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The influence of menopause symptoms on workplace mental health among Irish women: a preliminary study
No full textIntroductionWomen's experiences of menopause are shaped not only by biological changes but also by the social contexts in which they occur, such as the workplace. This study examines how psychological, somatic and urogenital menopause symptoms affect occupational self-efficacy, work ability, perceived health and work quality, and perceived workplace support among Irish women.MethodsA total of 121 participants (Mage = 49.9, SD = 4.9, Range = 37–62) experiencing perimenopausal or postmenopausal symptoms participated in an online survey. Participants completed validated measures assessing menopause symptom severity, occupational self-efficacy, work ability, health and work quality, perceived workplace support, and menopause-related absenteeism.ResultsPsychological symptoms were significantly associated with lower occupational self-efficacy and work ability, whilst somatic and urogenital symptoms were not. Higher psychological, somatic and urogenital symptoms were correlated with multiple health and work quality measures. Organisational support was significantly associated with lower symptom severity. No significant relationships were found between symptom severity and absenteeism or reduced working hours.ConclusionPsychological menopause symptoms impact key workplace outcomes, while organisational support appears protective. These findings underscore the importance of menopause-informed policies in promoting the well-being, confidence, and retention of the workforce.<br/
Serial ketamine infusions as adjunctive therapy to inpatient care for depression: the KARMA-Dep 2 randomized clinical trial
No full textImportance Serial ketamine infusions are being increasingly adopted as off-label treatment for major depression in routine clinical practice, yet robust psychoactive placebo-controlled trial evidence for short- and long-term efficacy and safety remains limited.Objective To assess antidepressant efficacy, safety, tolerability, cost-effectiveness, and quality of life during and after serial ketamine infusions compared with midazolam as an adjunct to usual inpatient care.Design, Setting, and Participants The KARMA-Dep 2 trial was an investigator-led, double-blind, randomized, midazolam-controlled, pragmatic trial conducted at an academic center in Ireland between September 2021 and August 2024. Participants included adults (≥18 years) hospitalized with a DSM-5 major depressive episode (unipolar or bipolar) and baseline Montgomery-Åsberg Depression Rating Scale (MADRS) score ≥20.Interventions Participants were randomized 1:1 to receive up to 8 twice-weekly intravenous infusions of either ketamine (0.5 mg/kg) or midazolam (0.045 mg/kg) as an adjunct to usual-care pharmacotherapy and other aspects of routine inpatient psychiatric care. Participants were followed up for 6 months.Main Outcomes and Measures The primary outcome was change in depression symptom severity measured by the observer-rated MADRS score from baseline to end of treatment. Secondary outcomes included self-reported depression severity, safety, tolerability, health care costs, and quality of life.Results Of 65 randomized participants (mean [SD] age, 53.5 [18.6] years; 37 [59.7%] male), 62 were included in the final analysis. In the analysis of primary outcome, end-of-treatment MADRS scores did not significantly differ between the ketamine and midazolam groups (adjusted mean difference, −3.16 points, 95% CI, −8.54 to 2.22; P = .25; Cohen d, −0.29). Similarly, there was no significant between-group difference between Quick Inventory of Depressive Symptoms, Self-Report, scores (adjusted mean difference, −0.002; 95% CI, −2.71 to 2.71; P > .99; Cohen d, −0.0004). There were no significant between-group differences on other secondary outcomes, including cognition, cost-effectiveness, or quality of life. Most patients and raters accurately guessed treatment allocation.Conclusions and Relevance Serial adjunctive ketamine infusions were not more effective than serial midazolam infusions in reducing depressive symptoms in inpatients receiving usual psychiatric care.Trial Registration ClinicalTrials.gov Identifier: NCT0493964
The impact of JAK2<sup>V617F</sup> variant allele frequency in MPN patients following PEGylated interferon alpha discontinuation
No full textTreatment with pegylated interferon α resulted in a molecular response in 91% of patients with an average decrease in JAK2V61F VAF of 48.5% from baseline. In patients that discontinued treatment, the JAK2V617F VAF at the time of treatment discontinuation was the best indicator of durable remission over the 6-month follow-up period. Created with SMART Servier Medical Art (https://smart.servier.com/).<br/
Causal insights into gestational diabetes mellitus
