Who is responsible?:The role of family physicians in the provision of supportive cancer care

Purpose: Patients living with cancer identify family physicians (FPs; ie, primary care physicians) as a preferred resource for supportive cancer care (SCC), either through direct provision or referral. However, little research exists on the specific role FPs play in addressing these needs. Methods: A mailed survey was sent to all FPs in a health care region in Ontario, Canada, to determine their current and preferred roles in the specific provision of SCC to patients with cancer who have been newly diagnosed or are at the end of life. Results: Completed surveys were received from 84 (64%) of 183 eligible FPs. Most practitioners reported providing for their patients' various SCC needs. However, clear gaps were demonstrated in psychosocial and nutritional counseling and in providing information about SCC services. FPs were satisfied with their current role reported in SCC coordination, although the type of role varied; FPs who were asked about their end-of-life patients tended to see themselves as part of coordinating teams, whereas FPs asked about their recently diagnosed patients were more likely to defer this responsibly to a third party. Conclusion: This study identified gaps in the provision of psychosocial and informational care to patients with cancer that may result in unmet needs. In general, FPs do not see themselves as primarily responsible for coordinating patients' SCC and do not wish to assume this role. Accordingly, models that involve FPs as team members in SCC coordination are more feasible for reducing patient need. Copyright © 2010 by American Society of Clinical Oncology.

Hospice at Home service:The carer's perspective

Goals of the work: The aim of this study was to explore the bereaved caregivers' experience of the Hospice at Home service delivered in one region of the UK. Materials and methods: Three hundred and ten bereaved caregivers identified by the Community Specialist Palliative Care Team or Hospice at Home nurse, who met inclusion criteria, were sent a postal questionnaire to explore their views and experiences of the Hospice at Home service. Data were collected during 2002. Main results: In total, 128 caregivers responded, providing a 41% response rate. Most caregivers believed that the Hospice at Home service enabled their loved one's wish to be cared for and to die at home to be fulfilled. A number of suggestions were made relating to increased awareness of the service, training for staff, coordination of service delivery and bereavement support. Conclusions: The bereaved caregivers were thankful for the Hospice at Home service; however, the need for practical support, increased awareness of the Hospice at Home service and bereavement support were also identified. Although the bereaved caregivers provided a valuable insight in evaluating service provision, it is acknowledged that some caregivers are often so grateful for the treatment and care received that they tend to forget or ignore their less pleasant experiences. Further research is therefore required using an in-depth qualitative approach investigating on the carers' views and experiences of accessing the Hospice at Home service. © 2006 Springer-Verlag.

Sexual offences against children: An exploration of attrition in the Northern Ireland criminal justice system

Objective: This paper uses data provided by the Police Service for Northern Ireland (PSNI) to compare the characteristics and outcomes of reported sexual offences involving child and adult victims and explore the factors associated with case outcomes.
Method: PSNI provided data on 8,789 sexual offences recorded between April 2001 and March 2006. Case outcomes were based on whether a case was recorded by police as having sufficient evidence to summons, charge, or caution an offender (detected). Where an offender was summonsed, charged, or cautioned, this is classified as detection with a formal sanction. A case can also be classified as "detected" without a formal sanction. The analysis focused on two key categories of detection without formal sanction: cases in which the police deem there to be sufficient evidence to charge an offender but took no further action because the victim did not wish to prosecute, or because the police or the Public Prosecution Service (PPS) decided that no useful purpose would be served by proceeding.
Results: The analysis confirmed that the characteristics of recorded sexual offences involving adult and child victims vary significantly according to gender, offence type, the timing of report and victim-offender relationship. Almost half of child sex abuse cases are not detected by police and a quarter do not proceed through the criminal justice system because either the victim declines to prosecute or the Police/PPS decide not to proceed. Only one in five child cases involved detection with a formal sanction. Child groups with lower detection with formal sanction rates included children under 5, teenagers, those who do not report when the abuse occurs but disclose at a later date; and those who experience abuse at the hands of peers and adults known to them but not related. The analysis also highlighted variation in formal sanction rates depending on where the offence was reported.
Conclusions: Consideration needs to be given to improving the criminal justice response to specific child groups as well as monitoring detection rates in different police areas in order to address potential practice variation.
Practice implications: Consideration needs to be given to improving the professional response in relation to with particularly lower detection with formal sanction rates. There is also a need to monitor case outcomes to ensure that child victims in different areas receive a similar service.

