Exodus? The training paths and plans of postgraduate medical trainees, under the Royal College of Physicians of Ireland

<p>Background: In 2006, the Buttimer report highlighted the paucity of demographic data on those applying for and entering postgraduate medical education and training (PGMET) in Ireland. Today, concerns that there is an "exodus" of graduates of Irish medical schools are at the forefront of national discussion, however, published data on PGMET remains inadequate.</p><p>Aims: The objectives of this study were to collate existing data relating to trainees and training programmes at three stages of training and to examine the career plans of junior trainees.</p><p>Methods: Data from application forms for training programmes, commencing July 2012, under the Royal College of Physicians of Ireland (n = 870), were integrated with data from other existing sources. Candidates entering basic specialist training were surveyed with regard to career plans. Descriptive and comparative analysis was performed in SPSS version 18.</p><p>Results: Graduates of Irish medical schools made up over 70 % of appointees. Over 80 % of BST trainees aspired to work as consultants in Ireland, but 92.5 % planned to spend time working abroad (response rate 77 %). Decisions to leave the Irish system were linked to lifestyle, but also to failure to be appointed to higher specialist training. Significant numbers of trainees return to Ireland after a period abroad.</p><p>Conclusions: The trainee "exodus" is more complex than is often portrayed. The desire to spend time working outside Ireland must be accounted for in workforce planning and configuration of training programmes. Expansion of HST is a potential solution to reduce the numbers of graduates leaving Ireland post-BST.</p>

Ophthalmic epidemiology in Europe: the ���European Eye Epidemiology��� (E3) consortium

<p>The European Eye Epidemiology (E3) consortium is a recently formed consortium of 29 groups from 12 European countries. It already comprises 21 population-based studies and 20 other studies (case-control, cases only, randomized trials), providing ophthalmological data on approximately 170,000 European participants. The aim of the consortium is to promote and sustain collaboration and sharing of data and knowledge in the field of ophthalmic epidemiology in Europe, with particular focus on the harmonization of methods for future research, estimation and projection of frequency and impact of visual outcomes in European populations (including temporal trends and European subregions), identification of risk factors and pathways for eye diseases (lifestyle, vascular and metabolic factors, genetics, epigenetics and biomarkers) and development and validation of prediction models for eye diseases. Coordinating these existing data will allow a detailed study of the risk factors and consequences of eye diseases and visual impairment, including study of international geographical variation which is not possible in individual studies. It is expected that collaborative work on these existing data will provide additional knowledge, despite the fact that the risk factors and the methods for collecting them differ somewhat among the participating studies. Most studies also include biobanks of various biological samples, which will enable identification of biomarkers to detect and predict occurrence and progression of eye diseases. This article outlines the rationale of the consortium, its design and presents a summary of the methodology.</p>

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

Clopidogrel use and cancer-specific mortality: a population-based cohort study of colorectal, breast and prostate cancer patients

<p>PURPOSE: Concerns were raised about the safety of antiplatelet thienopyridine derivatives after a randomized control trial reported increased risks of cancer and cancer deaths in prasugrel users. We investigate whether clopidogrel, a widely used thienopyridine derivative, was associated with increased risk of cancer-specific or all-cause mortality in cancer patients.</p><p>METHODS: Colorectal, breast and prostate cancer patients, newly diagnosed from 1998 to 2009, were identified from the National Cancer Data Repository. Cohorts were linked to the UK Clinical Practice Research Datalink, providing prescription records, and to the Office of National Statistics mortality data (up to 2012). Unadjusted and adjusted hazard ratios (HRs) for cancer-specific and all-cause mortality in post-diagnostic clopidogrel users were calculated using time-dependent Cox regression models.</p><p>RESULTS: The analysis included 10���359 colorectal, 17���889 breast and 13���155 prostate cancer patients. There was no evidence of an increase in cancer-specific mortality in clopidogrel users with colorectal (HR���=���0.98 95% confidence interval (CI) 0.77, 1.24) or prostate cancer (HR���=���1.03 95%CI 0.82, 1.28). There was limited evidence of an increase in breast cancer patients (HR���=���1.22 95%CI 0.90, 1.65); however, this was attenuated when removing prescriptions in the year prior to death.</p><p>CONCLUSIONS: This novel study of large population-based cohorts of colorectal, breast and prostate cancer patients found no evidence of an increased risk of cancer-specific mortality among colorectal, breast and prostate cancer patients using clopidogrel.</p>