No full textIntroduction: Gestational diabetes mellitus (GDM), defined by the onset of hyperglycaemia during pregnancy, remains the most prevalent metabolic complication in pregnancy. It is associated with increased risks of adverse maternal, neonatal, and long-term metabolic outcomes. This study aimed to identify potential causal relationships within clinical data on GDM that could support more targeted and effective interventions.Methods: A clinically curated dataset of patients diagnosed with GDM at a major Irish maternity hospital was analysed, covering the study periods 2014–2016 and 2020. A knowledge graph was constructed by integrating clinical expertise, established literature, and insights generated using the GPT-4 large language model. To complement this, 20 structure learning algorithms were applied to independently infer Causal Bayesian Networks (CBNs). A model-averaging approach was then used to generate a consensus-based causal structure to account for variability across individual models.Results: The integrative model produced a more stable representation of underlying relationships and yielded quantifiable insights to support clinical decision-making. Clinicians involved in the study reported improved confidence in patient care strategies due to the ability to quantify these relationships, facilitating more personalised, evidence-based practice. Key findings from the model-averaged CBN highlighted critical pathways in GDM management, such as the influence of birth weight on neonatal intensive care unit (NICU) admissions and the impact of dietary intervention on maternal glucose regulation. Sensitivity analysis confirmed birth weight, gestational age at delivery, and mode of delivery as major determinants of maternal and neonatal outcomes. Non-modifiable factors, including a history of multiple pregnancies and prior GDM, also contributed to risk stratification.Discussion: This study applied structure learning techniques to observational clinical data to identify clinically relevant relationships. The resulting insights provide a basis for generating hypotheses that could refine intervention strategies and improve patient outcomes in GDM care.<br/
Contesting power-sharing: contentious politics in divided societies
No full textThis introduction outlines an agenda for research on protest and power-sharing. Power-sharing scholarship has ignored grassroots contentious politics, viewing protest as a threat to the top-down model of consociationalism. Protest is thus seen as a destabilizing force, narrowing the ground needed for power-sharing elites to engage in moderative behaviour required for peace. This introductory article argues that citizen-led protest represents a broad spectrum of approaches to power-sharing, ranging from support to outright opposition. In this way, rather than simply a subverting type of politics, protest is a major arena for struggles for democracy in power-sharing systems.<br/
No evidence of BoHV-1 exposure and low levels of pestivirus exposure in sera from 116 opportunistically sampled wild deer in Northern Ireland
No full textBovine Viral Diarrhoea Virus (BVDV), Border Disease Virus (BDV), and Bovine Herpesvirus-1 (BoHV-1, the cause of Infectious Bovine Rhinotracheitis, IBR), are economically important endemic viruses in ruminant livestock in the United Kingdom and Ireland. Deer could undermine control efforts in livestock by contributing to virus transmission and maintenance, but information on the presence of these viruses in the wild deer population is lacking. Blood samples from wild fallow and sika deer culled in Northern Ireland were collected opportunistically in the 2022–23 hunting season and tested using enzyme-linked immunosorbent assay (ELISA) for the presence of antibodies to these viruses (n = 116). No antibodies against BoHV-1 were detected. Antibodies against pestivirus were detected in three samples (2.6%), all from sika deer, and constitute the first report in this species in Europe. Virus strain differentiation by virus neutralization test (VNT) was inconclusive. Results therefore indicate no evidence of exposure to BoHV-1 and very low levels of pestivirus exposure in these deer populations. Based on these results there are currently no grounds to implicate deer as significant wildlife reservoirs of these viruses.<br/
Bridging the finance gap for women entrepreneurs: insights from academic and policy research
No full textThis report prepared by the OECD and the Global Women's Entrepreneurship Policy Network examines the barriers women entrepreneurs face in accessing financing for creating and growing businesses and explores the policy reforms governments can introduce to address them. The first part of the report provides international data and evidence on the rate and nature of entrepreneurship activities by women compared with men and the levels and types of finance accessed by women entrepreneurs. It further offers an international overview of the barriers to women entrepreneurship financing and the potential policy solutions. The second part of the report offers 29 country-specific policy insight notes from selected OECD and non-OECD countries prepared by academic experts. The notes cover countries such as Australia, Brazil, China, France, India, Malaysia, Nigeria, Poland, Sweden, Spain, the United Kingdom and the United States. Each note is focused on a specific thematic issue and aligned with the issues in the international overview. The themes covered are influencing attitudes and culture towards women entrepreneurs, the potential of fintech innovations, the need to better-target interventions to different segments of women entrepreneurs, boosting financial literacy, leveraging angel investments, boosting microfinance, and financing growth-oriented starts
