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Introduction:\ud Malignant pleural mesothelioma (MPM) is difficult to diagnose. An accurate blood biomarker could prompt specialist referral or be deployed in future screening. In earlier retrospective studies, SOMAscan proteomics (Somalogic, Boulder, CO) and fibulin-3 seemed highly accurate, but SOMAscan has not been validated prospectively and subsequent fibulin-3 data have been contradictory.\ud \ud Methods:\ud A multicenter prospective observational study was performed in 22 centers, generating a large intention-to-diagnose cohort. Blood sampling, processing, and diagnostic assessment were standardized, including a 1-year follow-up. Plasma fibulin-3 was measured using two enzyme-linked immunosorbent assays (CloudClone [used in previous studies] and BosterBio, Pleasanton, CA). Serum proteomics was measured using the SOMAscan assay. Diagnostic performance (sensitivity at 95% specificity, area under the curve [AUC]) was benchmarked against serum mesothelin (Mesomark, Fujirebio Diagnostics, Malvern, PA). Biomarkers were correlated against primary tumor volume, inflammatory markers, and asbestos exposure.\ud \ud Results:\ud A total of 638 patients with suspected pleural malignancy (SPM) and 110 asbestos-exposed controls (AECs) were recruited. SOMAscan reliably differentiated MPM from AECs (75% sensitivity, 88.2% specificity, validation cohort AUC 0.855) but was not useful in patients with differentiating non-MPM SPM. Fibulin-3 (by BosterBio after failed CloudClone validation) revealed 7.4% and 11.9% sensitivity at 95% specificity in MPM versus non-MPM SPM and AECs, respectively (associated AUCs 0.611 [0.557–0.664], p = 0.0015) and 0.516 [0.443–0.589], p = 0.671), both inferior to mesothelin. SOMAscan proteins correlated with inflammatory markers but not with asbestos exposure. Neither biomarker correlated with tumor volume.\ud \ud Conclusions:\ud SOMAscan may prove useful as a future screening test for MPM in asbestos-exposed persons. Neither fibulin-3 nor SOMAscan should be used for diagnosis or pathway stratification.

Objective: EMS use of lights and sirens has long been employed in EMS systems, despite an increased risk of motor vehicle collisions associated with their use. The specific aims of this study were ...

Research supervision is the highest level of teaching for academics. Yet, in many cases, academics are allocated supervision without any formal training. For many supervisors, their supervision approach will be a mirror of what they have experienced themselves at post-graduate levels. Many supervisors consider that this form of teaching is stressful and onerous due to the responsibility placed on it by the Higher Education Institution and the student ultimately. What can be done to support supervisors in their supervisory journey? There is a void in the academic literature on research supervision with scant aids available to the supervisor (Cullen, 2009). Brew and Boud (1995) outline the importance of instructor knowledge; however, supervisors only gain extensive supervisory experience over the years. The aim of this study is to better understand the supervisory process. Data was gathered from 12 lecturers engaged in supervision across various disciplines. Findings indicate that supervisors need to adopt and continually change to differing circumstances and different student personalities while supervising. It is essential that formal supervisory training be provided for all supervisors. The findings from this evaluation are novel and will be beneficial to research supervisors across various disciplines. Keywords: Research Supervision, Multi-Disciplinary, Reflection.

The act of writing letters, rehearsing scenes that precede a calamitous event, can in itself become a form of valuable catharsis. This essay explores the ways in which Mary Shelley’s correspondence rehearses the scenes of her tragic circumstances as much to herself as to her addressee, and investigates how letters became to her a way in which she tested the contours of her grief, replaying the scenes and spaces that came before and after the death of Percy Shelley. Always intrigued by the forms and shortcomings of correspondence, Mary Shelley tested her views on letter-writing both in her frequent correspondence and in her fiction. Her letters and literature, I argue, work in close symbiosis, illustrating everywhere how they inform and converse with each other, from Frankenstein (1818) through to the grief-laden The Last Man (1826) and beyond.

