Review of Legislation and Policy Guidance relating to Adult Social Care in Northern Ireland

Introduction and Background

This research was undertaken by an international team of academics from Queen’s University, Belfast, Leeds University and Penn State University (USA) who have examined models of adult social care provision across thirteen jurisdictions. The aim of this research is to present the Commissioner for Older People in Northern Ireland (COPNI) with possible options for legal reform to adult social care provision for older people in Northern Ireland.

Project Objectives

The agreed objectives of this research were to provide:
• Identification of gaps and issues surrounding the current legislative framework including policy provision for adult social care in Northern Ireland.
• Comparison of Northern Ireland with best practice in other jurisdictions to include (but not be limited to): England and Wales, Republic of Ireland, Scotland and at least two other international examples; Recommendations, based on the above, as to whether there is a need for legislative reform – provision of suggestions other than legislative change (if applicable).
• Recommendations or options based on the above, on how to best change the current framework in Northern Ireland to provide better support outcomes for older people.
• Stakeholder engagement via roundtable event to discuss outcomes/ recommendations.

Structure of Report

The findings from this research are based on an international review of adult social care in the local, national and international contexts. The report will, therefore, firstly present the key recommendations for Northern Ireland which have emerged from a systematic examination and review of adult social care in diverse jurisdictions. Each jurisdiction is then examined in the context of legislative and policy provision and examples of best practice are provided. The final section of the report then compares Northern Ireland to best practice from each of these aforementioned jurisdictions and the discussion entails the background to the report’s final Recommendations. The recommendations in this report are thus directly linked in with the evidence we have gathered across different countries with contrasting systems of welfare.

Spitzer observations of the asteroid-comet transition object and potential spacecraft target 107P (4015) Wilson-Harrington

Context: Near-Earth asteroid-comet transition object 107P/ (4015) Wilson-Harrington is a possible target of the joint European Space Agency (ESA) and Japanese Aerospace Exploration Agency (JAXA) Marco Polo sample return mission. Physical studies of this object are relevant to this mission, and also to understanding its asteroidal or cometary nature. Aims: Our aim is to obtain significant new constraints on the surface thermal properties of this object. Methods: We present mid-infrared photometry in two filters (16 and 22 μm) obtained with NASA's Spitzer Space Telescope on February 12, 2007, and results from the application of the Near Earth Asteroid Thermal Model (NEATM). We obtained high S/N in two mid-IR bands allowing accurate measurements of its thermal emission. Results: We obtain a well constrained beaming parameter (η = 1.39±0.26) and obtain a diameter and geometric albedo of D = 3.46±0.32 km, and pV = 0.059±0.011. We also obtain similar results when we apply this best-fitting thermal model to single-band mid-IR photometry reported by Campins et al. (1995, P&SS, 43, 733), Kraemer et al. (2005, AJ, 130, 2363) and Reach et al. (2007, Icarus, 191, 298). Conclusions: The albedo of 4015 Wilson-Harrington is low, consistent with those of comet nuclei and primitive C-, P-, D-type asteorids. We establish a rough lower limit for the thermal inertia of W-H of 60 Jm-2s-0.5 K-1 when it is at r = 1 AU, which is slightly over the limit of 30 Jm-2 s-0.5 K-1 derived by Groussin et al. (2009, Icarus, 199, 568) for the thermal inertia of the nucleus of comet 22P/Kopff.

Guidance on the management of diarrhoea during cancer chemotherapy

Diarrhoea induced by chemotherapy in cancer patients is common, causes notable morbidity and mortality, and is managed inconsistently. Previous management guidelines were based on poor evidence and neglect physiological causes of chemotherapy-induced diarrhoea. In the absence of level 1 evidence from randomised controlled trials, we developed practical guidance for clinicians based on a literature review by a multidisciplinary team of clinical oncologists, dietitians, gastroenterologists, medical oncologists, nurses, pharmacist, and a surgeon. Education of patients and their carers about the risks associated with, and management of, chemotherapy-induced diarrhoea is the foundation for optimum treatment of toxic effects. Adequate—and, if necessary, repeated—assessment, appropriate use of loperamide, and knowledge of fluid resuscitation requirements of affected patients is the second crucial step. Use of octreotide and seeking specialist advice early for patients who do not respond to treatment will reduce morbidity and mortality. In view of the burden of chemotherapy-induced diarrhoea, appropriate multidisciplinary research to assess meaningful endpoints is urgently required.

