by 1 unit was associated with a decrease in the risk of death from RCC by 7% (hazard ratio = 0.93, P<0.001). In multivariable analyses, the PNI was an independent prognostic factor (P<0.001). Adding the PNI improved the discrimination of a base model by 0.4%. CONCLUSIONS: The PNI is an independent prognostic factor in patients with RCC. Its use increases the accuracy of established prognostic factors. PNI may be a meaningful adjunct for tailoring surveillance, medical therapy, and clinical trial design

A pilot trial of tumor lysate-loaded dendritic cells for the treatment of metastatic renal cell carcinoma.

Cultured tumor lysate-loaded dendritic cells (TuLy-DC) have been demonstrated in vitro to stimulate potent immune modulations and generate significant antitumor response. We report the results of a pilot trial of TuLy-DC vaccine for patients with metastatic renal cell carcinoma (mRCC). Fourteen mRCC patients underwent nephrectomy to obtain autologous TuLy prepared by subjecting tumor cells to 3 freeze/thaw cycles. Dendritic cells were generated from peripheral blood CD14+ precursors cultured in the presence of GM-CSF, IL-4, and 10% autologous serum. Patients received one vaccination of TuLy alone as an immunologic control, followed by 3 weekly vaccinations of DC-TuLy injected intradermally in the midaxillary region. Peripheral blood lymphocytes were collected before and after weekly vaccines and were assessed for changes in phenotype, cytotoxicity, and cytokine profile. The TuLy-DC vaccine was successfully prepared and administered to 12 patients, whereas 2 patients did not receive vaccine treatment due to declines in postoperative performance status. The vaccines were well tolerated, with only grade 1 toxicities noted. One patient had a partial response to treatment that did not correspond to any significant change in immunologic profile. This pilot trial demonstrated both the safety and feasibility of reliably preparing a DC-based vaccine for mRCC patients. Our data suggest that autologous TuLy-DC vaccines generate only limited clinical response. Further clinical studies are needed to identify the most potent treatment regimen that can consistently mediate an antitumor immune response in vivo

A pilot trial of tumor lysate-loaded dendritic cells for the treatment of metastatic renal cell carcinoma.

Item does not contain fulltextCultured tumor lysate-loaded dendritic cells (TuLy-DC) have been demonstrated in vitro to stimulate potent immune modulations and generate significant antitumor response. We report the results of a pilot trial of TuLy-DC vaccine for patients with metastatic renal cell carcinoma (mRCC). Fourteen mRCC patients underwent nephrectomy to obtain autologous TuLy prepared by subjecting tumor cells to 3 freeze/thaw cycles. Dendritic cells were generated from peripheral blood CD14+ precursors cultured in the presence of GM-CSF, IL-4, and 10% autologous serum. Patients received one vaccination of TuLy alone as an immunologic control, followed by 3 weekly vaccinations of DC-TuLy injected intradermally in the midaxillary region. Peripheral blood lymphocytes were collected before and after weekly vaccines and were assessed for changes in phenotype, cytotoxicity, and cytokine profile. The TuLy-DC vaccine was successfully prepared and administered to 12 patients, whereas 2 patients did not receive vaccine treatment due to declines in postoperative performance status. The vaccines were well tolerated, with only grade 1 toxicities noted. One patient had a partial response to treatment that did not correspond to any significant change in immunologic profile. This pilot trial demonstrated both the safety and feasibility of reliably preparing a DC-based vaccine for mRCC patients. Our data suggest that autologous TuLy-DC vaccines generate only limited clinical response. Further clinical studies are needed to identify the most potent treatment regimen that can consistently mediate an antitumor immune response in vivo