Suchergebnisse

Using the Blood reserve in Southern Alberta and the Blackfeet reserve in northern Montana as a case study, the Canadian legal system should recognize an inherent aboriginal right to cross the Canada-US border. This is not to suggest that such a right exists only upon recognition by the courts; rather, it is an acknowledgment that First Nations must assert control over their rights, either by court challenge, or by negotiations with the Canadian government. The latter course may be more flexible with respect to remedy. Questions of who is to be considered aboriginal for the purposes of the right, who may determine who is eligible, and who may determine the scope of the right could be determined by consultation with aboriginal groups. If a court challenge were successful, however, it might provide a catalyst for negotiations. The paper canvasses the legal situation governing cross-border movement by aboriginal groups as of 1995, the historical context, and the relevance of American and Canadian immigration, customs, and constitutional law.

Using the Blood reserve in Southern Alberta and the Blackfeet reserve in northern Montana as a case study, the Canadian legal system should recognize an inherent aboriginal right to cross the Canada-US border. This is not to suggest that such a right exists only upon recognition by the courts; rather, it is an acknowledgment that First Nations must assert control over their rights, either by court challenge, or by negotiations with the Canadian government. The latter course may be more flexible with respect to remedy. Questions of who is to be considered aboriginal for the purposes of the right, who may determine who is eligible, and who may determine the scope of the right could be determined by consultation with aboriginal groups. If a court challenge were successful, however, it might provide a catalyst for negotiations. The paper canvasses the legal situation governing cross-border movement by aboriginal groups as of 1995, the historical context, and the relevance of American and Canadian immigration, customs, and constitutional law.

With the adoption of statutes, policies and administrative guidance since the late 1980s, statutory child welfare agencies around the world have been implementing practice approaches to resolving and addressing child abuse and neglect concerns that involve extended family systems in decision making and planning. One such approach is the family group conference (FGC), enshrined in New Zealand law. This article provides a historical context and describes numerous provisions of the family group conference that protect participants and the proceedings. It then describes applications of FGC‐like approaches in the United States where practice models and policies—not laws—guide the implementation of such approaches.

IntroductionSeveral studies from resource‐limited settings have demonstrated that clinical and immunologic criteria are poor predictors of virologic failure, confirming the need for viral load monitoring or at least an algorithm to target viral load testing. We used data from an electronic patient management system to develop an algorithm to identify patients at risk of viral failure using a combination of accessible and inexpensive markers.MethodsWe analyzed data from HIV‐positive adults initiated on antiretroviral therapy (ART) in Johannesburg, South Africa, between April 2004 and February 2010. Viral failure was defined as ≥2 consecutive HIV‐RNA viral loads >400 copies/ml following suppression ≤400 copies/ml. We used Cox‐proportional hazards models to calculate hazard ratios (HR) and 95% confidence intervals (CI). Weights for each predictor associated with virologic failure were created as the sum of the natural logarithm of the adjusted HR and dichotomized with the optimal cut‐off at the point with the highest sensitivity and specificity (i.e. ≤4 vs. >4). We assessed the diagnostic accuracy of predictor scores cut‐offs, with and without CD4 criteria (CD4 <100 cells/mm3; CD4 < baseline; >30% drop in CD4), by calculating the proportion with the outcome and the observed sensitivity, specificity, positive and negative predictive value of the predictor score compared to the gold standard of virologic failure.ResultsWe matched 919 patients with virologic failure (1:3) to 2756 patients without. Our predictor score included variables at ART initiation (i.e. gender, age, CD4 count <100 cells/mm3, WHO stage III/IV and albumin) and laboratory and clinical follow‐up data (drop in haemoglobin, mean cell volume (MCV) <100 fl, CD4 count <200 cells/mm3, new or recurrent WHO stage III/IV condition, diagnosis of new condition or symptom and regimen change). Overall, 51.4% had a score 51.4% had a score ≥4 and 48.6% had a score <4. A predictor score including CD4 criteria performed better than a score without CD4 criteria and better than WHO clinico‐immunological criteria or WHO clinical staging to predict virologic failure (sensitivity 57.1% vs. 40.9%, 25.2% and 20.9%, respectively).ConclusionsPredictor scores or risk categories, with CD4 criteria, could be used to identify patients at risk of virologic failure in resource‐limited settings so that these patients may be targeted for focused interventions to improve HIV treatment outcomes.