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Lost among more than 150,000 federal prisoners is a small cohort of “old law” people who have served many decades in custody. They were sentenced for offenses committed prior to November 1987, when the Federal Sentencing Guidelines went into effect. These are some of the oldest and most vulnerable people in the federal system, and least likely to re-offend. The possibility of release for most of them lies with the U.S. Parole Commission, a dysfunctional government agency. Unlike other federal prisoners, old law people cannot ask a court for compassionate release. The Commission was scheduled to go out of business in 1992, but instead its role has changed and it has been continually re-authorized, currently through October 2023. But as the article explains, the Commission is a failed agency: it has lost track of old law people and has not reported accurately to Congress. Further, the Agency was created to oversee a vastly different population than the aging and medically vulnerable people under its jurisdiction now. The article recommends amending the First Step Act to allow all old law people to apply for compassionate release under the same procedures available to new law prisoners. Congress should not continue to re-authorize the Parole Commission. Parole authority should be transferred to U.S. magistrate judges, to apply release criteria more suited to an elderly population. Finally, clemency petitions for everyone sentenced under the old law should be prioritized by President Biden.

Learning, defined as the process of constructing meaning and developing competencies to act on it, is instrumental in helping individuals, communities, and organizations tackle challenges. When these challenges increase in complexity and require domain knowledge from diverse areas of expertise, it becomes difficult for single individuals to address them. In this context, collective intelligence, a capacity of groups of people to act together and solve problems using their collective knowledge, becomes of great importance. Technologies are instrumental both to support and understand learning and collective intelligence, hence the need for innovations in the area of technologies that can support user needs to learn and tackle collective challenges. Use-inspired research is a fitting paradigm that spans applied solutions and scientific explanations of the processes of learning and collective intelligence, and that can improve the technologies that may support them. Although some conceptual and theoretical work explaining and linking learning with collective intelligence is emerging, technological infrastructures as well as methodologies that employ and evidence that support them are nascent. We convened a group of experts to create a middleground and engage with the priorities for use-inspired research. Here we detail directions and methods they put forward as most promising for advancing a scientific agenda around learning and collective intelligence.

The US National Academy of Medicine released its consensus study for the next decade entitled The Future of Nursing 2020-2030: Charting a Path To Achieve Health Equity (National Academies of Sciences, Engineering, and Medicine, 2021). This paper examines the report, its implications for nursing globally, its focus on systemic, structural, and institutional racism, and the intersection with climate change and deleterious health consequences. The National Academies of Science, Engineering, and Medicine (NASEM) has led in addressing the critical role of the nursing profession in achieving optimal population health outcomes in the US. Yet, relevance exists for nursing in other global areas. The most recent US report focuses on social determinants of health (SDoH) and explicitly addresses climate change as a looming public health threat. An analysis of the key foci of nursing’s role in climate change amidst the critical role of health equity globally is explicated.

