The potential of Circles of Support and Accountability (COSA) to reduce child sexual abuse in Australia

This report addresses a number of issues relating to Circles of Support and Accountability, and their compatibility with the Australian criminal justice context, including: - What are Circles of Support and Accountability? - When and how did Circles of Support and Accountability emerge? - What forms do Circles of Support and Accountability take? - What is the purpose of Circles of Support and Accountability? - Where do Circles of Support and Accountability currently operate? - Why is it important for Australia to understand Circles of Support and Accountability? - What is the scope of the problem of child sexual abuse in Australia? - What is the research evidence about the effectiveness of Circles of Support and Accountability? - Some key issues for consideration. - Some limitations and potential “dangers” of Circles of Support and Accountability. - Recommendations for Australia. The report concludes that given the research evidence about Circles of Support and Accountability, Australia should build on its existing interest to more fully implement Circles of Support and Accountability, while taking the limitations of this criminal justice measure into consideration.

18FDG uptake during induction chemoradiation for oesophageal cancer fails to predict histomorphological tumour response

To determine whether [18F]-fluorodeoxyglucose-positron emission tomography (FDG-PET) could predict the pathological response in oesophageal cancer after only the first week of neoadjuvant chemoradiation. Thirty-two patients with localised oesophageal cancer had a pretreatment PET scan and a repeat after the first week of chemoradiation. The change in mean maximum standardised uptake value (SUV) and volume of metabolically active tissue (MTV) was compared with the tumour regression grade (TRG) in the final histology. Those who achieved a TRG of 1 and 2 were deemed responders and 3-5 nonresponders. In the responders (28%), the SUV fell from 12.6 (±6.3) to 8.1 (±2.9) after 1 week of chemoradiation (P = 0.070). In nonresponders (72%), the results were 9.7 (±5.4) and 7.1 (±3.8), respectively (P = 0.003). The MTV in responders fell from 36.6 (±22.7) to 22.3 (±10.4) cm3 (P = 0.180), while in nonresponders, this fell from 35.9 (±36.7) to 31.9 (±52.7) cm3 (P = 0.405). There were no significant differences between responders and nonresponders. The hypothesis that early repeat FDG-PET scanning may predict histomorphologic response was not proven. This may reflect an inflammatory effect of radiation that obscures tumour-specific metabolic changes at this time. This assessment may have limited application in predicting response to multimodal regimens for oesophageal cancer. © 2006 Cancer Research UK.

Gene expression analysis of diagnostic biopsies predicts pathological response to neoadjuvant chemoradiotherapy of esophageal cancer

OBJECTIVE: This study explored gene expression differences in predicting response to chemoradiotherapy in esophageal cancer. PURPOSE:: A major pathological response to neoadjuvant chemoradiation is observed in about 40% of esophageal cancer patients and is associated with favorable outcomes. However, patients with tumors of similar histology, differentiation, and stage can have vastly different responses to the same neoadjuvant therapy. This dichotomy may be due to differences in the molecular genetic environment of the tumor cells. BACKGROUND DATA: Diagnostic biopsies were obtained from a training cohort of esophageal cancer patients (13), and extracted RNA was hybridized to genome expression microarrays. The resulting gene expression data was verified by qRT-PCR. In a larger, independent validation cohort (27), we examined differential gene expression by qRT-PCR. The ability of differentially-regulated genes to predict response to therapy was assessed in a multivariate leave-one-out cross-validation model. RESULTS: Although 411 genes were differentially expressed between normal and tumor tissue, only 103 genes were altered between responder and non-responder tumor; and 67 genes differentially expressed >2-fold. These included genes previously reported in esophageal cancer and a number of novel genes. In the validation cohort, 8 of 12 selected genes were significantly different between the response groups. In the predictive model, 5 of 8 genes could predict response to therapy with 95% accuracy in a subset (74%) of patients. CONCLUSIONS: This study has identified a gene microarray pattern and a set of genes associated with response to neoadjuvant chemoradiation in esophageal cancer. The potential of these genes as biomarkers of response to treatment warrants further investigation. Copyright © 2009 by Lippincott Williams & Wilkins.

