Alternative Care and Children’s Rights in Northern Ireland

This report covers the rights of the most vulnerable children in Northern Ireland who cannot be cared for within their own family. The purpose of the report is to review the current provision and circumstances facing such children and young people and how international human rights standards can offer protection and support.

The inclusion of open-ended questions on quantitative surveys of children: Dealing with unanticipated responses relating to child abuse and neglect

Web surveys have been shown to be a viable, and relatively inexpensive, method of data collection with children. For this reason, the Kids’ Life and Times (KLT) was developed as an annual online survey of 10 and 11 year old children. Each year, approximately 4,000 children participate in the survey. Throughout the six years that KLT has been running, a range of questions has been asked that are both policy-relevant and important to the lives of children. Given the method employed by the survey, no extremely sensitive questions that might cause the children distress are included. The majority of questions on KLT are closed yielding quantitative data that are analysed statistically; however, one regular open-ended question is included at the end of KLT each year so that the children can suggest questions that they think should be asked on the survey the following year. While most of the responses are innocuous, each year a small minority of children suggest questions on child abuse and neglect. This paper reports the responses to this question and reflects on how researchers can, and should, deal with this issue from both a methodological and an ethical perspective.

The Rule of the Land

A study of Ireland's border.

Influence of tropical easterlies in southern Africa's winter rainfall zone during the Holocene

South Africa's southwestern Cape occupies a critical transition zone between Southern Hemisphere temperate (winter) and tropical (summer) moisture-bearing systems. In the recent geological past, it has been proposed that the relative influence of these systems may have changed substantially, but little reliable evidence regarding regional hydroclimates and rainfall seasonality exists to refine or substantiate the understanding of long-term dynamics. In this paper we present a mid-to late Holocene multi-proxy record of environmental change from a rock hyrax midden from Katbakkies Pass, located along the modern boundary between the winter and summer rainfall zones. Derived from stable carbon and nitrogen isotopes, fossil pollen and microcharcoal, these data provide a high resolution record of changes in humidity, and insight into changes in rainfall seasonality. Whereas previous work concluded that the site had generally experienced only subtle environmental change during the Holocene, our records indicate that significant, abrupt changes have occurred in the region over the last 7000 years. Contrary to expectations based on the site's location, these data indicate that the primary determinant of changes in humidity is summer rather than winter rainfall variability, and its influence on drought season intensity and/or length. These findings are consistent with independent records of upwelling along the southern and western coasts, which indicate that periods of increased humidity are related to increased tropical easterly flow. This substantially refines our understanding of the nature of temperate and tropical circulation system dynamics in SW Africa, and how changes in their relative dominance have impacted regional environments during the Holocene. 

Evolving southwest African response to abrupt deglacial North Atlantic climate change events

Climate change during the last deglaciation was strongly influenced by the „bipolar seesaw‟, producing antiphase climate responses between the North and South Atlantic. However, mounting evidence demands refinements of this model, with the occurrence of abrupt events in southern low to mid latitudes occurring in-phase with North Atlantic climate. Improved constraints on the north-south phasing and spatial extent of these events are therefore critical to
understanding the mechanisms that propagate abrupt events within the climate system. We present a 19,400 year multi-proxy record of climate change obtained from a rock hyrax midden in southernmost Africa. Arid anomalies in phase with the Younger Dryas and 8.2 ka events are apparent, indicating a clear shift in the influence of the bipolar seesaw, which diminished as the Earth warmed, and was succeeded after ~14.6 ka by the emergence of a dominant interhemispheric atmospheric teleconnection.

A systematic review of population based epidemiological studies in Myasthenia Gravis

Background: The aim was to collate all myasthenia gravis (MG) epidemiological studies including AChR MG and MuSK MG specific studies. To synthesize data on incidence rate (IR), prevalence rate (PR) and mortality rate (MR) of the condition and investigate the influence of environmental and technical factors on any trends or variation observed.

Methods: Studies were identified using multiple sources and meta-analysis performed to calculate pooled estimates for IR, PR and MR.

Results: 55 studies performed between 1950 and 2007 were included, representing 1.7 billion population-years. For All MG estimated pooled IR (eIR): 5.3 per million person-years (C.I.: 4.4, 6.1), range: 1.7 to 21.3; estimated pooled PR: 77.7 per illion persons (C.I.: 64.0, 94.3), range 15 to 179; MR range 0.1 to 0.9 per millions person-years. AChR MG eIR: 7.3 (C.I.: 5.5, 7.8), range: 4.3 to 18.0; MuSK MG IR range: 0.1 to 0.32. However marked variation persisted between populations studied with similar methodology and in similar areas.

Conclusions: We report marked variation in observed frequencies of MG. We show evidence of increasing frequency of MG with year of study and improved study quality. This probably reflects improved case ascertainment. But other factors must also influence disease onset resulting in the observed variation in IR across geographically and genetically similar populations.

A patient perspective of pharmacist prescribing: 'crossing the specialisms-crossing the illnesses'

Background: The drive for non-medical prescribing has progressed quickly since the late 1990s and involves a range of healthcare professionals including pharmacists. As part of a commissioned research project, this qualitative element of a larger case study focused on the views of patients of pharmacist prescribers. 

Objective: The aim of this study was to explore patients' perspectives of pharmacists as prescribers. 

Methods: Three pharmacists working as independent prescribers in the clinical areas of (i) hypertension, (ii) cardiovascular/diabetes management, (iii) anticoagulation were recruited to three case studies of pharmacist prescribing in Northern Ireland. One hundred and five patients were invited to participate in focus groups after they had been prescribed for by the pharmacist. Focus groups took place between November 2010 and March 2011 (ethical/governance approvals granted) were audio taped, transcribed verbatim, read independently by two authors and analysed using constant comparative analysis. 

Results: Thirty-four patients agreed to participate across seven focus groups. Analysis revealed the emergence of one overarching theme: team approach to patient care. A number of subthemes related to the role of the pharmacist, the role of the doctor and patient benefits. There was an overwhelming lack of awareness of pharmacist prescribing. Patients discussed the importance of a multidisciplinary approach to their care and recognized limitations of the current model of prescribing. 

Conclusion: Patients were positive about pharmacist prescribing and felt that a team approach to their care was the ideal model especially when treating those with more complex conditions. Despite positive attitudes, there was a general lack of awareness of this new mode of practice.

Community Sanctions and Measures

This chapter explores the use of community sanctions in the Republic of Ireland and in Northern Ireland. It locates this discussion within a wider international landscape, where the numbers of people subject to supervision in the community has risen markedly. It explores some of the reasons for this growth alongside the rationalities that are deployed to promote the use of community sanctions over time. The differing trajectories of the two jurisdictions in respect of the evolution and use of community sanctions are explored, as are some of the factors that explain areas of divergence and commonality. The chapter concludes by critically considering penal reductionism as a point of policy convergence in the two jurisdictions.