Recebido: 9/5/2022 Aceite: 16/7/2022

Summary Background PD-1 and PD-L1 inhibitors are active in metastatic urothelial carcinoma, but positive randomised data supporting their use as a first-line treatment are lacking. In this study we assessed outcomes with first-line pembrolizumab alone or combined with chemotherapy versus chemotherapy for patients with previously untreated advanced urothelial carcinoma. Methods KEYNOTE-361 is a randomised, open-label, phase 3 trial of patients aged at least 18 years, with untreated, locally advanced, unresectable, or metastatic urothelial carcinoma, with an Eastern Cooperative Oncology Group performance status of up to 2. Eligible patients were enrolled from 201 medical centres in 21 countries and randomly allocated (1:1:1) via an interactive voice-web response system to intravenous pembrolizumab 200 mg every 3 weeks for a maximum of 35 cycles plus intravenous chemotherapy (gemcitabine [1000 mg/m2] on days 1 and 8 and investigator's choice of cisplatin [70 mg/m2] or carboplatin [area under the curve 5] on day 1 of every 3-week cycle) for a maximum of six cycles, pembrolizumab alone, or chemotherapy alone, stratified by choice of platinum therapy and PD-L1 combined positive score (CPS). Neither patients nor investigators were masked to the treatment assignment or CPS. At protocol-specified final analysis, sequential hypothesis testing began with superiority of pembrolizumab plus chemotherapy versus chemotherapy alone in the total population (all patients randomly allocated to a treatment) for the dual primary endpoints of progression-free survival (p value boundary 0·0019), assessed by masked, independent central review, and overall survival (p value boundary 0·0142), followed by non-inferiority and superiority of overall survival for pembrolizumab versus chemotherapy in the patient population with CPS of at least 10 and in the total population (also a primary endpoint). Safety was assessed in the as-treated population (all patients who received at least one dose of study treatment). This study is completed and is no longer enrolling patients, and is registered at ClinicalTrials.gov , number NCT02853305 . Findings Between Oct 19, 2016 and June 29, 2018, 1010 patients were enrolled and allocated to receive pembrolizumab plus chemotherapy (n=351), pembrolizumab monotherapy (n=307), or chemotherapy alone (n=352). Median follow-up was 31·7 months (IQR 27·7–36·0). Pembrolizumab plus chemotherapy versus chemotherapy did not significantly improve progression-free survival, with a median progression-free survival of 8·3 months (95% CI 7·5–8·5) in the pembrolizumab plus chemotherapy group versus 7·1 months (6·4–7·9) in the chemotherapy group (hazard ratio [HR] 0·78, 95% CI 0·65–0·93; p=0·0033), or overall survival, with a median overall survival of 17·0 months (14·5–19·5) in the pembrolizumab plus chemotherapy group versus 14·3 months (12·3–16·7) in the chemotherapy group (0·86, 0·72–1·02; p=0·0407). No further formal statistical hypothesis testing was done. In analyses of overall survival with pembrolizumab versus chemotherapy (now exploratory based on hierarchical statistical testing), overall survival was similar between these treatment groups, both in the total population (15·6 months [95% CI 12·1–17·9] with pembrolizumab vs 14·3 months [12·3–16·7] with chemotherapy; HR 0·92, 95% CI 0·77–1·11) and the population with CPS of at least 10 (16·1 months [13·6–19·9] with pembrolizumab vs 15·2 months [11·6–23·3] with chemotherapy; 1·01, 0·77–1·32). The most common grade 3 or 4 adverse event attributed to study treatment was anaemia with pembrolizumab plus chemotherapy (104 [30%] of 349 patients) or chemotherapy alone (112 [33%] of 342 patients), and diarrhoea, fatigue, and hyponatraemia (each affecting four [1%] of 302 patients) with pembrolizumab alone. Six (1%) of 1010 patients died due to an adverse event attributed to study treatment; two patients in each treatment group. One each occurred due to cardiac arrest and device-related sepsis in the pembrolizumab plus chemotherapy group, one each due to cardiac failure and malignant neoplasm progression in the pembrolizumab group, and one each due to myocardial infarction and ischaemic colitis in the chemotherapy group. Interpretation The addition of pembrolizumab to first-line platinum-based chemotherapy did not significantly improve efficacy and should not be widely adopted for treatment of advanced urothelial carcinoma. Funding Merck Sharp and Dohme, a subsidiary of Merck, Kenilworth, NJ, USA.

This article is exploratory and experimental. It starts from the premise that leadership scholarship is a site of disagreement, where mainstream claims are challenged by critical scholars. Some criticism focuses on conceptual clarity, and incorporates consideration of who should be categorised as a leader, and on what basis, and whether it is helpful to refer to ‘leaders’ and ‘followers’. The ‘new wave’ of critical leadership studies generates controversial questions relating to whether leadership exists or is in fact a myth that we have reified. The bulk of criticism directed at educational leadership challenges three mainstream knowledge claims – underpinned by what I call the causality belief, the leadership dependency belief, and the conceptual belief – and which are the focus of this article's analysis. While criticism of these knowledge claims is well-rehearsed, the article breaks new ground by analysing them through an epistemic justification lens to address the question: is educational leadership (still) worth studying? Represented by these three component beliefs, the mainstream educational leadership scholarship belief system is analysed within a frame derived from the philosophy of science, and draws on BonJour's coherentist theory of epistemic justification to apply a more structured assessment than has hitherto been achieved by critical scholarship.

