Adequacy of reporting monitoring regimens of risk factors for cardiovascular disease in clinical guidelines: systematic review

Objective To assess the reporting of monitoring recommendations in guidelines on the prevention and treatment of cardiovascular disease.

The Adequacy of Traveller Education in Northern Ireland

The issues facing Travellers, including those associated with education are often linked to social exclusion, widespread disadvantage and discrimination (Reynolds, McCartan, and Knipe 2003




). The Office for Standards in Education (Office for Standards in Education 1999




) referred to Gypsy Traveller pupils as ‘the most at risk in the education system.’ Within this article issues pertaining to Traveller education are discussed and in particular accessing education provision in Northern Ireland. The article focuses on the views of the statutory and voluntary sector to assess the adequacy and effectiveness of educational provision for Traveller children and young people and reviews the policies in place relating to the provision of education for Travellers in Northern Ireland. It also considers the issue of segregated education for the Traveller community and how for some this segregation can exacerbate social exclusion, disadvantage and discrimination.

Levels and distribution of genetic diversity of coconut (Cocos nucifera L., var. Typica form typica) from Sri Lanka assessed by microsatellite markers

The coconut variety Typica, form typica, commonly known as Sri Lanka tall coconuts is the most widely exploited and grown variety in Sri Lanka. Under the coconut bio-diversity conservation programme, several Typica populations have been collected by island-wide surveys and planted ex situ. Thirty-three coconut populations were subjected to microsatellite assay with eight coconut-specific microsatellite primer pairs in order to study the levels and distribution of genetic variation of the collected materials for formulating future collection strategies and selecting parents for the breeding programme. A total of 56 alleles were detected ranging from 3 to 10 alleles per primer pair with an average of 7 alleles per locus. Overall a very high level of genetic diversity was detected (0.999) for all the populations studied ranging from 0.526 for population Debarayaya to 0.683 for population Dickwella. Only four introduced coconut populations, i.e. Clovis, Margeret, Dickwella, Mirishena and an embryo-cultured population were clearly separated from the resulting dendrogram. A very high level of within population variation (99%) accounted for native populations suggests a common history and a restricted genetic base for native Sri Lankan tall coconuts. Categorization of alleles into different classes according to their frequency and distribution confirmed the results of the dedrogram and concluded the adequacy of single large collection from the entire target area to represent the total genetic diversity in Sri Lanka. This study discusses useful information regarding conservation and breeding of coconut in Sri Lanka.

Exile or emigrant? Female ex-prisoners who left Ireland 1850-1921

In the popular mind, the concept of 'emigration' usually refers to people voluntarily leaving one country to go to another in search of a new and better life. It presupposes some degree of choice, although it is accepted that for many emigrants, such as those who left Ireland during the nineteenth century, there were few incentives to stay at home. Current scholarship on voluntary and forced movements of people demonstrates that the distinction between the categories of 'voluntary emigrant' and 'forced exile' is often blurred. Orm Overland's study of refugee communities in the United States highlights the fact that, although the differences between the 'emigrant' and the 'exile' may be clear in extreme cases, this is not always true, as there may be 'pressing political or economic reasons behind a decision to emigrate'. Migration scholars Jan Lucassen and Leo Lucassen also question the adequacy of conceptual models of migration based on what Lindsay Proudfoot and Dianne Hall refer to as the 'straightforward binarism between free and unfree emigration'. The questions raised by these scholars are very relevant to the study of Irish people who left their country during the second half of the nineteenth century immediately after they had been discharged from prison or from Dundrum. Their stories are discussed here against a background of substantial scholarship on emigration from Ireland and on the criminal justice system within Ireland. According to David Fitzpatrick, at least eight million men, women and children emigrated from Ireland between 1801 and 1921. This large-scale movement of people was generally characterised by the voluntary emigration of individuals who funded their own passages. However, it also included schemes of assisted emigration, funded variously by governments, landlords, the poor law authorities, earlier emigrants, and philanthropists. In addition, it included people who were transported from Ireland by means of the criminal justice system a practice that had originated in the seventeenth century. What is less well known is that after the end of transportation from Ireland to eastern Australia in 1853, to Bermuda in 1863 and to Western Australia in 1868, Irish convicts continued to be channelled towards emigration by being offered early release if they agreed to leave Ireland. These people, and especially the women among them, are the subject of this article.

