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Treatment of relapsed/refractory B-precursor acute lymphoblastic leukaemia (R/R B-ALL) in children remains a challenge, with only 30-50% of patients being salvaged by intensive chemotherapy and allogeneic haematopoietic stem cell transplantation (HSCT),1 with a dismal survival for those who relapse after HSCT.2 Results of immunotherapy with blinatumomab or autologous/allogeneic chimeric antigen receptor (CAR)-T cells hold out a promise of better outcomes3-6 and are now moving to the front-line of treatment protocols for selected high-risk patients (AALL1721/CASSIOPEIA, NCT03876769). The panel database included 230 patients with B-ALL, and for 138 patients (60%) the referring centre sought advice on curative treatment. The panel recommended antibody therapy for 47 patients (34%): blinatumomab for 34 patients, inotuzumab for eight, either blinatumomab or inotuzumab for five. [Extracted from the article]

Introduction: Paediatric dentists care for children who are medically compromised and with an orofacial disease; therefore, trainees need appropriate training in these areas. The prevalence of congenital and chronic diseases in children is increasing, and future specialists need an understanding of human health and disease and oral medicine. This study aimed to determine if current teaching and assessments were fulfilling these requirements., Materials and Methods: A survey distributed to the UK and Ireland specialty trainees asked their opinions on whether knowledge gained prior to entering training, and teaching and learning during training equipped them for future management of medically compromised children and those with oral medicine diagnoses., Results: The response rate was 51% (26 trainees). Most were aware of curriculum elements for medically compromised children and oral medicine. The majority felt that knowledge and experience gained as undergraduates and early graduates was insufficient and recognised the need for these topics in speciality training. For medically compromised children, this learning was considered a good use of time by 96% of trainees, and 88% felt that this topic should be given more attention. For oral medicine, this learning was considered a good use of time by 96% of trainees, and 69% felt that this topic should have more attention., Conclusion: Paediatric dentistry specialty trainees recognise that knowledge and experience of managing patients considered medically compromised and those with oral medicine conditions are an important part of training and need greater emphasis, especially in light of changing demographics with congenital and acquired chronic disease, and children with oral medicine disorders., (© 2022 The Authors. European Journal of Dental Education published by John Wiley & Sons Ltd.)

Abstract: Aim: The Association of Coloproctology of Great Britain and Ireland (ACPGBI) Delphi process identified prevention and treatment of parastomal hernia (PSH) as the second highest priority non‐cancer related colorectal pathology. This position statement aims to summarize the current evidence base. Methods: Four broad themes were identified (prevention, diagnosis/classification, management and operative repair). Guidelines are based on evidence from an extensive literature review using organized searches on the PubMed, MEDLINE, Embase and Cochrane databases. The Grading of Recommendations Assessment, Development and Evaluation (GRADE) system was adhered to for classifying the quality of evidence and reporting the strength of recommendations. Results: The suture repair of PSH other than for patients in extremis is not recommended. Synthetic non‐absorbable mesh can be used safely in the short term in the construction of colostomies post rectal surgery, but longer‐term follow‐up is needed. Other broad recommendations are made around access to stoma care nurses, prevention classification and management. Conclusion: There is a lack of high quality evidence for many domains in the prevention and treatment of PSH but the results of several studies are awaited. What does this paper add to the literature?: Parastomal hernias are a common and debilitating condition following stoma formation. This position statement from ACPGBI details the current evidence base and ongoing research for the prevention, diagnosis and management of parastomal hernias. [ABSTRACT FROM AUTHOR]

Abstract: Aims: To estimate the incidence of Type 2 diabetes in children aged <17 years, compare this with similar data 10 years ago, and characterize clinical features at diagnosis in the UK and Republic of Ireland. Methods: Using the British Paediatric Surveillance Unit reporting framework, cases of Type 2 diabetes diagnosed in children aged <17 years between 1 April 2015 and 30 April 2016 were reported each month. Results: A total of 106 cases were reported, giving a UK incidence of 0.72/100 000 (95% CI 0.58–0.88). Children from ethnic minorities had significantly higher incidence compared with white children (0.44/100 000) with rates of 2.92/100 000 and 1.67/100 000, in Asian and BACBB (black/African/Caribbean/black British) children respectively. Sixty‐seven percent were girls and 81% had a family history of Type 2 diabetes. The mean BMI sd score at diagnosis was 2.89 (2.88, girls; 2.92, boys); 81% were obese. Children of Asian ethnicity had a significantly lower BMI sd score compared with white children (P<0.001). There was a trend in increased incidence from 2005 to 2015, with a rate ratio of 1.35 (95% CI 0.99–1.84), although this was not statistically significant (P=0.062). There was statistical evidence of increased incidence among girls (P=0.03) and children of South‐Asian ethnicity (P=0.01) when comparing the 2005 and 2015 surveys. Conclusions: Type 2 diabetes remains far less common than Type 1 diabetes in childhood in the UK, but the number of cases continues to rise, with significantly increased incidence among girls and South‐Asian children over a decade. Female gender, family history, non‐white ethnicity and obesity were found to be strongly associated with the condition. [ABSTRACT FROM AUTHOR]

