Successful second unrelated donor BMT in a child with juvenile chronic myeloid leukaemia:documentation of chimaerism using the polymerase chain reaction

A 3-year old child with juvenile chronic myeloid leukaemia received a T cell-depleted BMT from a male unrelated donor. There was early graft failure associated with increasing splenomegaly and hypersplenism. Splenectomy was performed 53 days post-transplant and was followed by autologous marrow recovery with return of leukaemia. A second unrelated donor BMT was performed 9 months later using T cell-replete marrow from a similarly matched female donor. Grade 2 GVHD involving the skin and gut responded to treatment with steroids. Chimaerism was assessed using Y-specific polymerase chain reaction (PCR) and microsatellites. Samples taken at the time of splenectomy showed no donor marrow engraftment but there was significant engraftment in the spleen. Following the second transplant, donor-type haematopoiesis was documented using a panel of microsatellite probes. The patient remains well 6 months after transplant. Splenectomy should be considered prior to transplant in patients with significant splenomegaly and hypersplenism. Partial chimaerism in the spleen, but not bone marrow, post-BMT, has not previously been documented. PCR technology is a useful and highly sensitive way to assess chimaerism post-BMT and is informative in sex-matched cases, whilst the small amount of material required is advantageous in paediatric patients.

Childhood, Rights and Justice in Northern Ireland

Building on primary research and previous publications (Haydon, 2012; Haydon, 2014; Haydon and Scraton, 2008; McAlister, Scraton and Haydon, 2009; Scraton and Haydon, 2002), this chapter will provide a critical analysis of children’s rights and youth justice in Northern Ireland. More broadly, it will consider recent research concerning the criminalisation of children and young people in the United Kingdom and profound concerns regarding the policing and regulation of children raised in successive concluding observations about the UK Government’s implementation of the UN Convention on the Rights of the Child (UN Committee on the Rights of the Child, 1995, 2002, 2008). From this generic context, the chapter will map the ‘particular circumstances’ of Northern Ireland - a discrete legal jurisdiction to which powers for justice and policing were devolved only in 2010. Emerging from four decades of conflict and progressing through an uneasy ‘peace’, rights-based institutions and enabling legislation have, in principle, promoted and protected human rights. Yet children and young people living in communities marginalised by poverty and the legacy of conflict continue to experience inconsistent formal regulation by the police and the criminal justice system, while enduring often brutal informal regulation by paramilitaries. The chapter will explore evident tensions between the dynamics of criminalisation and promotion/ protection of children’s rights in a society transitioning from conflict. Further, it will analyse the challenges to securing children’s rights principles and provisions within a hostile political and ideological context, arguing for a critical rights-based agenda that promotes social justice through rights compliance together with policies and practices that address the structural inequalities faced by children and young people.

Perceptions of high involvement work practices and burnout: investigating the mediating role of procedural justice and role overload and the moderating role of colleague support

Purpose
The purpose of this paper is to investigate the impact of employees’ perceptions of high involvement work practices (HIWPs) on burnout (emotional exhaustion and depersonalisation) via the mediating role of role overload and procedural justice. Further, perceived colleague support was hypothesised to moderate the effects of role overload and procedural justice on these outcomes.

Design/Methodology
The study was conducted on a random sample of unionised registered nurses (RNs) working in the Canadian public health care sector, stratified by mission and size of the institution to ensure representativeness. Of the 6546 nurses solicited, 2174 returned a completed questionnaire, resulting in a response rate of 33.2%. To test our hypotheses we conducted structural equation modelling (SEM) in Mplus version 6.0 (Muthen and Muthen, 1998 – 2010) with Maximum Likelihood (ML) estimation.

Results
The results showed that procedural justice and role overload fully mediated the influence of HIWPs on burnout. Moreover, colleague support moderated the effects of procedural justice and role overload on emotional exhaustion but not depersonalisation.

Limitations
The study used a cross-sectional research design and is conducted among one occupational group (i.e. nurses).

Research/Practical Implications
The findings question the dark side of HRM in the health care context. They also contribute to the lack of theoretical and empirical work dedicated to understanding the ‘black box’ problem (Castanheira and Chambel, 2010).

Originality/Value
The study employs a well-known theoretical perspective from the occupational health psychology literature to the HR field in order to contribute to the lack of theorising in the HR-well-being link.

Methotrexate polyglutamates as a potential marker of adherence to long-term therapy in children with juvenile idiopathic arthritis and juvenile dermatomyositis: an observational, cross-sectional study

Introduction: Methotrexate (MTX) is a cornerstone of treatment in a wide variety of inflammatory conditions, including juvenile idiopathic arthritis (JIA) and juvenile dermatomyositis (JDM). However, owing to its narrow therapeutic index and the considerable interpatient variability in clinical response, monitoring of adherence to MTX is important. The present study demonstrates the feasibility of using methotrexate polyglutamates (MTXPGs) as a biomarker to measure adherence to MTX treatment in children with JIA and JDM.
Methods: Data were collected prospectively from a cohort of 48 children (median age 11.5 years) who received oral or subcutaneous (SC) MTX therapy for JIA or JDM. Dried blood spot samples were obtained from children by finger pick at the clinic or via self- or parent-led sampling at home, and they were analysed to determine the variability in MTXPG concentrations and assess adherence to MTX therapy.
Results: Wide fluctuations in MTXPG total concentrations (>2.0-fold variations) were found in 17 patients receiving stable weekly doses of MTX, which is indicative of nonadherence or partial adherence to MTX therapy. Age (P = 0.026) and route of administration (P = 0.005) were the most important predictors of nonadherence to MTX treatment. In addition, the study showed that MTX dose and route of administration were significantly associated with variations in the distribution of MTXPG subtypes. Higher doses and SC administration of MTX produced higher levels of total MTXPGs and selective accumulation of longer-chain MTXPGs (P < 0.001 and P < 0.0001, respectively).
Conclusions: Nonadherence to MTX therapy is a significant problem in children with JIA and JDM. The present study suggests that patients with inadequate adherence and/or intolerance to oral MTX may benefit from SC administration of the drug. The clinical utility of MTXPG levels to monitor and optimise adherence to MTX in children has been demonstrated.Trial Registration: ISRCTN Registry identifier: ISRCTN93945409 . Registered 2 December 2011.

