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Summary: Idelalisib (IDL) is an oral first‐in‐class phosphatidylinositol 3‐kinase delta (PI3Kδ) inhibitor approved for chronic lymphocytic leukaemia (CLL) alongside rituximab (R) since 2014. However, little data exist on routine practice. The RETRO‐idel was a protocol‐led, retrospective study of 110 patients [n = 27 front‐line (1L)] who received IDL‐R. The primary end‐point was clinical overall response rate (ORR). The median (range) follow‐up of the whole cohort was 30·2 (0·1–51·9) months. The median (range) age was 72 (48–89) years. Tumour protein p53‐disruption was common [100% 1L, 32·5% relapsed/refractory (R/R)]. The best ORR (intention‐to‐treat) was 88·2% (1L 96·3%, R/R 85·5%). Overall, the median event‐free survival (mEFS) was 20·3 months and time‐to‐next treatment was 29·2 months. The mEFS for 1L patients was 18·7 months and R/R patients was 21·7 months. The 3‐year overall survival was 56·1% (95% confidence interval 45·7–65·3). IDL was discontinued in 87·3% (n = 96). More patients discontinued due to adverse events in the front‐line setting (1L 63·0% vs. R/R 44·6%) and due to progressive disease in R/R patients (20·5% vs. 3·7% in 1L). Lower respiratory tract infection/pneumonia were reported in 34·5% (Grade ≥3, 19·1%), diarrhoea in 30·9% (Grade ≥3, 6·4%), and colitis in 9·1% (Grade ≥3, 5·5%). Overall, these data describe clear efficacy for IDL‐R in routine practice. No new safety signals were identified, although careful management of known toxicities is required. [ABSTRACT FROM AUTHOR]

Background: Evidence suggests specialist eating disorders services for children and adolescents with anorexia nervosa have the potential to improve outcomes and reduce costs through reduced hospital admissions. This study aimed to evaluate the cost-effectiveness of assessment and diagnosis in community-based specialist child and adolescent mental health services (CAMHS) compared to generic CAMHS for children and adolescents with anorexia nervosa. Method: Observational, surveillance study of children and adolescents aged 8 to 17, in contact with community-based CAMHS in the UK or Republic of Ireland for a first episode of anorexia nervosa. Data were reported by clinicians at baseline, 6 and 12-months follow-up. Outcomes included the Children's Global Assessment Scale (CGAS) and percentage of median expected body mass for age and sex (%mBMI). Service use data included paediatric and psychiatric inpatient admissions, outpatient and day-patient attendances. A joint distribution of incremental mean costs and effects for each group was generated using bootstrapping to explore the probability that each service is the optimal choice, subject to a range of values a decision-maker might be willing to pay for outcome improvements. Uncertainty was explored using cost-effectiveness acceptability curves. Results: Two hundred ninety-eight children and adolescents met inclusion criteria. At 12-month follow-up, there were no significant differences in total costs or outcomes between specialist eating disorders services and generic CAMHS. However, adjustment for pre-specified baseline covariates resulted in observed differences favouring specialist services, due to significantly poorer clinical status of the specialist group at baseline. Cost-effectiveness analysis using CGAS suggests that the probability of assessment in a specialist service being cost-effective compared to generic CAMHS ranges from 90 to 50%, dependent on willingness to pay for improvements in outcome. Conclusions: Assessment in a specialist eating disorders service for children and adolescents with anorexia nervosa may have a higher probability of being cost-effective than assessment in generic CAMHS. Trial registration: ISRCTN12676087. Date of registration 07/01/2014. Plain English summary: Specialist eating disorders services may improve outcomes and reduce hospitalisations for children and adolescents with anorexia nervosa. Reductions in hospitalisation could save money for the NHS and are better for young people because hospitalisation disrupts their home life, social life and education. This study evaluated outcomes and costs of specialist eating disorders services compared to general child and adolescent mental health services (CAMHS) for children and adolescents with anorexia nervosa. Children and adolescents were identified by contacting child and adolescent psychiatrists in the UK and Ireland and asking them to report any new cases of anorexia nervosa. These psychiatrists identified 298 young people aged 8 to 17 with an anorexia nervosa diagnosis for the first time. The psychiatrists provided information on the health services these young people used and how they were doing when they were first diagnosed and 6 months and 1 year later. Children and adolescents in specialist services were more severely ill than those in CAMHS when they were first diagnosed. Despite this, care for the young people in specialist services cost about the same as for those diagnosed in CAMHS, and their outcomes after 1 year were similar. This work showed that specialist services may be better value for money than CAMHS. [ABSTRACT FROM AUTHOR]

To evaluate the current clinical practice of quantifying ductions and fields of BSV in the UK and Ireland using an online questionnaire. An anonymous online questionnaire with twenty–one questions was distributed in February 2019 via the British and Irish Orthoptic Society (BIOS) members' newsletter. Objectives were to investigate: methods used, frequency of assessment, limiting factors and opinions of importance. Informed consent was gained to include the responses in the study. The data was analyzed using descriptive statistics and Wilcoxon Signed Ranks Testing. The questionnaire was completed by 105 orthoptists. The methods reported to quantify ductions and fields of BSV respectively were: Goldmann (33% and 34%), Aimark (22 and 23%), Lister (7%), Octopus (5 and 4%), Thomson ocular motility analyzer (2 and 3%), Binocular vision analyzer (2%) and no method reported (30% and 32%). The frequency of measuring ductions and fields of BSV per week (median 1–2) was significantly less than the number of patients seen with limited ocular motility per week (median 6–9). The main reasons for never or rarely measuring ductions or fields of BSV were not enough time, no method available and only on selected patients. Respondents indicated that they would measure ductions and fields of BSV more frequently if a quicker portable method was available (median 3–5 times per week). Most agreed that measurements of ductions and fields of BSV are important (89 and 95% respectively). There is no standardized method of quantitively measuring ductions or fields of BSV, with almost a third of respondents not measuring either. Although most orthoptists agreed these measurements are important, they are infrequently performed. The main factors limiting these assessments are insufficient time and lack of a testing method. If a faster portable device was available, orthoptists would measure ductions and fields of BSV more frequently. [ABSTRACT FROM AUTHOR]

Aim: To describe variation in the initial management of children presenting to Emergency Departments (ED) with coins lodged in the oesophagus. To determine the usage of hand-held metal detectors (HHMDs) in EDs, including their role in clinical decision-making, and training in their use.Methods: Online multicentre cross-sectional survey of EDs in the UK and Ireland, with results described using descriptive statistics.Results: Fifty-five (90%) of 61 sites responded. The two main strategies described for lodged oesophageal coins were endoscopic removal or observation with reassessment, dependent on location. For coins in the proximal third of the oesophagus 43/55 (78.2%) referred for endoscopic removal, 6/55 (10.9%) observed and the remaining 10.9% used a variety of methods, including: Foley catheter removal with fluoroscopy, blind Foley catheter removal, referral to paediatric surgery/ENT. Thirty (55%) of 55 used HHMDs, 21/30 (70%) had guidelines for their use, and 3/30 (10%) provided formal training. Twenty (67%) of 30 used the xiphisternum as the anatomical cut-off for assuming safe passage of metallic foreign bodies (FB) beyond the lower oesophageal sphincter.Conclusions: There is considerable variation in the management of oesophageal coins in children, though two dominant strategies were identified. As endoscopy is significantly more invasive than observation, future research should aim to determine whether either is more effective and safer in children. There is a clear division in departmental adoption of HHMDs. However, in those sites using HHMDs there was little formal training in their use, and there are large variations in techniques and their role in clinical decision-making. [ABSTRACT FROM AUTHOR]