Immunization is the most cost-effective health intervention in the world yet, vaccination uptake is still low with less than 50% of children aged 12-23 months fully vaccinated Cameroon. The objective of this study was to estimate the burden of vaccine hesitancy associated with routine EPI vaccines in Yaounde-Cameroon. A two-stage cross-sectional cluster survey was conducted in Yaoundé in May-June 2022, targeting parents/guardians of children 0-59 months. Clusters were selected with probability proportionate to size (PPS) and household’s selection done using a restricted sampling method. Data collection was done using an interviewer-administered questionnaire. Data were cleaned using MS-Excel 2019, and analyzed with R version 4.1.0 (2021-05-18). A total of 529 participants were enrolled out of 708 visited, giving a non-response rate of 25%. In total, vaccine hesitancy was reported in 137(25.90[22.35-29.80] %), and vaccine hesitancy prevalence did not vary significantly across different households’ wealth levels (p-value= 0.3786). However, in wealthy households’ refusal of vaccines (14%) was less than in poorer households (20%). Lack of trust, confidence, and perceived complacency are the leading causes of vaccine hesitancy related to routine immunization in Yaounde-Cameroon. We, therefore, recommend that the burden of vaccine hesitancy should be assessed at national scale and identify sources of misinformation that are at the origin of vaccine hesitancy. Having a clear notion of the effect of social media(Facebook, Instagram, WhatsApp, etc,), radio, TV, and other information sources might guide interventions to combat vaccine hesitancy.

Intentionally provocative, this article identifies weaknesses in mainstream educational leadership scholarship, and draws upon ‘new wave’ critical leadership studies to propose a new, potentially paradigm-shifting, direction for the field. The central argument is that educational leadership researchers, in focusing predominantly on how institutional heads and other formal ‘leaders’ may best ‘do’ leadership, are addressing the wrong questions and setting off from the wrong departure point. The unit of analysis should shift, it is argued, from leadership to influence, within a new research agenda that replaces surface-level, causality-assumptive ‘how?’ and ‘why?’ questions that have shaped mainstream educational leadership research for over thirty years, with more fundamental ‘who? and ‘what?’ questions, aimed at identifying who is in fact doing the influencing. An aspect of such inquiry is leadership scepticism and agnosticism, which confronts the question: Does leadership exist, or is it a myth that we have reified? A highly original feature of the proposed new research agenda is the adoption of the author's theoretical notion of a singular unit of micro-level influence as an ‘epistemic object’ – a concept derived from STEMM research, denoting a vague and undefined potential focus of inquiry that may (or may not) turn out to be significant.

Despite the ubiquitous presence and vital role of invertebrates in all known ecological systems, insects and arachnids are largely viewed as repugnant by people. Consequently, until nature intervenes in the form of infestations, swarms or plagues, we largely prefer to ignore them, lest our attention invite unwelcome interaction. In contrast, the people of ancient Egypt did not distance themselves from invertebrates but instead celebrated their myriad forms. Egyptian appreciation of insects and arachnids is reflected in a range of art, artefacts, and texts dating from the predynastic era until the Greco-Roman period, revealing many positive cultural roles, from practical to conceptual. By assigning them a useful function, they were rendered visible and relevant to Egyptian society. The Egyptians’ example suggests that as necessity forces us to acknowledge the value of invertebrates—from their function as pollinators to becoming future food sources—our respect for them may also grow.

