Immune checkpoint inhibitors in renal cell carcinoma

The immune system has long been known to play a critical role in the body's defence against cancer, and there have been multiple attempts to harness it for therapeutic gain. Renal cancer was, historically, one of a small number of tumour types where immune manipulation had been shown to be effective. The current generation of immune checkpoint inhibitors are rapidly entering into routine clinical practice in the management of a number of tumour types, including renal cancer, where one drug, nivolumab, an anti-programmed death-1 (PD-1) monoclonal antibody (mAb), is licensed for patients who have progressed on prior systemic treatment. Ongoing trials aim to maximize the benefits that can be gained from this new class of drug by exploring optimal timing in the natural course of the disease as well as combinations with other checkpoint inhibitors and drugs from different classes

Satellite tracking of offenders and integrated offender management: a local case study

This article reports findings from an evaluation of a Global Positioning System (GPS) pilot that took place in the Cardiff Integrated Offender Management Unit (IOMU). The evaluation was based primarily upon qualitative interviews with about half of the tracked sample of offenders, plus interviews with key stakeholders from the IOMU, police and courts. The findings revealed a general consensus of positive views from both offenders and practitioners about the experience of GPS tracking. However, these generally positive outcomes were clearly related to the voluntary and relatively targeted nature of the pilot, which would be challenged if/when GPS tracking was introduced more widely

"Misunderstood... not badly behaved." The Experiences of Young People Excluded from School"

Abstract Young people who may be at risk of or experience school exclusion have been discussed in the literature extensively across many disciplines: psychology, sociology, education, health and in policy. Multiple risk factors have been identified but there is a distinctive lack of studies identifying what young people themselves view as the reasoning behind their exclusion. The following study was a narrative inquiry undertaken using the method of qualitative semi-structured interviews and analysed from an Interpretative Phenomenological Analysis approach. Three young people aged 15 years: two female, one male and of varying identified ethnic backgrounds were interviewed. The superordinate themes identified were: social explanations of exclusion, psychological explanations of exclusion and interventions that would help other young people. The nested themes included: family, peers at school, mental health, personality, identity and behaviour, aspiration, lack of trust in authority, education and other support. Overall, the analysis revealed that these young people had complex social backgrounds and may have experienced multiple traumas and deprivation. This has implications for those working in health, social and educational professions as these young people would have benefited from accessing services, particularly in the early years

Novel parameters for assessing cardiac dyssynchrony

Cardiac mechanical dyssynchrony describes the variation in the timing of contraction or relaxation within the ventricle and can be assessed using various imaging techniques. Electrical dyssynchrony has previously been used as a surrogate for mechanical dyssynchrony. However, it is now widely recognised that mechanical dyssynchrony can occur without the presence of electrical dyssynchrony. Therefore, it has become increasingly important to develop quantitative measures of mechanical dyssynchrony. Although echocardiography has led in this area, radionuclide ventriculography (RNVG) imaging can also be used. This research aims to investigate the use of novel phase parameters from RNVG, including synchrony, entropy, phase standard deviation, approximate entropy, and sample entropy, to provide a quantitative measure of cardiac dyssynchrony. There is limited published data applying these parameters to phase images, and there is currently no established normal range. To achieve these aims, each parameter has been optimised and tested on both simulated and clinical data. In addition, the optimised parameters have been applied to clinical data sets to assess the ability to predict patient outcome. The results highlight the importance of optimising input parameters for approximate entropy and sample entropy and demonstrate that the selected values are appropriate for application to RNVG phase images. The clinical results using the optimised parameters are promising for assessing patients prior to receiving cardiotoxic cancer therapy. Approximate entropy combined with left ventricular ejection fraction was able to predict those at a higher risk of cardiac dysfunction before treatment commenced. The dyssynchrony parameters were also used to assess a group of patients with heart failure with reduced ejection fraction. The results demonstrated that dyssynchrony, left ventricular ejection fraction, and right ventricular ejection fraction improved after beta-blocker. In addition, patients with non-ischaemic heart failure and dyssynchronous left ventricular contraction were more likely to respond to beta-blocker therapy. This research has successfully investigated novel dyssynchrony parameters for radionuclide ventriculography imaging. Overall, this research strengthens the idea that dyssynchrony can predict patient outcomes and improve clinical decision making

Formulating foster care in Scotland for young children's emotional and mental wellbeing (short report)

Foster carers can play a key role in supporting a child’s recovery from abuse and neglect and improving their mental health, but optimising this requires appropriate formulation of the care arrangements. This is a report on a scoping study into the extent to which the way foster care as conceived and supported, provides the basis for meeting the emotional and mental health needs of young children. It focuses on children aged up to 60 months who have been removed from their parents’ care because of maltreatment, or risk of maltreatment and who have been placed in state provided (non-familial) foster care provision in Scotland. The project had three main objectives: 1. To establish what is known about the emotional and mental health needs of young children (aged zero to five years) coming into the care system. 2. To look at the preparation and support for foster carers in Scotland relevant to caring for these children, through analysis of local authority documents. 3. To explore the experience of foster carers in meeting the emotional and mental health needs of children, through interviews with a sample of foster carers