Statin use after diagnosis of breast cancer and survival: a population-based cohort study

<p>BACKGROUND: Preclinical studies have shown that statins, particularly simvastatin, can prevent growth in breast cancer cell lines and animal models. We investigated whether statins used after breast cancer diagnosis reduced the risk of breast cancer-specific, or all-cause, mortality in a large cohort of breast cancer patients.</p><p>METHODS: A cohort of 17,880 breast cancer patients, newly diagnosed between 1998 and 2009, was identified from English cancer registries (from the National Cancer Data Repository). This cohort was linked to the UK Clinical Practice Research Datalink, providing prescription records, and to the Office of National Statistics mortality data (up to 2013), identifying 3694 deaths, including 1469 deaths attributable to breast cancer. Unadjusted and adjusted hazard ratios (HRs) for breast cancer-specific, and all-cause, mortality in statin users after breast cancer diagnosis were calculated using time-dependent Cox regression models. Sensitivity analyses were conducted using multiple imputation methods, propensity score methods and a case-control approach.</p><p>RESULTS: There was some evidence that statin use after a diagnosis of breast cancer had reduced mortality due to breast cancer and all causes (fully adjusted HR = 0.84 [95% confidence interval = 0.68-1.04] and 0.84 [0.72-0.97], respectively). These associations were more marked for simvastatin 0.79 (0.63-1.00) and 0.81 (0.70-0.95), respectively.</p><p>CONCLUSIONS: In this large population-based breast cancer cohort, there was some evidence of reduced mortality in statin users after breast cancer diagnosis. However, these associations were weak in magnitude and were attenuated in some sensitivity analyses.</p>

Low-Dose Aspirin Use After Diagnosis of Colorectal Cancer Does Not Increase Survival: A Case���Control Analysis of a Population-Based Cohort

<p>BACKGROUND &amp; AIMS: Individuals who began taking low-dose aspirin before they were diagnosed with colorectal cancer were reported to have longer survival times than patients who did not take this drug. We investigated survival times of patients who begin taking low-dose aspirin after a diagnosis of colorectal cancer in a large population-based cohort study.</p><p>METHODS: We performed a nested case-control analysis using a cohort of 4794 patients diagnosed with colorectal cancer from 1998 through 2007, identified from the UK Clinical Practice Research Datalink and confirmed by cancer registries. There were 1559 colorectal cancer-specific deaths, recorded by the Office of National Statistics; these were each matched with up to 5 risk-set controls. Conditional logistic regression was used to calculate odds ratios (OR) and 95% confidence intervals (CI), based on practitioner-recorded aspirin usage.</p><p>RESULTS: Overall, low-dose aspirin use after a diagnosis of colorectal cancer was not associated with colorectal cancer-specific mortality (adjusted OR = 1.06; 95% CI: 0.92-1.24) or all-cause mortality (adjusted OR = 1.06; 95% CI: 0.94-1.19). A dose-response association was not apparent; for example, low-dose aspirin use for more than 1 year after diagnosis was not associated with colorectal cancer-specific mortality (adjusted OR = 0.98; 95% CI: 0.82-1.19). There was also no association between low-dose aspirin usage and colon cancer-specific mortality (adjusted OR = 1.02; 95% CI: 0.83-1.25) or rectal cancer-specific mortality (adjusted OR = 1.10; 95% CI: 0.88-1.38).</p><p>CONCLUSIONS: In a large population-based cohort, low-dose aspirin usage after diagnosis of colorectal cancer did not increase survival time.</p>

Digoxin use after diagnosis of colorectal cancer and survival: a population-based cohort study.

