A different appetite for sovereignty? Independence movements in subnational island jurisdictions

Local autonomy in a subnational jurisdiction is more likely to be gained, secured or enhanced where there are palpable movements or political parties agitating for independence in these smaller territories. A closer look at the fortunes, operations and dynamics of independence parties from subnational island jurisdictions can offer some interesting insights on the appetite for sovereignty and independence, but also the lack thereof, in the twenty-first century.peer-reviewe

Use of NSAIDs and patient safety

Objective: To assess the pattern of use of nonsteroidal anti-inflammatory drugs (NSAIDs) and propose methods whereby pharmacists can help to improve patient safety when these drugs are used. Method: A psychometrically-evaluated questionnaire was administered to 261 patients aged 18 and over who visited 13 different community pharmacies, 1 from each electoral district in Malta and Gozo, chosen by stratified random sampling. Information about the sociodemographic status, symptoms and disease states and the drugs taken in the past 6 months was collected. Analysis of data was carried out using Microsoft Office Excel 2007 and the Biomedical Data Package (BMDP ) Software. Key findings: Results show a high prevalence of analgesic (>80% per district) and NSAID use (about 50% per district). The first drug of choice to relieve analgesia was paracetamol (67.1%) followed by diclofenac (37.2%). Ibuprofen was the fourth drug of choice (7.3%). About 65% of patients who took diclofenac stated that they self-prescribe the medication. Statistical analysis of data showed an association between the use of NSAIDs, musculoskeletal pain and menstrual pain (both p=0.010). A number of patients at risk of gastro-intestinal bleeds, cardiovascular events and those suffering from asthma reported taking NSAIDs occasionally. The presence of risks of drug interactions was identified with various drugs. Conclusion: NSAIDs are overused in Malta and are often administered indiscriminately. Pharmacist intervention could ensure the rational and safe use of NSAIDs. This could be achieved by having a shared protocol between pharmacists and prescribers for appropriate prescribing and dispensing and by identifying scenarios where pharmacist prescribing can be carried out to ensure that the analgesic used is appropriate for the individual patient.peer-reviewe

Neuropsychological functioning and chronic methadone use:a systematic review and meta-analysis

The authors would like to thank the NHS Fife Research and Development Department for supporting this project.Introduction: There is a presumption that neurocognition is commonly impaired in chronicmethadone exposed individuals (CM) when compared with healthy controls (HP).Additionally, it remains unclear if short term (< 1 year) abstinence (AP) is associated with an altered cognitive profile when compared with CM. Method: A random effect model approach was used on data assembled into the Comprehensive Meta-Analysis programme.Cohen’s d effect sizes and a significance levels of p<0.01 were calculated for each domain. Results: Data from a total cohort of 1063 CM, 412 AP and 879 HP participants, from 23 independent studies indicate global impairments in neurocognitive function in CM relative to HP participants. The smaller body of evidence comparing CM to AP participants is inconclusive. Conclusion: Methodological issues such as small sample sizes, heterogeneity and poor quality limited the interpretation of the results and does not address whether the observed impairments reflect co-morbid functioning, methadone-related sedation and/or other factors. Only higher quality longitudinal studies will permit confident interpretation of the results observed in this meta-analysis.PostprintPeer reviewe

Islands and despots

This paper challenges a conventional wisdom: that when discussing political systems, small is democratic. And yet, can there be paradises without serpents? The presumed manageability of small island spaces promotes and nurtures dispositions for domination and control over nature and society. In such dark circumstances, authoritarian rule is a more natural fit than democracy. By adopting an inter-disciplinary perspective, this paper argues that small island societies may be wonderful places to live in, as long as one conforms to a dominant cultural code. Should one deviate from expected and established practices, the threat of ostracism is immense. Formal democratic institutions may and often do exist, and a semblance of pluralism may be manifest, but these are likely to be overshadowed by a set of unitarist and homogenous values and practices to which many significant social players, in politics and civil society, subscribe (at least in public).peer-reviewe

Lifelong learning and schools as community learning centres : key aspects of a national curriculum draft policy framework for Malta

The island of Malta has been engaged in policy document formulations for curriculum renewal in the country’s educational system (4-16 years of age) since 1988 when the first National Minimum Curriculum (henceforth NMC) was launched (Wain, 1991; Borg et al, 1995). In 1999 a revamped NMC (Ministry of Education, 1999) was developed following a long process of consultation involving various stages and stakeholders. It was a compromise document (Borg & Mayo, 2006) which emerged as a result of reactions to a more radical and coherent draft document produced in 1988. Both curricular documents were subject to debates and critiques (Wain, 1991; Darmanin, 1993; Borg et al, 1995; Giordmaina, 2000; Borg and Mayo, 2006). More recently a series of volumes providing guidelines, key principles and aims for a national curriculum framework (henceforth NCF) have been produced (MEEF, 2011a,b,c,d) and are currently the target of debate and the focus of reactions by various stakeholders in education including teachers who were asked to read the volumes and provide reactions in the form of answers to a set questionnaire. In this paper, I will focus on one aspect of the documents, the first of its three aims: ‘Learners who are capable of successfully developing their full potential as lifelong learners.’ It is that aspect of the framework documents that falls within the purview of the title for this special issue. The use of this notion attests to the influence of the EU’s policy communications on member states, Malta having joined the Union in 2004 (Mayo, 2007).peer-reviewe

