Working with a child Exposed to Community and Domestic violence in Northern Ireland: An Illustrated Case Example.

The focus of this paper is on the author’s multi-modal therapeutic practice with a 7-year-old boy referred to the Family Trauma Centre, following paramilitary assaults on his father. The work also addresses the boy’s experience of domestic violence. The work is contextualised in terms of the ‘Peace Process’ in Northern Ireland, including the establishment of the Family Trauma Centre as a response to the needs of victims of the Troubles. A rationale for working with children using a multi-modal approach is presented.

Macro impacts on caseworker decision-making in child welfare: a cross-national comparison

This paper focuses on the factors impacting on decision-making in child and family social work through a cross-national comparison. In doing so, the larger arena of the political and social contexts of both the United States and Northern Ireland are examined. For each of the countries we describe the historical and political context of child welfare, particularly the tension between child safety and family support, and how children’s rights are attended to and interpreted in each country. This discussion also examines the extent to which decision-making in each jurisdiction is influenced by constitutional imperatives, with particular reference to the US Constitution and the European Convention on Human Rights. From this general comparison we conclude with observations about child welfare decision-making within the national context and offer suggestions for further theoretical development in this area whilst also examining where the practices in each jurisdiction may benefit from review.

Child abuse and neglect: Training needs of student teachers

Increasing awareness of child abuse and neglect (CAN) raises questions about how well teachers are prepared for their role in child protection. This paper assesses and differentiates training needs of first-year students (n = 216) in Northern Ireland. Multiplechoice tests were used to assess knowledge of CAN statistics; recognising and reporting; policies, procedures, and legislative frameworks; and direct work with children. Considerable gaps in knowledge were found. Results between student groups varied and provide evidence of the need to develop pre-service child protection training. The importance of differentiation between student groups in terms of training content is emphasised.

Upholding the convention on the rights of the child: a quandary in cyberspace

Put in place to protect the rights of the child, the Convention on the Rights of the Child is a set of non-negotiable standards. A core principle underpinning the Convention is the child's right to participate fully in social arenas and to access sources of social support without excessive interference. Juxtaposing this is the right of the child to be shielded from harm, abuse and exploitation. Over the past several decades the Internet has emerged as a fast and easily accessible medium for people to connect and communicate. While the Internet provides children with a source of support through chat rooms, online communities and social networking sites, just as equally it can expose vulnerable children to predatory and deviant individuals exacerbating the potential for harm. Upholding the Convention in cyberspace is a challenge. The Internet is not owned or regulated by any governing body and accountability is difficult to enforce. This article discusses some of the difficulties of upholding the Convention online and provides recommendations for policy-makers to protect children as they participate in cyberspace.

The chronic fatigue syndrome: A comparative pathway analysis

In this paper, we introduce a method to detect pathological pathways of a disease. We aim to identify biological processes rather than single genes affected by the chronic fatigue syndrome (CFS). So far, CFS has neither diagnostic clinical signals nor abnormalities that could be diagnosed by laboratory examinations. It is also unclear if the CFS represents one disease or can be subdivided in different categories. We use information from clinical trials, the gene ontology (GO) database as well as gene expression data to identify undirected dependency graphs (UDGs) representing biological processes according to the GO database. The structural comparison of UDGs of sick versus non-sick patients allows us to make predictions about the modification of pathways due to pathogenesis.

Further reflections on Habermas's contribution to discourse in child protection: An examination of power in social life

Hayes and Houston's positive review of Habermas's contribution to discourse in family group conferences (in this journal) has been challenged by Garrett. In this paper, one of the authors replies to Garrett but extends the analysis through a more considered, developed and detailed examination of Habermas's thoughts on power in social life. This leads to a conceptual framework that enables the participants in the conference to exercise power in a positive manner. In developing this earlier analysis, the paper also acknowledges Garrett's argument that Bourdieu helps us to understand the nature of constraining social structures in child protection. However, Bourdieu's ideas are subsequently challenged on the grounds that they lack a competent formulation on human agency - a faculty that Habermas cogently elucidates. This enlarged understanding of agency, it is argued, offers a theoretical resource that fits better with the ethos of emancipatory social work.