Dynamic contrast-enhanced magnetic resonance imaging as a biomarker for the pharmacological response of PTK787/ZK 222584, an inhibitor of the vascular endothelial growth factor receptor tyrosine kinases, in patients with advanced colorectal cancer and liver metastases: Results from two phase I studies

Purpose: PTK787/ZK 222584 (PTK/ZK), an orally active inhibitor of vascular endothelial growth factor (VEGF) receptor tyrosine kinases, inhibits VEGF-mediated angiogenesis. The pharmacodynamic effects of PTK/ZK were evaluated by assessing changes in contrast-enhancement parameters of metastatic liver lesions using dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) in patients with advanced colorectal cancer treated in two ongoing, dose-escalating phase I studies. Patients and Methods: Twenty-six patients had DCE-MRI performed at baseline, day 2, and at the end of each 28-day cycle. Doses of oral PTK/ZK ranged from 50 to 2000 mg once daily. Tumor permeability and vascularity were assessed by calculating the bidirectional transfer constant (Ki). The percentage of baseline Ki (% of baseline Ki) at each time point was compared with pharmacokinetic and clinical end points. Results: A significant negative correlation exists between the % of baseline Ki and increase in PTK/ZK oral dose and plasma levels (P = .01 for oral dose; P = .0001 for area under the plasma concentration curve at day 2). Patients with a best response of stable disease had a significantly greater reduction in Ki at both day 2 and at the end of cycle 1 compared with progressors (mean difference in % of baseline Ki, 47%, P = .004%; and 51%, P = .006; respectively). The difference in % of baseline Ki remained statistically significant after adjusting for baseline WHO performance status. Conclusion: These findings should help to define a biologically active dose of PTK/ZK. These results suggest that DCE-MRI may be a useful biomarker for defining the pharmacological response and dose of angiogenesis inhibitiors, such as PTK/ZK, for further clinical development. © 2003 by American Society of Clinical Oncology.

The relationship between angiogenesis and the immune response in carcinogenesis and the progression of malignant disease

Recent studies have demonstrated that angiogenesis and suppressed cell- mediated immunity (CMI) play a central role in the pathogenesis of malignant disease facilitating tumour growth, invasion and metastasis. In the majority of tumours, the malignant process is preceded by a pathological condition or exposure to an irritant which itself is associated with the induction of angiogenesis and/or suppressed CMI. These include: cigarette smoking, chronic bronchitis and lung cancer; chronic oesophagitis and oesophageal cancer; chronic viral infections such as human papilloma virus and ano-genital cancers, chronic hepatitis B and C and hepatocellular carcinoma, and Epstein- Barr virus (EBV) and lymphomas; chronic inflammatory conditions such as Crohn's disease and ulcerative colitis and colorectal cancer; asbestos exposure and mesothelioma and excessive sunlight exposure/sunburn and malignant melanoma. Chronic exposure to growth factors (insulin-like growth factor-I in acromegaly), mutations in tumour suppressor genes (TP53 in Li Fraumeni syndrome) and long-term exposure to immunosuppressive agents (cyclosporin A) may also give rise to similar environments and are associated with the development of a range of solid tumours. The increased blood supply would facilitate the development and proliferation of an abnormal clone or clones of cells arising as the result of: (a) an inherited genetic abnormality; and/or (b) acquired somatic mutations, the latter due to local production and/or enhanced delivery of carcinogens and mutagenic growth factors. With progressive detrimental mutations and growth-induced tumour hypoxia, the transformed cell, to a lesser or greater extent, may amplify the angiogenic process and CMI suppression, thereby facilitating further tumour growth and metastasis. There is accumulating evidence that long-term treatment with cyclo-oxygenase inhibitors (aspirin and indomethacin), cytokines such as interferon-α, anti-oestrogens (tamoxifen and raloxifene) and captopril significantly reduces the incidence of solid tumours such as breast and colorectal cancer. These agents are anti-angiogenic and, in the case of aspirin, indomethacin and interferon-α have proven immunomodulatory effects. Collectively these observations indicate that angiogenesis and suppressed CMI play a central role in the development and progression of malignant disease. (C) 2000 Elsevier Science Ltd.