Neurobehavioral consequences of chronic intrauterine opioid exposure in infants and preschool children: a systematic review and meta-analysis

&lt;b&gt;Background&lt;/b&gt;&lt;p&gt;&lt;/p&gt; It is assumed within the accumulated literature that children born of pregnant opioid dependent mothers have impaired neurobehavioral function as a consequence of chronic intrauterine opioid use.&lt;p&gt;&lt;/p&gt; &lt;b&gt;Methods&lt;/b&gt;&lt;p&gt;&lt;/p&gt; Quantitative and systematic review of the literature on the consequences of chronic maternal opioid use during pregnancy on neurobehavioral function of children was conducted using the Meta-analysis of Observational Studies in Epidemiology (MOOSE) and the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines. We searched Cinahl, EMBASE, PsychINFO and MEDLINE between the periods of January 1995 to January 2012.&lt;p&gt;&lt;/p&gt; &lt;b&gt;Results&lt;/b&gt;&lt;p&gt;&lt;/p&gt; There were only 5 studies out of the 200 identified that quantitatively reported on neurobehavioral function of children after maternal opioid use during pregnancy. All 5 were case control studies with the number of exposed subjects within the studies ranging from 33–143 and 45–85 for the controls. This meta-analysis showed no significant impairments, at a non-conservative significance level of p &#60; 0.05, for cognitive, psychomotor or observed behavioural outcomes for chronic intra-uterine exposed infants and pre-school children compared to non-exposed infants and children. However, all domains suggested a trend to poor outcomes in infants/children of opioid using mothers. The magnitude of all possible effects was small according to Cohen’s benchmark criteria.&lt;p&gt;&lt;/p&gt; &lt;b&gt;Conclusions&lt;/b&gt;&lt;p&gt;&lt;/p&gt; Chronic intra-uterine opioid exposed infants and pre-school children experienced no significant impairment in neurobehavioral outcomes when compared to non-exposed peers, although in all domains there was a trend to poorer outcomes. The findings of this review are limited by the small number of studies analysed, the heterogenous populations and small numbers within the individual studies. Longitudinal studies are needed to determine if any neuropsychological impairments appear after the age of 5 years and to help investigate further the role of environmental risk factors on the effect of ‘core’ phenotypes

The métier of living:Art, genocide and education

In art what appears to be a condition for change is almost always strategically expedient. This is especially the case when one positions art and change within a prosthetic space. Charles Garoian lays claim to this strategy by posing prosthesis as the fourth dimension that follows a third synthetic stage that dialectically binds a thesis to its antithesis. Re-reading Garoian’s claims against the Soviet and Neo-Liberal renditions of Hegel’s theory of the dialectic, this article argues that such claims could reduce art’s space to a prosthetic synthesis that risks pedagogical and aesthetic ossification. Given the performative élan by which Garoian invests education, this appears paradoxical, especially in terms of the personal dimension by which he invests his art as a metier of living and surviving a history that is firmly marked by the devastation of genocide. Strangely, this paradox is what gives us the ability and power by which we could seek a counter-Bildung. As this articles’s author puts it, in art such a counter-Bildung takes the form of unlearning by which one would exit the predicament of instrumental reason. For unlearning to become possible prosthetic syntheses must be reversed by making of arts education a case for synthetic prostheses. Only then could Garoian’s performative method begin to assert an inverse positioning that would effectively counter the instrumentalization of the dialectic, and with it, that of history and art

Feeding the rural tourism strategy? Food and notions of place and identity

The humble rural cuisine has now been thrust at the forefront of economic development strategies. This conceptual paper is a contribution to a growing critical awareness of the operations of the food industry and helps to foster a critical understanding of how, if at all, local food and its associated culture can help sustain rural tourism particularly and rural communities generally. It is inspired by literature about the international political economy of food and the many experiences of local food development, and is aware of the contrast between the structure of the industry and the hopes associated with its practice on the ground. The paper thus argues that, beyond the glamour and hype, there are those who gain, as well as those who lose, from the current food fad. While it explains the causes of the contemporary craze with food, the paper also interrogates the naı¨ve expectations often placed in food as a motor of rural development, and as the panacea for struggling rural communities. The empirical data on which this chapter is based are drawn from 18 short chapters explaining the history of various “traditional dishes” from the islands of the broad North Atlantic that feature in a recent food publication.peer-reviewe

Managing tourism decline: insights from the Isle of Man

Qualitative interviews conducted in the Isle of Man investigate local perceptions of a tourism industry in long-term decline: a development stage typically overlooked. Negative impacts of decline are revealed; including facilities loss, landscape erosion, and a heightened sense of peripherality. Together such impacts undermine local identity and attractiveness of place. Tourists are welcomed as they help to affirm the pride residents have in their island, create atmosphere, provide social interaction opportunities, stimulate positive emotions and combat negative stereotyping. Emphasised is the on-going importance of tourism impacts in a peripheral location. Practioner recommendations are therefore made calling attention to the need to more carefully manage the process of decline. Potential strategies for achieving this are signposted