BACKGROUND: <br/><br/>Digoxin has been shown to affect a number of pathways that are of relevance to cancer, and its use has been associated with increased risks of breast and uterus cancer and, more recently, a 40% increase in colorectal cancer risk. These findings raise questions about the safety of digoxin use in colorectal cancer patients, and, therefore, we investigated whether digoxin use after colorectal cancer diagnosis increased the risk of colorectal cancer-specific mortality.<br/><br/>METHODS: <br/><br/>A cohort of 10,357 colorectal cancer patients newly diagnosed from 1998 to 2009 was identified from English cancer registries and linked to the UK Clinical Practice Research Datalink (to provide digoxin and other prescription records) and to the Office of National Statistics mortality data (to identify 2,724 colorectal cancer-specific deaths). Using time-dependent Cox regression models, unadjusted and adjusted HRs and 95% confidence intervals (CI) were calculated for the association between postdiagnostic exposure to digoxin and colorectal cancer-specific mortality.<br/><br/>RESULTS: <br/><br/>Overall, 682 (6%) colorectal cancer patients used digoxin after diagnosis. Digoxin use was associated with a small increase in colorectal cancer-specific mortality before adjustment (HR, 1.25; 95% CI, 1.07-1.46), but after adjustment for confounders, the association was attenuated (adjusted HR, 1.10; 95% CI, 0.91-1.34) and there was no evidence of a dose response.<br/><br/>CONCLUSIONS: <br/><br/>In this large population-based colorectal cancer cohort, there was little evidence of an increase in colorectal cancer-specific mortality with digoxin use after diagnosis.<br/><br/>IMPACT: <br/><br/>These results provide some reassurance that digoxin use is safe in colorectal cancer patients.<br/>

Civil defence pedagogies and narratives of democracy: disaster education in Germany

���Disaster education��� is a fledgling area of study in lifelong education. Many countries educate their populations for disasters, to mitigate potential damage and loss of life, as well as contribute to national security. In this paper, which draws on interview data from the German Federal Office for Civil Defence and Disaster Assistance and the Federal Agency for Technical Relief, archival research, analysis of websites and promotional materials as well as relevant academic literature, I examine disaster education and preparedness for national emergencies in Germany. I argue that it is not generally extended to the general public, rather confined to trained experts, decentralised, localised and exclusive. Theorising disaster education as a ���civil defence pedagogy��� (Preston, 2008), a type of public pedagogy, which contributes to shaping narratives of national identity, I argue that it is unlikely that Germany will develop a more inclusive, universal, formalised, nor high-profile campaign in disaster education in the foreseeable future. This, I suggest, is due to narratives of the German democratic nation state as secure, federal, peaceful and unified, which originated at the founding of West Germany in 1949, and continue to shape contemporary political narratives.

Transformation or bureaucratisation?: the changing role of community representation in local strategic partnerships in England

The debate about the need to build social capital and to engage local communities in public policy has become a central issue in many advanced liberal societies and developing countries. In many countries new forms of governance have emerged out of a growing realisation that representative democracy by itself is no longer sufficient. One of the most significant public policy trends in the UK has been the involvement of community organisations and their members in the delivery of national policy, mediated through local systems of governance and management. One such policy area is urban regeneration. Central government now requires local authorities in England to set up Local Strategic Partnerships (LSPs) to bring together stakeholders who can prepare Community Strategies and deliver social and economic programmes which target areas of deprivation. This paper reviews the key institutional processes which must be addressed, such as representation, accountability and transformation.

Marriage and gender inequality: work���family arrangements of Portuguese and British highly qualified women

This article examines work���family reconciliation processes in order to understand if, over the course of marital life, women become socially closer or further away from their partner. Drawing on work���life interviews with highly qualified women in Portugal and Britain, we compare these processes in two societies with different historical and social backgrounds. Findings reveal three main configurations of social (in)equality which emerge during married life: growing inequality in favour of the man, in favour of the woman or equality between spouses. With due attention to the importance of national specific factors, we present three main conclusions. First, (in) equality is built up over the course of marital life and female strategies for reconciling family and work are at the core of this process. Second, the national specificities can mould the effects of cross-national gender mechanisms. Third, the intersection between cross-cultural phenomena such as conservative attitudes towards domestic work and national specificities (such as the availability of part-time options) is a rather complex process which needs further research.