A metastatic neuroendocrine anaplastic small cell tumor in a patient with multiple endocrine neoplasia type 1 syndrome : assessment of disease status and response to doxorubicin, cyclophosphamide, etoposide chemotherapy through scintigraphic imaging with 111In-pentetreotide

Extrapulmonary small cell and small cell neuroendocrine tumors of unknown primary site are, in general, aggressive neoplasms with a short median survival. Like small cell lung cancer (SCLC), they often are responsive to chemotherapy and radiotherapy. Small cell lung cancer and well differentiated neuroendocrine carcinomas of the gastrointestinal tract and pancreas tend to express somatostatin receptors. These tumors may be localized in patients by scintigraphic imaging using radiolabeled somatostatin analogues. A patient with an anaplastic neuroendocrine small cell tumor arising on a background of multiple endocrine neoplasia type 1 syndrome is reported. The patient had a known large pancreatic gastrinoma and previously treated parathyroid adenopathy. At presentation, there was small cell cancer throughout the liver and skeleton. Imaging with a radiolabeled somatostatin analogue, 111In- pentetreotide (Mallinckrodt Medical B. V., Petten, Holland), revealed all sites of disease detected by routine biochemical and radiologic methods. After six cycles of chemotherapy with doxorubicin, cyclophosphamide, and etoposide, there was almost complete clearance of the metastatic disease. 111In-pentetreotide scintigraphy revealed uptake consistent with small areas of residual disease in the liver, the abdomen (in mesenteric lymph nodes), and posterior thorax (in a rib). The primary gastrinoma present before the onset of the anaplastic small cell cancer showed no evidence of response to the treatment. The patient remained well for 1 year and then relapsed with brain, lung, liver, and skeletal metastases. Despite an initial response to salvage radiotherapy and chemotherapy with carboplatin and dacarbazine, the patient died 6 months later.

Cultural inhibitors to hearing the voices of child sexual abuse by church personnel

It is increasingly recognised that Christian Churches and their Institutions have historically been sites where the voices of survivors of child sexual abuse (csa) by Church personnel have not been effectively heard. This paper draws on data from a research project which sought the voices of Church Leaders who were identified as being pro-active in addressing csa within their individual denominations. From this research several key inhibitors to hearing survivor’s voices, within Churches of Australia, were identified. These key inhibitors include the culture of Churches themselves, gendered ideologies, constructions of leadership and the deployment of forgiveness. The identification of such factors creates space to learn more effective strategies for hearing the voices of survivors both within Churches and their organisations and externally. This paper goes beyond considering these factors to report on a collaborative project initiated, between Survivors Australia and Dr Death. This project specifically targets the voices of Australian Survivors of csa by Church leaders. It is hoped that this project will not only achieve the primary objective of hearing and valuing the voices of survivors of csa by Church leaders, but will also provide impetus for the creation of alternative ways of managing complaints of csa by Church leaders in Australia. Such complaints processes will be increasingly survivor focussed and include the creation of spaces where the voices of survivors are valued.

Consequences of introducing mandatory reporting legislation for child sexual abuse

To improve detection of child sexual abuse, many jurisdictions have enacted mandatory reporting laws requiring selected persons to report known and suspected cases. In Ireland, the Child First approach previously incorporated only a policy-based approach to reporting. Due to a perceived lack of efficacy, the Children First Bill was drafted in 2012 to shift this policy guidance to a legislative approach. What effects will the new legislative reporting duties have on numbers of reports, and outcomes of reports, of suspected child sexual abuse? This paper will shed light on these important questions by presenting results of analyses of the introduction of legislative reporting obligations in two Australian States. Three questions will be explored: 1. Does introducing reporting legislation result in enhanced detection of child sexual abuse? 2. Do different reporter groups have different patterns of reporting? 3. What do the patterns of report numbers and outcomes indicate for child protection systems and communities?

Community health workers' response to violence against women

This paper reports on a qualitative study of community health workers from a predominantly rural based region in Queensland. The purpose of this study was to determine the community health worker barriers to identification, assessment and intervention on the issue of violence against women. The qualitative research method comprised five structured focus group interviews with 28 community health workers using open-ended questions to explore their perceptions. Analysis of the focus group data revealed that community health workers expressed reluctance to become involved in cases of violence against women. The reasons they provided are grouped under three main themes: barriers to identification; barriers to assessment; and barriers to intervention. Training programs offered to rural community health workers need to be aware of the barriers to identifying, assessing and intervening in cases of violence against women that are highlighted by this study. Further studies are needed to assess the wider relevance of these findings to other groups of community health workers in rural and non-rural settings.