Counter-Revolution by Ideology? Law and development's vision(s) for post-revolutionary Egypt

Law and development, as both movement and practice, has led a tumultuous life: a hurried zenith cut short by a fatal critique followed by an opportunistic resurrection. The name alone is su?cient to trigger a range of reactions, extending from the complimentary to the condemnatory. In this article I track law and development’s evolution via an examination of its role in the remodelling of Egyptian society in the post-Nasser era. While the 2011 revolution has encouraged institutions such as USAID to hasten their legal reform e?orts, I argue that these are more akin to counter-revolution by ideology than genuine revolution by law. Nevertheless, rather than relegate the movement to the annals of imperial intrigue, I conclude by proposing the use of legal pluralism to revive, and possibly ignite, law and development’s emancipatory potential.

The sustainability and assessment of drystone retaining walls

The art of drystone walling is a highly sustainable traditional practice which uses local materials and craftsmen. As no
mortar is used they have low embodied carbon, and much repair work or rebuilding can be carried out using very little if any new
materials. However local practices developed to suit local materials, leading to a range of construction styles, making them difficult to
assess. This paper examines a range of construction styles of drystone retaining walls in use across the United Kingdom.
Understanding of the substantial variations of construction style is essential to enable proper assessment of these structures. Different
frictional and weathering characteristics, and the naturally occurring shapes of stone found in an area, all affect the ways in which the
stones have traditionally been assembled into walls. Ease of construction also plays a part, as the craftsman will naturally wish to
achieve a robust construction in a way that is economical of time and effort. Aesthetics may be very important, for both client and
craftsman. It is also shown that construction style is influenced by the location and function of the structures, with harbour walls
particularly likely to have unique characteristics, and the reasons for this are explored.

The Biospheric Project - Manchester International Festival 2013:Technical food systems

The Biospheric Project is a nested multi-scalar urban agriculture project that aims to develop sustainable food systems in disadvantaged communities, though not only physical interventions, such as the urban masterplan and neighbourhood design to the building and its roof and façade, but also through social and commercial interventions, such as community involvement, businesses and a distribution system.

The project is focused around the Biospheric Foundation, a community interest company and research think-tank whose aim is to hasten our transition to a closed cycle, low-carbon economy. Its home is Irwell house, that houses a large-scale aquaponic-based food production system, which is directly linked to a whole-food shop (78 Steps, named after the distance from the productive system) and a whole food distribution system (the Whole Box). The building sits within a post-industrial landscape which is being developed into a new productive landscape, utilizing the the technologies developed by the Biospheric Foundation and Prof Greg Keeffe of Queens University Belfast. The collaboration links designer, academics and activists across the disciplines of Urban design, Architecture, Permaculture, landscape design, environmental science and business and community.

Soundspace: A Manifesto

The manifesto is a long-standing and powerful tool for challenge within architecture, deployed by those as diverse as Vitruvius and Frank Lloyd Wright (who proposed a Walt Whitman-inspired “Work Song” of 1896) to those publishing in blogs across the designing planet today. Manifestos are locations for dreaming, for the banging of shoes, for passion in words about the environment we invent. Our manifesto follows in that tradition of poetry and critical optimism in calling for a new architecture of soundspace.

Here we wish to act as Markus Miessen’s “uninvited outsider” (Miessen 2010), a transgressive voice that disturbs the status quo beyond comfortable familiarity and brings together different types of thinkers and various modes of critique.[1] In this article we seek to probe “fundamental questions about how and for whom the built environment is produced and … conventional frameworks or oldestablished rules and regulations” through the interdisciplinarity that sound studies demands.[2] The ear to transgression is open.[3]

Breast cancer following augmentation mammoplasty - a review of its impact on prognosis and management

The incidence of breast cancer in women with implants is increasing and will continue to do so for the foreseeable future due to the marked increase in breast implant insertion in recent years. Undoubtedly many of these women will wish to know whether the presence of implants worsens the prognosis of their breast cancer. Furthermore, the clinical management of such patients may be difficult, as aesthetic results are likely to be a major concern for women who have already undergone cosmetic surgery to the breast. There is no consensus on surgical approach to this scenario. This article reviews the literature on the prognosis of breast cancer patients with a history of augmentation mammoplasty and examines the available data regarding their surgical treatment. (c) 2007 Published by Elsevier Ltd on behalf of British Association of Plastic, Reconstructive and Aesthetic Surgeons.

Architecture from the dogs …

In this chapter Morrow talks of her return to Northern Ireland to 2003 and how her involvement in establishing a new school of architecture and a recent suite of interdisciplinary masters has led her to consider the relationship between the post-conflict context, architectural practice and its education. She examines the consequences of not facing the effects of conflict; the impact on societal and architectural creativity; and the potential for live project pedagogy to evolve effective models of socio-spatial rehearsals. She concludes with some strategies for schools of architecture that wish to feed and be fed by their context. This is a personalized commentary that teeters somewhere between deep-seated frustration with a blind-folded profession and sustained belief in architectural education’s potential to offer more than built solutions.

