One-step nucleic acid amplification (Osna) of sentinel lymph node in early-stage endometrial cancer: Spanish multicenter study (endo-osna)

The objective of this study was to evaluate the efficacy of one-step nucleic acid amplification (OSNA) for the detection of sentinel lymph node (SLN) metastasis compared to standard pathological ultrastaging in patients with early-stage endometrial cancer (EC). A total of 526 SLNs from 191 patients with EC were included in the study, and 379 SLNs (147 patients) were evaluated by both methods, OSNA and standard pathological ultrastaging. The central 1 mm portion of each lymph node was subjected to semi-serial sectioning at 200 µm intervals and examined by hematoxylin–eosin and immunohistochemistry with CK19; the remaining tissue was analyzed by OSNA for CK19 mRNA. The OSNA assay detected metastases in 19.7% of patients (14.9% micrometastasis and 4.8% macrometastasis), whereas pathological ultrastaging detected metastasis in 8.8% of patients (3.4% micrometastasis and 5.4% macrometastasis). Using the established cut-off value for detecting SLN metastasis by OSNA in EC (250 copies/µL), the sensitivity of the OSNA assay was 92%, specificity was 82%, diagnostic accuracy was 83%, and the negative predictive value was 99%. Discordant results between both methods were recorded in 20 patients (13.6%). OSNA resulted in an upstaging in 12 patients (8.2%). OSNA could aid in the identification of patients requiring adjuvant treatment at the time of diagnosis. © 2021 by the authors. Licensee MDPI, Basel, Switzerland

African decentralization : local actors, powers and accountability

Abstract in French and Spanis

Integral local development: 'accommodating multiple interests' through entrustment and accountable representation

Accommodating multiple interests involves integrating across-highly stratified societies. Integral local development is a means of integrating across these interests through locally accountable representative authorities entrusted with public powers. It is integral to the local community because it is based on democratic representation -where 'democratic' is substantively defined as a system of public power holders who are accountable to the public. Customary authorities, NGOs, local environmental agents and ad hoc committees do not necessarily represent the public nor are they systematically accountable. This paper advances elected local government as a legitimate representative of local people in environmental and other matters

Lessons from forestry decentralisation

REDD+ is more likely to be just and locally legitimate if the design, implementation and allocation of benefits represent local needs and aspirations. Decentralisation of meaningful decisions to locally accountable and responsive (e.g., representative) local authorities would promote local engagement in REDD+ decision making. The level at which rules are made and benefits distributed will be a key issue in the legitimacy, effectiveness, efficiency and equity of REDD+

The poverty of forestry policy: double standards on an uneven playing field

Can policies designed to maximize exploitation by elites benefit the people who live in forests? Forestry policy throughout the developing world originates from European ‘‘scientific’’ forestry traditions exported during the colonial period. These policies were implemented by foreign and local elite whose interest was to maximize and extract profit. In spite of reforms since the end of the colonial period, policies on the environment usually remain biased against rural communities. Even when more recent policies are fair, the rural poor face severe biases in implementation. In addition, they must compete on an uneven playing field of ethnic and other social inequities and economic hurdles. This article examines how forestry policy and implementation maintain double standards on this uneven playing field in a manner that permanently excludes the rural poor from the natural wealth around them—producing poverty in the process. Change that would support poverty alleviation for forest-based communities requires a radical rethinking of forest policy so as to counterbalance widespread regressive policies and structural asymmetries