Histopathological classification of colorectal cancer based on domain-specific transfer learning and multi-model feature fusion
No full textColorectal cancer (CRC) poses a significant global health burden, where early and accurate diagnosis is vital to improving patient outcomes. However, the structural complexity of CRC histopathological images renders manual analysis time-consuming and error-prone. This study aims to develop an automated deep learning framework that enhances classification accuracy and efficiency in CRC diagnosis. The proposed model integrates domain-specific transfer learning and multi-model feature fusion to address challenges such as multi-scale structures, noisy labels, class imbalance, and fine-grained subtype classification. The model first applies domain-specific transfer learning to extract highly relevant features from histopathological images. A multi-head self-attention mechanism then fuses features from multiple pre-trained models, followed by a multilayer perceptron (MLP) classifier for final prediction. The framework was evaluated on three publicly available CRC datasets: EBHI, Chaoyang, and COAD. The model achieved a classification accuracy of 99.68% on the EBHI dataset (200 × subset), 86.72% on the Chaoyang dataset, and 99.44% on the COAD dataset. These results demonstrate strong generalization across diverse and complex histopathological image conditions. This study highlights the effectiveness of combining domain-specific transfer learning with multi-model feature fusion and attention mechanisms for CRC classification. The proposed model offers a reliable and efficient tool to support pathologists in diagnostic workflows, with the potential to reduce manual workload and improve diagnostic consistency.<br/
Beta-blocker prescription adherence of children and young people with long QT syndrome: a retrospective cohort study
No full textBackground:Beta blocker non-adherence is a key factor in precipitating cardiac events in patients affected by congenital long QT syndrome. Adherence has been examined in adults affected by congenital long QT syndrome but not in a large paediatric group.Method:Patients with congenital long QT syndrome types 1 and 2 were identified using a database curated by the Inherited Cardiac Conditions team in Northern Ireland. Medication adherence was reviewed by contacting the patient’s GP. A medication possession ratio was then calculated for the year. Adequate adherence was defined as a ratio of ≥0.8, and ideal adherence was defined as a ratio of ≥1.0. Risk factor analysis for poor adherence was performed using multivariable binary logistic regression.Results:99 patients’ data was suitable for analysis, 71 had LQT1 (78%) and 28 had LQT2 (28%). The median age of the children involved was ten years old. Over 36,135 days the median medication possession ratio of this patient group was 0.92. 56 patients (57%) had at least adequate adherence, of these 44 patients (44%) had ideal adherence. In contrast 43 patients (43%) had less than adequate adherence and of these six patients (6%) were completely non-adherent. Increased deprivation was significantly associated with “less than” ideal adherence Odds Ratio (OR) 1.2 95% confidence intervals CI (1.1–1.4).Conclusion:Adherence in the paediatric cohort was mostly in the “adequate range.” Increased deprivation is a risk factor for “less than” ideal adherence. A small minority of patients can be identified as completely non-adherent by checking prescription records. Future studies should focus on elucidating barriers and enablers to ideal adherence in this population.<br/
Development and validation of an artificial intelligence-based pipeline for predicting oral epithelial dysplasia malignant transformation
No full textBackgroundOral epithelial dysplasia (OED) is a potentially malignant histopathological diagnosis given to lesions of the oral cavity that are at risk of progression to malignancy. Manual grading of OED is subject to substantial variability and does not reliably predict prognosis, potentially resulting in sub-optimal treatment decisions.MethodWe developed a Transformer-based artificial intelligence (AI) pipeline for the prediction of malignant transformation from whole-slide images (WSIs) of Haematoxylin and Eosin (H&E) stained OED tissue slides, named ODYN (Oral Dysplasia Network). ODYN can simultaneously classify OED and assign a predictive score (ODYN-score) to quantify the risk of malignant transformation. The model was trained on a large cohort using three different scanners (Sheffield, 358 OED WSIs, 105 control WSIs) and externally validated on cases from three independent centres (Birmingham and Belfast, UK, and Piracicaba, Brazil; 108 OED WSIs).ResultsModel testing yielded an F1-score of 0.96 for classification of dysplastic vs non-dysplastic slides, and an AUROC of 0.73 for malignancy prediction, gaining comparable results to clinical grading systems.ConclusionsWith further large-scale prospective validation, ODYN promises to offer an objective and reliable solution for assessing OED cases, ultimately improving early detection and treatment of oral cancer.<br/