Background: ‘Paediatric bipolar disorder’ (PBD) is a controversial diagnosis where often prepubertal children as well as adolescents, who may have a range of psychiatric disorders or symptoms, are diagnosed with a severe mental illness requiring lifelong medication. Clinically, it has often been applied in the United States but rarely in most other countries. A meta‐analysis (Van Meter et al., Journal of Clinical Psychiatry, , 72, 1250) claimed that the prevalence of PBD was similar to adults at 1.8% with no difference between the United States and other countries. This conclusion has been highly cited. Methods: The heterogeneous nature of the original 12 epidemiological surveys warrants a qualitative analysis, rather than statistical meta‐analysis as performed by Van Meter et al. (Journal of Clinical Psychiatry, 2011, 72, 1250). Thus, the meta‐analysis and each of the 12 studies (six from the United States; six from other countries) were reexamined. Results: Most of the 12 surveys predated the emergence of the PBD hypothesis. The 12 surveys were mainly of adolescents and at times young adults with few prepubertal children. Prevalence rates in the 12 studies suggest a lower rate of bipolar disorder, especially in non‐US samples. For example, the Van Meter et al. (Journal of Clinical Psychiatry, 2011, 72, 1250) meta‐analysis chose a rate of 2.8% by summation of adolescent and parent responses in a Dutch survey, however the rate fell to 0% if requiring concordance of adolescent and parent responses. Indeed, it could be argued that four of the non‐US studies show 0% rates of PBD. Conclusions: Rates of PBD were generally substantially lower than 1.8%, particularly in non‐US surveys, and if both parent and adolescent reports were required to meet the diagnostic threshold they fell to close to zero. The reanalysis suggests that bipolar disorder is rare before the expected age of onset in later adolescence. [ABSTRACT FROM AUTHOR]

The latest report from the UK and Ireland Confidential Enquiries into Maternal Deaths, the fourth in the new annual report format, and the first to repeat the 3‐yearly thematic cycle, was published in December,1 and includes surveillance and Confidential Enquiries covering the period 2013–15. Once again the report includes reviews into the care of women who died during or after pregnancy in the Republic of Ireland as well as the UK. Following the annual topic‐specific format, this report includes topic‐specific reviews into the care of women who died from neurological conditions, other medical and surgical conditions, sepsis, anaesthetic complications, haemorrhage and amniotic fluid embolism, as well as Confidential Enquiries into the care of women with morbidity due to uncontrolled epilepsy in pregnancy and those with severe postpartum mental illness. [ABSTRACT FROM AUTHOR]

Butterflies and moths, collectively Lepidoptera, are integral components of ecosystems, providing key services such as pollination and a prey resource for vertebrate and invertebrate predators. Lepidoptera are a relatively well studied group of invertebrates. In Great Britain and Ireland numerous citizen science projects provide data on changes in distribution and abundance. The availability of high‐quality monitoring and recording data, combined with the rapid response of Lepidoptera to environmental change, makes them ideal candidates for traits‐based ecological studies. Recently, there has been an increase in the number of studies documenting traits‐based responses of Lepidoptera, highlighting the demand for a standardized and referenced traits database. There is a wide range of primary and secondary literature sources available regarding the ecology of British and Irish Lepidoptera to support such studies. Currently these sources have not been collated into one central repository that would facilitate and enhance future research. Here, we present a comprehensive traits database for the butterflies and macro‐moths of Great Britain and Ireland. The database covers 968 species in 21 families. Ecological traits fall into four main categories: life cycle ecology and phenology, host plant specificity and characteristics, breeding habitat, and morphological characteristics. The database also contains data regarding species distribution, conservation status, and temporal trends for abundance and occupancy. This database can be used for a wide array of purposes including further fundamental research on species and community responses to environmental change, conservation and management studies, and evolutionary biology. There are no copyright restrictions, and this paper must be cited if data are used in publications. [ABSTRACT FROM AUTHOR]

Understanding how survivors of complex trauma navigate towards resources can inform the design of interventions and health promotion strategies. However, there are little data on the resilience and help-seeking experiences of this group or others who have experienced institutional abuse in childhood. This empirical study sets out to illustrate the help-seeking experiences of Irish emigrant survivors of institutional childhood abuse (ICA). Twenty-two survivors of ICA were purposefully recruited from community organisations in the UK and data were collected via semi-structured interviews. As a result of negative initial help-seeking experiences in Ireland, most participants engaged in long periods of self-management and disclosed information about their childhood as part of a redress scheme in later life. Outside of this scheme, turning points, such as illness or family problems, and the needs of children were influential in seeking help. Peer support networks played an important role as a trusted signposting pathway towards formal interventions. Participants identified interpersonal barriers to formal help-seeking as helping professionals' failure to share control, insensitivity to identity loss and literacy issues, and the lack of explicit boundaries. The paper concludes with a discussion about the implications for research and future practice. Key Practitioner Messages: Turning points, such as illness and bereavement, and the desire to provide for children, influence the help-seeking of survivors of ICA., Irish emigrant survivors of ICA cite failure to share control, insensitivity to identity loss, literacy issues and the lack of explicit boundaries as barriers to help-seeking., General awareness of ICA can help practitioners in low-threshold services prevent against culturally insensitive practice., Peer support networks can provide uniquely trusted signposting towards formal interventions. [ABSTRACT FROM AUTHOR]

The role of charity as a provider of relief was notably little discussed in the comprehensive English Poor Law Report of 1834. By contrast, however, the debate at the time in Ireland over whether any kind of Poor Law at all was desirable ranged much more broadly, with the respective roles of statutory and voluntary provision hotly contested. In fact, beyond the confines of the English Report itself, the topic of the place of charity in relief was exercising plenty of minds on both shores of the Irish Sea. This article examines aspects of the intellectual importance accorded to the role of individual charity and wider voluntary action in welfare provision across the British Isles by some of the central figures in the English and Irish Poor Law debates in the 1830s. It is a study of how justifications were forged to underpin charitable activity and specific policy proposals as advanced by the main proponents of Christian political economy from the late 18th to the early 19th centuries, including William Paley, Thomas Robert Malthus, John Bird Sumner, Edward Copleston, James Ebenezer Bicheno, Thomas Chalmers and Richard Whately. The discussions of Irish circumstances and problems furnish new insights into the substance and reach of a 'philosophy of charity' which was firmly in place by the 1830s. [ABSTRACT FROM AUTHOR]

