10 research outputs found
Of Gods and Monsters : National Security and Canadian Refugee Policy
No full textThe fiftieth anniversary year of the 1951 Convention affords an appropriate juncture to turn our gaze to the pledges Canada has made as a signatory state and the extent to which Canadian refugee policy has been "securitized" at the expense of vulnerable refugees and the very objectives the Convention was designed to address. Through the lens of the legal standards established by the Convention as well as complementary international norms and jurisprudence, this paper considers Canada's contemporary record on refugee issues with specific reference to the national security dimension of domestic policy. The author begins by tracing the evolution of refugee law and policy during the Cold War period, as well as parallel developments in the area of immigration security. The primary focus then turns to the anti-terrorism and security measures implemented by the federal government in 1992, together with proposals for reform under review in the Canadian Senate. The author concludes by locating the coordinates of an alternative approach to national security, one which incorporates the legal standards and normative values codified in the Refugee Convention. It is an approach that is premised on the overarching objective of bridging the chasm between "civilized self' and "barbaric other", of enhancing human security for refugees and host population alike.Le cinquantième anniversaire de la Convention de 1951 permet de porter un regard sur les promesses faites par le Canada en tant que pays signataire, d'analyser l'étendue de la politique canadienne sur les réfugiés, ainsi que de définir les véritables objectifs de la Convention. A travers la vision des principes juridiques établis par la Convention , les normes internationales complémentaires, ainsi que la jurisprudence disponible, cet article étudie les situations contemporaines des réfugiés particulièrement par rapport à la dimension de la sécurité nationale. L'article trace l'évolution des lois concernant les réfugiés et leur application pendant la période de la Guerre froide, ainsi que les développements parallèles relatifs à la sécurité et l'immigration. Ensuite, l'analyse se penche sur les mesures de sécurité nationale et d' an ti terrorisme mises en œuvre par le gouvernement canadien en 1992 et celles actuellement étudiées par le Sénat. L'article conclut avec l'élaboration d'une approche alternative à la sécurité nationale qui s'inspire des normes légales ainsi que des valeurs fondamentales établies par la Convention. Il s'agit d'une approche qui a comme objectif de réduire l'écart entre le «soi civilisé » et «l'autre barbare », ainsi que d'améliorer la sécurité humaine des réfugiés et des populations qui les accueillent.Aiken Sharryn J. Of Gods and Monsters : National Security and Canadian Refugee Policy. In: Revue Québécoise de droit international, volume 14-1, 2001. Cinquantenaire de la Convention de Genève sur les réfugiés, sous la direction de Michael Barutciski . pp. 7-36
New Directions for Refugee Determination and Protection in Canada
No full textThis article is a review and analysis of the
Canadian government's recent "white
paper" on immigration and refugee
policy and legislation. This review focuses
on the proposals related to inland
refugee determination and protection.
While noting a number of positive initiatives
in the document, the author expresses
concern about the future of
Canada's role in refugee protection in the
next millennium.Cet article passe en revue et analyse le
récent « livre blanc » du gouvernement
canadien sur les législations et politiques
en matière de réfugiés et d'immigration.