There are two Irish countries on the Island of Ireland, one is independent and the other is dependent on the United Kingdom (UK). These two countries have been integrated for half a century to the extent permitted by the integration opportunities provided by the European Union (EU) membership. However, after the Brexit referendum held in June 2016, the UK has finally decided to withdraw from the EU. The Brexit referendum has produced a result that reflects the will to remain within the EU for Northern Ireland, which is affiliated to the United Kingdom, and therefore to maintain the status of integration within the Union with the Republic of Ireland. This result was the beginning of a new era for the British countries, which have been together under the roof of the EU for a long time. As a result of the referendum, as the Scottish people's decisive will to remain in the EU rather like the Northern Ireland, displayed a trend that contradicts the withdrawal decision that emerged with a slight difference across the UK. Thus, the longstanding independence debates in these two countries came to the fore again. The fact that the Brexit referendum was carried out with a centralist tendency and an imposing propaganda process reflecting the British hegemony has been a factor that fueled these discussions. In the case of Northern Ireland, this process is also supported by the driving force of the will to remain in the EU and makes the option of uniting with the Republic of Ireland that would put an end to the historical division in the Island of Ireland, more possible and predictable than ever before. However, it is not possible to consider this option independently of the establishment and multilayered political dynamics in the UK. Taking the historical background of the Irish Question and the new conditions created by the post-Brexit process into account, the possibility for the unification of the two Ireland is discussed in this study, within the context of both the future of the UK and the dynamics affecting this possibility through the EU level. [ABSTRACT FROM AUTHOR]

In UK forestry, the synthetic pyrethroid insecticides alpha-cypermethrin and cypermethrin have been used for many years to provide protection for young trees from damage by the large pine weevil, Hylobius abietis L. However, concerns over the toxicity of these insecticides has led to a search for alternatives. In our work, applications of 0.037 g.a.i.stem–1 acetamiprid provided high levels of protection from Hylobius browsing, comparable to alpha-cypermethrin or cypermethrin, and without causing phytotoxicity. However, re-application is likely to be required in the second growing season after planting. Our research identified that acetamiprid treated trees can be safely cold stored as part of normal nursery practice. Acetamiprid is less toxic than synthetic pyrethroids. We also found that pre-treating trees with 0.016 g.a.i.stem–1 chlorantraniliprole, a relatively low toxicity insecticide, can be equally effective in protecting trees, and that dye markers can be safely used to help target spays. Our testing of physical barriers such as MultiPro®, and to a lesser extent Kvaae® wax, suggests they may have a role as a partial substitute for the use of insecticides in some circumstances in the UK and Ireland, but only as part of an integrated approach where on-site populations of Hylobius are predicted to be low. [ABSTRACT FROM AUTHOR]

Background In responding to Covid-19, governments have tried to balance protecting health while minimizing gross domestic product (GDP) losses. We compare health-related net benefit (HRNB) and GDP losses associated with government responses of the UK, Ireland, Germany, Spain and Sweden from UK healthcare payer perspective. Methods We compared observed cases, hospitalizations and deaths under 'mitigation' to modelled events under 'no mitigation' to 20 July 2020. We thus calculated healthcare costs, quality adjusted life years (QALYs), and HRNB at £20,000/QALY saved by each country. On per population (i.e. per capita) basis, we compared HRNB with forecast reductions in 2020 GDP growth (overall or compared with Sweden as minimal mitigation country) and qualitatively and quantitatively described government responses. Results The UK saved 3.17 (0.32–3.65) million QALYs, £33 (8–38) billion healthcare costs and £1416 (220–1637) HRNB per capita at £20,000/QALY. Per capita, this is comparable to £1455 GDP loss using Sweden as comparator and offsets 46.1 (7.1–53.2)% of total £3075 GDP loss. Germany, Spain, and Sweden had greater HRNB per capita. These also offset a greater percentage of total GDP losses per capita. Ireland fared worst on both measures. Countries with more mask wearing, testing, and population susceptibility had better outcomes. Highest stringency responses did not appear to have best outcomes. Conclusions Our exploratory analysis indicates the benefit of government Covid-19 responses may outweigh their economic costs. The extent that HRNB offset economic losses appears to relate to population characteristics, testing levels, and mask wearing, rather than response stringency. [ABSTRACT FROM AUTHOR]

This article explores John Wesley's relationship both to Ireland and to the Roman Catholic faith and argues that Wesley's reputation as a proto‐ecumenist needs to become more muted and less idealised. Many in Ireland drew the intellectual content of their grievances against British rule from the rhetoric of liberty employed to support the Americans. Wesley's opposition to the rebellion of the colonists, as well as his support for the Church of Ireland and the Protestant landed gentry weakened the appeal of his message to the Catholic Irish. Wesley's ministry among the Pietist diaspora communities in Ireland, shows that he preferred their form of piety to that of the Catholic population. Wesley's anti‐Catholic sentiment was in keeping with widely‐held fears about Catholicism as a threat to Protestant liberty, and is considered here in the context of the rising strength of the Irish Catholic population in England and corresponding Acts to grant them greater liberties from the late 1770s. Wesley's support for the Protestant Association and the false accusation that he was an instigator of the 1780 Gordon Riots, his numerous anti‐Catholic pamphlets, and his correspondence with the Irish Capuchin monk Arthur O'Leary bring together an outline of Wesley's approach to Roman Catholicism which he saw as both a false religion and a threat to Britain's role as a global Protestant power. [ABSTRACT FROM AUTHOR]

Perinatal autopsy rates have declined significantly in recent decades. There is a lack of consensus concerning the potential religious influences for bereaved parents in their decision making process for post-mortem. This online study of British and Irish maternity healthcare chaplains explored their understanding of general and local perinatal post-mortem procedures and their experiences in the support of parents. Participants included Christian, Muslim and non-faith chaplains. No chaplain identified any religious prohibition to perinatal post-mortem. A majority of chaplains reported that they had been asked about post-mortem by parents; only a minority felt adequately prepared. A key recommendation is that following appropriate training chaplains may be well placed to support colleagues and parents during the decision making process. [ABSTRACT FROM AUTHOR]

Predicting how populations may respond to climate change and anthropogenic pressures requires detailed knowledge of demographic traits, such as survival and reproduction. However, the availability of these data varies greatly across space and taxa. Therefore, it is common practice to conduct population assessments by filling in missing values from surrogate species or other populations of the same species. Using these independent surrogate values concurrently with observed data neglects the life‐history trade‐offs that connect the different aspects of a population's demography. Consequently, this approach introduces biases that could ultimately lead to erroneous management decisions.We use a Bayesian hierarchical framework to combine fragmented multi‐population data with established life‐history theory and reconstruct population‐specific demographic data across a substantial part of a species breeding range. We apply our analysis to a long‐lived colonial species, the black‐legged kittiwake Rissa tridactyla, that is classified as globally Vulnerable and is highly threatened by increasing anthropogenic pressures, including offshore renewable energy development. We then use a projection analysis to examine how the reconstructed demographic parameters may improve population assessments, compared to models that combine observed data with independent surrogate values.Demographic parameters reconstructed using a hierarchical framework can be utilised in a range of population modelling approaches. They can also be used as reference estimates to assess whether independent surrogate values are likely to over or underestimate missing demographic parameters. We show that surrogate values from independent sources are often used to fill in missing parameters that have large potential demographic impact, and that resulting biases are driven in unpredictable directions thus precluding assessments from being consistently precautionary.Synthesis and applications. Our study dramatically increases the spatial coverage of population‐specific demographic data for black‐legged kittiwakes. The reconstructed demographic parameters presented can also be used immediately to reduce uncertainty in the consenting process for offshore wind development in the United Kingdom and Ireland. More broadly, we show that the reconstruction approach used here provides a new avenue for improving evidence‐based management and policy action for animal and plant populations with fragmented and error prone demographic data. [ABSTRACT FROM AUTHOR]

