Emerging Practice in Responsible Supply Chain Management: Closed-Pipe Supply Chain of Conflict-Free Minerals from the Democratic Republic of Congo

Minerals originated from eastern Democratic Republic of Congo (DRC) are blamed for financing violent conflict in the area over the past decade and have been called conflict minerals. They vividly demonstrate a key human rights issue facing responsible supply chain management. The conflict minerals issue has led to a significant shift in responsible supply chain management in two ways: extending producer responsibility to respect human rights in the total supply chain through establishing traceability and transparency; and developing legally binding supply chain responsibility.This article examines an emerging effort to source conflict-free minerals using closed-pipe supply chain in the DRC as a new strategy to respond to the above paradigm shift. By exploring whether this new strategy can contribute to conflict prevention in the DRC, this article argues that the closed-pipe supply chain allows building long-term relationship with various stakeholders and has the potential to transform socio-economic structures in the producing communities, thereby leading to peacebuilding in the long run.<br/

AGENDA: Seeds of Change: Responding to Global Change in a Bottom-up World

Sponsors: Posner Center for International Development, RESOLVE, Inc., Newmont Mining Corporation, and Getches-Wilkinson Center for Natural Resources, Energy, and the Environment. Conference moderators, panelists and speakers included University of Colorado Law School professors Phil Weiser, Sarah Krakoff, Britt Banks, and Lakshman Guruswamy. This conference is made possible through the generous support of donors who sponsored this year’s Martz Sustainability Symposium (including Newmont Mining Corporation) and those who have invested in our Clyde O. Martz Endowed Fund for Natural Resources Management (including Brian Dolan and Davis Graham and Stubbs LLP). The Martz Natural Resources Management Fund was established in the memory of natural resources law pioneer Clyde Martz and supports innovative programming at Colorado Law in best practices in natural resources management. Many believe that global institutions and frameworks are failing to generate necessary progress on issues such as climate change, water scarcity, biodiversity, food security, and poverty eradication; and that state, tribal and local governments and communities, innovative companies, social and technology entrepreneurs, NGOs, impact investors, consumers and philanthropists increasingly are taking the lead in creating bottom-up solutions to these challenges. The conference will explore this dynamic in detail, with an emphasis on the drivers behind these ground level innovations, and on how they can better “filter up” to inform the global conversations occurring on how best to address the various dimensions of “global change”

AGENDA: Seeds of Change: Responding to Global Change in a Bottom-up World

Sponsors: Posner Center for International Development, RESOLVE, Inc., Newmont Mining Corporation, and Getches-Wilkinson Center for Natural Resources, Energy, and the Environment. Conference moderators, panelists and speakers included University of Colorado Law School professors Phil Weiser, Sarah Krakoff, Britt Banks, and Lakshman Guruswamy. This conference is made possible through the generous support of donors who sponsored this year’s Martz Sustainability Symposium (including Newmont Mining Corporation) and those who have invested in our Clyde O. Martz Endowed Fund for Natural Resources Management (including Brian Dolan and Davis Graham and Stubbs LLP). The Martz Natural Resources Management Fund was established in the memory of natural resources law pioneer Clyde Martz and supports innovative programming at Colorado Law in best practices in natural resources management. Many believe that global institutions and frameworks are failing to generate necessary progress on issues such as climate change, water scarcity, biodiversity, food security, and poverty eradication; and that state, tribal and local governments and communities, innovative companies, social and technology entrepreneurs, NGOs, impact investors, consumers and philanthropists increasingly are taking the lead in creating bottom-up solutions to these challenges. The conference will explore this dynamic in detail, with an emphasis on the drivers behind these ground level innovations, and on how they can better “filter up” to inform the global conversations occurring on how best to address the various dimensions of “global change”

Comparative Efficacy of Immunosuppressive Therapies in the Treatment of Diffuse Cutaneous Systemic Sclerosis

