An Inconvenient Truth: Barriers to Truth Recovery in the Aftermath of Institutional Child Abuse in Ireland

Contemporary settled democracies, including the United States, England and Wales and Ireland, have witnessed a string of high profile cases of institutional child abuse in both church and state settings. Set against the broader literature on transitional justice, this analysis argues that there are significant barriers to truth recovery within the particular context of historical institutional abuse by the clergy in the Republic of Ireland. In the main, I argue that the frameworks of the inquiries and commissions into historical institutional child abuse are not conducive to truth recovery or the search for justice in dealing with the legacy of an abusive past. It is the church-state relationship which makes the Irish situation noteworthy and unique. The Catholic Church and child care institutions are especially self-protective, secretive and closed by nature and strongly discourage the drawing of attention to any deficiencies in organisational procedures. The nature of the public inquiry process also means that there is often a rather linear focus on accountability and apportioning blame. Collectively, such difficulties inhibit fuller systemic investigation of the veracity of what actually happened and, in turn, meaningful modification of child care policies. The article concludes by offering some thoughts on implications for transitional justice discourses more broadly as well as the residual issues for Ireland and other settled democracies in terms of moving on from the legacy of institutional child abuse.

Denial, Silence and the Politics of the Past: Unpicking the Opposition to Truth Recovery in Northern Ireland

There has been considerable and protracted debate on whether a formal truth recovery process should be established in Northern Ireland. Some of the strongest opposition to the creation of such a body has been from unionist political elites and the security forces. Based on qualitative fieldwork, this article argues that the dynamics of denial and silence have been instrumental in shaping their concerns. It explores how questions of memory, identity and denial have created a ‘myth of blamelessness’ in unionist discourse that is at odds with the reasons for a truth process being established. It also examines how three interlocking manifestations of silence – ‘silence as passivity,’ ‘silence as loyalty’ and ‘silence as pragmatism’ – have furthered unionists’ opposition to dealing with the past. This article argues that making peace with the past requires an active deconstruction of these practices.

Preparation of highly stable oligo (ethylene glycol) derivatives-functionalized gold nanoparticles and their application in LSPR-Based detection of PSA/ACT complex

A sandwich immunoassay for PSA/ACT complex detection based on gold nanoparticle aggregation using two probes was developed. The functionalized colloidal gold nanoparticles (AuNPs) showed highly stable not only in the presence of high ionic strength but also in a wide pH range. The functionalized AuNPs were tagged with PSA/ACT complex monoclonal antibody and goat PSA polyclonal antibody and served as the probes to induce aggregation of the colloidal particles. As a result, PSA/ACT complex was detected at concentrations as low as 1 ng/ml. This is the first time that a new aggregation sandwich-immunoassay technique using two gold probes has been used, and the results are generally applicable to other LSPR-based immunoassays.

Preparation of Highly Stable OEG derivatives-functionalized AuNPs and Its Application in LSPR-based Detection of PSA/ACT Complex

The zero-length crosslinker EDC has been widely used to make amide bonds between carboxylic acid and amine groups for bioconjugation because no residues remain in the crosslinked protein. During the conjugation process, EDC activates the carboxyl groups (negatively charged) and forms an unstable amine-reactive intermediate (positively charged). However, the process turns to be a problematic issue if it is applied to modify carboxyl-functionalized and –stabilized Au nanoparticles (AuNPs) due to the fact that the negatively repulsive forces which help to stabilize the AuNPs were disrupted leading to the colloid aggregation. Therefore, to modify the negatively carboxyl-terminated AuNPs while their stability can be maintained yet, we assume that functionalization of the AuNPs using 02 kinds of negatively charged groups which one serves as a linking agent, and the other one plays a role of negative charge maintainer could overcome the impediment.

In this study, the colloidal gold nanoparticles were synthesized by Turkevitch’s method, and then their surface was rationally functionalized with different molar ratios of HS(CH2)11(OCH2CH2)6OCH2COOH and HS(CH2)11(OCH2CH2)3OH (OEG6-COOH/OEG3-OH) by self assembling technique. As a result, the most appropriate molar ratio was found to be 1:10, and the AuNP aggregation was prevented not only in the activation process by EDC but also in the present of high concentration of NaCl as well as over in a wide pH range. This is the first time that extremely stable OEG derivatives-functionalized Au nanoparticles for protein bioconjugation using EDC chemistry is reported, and the results open the door for covalent bioconjugation of AuNPs in biological applications.