Summary: The objective of this study was to determine the effect of temperature on whole milk density measured at four different temperatures: 5, 10, 15, and 20 °C. A total of ninety‐three individual milk samples were collected from morning milking of thirty‐two Holstein Friesian dairy cows, of national average genetic merit, once every two weeks over a period of 4 weeks and were assessed by Fourier transform infrared spectroscopy for milk composition analysis. Density of the milk was evaluated using two different analytical methods: a portable density meter DMA35 and a standard desktop model DMA4500M (Anton Paar GmbH, UK). Milk density was analysed with a linear mixed model with the fixed effects of sampling period, temperature and analysis method; triple interaction of sampling period x analysis method x temperature; and the random effect of cow to account for repeated measures. The effect of temperature on milk density (ρ) was also evaluated including temperature (t) as covariate with linear and quadratic effects within each analytic method. The regression equation describing the curvature and density–temperature relationship for the DMA35 instrument was ρ = 1.0338−0.00017T−0.0000122T2 (R2 = 0.64), while it was ρ = 1.0334 + 0.000057T−0.00001T2 (R2 = 0.61) for DMA4500 instrument. The mean density determined with DMA4500 at 5 °C was 1.0334 g cm−3, with corresponding figures of 1.0330, 1.0320 and 1.0305 g cm−3 at 10, 15 and 20 °C, respectively. The milk density values obtained in this study at specific temperatures will help to address any bias in weight–volume calculations and thus may also improve the financial and operational control for the dairy processors in Ireland and internationally. [ABSTRACT FROM AUTHOR]

Introduction At all ages, randomised trials demonstrate lower mortality and cardiovascular disease incidence with blood pressure (BP) lowering. However, this may not generalise to older people with frailty. We aimed to determine the acceptability to clinicians of key aspects of trial designs using different BP targets and strategies to better manage hypertension in the context of frailty. Methods We conducted a multinational survey of clinicians managing hypertension in older people, distributed using an online survey link amongst professional societies and social networks. Questions described case histories of patients who were frail with different systolic blood pressures (SBP), treatment target, strategy and target trial population. Results In total, 114 responses were received (48 primary care, 66 secondary care). A majority would consider recruiting patients to a trial of relaxing treatment in those whose SBP < 130 mm Hg; a majority would consider recruiting to a trial intensifying treatment in patients with SBP > 150 mm Hg. Respondents elected to intensify treatment by: choosing the next step by NICE guidelines, adding a new treatment agent at full dose, or adding two agents at half dose. Conclusion A majority of clinicians surveyed would recruit older people to a trial intensifying treatment where SBP is more than 150 mm Hg and where patients have high cardiovascular risk or to a trial relaxing treatment where the SBP is below 130 mm Hg and where the patient has frailty. [ABSTRACT FROM AUTHOR]

EMERGING EVIDENCE FOR EARLY MEDIEVAL UPLAND COLONISATION IN BRITAIN AND IRELAND When we broaden the perspective out to the whole of Britain and to Ireland, the temporal correlation between upland colonisation and the population growth and temperature increases c 850-1300 becomes less clear. Graph: Fig 4 Illustration of the "pull" and "push" factors in upland colonisation in the 10th to 14th centuries, in the context of wider climate variability: A) local factors within uplands which acted as facilitative "pull" factors for new hill farms; B) regional socio-political and demographic pressures which acted as "push" factors for people to settle in uplands. PHOTO (COLOR): Fig 8 Hypothetical summary of three key long-term trends that influenced decisions to establish year-round farms in uplands and influenced the viability of these farms once established (c ad 500-1900): A) the economic value of uplands; B) population pressure to settle in uplands; and C) arable carrying capacity of uplands. The review comprises three temporal case studies: (1) "classic" early second millennium ad expansion in south-west England, and the role of pre-existing transhumant niches in upland colonisation; (2) the growing evidence for early medieval farming in uplands across Britain and Ireland, and the role of local environmental factors in this expansion; and (3) the resilience of hill farmers during the late-medieval and early modern "Little Ice Age". [Extracted from the article]

This study examined plant-based product (PBP) consumption, related motivations and barriers, and PBP attributes of importance. An online survey collected responses (n = 456) from PBP consumers and non-PBP consumers in the Republic of Ireland (ROI) and the United Kingdom (UK). Responses were analyzed using univariate statistics, binary logistic regression, and Principal Component Analysis. Females, and those living in urban areas were more likely to consume PBPs. Primary motivations for consumption were 'sustainability,' 'animal welfare' and 'health.' Barriers to consumption for non-PBP consumers were 'not seeing a need to change their diet' and 'taste.' Taste, health, and product information on the label were cited as the most important PBP attributes. Findings are of relevance to PBP manufacturers and marketers; the paper presents related recommendations for PBP marketing strategies, considers how best to target both usage segments (PBP and non-PBP consumers), and evaluates the usefulness of a usage segmentation approach for this product category. [ABSTRACT FROM AUTHOR]

Background The true frequency of hospital outbreaks of invasive group B streptococcal (iGBS; Streptococcus agalactiae) disease in infants is unknown. We used whole genome sequencing (WGS) of iGBS isolates collected during a period of enhanced surveillance of infant iGBS disease in the UK and Ireland to determine the number of clustered cases. Methods Potentially linked iGBS cases from infants with early (<7 days of life) or late-onset (7–89 days) disease were identified from WGS data (HiSeq 2500 platform, Illumina) from clinical sterile site isolates collected between 04/2014 and 04/2015. We assessed time and place of cases to determine a single-nucleotide polymorphism (SNP) difference threshold for clustered cases. Case details were augmented through linkage to national hospital admission data and hospital record review by local microbiologists. Results Analysis of sequences indicated a cutoff of ≤5 SNP differences to define iGBS clusters. Among 410 infant iGBS isolates, we identified 7 clusters (4 genetically identical pairs with 0 SNP differences, 1 pair with 3 SNP differences, 1 cluster of 4 cases with ≤1 SNP differences) of which 4 clusters were uncovered for the first time. The clusters comprised 16 cases, of which 15 were late-onset (of 192 late-onset cases with sequenced isolates) and 1 an early-onset index case. Serial intervals between cases ranged from 0 to 59 (median 12) days. Conclusions Approximately 1 in 12 late-onset infant iGBS cases were part of a hospital cluster. Over half of the clusters were previously undetected, emphasizing the importance of routine submission of iGBS isolates to reference laboratories for cluster identification and genomic confirmation. [ABSTRACT FROM AUTHOR]

There is increasing focus on the frequency of jellyfish blooms in the Northeast Atlantic because of negative interactions with humans. However, uncertainty exists as to whether perceptions of increasing bloom frequencies reflect reality due to limitations within long-term population trend data. This study, therefore, developed and applied a semi-quantitative mapping approach to visualise bloom suitability based on the physiological tolerances of seven jellyfish to ocean temperature, salinity and a prey index across the Northeast Atlantic. A 10% increase and a 10% decrease in the environmental parameters was then applied to the maps to assess model sensitivity and the potential influence of environmental change on bloom suitability. The study found that optimal physiological temperatures and salinities combined with peaks in prey abundance drove higher bloom suitability and determined distribution. Several locations predicted to be at high risk of bloom occurrence off British and Irish coasts were found to coincide with areas of high anthropogenic activity that could be impacted by blooms. In the absence of long-term datasets on jellyfish population dynamics, the results and methods developed in this study allow an understanding of historic bloom events and predictions of future populations that will be useful in informing monitoring and management. [ABSTRACT FROM AUTHOR]

Background: Surgical Hot Clinic (SHC) is an acute, ambulatory service for management provided on an outpatient basis. Following the start of global Novel Coronavirus (COVID-19) pandemic and as per the statement released by the Association of Surgeons of Great Britain and Ireland (ASGBI), we also modified our services to hybrid SHC (HSHC) by mainly providing telephonic follow-up with an occasional face-to-face (F2F) service. We conducted a service evaluation to assess the effectiveness and serviceability of HSHC during a pandemic. Methods: This service evaluation was conducted from 30th March till 26th May 2020. The pathway was developed to mostly telephonic consultation with selective face-to-face consultation at a designated area in the medical ambulatory unit. The analysis then performed using SPSS version 21. Results: As the overall attendance fell in hospital, 149 patients, including 54(36.2%) male, and 95(63.8%) females, attended SHC during COVID-19 lockdown. Out of these 149, 87(58.3%) were referred from Accident & Emergency (A&E), 2(1.3%) from GP, 9(6.04%) after scan through radiology department, while 51(34.2%) after discharge from hospital. Out of those who have telephonic consultation (n = 98), 12 patients were called in for review with either blood tests or further clinical examination. In total, only 10 out of 149 patients required admission to the hospital, for either intervention or symptomatic treatment. Conclusion: Hybrid Surgical Hot Clinic (HSHC) with both telephonic & face-to-face consultation, as per requirement, is flexible, effective and safe patient-focused acute surgical service during COVID-19 like crisis. [ABSTRACT FROM AUTHOR]