Individual Participant Data (IPD) Meta-analyses of Randomised Controlled Trials: Guidance on Their Use

Jayne Tierney and colleagues offer guidance on how to spot a well-designed and well-conducted individual participant data meta-analysis.

Summary Points 

• Systematic reviews are most commonly based on aggregate data extracted from publications or obtained from trial investigators. 

• Systematic reviews involving the central collection and analysis of individual participant data (IPD) usually are larger-scale, international, collaborative projects that can bring about substantial improvements to the quantity and quality of data, give greater scope in the analyses, and provide more detailed and robust results. 

• The process of collecting, checking, and analysing IPD is more complex than for aggregate data, and not all IPD meta-analyses are done to the same standard, making it difficult for researchers, clinicians, patients, policy makers, funders, and publishers to judge their quality. 

• Following our step-by-step guide will help reviewers and users of IPD meta-analyses to understand them better and recognise those that are well designed and conducted and so help ensure that policy, practice, and research are informed by robust evidence about the effects of interventions.

After the Liverpool Care Pathway clear guidance and support on end-of-life care is needed

Commentary on: Ramasamy Venkatasalu M, Whiting D, Cairnduff K. Life after the Liverpool Care Pathway (LCP): a qualitative study of critical care practitioners delivering end-of-life care. J Adv Nurs 2015;71:2108–18.

Guidance for laboratories performing molecular pathology for cancer patients

Molecular testing is becoming an important part of the diagnosis of any patient with cancer. The challenge to laboratories is to meet this need, using reliable methods and processes to ensure that patients receive a timely and accurate report on which their treatment will be based. The aim of this paper is to provide minimum requirements for the management of molecular pathology laboratories. This general guidance should be augmented by the specific guidance available for different tumour types and tests. Preanalytical considerations are important, and careful consideration of the way in which specimens are obtained and reach the laboratory is necessary. Sample receipt and handling follow standard operating procedures, but some alterations may be necessary if molecular testing is to be performed, for instance to control tissue fixation. DNA and RNA extraction can be standardised and should be checked for quality and quantity of output on a regular basis. The choice of analytical method(s) depends on clinical requirements, desired turnaround time, and expertise available. Internal quality control, regular internal audit of the whole testing process, laboratory accreditation, and continual participation in external quality assessment schemes are prerequisites for delivery of a reliable service. A molecular pathology report should accurately convey the information the clinician needs to treat the patient with sufficient information to allow for correct interpretation of the result. Molecular pathology is developing rapidly, and further detailed evidence-based recommendations are required for many of the topics covered here.

Elucidation of the Retinoid Signalling Pathway Involved in Axon Guidance in Lymnaea stagnalis and Xenopus laevis

The vitamin A metabolite, retinoic acid (RA), is known to play a crucial role in several developmental processes including axial patterning and differentiation. More recently, RA has been implicated in the regenerative process acting through its classical signaling pathway, the nuclear receptors, retinoic acid receptor (RAR) and retinoid X receptor (RXR), to mediate gene transcription. Moreover, RA has been shown to act as a guidance molecule for growth cones of regenerating motorneurons of the pond snail, Lymnaea stagnalis. Our lab has recently shown that RA can induce this morphological response independent of nuclear transcription, however, the role of the retinoid receptors in RA-induced chemoattraction is still unknown. Here, I show that the retinoid receptors, RXR and RAR, may mediate the growth cones response to the metabolically active retinoic acid isomers, all-trans and 9-cis RA, in Lymnaea stagnalis. Data presented here show that both an RXR and RAR antagonist can block growth cone turning in response to application of both isomers. Because no prior investigations have shown growth cone turning of individual vertebrate neurons, I aimed to show that both retinoic acid isomers were capable of inducing growth cone turning of embryonic spinal cord neurons in the frog, Xenopus laevis. For the first time in Xenopus, I showed that both all-trans and 9-cis RA were able to induce significantly more neurite outgrowth from cultured embryonic spinal cord neurons and induce positive growth cone turning of individual growth cones. In addition, I showed that the presence of the RXR antagonist, HX531, blocked 9-cis RA-induced growth cone turning and the RARβ antagonist, LE135, blocked all-trans RA-induced growth cone turning in this species. Evidence provided here shows for the first time, conservation of retinoic acid-induced growth cone turning in a vertebrate model system. In addition, these data show that the receptors involved in this morphological response may be the same in vertebrates and invertebrates.

