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Preparing allied health professional students to work collaboratively with families of young children (0-8 years): A scoping review
No full textCollaborative working with families has positive impacts on outcomes for families and children. However, implementing a collaborative approach requires allied health professionals to have knowledge, skills, experience, and confidence in working with families. This scoping review aimed to explore teaching practices used in order to prepare allied health profession students to work collaboratively with families of children under the age of 8 years. Eight studies were identified: these studies captured different teaching and learning methods which included both a component of classroom-based instruction covering theory and a form of skill development practice. Experiential outcomes for students were reported to be positive. Results highlight the need for the design of new, reflexive learning opportunities for allied health profession students which prepare them to collaborate with families in early intervention. Effective learning using role-play and simulation should be explored as a priority considering the identified shortages of clinical placements for students internationally.peer-reviewe
Anxiety, depression and stress in parents and siblings of people who have Prader-Willi syndrome: Morbidity prevalence and mitigating factors
No full textBackground
Individuals with PWS need constant support and/or supervision, which creates a high caregiver burden on their parents and siblings. Previous research has identified adverse stress outcomes in relatively small and country-specific samples. This study's aims were to examine stress outcomes in a large multi-country sample of parents and siblings and to expand upon previous research by incorporating data on psychosocial factors that may mitigate stress outcomes.
Methods
The sample comprised 135 parents of a child with PWS, with additional data for 45 siblings as reported by parents. Participants were recruited from 31 countries, spanning Europe, North and South America, Africa, Asia and Australasia, who participated by completing an online questionnaire that included standardised psychometric measures of depression and anxiety (HADS), life stress (PSS), PTSD symptoms (CATS-C) and family cohesion (FACES II). Outcomes were compared to published population norms, and multiple regression was used to investigate the role of potential exacerbating and mitigating factors.
Results
Findings revealed high rates of mental pathologies in both parents and siblings. Parents' scores for depression and anxiety indicated high rates of caseness: 67.4% of parents exhibited ‘abnormal’ levels of anxiety, while 15.6% exhibited ‘borderline abnormal’ levels; 34.8% exhibited ‘abnormal’ levels of depression, with 22.2% exhibiting ‘borderline abnormal’ levels. Younger parents exhibited higher anxiety than older parents (p = 0.007); younger male parents reported higher depression than older male parents (p = 0.029). Parents whose child with PWS lived in the family home exhibited higher depression scores than parents whose child with PWS lived away from home (p = 0.035). Family cohesion was inversely associated with parental depression (p < 0.001) and parental anxiety (p = 0.012), even when statistically controlling for age of parent, age of child with PWS and parental education level. Scores for life stress were markedly higher than population norms, with 88.7% of parents exhibiting ‘high’ or ‘moderate’ life stress. Parental life stress was significantly correlated with temper outburst severity in their child with PWS (p < 0.001) and with food problem severity (p < 0.001). All siblings exhibited at least one symptom of PTSD, with 28.9% of siblings exhibiting ‘clinically relevant’ levels of PTSD symptoms. Sibling PTSD symptom levels were significantly associated with temper outburst severity in the child with PWS (p = 0.025) but not with ratings of food problem severity (p = 0.114). Family cohesion was inversely associated with PTSD symptoms in siblings (p = 0.022).