Objectives The aim of the study was to compare maternal characteristics and pregnancy outcomes in women aged < 40 years and ≥ 40 years in a large unselected population of HIV-positive women delivering in the UK and Ireland between 2000 and 2014. Methods Comprehensive population-based surveillance data on all HIV-positive pregnant women and their children seen for care in the UK and Ireland are collected through the National Study of HIV in Pregnancy and Childhood. All singleton and multiple pregnancies reported by the end of June 2015 resulting in live birth or stillbirth to women diagnosed with HIV infection before delivery and delivering in 2000−2014 were included. Logistic regression models were fitted in analyses examining the association between older maternal age and specific outcomes (preterm delivery and stillbirth). Results Among 15 501 pregnancies in HIV-positive women, the proportion in older women (≥ 40 years) increased from 2.1% (73 of 3419) in 2000−2004 to 8.9% (510 of 5748) in 2010−2014 ( P < 0.001). Compared with pregnancies in younger women, those in older women were more likely to result in multiple birth (3.0 vs. 1.9% in younger women; P = 0.03), stillbirth (adjusted odds ratio 2.39; P = 0.004) or an infant with a chromosomal abnormality (1.6 vs. 0.2%, respectively; P < 0.001). However, there was no increased risk of preterm delivery, low birth weight or mother-to-child HIV transmission among older mothers. Conclusions There has been a significant increase over time in the proportion of deliveries to women living with HIV aged ≥ 40 years, which has implications for pregnancy management, given their increased risk of multiple births, stillbirth and chromosomal anomalies, as also apparent in the general population. [ABSTRACT FROM AUTHOR]

Aims To identify factors that influence lack of engagement of young adults with Type 1 diabetes (aged 13-21 years) with structured diabetes education ( SDE) to inform and broaden the reach of future SDE. Methods A quantitative, cross-sectional survey was undertaken of 227 young people with Type 1 diabetes drawn from 11 health trusts across Northern Ireland and England, deemed to be representative of the wider population. Participants were asked to complete a questionnaire exploring non-attendance, along with the Diabetes Care Profile, the Diabetes Empowerment Scale (Short Form), the Diabetes Knowledge Test and the 12-item General Health Questionnaire. Demographic, health and diabetes-specific variables including HbA1c were also collected. Results The five most commonly cited reasons for non-attendance were 'Had other things to do' (68.3%), 'No time' (62.2%), 'Could not get time off school/college or work' (60.8%), 'Learnt about diabetes from other sources' (55.5%) and 'Feel able to cope on own' (52.9%). Conclusions Greater emphasis is required on communication with young people about the benefits of SDE. In addition, efforts need to be directed to making diabetes education more accessible without losing the quality of structured programmes. [ABSTRACT FROM AUTHOR]

The article presents addiction-related news briefs on topics such as the establishment of the President's Commission on Combating Drug Addiction and the Opioid Crisis in the U.S., and it previews several conferences and events such as the 9th International AIDS Society (IAS) Conference on HIV Science in Paris, France on July 23-26, 2017. The legalisation of electronic cigarettes (e-cigarettes) in New Zealand is examined, along with a cigarette tax increase in California.

ABSTRACT This study uses the Limerick Corpus of Irish English (LCIE), and a sample of the Cambridge and Nottingham Corpus of Discourse in English (CANCODE) to implement a corpus pragmatic approach to the analysis of Irish English by focusing on the organization of turn-taking in two connected, though distinct, varieties of world Englishes, Irish English and British English. The aim of the research is two-pronged: we explore how naturally-occurring conversation is organised in the two varieties for comparative purposes, seeking to understand how confluence in turn-taking is achieved in everyday interactions, as well as examining how the interactional flow is achieved through the manipulation of small, interpersonally loaded items, turn initial and turn final, with the focus here on turn final items. [ABSTRACT FROM AUTHOR]

ABSTRACT This article takes a variational pragmatic approach to investigating language use in Ireland by focusing on the speech act of 'offers' in Irish English as compared to those in British English. Using comparable Irish and British components of the International Corpus of English, the analysis centres on the offer strategies and strategy realisations employed in these offers. The study highlights the need for corpus analyses of speech acts to include a fine-grained qualitative analysis, particularly in light of the fact that findings reveal the distribution of offer topic to differ across the Irish and British corpora and also offer realisations to differ by topic. [ABSTRACT FROM AUTHOR]

▀ The UK's decision to leave the EU customs union is likely to see physical customs borders being introduced, including in Ireland. This will impose administrative costs and delays, with our modelling suggesting that introducing customs checks would reduce the level of UK GDP in 2030 by between 0.7-1.3%. But there are opportunities for the two sides to limit the damage through cooperation and the UK could also mitigate the costs by agreeing free-trade agreements (FTA) with third countries., ▀ The UK can take as 'light-touch' an approach to customs checks on imports from the EU as it desires. But it is likely that the EU will introduce customs checks on goods imported from the UK, even if the two sides agree an FTA, to ensure regulatory compliance and that 'rules of origin' have been satisfied - this will be particularly important if the UK agrees FTA with countries the EU does not have deals with., ▀ Introducing customs borders would pose some logistical problems, particularly in the Dover Strait where existing infrastructure is limited and there are space constraints. A potential fivefold increase in customs declarations will also pose challenges on the IT front. If the UK and EU are unable to agree transitional arrangements, then the additional infrastructure would need to be up and running in a very short period of time. This risks a period of substantial disruption., ▀ Traders will have to complete additional paperwork - such as export licences and import declarations - but much of this can be dealt with electronically, which should help to limit costs and delays. In addition, if the two sides were to share information then this could help to limit the extent to which risk-based inspections caused delays., ▀ The Government is effectively calculating that the benefits from agreeing FTA with other countries will outweigh the costs of customs controls on the UK-EU border. This judgement looks doubtful and, at best, would take many years to bear fruit. [ABSTRACT FROM AUTHOR]

