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In an attempt to reduce the negative sequelae of cardiopulmonary bypass (CPB), a variety of new technologies have been created. This study investigates variations in the application of these technologies throughout Great Britain and Ireland (GB & I). All perfusion departments within GB & I were surveyed about equipment and technologies used in CPB. Eighty-five percent of units use a standard arterial line filter in all cases. Forty percent of units occasionally use leukocyte-depleting filters in various sites within the circuit. Sixteen percent always use some element of heparin-bonded circuit, but 62% never use them. Twenty-five percent use solely rotary pumps, 18% use solely centrifugal pumps, and 56% use both. Finally, 20% are now using minimal extracorporeal circulation in certain clinical scenarios. These decisions are most frequently affected by clinician preference and cost. This survey has highlighted significant variation in the utilization of various technologies used in CPB. While some variation between centers is to be expected, as innovative technologies are adopted at varying rates, surveys such as this are useful for alerting clinicians to gaps between evidence-based knowledge and clinical practice. [ABSTRACT FROM AUTHOR]

Objective To measure the UK and Ireland incidence of childhood (<15 years) thyrotoxicosis and to describe the presenting features. Context Incidence data on thyrotoxicosis in childhood are not available for the UK and Ireland. Recent studies have reported an apparent increase in cases in Europe. Design A national prospective surveillance study for 12 months from September 2004, co-ordinated by The British Paediatric Surveillance Unit (BPSU). Patients and measurements All paediatricians across the UK and Ireland were requested monthly to report new cases. Details of presenting features were then obtained by questionnaire. Results One hundred ten cases of acquired childhood thyrotoxicosis were identified in the UK and Ireland. The incidence of acquired thyrotoxicosis was 0·9 per 100,000 <15 years olds in the UK and Ireland, (95% CI: 0·8–1·1). Autoimmune thyrotoxicosis accounted for 96% of cases. There was an increasing incidence with age in each sex. Females have a significantly higher incidence than males in the 10- to 14-year age group. A variety of presenting symptoms were reported: weight loss (64%), fatigue/tiredness (54%), change in behaviour’ (50%) and heat intolerance (47%). 4.5 % cases were asymptomatic. The commonest signs were goitre (78%) and tremor (58%). There were no cases of thyroid storm. Conclusions This national population survey defines the incidence of thyrotoxicosis in children in the UK and Ireland during 2004–2005, which was lower than expected in comparison with other European studies. The survey illustrates contemporary presenting characteristics of the disease. [ABSTRACT FROM AUTHOR]

The phylogeographical structure of brown trout Salmo trutta in Britain and Ireland was studied using polymerase chain reaction–restriction fragment length polymorphism (PCR–RFLP) analysis of four mitochondrial DNA segments (16S/ND1, ND5/6, COXIII/ND5 and ND5/12S). Analysis of 3636 individuals from 83 sites–morphotypes revealed a total of 25 haplotypes. These haplotypes were nested in seven two-step clades. Although there was a clear geographical patterning to the occurrence of derived clades, admixture among ancestral clades was extensive throughout the studied area. A relevant feature of the data was that some populations contained mixtures of highly divergent clades. This type II phylogeographic pattern is uncommon in nature. Clade intermixing is likely to have taken place during earlier interglacials as well as since the Last Glacial Maximum. The anadromous life history of many S. trutta populations has probably also contributed to clade mixing. Based on the data presented here and published data, postglacial colonization of Britain and Ireland most likely involved S. trutta from at least five potential glacial refuges. Probable locations for such refugia were: south of England–western France, east of the Baltic Sea, western Ireland, Celtic Sea and North Sea. Ferox S. trutta, as defined by their longevity, late maturation and piscivory, exhibited a strong association with a particular clade indicating that they share a common ancestor. Current evidence indicates that the Lough Melvin gillaroo S. trutta and sonaghen S. trutta sympatric types diverged prior to colonization of Lough Melvin and, although limited gene flow has occurred since secondary contact, they have remained largely reproductively isolated due to inlet and outlet river spawning segregation. Gillaroo S. trutta may reflect descendents of a previously more widespread lineage that has declined due to habitat alterations particularly affecting outlet rivers. The mosaic-like distribution of mtDNA lineages means that conservation prioritization in Britain and Ireland should be based on the biological characteristics of local populations rather than solely on evolutionary lineages. [ABSTRACT FROM AUTHOR]

In Ireland in the 17th century before the Battle of the Boyne, there were only five parliaments held. For these parliaments there was a total of 16 different individuals who acted as Speaker or made an attempt to become Speaker in the Commons or the Lords. This article will attempt to consider the possible criteria that may have been important in assessing the suitability of the candidates and also to see how many of those 16 are found to be suitable according to these conditions. We can be assured that the vast majority of those appointed and selected were politically reliable and that other issues such as legal training and legal experience are also common among most. However, ethnicity, religion (including attitudes to others' religion), family and marriage contacts, and administrative experience show that the Speakers did not always share a common background. To a certain extent, it may be deduced that these differences may be reflective of the changing political scene in Ireland over the course of this short 17th century. The performance and attributes of those who failed to become Speaker can also be useful in a study that attempts to understand the qualifications deemed desirable in a Speaker in 17th-century Ireland. [ABSTRACT FROM AUTHOR]

The article examines the leveling off of employment and unemployment in Great Britain in comparison with international experience and in relation to factors influencing the labor market. The differential changes between the U.S. and Great Britain is attributed to labor productivity. Cited are Spain and Ireland with bigger employment falls, while Germany has actually increased employment during the recession. The age dimension of employment is discussed along with labor market flexibility in reaction to pay freezes and pay cuts.