Conclusions
PWS impacts families negatively, and relatives suffer as a result. The findings of this study confirm that parents and siblings of persons with PWS exhibit clinically notable levels of mental pathology. Strategies to enhance family cohesion should be employed to help diminish adverse outcomes among PWS families.While conducting this research, K.M.P. was supported by the Government of Malta's Endeavour II Scholarships Scheme, a project co-funded by the ESF+ 2021–2027.peer-reviewe
LatticeWorks: An open-source MATLAB toolbox for nonuniform, gradient and multi-morphology lattice generation, and analysis
No full textThis study introduces an open-source MATLAB toolbox, LatticeWorks, that offers a versatile platform for generating and analysing lattice structures, facilitating the exploration of nonuniform, functionally graded designs. It encompasses various lattice generation methods, including single- and multi-morphology lattices, linearly graded lattices, different boundary shapes, and cell arrangements (such as cylindrical and spherical). The toolbox also features volume infill lattice generation based on a signed distance function, allowing lattice structures to be applied to arbitrary domains. Other developments include extending transition boundary shapes to cylindrical and spherical coordinates, enhancing cylindrical cell arrangement methods, and introducing tailored density lattice methods for smooth density mapping. Unlike other available packages, LatticeWorks offers inclusive and detailed implementation methods that are integrated with finite element analysis for mechanical property evaluation. The toolbox’s capabilities open new paths for designing complex lattice structures, tailored to specific functional requirements, across diverse applications.This work was supported by the European Research Council (ERC) under the EU’s Horizon 2020 research and innovation program (Grant agreement No. 804108); and the European Union’s Horizon Europe research and innovation programme under grant agreement No 101047008 (BIOMET4D). Views and opinions expressed are however those of the author(s) only and do not necessarily reflect those of the European Union or the European Innovation Council and SMEs Executive Agency (EISMEA). Neither the European Union nor the EISMEA can be held responsible for them.peer-reviewe
The development, deployment, and analysis of a bespoke patient-family clinical videoconferencing system in Ireland during the COVID-19 pandemic
No full textThe Covid-19 pandemic accelerated digital transformation in healthcare worldwide. This period brought innovative telemedicine solutions and new challenges to healthcare systems. This MD thesis examines telemedicine in Ireland during the Covid pandemic and challenges encountered during this time. This research describes the rapid development and deployment of a bespoke video-conferencing platform, ICU FamilyLink, which was used to facilitate patient-to-family communication during the COVID-19 pandemic. This research identifies key technology requirements and the useability factors of video-conferencing systems in a healthcare setting and highlights the need for robust clinical cyber-resilience in the Irish healthcare system
Palm trees, energy security and green hydrogen futures: Tourists' views on Mallorca's low carbon transition
No full textThe development of green hydrogen can provide a welcome boost in energy security, particularly for island nations that may be reliant on energy imports or intermittent renewables as part of their energy transition. However, the expansion of a green hydrogen economy may have social, environmental and economic impacts on tourism-reliant islands, which may not be accounted for using typical market assessments. In this study, focus groups and an online choice experiment survey are conducted with recent international tourists to Mallorca, Spain, to elicit preferences for green hydrogen infrastructure, including the visual and biodiversity impacts, potential for export, and the value for the provision of additional local and tourism benefits. The results indicate generally positive attitudes to the development of green hydrogen in Mallorca, however respondents indicate significant disutility associated with high visual impact of green hydrogen infrastructure, with the exception of respondents that have previous experience with hydrogen transport. In general, respondents favour policies that do not negatively impact biodiversity, value restrictions on exports to enhance energy security on the island and are willing to pay to support green hydrogen development in Mallorca which provides benefits to tourism and local residents.This work has been carried out as part of the Green Hysland project. This project has received funding from the Fuel Cells and Hydrogen 2 Joint Undertaking (now Clean Hydrogen Partnership) under Grant Agreement No 101007201. This Joint Undertaking receives support from the European Union's Horizon 2020 Research and Innovation programme, Hydrogen Europe and Hydrogen Europe Research.peer-reviewe
Revascularization based on coronary computed tomography angiography and novel antiplatelet therapy in coronary artery disease