Background: Survival outcomes are poor for patients with metastatic urothelial carcinoma who receive standard, first-line, platinum-based chemotherapy. We assessed the overall survival of patients who received durvalumab (a PD-L1 inhibitor), with or without tremelimumab (a CTLA-4 inhibitor), as a first-line treatment for metastatic urothelial carcinoma.Methods: DANUBE is an open-label, randomised, controlled, phase 3 trial in patients with untreated, unresectable, locally advanced or metastatic urothelial carcinoma, conducted at 224 academic research centres, hospitals, and oncology clinics in 23 countries. Eligible patients were aged 18 years or older with an Eastern Cooperative Oncology Group performance status of 0 or 1. We randomly assigned patients (1:1:1) to receive durvalumab monotherapy (1500 mg) administered intravenously every 4 weeks; durvalumab (1500 mg) plus tremelimumab (75 mg) administered intravenously every 4 weeks for up to four doses, followed by durvalumab maintenance (1500 mg) every 4 weeks; or standard-of-care chemotherapy (gemcitabine plus cisplatin or gemcitabine plus carboplatin, depending on cisplatin eligibility) administered intravenously for up to six cycles. Randomisation was done through an interactive voice–web response system, with stratification by cisplatin eligibility, PD-L1 status, and presence or absence of liver metastases, lung metastases, or both. The coprimary endpoints were overall survival compared between the durvalumab monotherapy versus chemotherapy groups in the population of patients with high PD-L1 expression (the high PD-L1 population) and between the durvalumab plus tremelimumab versus chemotherapy groups in the intention-to-treat population (all randomly assigned patients). The study has completed enrolment and the final analysis of overall survival is reported. The trial is registered with ClinicalTrials.gov, NCT02516241, and the EU Clinical Trials Register, EudraCT number 2015-001633-24.Findings: Between Nov 24, 2015, and March 21, 2017, we randomly assigned 1032 patients to receive durvalumab (n=346), durvalumab plus tremelimumab (n=342), or chemotherapy (n=344). At data cutoff (Jan 27, 2020), median follow-up for survival was 41·2 months (IQR 37·9–43·2) for all patients. In the high PD-L1 population, median overall survival was 14·4 months (95% CI 10·4–17·3) in the durvalumab monotherapy group (n=209) versus 12·1 months (10·4–15·0) in the chemotherapy group (n=207; hazard ratio 0·89, 95% CI 0·71–1·11; p=0·30). In the intention-to-treat population, median overall survival was 15·1 months (13·1–18·0) in the durvalumab plus tremelimumab group versus 12·1 months (10·9–14·0) in the chemotherapy group (0·85, 95% CI 0·72–1·02; p=0·075). In the safety population, grade 3 or 4 treatment-related adverse events occurred in 47 (14%) of 345 patients in the durvalumab group, 93 (27%) of 340 patients in the durvalumab plus tremelimumab group, and in 188 (60%) of 313 patients in the chemotherapy group. The most common grade 3 or 4 treatment-related adverse event was increased lipase in the durvalumab group (seven [2%] of 345 patients) and in the durvalumab plus tremelimumab group (16 [5%] of 340 patients), and neutropenia in the chemotherapy group (66 [21%] of 313 patients). Serious treatment-related adverse events occurred in 30 (9%) of 345 patients in the durvalumab group, 78 (23%) of 340 patients in the durvalumab plus tremelimumab group, and 50 (16%) of 313 patients in the chemotherapy group. Deaths due to study drug toxicity were reported in two (1%) patients in the durvalumab group (acute hepatic failure and hepatitis), two (1%) patients in the durvalumab plus tremelimumab group (septic shock and pneumonitis), and one (Interpretation: This study did not meet either of its coprimary endpoints. Further research to identify the patients with previously untreated metastatic urothelial carcinoma who benefit from treatment with immune checkpoint inhibitors, either alone or in combination regimens, is warranted.Funding: AstraZeneca.

Representations of reptiles are relatively rare in Egyptian rock art. Here, we present a petroglyph found at the site of el-Hosh that closely resembles a chameleon, a morphologically distinct type of lizard. In evaluating the image, we provide a comprehensive review of the limited evidence for chameleons in other Egyptian graphical depictions and texts, revealing previously unrecognised examples found in New Kingdom tomb decorations. We conclude that the el-Hosh creature was likely executed during the Dynastic period or later, and was inspired by the observation of a chameleon, the precise species of which cannot be determined.

The advantage of using DStretch® – image enhancement software developed for rock art research – for the analysis and recording of ancient Egyptian wall paintings is demonstrated via its recent application at the cemetery site of Beni Hassan. DStretch® enhanced photographs of painted surfaces enable obscure or faded details to be viewed by artificially highlighting traces of remaining pigment. Trial use of DStretch® for the examination of wall paintings at Beni Hassan has revealed or confirmed new images of pigs and bats (animals that are rarely attested in Egyptian art), and a highly unusual depiction of a vulture, exposing features that were otherwise unavailable visually. When used in conjunction with digital epigraphy, DStretch® offers an invaluable tool for achieving a more complete record of Egypt's artistic legacy.

There is currently a proliferation of digital analytics and machine/artificial intelligence productivity tools for creating and sustaining competitive advantage through strategic flexibility. Transformational e-HRM enables organizations to achieve and sustain competitive advantage through exploitation of these new productivity tools and approaches. However, it has been observed that many organizations have not been able to realize this. Using findings from an empirical exploration of e-HRM’s contribution to sustaining business performance, derived through an interpretative phenomenological analysis of a single case study, we propose in this chapter that for organizations to leverage the productivity gains of implementing Transformational e-HRM, HR and frontline managers require access to readily available artificial intelligence productivity tools. For e-HRM to contribute to sustaining business performance, we add to strategic flexibility theory that this can be realized by using e-HRM to enable strategic flexibility and adaptive capability. As we propose that it will be about organizations using the strategic capability derived by using Transformational e-HRM to create flexible and adaptive organizations. Its implications for practice are stated.