This article examines implications of the MOX Plant European Court of Justice (ECJ) case for dispute settlement between Member States that are parties to mixed environmental agreements. In 2006, the ECJ held Ireland in breach of EC law for failing to consult the Commission about its dispute with the UK and for instituting proceedings under an international treaty rather than through EC law; this was held necessary because it concerned two Member States and EC law which the ECJ was competent to determine. The completed litigation illustrates the operation of autonomous legal systems in public international law and the proliferation of overlapping courts and tribunals. Although it clarifies the relationship between international and EC law, it leaves some questions unanswered, in particular regarding dispute settlement by Member States that are parties to mixed agreements outside EC law. Is non-EC dispute settlement still possible, and if so how? Is this limited to judicial processes? Viewing the dispute primarily as relating to transboundary environmental impact assessement (EIA), the article examines the role of the Espoo Convention, in particular the Inquiry Commission. The failure of Ireland to challenge the UK under the EIA Directive implementing the Convention was noted by the ECJ and some commentators. What is not clear is whether the Inquiry Procedure, which is a scientific process for determining effect significance when parties dispute this, can still be used. It has not been incorporated into the EIA Directive and there is nothing comparable under EC law. Its recent application in the Danube Delta case is considered and the options for Member States outlined. It is concluded that EC Member States that use this procedure against other Member States are likely to be found in breach of EC law. [ABSTRACT FROM AUTHOR]

The article presents chapter 2 of the book "The House of Lords in the Age of George III (1760-1811),” by Michael W. McCahill, describing the Representative Peers of Scotland and Ireland within the British House of Lords during the reign of King George III. Introductory comments are given describing the political dynamics of Great Britain after the Act of Union in 1707 and its manifestations within the Parliament. The activities and characteristics of the Scottish and Irish lords during the period are described in depth, noting their relative level of political participation and power in comparison to their British equivalents.

The article presents chapter 11 from the book "The House of Lords in the Age of George III (1760-1811),” by Michael W. McCahill, discussing the political dynamics and influence of public opinion within the British House of Lords from 1784 to 1811 at the end of the active reign of King George III. Discussion is given outlining the various forms of public opinion and public pressure which emerged throughout Great Britain during the period and the responses by the House of Lords to them. The particular incidents of the Irish commercial proposals of 1785 are examined in depth as a case example of the political attitudes of the peers.

Aims. The aim of this paper is to provide an account of the early development of what was originally known as 'mental deficiency' nursing in the UK and Ireland.Background. After a brief review of research literature, it analyses key issues behind the development of a workforce positioned on the margins of nursing in the two jurisdictions through a comparative discussion of similarities and differences.Design. The paper draws on two doctoral studies that examined the development of intellectual disability nursing using an historiographical design.Methods. Primary sources consulted included records of nursing regulatory bodies, national archives, Royal College of Psychiatrists, archives, nursing journals, individual institutional records in both jurisdictions.Results. In both countries, psychiatrists established early training programmes for nurses, although a nursing model was adopted to meet service needs in the 1950s.Conclusions. However, the way in which this branch of nursing developed laid the foundation for tensions as to whether it is appropriately located within the discipline of nursing. Ireland's colonial past and postcolonial position, the role of the church, welfare systems and diverse socio-political drivers for change represent key differences between the two jurisdictions.Implications. What eventually became known as learning or intellectual disability nursing poses a continued challenge for the profession as a whole in regard to its breadth, role and focus in working with marginalised groups in society. The paper considers the risks for UK and Irish intellectual disability nurses for marginalisation in nursing should they forge closer links to other disciplines concerned with common threads of disability, education or social care. [ABSTRACT FROM AUTHOR]

Aim We consider three hypotheses – MacArthur and Wilson’s island biogeography theory (IBT), Lack’s habitat diversity idea and the ‘target effect’– that explain the pattern of decreased species richness on small and distant islands. Location We evaluate these hypotheses using a detailed dataset on the occurrence and abundance of terrestrial birds on nine islands off the coast of Britain and the Republic of Ireland. Methods  Unlike previous studies, we compile data on species that visit the islands, rather than just those that breed on them. We divided the species into five mutually exclusive categories based upon their migratory status and where they regularly breed: British residents, summer visitors to Britain, winter visitors to Britain, and vagrants from Europe or beyond Europe. For each species group on each island we calculated the average number of species visiting each year. We then regressed the average number of species against island area and distance to the mainland (all variables were log-transformed). We also compared the average number of species visiting each island with the average number of species breeding on each island. Results  Average number of visiting British residents decreased significantly with increasing island distance, but showed no relationship with island area. There was no significant relationship between island area or island distance and average number of summer or winter visitors. European and non-European vagrants likewise showed no relationship between numbers of species visiting and island distance. However, the relationship between island area and number of visiting species was significant for both these categories; as island area increases so too does the number of visiting species. Main conclusions  As predicted by IBT, there were fewer visiting species on more distant islands. There were substantially more visitors to each island than breeding species, supporting Lack’s argument that lower bird richness is not a result of varying immigration rates (as predicted by IBT) but rather a result of some other island property, e.g. fewer resources. Birds make a decision to either leave an island or stay and breed. The target effect was also clearly demonstrated by the increase in European and non-European breeders with increasing island size. [ABSTRACT FROM AUTHOR]