OBJECTIVES: The RESOLVE-1 trial of lenabasum in diffuse cutaneous systemic sclerosis (dcSSc) allowed background immunosuppressive therapy (IST) at the discretion of individual investigators, and no significant differences were observed between treatment arms. This provides a powerful opportunity to compare the relative efficacy of different ISTs in a well-defined large cohort of patients with dcSSc. METHODS: Prespecified IST categories, efficacy end points, baseline disease characteristics likely to influence efficacy outcomes, the definition of interstitial lung disease, definitions of IST use, and categories of IST use by which efficacy outcomes were evaluated were. Descriptive statistics are used to present results. RESULTS: For skin, change in modified Rodnan skin score (mRSS) was numerically greatest with mycophenolate mofetil (MMF) treatment in patients with the earliest disease, reaching -10.8 points in the MMF group versus -4.8 points in the no IST group in patients with a disease duration ≤2 years. Other ISTs had improvements intermediate between that seen in the MMF and no IST groups. Forced vital capacity (mL) was stable over 52 weeks in patients in the MMF group compared to an around 160-mL decline over 52 weeks in no IST group. Differences in outcome were observed between antinuclear antibody subgroups, with greater difference in favor of MMF for skin and lungs being observed in anti-topoisomerase 1 autoantibody-positive patients. In contrast, anti-RNA polymerase III autoantibody-positive patients in both the no IST and MMF groups improved rapidly, with a decrease in mRSS. CONCLUSION: Taken together, our findings robustly support routine use of MMF in dcSSc and show benefit especially in early-stage disease. Those patients with high-risk antibodies for lung fibrosis might be especially suitable for MMF treatment

The impact of hypoglycemia on quality of life and related outcomes in children and adolescents with type 1 diabetes: a systematic review

Objective To conduct a systematic review to examine associations between hypoglycemia and quality of life (QoL) in children and adolescents with type 1 diabetes. Methods Four databases (Medline, Cochrane Library, CINAHL, PsycINFO) were searched systematically in November 2019 and searches were updated in September 2021. Studies were eligible if they included children and/or adolescents with type 1 diabetes, reported on the association between hypoglycemia and QoL (or related outcomes), had a quantitative design, and were published in a peer-reviewed journal after 2000. A protocol was registered the International Prospective Register of Systematic Reviews (PROSPERO; CRD42020154023). Studies were evaluated using the Joanna Briggs Institute’s critical appraisal tool. A narrative synthesis was conducted by outcome and hypoglycemia severity. Results In total, 27 studies met inclusion criteria. No hypoglycemia-specific measures of QoL were identified. Evidence for an association between SH and (domains) of generic and diabetes-specific QoL was too limited to draw conclusions, due to heterogenous definitions and operationalizations of hypoglycemia and outcomes across studies. SH was associated with greater worry about hypoglycemia, but was not clearly associated with diabetes distress, depression, anxiety, disordered eating or posttraumatic stress disorder. Although limited, some evidence suggests that more recent, more frequent, or more severe episodes of hypoglycemia may be associated with adverse outcomes and that the context in which hypoglycemia takes places might be important in relation to its impact. Conclusions There is insufficient evidence regarding the impact of hypoglycemia on QoL in children and adolescents with type 1 diabetes at this stage. There is a need for further research to examine this relationship, ideally using hypoglycemia-specific QoL measures

Efficacy and Safety of Lenabasum, a Cannabinoid Type 2 Receptor Agonist, in a Phase 3 Randomized Trial in Diffuse Cutaneous Systemic Sclerosis

INTRODUCTION: Efficacy and safety of lenabasum, a cannabinoid type 2-receptor agonist, was tested in a Phase 3 study in patients with diffuse cutaneous systemic sclerosis (dcSSc). METHODS: A multi-national double-blind study was conducted in 365 dcSSc patients who were randomized and dosed 1:1:1 with lenabasum 20 mg, lenabasum 5 mg, or placebo, each twice daily and added to background treatments including immunosuppressive therapies (IST). RESULTS: The primary endpoint, ACR Combined Response Index in dcSSc (ACR-CRISS) score at Week 52, lenabasum 20 mg BID versus placebo, was not met, with ACR-CRISS scores of 0.888 versus 0.887, P = 0.4972, mixed models repeated measures (MMRM). Change in modified Rodnan Skin Score (mRSS) at Week 52 was -6.7 versus -8.1 points for lenabasum 20 mg BID versus placebo, P = 0.1183, MMRM. Pre-specified analyses showed higher ACR-CRISS scores, greater improvement in mRSS, and less decline in forced vital capacity in subjects on background mycophenolate and those receiving IST for ≤ 1 year duration. No deaths or excess in serious or severe adverse events related to lenabasum were observed. CONCLUSIONS: A benefit of lenabasum in dcSSc was not demonstrated. The majority of patients were treated with background IST, and treatment with MMF in particular was associated with better outcomes. This supports the use of IST in the treatment of dcSSc, and highlights the challenge of demonstrating a treatment effect when investigational treatment is added to standard of care IST. These findings have relevance to trial design in SSc, as well as clinical care