Rethinking Prison Disciplinary Processes: A Potential Future for Restorative Justice

The movement for restorative justice (RJ) has struggled with marginalization on the soft end of the criminal justice system where the threat of net widening and iatrogenesis looms large. To realize the full potential of RJ as an alternative philosophy of justice, restorative practices need to expand beyond the world of adolescent and small-level offences into the deeper end of the justice system. Disciplinary hearings inside of adult prisons may be a strategic space to advance this expansion. This paper presents findings from a study of prison discipline in four UK prisons. The findings strongly suggest that in their current form, such disciplinary proceedings are viewed by prisoners as lacking in legitimacy. Although modelled after the adversarial system of the criminal court, the adjudications were instead universally derided as ‘kangaroo courts’, lacking in the basic elements of procedural justice. Based on these findings, we argue that restorative justice interventions may offer a viable redress to these problems of legitimacy which, if successful, would have ramifications that extend well beyond the prison walls.

Good Practice in Achieving Best Evidence Interview with Child Witnesses in Northern Ireland – Criminal Justice Perspectives

This report outlines the findings from a research project examining what works well in investigative interviews (ABE interviews) with child witnesses in Northern Ireland. The project was developed in collaboration with key stakeholders and was joint funded by the Department of Justice NI, NSPCC, SBNI and PSNI. While there is substantial a research literature examining the practice of forensic interview both internationally and within the UK there has been little in the way of exploration of this issue in Northern Ireland. Equally, the existing literature has tended to focus on a ‘deficit’ approach, identifying areas of poor practice with limited recognition of the practical difficulties interview practitioners face or what works well for them in practice. This study aimed to address these gaps by adopting an ‘appreciative inquiry’ approach to explore stakeholder perspectives on what is working well within ABE current practice and identify what can be built on to deliver optimal practice.

Northern Ireland: Religion and Transitional Justice

The right to practice religion is recognised as one of the universal liberties transitional justice interventions are designed to defend, and religion is often mentioned as one of the cultural factors that impact on local transitional justice practices from below. Many human rights cases of abuse, however, are motivated by religious extremism and the association of religion with conflict has largely a discouraged reflection on its positive contribution to transitional justice. This field is undeveloped and the little work that elaborates its positive role is descriptive. This paper theorises the relationship between religion and transitional justice and develops a model for understanding its potential role that better allows an assessment of its strengths and weaknesses. The model is applied to original research conducted on ex-combatants in Northern Ireland, and concludes that only in very limited circumstances can religious actors make a telling contribution to transitional justice.Understanding what these circumstances are is the purpose of the model developed here.

Complementarity’s monopoly on justice in Uganda: the International Criminal Court, victims and Thomas Kwoyelo

Complementarity has been extolled as the pioneering way for the International Criminal Court (ICC) to navigate the difficulties of state sovereignty when investigating and prosecuting international crimes. Victims have often been held up to justify and legitimise the work of the ICC and states complementing the Court through domestic processes. This article examines how Uganda has developed its laws, legal procedure, and accountability for international crimes over the past decade. This has culminated in the trial of Thomas Kwoyelo, which after five years of proceedings, has yet to move to the trial phase, due to the issue of an amnesty. While there has been a profusion of provisions to allow victims to participate, avail of protection measures and reparations, in practice very little has changed for them. This article highlights the dangers of complementarity being the sole solution to protracted conflicts, in particular the realisation of victims’ rights.

Carbon Sink Conservation and Global Justice: Benefiting, Free Riding and Non-Compliance

It is often assumed that in order to avoid the most severe consequences of global anthropogenic climate change we have to preserve our existing carbon sinks, such as for instance tropical forests. Global carbon sink conservation raises a host of normative issues, though, since it is debatable who should pay the costs of carbon sink conservation, who has the duty to protect which sinks, and how far the duty to conserve one’s carbon sinks actually extends, especially if it conflicts with other duties one might have. According to some, forested states like Ecuador have a duty to preserve their tropical forests while the rich states of the global North have a duty of fairness to compensate states like Ecuador for the costs they incur. My aim in this paper is to critically analyse this standard line of argument and to criticise its validity both internally (i.e. with regard to its normative conclusion based on its premises) and externally (i.e. with regard to the argument’s underlying assumptions and its lack of contextualisation). As I will argue, the duty to conserve one’s forests is only a particular instantiation of a wider, more general duty to contribute towards global climate justice for which the context in which one operates (e.g. whether other agents are complying with their duties of global climate justice or not) matters significantly.