Practical Application of Glaucoma Care in Different Societies

Diagnosis of glaucoma and delivery of effective treatment is difficult everywhere, but additional challenges are evident in less affluent parts of the world, where the largest numbers of patients with this disease are living. The problems of providing good glaucoma care are examined with especial reference to south-east Asia including China and India and countries in sub-Saharan Africa. The relatively low priority given to glaucoma by vision-related and other nongovernmental organizations (NGOs) due to difficulties faced in delivering effective glaucoma screening and therapeutic interventions are discussed, together with possible future directions for increasing resources and priority for glaucoma care in poor areas.

Transfusion and Treatment of severe anaemia in African children (TRACT): a study protocol for a randomised controlled trial

BACKGROUND: In sub-Saharan Africa, where infectious diseases and nutritional deficiencies are common, severe anaemia is a common cause of paediatric hospital admission, yet the evidence to support current treatment recommendations is limited. To avert overuse of blood products, the World Health Organisation advocates a conservative transfusion policy and recommends iron, folate and anti-helminthics at discharge. Outcomes are unsatisfactory with high rates of in-hospital mortality (9-10 %), 6-month mortality and relapse (6 %). A definitive trial to establish best transfusion and treatment strategies to prevent both early and delayed mortality and relapse is warranted.

METHODS/DESIGN: TRACT is a multicentre randomised controlled trial of 3954 children aged 2 months to 12 years admitted to hospital with severe anaemia (haemoglobin < 6 g/dl). Children will be enrolled over 2 years in 4 centres in Uganda and Malawi and followed for 6 months. The trial will simultaneously evaluate (in a factorial trial with a 3 x 2 x 2 design) 3 ways to reduce short-term and longer-term mortality and morbidity following admission to hospital with severe anaemia in African children. The trial will compare: (i) R1: liberal transfusion (30 ml/kg whole blood) versus conservative transfusion (20 ml/kg) versus no transfusion (control). The control is only for children with uncomplicated severe anaemia (haemoglobin 4-6 g/dl); (ii) R2: post-discharge multi-vitamin multi-mineral supplementation (including folate and iron) versus routine care (folate and iron) for 3 months; (iii) R3: post-discharge cotrimoxazole prophylaxis for 3 months versus no prophylaxis. All randomisations are open. Enrolment to the trial started September 2014 and is currently ongoing. Primary outcome is cumulative mortality to 4 weeks for the transfusion strategy comparisons, and to 6 months for the nutritional support/antibiotic prophylaxis comparisons. Secondary outcomes include mortality, morbidity (haematological correction, nutritional and infectious), safety and cost-effectiveness.

DISCUSSION: If confirmed by the trial, a cheap and widely available 'bundle' of effective interventions, directed at immediate and downstream consequences of severe anaemia, could lead to substantial reductions in mortality in a substantial number of African children hospitalised with severe anaemia every year, if widely implemented.

Shared education in Northern Ireland: school collaboration in divided societies

During the years of political violence in Northern Ireland many looked to schools to contribute to reconciliation. A variety of interventions were attempted throughout those years, but there was little evidence that any had produced systemic change. The peace process provided an opportunity for renewed efforts. This paper outlines the experience of a series of projects on 'shared education', or the establishment of collaborative networks of Protestant, Catholic and integrated schools in which teachers and pupils moved between schools to take classes and share experiences. The paper outlines the genesis of the idea and the research which helped inform the shape of the shared education project. The paper also outlines the corpus of research which has examined various aspects of shared education practice and lays out the emergent model which is helping to inform current government practice in Northern Ireland, and is being adopted in other jurisdictions. The paper concludes by looking at the prospects for real transformation of education in Northern Ireland.

Judicial Impartiality and Independence in Divided Societies: An Empirical Analysis of the Constitutional Court of Bosnia-Herzegovina

The role of Constitutional Courts in deeply divided societies is complicated by the danger that the salient societal cleavages may influence judicial decision-making and, consequently, undermine judicial independence and impartiality. With reference to the decisions of the Constitutional Court of Bosnia-Herzegovina, this article investigates the influence of ethno-nationalism on judicial behaviour and the extent to which variation in judicial tenure amplifies or dampens that influence. Based on a statistical analysis of an original dataset of the Court’s decisions, we find that the judges do in fact divide predictably along ethno-national lines, at least in certain types of cases, and that these divisions cannot be reduced to a residual loyalty to their appointing political parties. Contrary to some theoretical expectations, however, we find that long-term tenure does little to dampen the influence of ethno-nationalism on judicial behaviour. Moreover, our findings suggest that the longer a judge serves on the Court the more ethno-national affiliation seems to influence her decision-making. We conclude by considering how alternative arrangements for the selection and tenure of judges might help to ameliorate this problem.

Heritage and nation narration in contested societies

The targeted destruction of heritage sites in recent conflicts in Syria, Iraq and Mali has tragically illustrated how the treatment of heritage, as the tangible manifestation of the identity of the ‘other’, can be a symptom of the nadir to which group relations can descend. In a world in which the nation-state remains the primary means of identification, the following overarching research question was investigated: How do nation-states narrate their pasts in the built form? Drawing upon the conceptualisation of heritage as a present-orientated and political construct that is utilised to represent the values of the “dominant political, social, religious or ethnic groups” (Graham, Ashworth & Tunbridge 2000: p.183), this paper discusses the role that heritage interventions can play in both emphasising gulfs and building bridges in divided post-conflict societies (Fojut 2009).

Narratively framing emergent identities in post-agreement societies: patterns of the Northern Irish identity within the provincial media

The research analyses ‘Northern Irish’ identity narratives post-agreement, and examines the configuration of frame agendas in terms of individual narrative components. A content analysis utilised news published through 1997–2014 within Northern Ireland daily newspapers – the Belfast Telegraph, the Irish News and the News Letter. A process of manifest coding produced an emergent coding scheme displaying the relative stability of media frames surrounding the Northern Irish identity as broadly partisan; however, there is also a subtle narrative shift of Northern Irish identity across the time periods; and findings of a dominant framing paradigm of political and social conceptions of identification post-agreement.

Resolving conflict in bipolar societies: The fate of political settlements in Fiji and Northern Ireland

Ethnically divided societies that might be described as ‘balanced bicommunal’ (where there are two communities, each of which comes close to representing half of the population) pose a particular challenge to conventional principles of collective decision-making, and commonly threaten political stability. This article analyses the experience of two such societies – Northern Ireland and Fiji – with a view to exploring whether there are common processes in the route by which political stability has been pursued. We assess the manner in which a distinctive relationship with Great Britain and its political culture has interacted with local conditions to produce a highly competitive, bipolar party system. This leads to consideration of the devices that have been adopted in an effort to bridge the gap between the communities: the Fiji constitution as amended in 1997, and Northern Ireland’s Good Friday Agreement of 1998. We focus, in particular, on the use of unusual (preferential voting) formulas for the election of parliamentarians and of an inclusive principle in the selection of ministers, and consider the contribution of these institutional devices to the attainment of political stability. We find that, in both cases, the intervention of forces from outside the political system had a decisive impact, though in very different ways. In addition to being underpinned by solid institutional design, for political settlements to work effectively, some minimal level of trust between rival elites is required.