Much of the cooperation on criminal justice matters between the United Kingdom and the Republic of Ireland is based on EU level instruments. While there has been consideration of the broader impact of Brexit on the Good Friday Agreement and consensus on the need to avoid a return to a hard border between Ireland and Northern Ireland, more detailed consideration has not been given to the effect that Brexit may have on continued criminal justice cooperation across the border. This article highlights the combined risks that Brexit presents for Northern Ireland in the form of increased criminality at a time when the loss of EU police cooperation mechanisms may result in a reduction of operational capacity and the removal of the legal architecture underpinning informal cooperation. Part 1 seeks to highlight the historical context of UK-Irish cooperation in policing matters. Part 2 explores the risk that post Brexit the Irish border may become a focus for criminal activity. The risks relating to increased immigration crime, smuggling of commodities and potential rise in terrorist activities are explored. Part 3 considers how the risks of increased criminal threats are exacerbated by the loss of EU criminal justice cooperation mechanisms and how this will affect UK-Irish cooperation specifically. Consideration is particularly given to the loss of information sharing systems. Part 4 considers how loss of EU level cooperation mechanisms could be mitigated. The viability of bilateral agreements between the UK and Ireland is considered alongside ways which police cooperation can be formalised to compensate for the potential loss of EU criminal justice information sharing systems. Nordic police cooperation is considered as a potential blueprint for the UK and Ireland. [ABSTRACT FROM AUTHOR]

The Republic of Ireland and the United Kingdom have a long, close and difficult history. The most recent phase of which dates from 1998 and the conclusion of the Good Friday Agreement. Since 1921, however, there has been unique practice between Ireland and the UK as regards the transfer of accused and convicted persons from one to the other. Indeed, there has been a special and close relationship between the two in that regard; albeit one not without difficulties. In recent times EU Justice and Home Affairs measures and the Good Friday Agreement have supplemented and strengthened the relationship. These include, since January 2004, the European Arrest Warrant (EAW). The EAW has been particularly important in streamlining the extradition process between the Ireland and the UK. This phase of history and co-operation is coming to an end. The UK's membership of the EU has now ceased, and a transition period during which the UK remains part of the EAW will end on 31st December 2020. The extradition relationship between the two is therefore facing a considerable challenge. There are several options open to Ireland, the UK and the EU as a replacement. Time, political will and the interests of third states, however, may well stand in the way of the conclusion of an agreement that optimally serves the interests of all parties and criminal justice. This paper considers the origins of extradition between the UK and Ireland and the alternative methods of extradition open to the UK and Ireland after Brexit. Consideration is given to the likely operation of a Norway-Iceland style agreement and whether such an agreement will be in place by the end of the transition and, if it was, whether its terms are likely to be sufficient for the needs of Ireland and the UK. The possibility of a bilateral arrangement on extradition between Ireland and the UK is also explored. Underlying the discussion is the critical point that the future extradition relationship must retain its 'special' characteristics, and therefore maintain the trust and good will that has developed over the years and given rise to an effective extradition relationship between the two countries. In other words, the lessons of history must be remembered. [ABSTRACT FROM AUTHOR]

This paper explores select themes relating to legal culture in European criminal justice post-Brexit by focusing on aspects of the common law trial process in the Irish courts. The incorporation of EU law and the ECHR within the domestic legal order has necessitated the nurturing of a constructive co-existence with the country's longer standing constitutional and common law traditions. Ireland and the United Kingdom have collaborated closely as common law Member States and the departure of the UK from the EU will affect Ireland's position in EU criminal justice in many and varied ways. Using the examples of victim participation in criminal trials and pre-trial access of suspects to legal assistance, the paper seeks to illuminate trends of consonance and dissonance in Ireland's relationship with European law. Drawing on the shared commitment to the protection of fundamental rights in the EU and the ECHR, the discussion reflects on some of the longer term implications of Brexit for the common law presence in European criminal legal culture. [ABSTRACT FROM AUTHOR]

Background: The Great Recession, starting in 2008, was characterized by an overall reduction in living standards. This pushed several governments across Europe to restrict expenditures, also in the area of healthcare. These austerity measures are known to have affected access to healthcare, probably unevenly among social groups. This study examines the unequal effects of retrenchment in healthcare expenditures on access to medical care for different income groups across European countries. Method: Using data of two waves (2008 and 2014) of the European Union Statistics of Income and Living Conditions survey (EU-SILC), a difference-in-differences (DD) approach was used to analyse the overall change in unmet medical needs over time within and between countries. By adding another interaction, the differences in the effects between income quintiles (difference-in-difference-in-differences: DDD) were estimated. To do so, comparisons between two pairs of a treatment and a control case were made: Iceland versus Sweden, and Ireland versus the United Kingdom. These comparisons are made between countries with recessions equal in magnitude, but with different levels of healthcare cuts. This strategy allows isolating the effect of cuts, net of the severity of the recession. Results: The DD-estimates show a higher increase of unmet medical needs during the Great Recession in the treatment cases (Iceland vs. Sweden: + 3.24 pp.; Ireland vs. the United Kingdom: + 1.15 pp). The DDD-estimates show different results over the two models. In Iceland, the lowest income groups had a higher increase in unmet medical needs. This was not the case in Ireland, where middle-class groups saw their access to healthcare deteriorate more. Conclusion: Restrictions on health expenditures during the Great Recession caused an increase in self-reported unmet medical needs. The burden of these effects is not equally distributed; in some cases, the lower-income groups suffer most. The case of Ireland, nevertheless, shows that certain policy measures may relatively spare lower-income groups while affecting middle-class income groups more. These results bring in evidence that policies can reduce and even overshoot the general effect of income inequalities on access to healthcare. [ABSTRACT FROM AUTHOR]

This research aims to contribute to understanding the range of site characteristics that are associated with multi-modal trip generation rates at residential developments. Data was extracted from the Trip Rate Information Computer System (TRICS) database for 933 residential developments in the United Kingdom and Ireland, with trip generation rates estimated separately for person, vehicle, public transport, pedestrian and bicycle trips. A total of 65 independent variables were included in the analysis, representing a range of site characteristics relating to location and housing attributes, public transport service quality, parking and travel plan measures. Trip generation rates by mode and time period were then regressed against the site characteristics to explore their association with multi-modal trip generation. Key findings showed that multi-modal trip generation rates are associated with a range of site characteristics at residential developments. These include, to varying degrees, locational and housing attributes such as apartment developments and housing size, population density, car ownership, distance to local facilities such as the nearest local/corner shop, public transport service quality, on-site parking spaces/dwelling, plus various travel plan initiatives such as secure well-lit/covered cycle parking. The results imply that various site characteristics deserve greater consideration in establishing multi-modal trip generation rates and that characteristics that support travel by non-vehicle modes should be incorporated within new residential developments where possible. • Data extracted from TRICS database for 933 residential developments (UK & Ireland). • Trip generation rates estimated separately by transport mode and time period. • Total of 65 variables considered, representing a range of site characteristics. • Multi-modal trip generation rates were associated with various site characteristics. • Associations with site characteristics differed by transport mode and time period. [ABSTRACT FROM AUTHOR]

Summary: This is a 5‐year real‐world study of 65 patients treated with ibrutinib for relapsed/refractory mantle cell lymphoma across the UK and Ireland. Ibrutinib was well tolerated with no fatal adverse events. The median progression‐free survival and overall survival (OS) was 12 and 18·5 months, respectively. Overall, 80% of patients discontinued treatment, predominantly for progressive disease. On discontinuation, 20% received alternative immunochemotherapy with a median OS of 24 months. Ibrutinib was used as a bridge to transplant in 8% (median OS not reached). These observations are comparable with trial outcomes with encouraging responses to immunochemotherapy at relapse. [ABSTRACT FROM AUTHOR]

