ABSTRACT
Around the world, progressive customs administrations recognise the importance of strengthening their gender balance. In the past decade, the deliberate efforts of contemporary leaders have resulted in positive organisational changes focused on equitable opportunities to prepare women and men for customs leadership. We know that customs administrations are capable of large-scale and rapid transformation – the COVID-19 pandemic has clearly demonstrated just how adaptive and responsive they can be. We contend that customs administrations are well-placed to drive timely, organisation-wide change that will make gender diversity a reality. This paper highlights the need for diversity in administrations and introduces the Container Control Programme – Women's Professional Development Programme (CCP – WPDP) that is designed to significantly advance diversity in agencies to strengthen their organisational effectiveness. © 2022, International Network of Customs Universities. All rights reserved.
ABSTRACT
Background: The PEXIVAS trial (2018) showed no outcome benefit with the routine use of plasma-exchange (PLEX) in patients with ANCA vasculitis and eGFR < 50mL/min. As a result, our clinical practice changed in favour of no PLEX and replacing a standard steroid wean with a fast steroid taper, thus altering the burden of immunosuppression in patients with ANCA vasculitis. We performed a retrospective analysis of a cohort of patients with ANCA vasculitis and renal involvement to determine whether this change in management impacted on patient outcomes and infections requiring hospitalisation. Method(s): We audited a cohort of ANCA vasculitis patients with renal involvement under follow-up at a tertiary centre diagnosed in the last 20 years. We collected demographic and clinical data including induction agent, PLEX regimen, and details of infections due to immunosuppression. The outcomes measured were patients who were in remission at one year and infections that required hospitalisation or CMV viraemia within 1 year of diagnosis Results: A total of 134 patients were identified, 91 diagnosed pre-PEXIVAS and 43 post-PEXIVAS. 6 patients died from COVID-19 by 1 year in the post-PEXIVAS group, these patients were excluded from analysis. Pre- and post-PEXIVAS mean age (60.6 yrs and 59 yrs respectively) and sex ratio (54/91 (59%) and 24/43 (55%)) were similar. The preferred induction agent pre-PEXIVAS was cyclophosphamide (65/91 (75%)) whilst there was a move to Rituximab in the post-PEXIVAS cohort(13/43 (48%)). Pre-PEXIVAS, 27/91 (29%) patients underwent PLEX versus 2/43 (4%) post-PEXIVAS. Remission rates at 1 year after diagnosis were similar between the two cohorts (pre: 65/91 (71.4%);post: 23/37 (53%);p=0.18 by Fisher's exact test). Infections that required hospitalisation were not significantly different but there was a trend to lower rate of admissions (pre: 16/91 (17.6%);post: 5/37 (12.2%);p=0.61 by Fisher's exact test). Conclusion(s): Our results suggest that change in clinical management after PEXIVAS was not associated with poorer outcomes in relation to treatment response and there was no significant difference in infections requiring hospitalisation at 1 year in patients with ANCA vasculitis. Our work complements recent findings that PLEX was not associated with improved rates of renal replacement therapy or mortality (Nezam et al. 2022).