Understanding Refugee Law in an Enlarged European Union Theory

The present article seeks to explore how asylum law is formed, transformed and reformed in Europe, what its effects are on state practice and refugee protection in the Baltic and Central European candidate countries, and what this process reveals about the framework used by scholars to understand the dynamics of international refugee law. Arguably, an exclusive focus on EU institutions and their dissemination of regional and international norms among candidate countries through the acquis communitaire is misleading. Looking at the subregional interplay between Vienna and Budapest, Berlin and Warsaw, Copenhagen and Vilnius provides a richer understanding of the emergence of norms than the standard narrative of a Brussels dictate. Hence, to capture these dynamics, we will attempt to expand the framework of analysis by incorporating sub-regional settings, cutting across the divide between old and new Members, and by analysing the repercussions sent out by domestic legislation within these settings. While acknowledging that bilateral and multilateral relations are continuously interwoven, we conclude that bilateralism accounts for a greater degree of normative development and proliferation than multilateralism at EU level, and that domestic legislation as formed by sub-regional dynamics will remain the ultimate object of study for scholars of international refugee law.

Risk Perception, Behavioural Response to COVID-19, and the Mediating Role of Information Sources in Zambia

The role of information sources in mediating the relationship between behavioural responses to COVID-19 and its determinants has hardly been studied. This study fills the knowledge gap with a focus on Zambia, a middle-income country. Data was collected using an online questionnaire. The key independent variables were risk perception of COVID-19, risk perception of the health care system (local and global), and risk perception of the big five global health problems (HIV/AIDS, cancer, injury from road traffic accidents, influenza, and diabetes). Risk perception of the health care system was measured by looking at whether or not the respondents trust the World Health Organisation (WHO) and Ministry of Health (MoH) backed COVID-19 vaccines. The three Independent Variables (IV) of risk perception predicted behavioural response as a Dependent Variable (DV). The behavioural response was found as an average of responses on a five-point Likert scale of questions, relating to safety measures taken by respondents against COVID 19. The relationship between IVs and the DV was hypothesised to be mediated by information sources. Information sources were measured by the frequency with which respondents obtained information about COVID-19 from various sources. A statistically significant positive relationship was found between risk perception of the health system and information sources. The same was not true for the other two independent variables. Further, a statistically significant indirect effect was found between risk perception of health systems and behavioural responses (mediated by information sources). Our findings can be used to influence policy, practice, and scholarship on sources of information for COVID-19 and expected behavioural responses. It is recommended that policy on sources of public health information be directed towards enhancing credible sources of information. Future studies must consider using longitudinal data. The big five health risks should include malaria and tuberculosis (TB), making it the big seven. Corruption’s role in risk perception of health systems should also be explored

Risk Perception, Behavioural Response to COVID-19, and the Mediating Role of Information Sources in Zambia

The role of information sources in mediating the relationship between behavioural responses to COVID-19 and its determinants has hardly been studied. This study fills the knowledge gap with a focus on Zambia, a middle-income country. Data was collected using an online questionnaire. The key independent variables were risk perception of COVID-19, risk perception of the health care system (local and global), and risk perception of the big five global health problems (HIV/AIDS, cancer, injury from road traffic accidents, influenza, and diabetes). Risk perception of the health care system was measured by looking at whether or not the respondents trust the World Health Organisation (WHO) and Ministry of Health (MoH) backed COVID-19 vaccines. The three Independent Variables (IV) of risk perception predicted behavioural response as a Dependent Variable (DV). The behavioural response was found as an average of responses on a five-point Likert scale of questions, relating to safety measures taken by respondents against COVID 19. The relationship between IVs and the DV was hypothesised to be mediated by information sources. Information sources were measured by the frequency with which respondents obtained information about COVID-19 from various sources. A statistically significant positive relationship was found between risk perception of the health system and information sources. The same was not true for the other two independent variables. Further, a statistically significant indirect effect was found between risk perception of health systems and behavioural responses (mediated by information sources). Our findings can be used to influence policy, practice, and scholarship on sources of information for COVID-19 and expected behavioural responses. It is recommended that policy on sources of public health information be directed towards enhancing credible sources of information. Future studies must consider using longitudinal data. The big five health risks should include malaria and tuberculosis (TB), making it the big seven. Corruption’s role in risk perception of health systems should also be explored