Career choices on graduation--a study of recent graduates from University College Cork

INTRODUCTION: Irish dental graduates are eligible to enter general dental practice immediately after qualification. Unlike their United Kingdom counterparts, there is no requirement to undertake vocational training (VT) or any pre-registration training. VT is a mandatory 12-month period for all UK dental graduates who wish to work within the National Health Service. It provides structured, supervised experience in training practices and through organised study days.

AIMS: This study aimed to profile the career choices made by recent dental graduates from UCC. It aimed to record the uptake of VT and associate posts, and where the graduates gained employment.

METHODOLOGY: A self-completion questionnaire was developed and circulated electronically to recent graduates from UCC. An existing database of email addresses was used and responses were returned by post or by email. A copy of the questionnaire used is included as Appendix 1.

RESULTS: Questionnaires were distributed over an eight-week period and 142 were returned, giving a response rate of 68.90%. Responses were gathered from those who graduated between 2001 and 2007; however, the majority came from more recent classes. Overall, the majority of graduates took up associate positions after qualification (71.8%) with smaller numbers undertaking VT (28.2%). Increasing numbers have entered VT in recent years, including 54.3% from the class of 2007. Overall, the majority of graduates initially took up positions in England (43%); however, in recent times more have been employed in Scotland. Subsequent work profiles of the graduates illustrate that the majority are now working as associates in general practice (51.4%) and in Ireland (54.2%).

CONCLUSIONS: There has been an increase in the proportion of UCC graduates undertaking VT. Graduates tended to move away from Ireland initially to gain employment. There has been a shift away from employment in England towards Scotland where the majority of new UCC graduates are now initially employed. The majority of graduates returned to Ireland for employment after the initial move away.

Risk and the Politics of Public Health:A Critical Review

Twentieth century public health initiatives have been crucially informed by perceptions and constructions of risk. Notions of risk identification, assessment and mitigation have guided political and institutional actions even before these concepts became an explicit part of the language of public administration and policy making. Past analyses investigating the link between risk perceptions and public health are relatively rare, and where researchers have investigated this nexus, it has typically been assumed that the collective identification of health risks has led to progressive improvements in public health activities.
Risk and the Politics of Public Health addresses this gap by presenting a detailed critical historical analysis of the evolution of risk thinking within medical and health related discourses. Grouped around the four core themes of 'immigration', 'race', 'armed conflict' and 'detention and prevention' this book highlights the innovative capacity of risk related concepts as well as their vulnerability to the dysfunctional effects of dominant social ideologies. Risk and the Politics of Public Health is an essential reference for those who seek to understand the interplay of concepts of risk and public health throughout history as well as those who wish to gain a critical understanding of the social dynamics which have underpinned, and continue to underpin, this complex interaction.

Core outcome sets and trial registries

Some reasons for registering trials might be considered as self-serving, such as satisfying the requirements of a journal in which the researchers wish to publish their eventual findings or publicising the trial to boost recruitment. Registry entries also help others, including systematic reviewers, to know about ongoing or unpublished studies and contribute to reducing research waste by making it clear what studies are ongoing. Other sources of research waste include inconsistency in outcome measurement across trials in the same area, missing data on important outcomes from some trials, and selective reporting of outcomes. One way to reduce this waste is through the use of core outcome sets: standardised sets of outcomes for research in specific areas of health and social care. These do not restrict the outcomes that will be measured, but provide the minimum to include if a trial is to be of the most use to potential users. We propose that trial registries, such as ISRCTN, encourage researchers to note their use of a core outcome set in their entry. This will help people searching for trials and those worried about selective reporting in closed trials. Trial registries can facilitate these efforts to make new trials as useful as possible and reduce waste. The outcomes section in the entry could prompt the researcher to consider using a core outcome set and facilitate the specification of that core outcome set and its component outcomes through linking to the original core outcome set. In doing this, registries will contribute to the global effort to ensure that trials answer important uncertainties, can be brought together in systematic reviews, and better serve their ultimate aim of improving health and well-being through improving health and social care.