No full textInvasive coronary angiography (ICA) is the cornerstone of cardiology and has revolutionized the diagnosis and treatment of coronary artery disease (CAD). Its history can be traced back to the early 20th century, with evolution through a series of experimental advances, technological breakthroughs, and clinical applications (1). Although ICA remains the gold standard for visualising the coronary anatomy, coronary computed tomography angiography (CCTA) has evolved into a non-invasive imaging modality that plays a pivotal role in the management of CAD in contemporary clinical practice (2). Current clinical guidelines, including those from the European Society of Cardiology (ESC) and the American College of Cardiology (ACC), have recommended CCTA as the first-line diagnostic test in patients with an intermediate pre-test probability of obstructive CAD (3,4). Its high sensitivity and negative predictive value make it a powerful tool for excluding significant coronary artery stenoses, reducing the need for ICA in many patients. In those without significant epicardial obstruction, its role is either to rule out atherosclerosis or to detect subclinical plaque, that can be monitored for progression/regression following preventative therapy and provide risk stratification (2). Furthermore, FFR-CT has become increasingly integrated into the management of CAD, enhancing patient care and optimizing revascularization strategies by providing anatomical and functional assessment in one modality (5). Coronary revascularisation, whether percutaneous or surgical, aims not simply to address coronary artery obstruction but to improve clinical outcomes. Previous randomized controlled trials (RCTs) have shown that the anatomical SYNTAX score plays an essential role in risk stratification and is associated with clinical outcomes; notably the treatment effects observed in RCTs often achieved the basis of treatment guidelines, but despite the wide range of treatment effects between patients the focus has been on the average treatment effect. The optimal revascularization strategy should be individualized, considering both the severity of CAD and factors affecting the patient's prognosis. Additionally, as the first-line test for investigating CAD is moving from ICA to CCTA, it is essential to investigate the feasibility and long-term prognosis of revascularization strategies based on CCTA. Optimal medical therapy is essential to improve clinical outcomes regardless of the modality of revascularization. In recent years, the approach to short dual antiplatelet therapy (DAPT) after coronary artery stent deployment has evolved significantly. The latest ESC guidelines recommend tailoring the duration of DAPT based on patient risk profiles, balancing the risk of bleeding against thrombotic events (6). This shift is an essential step in optimizing post-stenting treatment and improving long-term clinical outcomes while preventing ischemic events, and reducing bleeding events
Exploring the effects of parental smartphone use on parent-child interactions relevant to language acquisition in young children
No full textBackground
The importance of parent-child interactions, and time spent interacting and talking with children, on the development of a child’s language cannot be overstated (Tamis-LeMonda et al., 2001; Tamis- LeMonda et al., 2012; Rowe; 2012; Fusaro et al., 2014; Safwat & Sheikhany, 2014; Masek et al., 2021; Sundqvist et al., 2021). It is critical to a young child’s socioverbal development to engage regularly with their parents. The socioverbal skills milestones that are acquired during early childhood are in large part a direct effect of parent and child interactions (Hart & Risley, 1995). From a behavioural perspective, language is learned behaviour conditioned by contact with the environment including, most importantly, one’s primary caregivers (Skinner, 1957). Studies have shown that reduced time for such critical social interactions caused for example by parents or children spending longer periods of time engaging in screen use may contribute to children developing inadequate socioverbal skills including language (Sigman, 2012). Paediatricians, researchers and a wide variety of professionals and parents have had concerns about the negative effects of screen time on children of all ages (Council on Communications and Media et al., 2013). The American Academy of Paediatrics (AAP) discourages screen media exposure for children under the age of 18-months and recommends no more than 1 hour per day for children older than 18-months. However, recommendations for parental smartphone use are minimal. A subsection on Parental Media Use was added to the AAP (2016) cautioning parents that heavy parental smartphone use is associated with fewer verbal and non-verbal parent-child interactions. Despite the understanding that parent-child interactions are critical to language development, and that parental smartphone use is associated with a decrease in parent-child interactions, the effects of parental smartphone use on parent communications relevant to language development has not been extensively examined.
Aim The aim of the present program of research was to determine the relationship between parental smartphone use, child screen use, and parent-child interactions that facilitate child language outcomes such as a child’s vocabulary, child-directed speech, overheard speech, joint attention and fluency. Methods This research comprised: (1) A survey study to determine the relationship between parental smartphone use, child screen use, and child language outcomes; (2) a longitudinal naturalistic observation in the home setting to explore the effects of parental smartphone use on the quantity of words spoken by parent per minute and per hour in smartphone and non-smartphone conditions; and (3) a naturalistic microanalysis to explore the effects of parental smartphone use on the quality of parental joint attention and fluency.