This paper explores a retrospective analysis of children's file data as a research method of gathering information on children's experiences of informal disclosure of child sexual abuse. This study extracted data from files where children were seen for a child sexual abuse evaluation in Ireland and the children were deemed to have given a credible account of abuse by the professionals concerned. A content analysis was conducted using themes identified in previously published research, based on direct interviews with children about their experiences of informal disclosure. The paper discusses the relative merits and limitations of this method, through reporting on the findings of the file analysis and comparing these findings with findings obtained from a smaller sub-sample of this sample of children, who were interviewed about their experiences of disclosure. It is suggested that this method is worth exploring with a larger sample size which would enable statistical analysis and thus explore the predictive factors influencing early informal disclosure. Frontline services can contribute to the knowledge base on what helps children tell through service-based research that uses data already collected from evaluation interviews with children, thus eliminating the need to interview children for research purposes. Copyright © 2015 John Wiley & Sons, Ltd. Key Practitioner Messages Frontline professionals gather useful data on a daily basis on informal disclosures of child sexual abuse., Practitioners can contribute to the knowledge base on informal disclosure by systematically gathering information from service users., We need more information on what helps children tell. We therefore need to explore innovative methods of gathering such information directly from children in ways that do not rely on interviewing children repeatedly yet include the child's voice. [ABSTRACT FROM AUTHOR]

Objective Homozygous mutations in the TSH beta subunit gene ( TSHB) result in severe, isolated, central congenital hypothyroidism ( CCH). This entity evades diagnosis in TSH-based congenital hypothyroidism ( CH) screening programmes in the UK and Ireland. Accordingly, genetic diagnosis, enabling ascertainment of affected relatives in families, is critical for prompt diagnosis and treatment of the disorder. Design, Patients and Measurements Four cases of isolated TSH deficiency from three unrelated families in the UK and Ireland were investigated for mutations or deletions in TSHB. Haplotype analysis, to investigate a founder effect, was undertaken in cases with identical mutations (c.373delT). Results Two siblings in kindred 1 were homozygous for a previously described TSHB mutation (c.373delT). In kindreds 2 and 3, the affected individuals were compound heterozygous for TSHB c.373delT and either a 5·4- kB TSHB deletion (kindred 2, c.1-4389_417*195delins CTCA) or a novel TSHB missense mutation (kindred 3, c.2T>C, p.Met1?). Neurodevelopmental retardation, following delayed diagnosis and treatment, was present in 3 cases. In contrast, the younger sibling in kindred 1 developed normally following genetic diagnosis and treatment from birth. Conclusions This study, including the identification of a second, novel, TSHB deletion, expands the molecular spectrum of TSHB defects and suggests that allele loss may be a commoner basis for TSH deficiency than previously suspected. Delayed diagnosis and treatment of profound central hypothyroidism in such cases result in neurodevelopmental retardation. Inclusion of thyroxine (T4) plus thyroxine-binding globulin ( TBG), or free thyroxine ( FT4) in CH screening, together with genetic case ascertainment enabling earlier therapeutic intervention, could prevent such adverse sequelae. [ABSTRACT FROM AUTHOR]

Purpose: The aim of this study was to provide the first formal evaluation of a unique 12‐session group therapy programme developed by the UK‐based National Association for People Abused as Children (NAPAC). Method: The therapy outcomes of this programme were assessed using the CORE‐OM tool. Clients comprised 26 individuals (7 males and 19 females), with an age range of 19–67 (mean = 41; SD = 12.76). Clients were survivors of sexual, physical, emotional or neglectful childhood abuse, or a combination of these, and were from four different locations: London (n = 9), Bury (n = 4), Belfast (n = 8) and prison (n = 5). Findings: Across all CORE domains, improvements were shown from pre‐ to post‐therapy. No gender or age differences were revealed, and improvements were shown across both community members and prison inmates. Implications: A person‐centred approach to group therapy is beneficial to a wide range of adult clients within the community and prison settings that require therapy after historical sexual, physical, emotional or neglectful childhood abuse. [ABSTRACT FROM AUTHOR]

Objectives To design and evaluate the effectiveness of a pre-notification leaflet about research to increase recruitment to a randomized controlled trial (RCT). Methods A methodological, two-arm, RCT was conducted, embedded within an existing cohort RCT (REFORM). Participants were randomized for the embedded trial, using a 1:2 ratio (intervention : control) before being randomized for REFORM. Controls received a trial recruitment pack. The intervention group received an additional pre-notification leaflet 2-3 weeks before the recruitment pack. Primary and secondary analyses were conducted using relative risk, the Cox proportional hazards model and incremental cost-effectiveness ratios. Results Of the 1436 intervention group participants, 73 (5.1%) were randomized into the REFORM trial compared with 126 (4.4%) of the 2878 control group participants. The associated relative risk (1.16) was not statistically significant [95% confidence interval (CI) 0.88-1.56]. Return rate was not significantly increased (relative risk 1.10, 95% CI 0.92-1.28) nor time to return decreased (hazard ratio: 1.11, 95% CI 0.93-1.33). Incremental cost-effectiveness ratios indicated the intervention may be cost-effective if the true estimate of effect was close to the upper bound of the associated 95% CI. Conclusion Pre-notification for potential trial participants demonstrated a small difference to randomization (0.7% difference) and return rates (1.1% difference) in favour of the intervention. Results should however be interpreted with caution as CIs for these estimates cross the point of no effect. Nevertheless, this research enhances existing evidence for pre-notification to increase recruitment rates, with further development and assessment of this potentially cost-effective intervention being recommended. [ABSTRACT FROM AUTHOR]

Reviews are provided for several articles which were published in periodicals in 2015, including "Early Medieval Settlement and Social Power: The Middle Anglo-Saxon 'Home Farm'" by D.W. Wright, "Medieval Coastal Sand Inundation in Britain and Ireland" by D. Griffiths, and "Commerce and Cult: Confronted Ideologies in 6th-9th-Century Europe" by M. Carver which appear in the "Medieval Archaeology" journal.