Maternal depression symptoms in early childhood and children's cognitive performance at school entry : the role of maternal guidance

Mémoire numérisé par la Division de la gestion de documents et des archives de l'Université de Montréal

The plant ovule omics : an integrative approach for pollen−pistil interactions and pollen tube guidance studies in solanaceous species

Chez les plantes à fleurs, l’ovaire est l’organe reproducteur femelle et il interagit de façon importante avec les gamètes mâles durant la croissance, le guidage, la réception et la rupture du tube pollinique ainsi que la fusion des gamètes. Le processus débute lorsque de nombreux gènes de l’ovule sont activés à longue distance lors de la réception du pollen sur le stigmate. Afin d’explorer les signaux provenant de l’ovule ayant un impact important sur les interactions pollen–pistil, particulièrement les molécules sécrétées impliquées dans la signalisation espècespécifique, l’expression génique des ovules sous forme d’ARNm ainsi et la sécrétion protéique ont été étudiées chez Solanum chacoense, une espèce diploïde de pomme de terre sauvage. S. chacoense a subi beaucoup d’hybridation interspécifique avec d’autres espèces sympathiques de solanacées, facilitant ainsi grandement l’étude des interactions pollen–ovule de façon espècespécifique ainsi que leur évolution. Dans ce projet, des ovules provenant de trois conditions différentes ont été comparés: des ovules matures de type sauvage, des ovules légèrement immatures, récoltés deux jours avant l’anthèse et des ovules provenant du mutant frk1 pour lesquels le sac embryonnaire est absent. Un séquençage d’ARN à haut débit a d’abord été effectué sur les ovules de type sauvage de S. chacoense afin de générer un assemblage de référence comprenant 33852 séquences codantes. D’autres séquençages ont été effectués sur les trois conditions d’ovules et sur les feuilles afin de faire une analyse d’expression différentielle des gènes. En comparaison avec les ovules de type sauvage, 818 gènes sont réprimés dans les ovules du mutant frk1. Un sous-groupe de 284 gènes, étaient également sous-exprimés dans les ovules légèrement immatures, suggérant un rôle spécifique dans les stades tardifs de la maturation du sac embryonnaire (stade de développent FG6 à FG7) ainsi que du guidage du tube pollinique, puisque ni les ovules du mutant frk1 ni ceux légèrement immatures ne sont capables d’attirer les tubes polliniques lors d’essais de croissance semi in vivo. De plus, 21% de ces gènes sont des peptides riches en cystéines (CRPs). En utilisant un transcriptome assemblé de novo provenant de deux proches parents de S. chacoense, S. gandarillasii et S. tarijense, une analyse d’orthologie a été effectuée sur ces CRPs, révélant une grande variabilité et une évolution rapide chez les solanacées. De nouveaux motifs de cystéine uniques à cette famille ont également été découverts. En comparant avec des études similaires chez Arabidopsis, le sac embryonnaire de S. chacoense montre un transcriptome fortement divergent, particulièrement en en ce qui a trait à la catégorisation fonctionnelle des gènes et de la similarité entre les gènes orthologues. De plus,même si la glycosylation n’est pas requise lors du guidage mycropylaire du tube pollinique chez Arabidopsis, Torenia ou le maïs, des extraits d’ovules glycosylés de S. chacoense sont capables d’augmenter la capacité de guidage de 18%. Cette étude est donc la première à montrer une corrélation entre glycosylation et le guidage du tube pollinique par l’ovule. En complément à l’approche transcriptomique, une approche protéomique portant sur les protéine sécrétées par l’ovule (le secrétome) a été utilisée afin d’identifier