'Team GB', 'Team England' or 'Team Scotland'? Media Representations of 'Britishness', 'Englishness' and 'Scottishness' in London 2012 and Glasgow 2014

Given the timing of the Scottish independence referendum in September 2014, the hosting of both the London 2012 Olympic Games and the Glasgow 2014 Commonwealth Games coincided with a period of considerable political turmoil and reflection within the United Kingdom. The extensive levels of public, political and media scrutiny of both of these major sporting events can therefore be framed within a wider consideration of the contemporary dynamics of the political union between the constituent nations of the UK, as well as the multifarious forms of national identities expressed within the various regions of the ���nation-state���. Despite the growing influence of social media forms within contemporary society, politics and sport within the UK, the ���traditional��� print media retain a central (although arguably diminishing) role in the dissemination of information relating to major societal, political and sporting issues to the British public. This paper will therefore critically reflect upon the nature of print media representations of ���Britishness���, ���Englishness��� and ���Scottishness��� at London 2012 and Glasgow 2014 from both London-based and Scotland-based publications, drawing upon empirical data from completed and ongoing doctoral theses from the respective authors. In particular, the implications of the contrasting competitive structures of each event will be considered, given the symbolic differences between the unitary ���Team GB��� at the London 2012 Olympics and the separated representative teams for Scotland and England at the Glasgow 2014 Commonwealth Games.

Democracy, cosmopolitanism and national identity in a ���globalising��� world

Broadly globalising processes have been in train for centuries, but contemporary discourse about globalisation is here located within a specific historical context, particularly characterised by new forms of communications and the pressures on states produced by the decline of Keynesianism and the end of the Cold War. Coincident changes also led to a growing interest in national identities, marked not least by the founding of this journal in 1999. Globalisation, a series of processes rather than a single force, has a range of effects on states, nations and national identities, including accommodation and adaptation as well as resistance. Indeed, globalising forces, such as democratisation, are shown to require nation-building. Attempts to impose order on international society through cosmopolitan devices are arguably more inimical to national identities. As with nations, cosmopolitanism involves an imagined community. Because this necessarily exists outside time, the building of a sense of trust and commonality across people and territory is however more challenging. Without popular ownership, it is argued, cosmopolitanism is often more likely to appear a threat than a boon. Building a global civil society, or indeed local democracies, is also unlikely when so many societies still lack local versions anchored in some form of national identity.

Introducing EbolaCheck: potential for point-of-need infectious disease diagnosis

The 2013���2015 Ebolavirus disease humanitarian crisis has spurred the development of laboratory-free, point-of-care nucleic acid testing solutions. EbolaCheck is an international consortium of public health, academic and biotechnology industry stakeholders aiming to deliver clinical molecular diagnostic standard-of-care testing suitable for the West African milieu within 12 months. In this article, the current status of the EbolaCheck platform is discussed in the context of the current regulatory framework. Presented here are future goals to achieve differential diagnosis of hemorrhagic fever disease from <5-��l of whole blood samples or mucosal biofluids, in a single tube process, under 40 min and with minimal operator training requirements.

National Policies for Local Urban Sustainability: A New Governance Approach?

Cities have become a focal point for efforts to transition towards a more sustainable, low-carbon society, with many municipal agencies championing ���eco city��� initiatives of one kind or another. And yet, national policy initiatives frequently play an important ��� if sometimes overlooked ��� role, too. This chapters provides comparative perspectives on four recent national sustainable city programmes from France, India, Japan, and the United Kingdom. The analysis reveals two key insights: first, national policy is found to exercise a strong shaping role in what sustainable development for future cities is understood to be, which helps explain the considerable differences in priorities and approaches across countries. Second, beyond articulating strategic priorities, national policy may exercise a ���soft��� governance function by incentivising and facilitating wider, voluntary governance networks in the effort to implement sustainable city projects locally. This innovative role, however, depends on the ability of national policy to produce resonance among societal actors and on its effective interaction with formal planning processes.

Assessing the influence of the Responsibility to Protect on the UN Security Council during the Arab Spring

This article challenges those perspectives which assert first, that the Security Council���s engagement with the Responsibility to Protect (R2P) during the Arab Spring evidences a generally positive trend, and second, that the response to the Arab Spring, particularly Syria, highlights the need for veto restraint. With respect to the first point, the evidence presented in this article suggests that the manner in which R2P has been employed by the Security Council during this period evidences three key trends: first, a willingness to invoke R2P only in the context of Pillar I; second, a pronounced lack of consensus surrounding Pillar III; and third, the persistent prioritisation of national interests over humanitarian concerns. With respect to veto restraint, this article argues that there is no evidence that this idea will have any significant impact on decision-making at the Security Council; the Council���s response to the Arab Spring suggests that national interests continue to trump humanitarian need.