Aim: Triage is key to effective management of major incidents, yet there is scarce evidence surrounding the optimal method of paediatric major incident triage (MIT). This study aimed to derive consensus on key components of paediatric MIT among healthcare professionals responsible for triage during paediatric major incidents., Methods: Two-round online Delphi consensus study delivered July 2021-October 2021, including participants from pre-hospital and hospital specialities responsible for triage during paediatric major incidents. A 5-point Likert scale was used to determine consensus, set a priori at 70%., Results: 111 clinicians completed both rounds; 13 of 17 statements reached consensus. Positive consensus was reached on rescue breaths in mechanisms associated with hypoxia or asphyxiation, mobility assessment as a crude discriminator and use of adult physiology for older children. Whilst positive consensus was reached on the benefits of a single MIT tool across all adult and paediatric age ranges, there was negative consensus in relation to clinical implementation., Conclusions: This Delphi study has established consensus among a large group of clinicians involved in the management of major incidents on several key elements of paediatric major incident triage. Further work is required to develop a triage tool that can be implemented based on emerging and ongoing research and which is acceptable to clinicians., (© 2022 Foundation Acta Paediatrica. Published by John Wiley & Sons Ltd.)

Background/aim The successful development and maintenance of professional identity is associated with professional development and retention in the health workforce. This paper explores students' perspectives on the ways pre-entry experiences and curricula content shape professional identity. Methods An online cross-sectional survey was sent to students enrolled in the final year of entry-level programmes in five countries. Descriptive statistical analyses of data were completed. Results The results reflect the perceptions of 319 respondents from five countries. Respondents identified professional education (98%) and professional socialisation during placement (92%) as curricula components with the greatest influence on professional identity formation. Discipline-specific knowledge such as, occupation-focussed models and occupational science were ranked lower than these aspects of practice. The students' length of programme and level of entry-level programme did not impact on these results. Conclusion When designing curricula educators need to be mindful that students perceive practice education and professional socialisation have the greatest affect on professional identity formation. The findings reinforce the need for curricula to provide students with a range of practice experiences, which allow the observation and application of occupation-based practices. It highlights a need for educators to provide university-based curricula activities, which better prepare students for a potential dissonance between explicit occupation-based curricula and observed practice education experiences. The study indicates the need for further research into the role curricula content, and in particular practice education, plays in the multidimensional formation of professional development within entry-level programmes. [ABSTRACT FROM AUTHOR]

Background Emetophobia (fear of vomiting) is an anxiety disorder in which individuals report clinical levels of fear that they may vomit or be exposed to the vomit of others. The prevalence of comorbidity of emetophobia with other conditions has previously only been investigated using self-report instruments. Method Sixty-four adults with emetophobia participated in an online structured clinical diagnostic interview assessing the presence of emetophobia and other conditions. Results Higher comorbidity for depression, generalized anxiety disorder, panic disorder, social anxiety disorder and obsessive-compulsive disorder were found in participants compared with general population norms. Conclusions Emetophobia is commonly comorbid with other anxiety and depressive disorders. Comorbidity rates, when assessed using a structured clinical interview, were lower than previously reported using self-report alone. Copyright © 2015 John Wiley & Sons, Ltd. Key Practitioner Message Emetophobia (specific phobia of vomiting) is a clinical fear of vomiting., Individuals with emetophobia show high comorbidity with other anxiety and mood disorders., The most common comorbid conditions were generalized anxiety disorder, panic disorder, hypochondriasis and obsessive-compulsive disorder., Clinicians should ensure that they assess for the presence of comorbid conditions when treating emetophobia. [ABSTRACT FROM AUTHOR]

Safe vascular access is integral to anaesthetic and critical care practice, but procedures are a frequent source of patient adverse events. Ensuring safe and effective approaches to vascular catheter insertion should be a priority for all practitioners. New technology such as ultrasound and other imaging has increased the number of tools available. This guidance was created using review of current practice and literature, as well as expert opinion. The result is a consensus document which provides practical advice on the safe insertion and removal of vascular access devices. [ABSTRACT FROM AUTHOR]

When developing case studies within a longitudinal study of special educational needs provision within the Republic of Ireland, the authors were conscious of the critiques of the use of this approach within educational research. The difficulties associated with generalisation, challenges of ensuring trustworthiness and the possibilities of researcher bias have been identified as limiting factors in the presentation of case study data. In order to confront these limitations, the researchers developed a framework for case study development that aimed to provide a secure database and trustworthy interpretation in order to make assertions in relation to special educational needs provision. This paper describes this process and suggests that the need to develop safeguards in order to present case studies that have high degree of credibility is essential when using this approach. Furthermore, the transparency of research methods, a significant omission in many reports of research, is necessary in order to demonstrate the trustworthiness of data. [ABSTRACT FROM AUTHOR]

There is a growing interest into how attachment theory can inform psychotherapeutic practice with adults. This study aimed to explore how a group of therapists with an interest in attachment theory use it in their work with adult clients. A cross-sectional qualitative design was adopted. Sampling, data collection and analysis procedures were guided by grounded theory principles. Semi-structured telephone interviews were conducted with 12 therapists from a variety of training backgrounds. Data were coded and developed into thematic categories. Six primary themes were identified to describe how attachment theory influenced the clinical practice of the sample through the following: (i) complementing other therapeutic models; (ii) providing a framework to understand the development of clients' mental health problems; (iii) working with different attachment styles; (iv) thinking about the therapeutic relationship as an attachment relationship; (iv) influencing the different stages of the therapeutic process; and (vi) influencing clinical service design and delivery. It is concluded that attachment theory can play a significant role in influencing the practice of therapists and can be usefully adopted to complement therapeutic processes irrespective of the therapist's dominant clinical orientation. Further research is needed to explore the views of clinicians from different theoretical orientations and to investigate the security of the client-therapist attachment within the context of therapeutic change processes. Copyright © 2015 John Wiley & Sons, Ltd. Key Practitioner Message Attachment theory may have implications for practice across a range of different types of therapy and may help therapists to bridge apparent differences between modality-specific formulation and techniques., Attachment theory can be used to understand the development of mental health problems. Therapists should assess and formulate clients' attachment styles, and these formulations should guide therapeutic approaches., Attachment theory provides a comprehensive framework for facilitating the therapist's attentiveness to relational issues and use of the therapeutic relationship as a fulcrum for change., The principles of attachment theory can be used to inform all stages of the therapeutic process, as well as the design and delivery of mental health services. [ABSTRACT FROM AUTHOR]