Prescribing Practices and Polypharmacy in Kitovu Hospital, Uganda.

This audit of prescribing practices explores recent trends at Kitovu Hospital, Uganda. The average number of drugs prescribed per patient was 2.89 ± 0.11, of which 1.79±0.09 were generics and 0.69±0.06 antibiotics. No injections were prescribed. Patient essential drug knowledge was 100% while the adequacy of labelling was 0%. The number of drugs prescribed correlated positively with patient age, was greater for female patients, similar for doctors and clinical officers but greater in medical (3.30±0.15, n=50) than surgical (2.48±0.13, n=50) outpatient clinics. The mean consultation time was 6.56 min and 10.25 min per patient in medical and surgical outpatient clinics respectively. The patient essential knowledge indicators were greatly improved but only modest reduction in polypharmacy was evident compared to the Ugandan Pharmaceutical Sector national survey of 2002. Antibiotic prescription was high and generic prescribing was found to be low. Policy changes are required to enhance rational drug use in the health sector in Uganda.

Deriving the Edge: What's in a phase?

This article offers a critical conceptual discussion and refinement of Chomsky’s (2000, 2001, 2007, 2008) phase system, addressing many of the problematic aspects highlighted in the critique of Boeckx & Grohmann (2007) and seeking to resolve these issues, in particular the stipulative and arbitrary properties of phases and phase edges encoded in the (various versions of the) Phase Impenetrability Condition (PIC). Chomsky’s (2000) original conception of phases as lexical subarrays is demonstrated to derive these properties straightforwardly once a single assumption about the pairwise composition of phases is made, and the PIC is reduced to its necessary core under the Strong Minimalist Thesis (SMT)—namely, the provision of an edge. Finally, a comparison is undertaken of the lexical-subarray conception of phases with the feature-inheritance system of Chomsky 2007, 2008, in which phases are simply the locus of uninterpretable features (probes). Both conceptions are argued to conform to the SMT, and both converge on a pairwise composition of phases. However, the two conceptions of phases are argued to be mutually incompatible in numerous fundamental ways, with no current prospect of unification. The lexical-subarray conception of phases is then to be preferred on grounds of greater empirical adequacy.

Invisible from View: Leaving and Aftercare Provision in the Republic Of Ireland

The adequacy of provisions for young people leaving care and in aftercare in the Republic of Ireland have been the subject of recent policy attention. A landmark report, the Ryan Report (2009), into historic abuse in state institutions recommended strengthening provisions in this area. However, the legislative basis for aftercare remains relatively weak and services for young people leaving care remain ad hoc and regionally variable. This article outlines the current context of leaving and aftercare provision in the Republic of Ireland and traces some of the recent policy debates and recommendations in this area. A genealogical analysis of leaving care and aftercare provision highlights that this issue has historically only emerged as a concern in the context in which young people leaving the care system are perceived as a ‘threat’ to social order. It is argued that the failure to adequately reform leaving and aftercare provision is reflective of wider social inequality and of a context in which young people in care are largely invisible from view.

Completeness and timeliness: Cancer registries could/should improve their performance

Cancer registries must provide complete and reliable incidence information with the shortest possible delay for use in studies such as comparability, clustering, cancer in the elderly and adequacy of cancer surveillance. Methods of varying complexity are available to registries for monitoring completeness and timeliness. We wished to know which methods are currently in use among cancer registries, and to compare the results of our findings to those of a survey carried out in 2006.