Findings (1) The survey data showed a significant negative correlation between child screen use and a child’s vocabulary and a negative but non-significant correlation between parental smartphone use and children’s vocabulary. (2) The longitudinal naturalistic observation showed that parents say fewer words per minute when using their smartphone to view/type/scroll than in any other screen and non-screen condition. (3) The naturalistic microanalysis indicated that parents engage in the highest number of utterances when they are engaging in an activity with their child and there are no screens involved, and the second highest number of utterances when they are engaged in a screen activity with their child, or when they are engaged in separate activities but there are no screens present. The results also suggested that there is a higher level of interference/technoference (i.e., fewer percentage of utterances paired with joint attention) when parents are on their phones than in any other screen or non-screen condition. Lastly, parents exhibited a higher ratio of disfluency in the smartphone condition than in any other screen or non-screen condition.
Conclusion The findings of this research provide new insights into the effects of parental smartphone use on parent-child interactions relevant to child language acquisition. The identification of fewer words per minute in the smartphone condition (Study 2) suggest that too much time on smartphones to view/type/scroll could contribute to fewer opportunities for children to be exposed to language. The microanalysis (Study 3) suggests that parents and children can engage in a high frequency of language exchanges even when they are not engaged in an activity together, if screens aren’t present. This suggests that smartphones can prevent parent-child interactions from occurring, even when parents and children are not engaged in an activity with each other. Additionally, the results on joint attention and fluency suggest that smartphone use can interrupt an already-established interaction or prevent an interaction from occurring. These results indicate that parental smartphone use can have a negative effect on parent-child interactions relevant to child language acquisition. Given the importance of parent-child interactions in the development of language in young children, and the effects that parental smartphone use can have on these interactions (e.g., fewer verbal exchanges, preventing or interrupting an exchange, a decrease in joint attention, and an increase in disfluency), continued work in this area is warranted
Investigating the relationship between toll-like receptor activity, low-grade inflammation and cognitive deficits in schizophrenia patients – A mediation analysis Author links open overlay panel
No full textBackground
Schizophrenia is a debilitating psychiatric illness. Many studies report alterations in immune biomarkers (cytokines) in such patients. In addition, such prolonged low-grade inflammatory responses are associated with lowered cognitive performance. In this study, we investigated whether the expression and activity of Toll-like receptors (TLRs), receptors involved in initiating innate immune responses, are associated with the reported immune changes and, if so, whether they are associated with cognitive deficits in such patients.
Methods
300 participants (202 healthy controls (HC) and 98 patients with schizophrenia (SZ)) were recruited. A battery of cognitive tasks using WAIS-III and CANTAB were administered to the participants. Whole blood collected from participants was used to assess TLR2, 3, and 4 activity. mRNA expression of cytokines and TLR1-10 were quantified using RT-QPCR. Using ELISA, plasma was analysed for basal levels of cytokines such as IL-6, IL-8, IL-10, IL-12, TNF-α, IFN-γ and C-reactive proteins (CRP).
Results
We found significantly elevated plasma levels of IL-6, IL-8, IL-10, TNF-α, and CRP in the SZ group. In the SZ patient-only group, significantly higher levels of TLR2 and −4 activity (as measured by IL-6, IL-8, and IL-10 release following agonist stimulation) were observed. Significant negative associations in patients were observed between plasma IL-6 levels and measures of attention & processing speed and working memory; IL-8 and intelligence quotient; TNF-α and logical memory; and social cognition and IL-10 and CRP. Multiple-linear regression analysis suggests that TLR2 and TLR4 activity was associated with increased and decreased cytokine levels respectively and decreased cognitive performance. Finally, the significant association between TLR activity and decreased cognitive performance was mediated by IL-6 and IL-8.
