Twelve-month observational study of children with cancer in 41 countries during the COVID-19 pandemic

Introduction Childhood cancer is a leading cause of death. It is unclear whether the COVID-19 pandemic has impacted childhood cancer mortality. In this study, we aimed to establish all-cause mortality rates for childhood cancers during the COVID-19 pandemic and determine the factors associated with mortality. Methods Prospective cohort study in 109 institutions in 41 countries. Inclusion criteria: children <18 years who were newly diagnosed with or undergoing active treatment for acute lymphoblastic leukaemia, non-Hodgkin's lymphoma, Hodgkin lymphoma, retinoblastoma, Wilms tumour, glioma, osteosarcoma, Ewing sarcoma, rhabdomyosarcoma, medulloblastoma and neuroblastoma. Of 2327 cases, 2118 patients were included in the study. The primary outcome measure was all-cause mortality at 30 days, 90 days and 12 months. Results All-cause mortality was 3.4% (n=71/2084) at 30-day follow-up, 5.7% (n=113/1969) at 90-day follow-up and 13.0% (n=206/1581) at 12-month follow-up. The median time from diagnosis to multidisciplinary team (MDT) plan was longest in low-income countries (7 days, IQR 3-11). Multivariable analysis revealed several factors associated with 12-month mortality, including low-income (OR 6.99 (95% CI 2.49 to 19.68); p<0.001), lower middle income (OR 3.32 (95% CI 1.96 to 5.61); p<0.001) and upper middle income (OR 3.49 (95% CI 2.02 to 6.03); p<0.001) country status and chemotherapy (OR 0.55 (95% CI 0.36 to 0.86); p=0.008) and immunotherapy (OR 0.27 (95% CI 0.08 to 0.91); p=0.035) within 30 days from MDT plan. Multivariable analysis revealed laboratory-confirmed SARS-CoV-2 infection (OR 5.33 (95% CI 1.19 to 23.84); p=0.029) was associated with 30-day mortality. Conclusions Children with cancer are more likely to die within 30 days if infected with SARS-CoV-2. However, timely treatment reduced odds of death. This report provides crucial information to balance the benefits of providing anticancer therapy against the risks of SARS-CoV-2 infection in children with cancer

Narrative identity as a central theme in an ethics of librarianship

The theory of narrative identity presented by Paul Ricoeur is suggested as a basis for understanding the notion of person. The action of reading is considered as an analogy to understand not only how we make an account of an individual or corporate life, but also how we as persons live inside an identity as an ongoing consciousness. Some implications for an ethics of librarianship are explored

Narrative identity in transition : the lived experience of an organisational merger in local government

This thesis is concerned with the question of how narrative activity influences the conditions in which a new sense of self is actively emergent for an employee at a time of organisational merger. It is contended that an organisational merger is a transformational event with complex temporal and spatial characteristics, involving the activities of making shared meaning (MacIntyre, 1981; Ricoeur, 1974a), narrative-making (Carr, 1986; MacIntyre, 1981; Ricoeur, 1984, 1985, 1988) and positioning (Bourdieu, 1993, 1998b). These activities are central to the conditions in which persons and organisations are both formed and reformed. Consideration of how they are part of a project of narrative identity (Ricoeur, 1984, 1985, 1988, 1992) opens new possibilities in our understanding of the lived experience of a merger. In appropriating narrative theory, this thesis is exploratory in nature as narrative ideas have not, to date, been applied to an understanding of the lived experience of an organisational merger. Mergers are currently understood as a clash of cultures, and a merger is treated as a marriage with partners, compatibility, commitment, rituals, dominance and fit. Whereas culture is construed in the literature as a quality that differentiates one organisation from another, and personal experience is understood in terms of adjusting to the presence of another culture, in this thesis a different theory is employed. The main theory integration in this thesis gives prominence to the dynamic of activity/passivity (Allen & Starr, 1982; Schelling, 1800/1978) and the notions of agency, relationship, transformation, and identity. Narrative theory is integrated with social theory (Bourdieu, 1998b) to enrich our understanding of these notions. Hence this thesis extends the contribution of Drummond (1996, 1998), and is situated in the constructive postmodern stance of process philosophy (Gare, in press-a; Griffin, 1993). This stance is invoked as a response to calls for better theories of action in management studies (Reed, 1996; Wilmott, 1994). It is argued, in agreement with Gare (in press-a, in press-b), that living organisms have a complexity that makes it difficult to maintain a state of indifference with respect to changes in their environment, and that they must form and reform themselves as products. Attention within management studies to self-organising activity at the levels of person, organisation and field of practice, is therefore central to our understanding of complex events such as organisational mergers. In this regard narrative-making and positioning are self-organising activities that are yet to be brought to centre stage in management theory. While no previous work has been done to apply narrative ideas to an understanding of mergers, such a move is nevertheless consistent with the increasing interest in narrative that is occurring across the theoretical divides in management studies. The application in this thesis concerns a merger of two government organisations. These organisations, herein given the fictitious names of 'Anessa' and 'Isengate' (for reasons of confidentiality), were each part of what is usually referred to in local government as 'a council'. This thesis is about the employees in these organisations during this time of political amalgamation of the two councils, and the consequent organisational merger. Through interviews with informants, the use of documents, and the integration of theory, a narrative is created. Of the many narratives that could be offered about this merger, it is the narrative given here that constitutes a response to the research question. Hence the methodology used sustains the purpose, which is to contribute to a reading experience, and the possibility of new interpretations regarding the lived experience of an organisational merger. This thesis concludes that it is at the level of 'ongoing argument' that persons and organisations are contributors to the process of 'making shared meaning'. At the federal level of government this argument is about how best to govern, and at the level of the field of practice it encompasses the argument over what constitutes public service activity. The State Government of Victoria actively furthered this contest when it undertook local government reform. It is argued that their narrative about local government reform has a life as part of 'economic rationalism' (Pusey, 1991), and it proceeds from an ideological position in a tradition of readings known as 'neoliberalism' (Bourdieu, 1998a). In this thesis employees are regarded as actively emergent beings living out a process of narrative identity. Under the authorship of the State Government employees were positioned as passive characters in the narrative of local government reform. For the employees considered in this thesis, this brought closure to a current and projected life narrative as a public servant at the local level. Their response was to reauthor their position to transcend this limitation, but it was found that this activity could be further limited according to the capital an employee could acquire in the form of 'time to tell a story' and 'space to tell a story'. The main contribution of this thesis, as a response to calls for better theories of action in management studies, is an exploration of how individual employees are processes of becoming, and how they participate in the becoming of the organisation and field to which they contribute. It is concluded that employees could be valued as processes of becoming, and this is a major contribution that they make to the field and organisation