1. This account presents information on all aspects of the biology of Primula vulgaris Huds. (Primrose) that are relevant to understanding its ecological characteristics and behaviour. The main topics are presented within the framework of the Biological Flora of the British Isles: distribution, habitat, communities, responses to biotic factors, responses to environment, structure and physiology, phenology, floral and seed characteristics, herbivores and disease, history and conservation. 2. Primula vulgaris is a native perennial herb with a very wide distribution in the British Isles. In many lowland areas it is essentially a plant of woodlands and hedgerows, although in the west it can occur abundantly in grasslands and other communities such as heaths. In northern and western Britain and Ireland, it may be frequent in open and even exposed habitats. Its distribution is linked with soil moisture and atmospheric humidity. It is shade tolerant, but it flowers most profusely in canopy gaps. 3. Primula vulgaris is a rosette hemicryptophyte that reproduces mainly through seeds. Vegetative spread is restricted and only occurs within very short distances from the mother plant through the production of lateral rosettes. Although individual rosettes may die, plants are relatively long-lived (life expectancy of a newborn individual: 48.3 years). The mean age at first flowering was 20 months. 4. Pollination is mainly by bumblebees and other bees, but other long-tongued pollinators including syrphids, bee-flies and even butterflies may be locally important. P. vulgaris is an obligate outbreeder, with two genetically determined self-incompatible morphs (‘pin’ and ‘thrum’). A third morph (‘homostyle’ or ‘long homostyle’), with a stigma like that of pin but anthers like that of thrum, has been found in Somerset and North Dorset. In years when pollinators are scarce, homostyles have higher reproductive success than pins and thrums, suggesting that reproductive assurance could have had a profound effect on the evolution of homostyly in P. vulgaris. 5. Seeds are dispersed by ants and rodents. Dispersal is usually restricted to a few centimetres or decimetres from maternal plants, resulting in significant fine-scale spatial genetic structure and small neighbourhood sizes. Pollen flow, on the other hand, is more extensive, but still limited to a few metres from paternal plants. 6. Populations of P. vulgaris have not changed markedly during the last century in most parts of Britain and Ireland and it is not threatened with extinction nationally. However, there is evidence that Primroses were formerly more widespread and have decreased with the decline of coppicing and pollarding. In East Anglia, woodland populations have declined greatly in response to a series of hot, dry summers since 1970. Small, isolated populations of P. vulgaris often show reduced reproductive success, potentially affecting their long-term survival. Preservation of local habitat conditions and restoration of gene flow among populations are required to maintain viable populations of P. vulgaris in the long term. [ABSTRACT FROM AUTHOR]

Infusion of lipid emulsion has been demonstrated to facilitate return of spontaneous circulation in animal models and human cases of local anaesthetic induced cardiac arrest. Guidelines for lipid application exist; however, experimental evidence of efficacy at recommended dosing is lacking. In 20 sedated, mechanically ventilated, and invasively monitored New Zealand White rabbits, asystole was induced via bolus bupivacaine injection. Animals were randomised to receive either 20% Intralipid administered according to Association of Anaesthetists of Great Britain and Ireland guidelines, or identical volumes of 0.9% saline solution, in addition to standard Advanced Cardiac Life Support resuscitative measures. Seven lipid treated rabbits developed return of spontaneous circulation vs four saline treated animals (p = 0.370). A trend toward sooner return of spontaneous circulation in the lipid treated group was observed (2.4 (0.53) vs 3.8 (1.7) min; p = 0.082). Five animals in the lipid treated group survived to protocol termination vs nil animals from the saline treated group (p = 0.033). The current Association of Anaesthestists of Great Britain and Ireland lipid infusion protocol provides a useful beginning for lipid emulsion administration. [ABSTRACT FROM AUTHOR]

The article discusses the potential for ochre to sequester phosphorus in an environmentally sustainable fashion. Ochre deriving from coal mine drainage sites in the United Kingdom displays a high phosphorus retention capacity without highly mobilizing metals, indicating that it can potentially adsorb phosphorus from agricultural wastewaters and be used as a fertilizer. A study focused upon untreated acid mine drainage from an abandoned copper-sulfur mine in a catchment of southeast Ireland. Ochre was mixed with phosphorus-amended water in batch experiments and a maximum adsorption capacity was calculated from the Langmuir equation.

This paper offers a reassessment of the origins and derivation of many of Sir William Petty's economic ideas, based on an analysis of his unpublished papers. Petty's archive makes clear what a large part Ireland played in his writings, and it is suggested that this preoccupation is essential to an appreciation of him as an economist. It also demonstrates the point that Petty was not principally a theorist but rather a practical political economist whose schemes for the enrichment of the king's dominions were inspired by the underdevelopment which he experienced at first hand in Ireland. [ABSTRACT FROM AUTHOR]

Objective The aim of the study was to describe the characteristics of young people with vertically acquired HIV diagnosed aged ≥13 years. Methods A retrospective review of HIV diagnoses reported to well-established national paediatric and adult HIV surveillance systems in the United Kingdom/Ireland was conducted. Results Forty-two young people with vertically acquired HIV diagnosed aged ≥13 years were identified; 23 (55%) were female, 40 (95%) were black African and 36 (86%) were born in sub-Saharan Africa. The median age at HIV diagnosis was 14 years (range, 13–20 years). Half of the patients presented with symptoms; the remainder were screened for HIV following diagnosis of a relative. The median CD4 count at diagnosis was 210 cells/μL (range, 0–689 cells/μL), 12 patients (29%) were diagnosed with AIDS at HIV diagnosis or subsequently, and 34 (81%) started combination antiretroviral therapy (ART), most (31 of 34) within a year of diagnosis. Conclusion A small number of young people with vertically acquired HIV survive childhood without ART and are diagnosed at age ≥13 years in the United Kingdom/Ireland. Half of the patients were asymptomatic, highlighting the importance of considering HIV testing for all offspring of HIV-infected women, regardless of age or symptoms. Increased awareness among clinicians and parents is required to reduce delayed presentation with advanced disease and to avoid onward transmission as these young people become sexually active. [ABSTRACT FROM AUTHOR]

Abstract: A task group of the Science Committee of the Association for Palliative Medicine of Great Britain and Ireland (APM) was convened to produce some up-to-date, evidence-based, practical, clinical guidelines on the management of cancer-related breakthrough pain in adults. On the basis of a review of the literature, the task group was unable to make recommendations about any individual interventions, but was able to make a series of 12 recommendations about certain generic strategies. However, most of the aforementioned recommendations are based on limited evidence (i.e., case series, expert opinion). The task group also proposed a definition of breakthrough pain, and some diagnostic criteria for breakthrough pain. [Copyright &y& Elsevier]