This study has addressed and identified the problems in managing the existing emergency supply chain of Bangladesh in all phases of operation in terms of the primary drivers of the supply chain. It has also attempted to conceptualize and suggest an effective emergency supply chain. In this context, a thorough field investigation in several districts was conducted among the employees of the organizations sharing common information with similar protocols and implications (interoperable). Information was collected from the employees of all the participating organizations involved in disaster management through a semi-structured questionnaire based survey. The respondents addressed and illustrated several interconnected reasons which are inhibiting proper forecasting, procurement, storage, identification of affected people, and distribution. The respondents pointed out that the mismatching of objectives in the different organizations resulted in non-interoperability among the participating organizations. These issues are related to the malfunctioning of management with multidimensional organizational conflicts. Reflecting those issues, an emergency supply chain for disaster management is proposed in this study.

The main objective of this study is to develop the scale items of consumers’ attitudes toward Facebook advertisements and to theorize consumers’ attitudinal behaviour. To undertake this study, a research assistant was appointed, who is also an active member of Facebook, to introduce a message about the product Samsung Tab S, and to pass it to other members of their network. From this experiment, different members of their network participated in generating, passing, and receiving messages to develop a preliminary structured perception which was converted to generate scale items to measure attitude. Then an independent empirical study was conducted among members of a social network to verify and validate these scale items and their underlying constructs. From the findings in this study, it is identified that attitudes toward social network advertisement, i.e., any effort to communicate messages about products among network members, who are also consumers of different products, is formed and persuaded by hedonic motivation (HM), source derogation (SD), self-concept (SC), message informality (MI), and experiential messages (EM).

This essay takes a close look at the way Alain Mabanckou positions himself vis-à-vis discipline and market by way of his negotiations of a range of terms—French, francophone, postcolonial, and world literature—and the ways that such disciplinarity and appeal might be generated in his first major novel, Blue White Red. How Mabanckou picks his way through these intercalating terms speaks to the appeal and centrality of his work in a world literature canon. The authors argue that Mabanckou quite consciously and effectively makes use of the figures of allegory and parable from a distinctly biblical context, mapping the permutations and vicissitudes of his protagonist's rise and fall in fortunes to the life and narrative of Saint Paul—primarily his conversion and his epistolary interventions in the shape of a universal(ized) Christianity. The authors ground this Pauline allegory in Alain Badiou's own mobilization of Saint Paul as the engineer and emissary of a certain kind of antiphilosophical intervention. This parallel thereby foregrounds the liminality of the transnational African emigrant and his or her struggles with identity, citizenship, economics, and esteem in the novelistic form, which is read as a complex cautionary tale about the erosion and challenges to those transnational aspirations of success and seamless transnational citizenship. In this manner, Blue White Red disempowers narratives that blindly valorize emigration, and the text serves as a kind of epistle to those whose aspirations require self-conscious blindness to the complexities and hurdles to effortless movement across borders in the globalized economy.

This novel research pivoted around a collaborative cyclical learning experience between businesses in a City Centre scape and a local Higher Education Institution. This concept provided for a dual aspect to learning; third level MBA students in parallel with business operatives in a City. The students were tasked with addressing a business problem in cooperation with City Hall and to write a ‘service charter for this city’, while being assessed for progression for their MBA. This Collaborative experiential learning (Kolb, & Kolb, 2017) centred on a group of 22 MBA students while they interacted with 20 businesses in a European City to research, develop and write a service charter. Details of the development of the charter per se are not dealt with in this paper, just the experience of its development by the students and business alike. Finding novel ways to assess third level students is always a challenge for Higher Education Institutions. Imagine the opportunity of being placed at the fulcrum of learning and business development through a dual aspect collaborative learning challenge and experiential learning. An experimental approach was afforded to MBA level 9 students when they were tasked with writing a ‘Service Charter ‘for their City – while in parallel, being assessed through ‘problem solving’ for 5 ECTS credits with the third level partner. The dual aspect of learning and co-creation between businesses and college began when the students sought to solve a problem for City businesses and find a solution to their problem and reflect on it, and the second, when a recommendation came from the research that the businesses needed to undertake further training in order to implement the plan of the final City Service Charter.