The article is focused on an analysis of British-Irish relations in 1921. From the British point of view, the best solution to the conflict seemed to be the granting of Dominion status. It was based on the assumption that the British Empire represented the largest community of free sister nations in the world. On the contrary, Irish officials did not have the confidence to participate in various colonial or imperial projects because they considered themselves a victim of British colonialism. The question of the accepting of the Dominion status divided the Irish political scene into supporters and opponents of the Anglo-Irish treaty. Supporters of the agreement calmed their own sympathizers by claiming that freedom and equality derive directly from Dominion status. However, the lack of precise determination of the rights and duties of the Dominions was a complication of the situation. The question arises as to whether negotiations on reconciliation between Britain and Ireland led from the British and Irish perspectives, in the context of the then unclear situation of what precisely it means to be a Dominion, to a fair solution to the British-Irish Disputes. [ABSTRACT FROM AUTHOR]

The UK and Ireland responded to the rapid health and economic impacts of COVID‐19 by supporting incomes through job retention and job loss instruments, However distinct policy legacies, political and institutional differences between the two countries mean critical differences in both the nature and the relative weight placed on these instruments. The UK income support package was announced in one go and centred on a generous, newly created Job Retention Scheme as well as an enhanced Universal Credit for people who became unemployed. Ireland, by contrast, created a new, more generous social security payment, the Pandemic Unemployment Payment, while a less prominent job retention scheme followed a week later. These initial decisions generated distinct policy dilemmas during a second round of policy changes, in which Ireland sought to reintegrate the more generous Pandemic Unemployment Payment into the mainstream welfare system, while UK sought to ensure that the Job Retention Scheme was only supporting retained (or "viable") jobs. A second wave of infections in October 2020, requiring new restrictions, led both nations to make substantial retreats from resolving these core policy dilemmas. [ABSTRACT FROM AUTHOR]

The current global pandemic of Covid-19 is a health and broader crisis of overwhelming proportions, threatening livelihoods, economies, and societies, particularly those already experiencing the greatest vulnerabilities. In putting the lives of millions of people at risk, creating uncertainties, heightening existing fragilities, and exacerbating inequalities, it has become a truly global challenge. Crisis also brings opportunity, however, and in addition to short- and mid-term responses, this is a time to explore and work towards a genuine transformation of ideas, policies, programmes, and practices. This may all be encapsulated in the overall notion of 'building back a better world'. Against this backdrop, this article introduces this IDS Bulletin issue which asks, fundamentally, how we can collectively and equitably shape - and even transform - our shared future, in the light of experience of Covid-19, and what steps are necessary for us to do so. It draws upon strategic approaches guiding the efforts of two highly engaged organisations: Irish Aid, Ireland; and the Institute of Development Studies, UK. This editorial introduction explores lessons learned from the impact of Covid-19 by highlighting some key viewpoints and evidence provided in the articles3 that follow. It then offers a number of priority areas for action looking forward, as well as several principles that may help to guide those future actions in efforts to build back a better world. [ABSTRACT FROM AUTHOR]

Background: Deep sternal wound infections are a financially costly complication of cardiac surgery with serious implications for patient morbidity and mortality. Prophylactic antimicrobials have been shown to reduce the incidence of infection significantly. In 2018, the European Association for CardioThoracic Surgery (EACTS) provided clear guidance advising that third-generation cephalosporins are the first-line prophylactic antimicrobial of choice for cardiac surgery via median sternotomy as a result of their broad spectrum of activity and association with reduced postoperative mortality. Despite this guidance, it was believed that UK practice differed from this as a consequence of national concerns surrounding cephalosporins use and Clostridioides difficile infection. Methods: A survey was developed and distributed to all UK and Republic of Ireland (ROI) cardiac surgery centres in January 2019 to quantify this variation. Results: Of the 38 centres, 34 responded. Variation existed between the antimicrobial agent used, as well as the dosage, frequency and duration of suggested regimens even among centres using the same antimicrobial agent. The most common antimicrobial prophylaxis prescribed was a combination of flucloxacillin and gentamicin (16, 47%). Followed by cefuroxime (6, 17.6%) and cefuroxime combined with a glycopeptide (4, 11.7%). In patients colonised with methicillin-resistant Staphylococcus aureus or those with penicillin allergy gentamicin combined with teicoplanin was most common (42% and 50%, respectively). Discussion: This variation in antimicrobial agents and regimens may well contribute to the varying incidence of surgical site infection seen across the UK and ROI. [ABSTRACT FROM AUTHOR]

Background: Research indicates that the internet is used to source health-related information, including pregnancy-related information. The aim of this study was to examine websites targeted at the pregnant population and to assess the content therein relating to stillbirth and modifiable risk factors. Methods: The study was limited to websites hosted in Ireland and the UK, and results organized by provider and topic. A codebook was designed to record the information found on the websites. Data were collected on different website characteristics, and a search was undertaken for basic information related to stillbirth (prevalence, causes, procedures, consequences, etc.), and information relating to modifiable risk factors (smoking, alcohol/drug use, medicines use, sleep position, attendance at antenatal care, and weight management). Results: 92 websites were included in the study, of which 39.1% (n = 36) contained basic information about stillbirth and 29.3% (n = 27) contained information related to modifiable risk factors. Only one website (1.1%) contained all the information that was sought. Websites hosted by charities were more likely to contain basic information related to stillbirth, (39.3%, n = 11 of the 28 websites hosted by charities) whereas the commercial sites were more likely to contain information about modifiable risk factors (53.3%, n = 8 of the 15 commercial sites). Conclusion: The results of this study illustrate that websites directed at the pregnant population are a poor source for information related to stillbirth. Some stillbirth risk factors are modifiable; therefore, it is crucial that women and stakeholders can avail of reliable sources of information to make informed decisions. [ABSTRACT FROM AUTHOR]

The objective of this study was to examine the characteristic, content, and role of Paediatric Intensive Care Units (PICUs) in the provision of follow‐up for children and their families' post‐intensive care discharge in the United Kingdom (UK) and Republic of Ireland (RoI). The study followed a descriptive self‐reported, web‐based survey design. "In‐hospital PICU follow‐up" was defined as follow‐up delivered by the PICU team following PICU discharge but before hospital discharge and "post‐discharge PICU follow‐up" was defined as follow‐up delivered by the PICU team following hospital discharge. The survey was administered to all 28 PICUs in the UK and RoI. Paediatric intensive care medical directors or delegated individuals participated. Data were collected between September 2017 and January 2018 with a response rate of 79% (n = 22/28). Twelve units provided either in‐hospital and/or post‐discharge PICU follow‐up. Ten (45%) PICUs reported providing in‐hospital follow‐up, with half (n = 5) using an eligibility criteria for in‐hospital follow‐up, which related to disease groups. The most frequently reported form of in‐hospital PICU follow‐up consisted of face‐to‐face patient consultation (n = 8) by a PICU doctor (n = 5) and/or nurse (n = 4). The time at which initial contact was made was usually not predetermined (n = 4) and the assessment of care needs included are tracheostomy care (n = 4), respiratory care (n = 4), and sedative medication weaning plan (n = 5). Four PICUs reported to provide post‐discharge follow‐up. This involved telephone (n = 2), follow‐up clinic consultations (n = 1) or home visits (n = 1), provided predominantly by PICU doctors (n = 2), with their activity directed by patient needs (n = 3). Despite increasing evidence to suggest PICU survivors and their families experience negative sequalae post‐PICU discharge, less than half of PICUs surveyed provide in‐hospital follow‐up and only a minority provide post‐discharge follow‐up. There is variation in the delivery, content, and format of in‐hospital and post‐discharge PICU follow‐up in the UK and RoI. [ABSTRACT FROM AUTHOR]

With the conclusion of the Trade and Cooperation Agreement EU-UK on 31 December 2020, a long process began in 2016 with the referendum is closed. The author assesses the history of the UK membership to the EU from 1973, plenty of British exceptions negotiated into the EU and analyses the main aspects of both, the 2020 Withdrawal Agreement as well as the future framework of relationship established in the Trade and Cooperation Agreement. As a conclusion, it seems evident the EU has been able to negotiate with a single voice face to the internal political cacophony in the United Kingdom, and to preserve the citizens' rights and the peace process in North Ireland. [ABSTRACT FROM AUTHOR]