Cette analyse concentre son attention sur
les propositions formulées en matière de
détermination et de protection des réfugiés
intra-nationaux. Signalant un certain
nombre d'initiatives positives dans
ce document, l'auteur exprime malgré
tout son inquiétude sur l'avenir du rôle
du Canada en matière de protection des
réfugiés dans le prochain millénaire
Manufacturing “Terrorists”: Refugees, National Security, and Canadian Law
No full textIn the first part of a two-part article, the author critically
evaluates the anti-terrorism provisions of Canada’s Immigration
Act. The impact of these provisions on refugees is
the focus of the essay, but her observations are relevant to
the situation of other categories of non-citizens as well. The
inquiry begins by considering international efforts to
address “terrorism,” the relevance of international humanitarian
law to an assessment of acts of “terror,” and the
nature of contemporary discourse on “terrorism.” Next, the
evolution of the current admissibility provisions in Canadian
immigration law, with particular reference to refugee
policy and national security, is reviewed. A brief discussion
of current policy directions concludes part 1.Dans ce premier volet (d’un article à deux volets), l’auteure se livre à une évaluation critique des dispositions antiterroristes de la loi canadienne sur l’immigration. Elle se concentre sur l’impact de ces dispositions sur les réfugiés, mais ses remarques sont aussi valables pour d’autres catégories de non-citoyens. L’enquête examine, avant tout, les efforts déployés au niveau international pour contrecarrer « le terrorisme », la pertinence de la loi humanitaire internationale dans le cadre de l’évaluation des actes de « terreur », et la nature du discours contemporain sur le « terrorisme ». Seront examinés ensuite, la façon dont ont évolué les dispositions courantes de la loi canadienne sur l’immigration, la notion d’admissibilité, avec une référence particulière à la politique sur les réfugiés et la sécurité nationale. Pour conclure cette première partie, on trouvera une brève discussion sur les tendances dans la politique actuelle
Treatment of acute trauma-related pain in children and adolescents with methoxyflurane (Penthrox®) compared to placebo (MAGPIE) : A randomised clinical trial
No full textWe thank the Paediatric Emergency Research in the United Kingdom & Ireland (PERUKI) collaborative participating sites and investigators: Stuart Hartshorn, Jemima Dubif, Emma Bagshaw, Joshua Evans, Rachel Gittings, Chloe Marshall, Heather Prescott, Lisa Weston, Harriet Wienkamp, Paige Williams (Birmingham Women's and Children's NHS Foundation Trust, Birmingham, UK); Michael J Barrett, Amanda McDonnell, Ann Marie Brogan, Bláithín Arnold, Bridget Conway, Carol Blackburn, Ellen Barry, Madeleine Niermeyer, Rachel Gallagher and all the CHI Emergency Department staff, families and the Children’s Health Ireland Clinical Research Centre (CHI-CRC) (Our Lady’s Children’s Hospital, Crumlin, Ireland); Shrouk Messahel, Elizabeth Lee, Rachel Greenwood (Alder Hey Children’s Hospital, Liverpool, UK); Emily Walton, Vivien Richmond, Dan Yusef (Royal Alexandra Children’s Hospital, Brighton, UK); Mark Lyttle, Nick Sargant, Pauline Jackson, Alice Smith, Beth Pittaway, Sarah Sheedy, Yesenia Tanner, Lucie Aplin, Dodd Hopgood, Cath Jones (Bristol Royal Hospital for Children, Bristol, UK); Chris Gough, Megan McAulay (Nottingham University Hospitals NHS Trust, Nottingham, UK); Andrew Appelboam, Su Wilkins-Scrivener, Daisy Sykes (Royal Devon and Exeter Hospital, Exeter, UK); Jamie Cooper, Gareth Patton (Royal Aberdeen Children’s Hospital, Aberdeen, UK); Benjamin Bloom, Raine Astin-Chamberlain, Jason Pott, Imogen Skene, Nimca Omer, Helen Power, Grace Tunesi, Noemi Caponi, Lyrics Noba, Kirsten Parkin, Philippa Hartridge, Nuria M Morrell, Alison Quinn, Jacqueline Sear, Stuart Chandler (Royal London Hospital, London, UK); Sharryn Gardner (Ormskirk District Hospital, Ormskirk, UK); Gareth Lewis, Lydia Garcia-Rodriguez, Lesley Hall, Samantha Hunt, Jackie Philps, Damian Roland (Leicester Royal Infirmary, Leicester, UK). We thank the members of the Data Safety Monitoring Board, Dr Alan Irvine, Professor Damian Roland, Dr Gareth Patton and Professor Thomas Jaki. We thank Belinda Butcher of WriteSource Medical Pty Ltd, Sydney, Australia, for providing medical writing support and funded by MDI.Peer reviewe
Paediatric virology:A rapidly increasing educational challenge (Review)
No full textThe ‘2nd Workshop on Paediatric Virology’, which took place on Saturday the 8th of October 2016 in Athens, Greece, provided an overview on recent views and advances on Paediatric Virology. Emphasis was given to HIV-1 management in Greece, a country under continuous financial crisis, hepatitis B vaccination in Africa, treatment options for hepatitis C virus in childhood, Zika virus in pregnancy and infancy, the burden of influenza on childhood, hand-foot-mouth disease and myocarditis associated with Coxsackie viruses. Other general topics covered included a critical evaluation of Paediatric Accident and Emergency viral infections, multimodality imaging of viral infections in children, surgical approaches of otolaryngologists to complex viral infections, new advances in the diagnosis and treatment of viral conjunctivitis and novel molecular diagnostic methods for HPV in childhood. A brief historical overview of the anti-vaccination movement was also provided, as well as presentations on the educational challenge of Paediatric Virology as a new subspecialty of Paediatrics. This review highlights selected lectures and discussions of the workshop.</p
High-resolution genomics identifies pneumococcal diversity and persistence of vaccine types in children with community-acquired pneumonia in the UK and Ireland