Objective The National Institute for Clinical Excellence (NICE) has recommended laparoscopic resection as an alternative to open surgery for patients with colorectal cancer. The aim of this study was to evaluate the current uptake of laparoscopic colorectal surgery in Great Britain and Ireland. Method A questionnaire was distributed to members of the Association of Coloproctology of Great Britain and Ireland (ACPGBI) regarding their current surgical practice. Results were analysed individually, by region, and nationwide . Results Information was received on 436 consultants (in 155 replies), of whom 233 (53%) perform laparoscopic colorectal procedures. During the previous year, 25% of colorectal resections were performed laparoscopically by the respondents. However, of those surgeons who were performing laparoscopic resections, only 30% performed more than half of all their resections laparoscopically. Right hemicolectomy, left-sided resections, and rectopexy were the most frequently performed laparoscopic resections. There was an even distribution throughout the country of consultants performing laparoscopic resections (regional IQR 48–60%). The main reason for consultants not performing laparoscopic procedures was a lack of training or funding. Conclusion Laparoscopic colorectal surgery is being performed by more than half (53%) of colorectal consultants nationwide, although only a quarter of all procedures are being undertaken laparoscopically. [ABSTRACT FROM AUTHOR]

Changes to the definition of internal auditing have increased the scope of internal audit by explicitly including consulting activities. Yet, despite recognition and clarification of the consulting role for internal audit, little subsequent research has been undertaken. Hence, we aim in this article to provide a comparison of the nature, extent and consequences of the definitional change on internal audit consulting activities undertaken by a sample of IIA members in the UK/Ireland and Italy. A comparison of the results of the two self-completion questionnaire surveys reveals a significant rise in the levels and scope of activities in consulting in both countries but this has been greater in the UK/Ireland. While there are similarities between the countries, more UK/Ireland members are involved in change management and project management, while a majority of Italian members are involved in model design and implementation. In both countries, internal auditors are experiencing both benefits and drawbacks. [ABSTRACT FROM AUTHOR]

One of the less visible consequences of the Good Friday (Belfast) Agreement of 1998 was that it finally put to rest a fifty year dispute between Ireland and the United Kingdom about the names of the respective states. This article begins by outlining the constitutional background to this complex terminological dispute, and then examines it from three perspectives. The first is that of the Irish state itself, which in recent decades has opted unambiguously for ‘Ireland’. The second is the British government, which until the end of the twentieth century preferred the labels ‘Eire’ or ‘Irish Republic’. The third is the militant nationalist republican movement, whose terminology was designed to deny the legitimacy of the existing state. The article concludes by examining the political significance of this issue, arguing that while its most obvious importance is symbolic, it has also had real meaning for the identity and for the geographical definition of the state, as well as for the British-Irish relationship. [ABSTRACT FROM AUTHOR]

Explaining the huge variability present in bird colony sizes within and between species is intimately related to the understanding of the proximate and ultimate reasons for bird coloniality. However, natural patterns of colony size frequency distributions (CSFDs) remain poorly known. It is widely believed that colonial birds have similar long-tailed (highly right-skewed) CSFDs and that species mainly differ in their maximum colony sizes (in the length of the ‘tail’ of their CSFDs). We used data from the Seabird 2000 project (20 species; 19 978 colonies; 3 779 919 nests), the largest and most detailed dataset currently available, to analyse the CSFDs of seabird breeding in Britain and Ireland. Log-transformations of colony sizes revealed that the often reported long-tailed CSFDs in common histograms were hiding contrasting patterns, mainly log-normal but also power law CSFDs. The different statistical characteristics of CSFDs did not co-occur at random within species and were in fact highly correlated (e.g. a large geometric mean correlated with a large coefficient of variation). A PCA with these characteristics revealed a smoothed transition between species’ CSFD. Therefore, (a) a logarithmic analysis will allow different aspects of what is currently only referred to as ‘colony size variation’ to be quantified; (b) we challenge the current idea that all species show similar long-tailed CSFDs; (c) we offer a new (unified) view of colony size variation and discuss how these new patterns confirm, challenge and may advance theoretical and applied research into bird coloniality. [ABSTRACT FROM AUTHOR]

Studies of the impacts of climate and climate change on biological systems often attempt to correlate ecological responses with basin-scale indices such as the North Atlantic Oscillation (NAO). However, such correlations, while useful for detecting long-term trends, are unable to provide a mechanism linking the physical environment and ecological processes. Here we evaluate the effects of the NAO on recruitment variability of rocky intertidal invertebrates in the North Atlantic examining two possible climate-related pathways. Using a highly conservative test we interpret associations with the NAO integrated over a season (three months) as an indicator of atmospheric effects on newly settled recruits (NAO3), and the effects of the NAO integrated over six months (NAO6) as an indicator of changes in ocean circulation affecting patterns of larval transport. Through an extensive literature survey we found 13 time series, restricted to southwest Ireland and Britain and comprising five species, that could be used for statistical analysis. Significant correlations with NAO3, our proxy for atmospheric effects, were observed in the south-central domain of our study region (southwest Ireland and south England). Significant correlations with NAO6, the proxy for ocean circulation effects, were detected on southwest Ireland. The associations were detected for three (two barnacles and a topshell) at two sites. These results suggest that the NAO can have effects on the recruitment of intertidal invertebrates through different pathways linked to climate and be distributed heterogeneously in space. Based on previous evidence and the sign and geographic location of significant correlations, we suggest that winter NAO effects are likely to occur as a result of effects on the survival of early life stages settling during spring or through changes in phenology. Our results argue that a combination of modeling and synthesis can be used to generate hypotheses regarding the effects of climate on recruitment and aid in the design of field-based tests of explicit ecological mechanisms. [ABSTRACT FROM AUTHOR]

This article examines Ireland's relative position within the UK industrial sector in the early twentieth century, by critically evaluating the Irish component of the First UK Census of Production. Firstly, Ireland's employment, net output shares, and net output per person are compared to the UK results. Secondly, by supplementing and adjusting the census evidence, a new estimate of the size of the industrial workforce is constructed, which is then used to produce a new estimate of Irish industrial output. From this it is possible to estimate the contribution of industry to Irish GDP, which can then be compared to its contribution in other European economies. [ABSTRACT FROM AUTHOR]

We analyze the impact of volatility per se on real exports for a small open economy concentrating on Irish trade with the United Kingdom and the United States. An important element is that we take account of the time lag between the trade decision and the actual trade or payments taking place by using a flexible lag approach. Rather than adopting a single measure of risk, we adopt a spectrum of risk measures and detail varied size characteristics and statistical properties. We find that the ambiguous results found to date may be due to not taking account of the timing effect, which varies substantially depending on which volatility measure is used. ( JEL C32, C51, F14, F31) [ABSTRACT FROM AUTHOR]