Methods
In the framework of the EUROCOURSE project, and to prepare cancer registries for participation in the ERA-net scheme, we launched a survey on the methods used to assess completeness, and also on the timeliness and methods of dissemination of results by registries. We sent the questionnaire to all general registries (GCRs) and specialised registries (SCRs) active in Europe and within the European Network of Cancer Registries (ENCR).

Results
With a response rate of 66% among GCRs and 59% among SCRs, we obtained data for analysis from 116 registries with a population coverage of ∼280 million. The most common methods used were comparison of trends (79%) and mortality/incidence ratios (more than 60%). More complex methods were used less commonly: capture–recapture by 30%, flow method by 18% and death certificate notification (DCN) methods with the Ajiki formula by 9%.

The median latency for completion of ascertainment of incidence was 18 months. Additional time required for dissemination was of the order of 3–6 months, depending on the method: print or electronic. One fifth (21%) did not publish results for their own registry but only as a contribution to larger national or international data repositories and publications; this introduced a further delay in the availability of data.

Conclusions
Cancer registries should improve the practice of measuring their completeness regularly and should move from traditional to more quantitative methods. This could also have implications in the timeliness of data publication.

The need for qualitative methodologies in cancer cachexia research

Background: Cancer cachexia is not well understood or managed in clinical practice (Delmore 2000; Poole and Froggatt 2002). Whilst a dedicated effort has been made towards understanding the biological processes of the syndrome, little attention has been paid to its multidimensional impact. This is despite previous qualitative research, enriching our understanding of the holistic impact of the syndrome which traditional quantitative methods could not have uncovered (Reid 2007).

Aim: The aim of this study is to determine the adequacy of the existing clinical knowledge base of cancer cachexia management.

Methods: A systematic critical review of the literature on cancer cachexia was undertaken.

Results: There is a need to develop protocols for care delivery, which move beyond a purely biological approach to care towards a more holistic approach. This can only be achieved by gaining the perspectives of those who are involved in care delivery to advanced cancer patients with cachexia and their families using qualitative methodologies.

Conclusions: Cancer cachexia is a complex, challenging syndrome, which must be understood from a holistic bio-psychosocial model of care in order to meet the multidimensional needs of this client population. The perspectives of those involved in care delivery is required in order to contribute to a knowledge base which will inform the development of interventions directed at empowering patients and their families to understand cancer cachexia and recognise it as part of the disease process.

Regulatory Change and Capital Adjustment of US Credit Unions

We investigate the determinants of US credit union capital-to-assets ratios, before and after the implementation of the current capital adequacy regulatory framework in 2000. Capitalization varies pro-cyclically, and until the financial crisis credit unions classified as adequately capitalized or below followed a faster adjustment path than well capitalized credit unions. This pattern was reversed, however, in the aftermath of the crisis. The introduction of the PCA regulatory regime achieved a reduction in the proportion of credit unions classified as adequately capitalized or below that continued until the onset of the crisis. Since the crisis, the speed of recovery of credit unions in this category following an adverse capitalization shock was sharply reduced.

The Democratic Dynamics of Government Consultations. Speaking Freely and Listening Properly

There is a growing use of consultation and e-consultation procedures by governments. This chapter seeks to examine the role of consultation as part of a new technology of government. Consultation on policy development can reinvigorate democratic engage- ment but often it can silence views through a sort of participatory disempowerment; it can loosen the democratic anchorage of the public service within the state. The chapter develops a governmentality perspective interrogating what participation, democratic engagement and free speech mean in this context, and how ideas of publicness are constructed, managed and controlled. The focus is on the nature of consultation, its relationship to ideas of free speech and speaking freely, and its potential to empower subaltern counterpublics which can formulate oppositional interpretations and urge alternative conclusions. The aim is to develop an idea of the democratic adequacy of the consultation process and draw out a sense of how democratic engagement here can be structured – for good or ill.