No full textAbstract: Background Streptococcus pneumoniae is a global cause of community-acquired pneumonia (CAP) and invasive disease in children. The CAP-IT trial (grant No. 13/88/11; https://www.capitstudy.org.uk/) collected nasopharyngeal swabs from children discharged from hospitals with clinically diagnosed CAP, and found no differences in pneumococci susceptibility between higher and lower antibiotic doses and shorter and longer durations of oral amoxicillin treatment. Here, we studied in-depth the genomic epidemiology of pneumococcal (vaccine) serotypes and their antibiotic resistance profiles. Methods Three-hundred and ninety pneumococci cultured from 1132 nasopharyngeal swabs from 718 children were whole-genome sequenced (Illumina) and tested for susceptibility to penicillin and amoxicillin. Genome heterogeneity analysis was performed using long-read sequenced isolates (PacBio, n = 10) and publicly available sequences. Results Among 390 unique pneumococcal isolates, serotypes 15B/C, 11 A, 15 A and 23B1 were most prevalent (n = 145, 37.2%). PCV13 serotypes 3, 19A, and 19F were also identified (n = 25, 6.4%). STs associated with 19A and 19F demonstrated high genome variability, in contrast to serotype 3 (n = 13, 3.3%) that remained highly stable over a 20-year period. Non-susceptibility to penicillin (n = 61, 15.6%) and amoxicillin (n = 10, 2.6%) was low among the pneumococci analysed here and was independent of treatment dosage and duration. However, all 23B1 isolates (n = 27, 6.9%) were penicillin non-susceptible. This serotype was also identified in ST177, which is historically associated with the PCV13 serotype 19F and penicillin susceptibility, indicating a potential capsule-switch event. Conclusions Our data suggest that amoxicillin use does not drive pneumococcal serotype prevalence among children in the UK, and prompts consideration of PCVs with additional serotype coverage that are likely to further decrease CAP in this target population. Genotype 23B1 represents the convergence of a non-vaccine genotype with penicillin non-susceptibility and might provide a persistence strategy for ST types historically associated with vaccine serotypes. This highlights the need for continued genomic surveillance
The clinical impact of serious respiratory disease in children under the age of two years during the 2021-2022 bronchiolitis season in England, Scotland and Ireland
No full textBackgroundInterventions introduced to reduce the spread of SARS-CoV-2 led to a widespread reduction in childhood infections. However, from spring 2021 onwards the United Kingdom and Ireland experienced an unusual out-of-season epidemic of respiratory disease. MethodsWe conducted a prospective observational study (BronchStart), enrolling children 0-23 months of age presenting with bronchiolitis, lower respiratory tract infection or first episode of wheeze to 59 Emergency Departments across England, Scotland and Ireland from May 2021 to April 2022. We combined testing data with national admissions datasets to infer the impact of respiratory syncytial virus (RSV) disease. ResultsThe BronchStart study collected data on 17,899 presentations for 17,164 children. Risk factors for admission and escalation of care included prematurity and congenital heart disease, but most admissions were for previously healthy term-born children. Of those aged 0-11 months who were admitted and tested for RSV, 1,907/3,912 (48.7%) tested positive. We estimate that every year in England and Scotland 28,561 (95% confidence interval 27,637-29,486) infants are admitted with RSV infection.ConclusionsRSV infection was the main cause of hospitalisations in this cohort, but 51.3% of admissions in infants were not associated with the virus. The majority of admissions were in previously healthy term-born infants. <br/
Point-of-care testing in Paediatric settings in the UK and Ireland: a cross-sectional study
No full textBackground: Point-of-care testing (POCT) is diagnostic testing performed at or near to the site of the patient. Understanding the current capacity, and scope, of POCT in this setting is essential in order to respond to new research evidence which may lead to wide implementation. Methods: A cross-sectional online survey study of POCT use was conducted between 6th January and 2nd February 2020 on behalf of two United Kingdom (UK) and Ireland-based paediatric research networks (Paediatric Emergency Research UK and Ireland, and General and Adolescent Paediatric Research UK and Ireland). Results: In total 91/109 (83.5%) sites responded, with some respondents providing details for multiple units on their site based on network membership (139 units in total). The most commonly performed POCT were blood sugar (137/139; 98.6%), urinalysis (134/139; 96.4%) and blood gas analysis (132/139; 95%). The use of POCT for Influenza/Respiratory Syncytial Virus (RSV) (45/139; 32.4%, 41/139; 29.5%), C-Reactive Protein (CRP) (13/139; 9.4%), Procalcitonin (PCT) (2/139; 1.4%) and Group A Streptococcus (5/139; 3.6%) and was relatively low. Obstacles to the introduction of new POCT included resources and infrastructure to support test performance and quality assurance. Conclusion: This survey demonstrates significant consensus in POCT practice in the UK and Ireland but highlights specific inequity in newer biomarkers, some which do not have support from national guidance. A clear strategy to overcome the key obstacles of funding, evidence base, and standardising variation will be essential if there is a drive toward increasing implementation of POCT
Effect of Amoxicillin Dose and Treatment Duration on the Need for Antibiotic Re-treatment in Children With Community-Acquired Pneumonia: The CAP-IT Randomized Clinical Trial.