Introduction Before publication of the British Society of Gastroenterology and Association of Coloproctology of Great Britain and Ireland guidelines in 2002, screening for people with a family history of colorectal cancer was sporadic and largely dependant on unvalidated local guidelines. Since 1990 we have been screening patients with both high and moderate risk family histories of colorectal cancer using local protocols which were more liberal than the new guidelines. In this study, we have analysed the pathology that would have been missed if we had been using the new guidelines in the period 1990–2002. Method A total of 399 consecutive patients with a positive family history of colorectal malignancy underwent screening endoscopy according to local guidelines. Demographic, endoscopic and pathologic data were prospectively collected. Patients were retrospectively divided into those who would have been screened under the new guidelines (group 1) and those who would not (group 2). The recorded pathology was graded as significant or insignificant and the findings compared between the two groups. Results A total of 399 patients underwent 557 endoscopies of which 278 (50%) were indicated under the new guidelines (group 1) and 279 (50%) were not indicated (group 2). A significant pathology or carcinoma was found in 15.8% of group 1 endoscopies and 10.0% of group 2 endoscopies. This difference was significant. Conclusion If we had been using the new guidelines in the period 1990–2002, we would not have performed 279 (50%) of the 557 procedures, but would not have discovered significant pathology in 10% of the moderate risk endoscopies representing 39% of the significant pathology, which was actually present in this population. [ABSTRACT FROM AUTHOR]

Objective To assess the safety and short term outcomes of the procedure for prolapsing haemorrhoids (PPH), a relatively new procedure for the treatment of symptomatic haemorrhoids. Method In 2005, the Association of Coloproctology of Great Britain and Ireland set up an online electronic database to audit the indications and outcomes for patients undergoing a PPH procedure. Results During the audit period, 695 patients were entered onto the database by 61 surgeons (range 1–50 patients per surgeon). The main indications for surgery were bleeding (90.5%) and prolapse (83.9%). Three hundred and ninety-seven (57.1%) patients had grade III or IV haemorrhoids. PPH was performed under general anaesthetic in 602 (86.6%) cases and a consultant surgeon performed the procedure in 572 (82.3%) cases. The median length of stay was 1 day (range 0–6 days). Two hundred and eighty-nine (41.6%) procedures were performed as a day case. Immediate complications were recorded in 75 (10.8%) patients, the commonest being bleeding (21) and urinary retention (24). At 6-week follow-up, 626 (90.1%) patients were pain free. Five patients required hospital re-admission for secondary haemorrhage (3), peri-anal abscess (1) and pain (1). The commonest problems were minor bleeding (48), urgency (22), pain (14), continued prolapse (12) and pruritus (11). Four patients required an open haemorrhoidectomy for persistent symptomatic haemorrhoids. Conclusion Procedure for PPH is a safe and effective procedure for symptomatic haemorrhoids with good short-term outcomes. Long-term follow-up is required perhaps through a compulsory national register. [ABSTRACT FROM AUTHOR]

Background: Since the introduction of propofol in 1977, it has been widely used for the induction and maintenance of anaesthesia and for sedation on the intensive care unit. Recently, case reports of suspected propofol infusion syndrome (PRIS) following short term infusions have been published. We set out to obtain a picture of the current use of propofol infusions by paediatric anaesthetists in Great Britain and Ireland. Methods: A questionnaire concerning the use of propofol infusions was sent to 388 paediatric anaesthetists. Results: A total of 242 (62%) replies were received. 26% of anaesthetists used propofol infusions with at least a monthly frequency. 136 (56%) anaesthetists thought that propofol infusions were of benefit in reducing postoperative nausea and vomiting. The majority of anaesthetists did not state a maximum infusion rate or length of infusion. Of those anaesthetists who answered the questions the maximum rate used was 30 mg·kg−1·h−1 and the longest time considered for an infusion was 72 h. Only 5 (2%) anaesthetists regularly used BIS monitoring, although 106 (44%) expressed a desire to use it if it was freely available in their hospitals. Modifications to infusions from 1% to 2% propofol were used by 38 (16%) anaesthetists and 28 (12%) used glucose infusions intra-operatively. Conclusions: There is a wide variety in the use of propofol infusions by paediatric anaesthetists. The mechanisms underlying PRIS are poorly understood and require further work to ensure propofol infusions are used appropriately for anaesthesia in children. [ABSTRACT FROM AUTHOR]

Recent years have seen growing interest in the political power of ideas, especially in debates about globalisation and European integration. As is now widely noted, constructions of globalisation and European integration may play a powerful causal role in shaping policy prescriptions across Europe. Yet, while a substantial body of theoretical literature has pointed to the need for sustained empirical analysis of such discourses, little systematic and comparative analysis has been undertaken into policy makers' attitudes towards globalisation, European integration and the relationship between the two. This article presents the initial findings of a survey of elite political attitudes to globalisation and European integration in the United Kingdom and Ireland. The authors develop and apply a theoretical schema for the classification and mapping of such discourses. Their analysis reveals, on the one hand, the range and diversity of discourses of globalisation and European integration among elite political actors and, on the other, the continued prevalence of specific conceptions (and indeed misperceptions) of globalisation in particular that have now been challenged empirically. They identify a series of core tensions and contradictions within elite political discourse in both the United Kingdom and Ireland. This suggests a certain frailty in the prevalent understanding of globalisation to which elite political actors would otherwise seem committed when confronted with its distributive consequences. [ABSTRACT FROM AUTHOR]