Living with a chronic or mental health condition can be challenging and requires considerable adjustment. As ways of coping are culturally influenced, it is important to understand how minority ethnic populations cope, to inform appropriate services. This review aimed to explore the coping strategies used by UK residents from an African Caribbean or Irish background between 1960 and 2020. A systematic literature search on strategies used to cope with chronic health conditions in both populations living in the United Kingdom identified 26 relevant studies. Data were extracted, quality of papers was appraised and critical interpretive synthesis was applied. Two major foci of the studies were coping strategies and barriers to coping. The main coping strategies were denial/scepticism, self‐management, spirituality and religion. Within each population, there was variation in ways of coping. The review highlights the complex role of religion in influencing coping strategies. It demonstrates how personal and minority ethnic populations' experiences of service use are connected with stigma, fear and mistrust, which also act as barriers to seeking help and to coping. Coping with a chronic or mental health condition in the Irish and African Caribbean populations is under‐researched. Stigma, fear and mistrust in services act as key barriers to help‐seeking and religion is a prominent coping strategy. However, few detailed examples were given on how it was used to assist individuals when managing a chronic or mental health condition. Also due to a lack of research, firm conclusions cannot be drawn for the Irish population. [ABSTRACT FROM AUTHOR]

The principal effects of Brexit on health and health care will fall within the United Kingdom, and all forms of Brexit have overwhelmingly negative implications for health care and health within the UK. This article focuses on the external effects of Brexit ("Brexternalities") for health and health care. The EU is a particularly powerful institutional and legal arrangement for managing economic and political externalities in health policy as in any other policy. Equally, when a state leaves the EU, the manner of leaving will result in better or worse management of relevant externalities. Brexternalities thus involve questions about policy legitimacy and accountability. Health Brexternalities do not fall equally in all EU countries. They are felt more distinctly in the context of those elements of health policy that are most closely entwined with the UK's health policy (e.g., on the island of Ireland, certain areas of Spain, and other parts of southern Europe). Some health Brexternalities, such as in medicine safety, will be imposed on the whole population of the EU. And some health Brexternalities, such as communicable disease control, will be felt globally. [ABSTRACT FROM AUTHOR]

The HeadUp collar (previously known as the Sheffield Support Snood) provides support for neck weakness caused by amyotrophic lateral sclerosis (ALS) and has shown to be superior to alternative options in a small cohort of patients from one single center. Here we report the assessment of the HeadUp collar in a larger cohort of patients, exploring the use in other neurological conditions and expanding to other centers across the UK and Ireland. An interventional cross-sectional study design was implemented to investigate the usability and acceptability of the HeadUp collar. A total of 139 patients were recruited for the study, 117 patients had a diagnosis of ALS and 22 patients presented with neck weakness due to other neurological conditions. Participants were assessed at baseline, fitted a HeadUp collar and followed-up one month later. The performance of the HeadUp collar was rated favorably compared to previously worn collars in terms of the ability to eat, drink and swallow. Findings suggest that the collar also permitted a more acceptable range of head movements whilst maintaining a good level of support. We conclude that the HeadUp collar is a suitable option for patients with neck weakness due to ALS and other neurological conditions. [ABSTRACT FROM AUTHOR]

Objective: We evaluated cognitive, emotional, and social function after encephalitis, as perceived and reported by individuals post-encephalitis and their relatives. Hypothesis: There will be differential effects on various domains as self-reported by individuals post-encephalitis. Outcomes will be worse than in prior studies of other forms of acute brain injury. Post-encephalitis relative-report will demonstrate worse outcomes than self-report. Methods and Procedures: Members of The Encephalitis Society residing in the United Kingdom and Ireland were recruited to complete a demographic questionnaire and the European Brain Injury Questionnaire (EBIQ). Results: 266 individuals affected by encephalitis and 140 relatives participated in this study. The three domains with the highest (worst) mean scores were somatic, cognitive, and communication (p <.001). Individuals post-encephalitis self-reported worse outcomes than individuals post-stroke in seven of nine domains (p <.005), but there were no differences compared to individuals post-traumatic brain injury (TBI). Relatives reported worse encephalitis outcomes in seven of nine domains than did individuals directly affected by encephalitis (p <.005). Conclusions: Individuals affected by encephalitis experience the most significant symptoms in the somatic, cognitive, and communication domains. Outcomes as assessed by relatives were notably worse than those assessed by individuals themselves in nearly all domains. [ABSTRACT FROM AUTHOR]

Aim: There is a requirement for an expansive and up to date review of the management of emergency colorectal conditions seen in adults. The primary objective is to provide detailed evidence‐based guidelines for the target audience of general and colorectal surgeons who are responsible for an adult population and who practise in Great Britain and Ireland. Methods: Surgeons who are elected members of the Association of Coloproctology of Great Britain and Ireland Emergency Surgery Subcommittee were invited to contribute various sections to the guidelines. They were directed to produce a pathology‐based document using literature searches that were systematic, comprehensible, transparent and reproducible. Levels of evidence were graded. Each author was asked to provide a set of recommendations which were evidence‐based and unambiguous. These recommendations were submitted to the whole guideline group and scored. They were then refined and submitted to a second vote. Only those that achieved >80% consensus at level 5 (strongly agree) or level 4 (agree) after two votes were included in the guidelines. Results: All aspects of care (excluding abdominal trauma) for emergency colorectal conditions have been included along with 122 recommendations for management. Conclusion: These guidelines provide an up to date and evidence‐based summary of the current surgical knowledge in the management of emergency colorectal conditions and should serve as practical text for clinicians managing colorectal conditions in the emergency setting. [ABSTRACT FROM AUTHOR]

The over-purchasing and hoarding of necessities is a common response to crises, especially in developed economies where there is normally an expectation of plentiful supply. This behaviour was observed internationally during the early stages of the Covid-19 pandemic. In the absence of actual scarcity, this behaviour can be described as 'panic buying' and can lead to temporary shortages. However, there have been few psychological studies of this phenomenon. Here we propose a psychological model of over-purchasing informed by animal foraging theory and make predictions about variables that predict over-purchasing by either exacerbating or mitigating the anticipation of future scarcity. These variables include additional scarcity cues (e.g. loss of income), distress (e.g. depression), psychological factors that draw attention to these cues (e.g. neuroticism) or to reassuring messages (eg. analytical reasoning) or which facilitate over-purchasing (e.g. income). We tested our model in parallel nationally representative internet surveys of the adult general population conducted in the United Kingdom (UK: N = 2025) and the Republic of Ireland (RoI: N = 1041) 52 and 31 days after the first confirmed cases of COVID-19 were detected in the UK and RoI, respectively. About three quarters of participants reported minimal over-purchasing. There was more over-purchasing in RoI vs UK and in urban vs rural areas. When over-purchasing occurred, in both countries it was observed across a wide range of product categories and was accounted for by a single latent factor. It was positively predicted by household income, the presence of children at home, psychological distress (depression, death anxiety), threat sensitivity (right wing authoritarianism) and mistrust of others (paranoia). Analytic reasoning ability had an inhibitory effect. Predictor variables accounted for 36% and 34% of the variance in over-purchasing in the UK and RoI respectively. With some caveats, the data supported our model and points to strategies to mitigate over-purchasing in future crises. [ABSTRACT FROM AUTHOR]

Background: Palliative care day services provide a safe environment for people with palliative care needs, enabling them to access a range of services while acting as a respite services for family caregivers. Viewed as marginal services, they are often under resourced and under researched. The aim of this study was to understand how palliative day care services contribute to client care from the perspective of management and hospice multidisciplinary teams. Methods: A descriptive qualitative study, using six focus groups conducted with staff at three United Kingdom hospices in England, Scotland and Northern Ireland. Thirty-five participants were recruited, including management and staff. Discussions were transcribed and analysed thematically. Results: Four key themes emerged: (1) variations of care, beyond heterogeneity of patients; (2) unclear referrals and inconsistent patient population; (3) recognising strengths and challenges and (4) an uncertain future. A major focus of group discussions was the model of care and the benefits of the service, however the importance of demonstrating services' effectiveness and value for money was highlighted. Conclusions: Management and hospice staff believed day-services to be a helpful introduction to palliative care, providing both social and medical support. Economic pressures and patient demand were influencing them to move from a social model to a hybrid model. Further research is needed to understand the effectiveness of the service. [ABSTRACT FROM AUTHOR]

