Background Surgery is the main modality of cure for solid cancers and was prioritised to continue during COVID-19 outbreaks. This study aimed to identify immediate areas for system strengthening by comparing the delivery of elective cancer surgery during the COVID-19 pandemic in periods of lockdown versus light restriction. Methods This international, prospective, cohort study enrolled 20 006 adult (≥18 years) patients from 466 hospitals in 61 countries with 15 cancer types, who had a decision for curative surgery during the COVID-19 pandemic and were followed up until the point of surgery or cessation of follow-up (Aug 31, 2020). Average national Oxford COVID-19 Stringency Index scores were calculated to define the government response to COVID-19 for each patient for the period they awaited surgery, and classified into light restrictions (index <20), moderate lockdowns (20–60), and full lockdowns (>60). The primary outcome was the non-operation rate (defined as the proportion of patients who did not undergo planned surgery). Cox proportional-hazards regression models were used to explore the associations between lockdowns and non-operation. Intervals from diagnosis to surgery were compared across COVID-19 government response index groups. This study was registered at ClinicalTrials.gov , NCT04384926 . Findings Of eligible patients awaiting surgery, 2003 (10·0%) of 20 006 did not receive surgery after a median follow-up of 23 weeks (IQR 16–30), all of whom had a COVID-19-related reason given for non-operation. Light restrictions were associated with a 0·6% non-operation rate (26 of 4521), moderate lockdowns with a 5·5% rate (201 of 3646; adjusted hazard ratio [HR] 0·81, 95% CI 0·77–0·84; p<0·0001), and full lockdowns with a 15·0% rate (1775 of 11 827; HR 0·51, 0·50–0·53; p<0·0001). In sensitivity analyses, including adjustment for SARS-CoV-2 case notification rates, moderate lockdowns (HR 0·84, 95% CI 0·80–0·88; p<0·001), and full lockdowns (0·57, 0·54–0·60; p<0·001), remained independently associated with non-operation. Surgery beyond 12 weeks from diagnosis in patients without neoadjuvant therapy increased during lockdowns (374 [9·1%] of 4521 in light restrictions, 317 [10·4%] of 3646 in moderate lockdowns, 2001 [23·8%] of 11 827 in full lockdowns), although there were no differences in resectability rates observed with longer delays. Interpretation Cancer surgery systems worldwide were fragile to lockdowns, with one in seven patients who were in regions with full lockdowns not undergoing planned surgery and experiencing longer preoperative delays. Although short-term oncological outcomes were not compromised in those selected for surgery, delays and non-operations might lead to long-term reductions in survival. During current and future periods of societal restriction, the resilience of elective surgery systems requires strengthening, which might include...

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New Zealand's youth justice system has been lauded internationally for its restorative and diversionary approach to youth justice. This article takes a fresh perspective to youth justice in New Zealand, namely that of children's rights. Using the Convention on the Rights of the Child (CRC) and associated international standards as benchmarks, this article argues that although the system has many positive aspects in its design, there are diffi culties in implementation, especially in relation to checks on discretion. This article also queries whether the future direction of the New Zealand youth justice system, especially the increased emphasis on restorative justice, is positive for children.

The New Zealand youth justice system emerged as a ‘new paradigm’ in the early 1990s. This model of reintegration, restorativeness, diversion and family empowerment has been highly influential worldwide. The New Zealand system has remained stable and non-punitive in the context of a volatile and punitive adult criminal justice system and the ‘punitive turn’ in the youth justice systems of similar jurisdictions. Significant reforms have been made through amending legislation in 2010. Here, three significant conceptual shifts underpinning the recent reforms are discussed. It is suggested that the New Zealand youth justice system is ‘playing catch-up’ both with the adult system, and with comparable jurisdictions. Nevertheless, those factors which allowed the youth justice system to remain non-punitive up to now may act to mitigate the potentially harsh effects of the legislative changes.

Restorative justice is an alternative to the formal criminal justice system which focuses on repairing the harm caused to the victim of the offence, effecting reconciliation between victim and offender, and the re-integration of the offender. Its use is widespread in national youth justice systems. This article will analyse the use of restorative justice in connection with offending by children. It will be argued that despite evidence of endorsement by the Committee on the Rights of the Child, the fundamental concepts of restorative justice are at odds with a children's rights model of youth justice as required by international standards. Not only do similar concerns about due process rights exist for children as for the adult system, it is difficult to reconcile the best interests of the child standard with the victim focused approach of restorative justice, and there are doubts as to whether children have sufficient maturity for remorse and reintegration.