Taking as its starting point Carr's view that historical narrative reflects the preoccupations of the time in which it is written and Foucault's concept of consensual historical discourse as the outcome of a social struggle in which the victor suppresses or at least diminishes contrary versions of historical events in favour of their own, this paper traces and discusses the historical narrative of British nursing in the Crimean war and, in particular, three competing narratives that have arisen in the latter half of the 20th century and the first decade of the 21st. These are the established narrative surrounding Florence Nightingale, the new narrative surrounding Mary Seacole and an Irish narrative surrounding the role of the Sisters of Mercy. It is argued that the increased vehemence of the debate surrounding these narratives is representative of the changes that have taken place in British society. However, we also argue that the Irish narrative and its critique are reflective of deep‐rooted Anglo‐Protestant attitudes articulated by Nightingale and uncritically accepted by subsequent historians even in modern British historiography. [ABSTRACT FROM AUTHOR]

This guideline updates and replaces the 4th edition of the AAGBI Standards of Monitoring published in 2007. The aim of this document is to provide guidance on the minimum standards for physiological monitoring of any patient undergoing anaesthesia or sedation under the care of an anaesthetist. The recommendations are primarily aimed at anaesthetists practising in the United Kingdom and Ireland. Minimum standards for monitoring patients during anaesthesia and in the recovery phase are included. There is also guidance on monitoring patients undergoing sedation and also during transfer of anaesthetised or sedated patients. There are new sections discussing the role of monitoring depth of anaesthesia, neuromuscular blockade and cardiac output. The indications for end-tidal carbon dioxide monitoring have been updated. [ABSTRACT FROM AUTHOR]

Background A number of neurogenetic syndromes have a high association with special educational needs including fragile X syndrome (FXS), Prader-Willi syndrome (PWS), Williams syndrome (WS) and Velo-Cardio-Facial syndrome (VCFS). There is a paucity of research on educational provision for children affected by these syndromes. Method Parents (n =381) and teachers (n= 204) of school-aged children with one of the four syndromes in the UK and Ireland were surveyed in a range of areas concerning the child's educational provision. Areas surveyed included school placement, views on the needs of children with the syndromes, desired changes to current provision and perceived teacher knowledge. Results School placement in mainstream settings decreased with age in all of the syndromes. Males with the syndromes were more likely to be in specialised educational settings with the exception of WS. Teachers reported limited input on initial or subsequent training for all of the syndromes. The majority of teachers did not view the needs of children with syndromes as different from other children with intellectual disability (ID) although there were significant differences between the syndromes. Changes deemed necessary to provision by parents and teachers differed between the syndromes indicating the existence of perceptions of syndrome specific needs. The lowest perceived level of teacher knowledge was in the VCFS group. Conclusion The majority of teachers of children with neurogenetic syndromes report limited knowledge of the syndromes, but also a lack of belief that the children's needs are different from the majority of children with ID. Differences between the syndromes in some areas of provision suggest that a child's syndrome does impact on educational provision in some areas. [ABSTRACT FROM AUTHOR]

Diabetes affects 10-15% of the surgical population and patients with diabetes undergoing surgery have greater complication rates, mortality rates and length of hospital stay. Modern management of the surgical patient with diabetes focuses on: thorough pre-operative assessment and optimisation of their diabetes (as defined by a HbA1c < 69 mmol.mol(-1) ); deciding if the patient can be managed by simple manipulation of pre-existing treatment during a short starvation period (maximum of one missed meal) rather than use of a variable-rate intravenous insulin infusion; and safe use of the latter when it is the only option, for example in emergency patients, patients expected not to return to a normal diet immediately postoperatively, and patients with poorly controlled diabetes. In addition, it is imperative that communication amongst healthcare professionals and between them and the patient is accurate and well informed at all times. Most patients with diabetes have many years of experience of managing their own care. The purpose of this guideline is to provide detailed guidance on the peri-operative management of the surgical patient with diabetes that is specific to anaesthetists and to ensure that all current national guidance is concordant. [ABSTRACT FROM AUTHOR]

Background: Surgical neutering of dogs is common, however the average age that dogs reach sexual maturity, are neutered, and dog owners' attitudes to neutering in the UK and the Republic of Ireland have not been explored in a longitudinal study. Methods: Owner‐reported data on the timing of the first oestrus, timing of neutering and the reasons given for neutering dogs by 12 and 15 months of age were summarised. Factors associated with neutering at 15 months and factors associated with intention to neuter were quantified using multivariable logistic regression. Results: At 15 months of age, 90.0% (n = 207/230) of unneutered females had had their first oestrus. By 7, 9, 12 and 15 months of age, 22.1% (n = 131/593), 32.2% (197/593), 45.4% (n = 269/593) and 59.9% (n = 352/593) of dogs were neutered, respectively. Breed purity, dog's source, owners' intentions to neuter and the number of dogs in the household were associated with neuter status at age 15 months. Dog's sex, Kennel Club registration, dog's source, dogs intended to be working dogs and previous dog ownership were associated with intentions to neuter. Preventing puppies was the most common reason for neutering. Conclusion: Understanding factors that shape owners' intentions to neuter can inform owner‐vet discussions regarding whether to neuter a dog and the optimal age for doing so. [ABSTRACT FROM AUTHOR]

The article presents abstracts related to anaesthesia including transient torticollis following general anaesthesia, starvation ketoacidosis in the third trimester of pregnancy in a non-diabetic patient, and cardiac arrest in pregnancy: anaesthetic lessons.