Salbutamol up-regulates matrix metalloproteinase-9 in the alveolar space in the acute respiratory distress syndrome.

Objectives: Acute respiratory distress syndrome (ARDS) is characterized by alveolar-capillary barrier damage. Matrix metalloproteinases (MMPs) are implicated in the pathogenesis of ARDS. In the Beta Agonists in Acute Lung Injury Trial, intravenous salbutamol reduced extravascular lung water (EVLW) in patients with ARDS at day 4 but not inflammatory cytokines or neutrophil recruitment. We hypothesized that salbutamol reduces MMP activity in ARDS.

Methods: MMP-1/-2/-3/-7/-8/-9/-12/-13 was measured in supernatants of distal lung epithelial cells, type II alveolar cells, and bronchoalveolar lavage (BAL) fluid from patients in the Beta Agonists in Acute Lung Injury study by multiplex bead array and tissue inhibitors of metalloproteinases (TIMPs)-1/-2 by enzyme-linked immunosorbent assay. MMP-9 protein and activity levels were further measured by gelatin zymography and fluorokine assay.

Measurements and Main Results: BAL fluid MMP-1/-2/-3 declined by day 4, whereas total MMP-9 tended to increase. Unexpectedly, salbutamol augmented MMP-9 activity. Salbutamol induced 33.7- and 13.2-fold upregulation in total and lipocalin-associated MMP-9, respectively at day 4, compared with 2.0- and 1.3-fold increase in the placebo group, p < 0.03. Salbutamol did not affect BAL fluid TIMP-1/-2. Net active MMP-9 was higher in the salbutamol group (4222 pg/mL, interquartile range: 513-7551) at day 4 compared with placebo (151 pg/mL, 124-2108), p = 0.012. Subjects with an increase in BAL fluid MMP-9 during the 4-day period had lower EVLW measurements than those in whom MMP-9 fell (10 vs. 17 mL/kg, p = 0.004): change in lung water correlated inversely with change in MMP-9, r = -.54, p = 0.0296. Salbutamol up-regulated MMP-9 and down-regulated TIMP-1/-2 secretion in vitro by distal lung epithelial cells. Inhibition of MMP-9 activity in cultures of type II alveolar epithelial cells reduced wound healing.

Conclusions: Salbutamol specifically up-regulates MMP-9 in vitro and in vivo in patients with ARDS. Up-regulated MMP-9 is associated with a reduction in EVLW. MMP-9 activity is required for alveolar epithelial wound healing in vitro. Data suggest MMP-9 may have a previously unrecognized beneficial role in reducing pulmonary edema in ARDS by improving alveolar epithelial healing.

Exploring the perspective of midwives involved in offering serum screening for Down's syndrome in Northern Ireland

Aims. To explore the perspective of midwives offering serum screening for Down’s syndrome.

Background. Previous literature has indicated that the offer and discussion of prenatal serum screening tests with women is complex, and health professionals may influence women’s decisions to accept or decline screening. Midwives are usually the key professional to offer serum screening for Down’s syndrome in the UK but their perspective is relatively neglected in the literature.

Design. An explorative qualitative interview study with 15 midwives employed in a maternity unit in Northern Ireland involved in offering prenatal screening to pregnant women. Data were collected from 1 July 2005–31 October 2005.

Methods. A focused ethnographic approach was used to explore the perspective of midwives.

Results. Midwives reported difficulty in explaining the test to women and felt unable to provide the necessary information to adequately inform women within their appointment time. The test offered (the triple test) and potential pathway of subsequent care, were identified as sources of professional and personal conflict by midwives. The expectation that midwives would provide a universal offer of Down’s syndrome serum screening but be unable to support women regarding termination of pregnancy also created dissonance.

Conclusions. The feasibility of proceeding with a universal serum screening programme for Down’s syndrome is questionable in countries which legally or culturally oppose termination of pregnancy. Professionals practising within environments such as this experience conflict in their role, which affects communication with women when discussing screening tests.

Relevance to clinical practice. As midwives are often, the primary health professional providing information to women, it is important that midwives are key participants in ongoing planning and discussions about screening policy to ensure programmes are implemented successfully.