What outcome domains are considered core to assessing the impact of adult specialist palliative care services in Wales? A rapid review

Assessment of palliative care delivery is essential for managing service performance and providing im-provement in care (Donabedian, 2005). However, such assessments have tended to focus on capturing process related outcomes (service volume, response times etc.) to demonstrate service activity, rather than consistently measuring impact of services on patient and family. There has been increasing emphasis on, and international consensus on the need for, outcomes which focus more specifically on impact, in particular on domains such as quality, effectiveness and efficiency of palliative care rather than just service activity (Davis et al., 2013, Clark et al., 2016). Recently, there have been several initiatives to standardise approaches to this type of outcome assess-ment and to encourage regional approaches which will meet local needs but also allow benchmarking at national and international levels. In Wales, the End-of-Life Board (EoLB) has prioritised the need to establish a standardised approach to the collection of this type of data set, by establishing a consensus on the domains of importance and to identify whether an existing approach such as the Outcome Assessment and Complexity Collaborative (OACC) (Witt et al., 2014) or Palliative Care Outcomes Collaboration (PCOC) (Eager et al., 2010), may meet ‘needs’ in Wales or whether the specific health and social care economy unique to Wales man-dates for additional or different domains of care to be addressed. This project is a multi-stage study, with this first stage rapid review identifying from the published literature those outcomes for adult palliative care services that are considered most important to capture in order to assess service quality

Comparison of four commercially available ELISA kits for diagnosis of Fasciola hepatica in Irish cattle

peer-reviewedBackground Fasciola hepatica is a liver parasite of mammals and it results in poor welfare outcomes and economic losses in ruminants. While faecal egg count is the test most commonly used for diagnosis, it does not indicate presence of migrating immature stages. Serological techniques increase sensitivity at all stages of the liver fluke infection. The aim of this study was to compare four commercially available ELISA tests for the diagnosis of F. hepatica. For this purpose, we tested three sample types; (i) known F. hepatica status sera from an experimental infection for the comparison of sensitivities and specificities, (ii) sera from pre- and post-flukicide-treated (albendazole, closantel, nitroxynil and triclabendazole) beef cattle to contrast the differences of seropositivity before and after treatment, and (iii) bulk tank milk samples from dairy herds sampled during high and low F. hepatica exposure periods for assessing seasonal variations with the four tests available. Samples were tested using ELISA kits supplied by four manufacturers (Ildana Biotech, IDEXX, Svanova, and Bio-X). Samples were analysed simultaneously and in duplicate. Results In the control population Ildana, IDEXX and Bio-X presented 100% sensitivity (Se) and specificity (Sp), Svanovir presented a Se of 59% and a Sp of 96%. In flukicide-treated beef cattle, kits highlighted decreasing antibody levels 90 days post-treatment in variable degrees. Finally, bulk milk showed a significant decrease in ELISA value between high and low fluke exposure periods with all tests studied. Conclusions Se and Sp found in the present study, confirm that Ildana, IDEXX and Bio-X are accurate for the detection of F. hepatica exposure in Irish cattle. Svanovir Se and Sp in this population, indicate that a larger study is necessary to confirm this test characteristic in Irish herds. In post-treatment use, Bio-X showed a consistent and significant decrease of ELISA value in all groups treated, denoting to be a reliable tool for assessing treatment effect at 90 days post-treatment. Finally, all tests showed to be a reliable tool for the F. hepatica monitoring of high and low exposure seasons, using bulk tank milk samples

What are patient perspectives in atypical and idiopathic Parkinson’s disease of the benefits and timing of ACP and palliative care input? A rapid review