Economic Stability and Economic Governance in the Euro Area:What the European Crisis Can Teach on the Limits of Economic Integration

The recent European economic crisis has dramatically exposed the failures of
the various institutional mechanisms in place to maintain economic stability
in Europe, and has unveiled the difficulty in achieving international coordination
on fiscal and financial stability policies. Drawing on the European
experience, this article analyzes the concept of economic stability in international
law and highlights the peculiar problems connected to its maintenance
or promotion. First, we demonstrate that policies that safeguard and
protect economic stability are largely regulated and managed at the national
level, due to their inextricable relationship with the exercise of national political
power. Until recently, more limited levels of pan-European integration
did not make the coordination of economic stability policies seem necessary.
However, a much deeper level of economic integration makes it very difficult
to tackle an international economic crisis through national responses. If EU
Member states wish to maintain and deepen economic integration, they
must accept an erosion of sovereignty over their economic stability policies.
This will not only deprive states of a fundamental anchor of political power,
but also create a challenge for the maintenance of democratic control over
economic policies. Second, this article argues that soft law approaches are
likely ineffective in enforcing the regulatory disciplines required to ensure
economic stability.

Precarious spaces and urban change in post-conflict Belfast

The Northern Ireland conflict is shaped by an ethno-national contest between a minority Catholic/Nationalist/Republican population who broadly want to see the reunification of Ireland; and a majority Protestant/Unionist/Loyalist one, who mainly wish to maintain the sovereign connection with Britain. After nearly three decades of violence, which intensified segregation in schooling, labour markets and especially housing, a Peace Agreement was signed on Good Friday 1998. This paper is concerned with the peace process after the Agreement, not so much for the ambiguous political compromise, but for the way in which the city is constitutive of transformation and how Belfast in particular, is now embedded with a range of social instabilities and spatial contradictions. The Agreement encouraged rapid economic expansion, inward investment, especially in knowledge–intensive sectors and a short-lived optimism that markets and the neo-liberal fix would drive the post-conflict, post-industrial and post-political city. Capital would trump ethnicity and the economic uplift would bind citizens to a new expression of hope based on property speculation, tourism and global corporate investment.

Comunicação pública em territórios rurais – perceções e participação dos atores globais em Avelãs de Cima

Vivemos num mundo cada vez mais globalizado e uma das consequências é a crescente concorrência que existe entre territórios, reforçando-se a necessidade de fazer chegar aos públicos interessados, um conjunto de atributos e diferenciações, suficientemente atrativos e apelativos, para que estes territórios sejam “consumidos”, não só pelo seu reconhecimento temporal, mas também pela forma como ele se comunica. Se até ao momento esta diferenciação era apenas explicitada numa base meramente turística (pelos impactos económicos positivos que normalmente se conseguem), hoje a estratégia deve seguir um plano de marketing capaz de atrair e fixar quer residentes, excursionistas, turistas e investidores, satisfazendo-os. Dos estudos realizados é comumente aceite que o sucesso da execução de um plano de marketing territorial assenta num modelo participativo que promova e antecipe necessidades e desejos dos atores globais e que valide e identifique os pontos fortes, para ajudar a desenvolver (definir e implementar) uma estratégia sustentável, a prazo. Então é relevante chamar ao processo estes atores (públicos e privados, residentes e visitantes) envolvendo-os nesta identificação, comprometendo-os também nos seus resultados.Com este artigo apresenta-se então um estudo de caso aplicado a um território rural, na freguesia de Avelãs de Cima, tendo sido utilizada como metodologia um inquérito por questionário a todos os atores. Enumeram-se os fatores relevantes identificados, assim como os que não se desejam ver aplicados, requisitos evidentes para iniciar uma nova política de comunicação pública. Deste trabalho já resultou uma nova abordagem pelos atores públicos locais, destacando a perspetiva de utilização de sinergias pela integração dos recursos de duas outras freguesias, estando em construção um projeto comum de rotas com base nos atributos dessas localidades.-----We live in an increasingly globalized world and one of the consequences is the increasing competition that exists between areas, reinforcing the need to reach out to stakeholders, a set of attributes and differences sufficiently attractive and appealing, so that these territories are "consumed ", not only by their temporal recognition, but also for how it communicates. If so far this differentiation was only explained in a purely tourist base (by the positive economic impacts that usually can get), today the strategy must follow a marketing plan able to attract and retain residents, hikers, tourists and investors. There are studies where is commonly accepted that the successful implementation of a territorial marketing plan based on a participatory model that promotes and anticipate needs and desires of the global players and validate and identify the strengths, to help develop (define and implement) one sustainable strategy in the long term. So it is relevant to call these actors (public and private, residents and visitors) involving them in this identification and also committing them in their results. With this article we present a case study applied to a rural area in the parish of Avelãs de Cima, having been used a survey methodology for all actors. All the relevant identified factors are listed, as well as those which do not wish to see applied, clear requirements to start a new policy of public communication. This work has resulted in a new approach by local public actors, highlighting the prospect of using synergies by integrating the features of two other parishes, under construction with a common design routes based on attributes of those localities.