Conclusion
We have demonstrated that patients with schizophrenia have elevated protein and mRNA expression of a range of cytokines and Toll-like receptors. Some of these changes are associated with deficits in cognition. Finally, our study has demonstrated a modest relationship between TLR activity and cognitive deficits in schizophrenia patients in a manner that may be mediated by IL-6 and IL-8.This work was funded through the Hardiman Scholarship, University of Galway, and grants from the European Research Council (ERC-2015-STG-677467) to GD.peer-reviewe
Achieving greenhouse gas reductions in the Irish dairy sector through carbon pricing: The feasibility of living labs and the attitudes of stakeholders
No full textThe Irish government has committed to a 51% reduction of national greenhouse gas (GHG) emissions by 2030 as compared to 2018, in line with European Union directives, international treaties, and the Climate Action and Low Carbon Development (Amendment) Act of 2021. Given the proportion of Irish GHG emissions originating in the agricultural sector and the difficulties in reducing these emissions to date, new approaches may be required to achieve emissions reduction goals. One potential approach may be the introduction of voluntary carbon markets (VCM). In a VCM participating farmers implement GHG emissions reducing technologies of their choosing on their farms. The GHG emissions reductions achieved can be sold to generate an additional income stream. There is however uncertainty about the feasibility of VCMs due to limited implementation and the complexity of their establishment and operation. Given this complexity, the establishment of a fullscale test VCM would be unrealistic, however, utilizing the Living Labs Framework, a small-scale pilot VCM is feasible. This will provide insight into the feasibility of VCMs, the willingness of farmers to participate, and the demand for carbon credits generated by farmers. This thesis will examine these issues through the lens of the SmartDairy project1 including its living labs. In addition, interviews conducted among Irish dairy farmers by the SmartDairy team will be examined to assess farmers willingness to engage in VCMs, their thoughts on the potential structures of those VCMs and who they believe should be tasked with organisation and oversight of VCMs
The organisation of government in Ireland 1900-1960: growth, efficiency, and specialisation
No full textThis thesis examines the economic rationale for the growth and consolidation in central general government organisations in Ireland during the first sixty years of the 20th century, through the lens of government expenditure and employment.
While concerns over the allegedly excessive number of government organisations have typically intensified in Ireland at times of economic and fiscal stress, it has proved difficult to advance that public debate by reference to a framework for understanding what might constitute optimal or even better organisational arrangements for government. The internal organisation of government, as opposed to its overall size, has received surprisingly little attention in economic theory and correspondingly limited guidance is available to policy makers and citizens from empirical work in economics.
Thus this study first advances a basic theoretical framework with a decision tree to guide policy makers in the economic assessment of the organisational implications of a new or existing government activity. The policy-maker must choose between the internal (to make) and the external (to buy) provision of resources, using the transactions costs approach. A decision ‘to make’ is followed by further organisational decisions between ‘to create’, ‘to add’, or ‘to keep’ organisations based on the trade-offs between specialisation and economies of scale or scope.
To explore empirically the explanatory power of this framework, I present a detailed database on central government employment in Ireland between 1900 and 1960. This draws upon a range of sources, principally official publications centred on the annual budgetary process, as well as annual reports of departments, to provide estimates of government employment for up to 133 organisations over the study period. While limitations of the sources mean that some gaps are filled by interpolation, the results match well with census totals. This data is linked with Irish government expenditure, organisations, and macroeconomic outcomes. It allows the exploration of the changing structure of Irish government organisation before and after Independence. In particular, the data allows classification of organisations by both their policy domain (health, education, defence etc.) and their core policy activity (e.g., delivery, regulations, policy formation).
This data in turn permits the construction of indices of specialisation in government employment and expenditure, i.e., Herfindahl-Hirschman and Balassa indices, to align with the theoretical framework advanced earlier. This shows that the growth in Irish government organisations principally reflects specialisation rather than economies of scale. The increase in government organisations is not matched by the expansion of government employment or real government expenditure. Government employment and real expenditure are dominated by four to five organisations in the delivery of government services in policy domains such as education, policing and defence. The growth in government organisations typically occurs in other activities, such as policy development, regulation and taxation, that make up a small share of overall expenditure and employment.
Finally, the impact of consolidation of government organisations through mergers is examined. The results found some supporting evidence of efficiency gains in both expenditure and employment of the merged organisations.Commission for Communications Regulatio