Parkinson’s Disease (PD) is a progressive neurological condition affecting 145,000 people living in the UK. The disease trajectory is both unpredictable and highly variable with a re-cent review of patients dying with a diagnosis of idiopathic PD in Cardiff, (personal commu-nication) showed the time from diagnosis to death ranged from 2-23 years. The review also showed that fewer than 5% of patients had any documented advanced care planning (ACP) and only 8.5% had been referred to a palliative care service prior to being in their last days of life in hospital. This rapid review aims to examine the evidence on patient perception of these issues. The review findings will be used to identify patients perspectives on the benefit and timing of advanced care planning (ACP) and palliative care team involvement and subsequently a Cardiff and Vale University Health Board development project enhancing palliative care in advanced Parkinson’s Disease

Hyperbaric oxygen effectively addresses the pathophysiology of long COVID: clinical review

BackgroundThe World Health Organization defines long COVID as “the continuation or development of new symptoms 3 months after the initial SARS-CoV-2 infection, with these symptoms lasting for at least 2 months with no other explanation.” Estimations of approximately 50 million individuals suffer from long COVID, reporting low health-related quality of life. Patients develop ongoing persistent symptoms that continue for more than 12 weeks that are not explained by another alternative diagnosis. To date, no current therapeutics are effective in treating the underlying pathophysiology of long COVID.DiscussionA comprehensive literature search using PubMed and Google Scholar was conducted and all available articles from November 2021 to January 2024 containing keywords long covid and hyperbaric oxygen were reviewed. These published studies, including case series and randomized trials, demonstrate that utilizing Hyperbaric Oxygen Therapy (HBO) provided significant improvement in patients with long COVID.ConclusionA large cohort of patients suffer from long COVID or post-COVID-19 syndrome after recovery from their acute infection with no effective treatment options. HBO is a safe treatment and may provide benefit for this population and should continue to be researched for adjunctive treatment of long COVID

Liver fluke in Irish sheep: prevalence and associations with management practices and co-infection with rumen fluke

peer-reviewedBackground: The present study aimed to identify the national prevalence of Fasciola hepatica in Irish sheep and to conduct a risk analysis assessment based on management and treatment practices in participating focks. Also, co-infection with rumen fuke was quantifed and its association with liver fuke and management practices was assessed. Methods: A total of 305 sheep focks were selected ensuring even national representation of the sheep population. Participating farms were asked to complete a survey questionnaire on farm management practices and submit faecal samples during the winter of 2014–2015. Pooled faecal samples were analysed for the presence of F. hepatica and coinfection with rumen fuke. Apparent and true prevalence were calculated, additionally, the rate of co-infection with rumen fuke was also obtained. Correlation and regression analyses were used for assessing associations between management practices, liver fuke infection and co-infection with rumen fuke. Results: The national true prevalence of F. hepatica was 50.4% (n=305). Regional prevalence varied from 41% in the east to 52% in the south. Co-infection with rumen fuke was observed in 40% of the studied population and corre‑ lated with increased F. hepatica egg counts (OR=2.9; P≤0.001). Predominant breeds were Sufolk, Texel and Horned Mountain breeds. Beef cattle were the most frequent type of other livestock present on farms and mixed species grazing was frequently reported (73%). More than half of the focks reported a mid-to-late lambing period (MarchApril). Use of mountain land for grazing was of 32%. Flukicides were most commonly used twice over the autumnwinter period. Regression analyses highlighted signifcant association of F. hepatica status, with the presence of other livestock on farm, frequency of fukicides used during the winter and clinical presentation of liver fuke. A signifcant increase in eggs per gram of faeces was observed in Charollais sheep in comparison with all other breeds. Co-infec‑ tion with F. hepatica and Calicophoron daubneyi was also signifcantly associated with the presence of other livestock on the farm, type of fukicide used and clinical fasciolosis. Conclusions: The present study provides up-to-date information on the prevalence of F. hepatica in Irish sheep and adds insight to the epidemiology of the disease. These fndings will be useful for designing new holistic control meas‑ ures for F. hepatica infection

