External validation of the 2008 Framingham cardiovascular risk equation for CHD and stroke events in a European population of middle-aged men. The PRIME study

To test the applicability of the sex-specific 2008 Framingham general cardiovascular risk equation for coronary heart disease (CHD) and stroke in European middle-aged men from Ireland and France.

Towards Understanding Man-In-The-Middle Attacks on IEC 60870-5-104 SCADA Networks

This paper investigates cyber attacks on ICS which rely on IEC 60870-5-104 for telecontrol communications. The main focus of the paper is on man-in-the-middle attacks, covering modification and injection of commands, it also details capture and replay attacks. An initial set of attacks are preformed on a local software simulated laboratory. Final experiments and validation of a man-in-the-middle attack are performed in a comprehensive testbed environment in conjunction with an electricity distribution operator.

An exploration of nursing home managers' knowledge of and attitudes towards the management of pain in residents with dementia

Background The aims of this study were to explore the knowledge, attitudes and beliefs that nursing home managers hold with regard to the assessment and management of pain in residents with dementia and to determine how these may be affected by the demographic characteristics of the respondents.

Methods A questionnaire comprising six sections was mailed, on two occasions during March and April 2010, to 244 nursing home managers in Northern Ireland (representing 96% of the nursing homes in Northern Ireland).

Results The response rate was 39%. Nearly all respondents (96%) provided care to residents with dementia, yet only 60% of managers claimed to use pain treatment guidelines within their nursing home. Respondents demonstrated good knowledge about pain in residents with dementia and acknowledged the difficulties surrounding accurate pain assessment. Nursing home managers were uncertain about how to manage pain in residents with dementia, demonstrating similar concerns about the use of opioid analgesics to those reported in previous studies about pain in older people. Managers who had received recent training (p = 0.044) were less likely to have concerns about the use of opioid analgesia than those who had not received training. Respondents' beliefs about painkillers were largely ambivalent and were influenced by the country in which they had received their nursing education.

Conclusions The study has revealed that accurate pain assessment, training of nursing staff and a standardised approach to pain management (the use of pain management guidelines) within nursing homes all have a significant part to play in the successful management of pain in residents with dementia. Copyright (c) 2012 John Wiley & Sons, Ltd.

The development of the PROMPT (PRescribing Optimally in Middle-aged People’s Treatments) criteria

BACKGROUND: Whilst multimorbidity is more prevalent with increasing age, approximately 30% of middle-aged adults (45-64 years) are also affected. Several prescribing criteria have been developed to optimise medication use in older people (≥65 years) with little focus on potentially inappropriate prescribing (PIP) in middle-aged adults. We have developed a set of explicit prescribing criteria called PROMPT (PRescribing Optimally in Middle-aged People's Treatments) which may be applied to prescribing datasets to determine the prevalence of PIP in this age-group.

METHODS: A literature search was conducted to identify published prescribing criteria for all age groups, with the Project Steering Group (convened for this study) adding further criteria for consideration, all of which were reviewed for relevance to middle-aged adults. These criteria underwent a two-round Delphi process, using an expert panel consisting of general practitioners, pharmacists and clinical pharmacologists from the United Kingdom and Republic of Ireland. Using web-based questionnaires, 17 panellists were asked to indicate their level of agreement with each criterion via a 5-point Likert scale (1 = Strongly Disagree, 5 = Strongly Agree) to assess the applicability to middle-aged adults in the absence of clinical information. Criteria were accepted/rejected/revised dependent on the panel's level of agreement using the median response/interquartile range and additional comments.

RESULTS: Thirty-four criteria were rated in the first round of this exercise and consensus was achieved on 17 criteria which were accepted into the PROMPT criteria. Consensus was not reached on the remaining 17, and six criteria were removed following a review of the additional comments. The second round of this exercise focused on the remaining 11 criteria, some of which were revised following the first exercise. Five criteria were accepted from the second round, providing a final list of 22 criteria [gastro-intestinal system (n = 3), cardiovascular system (n = 4), respiratory system (n = 4), central nervous system (n = 6), infections (n = 1), endocrine system (n = 1), musculoskeletal system (n = 2), duplicates (n = 1)].

CONCLUSIONS: PROMPT is the first set of prescribing criteria developed for use in middle-aged adults. The utility of these criteria will be tested in future studies using prescribing datasets.

Economic Stress and the Great Recession in Ireland: Polarization, Individualization or ‘Middle Class Squeeze’?

Following an unprecedented boom, since 2008 Ireland has experienced a severe economic crisis. Considerable debate persists as to where the heaviest burden of the recession has fallen. Conventional measures of income poverty and inequality have a limited capacity to answer this question. Our analysis, which focuses on economic stress and the mediating role of material deprivation, provides no evidence for individualization or class polarization. Instead we find that while economic stress level are highly stratified in income class and social class terms in both boom and bust periods, the changing impact of class is contingent on life course stage. The affluent income class remained largely insulated from the experience of economic stress. However, it saw its relative advantage overthe income poor class decline at the earlier stage of the life-course. At the other end of the hierarchy, the income poor experienced a relative improvement in their situation in the early life course phases. The precarious income class experienced some improvement in its situation at the earlier life course stages while the outcomes for the middle classes remain unchanged. In the mid-life course stages the precarious and lower middle classes experienced disproportionate increase in their stress levels while at the later life-cycle stage it is the combined middle classes that lost out. Additional effects over time relating to social class are restricted to the deteriorating situation of the petit bourgeoisie at the middle stage of the life-course. The pattern is clearly a good deal more complex that suggested by conventional notions of ‘middle class squeeze’ and points to the distinctive challenges relating to welfare and taxation policy faced by governments in the Great Recession.

Ethnic Segregation, Moral Panics and Social Class: A Comparative Study of the Experiences and Perspectives of Working Class and Middle Class Children in Belfast

This paper begins by describing the moral panics that have tended to emerge sporadically in Northern Ireland over the last few years with regard to young people’s involvement in sectarian violence in Belfast. Within this, while these young people have been cast in the traditional role of folk devils, the paper will show how younger children also tend to be explicitly identified and named in an ambiguous way through such moral panics; playing a deviant role as participators, and sometimes instigators, of sectarian violence but also carrying the symbolic responsibility of representing Belfast’s future. It will be shown that it is because of this ambiguous position that it is adults rather than the children themselves that tend to be held responsible for their actions; either as rioters using the children as political pawns or as parents guilty of neglect. With this as a starting point the paper then explores the perspectives and experiences of two groups of 10-11 year old children living in Belfast and the impact of these moral panics on them. One group of children, living in affluent middle class areas were found to be appropriating and re-working these broader moral panics into more general discourses of derision that tended to pathologize working class children and communities more generally. For the other group of children, living in economically deprived areas with high levels of sectarian tensions and violence, their experiences of such violence and their participation in it are discussed. It will be shown that for these children, the broader moral panics that exist tend to have the effect of reinforcing the processes that tend to segregate and exclude them.