Aggressive driving is acknowledged as a contributor to motor vehicle crashes. This study explored a theoretical model of aggressive expression and crash-related outcomes using self-report data collected, using an online questionnaire, from drivers in the United Kingdom and the Republic of Ireland. The proposed model tested whether the personality traits of boredom proneness, sensation seeking, and impulsivity, coupled with trait driving anger, predicted aggressive driving; and whether aggressive driving predicted crash-related outcomes (loss of concentration and control, near misses, and moving violations). The structural model was confirmed, with aggressive expressions of anger being found to mediate the relationships driving anger and impulsivity had with the crash-related outcomes. Multigroup invariance analysis showed that the model remained invariant across drivers from the United Kingdom and Ireland, suggesting that the contributing factors for aggressive expression and crash involvement are similar across both countries. When self-reported crash-related conditions were compared between drivers in the United Kingdom and Ireland, drivers in the United Kingdom reported more aggressive driving, more minor crashes, more incidents of road rage, and more frequent losses of concentration and vehicle control. [ABSTRACT FROM AUTHOR]

Guidelines are presented for the organisational and clinical peri-operative management of anaesthesia and surgery for patients who are obese, along with a summary of the problems that obesity may cause peri-operatively. The advice presented is based on previously published advice, clinical studies and expert opinion. [ABSTRACT FROM AUTHOR]

Objectives The purpose of this review was to uncover areas of competence which may lead to a baseline of skills for health librarians. A baseline could inform personal development plans for health librarians, criteria for job descriptions and curriculum for library and information science ( LIS) courses. Methods This research outlines existing competencies for librarians working in health care as defined by library associations, recent job descriptions and a mapping review of the library and information science literature. This is performed in the context of librarians working in the Irish health system with examples of practice drawn from the Irish experience. Results Ten areas of competence were found to be common to three of five library associations, which were also common to recent job descriptions. The literature reveals an ever changing working environment for librarians working in health with opportunities for new and evolving roles. Conclusions The challenge for librarians moving into these roles will be to stay relevant and to keep skills updated in a rapidly moving health and information environment. [ABSTRACT FROM AUTHOR]

Background There are a number of neurogenetic syndromes with well described behavioural phenotypes including fragile X syndrome, Prader-Willi syndrome, Williams syndrome and velo-cardio-facial syndrome (VCFS). Autism spectrum disorder (ASD), attention deficit hyperactivity disorder (ADHD) and psychiatric conditions are often associated with the syndromes. Method Parents (n = 381) of school-aged children with one of the four syndromes in the UK and Ireland were asked whether their child had been professionally diagnosed with ASD, ADHD or a mental health condition. Parents were also asked whether their child had been prescribed medication for behavioural or psychiatric reasons. Results The highest level of reported diagnoses of ASD and ADHD was in fragile X syndrome. In all syndrome groups, lower rates of diagnosis were reported in comparison to previously published research. Prescribing of medication for behavioural/ psychiatric reasons was highest in fragile X syndrome although the highest usage of melatonin was in Williams syndrome. Conclusion Reasons for a lower recognition of ASD, ADHD and mental health conditions in clinical practice compared with research studies may include 'diagnostic overshadowing' due to presence of intellectual disability and a genetic syndrome. However, there may also be a lack of belief in the utility of such diagnoses in neurogenetic syndromes among relevant professionals and/or lack of access to professionals with sufficient expertise in the recognition of such diagnoses in those with neurogenetic syndromes. The low rates of prescribing of medication for behavioural/psychiatric reasons may reflect the low level of clinical diagnoses or lack of belief in the utility of psychopharmacology in this population. [ABSTRACT FROM AUTHOR]

Introduction The expanding role of physiotherapists, with increasing use of services such as self-referral, means that demonstrating an ability to understanding and ask red-flag questions appropriately has never been more important. The present study investigated how physiotherapists define common red flags, how they ask red-flag questions, which red flags they routinely record and the importance that therapists attribute to individual red-flags. Methods In this qualitative study, an online questionnaire survey was circulated to physiotherapists using various UK special interests networks. A total of 98 physiotherapists participated in the study, the majority of whom worked exclusively in the National Health Service. Results In general, clinicians defined red flags for back pain in line with guidelines but there was little consensus on how therapists asked patients about red flags. Questioning often included undefined terminology and therapists not asking some red-flag questions. Additionally, the more recently recognized flags (vague, non-specific lower-leg symptoms; band-like trunk pain; decreased mobility) had less importance attached to them and were recorded less frequently. Conclusions If only certain red flags are being assessed, this may put patients at risk of having serious spinal pathologies going undetected. Thus, strategies encouraging therapists to ask all red-flag questions may be needed. The importance of the more recently recognized red flags may need to be emphasized to clinicians. Finally, the inconsistent way in which the red-flag questions were asked highlights a potential practical barrier to translating red-flag knowledge into clinical practice. There is a need to build on this work, using in-depth qualitative interviews, to gain a deeper understanding of how therapists understand and apply the red flags commonly used in back pain assessment. Copyright © 2014 John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

Background The present study was undertaken to review how much time paediatric dietitians spend in direct contact with patients and to determine what levels of staffing are available throughout paediatric dietetic departments in Ireland and the UK. Methods A work sampling tool was devised to capture paediatric dietetic activity for a period of 1 day. A semi-structured questionnaire was sent to paediatric dietitian managers to provide demographic information on their facility. Results Fourteen questionnaires were returned by paediatric dietitian managers and 86 work sampling tools were returned for analysis by dietitians working in the various departments. Paediatric dietitians spend 23% of the working day in direct patient contact, although up to 58% of the day in direct patient-related activities, of which communication comprised 25.2%. Staffing levels are below clinical recommendations in four out of five specialties. National activity reports focus on the number of patient contacts but do not include information on the complexity of patient care. Conclusions Work sampling is a useful tool in the assessment of activity in healthcare. Inadequate staff levels and limitations in activity reporting in paediatric dietetics will affect estimations for future service developments. Information obtained from the present study could contribute to the supply analysis of a workforce planning exercise in paediatric services in the future. [ABSTRACT FROM AUTHOR]