Elevated lipoprotein(a) increases risk of subsequent major adverse cardiovascular events (MACE) and coronary revascularisation in incident ASCVD patients: a cohort study from the UK biobank

Background and aims: Elevated lipoprotein(a) [Lp(a)] is a genetic driver for atherosclerotic cardiovascular disease (ASCVD). We aimed to provide novel insights on the associated risk of elevated versus normal Lp(a) levels on major adverse cardiovascular events (MACE) in an incident ASCVD cohort. Methods: This was an observational cohort study of incident ASCVD patients. MACE counts and incidence rates (IRs) per 100-person-years were reported for patients with normal (<65 nmol/L) and elevated (>150 nmol/L) Lp(a) within the first year after incident ASCVD diagnosis and overall follow-up. Cox proportional hazard models quantified the risk of MACE associated with a 100 nmol/L increase in Lp(a). Results: The study cohort included 32,537 incident ASCVD patients; 5204 with elevated and 22,257 with normal Lp(a). Of those with elevated Lp(a), 41.2% had a subsequent MACE, versus 35.61% with normal Lp(a). Within the first year of follow-up, the IRs of composite MACE and coronary revascularisation were significantly higher (p < 0.001) in patients with elevated versus normal Lp(a) (IR difference 6.79 and 4.66). This trend was also observed in the overall follow-up (median 4.7 years). Using time to first subsequent MACE, a 100 nmol/L increase in Lp(a) was associated with an 8.0% increased risk of composite MACE, and 18.6% increased risk of coronary revascularisation during the overall follow-up period. Conclusions: The association of elevated Lp(a) with increased risk of subsequent MACE and coronary revascularisation, highlights a population who may benefit from earlier and more targeted intervention for cardiovascular risk including Lp(a), particularly within the first year after ASCVD diagnosis. Proactive Lp(a) testing as part of routine clinical practice can help to identify and better manage these higher-risk individuals

Dietary supplementation with inulin-propionate ester or inulin improves insulin sensitivity in adults with overweight and obesity with distinct effects on the gut microbiota, plasma metabolome and systemic inflammatory responses: a randomised cross-over trial

Objective: To investigate the underlying mechanisms behind changes in glucose homeostasis with delivery of propionate to the human colon by comprehensive and coordinated analysis of gut bacterial composition, plasma metabolome and immune responses. Design: Twelve non-diabetic adults with overweight and obesity received 20 g/day of inulin-propionate ester (IPE), designed to selectively deliver propionate to the colon, a high-fermentable fibre control (inulin) and a low-fermentable fibre control (cellulose) in a randomised, double-blind, placebo-controlled, cross-over design. Outcome measurements of metabolic responses, inflammatory markers and gut bacterial composition were analysed at the end of each 42-day supplementation period. Results: Both IPE and inulin supplementation improved insulin resistance compared with cellulose supplementation, measured by homeostatic model assessment 2 (mean±SEM 1.23±0.17 IPE vs 1.59±0.17 cellulose, p=0.001; 1.17±0.15 inulin vs 1.59±0.17 cellulose, p=0.009), with no differences between IPE and inulin (p=0.272). Fasting insulin was only associated positively with plasma tyrosine and negatively with plasma glycine following inulin supplementation. IPE supplementation decreased proinflammatory interleukin-8 levels compared with cellulose, while inulin had no impact on the systemic inflammatory markers studied. Inulin promoted changes in gut bacterial populations at the class level (increased Actinobacteria and decreased Clostridia) and order level (decreased Clostridiales) compared with cellulose, with small differences at the species level observed between IPE and cellulose. Conclusion: These data demonstrate a distinctive physiological impact of raising colonic propionate delivery in humans, as improvements in insulin sensitivity promoted by IPE and inulin were accompanied with different effects on the plasma metabolome, gut bacterial populations and markers of systemic inflammation