Background: Randomized controlled trials suggest that prophylactic administration of antifungal agents reduce the rate of colonization and invasive Candida infection in a subgroup of high-risk very low birth weight (VLBW) neonates. The extent of antifungal prophylaxis use in the United Kingdom and Ireland is unknown. Methods: A postal questionnaire was administered to neonatologists practicing in the United Kingdom and Ireland caring for VLBW infants. Information was requested on the prophylactic agents used, dosing schedules and duration of therapy. The rationale for reported practices was also ascertained. Results: The response rate was 55% (125/228). Antifungal prophylaxis use was reported by 66 (53%) respondents. First-line agents utilized included oral nystatin (53%) and intravenous fluconazole (41%). The most frequent indications for antifungal prophylaxis included antibiotic administration in 45 (68%) and decreased birth weight in 33 (50%) respondents. The majority of respondents who did not use antifungal prophylaxis felt that the perceived rate of invasive fungal disease within their unit was not high enough to justify its use. Conclusions: A small majority of clinicians caring for VLBW neonates routinely use antifungal prophylaxis. This reflects the wide variation in the incidence of invasive disease, lack of guidelines supporting a role for prophylaxis and concerns related to emergence of resistant strains. [ABSTRACT FROM AUTHOR]

In this paper, we use commodity chain ideas to compare the All Blacks rugby tour of Great Britain and Ireland in 2005 with the formative 1905 tour, and to relate their cultural economy to their political economy. We argue that ‘globalization’ has become imagined and institutionalized in new ways that more thoroughly exploit rugby's production values. We highlight the value-adding potential of a 100-year-old tension between a colonial/imperial and a national identity. Our point is that fresh insights can be drawn from bringing cultural economy sensitivities to political economy approaches and concerns with identity and consumption to those of value and production. [ABSTRACT FROM AUTHOR]

This prospective observational study reports on 126 women from 25 UK centres with image-proven antenatal venous thromboembolism (VTE), 62% deep vein thrombosis and 38% pulmonary embolism. Thrombophilia screening was of limited benefit except to identify antithrombin deficiency. Sixteen (13%) patients had previous VTE, all but one was related to previous pregnancy or combined oral contraceptive and 12 received no thromboprophylaxis in the index pregnancy, the other four thus received inadequate low molecular weight heparin (LMWH) doses. Treatment was with dalteparin in 25%, enoxaparin in 47%, tinzaparin in 25% and unfractionated heparin alone in 3%. 66% of patients received once-daily LMWH. Anti-activated factor X (anti-Xa) monitoring was performed at 90% of centres, with a wide range of target values. Thus current management of antenatal VTE, despite widely diverse clinical practice, appeared effective and safe, for there were no recurrent events and postpartum haemorrhage was not increased when compared to known rates. Larger studies are required to confirm this. The need for twice as opposed to once daily LMWH and for anti-Xa monitoring is questioned by this study. The importance of clinical risk assessment and adherence to the Royal College of Obstetricians and Gynaecologists guidelines on antenatal thromboprophylaxis, with adequate LMWH dosing is confirmed. [ABSTRACT FROM AUTHOR]

(The place of publication is London and the date 2006 unless otherwise stated.) [ABSTRACT FROM AUTHOR]

The aim of this study was to analyze the factors that influence the advancement and the career choices of doctors and medical students. Using the combined databases of the iformix and surgent websites, 450 doctors and medical students were invited to complete an internet-based survey. Surgent (.ie) and iformix () are two free internet services administered by the authors. Surgent is a medical educational website, while iformix facilitates the online submission of abstracts to surgical and medical conferences across Britain and Ireland. The combined database of these two websites is approximately 4500 entries. Four hundred and fifty users represented a 10% sample based on an expected 40%-45% response rate. This was anticipated to yield between 180 and 202 respondents, statistically sufficient to analyze the data. A detailed Likert scale assessed the importance of “academic,” “clinical,” and “lifestyle” factors in determining career choice and progression. Analysis included descriptive statistics and inferential testing. Fifty percent ( N = 222) of surveys were returned; 142 men and 78 women. Thirty-seven percent of respondents were Irish, 28% British, and 35% non-European. Fifteen percent were undergraduates, 4% interns, 12% had 2-4 years of clinical experience, while 69% had completed more than 4 years. Fifty-six percent had decided upon a career in general surgery. Overall, the most important factors for career choice were intellectual challenge (95%), academic opportunities (61%), and research opportunities(54%). Doctors with more than 4 years of experience deemed duration of training ( p = 0.002), lifestyle during training ( p = 0.02), and stress (0.005) as less important factors when considering career choice. Correlation analyses demonstrated that prestige ( p = 0.002), patient relationships ( p = 0.006), and advice from friends or family ( p = 0.01) were more important influencing factors for interns. In terms of career advancement, 66% of non-Europeans considered family contacts important as opposed to 20% of British and 45% of Irish doctors ( p < 0.001). In addition, 47% of females felt gender was important for career advancement as opposed to 31% of males ( p = 0.01). Academic and clinical factors play an important role in career choice. However, it is clear that lifestyle factors predominate in determining an individual’s career decisions in surgery. [ABSTRACT FROM AUTHOR]

Recent changes in European legislation have meant that certain processed abattoir waste, which has been appropriately heat treated and ground to a specified particle size, can be spread on nonpasture agricultural land. This has opened the way for the potential landspreading of mammalian meat and bone meal (mMBM) derived from animals slaughtered for human consumption. This article reports on two separate case studies (Study 1 carried out in Great Britain (GB) and Study 2 carried out in Ireland) on the potential exposure to TSE infectivity following the spreading of abattoir waste (derived from animals slaughtered for human consumption) on nonpasture agricultural land. For Study 1, the average TSE infectivity on nonpasture agricultural land per year from sheep with scrapie was found to be higher (five orders of magnitude) than that estimated for BSE in cattle (3.9 × 10−3 Ovine Oral ID50/ton of soil compared to 3.3 × 10−8 Bovine Oral ID50/ton of soil). The mean estimate for BSE in sheep was 8.1 × 10−6 Ovine Oral ID50/ton of soil. The mean level of infectivity in mMBM was assessed to be 1.2 × 10−5 and 2.36 × 10−5 ID50/ton of mMBM for Study 1 and 2, respectively. For Study 2 the spreading of mMBM was estimated to result in infectivity on nonpasture land of 1.62 × 10−8 Bovine Oral ID50/m3. The mean simulated probability of infection per year per bovine animal was 1.11 × 10−9. Given the low infectivity density and corresponding low risks to bovines the spreading of mMBM could be considered a viable alternative for the utilization of mMBM. [ABSTRACT FROM AUTHOR]