Covid-19, a corona virus, has maintained its momentum in spreading among communities. In this context of social crisis, this study seeks to identify the reasons for the partial failure to fulfill the intended goal of lockdown, and to formulate an inclusive behavioral model reflecting comprehensive human behavior and social psychology. In order to answer the research questions, this study has conducted extensive interviews among individuals who were targets of the lockdown system. From this exploratory and qualitative investigation, researchers have recognized four paradigms as the key to understanding human behavior and social psychology in violating lockdown as a social isolation system during this period of crisis. The identified parameters depicting social behavior are: Derogation and Argument (SDA), Tangible Need and Deficiency (TND), Intangible Desire and Expectancy (IDE), and Evaluation of Benefit and Loss (UBL). Finally, as a comprehensive guideline, a grounded theory of the social behavior ‘paradigm for lockdown violation (PLV)’ is explored as the reason for the violation of the social system.

IntroductionVentilator-associated pneumonia (VAP) is a common healthcare-associated infection in the intensive care unit (ICU). Probiotics are defined as live microorganisms that may confer health benefits when ingested. Prior randomised trials suggest that probiotics may prevent infections such as VAP and Clostridioides difficile–associated diarrhoea (CDAD). PROSPECT (Probiotics to Prevent Severe Pneumonia and Endotracheal Colonization Trial) is a multicentre, double-blinded, randomised controlled trial comparing the efficacy of the probiotic Lactobacillus rhamnosus GG with usual care versus usual care without probiotics in preventing VAP and other clinically important outcomes in critically ill patients admitted to the ICU.Methods and analysisThe objective of E-PROSPECT is to determine the incremental cost-effectiveness of L. rhamnosus GG plus usual care versus usual care without probiotics in critically ill patients. E-PROSPECT will be performed from the public healthcare payer’s perspective over a time horizon from ICU admission to hospital discharge.We will determine probabilities of in-ICU and in-hospital events from all patients alongside PROSPECT. We will retrieve unit costs for each resource use item using jurisdiction-specific public databases, supplemented by individual site unit costs if such databases are unavailable. Direct costs will include medications, personnel costs, radiology/laboratory testing, operative/non-operative procedures and per-day hospital ‘hoteling’ costs not otherwise encompassed. The primary outcome is the incremental cost per VAP prevented between the two treatment groups. Other clinical events such as CDAD, antibiotic-associated diarrhoea and in-hospital mortality will be included as secondary outcomes. We will perform pre-specified subgroup analyses (medical/surgical/trauma; age; frailty status; antibiotic use; prevalent vs no prevalent pneumonia) and probabilistic sensitivity analyses for VAP, then generate confidence intervals using the non-parametric bootstrapping approach.Ethics and disseminationStudy approval for E-PROSPECT was granted by the Hamilton Integrated Research Ethics Board of McMaster University on 29 July 2019. Informed consent was obtained from the patient or substitute decision-maker in PROSPECT. The findings of this study will be published in peer-reviewed journals.Trial registration numberNCT01782755; Pre-results.

I hear, and I forget. I see, and I remember. I do, and I understand, (Asian Proverb). The context of this research is the examinination of teaching practice through the lens of ‘microteaching’, thus affording the opportunity to reflect on and evaluate one’s personal delivery with the view to instigating better actions for practice in the future. This study specifically contributes to a novel critical enhancement of level 9 teaching delivery where the cohort are adult learners. The focus of this evaluation on current practices is to establish where improvements could be made to teaching delivery through the direct scrutiny of peers. Reflection on the feedback and on the sessions was reviewed and recommendations were embraced and operationalised. The empirical data was gathered through three peer review microteaching sessions that were recorded and where feedback was given after each session. The microteaching was repeated once a month over a 3-month interval process. Feedback from the sessions was analysed and recommendations for practice were developed. These recommendations will be considered, and relevant resultant changes will be made to improve future practice at level 9. It is envisaged that the findings of this research will better inform the author, the academic plan, and the faculty for future teaching practice. Keywords: Microteaching, Instructor Evaluation, Reflection.