No full textImportance: The optimal dose and duration of oral amoxicillin for children with community-acquired pneumonia (CAP) are unclear. Objective: To determine whether lower-dose amoxicillin is noninferior to higher dose and whether 3-day treatment is noninferior to 7 days. Design, Setting, and Participants: Multicenter, randomized, 2 × 2 factorial noninferiority trial enrolling 824 children, aged 6 months and older, with clinically diagnosed CAP, treated with amoxicillin on discharge from emergency departments and inpatient wards of 28 hospitals in the UK and 1 in Ireland between February 2017 and April 2019, with last trial visit on May 21, 2019. Interventions: Children were randomized 1:1 to receive oral amoxicillin at a lower dose (35-50 mg/kg/d; n = 410) or higher dose (70-90 mg/kg/d; n = 404), for a shorter duration (3 days; n = 413) or a longer duration (7 days; n = 401). Main Outcomes and Measures: The primary outcome was clinically indicated antibiotic re-treatment for respiratory infection within 28 days after randomization. The noninferiority margin was 8%. Secondary outcomes included severity/duration of 9 parent-reported CAP symptoms, 3 antibiotic-related adverse events, and phenotypic resistance in colonizing Streptococcus pneumoniae isolates. Results: Of 824 participants randomized into 1 of the 4 groups, 814 received at least 1 dose of trial medication (median [IQR] age, 2.5 years [1.6-2.7]; 421 [52%] males and 393 [48%] females), and the primary outcome was available for 789 (97%). For lower vs higher dose, the primary outcome occurred in 12.6% with lower dose vs 12.4% with higher dose (difference, 0.2% [1-sided 95% CI -∞ to 4.0%]), and in 12.5% with 3-day treatment vs 12.5% with 7-day treatment (difference, 0.1% [1-sided 95% CI -∞ to 3.9]). Both groups demonstrated noninferiority with no significant interaction between dose and duration (P = .63). Of the 14 prespecified secondary end points, the only significant differences were 3-day vs 7-day treatment for cough duration (median 12 days vs 10 days; hazard ratio [HR], 1.2 [95% CI, 1.0 to 1.4]; P = .04) and sleep disturbed by cough (median, 4 days vs 4 days; HR, 1.2 [95% CI, 1.0 to 1.4]; P = .03). Among the subgroup of children with severe CAP, the primary end point occurred in 17.3% of lower-dose recipients vs 13.5% of higher-dose recipients (difference, 3.8% [1-sided 95% CI, -∞ to10%]; P value for interaction = .18) and in 16.0% with 3-day treatment vs 14.8% with 7-day treatment (difference, 1.2% [1-sided 95% CI, -∞ to 7.4%]; P value for interaction = .73). Conclusions and Relevance: Among children with CAP discharged from an emergency department or hospital ward (within 48 hours), lower-dose outpatient oral amoxicillin was noninferior to higher dose, and 3-day duration was noninferior to 7 days, with regard to need for antibiotic re-treatment. However, disease severity, treatment setting, prior antibiotics received, and acceptability of the noninferiority margin require consideration when interpreting the findings. Trial Registration: ISRCTN Identifier: ISRCTN76888927