Background Despite evidence that even mild dehydration is associated with various morbidities, water intake estimates in free-living populations are lacking. The present study aimed to estimate water intakes and dietary sources in a nationally representative sample of the Irish adult population. Methods A 4-day semi-weighed food record was used to collect dietary intake data from 1500 free-living adults aged 18-90 years in the Irish National Adult Nutrition Survey ( NANS) (2008-2010) from which water intake was estimated. To enable fluid intake estimation, additional questions on how water and milk were consumed were incorporated. Total water intake was calculated as drinking water plus water from other beverages and food moisture. Results The mean ( SD) daily total water intake for Irish adults was 2.31 (0.92) L day-1 [males 2.52 (1.00) L day-1; females 2.09 (0.79) L day-1]. Intakes were lowest in elderly adults, as well as in those with less education, a lower social class, less energy expenditure and a higher body mass index and body fat percentage. In total, 67% of water came from beverages and 33% came from food moisture. Alcoholic beverages and teas individually contributed to total water intake in amounts similar to the drinking water contribution. Conclusions These data may be used as a foundation for further research in the area of the effect of under consumption of water on health outcomes to guide public health messages regarding adequate water intakes. [ABSTRACT FROM AUTHOR]

The article offers news briefs related to addiction as of 2016. The unregulated cannabidiol (CBD) market in Great Britain has been halted by the UK Medicines and Healthcare Products Regulatory Agency (MHRA). The public is supporting minimum unit pricing (MUP) for alcohol products in Great Britain. A World Health Organization (WHO) report has found that the alcohol-attributable mortality burden has increased slightly in Europe since 1990.

The purpose of this cross-sectional study was to ascertain whether undergraduate dental students in the United Kingdom and Ireland are receiving formal teaching on recognizing and managing domestic violence (DV) as part of their curricula. A questionnaire was sent to all dental schools in the UK and Ireland in 2007 and again in 2012, requesting information on whether the subject was taught, by which specialty it was taught, and whether schools felt it was important to include in the curriculum. In 2007, twelve of the fifteen dental schools completed and returned the questionnaire, for a response rate of 80 percent; in 2012, eleven of the sixteen dental schools responded, for a response rate of 69 percent. The main findings were that, in 2007, 50 percent of the responding schools were providing teaching about DV and the majority of this teaching was delivered by oral surgery and pediatric dentistry departments. In 2012, only 45 percent of the responding schools were teaching DV, with 60 percent of this teaching being delivered by pediatric dentists. This study's findings suggest that DV is an undertaught area in UK and Irish undergraduate dental curricula. Some schools recognized the importance of DV teaching; however, they have been unable to implement it because of a full curriculum and lack of appropriately trained staff amongst other reasons. [ABSTRACT FROM AUTHOR]

This article considers an example of the impact of a new good on producers of close substitutes: the invention of margarine and its rapid introduction into the British market from the mid-1870s. This presented a challenge to the traditional suppliers of that market, butter producers from different European countries. We argue that the capacity to react quickly to the appearance of this cheap substitute by improving quality and establishing product differentiation was critical for the fortunes of butter producers. This is illustrated by a discussion of the different reactions to margarine and quality upgrading in Ireland, Denmark, and the Netherlands. A statistical analysis using monthly data for Britain from 1881-7 confirms that margarine had a greater impact on the price of poor quality butter than that of high quality butter, presumably because it was a stronger substitute. [ABSTRACT FROM AUTHOR]

The article offers news briefs related to the addiction behaviors as of January 2014. The decision of the New York City Council to prohibit people under the aged 21 from buying or selling cigarettes and the increased law enforcement on illegal tobacco sales. The Ireland government decision to increase the tobacco retail license fees. The decision of the Bihar government in India to make the state a tobacco tax-fee state contradicts the Indian government's anti-tobacco campaign.

Increasing numbers of elderly patients are undergoing an increasing variety of surgical procedures., There is an age-related decline in physiological reserve, which may be compounded by illness, cognitive decline, frailty and polypharmacy., Compared with younger surgical patients, the elderly are at relatively higher risk of mortality and morbidity after elective and (especially) emergency surgery., Multidisciplinary care improves outcomes for elderly surgical patients. Protocol-driven integrated pathways guide care effectively, but must be individualised to suit each patient. The AAGBI strongly supports an expanded role for senior geriatricians in coordinating peri-operative care for the elderly, with input from senior anaesthetists (consultants/associate specialists) and surgeons., The aims of peri-operative care are to treat elderly patients in a timely, dignified manner, and to optimise rehabilitation by avoiding postoperative complications. Effective peri-operative care improves the likelihood of very elderly surgical patients returning to their same pre-morbid place of residence, and maintains the continuity of their community care when in hospital., Postoperative delirium is common, but underdiagnosed, in elderly surgical patients, and delays rehabilitation. Multimodal intervention strategies are recommended for preventing postoperative delirium., Peri-operative pain is common, but underappreciated, in elderly surgical patients, particularly if they are cognitively impaired. Anaesthetists should administer opioid-sparing analgesia where possible, and follow published guidance on the management of pain in older people., Elderly patients should be assumed to have the mental capacity to make decisions about their treatment. Good communication is essential to this process. If they clearly lack that capacity, proxy information should be sought to determine what treatment, if any, is in the patient's best interests., Anaesthetists must not ration surgical or critical care on the basis of age, but must be involved in discussions about the utility of surgery and/or resuscitation., The evidence base informing peri-operative care for the elderly remains poor. Anaesthetists are strongly encouraged to become involved in national audit projects and outcomes research specifically involving elderly surgical patients. [ABSTRACT FROM AUTHOR]