Better prepared next time : considering nutrition in an emergency response

To the Editor: Cyclones, floods and bushfires are experienced in Australia every year, and Australia’s management of natural disasters centres on prevention, preparedness, response and recovery.1 Although access to safe food is a basic human need, during the 2010–2011 Queensland floods there was minimal information available to guide household food preparedness and food supply to communities...

Beyond the ‘three dogmas of juvenile justice’ : a response to Weatherburn, McGrath and Bartels

In 'Three Dogmas of Juvenile Justice', Weatherburn, McGrath and Bartels identify three 'assumptions' or 'dogmas' about youth justice, on which they claim 'juvenile justice policy in Australia currently rests'.

The influence of perpetrator and victim intoxication on perceivers' ratings of a sexual perpetrator's own awareness of wrongdoing for his sexually aggressive behaviour

Rape-perception studies have examined the influence of alcohol intoxication on perpetrator blame attributions: However, no studies have examined how intoxication affects perceptions of a sexual perpetrator’s awareness of the wrongfulness of his behaviour despite its relevance to the conceptualisation of responsibility and blame. This experiment investigated the impact of perpetrator and victim intoxication on perceptions of a perpetrator’s own awareness of wrongdoing for acquaintance rape. Undergraduate students (N = 314) read one of four rape-scenarios in which intoxication was manipulated and rated the perpetrator’s awareness of the consequences and wrongfulness of his sexual aggression. Findings supported the hypothesis that participants would assign less awareness of wrongdoing to an intoxicated, compared to sober, perpetrator. Further, males ascribed more awareness of wrongdoing to the perpetrator of an intoxicated, compared to sober, victim. Findings indicate that intoxicated sexual perpetrators are seen as not fully aware of the nature and consequences of their crime.

Factors influencing health professionals' response to victims of domestic violence

This thesis examined factors influencing health professional's response to victims of domestic violence in Vietnam. As this is the first time that this type of research has been conducted in Vietnam, it was expected that the results would contribute significantly to local knowledge and should add to global perspectives. Since it is the first questionnaire about this topic to be developed in Vietnam, the psychometric property of the questionnaire was primarily established, resulting in the questionnaire being recommended to use for further study. By explaining the factors that affect the intentions to respond of health workers, this project provides key data for authorities to design intervention strategies to improve the responses of health professionals to victims of domestic violence in Vietnam.

Elementary teachers’ knowledge of legislative and policy duties for reporting child sexual abuse

This study examined elementary school teachers’ knowledge of their legislative and policy-based reporting duties with respect to child sexual abuse. Data were collected from 470 elementary school teachers from urban and rural government and nongovernment schools in 3 Australian states, which at the time of the study had 3 different legislative reporting duties for teachers. Teachers completed the 8-part Teacher Reporting Questionnaire (TRQ). Multinomial logistic regression analysis was used to determine factors associated with (a) teachers’ legislation knowledge and (b) teachers’ policy knowledge. Teachers with higher levels of knowledge had a combination of pre- and in-service training about child sexual abuse and more positive attitudes toward reporting, held administration positions in their school, and had reported child sexual abuse at least once during their teaching career. They were also more likely to work in the state with the strongest legislative reporting duty, which had been in place the longest.

Making prevention matter : a survey of child sexual abuse prevention programs in Australia

Throughout Australia, there is considerable concern about the prevalence of child sexual abuse. Sexual abuse is experienced by over 3,500 Australian children each year, causing long-term psychological, health and social problems to children, their families and communities, and significant economic costs to society as a whole. In many countries, the provision of school-based programs has been a core strategy in efforts to prevent child sexual abuse. However, little is known about the range of programs in use in Australia, the numbers of children who have received programs, and the contents and methods used in program delivery. This presentation reports on a detailed National survey of child sexual abuse prevention programs currently used in Australian primary schools. An online survey was conducted over a six-month period from November 2011 to April 2012 yielding detailed data from 38 programs. The presentation will provide an overview of: the scope and reach of programs; program content, teaching strategies and resources; barriers and facilitators to program adoption by schools; and program evaluation strategies.