Background: This paper describes a prospective audit of children receiving epidural infusion analgesia (EIA) in Great Britain and Ireland. The aim was to quantify the risks associated with this technique. Methods: In order to obtain sufficient data on the number of pediatric epidurals performed and the incidence of unwanted events, a decision was taken, at an Annual Meeting of Great Britain and Ireland Paediatric Pain Services, to establish a national audit of EIA practice in these centers. Each site sent a monthly return of the numbers of EIA performed to the coordinating center. If an incident occurred then the referring site completed a more detailed form and the child was followed up for 1 year if possible. Incidents were graded by severity 1–3, serious to minor. These data were collected over the 5-year period (2001–2005). Results: (i) Ninety six incidents were reported in 10 633 epidurals performed. (ii) Fifty six were associated with the insertion or maintenance of EIA; most were of low severity (1 : 189). (iii) Five incidents were graded as 1 (serious) (approximately 1 : 2000). (iv) Nine incidents were graded as 2 (approximately 1 : 1100). (v) Only one child has residual effects from a grade 1 incident 12 months after surgery (approximately 1 : 10 000). (vi) Forty incidents were also reported that were felt to be associated with the use of EIA; 33 of these incidents were the development of pressures sores. Four incidents of compartment syndrome were reported, in each of these cases the presence of EIA did not mask the condition. Conclusions: Epidural infusion analgesia in children does have risks associated with the technique. The occurrence of compartment syndrome does not appear to be masked by the presence of working EIA. As a result of this audit we can now provide parents with better information, thereby improving the process of informed consent. [ABSTRACT FROM AUTHOR]

Background In a recent study, we constructed an item pool that contains items on the quality of life (QOL) and related aspects of support of people with profound multiple disabilities (PMD). In the present study, a panel of experts assessed the content and the structure of this item pool in order to enhance its validity and usefulness. Method A two-round Delphi study was set up. The panel consisted of 45 experts, of whom 12 were theory-experts, 12 practice-experts and 12 experience-experts from Belgium ( n = 12), Germany ( n = 12), the Netherlands ( n = 11) and the UK/Ireland ( n = 10). Both quantitative and qualitative methods of analysis were applied to the data. Results The majority of the items were considered relevant for the QOL of people with PMD. In the first round, 91% of the items reached the 80% criterion of consensus. In the second round, 78.7% of the items reached the 85% criterion of consensus. There were no significant differences in opinion neither between types of experts nor between countries. Several items were reported as missing in the item pool and were added. Conclusions The results provide some evidence that the item pool is a valid operationalization of QOL of people with PMD and can be used in an instrument to measure the QOL of this target group. [ABSTRACT FROM AUTHOR]

From both a modern and a historical perspective there is little doubt that the Arctic charr, Salvelinus alpinus, in Britain and Ireland (as well as elsewhere) is a ‘difficult’ species. Historically 15 separate species have been recognised from populations in Britain and Ireland and there have been recent attempts to reassert these specific names. Here we review the evidence for the status of these ‘species’. We conclude that the evidence for these 15 being afforded full species status is poor. However, both historical and contemporary data show that Salvelinus alpinus (Linnaeus 1758) in Britain and Ireland exhibits levels of variability in form that is much greater than in other species. We argue that a comprehensive genotypic and phenotypic survey of charr populations in Britain and Ireland is required to determine the full extent of variability and the status of populations with a view of providing suitable protection. [ABSTRACT FROM AUTHOR]

Background The use of rectal tubes in colorectal surgery appears to be a matter of individual choice, with little documented evidence to support their use. This study assesses the current practice of rectal tubes amongst consultant members of the Association of Coloproctology of Great Britain & Ireland (ACPGBI). Methods A piloted questionnaire was sent to practising ACPGBI consultant members listed in the 2003–04 directory. Statistical analysis was performed using SPSS software and Fishers exact test. Results Three hundred and thirty-nine replies were received from 579 posted questionnaires (response rate = 58.5%). Rectal tubes were used by 116 (35%) of responding surgeons. Rectal tubes were more commonly used by surgeons with less than 10 years practice as a consultant ( P < 0.005). The main indications for tube placement were following ileo-anal or colonic pouch surgery (73%), after any anterior resection (36%) (rectal tubes were reserved for only low anterior resections by 16% of surgeons) and in the rectal stump after total or subtotal colectomy for acute colitis (11%). Twenty-three percent of these practising surgeons would use a rectal tube as an alternative to a diverting stoma, predominantly in selected patients following ileo-anal pouch surgery. A Foley catheter was the commonest type of tube used (70%) and this was usually placed above the anastomosis (80%). Rectal tubes were left in situ for a median of 5 days (range = 1–13 days). Three surgeons (2.6%) reported serious complications including tube perforation of the bowel or anastomosis. Several different mechanisms were suggested for the purpose and functioning of the rectal tube, the commonest being to decompress the rectum and/or pouch. Conclusion Rectal tube placement is simple and safe and is used by a third of colorectal surgeons in UK and Ireland. Given their simplicity, the efficacy of rectal tubes in reducing local anastomotic complications requires further evaluation within the confines of a randomised controlled trial. [ABSTRACT FROM AUTHOR]

The article focuses on the experiences of Leone Industries with the Preheater/Filter System and cullet preheating. The system was taken from an installation partially sponsored by British glass and it was placed on an air-gas furnace at the Irish Glass Bottle in Dublin. It explains the factors to be considered in designing a Cullet Filter/preheater system. It offers an overview of the challenges involved in developing pyrolyzer, ionizers and filter module.

The article discusses the protocol issued by the U.S. Federal Aviation Authority (FAA) which would allow pilots with insulin-treated diabetes to operate a commercial aircraft. Topics explored include the required use of a U.S. Food and Drug Administration (FDA)-approved device for continuous glucose monitoring, countries that have previously implemented similar guidelines such as Canada and Great Britain, and the expansion of the occupational opportunities for diabetics in the U.S.