Background: Despite extensive research, many questions remain unanswered about common problems that impact dog welfare, particularly where there are multiple contributing factors that can occur months or years before the problem becomes apparent. The Generation Pup study is the first longitudinal study of dogs that recruits pure- and mixed-breed puppies, aiming to investigate the relative influence of environmental and genetic factors on a range of health and behaviour outcomes, (including separation related behaviour, aggression to familiar/unfamiliar people or dogs and obesity). This paper describes the study protocol in detail. Methods: Prior to commencing recruitment of puppies, the study infrastructure was developed, and subject specialists were consulted to inform data collection methodology. Questionnaire content and timepoint(s) for data collection for outcomes and potential predictors were chosen with the aim of providing the best opportunity of achieving the aims of the study, subject to time and funding constraints. Recruitment of puppies (< 16 weeks, or < 21 weeks of age if entering the United Kingdom or Republic of Ireland through quarantine) is underway. By 23 January 2020, 3726 puppies had been registered, with registration continuing until 10,000 puppies are recruited. Data collection encompasses owner-completed questionnaires issued at set timepoints throughout the dog's life, covering aspects such as training, diet, exercise, canine behaviour, preventative health care, clinical signs and veterinary intervention. Owners can elect to submit additional data (health cards completed by veterinary professionals, canine biological samples) and/or provide consent for access to veterinary clinical notes. Incidence and breed associations will be calculated for conditions for which there is currently limited information (e.g. separation related behaviour). Multivariable statistical analysis will be conducted on a range of outcomes that occur throughout different life stages, with the aim of identifying modifiable risk factors that can be used to improve canine health and welfare. Discussion: The Generation Pup project is designed to identify associations between early-life environment, genotypic make-up and outcomes at different life stages. Modifiable risk factors can be used to improve canine health and welfare. Research collaboration with subject specialists is welcomed and already underway within the fields of orthopaedic research, epilepsy, epigenetics and canine impulsivity. [ABSTRACT FROM AUTHOR]

This article reviews the historical debate on the colonial causation and dimensions of the Great Irish Famine of 1845-50. It does so by briefly reviewing the evolution of the colonial relationship between Great Britain and Ireland before focusing on a number of specific fields of debate relating to the coloniality of the Irish famine. These include the economic structures and dynamics developing over the century before 1845 and the vulnerability of Irish society, the vector of the potato blight and its impact on food availability, and, most extensively, the motivations for and characteristics of British state response to the catastrophe. The variant interpretations of these factors in the nationalist, revisionist, post-revisionist, and post-colonial historiography are reviewed. The author concludes by drawing on his own primary research to suggest that, while shaped by colonial stereotypes and a preoccupation with social engineering, the British state and public response to the Irish crisis was varied and not intentionally genocidal, although ultimately subordinating humanitarianism to perceived British national interest. Critical British contemporaries drew negative parallels between the neglect of Ireland and the prioritization of imperial expansion overseas, while Irish nationalists concluded that the mortality of the famine demonstrated the bankruptcy of the British-Irish Union of 1800. [ABSTRACT FROM AUTHOR]

In the years of 1821, 1822 and 1823, three Brazilian indigenous individuals were exhibited in the main cities in Great Britain and Ireland. A show titled Botocudo Chieftain, Wife and Child displayed a couple of indigenous Brazilian Botocudos and a 2- year-old from the Puris ethnicity. The spectacle drew a large audience to a stage where the “exotic and wild Botocudos” were presented alongside “rare birds” and a machine. By sourcing from newspapers of the period, this analysis not only reconstitutes such presentations, but also problematises the juxtaposition of the indigenous body and the machine, all of which therefore promote a reflection upon the presence/absence of the mechanic apparatus in ethnographic photography and cinema. Further, there is an addendum concerning another case of a Botocudos exhibition in which they were exposed to a machine: the 1882 Brazilian Anthropological Exhibition of the National Museum. This analysis is part of a broader research into exhibitions of indigenous Brazilians in human zoos and how such exhibitions relate to the cinema and photography of the period. Throughout the 19 th Century, human zoos were a format of mass entertainment which featured re-enactments of an exotic way of living. The non-western troupes that featured in such exhibitions travelled to a great number of cities and performed in a variety of venues such as circuses, theatres, fairs and zoos. [ABSTRACT FROM AUTHOR]

Summary: Background: Allergic contact dermatitis (ACD) to cosmetics is widely reported. To ensure we are accurately diagnosing ACD, patch test series should be continually reviewed to identify relevant and emerging allergens and highlight those that are outdated. The current British Society for Cutaneous Allergy (BSCA) facial series recommends 26 allergens and was last modified in 2012. Objectives: To review and update the BSCA facial series. Methods: We retrospectively reviewed the results from 12 UK and Ireland patch test centres' facial series from January 2016 to December 2017. We recorded the number of allergens tested in each centre and the detection rate for each allergen. Using a 0·3% positive rate as the inclusion threshold, we established which allergens in the BSCA facial series had positive patch test rates < 0·3% and > 0·3%. Allergens not in the BSCA facial series that had a positive patch test rate > 0·3% were identified. Results: Overall, 4224 patients were patch tested to the facial series. The number of allergens included in individual centres' facial series ranged from 24 to 66, with a total of 103 allergens tested across all centres. Twelve of the 26 allergens in the BSCA facial series had a positive patch test rate < 0·3% and 14 had a rate > 0·3%. Twenty‐five allergens not recommended in the BSCA facial series had a positive patch test rate > 0·3%. Conclusions: This audit has highlighted the significant variation in practice that exists among patch test centres, despite a recommended facial series. The BSCA facial series has been updated and now contains 24 allergens. Fifteen allergens remain, 11 allergens have been dropped and nine new allergens have been added. What is already known about this topic? Facial dermatitis is one of the dominant presenting complaints of allergic contact dermatitis to cosmetics.To ensure we are accurately diagnosing contact allergy, it is important that we patch test with relevant allergens.Reviewing current literature and auditing patch test practice is a vital requirement to ensure we identify relevant and emerging allergens and highlight those that are outdated. What does this study add? Despite recommended patch test series, there is significant variation in practice among different patch test centres.In response to this multicentre audit, the British Society for Cutaneous Allergy facial series has been updated and now contains 24 allergens: 15 allergens remain, 11 allergens have been dropped and nine new allergens have been added. Linked Comment:Boonchai. Br J Dermatol 2021; 184:13. Plain language summary available online [ABSTRACT FROM AUTHOR]

This study shows how interest group–party relations, parties' cross-cutting policy preferences, and competition with challenger parties shape the structure of issue competition on climate policy. It uses the 'most similar' cases of the UK and Ireland to show how differences in party systems influence the structure of issue competition. The study takes up the challenge of integrating salience and position in the conceptualisation of climate policy preferences. Empirically, it provides new evidence on factors influencing climate policy preferences and the party politics of climate change, focusing on interest groups, party ideology, and challenger parties. Further, it identifies similarities between the general literature on interest group influence on party preferences and the literature on interest groups in climate politics, and seeks to make connections between them. [ABSTRACT FROM AUTHOR]

This article discusses the Association of Coloproctology of Great Britain and Ireland's guideline on the management of anal fissure. The guideline emphasizes the need for high-quality research, education, and training in proctology, which has been a neglected area in colorectal surgery. The management of anal fissure is of interest to various healthcare professionals and stakeholders, and the guideline has been developed with broad stakeholder engagement, including patients. While there have been some refinements in pharmacological therapies and patient selection for operations, the guideline highlights the disappointingly low quality of evidence for most treatment options and calls for better research in this field. [Extracted from the article]

