'The End of the Irish Poor Law?: Welfare and Healthcare Reform in Revolutionary and Independent Ireland'

This book explores welfare provision in Ireland from the revolutionary period to the 1940s, This work is a significant addition to the growing historiography of twentieth-century Ireland which moves beyond political history. It demonstrates that concepts of respectability, deservingness, and social class where central dynamics in Irish society and welfare practices. This book provides the first major study of local welfare practices, policies, and attitudes towards poverty and the poor in this era.

This book’s exploration of the poor law during revolutionary and independent Ireland provides fresh and original insights into this critical juncture in Irish history. It charts the transformation of the former workhouse system into a network of local authority welfare and healthcare institutions including county homes, county and hospital hospitals, and mother and baby homes. This book provides historical context to current day debates and controversies relating to the institutionalisation of unwed mothers and child welfare policies.

This book undertakes two cases studies on county Kerry and Cork city; also, Irish experiences are placed against the backdrop of wider transnational trends.

This work has multiple audiences and will appeal to those interested in Irish social, culture, economic and political history. This book will also appeal to historians of welfare, the poor law, and the social history of medicine. It also informs modern-day social affairs.

'If we do not cut social spending, we will end up like Greece': Challenging consent to austerity through social work action

'If we do not cut social spending, we will end up like Greece'. Establishment politicians and media figures use this new ideological mantra throughout the Western world to frighten people into consenting to further neo-liberal restructuring along with cuts in social spending. This phrase and other ideologically laden assertions hide the real causes of the Greek public debt crisis. This commentary challenges the dominant discourse by contextualizing the Greek case within the larger global neo-liberal restructuring processes and then, drawing upon Gramsci's concept of the organic intellectual, proposes ways that the members of the Professional Association of Social Workers (PASW) can engage in a war of ideas and action, as organic intellectuals, to delegitimize the dominant discourse, which seeks consent for social spending cuts and further neo-liberal restructuring of society. © The Author(s) 2013.

Are family physician visits and continuity of care associated with acute care use at end-of-life? A population-based cohort study of homecare cancer patients

Background: Previous end-of-life cancer research has shown an association between increased family physician continuity of care and reduced use of acute care services; however, it did not focus on a homecare population or control for homecare nursing.

Aim: Among end-of-life homecare cancer patients, to investigate the association of family physician continuity with location of death and hospital and emergency department visits in the last 2 weeks of life while controlling for nursing hours.

Design: Retrospective population-based cohort study.

Setting/participants: Cancer patients with ≥1 family physician visit in 2006 from Ontario, Canada. Family physician continuity of care was assessed using two measures: Modified Usual Provider of Care score and visits/week. Its association with location of death and hospital and emergency department visits in the last 2 weeks of life was examined using logistic regression.

Results: Of 9467 patients identified, the Modified Usual Provider of Care score demonstrated a dose-response relationship with increasing continuity associated with decreased odds of hospital death and visiting the hospital and emergency department in the last 2 weeks of life. More family physician visits/week were associated with lower odds of an emergency department visit in the last 2 weeks of life and hospital death, except for patients with greater than 4 visits/week, where they had increased odds of hospitalizations and hospital deaths.

Conclusions: These results demonstrate an association between increased family physician continuity of care and decreased odds of several acute care outcomes in late life, controlling for homecare nursing and other covariates.©The Author(s) 2013 Reprints and permissions sagepub.co.uk/journalsPermissions.nav.

'Conditional candour' and 'knowing me': an interpretive description study on patient preferences for physician behaviours during end-of-life communication

OBJECTIVE: To understand patients' preferences for physician behaviours during end-of-life communication.

METHODS: We used interpretive description methods to analyse data from semistructured, one-on-one interviews with patients admitted to general medical wards at three Canadian tertiary care hospitals. Study recruitment took place from October 2012 to August 2013. We used a purposive, maximum variation sampling approach to recruit hospitalised patients aged ≥55 years with a high risk of mortality within 6-12 months, and with different combinations of the following demographic variables: race (Caucasian vs non-Caucasian), gender and diagnosis (cancer vs non-cancer).

RESULTS: A total of 16 participants were recruited, most of whom (69%) were women and 70% had a non-cancer diagnosis. Two major concepts regarding helpful physician behaviour during end-of-life conversations emerged: (1) 'knowing me', which reflects the importance of acknowledging the influence of family roles and life history on values and priorities expressed during end-of-life communication, and (2) 'conditional candour', which describes a process of information exchange that includes an assessment of patients' readiness, being invited to the conversation, and sensitive delivery of information.

CONCLUSIONS: Our findings suggest that patients prefer a nuanced approach to truth telling when having end-of-life discussions with their physician. This may have important implications for clinical practice and end-of-life communication training initiatives.

Rapid climate change did not cause population collapse at the end of the European Bronze Age

The impact of rapid climate change on contemporary human populations is of global concern. To contextualize our understanding of human responses to rapid climate change it is necessary to examine the archeological record during past climate transitions. One episode of abrupt climate change has been correlated with societal collapse at the end of the northwestern European Bronze Age. We apply new methods to interrogate archeological and paleoclimate data for this transition in Ireland at a higher level of precision than has previously been possible. We analyze archeological 14C dates to demonstrate dramatic population collapse and present high-precision proxy climate data, analyzed through Bayesian methods, to provide evidence for a rapid climatic transition at ca. 750 calibrated years B.C. Our results demonstrate that this climatic downturn did not initiate population collapse and highlight the nondeterministic nature of human responses to past climate change.

Tangible applications for regular objects:An end-user model for pervasive computing at home

This paper describes an end-user model for a domestic pervasive computing platform formed by regular home objects. The platform does not rely on pre-planned infrastructure; instead, it exploits objects that are already available in the home and exposes their joint sensing, actuating and computing capabilities to home automation applications. We advocate an incremental process of the platform formation and introduce tangible, object-like artifacts for representing important platform functions. One of those artifacts, the application pill, is a tiny object with a minimal user interface, used to carry the application, as well as to start and stop its execution and provide hints about its operational status. We also emphasize streamlining the user's interaction with the platform. The user engages any UI-capable object of his choice to configure applications, while applications issue notifications and alerts exploiting whichever available objects can be used for that purpose. Finally, the paper briefly describes an actual implementation of the presented end-user model. © (2010) by International Academy, Research, and Industry Association (IARIA).

An Appraisal of End-of-Life Care in Persons with Chronic Kidney Disease Dying in Hospital Wards

AIM: To review end-of-life care provided by renal healthcare professionals to hospital in-patients with chronic kidney disease, and their carers, over a 12-month period in Northern Ireland.

METHODS: Retrospective review of 100 patients.

RESULTS: Mean age at death was 72 years (19-95) and 56% were male. Eighty three percent of patients had a 'Not For Attempted Resuscitation' order during their last admission and this was implemented in 42%. Less than 20% of all patients died in a hospital ward. No patients had an advanced care plan, although 42% had commenced the Liverpool Care Pathway for the Dying Patient. Patients suffered excessive end-of-life symptoms. In addition, there was limited documentation of carer involvement and carer needs were not formally assessed.

CONCLUSION: End-of-life care for patients with advanced chronic renal disease can be enhanced. There is significant variation in the recording of discussions regarding impending death and little preparation. There is poor recording of the patients' wishes regarding death. Those with declining functional status, including those frequently admitted to hospital require holistic assessment regarding end-of-life needs. More effective communication between the patient, family and multi-professional team is required for patients who are dying and those caring for them.