des protéines impliquées dans l’interaction entre ovule et tube pollinique. Des exsudats d’ovules matures (capables d’attirer le tube pollinique) et d’ovules immatures (incapables d’attirer le tube pollinique) ont été récoltés en utilisant une nouvelle méthode d’extraction par gravité permettant de réduire efficacement les contaminants cytosoliques à moins de 1% de l’échantillon. Un total de 305 protéines sécrétées par les ovules (OSPs) ont été identifiées par spectrométrie de masse, parmi lesquelles 58% étaient spécifiques aux ovules lorsque comparées avec des données de protéines sécrétées par des tissus végétatifs. De plus, la sécrétion de 128 OSPs est augmentée dans les ovules matures par rapport aux ovules immatures. Ces 128 protéines sont donc considérées en tant que candidates potentiellement impliquées dans la maturation tardive de l’ovule et dans le guidage du tube pollinique. Cette étude a également montré que la maturation du sac embryonnaire du stade FG6 au stade FG7 influence le niveau de sécrétion de 44% du sécrétome total de l’ovule. De façon surprenante, la grande majorité (83%) de ces protéines n’est pas régulée au niveau de l’ARN, soulignant ainsi l’importance de cette approche dans l’étude du guidage du tube pollinique comme complément essentiel aux études transcriptomiques. Parmi tous les signaux sécrétés par l’ovule et reliés au guidage, obtenus à partir des approches transcriptomiques et protéomiques décrites ci-haut, nous avons spécifiquement évalué l’implication des CRPs dans le guidage du tube pollinique par l’ovule chez S. chacoense, vu l’implication de ce type de protéine dans les interactions pollen-pistil et le guidage du tube pollinique chez d’autres espèces. Au total, 28 CRPs étaient présentes dans les ovules capables d’attirer le tube pollinique tout en étant absentes dans les ovules incapables de l’attirer, et ce, soit au niveau de l’ARNm et/ou au niveau du sécrétome. De celles-ci, 17 CRPs ont été exprimées dans un système bactérien et purifiées en quantité suffisante pour tester le guidage. Alors que des exsudats d’ovules ont été utilisés avec succès pour attirer par chimiotactisme le tube pollinique, les candidats exprimés dans les bactéries n’ont quant à eux pas été capables d’attirer les tubes polliniques. Comme l’utilisation de systèmes d’expression hétérologue eucaryote peut permettre un meilleur repliement et une plus grande activité des protéines, les candidats restants seront de nouveau exprimés, cette fois dans un système de levure ainsi que dans un système végétal pour produire les peptides sécrétés. Ceux-ci seront ensuite utilisés lors d’essais fonctionnels pour évaluer leur capacité à guider les tubes polliniques et ainsi isoler les attractants chimiques responsable du guidage du tube pollinique chez les solanacées comme S. chacoense.

A Novel Slotless Halbach-Array Permanent-Magnet Brushless DC Motor for Spacecraft Applications

This paper presents the design and analysis of a novel machine family—the enclosed-rotor Halbach-array permanentmagnet brushless dcmotors for spacecraft applications. The initial design, selection of major parameters, and air-gap magnetic flux density are estimated using the analytical model of the machine. The proportion of the Halbach array in the machine is optimized using finite element analysis to obtain a near-trapezoidal flux pattern. The machine is found to provide uniform air-gap flux density along the radius, thus avoiding circulating currents in stator conductors and thereby reducing torque ripple. Furthermore, the design is validated with experimental results on a fabricated machine and is found to suit the design requirements of critical spacecraft applications