People immobilized following acute spontaneous intracerebral haemorrhage (ICH) are at risk of venous thromboembolism (VTE) but the role of short-term prophylactic anticoagulation remains uncertain. We surveyed UK clinical practice and opinion regarding preventing VTE after ICH. An online survey was sent to stroke healthcare professionals within the United Kingdom and Ireland via a professional society (British and Irish Association of Stroke Physicians (BIASP)). One hundred and twenty-three staff members responded to the survey, of whom 80% were consultant stroke physicians. All responders except one considered the issue to be important or extremely important, but only 5 (4%) were "extremely certain" and 51 (41%) "fairly certain" regarding the optimal treatment approach. Intermittent pneumatic compression (IPC) devices alone were the most used method (in 60%) followed by IPC devices and switching to low molecular weight heparin (LMWH) (in 30%). We identified high levels of uncertainty regarding the role of anticoagulation, and its optimal timing; uncertainty was greater in lobar compared to deep ICH. Most respondents (93%) consider a randomised controlled trial investigating the role of pharmacological VTE prophylaxis after acute ICH as important and would consider participation. The optimal method for the prevention of VTE in non-traumatic ICH patients remains an area of clinical uncertainty. Clinical trials assessing short-term anticoagulation in patients after acute ICH would be beneficial in providing evidence to resolve this clinical dilemma. • Venous thromboembolism prevention after intracerebral haemorrhage lacks consensus. • Intermittent pneumatic compression devices are the most commonly used method. • The role and optimal timing of prophylactic anticoagulation are unclear. • Evidence for safety and efficacy of anticoagulation is limited. • A randomised control trial is supported by the great majority of clinicians surveyed. [ABSTRACT FROM AUTHOR]

To explore and compare medical students' experiences with communication skills training (CST) in medical education. Five medical students from the U.S., U.K., and Ireland shared their experiences with CST at a 90-minute symposium held at the 2022 International Conference on Communication in Healthcare (ICCH). Students identified two areas of CST that may affect their preparedness for real-world clinical practice: 1) the impact of the COVID-19 pandemic on communication teaching and learning, and 2) the need to effectively communicate with diverse patient populations. The COVID-19 pandemic brought major changes to CST, and though training programs varied in their approach, students found that they were able to successfully adapt while gaining valuable skills needed to navigate communicating with patients on virtual platforms. When learning to communicate with patients from diverse backgrounds, students perceived generalized strategies that equipped them with the skills needed to adapt to uncertainty to be the most valuable. Collaboration between medical schools, both nationally and internationally, provides opportunity to share areas of strength and avenues for improvement in CST. Representation of learner perspectives is essential in order to better understand how well current educational methodologies prepare learners to enter real world clinical practice. • Communication skills • Learner perspective • Medical students • Undergraduate medical education • Simulated patients [ABSTRACT FROM AUTHOR]

Since March 2020, the UK and Ireland have entered a series of lockdowns in the wake of the coronavirus pandemic with restrictions resulting in the closure of nonessential retail, hospitality and sports with employees encouraged to work from home. In this retrospective study we have demonstrated a significant decrease in DLQI values, increase in the number of 'not relevant' responses (NRRs) in the DLQI and change between DLQI and the modified DLQI‐R during the pandemic. Given the restrictions imposed on our patients, it is important for clinicians to identify the number of NRRs in the DLQI and acknowledge the potential effect on treatment decisions and data collection for disease registries and clinical trials during the pandemic. [ABSTRACT FROM AUTHOR]

Introduction: In the last two decades and driven by the International Subarachnoid Aneurysm Trial (ISAT), the management of aneurysmal subarachnoid haemorrhage (aSAH) has undergone extensive change from predominantly neurosurgical (clipping) to predominantly neuroradiological (coiling) treatment. In 2013, the UK's national Confidential Enquiry into Patient Outcome and Death (NCEPOD) recommended aSAH to be definitively treated within 48h of ictus. The aim of this survey was to assess how this recommendation is being followed across the UK and Ireland 17 years after ISAT and 6 years after the NCEPOD. Methods: An online survey consisting of 9 questions was electronically distributed to neurosurgical consultants and trainees. Missing or ambivalent data was collected or verified by emailing consultant neurosurgeons to ensure the coverage of all 32 neurosurgical units in the UK and Ireland. Results: Only 9 (28%) of units provide 7 days a week interventional neuroradiology service, but all 32 (100%) units have established networks with other neuroradiology centres to provide aSAH treatment within 48h of ictus assuming no delays in patient transfer. For aSAH patients requiring neurosurgical clipping, 27 (84%) of units provide (locally or through networks) aneurysm repair within 48h of ictus, whereas 5 (16%) units may breach this recommendation by keeping the aSAH patients that present after 5PM on Fridays and delaying their clipping to the subsequent Monday. Conclusion: Assuming no delays in patient transfer, 32 (100%) neurosurgical centres in the UK and Ireland meet the <48h ictus-to-treatment target for endovascular coiling and 27 (84%) units for neurosurgical clipping of aSAH. [ABSTRACT FROM AUTHOR]

The World Health Organization recommends that "palliative care should be integrated as a routine element of all Undergraduate Medical Education." However, the provision of training for medical undergraduates is variable; only 18% of 51 European countries have mandatory training in palliative medicine. EDUPALL is an ERASMUS+ funded international collaborative project to develop and pilot an undergraduate program for training in palliative medicine. The objective of this study was to critically review and revise current European Association for Palliative Care (EAPC) Recommendations for the Development of Undergraduate Curricula in Palliative Medicine and translating these into an updated curriculum document. Clinicians, academics, and researchers from Romania, Ireland, Germany, Austria, Spain, and the United Kingdom reviewed the EAPC recommendations using a variant of consensus methodology, Nominal Group Technique. From the updated document, four working-groups translated each recommendation into a specific learning objective, and developed associated learning outcomes, stratified by domain: attitude, cognition, and skills. The outcomes and objectives were organized into discrete teaching units and transferred into a curriculum template, identifying notional hours, teaching, and assessment strategies. To ensure quality control, the draft template was circulated to experts from 17 European countries, together with a brief survey instrument, for peer review purposes. All 17 reviewers returned overwhelmingly positive comments. There was large agreement that: the teaching units were logically organized; learning outcomes covered core training needs; learning objectives provided guidance for teaching sessions; learning modalities were appropriately aligned; and assessment strategies were fit for purpose. An updated and standardized curriculum was developed, which provides a platform for the sequential development of the next phases of the EDUPALL project. [ABSTRACT FROM AUTHOR]

Namurian (Carboniferous) eustatic fluctuations drove the incision and backfill of shelf‐crossing valley systems located in humid subequatorial regions, which are now preserved in successions of the United Kingdom and Ireland. The infills of these valleys archive the record of palaeoriver systems whose environmental, hydrological and palaeogeographic characteristics remain unclear. A synthesis of sedimentological data from fluvial strata of 18 Namurian incised‐valley fills in the United Kingdom and Ireland is undertaken to elucidate the nature of their formative river systems and to refine regional palaeogeographic reconstructions. Quantitative analyses are performed of facies proportions, of geometries of incised‐valley fills and related architectural elements, and of the thickness of dune‐scale sets of cross‐strata. Reconstruction of the size of the drainage areas that fed these valleys is attempted based on two integrative approaches: flow‐depth estimations from dune‐scale cross‐set thickness statistics and scaling relationships of incised‐valley fill dimensions derived from late‐Quaternary examples. The facies organization of these incised‐valley fills suggests that their formative palaeorivers were perennial and experienced generally low discharge variability, consistent with their climatic context; however, observations of characteristically low variability in cross‐set thickness might reflect rapid flood recession, perhaps in relation to sub‐catchments experiencing seasonal rainfall. Variations in facies characteristics, including inferences of flow regime and cross‐set thickness distributions, might reflect the control of catchment size on river hydrology, importance of which is considered in light of data from modern rivers. Palaeohydrological reconstructions indicate that depth estimations from cross‐set thickness contrast with observations of barform and channel‐fill thickness, and projected thalweg depths exceed the depth of some valley fills. Limitations in data and interpretations and high bedform preservation are recognized as possible causes. With consideration of uncertainties in the inference of catchment size, the palaeogeography of the valley systems has been tentatively reconstructed by integrating existing provenance and sedimentological data. The approaches illustrated in this work can be replicated to the study of palaeohydrological characteristics and palaeogeographic reconstructions of incised‐valley fills globally and through geological time. [ABSTRACT FROM AUTHOR]