The article reviews several government web sites related to patient/user involvement in Great Britain, including "www.wales.nhs.uk" by Wales, "www.show.scot.nhs.uk" by Scotland and "www.healthandcareni.co.uk" by Northern Ireland.

The article explores how homelessness may impact on the educational participation of children and young people in families living in emergency accommodation in Dublin. Many difficulties arise in terms of maintaining consistent schooling for children when they are part of a homeless family, including problems getting to and from school if living at a distance from their original schools, frequent changes in school and inadequate facilities and overcrowding in their temporary accommodation. Despite the many difficulties involved in maintaining children's regular school attendance, it is evident that school may represent the only stability for a child in an otherwise insecure and changing routine. [ABSTRACT FROM AUTHOR]

(The place of publication is London and the date 2005 unless otherwise stated.) [ABSTRACT FROM AUTHOR]

The article compares the housing allocation system in Netherlands with that of Ireland, Spain, Great Britain and Germany. An overview of the housing allocation policy in Netherlands is provided. A discussion of the housing allocation process under the distribution model and deft allocation model is presented. The composition of the housing stock in each of the countries is explained.

Objective To assess current provision of specialist and transitional paediatric endocrine services in the UK and Ireland. Design A questionnaire was sent to paediatric endocrinologists requesting details of patients receiving GH and also details of specialist and transitional services. Results Of 72 questionnaires received, 56 [21 from historical growth centres (group 1), 10 from other teaching hospitals (group 2) and 25 from district general hospitals (DGHs) (group 3)] were analysed. A total of 4758 children [3709 (78%) in group 1] currently receive GH in the UK. Fifty-six per cent of units (90% in groups 1 and 2) provide transfer clinics: transition ( N = 27), adolescent (10), young adult (11) and adult (3). In 90% of the paediatric units, the paediatric and adult endocrinologist sit together, and 58% of clinics are held in the paediatric unit. Clinic entry is based on final height (33%), age (51%), both (14%), and other (2%). Fifty-five per cent of units transfer all GH-treated patients, the remainder transfer only those non-GH-deficient on retesting. Eighty per cent retest prior to transfer using the insulin tolerance test (ITT) [ N = 27 (including three DGHs)], glucagon (22), arginine (4), clonidine (2) and other (5). Apart from intersex clinics (13), there are few specialist clinics for other paediatric endocrine patients, including only three for Turner syndrome (TS). Adult TS transfer is to multidisciplinary clinics ( N = 11), adult endocrinology (27), gynaecology (14), cardiology (5) and general practitioner (GP) (1). Conclusions We have confirmed more GH-treated patients than before; many remain within historic growth centres. Although in the UK and Ireland transition services are established in many larger units, current guidelines are not always adhered to. Provision of specialist paediatric endocrine clinics for all groups remains variable. [ABSTRACT FROM AUTHOR]

I represent the Patient Liaison Group working with the Association of Coloproctology of Great Britain and Ireland (ACPGBI) particularly on the topic of inflammatory bowel disease (IBD). The IBD Surgical Guidelines have been commissioned by ACPGBI to sit alongside the review by the British Society of Gastroenterology of the medical guidelines for the measurement of IBD [2]. They look at Crohn's disease; pouch surgery, intestinal failure; surgery for IBD in pregnancy; right through to the impact of medications on surgery. [Extracted from the article]

This paper presents the case for and against the involvement of external organizations in new product development projects. It examines both the frequency of interaction of firms with their customers, suppliers, universities, research institutes and competitors, and also the correlation between such interaction and new product success. Empirical data were collected from 60 electronics firms in Ireland and the UK using a well-established framework ( Souder, et al., 1998 ). The analysis examines small and large, Irish and UK firms and concludes that the impact of networking and collaboration on new product success is dependent on a range of factors and should not be viewed as a panacea for product development problems. [ABSTRACT FROM AUTHOR]

This article presents a list of publications on the economic and social history of Great Britain and Ireland in 2004.

Complications at extubation remain an important risk factor in anaesthesia. A postal survey was conducted on extubation practice amongst consultant anaesthetists in the United Kingdom and Ireland. The use of short acting drugs encourages anaesthetists to extubate the trachea at lighter levels of anaesthesia. The results show that oxygen (100%) is not routinely administered either before extubation or en route to the recovery area. A trend towards a head up or sitting position at extubation is emerging. However, further research into the use of these positions is required. Airway related complications at extubation are relatively frequent but are usually dealt with by simple basic measures. The role of drugs such as propofol in decreasing the incidence of these complications needs further evaluation. Some of these results give concern for patient safety and for training. The importance of teaching and adherence to continued oxygenation until complete recovery is strongly emphasised. Nerve stimulators should be used continually as standard monitoring throughout the anaesthetic period when muscle-relaxing drugs are part of the anaesthetic technique. [ABSTRACT FROM AUTHOR]

The transmission of contagious equine metritis (CEM) on stud farms in Britain, Ireland and other European countries is prevented by following the recommendations in the Horserace Betting Levy Board's Code of Practice on CEM. A quantitative risk assessment was undertaken to estimate the likely impact of removing the recommendation, from the 2002 code, to culture endometrial or cervical swabs microaerophilically for the presence of Taylorella equigenitalis, the causative organism. The scientific literature was reviewed for evidence about the anatomical distribution of Tequigenitalis at different times after infection and it was found that, in chronically infected mares, the organism was detectable in the clitoral swabs of nearly 93 per cent, but in the cervical swabs of only 31 per cent. In contrast, in acutely infected mares, the organism was detectable in the clitoral swabs of nearly 69 per cent, but in the cervical swabs of 84 per cent. By using these results, a quantitative risk assessment was undertaken, assessing the likely effects of removing the recommendation that swabs from the cervix of low-risk mares should be cultured for T equigenitalis. The results were sensitive to the prevalence of the infection, but when it was low, there appeared to be few benefits in continuing to culture cervical swabs routinely. However, such swabs are vital when the disease is suspected. [ABSTRACT FROM AUTHOR]