Nonadherence in difficult asthma - facts, myths, and a time to act

Nonadherence to prescribed treatment is an important cause of difficult asthma. Rates of nonadherence amongst asthmatic patients have been shown to range between 30% and 70%. This is associated with poor health care outcomes and increased health care costs. There is no such thing as a "typical" nonadherent patient. The reasons driving nonadherence are multifactorial. Furthermore, adherence is a variable behavior and not a trait characteristic. Adherence rates can vary between the same individual across treatments for different conditions. There is no consistent link between socioeconomic status and nonadherence, and although some studies have shown that nonadherence is more common amongst females, this is not a universal finding. The commonly held perception that better adherence is driven by greater disease severity has been demonstrated to not be the case, in both pediatric and adult patients. Identification of nonadherence is the first step. If adherence is not checked, it is likely that poor adherence will be labeled as refractory disease. Failure to identify poor adherence may lead to inappropriate escalation of therapy, including the potential introduction of complex biological therapies. Surrogate measures, such as prescription counting, are not infallible. Nonadherence can be difficult to identify in clinical practice, and a systematic approach using a variety of tools is required. Nonadherence can be successfully addressed. Therefore, assessment of adherence is of paramount importance in difficult asthma management, in order to reduce exacerbations and steroid-related side effects as well as hospital and intensive care admissions, health care cost, and inappropriate treatment escalation. In this paper, we present an overview of the literature surrounding nonadherence in difficult asthma. We explore the facts and myths surrounding the factors driving nonadherence as well as how it can be identified and addressed.

Unearthing the Truth: The Politics of Exhumations in Cyprus and Spain

Contrary to the experience of other countries with memories of clandestine violence and “missing persons”, where the mobilisation of the (civil) society towards “truth recovery” was immediate and pivotal, the societies of Cyprus and Spain remained silent for a remarkably long period of time. This article aspires to explain the reasons why both Cypriot communities and the Spanish society did not manage, until recently, to comprehensively address—not to mention resolve—the problem of “missing persons”. The recent emergence of the “politics of exhumations” in these two countries, which highlight issues related to truth recovery and collective memory, renders the attempt to respond to the question of why these processes are taking place only today even more stimulating

The challenge to health professionals when carers resist truth telling at the end of life: a qualitative secondary analysis

Aims and objectives: To draw out the similar complexities faced by staff around
truth-telling in a children’s and adult population and to interrogate the dilemmas faced by staff when informal carers act to block truth-telling.

Background: Policy encourages normalisation of death, but carers may act to protect or prevent the patient from being told the truth. Little is known about the impact on staff.

Design: Secondary analysis of data using a supra-analysis design to identify commonality of experiences.

Methods: Secondary ‘supra-analysis’ was used to transcend the focus of two primary studies in the UK, which examined staff perspectives in a palliative children’s and a palliative adult setting, respectively. The analysis examined new theoretical questions relating to the commonality of issues independently derived in each primary study. Both primary studies used focus groups. Existing empirical data were analysed thematically and compared across the studies.

Results: Staff reported a hiding of the truth by carers and sustained use of activities aimed at prolonging life. Carers frequently ignored the advance of end of life, and divergence between staff and carer approaches to truth-telling challenged professionals. Not being truthful with patients had a deleterious effect on staff, causing anger and feelings of incompetence.

Conclusions: Both children’s and adult specialist palliative care staff found themselves caught in a dilemma, subject to policies that promoted openness in planning for death and informal carers who often prevented them from being truthful with patients about terminal prognosis. This dilemma had adverse psychological effects upon many staff.

Relevance to clinical practice: There remains a powerful death-denying culture in
many societies, and carers of dying patients may prevent staff from being truthful with their patients. The current situation is not ideal, and open discussion of this problem is the essential first step in finding a solution.