Efficacy and Safety of Lenabasum, a Cannabinoid Type 2 Receptor Agonist, in a Phase 3 Randomized Trial in Diffuse Cutaneous Systemic Sclerosis

Objective This phase 3 study was undertaken to investigate the efficacy and safety of lenabasum, a cannabinoid type 2 receptor agonist, in patients with diffuse cutaneous systemic sclerosis (dcSSc). Methods A multinational double-blind study was conducted in 365 dcSSc patients who were randomized and dosed 1:1:1 with lenabasum 20 mg, lenabasum 5 mg, or placebo, each twice daily and added to background treatments, including immunosuppressive therapies (IST). Results The primary end point, the American College of Rheumatology combined response index in dcSSc (CRISS) at week 52 for lenabasum 20 mg twice a day versus placebo, was not met, with CRISS score of 0.888 versus 0.887 (P = 0.4972, using mixed models repeated measures [MMRM]). The change in the modified Rodnan skin thickness score (MRSS) at week 52 for lenabasum 20 mg twice a day versus placebo was −6.7 versus −8.1 (P = 0.1183, using MMRM). Prespecified analyses showed higher CRISS scores, greater improvement in MRSS, and lower decline in forced vital capacity in patients on background mycophenolate and those who were taking IST for ≤1 year. No deaths or excess in serious or severe adverse events related to lenabasum were observed. Conclusion A benefit of lenabasum in dcSSc was not demonstrated. Most patients were treated with background IST, and treatment with mycophenolate mofetil in particular was associated with better outcomes. These findings support the use of IST in the treatment of dcSSc and highlight the challenge of demonstrating a treatment effect when investigational treatment is added to standard of care IST. These findings have relevance to trial design in SSc, as well as to clinical care

Quality of life, coping strategies and support needs of women seeking Traditional Chinese Medicine for infertility and viable pregnancy in Australia: a mixed methods approach

Extent: 11p.Background: Infertility affects about 15% of couples in Western-societies with most progressing to fertility clinics for treatment. Despite being common, infertility is often experienced as a lonely road for affected couples. In this paper we expand on our previously published findings of women’s experiences with infertility or difficulty of viable pregnancy who had sought Traditional Chinese Medicine (TCM) therapy in Australia, and focus on women’s quality of life, coping strategies, and support needs. Methods: We applied mixed methods using the Tuebingen Quality of Life and the COPE questionnaires and in-depth interviews with 25 women with primary or secondary infertility, recurrent miscarriages or unexplained stillbirth, and who had consulted a TCM practitioner. We used a thematic approach to analyse the interviews, and descriptive statistics to evaluate questionnaire responses. Results: Women reported through both questionnaires and interviews compromised quality of life due to the high level of distress, guilt, grief, and frustration caused by infertility. However, our women represented a highly motivated sample, actively seeking alternative support. While the TCM approach to infertility management increased women’s sense of personal agency and control through education and continuity of care, the need for greater understanding and support on a societal level remains. Conclusions: In infertility, ongoing emotional and instrumental support is pivotal to the wellbeing and quality of life of the affected. Traditional Chinese Medicine addresses some support needs in infertility not routinely available in the Western model of care. More peer-led and professional-led support groups are greatly needed for women experiencing infertility to help break isolation and raise awareness of integrative approaches to fertility management.Karin Ried and Ann Alfre

WCD Thematic Review V.5 Participation, Negotiation and Conflict Management in Large Dams Projects

This thematic review focuses on the siting, construction and operation of large dam facilities (or their alternatives) as sources of significant conflict, and as opportunities to involve many interested parties and groups in addressing local, regional, and national issues. The review is intended to improve understanding about large dam conflicts, identify essential principles and decision-making approaches for public involvement and conflict resolution, and provide a set of best practices in these areas for large dams or their alternatives.dams, regional, national, dam, alternatives, participation, negotiation, conflict, management, decision making, stakeholders, knowledge, institution, pubic participation