Any reader invited to imagine a Gothic novel set in Spain during the Romantic period may be forgiven for picturing lascivious priests, helpless male and female victims, and a harsh, impassive Spanish Inquisition which revels in meting out spectacular punishment to those characters who transgress its strictly encoded Catholic laws. But as this essay argues, representations of Spain in the popular Gothic novel during the Romantic period were more complex than this initial picture suggests due to evolving military alliances and further travel in Spain during this period.

This paper examines ‘Enquiry Based Learning’ (EBL) as an engagement strategy for assessment at ‘taught masters’ level 9. The master students in question are adult learners in full time employment and the empirical data was gathered from these students. First, an outline of the key features of EBL is presented and, from there, an investigation of how it is viewed when applied to a specific problem statement by the masters students. EBL creates a memorable atmosphere in the classroom and encourages deep learning (Ramsden, 1992). EBL also encourages active learning, which is more enjoyable for the students (Eison, 2010), especially adults – offering more control (Whowell, 2006). Learning should not be passive or a spectator sport; students learn most effectively by active engagement (Karmas, 2006), with an interesting project, hence, the use of EBL. It is vital that we move beyond a conceptualisation of education as the simple acquisition of knowledge to one which equally emphasises, nurtures and assesses innovation and expertise in the utilisation and application of knowledge, (Boland, 2010). The findings of this research are relevant and important as they inform practice and feed into future programme reviews when considering the inclusion of EBL for assessment.

Consumers are increasingly discerning about food choices. This research explores the attitudes of Irish consumers to local and artisan food products, and, in particular, if they would consider the supermarket environment as a location of choice for the purchase of these foods. This research applied a quantitative methodology to address the research question. 126,110 supermarket customers were contacted through an Irish supermarket loyalty data base, which resulted in 14,646 completed responses. This rich data allowed the researchers access to the attitude of Ireland’s consumers to speciality local food products, normally absent from the supermarket shelf. 98.8% of respondents would like to be able to purchase local food products in a supermarket, and 76% of respondents expect to pay either less than, or the same price for local food products, as they do for other similar standard foods. This research will be of direct benefit to parties involved with the grocery retail sector in Ireland.

Rack well you hero's nerves and heart, And let your heroine take her part; Her fine blue eyes were made to weep, Nor should she ever taste of sleep; Ply her with terrors day or night, And keep her always in a fright, But in a carriage when you get her, Be sure you fairly overset her; If she will break her bones – why let her: Again, if e'er she walks abroad, Of course you bring some wicked lord, Who with three ruffians snaps his prey, And to a castle speeds away; Those close confin'd in haunted tower, You leave your captive in his power, Till dead with horror and dismay, She scales the walls and flies away. (Mary Alcock, ‘A Receipt for Writing a Novel’, in Poems ) Published in 1799, Mary Alcock's parodic recipe for novel-writing repeats much-echoed commonplace assumptions about the comparative youth, fair complexion, victimisation, nervous constitution and tendency to flight that characterised the Gothic heroine of the 1790s. In playful tone, Alcock's recipe endows the heroine with the superhuman abilities of scaling walls and fleeing tyranny, underlining at the same time the unrealistic expectations that author and reader project onto a heroine. Still, despite the humorous vein, there is something disturbing about the way in which her poem conflates the role of Gothic authorship with the fictional role of villain. The imagined addressee of this poem (‘you’) holds the heroine captive, like the villain, subjects her to a carriage crash, kidnap, imprisonment and perpetual flight. It is an astute conflation on the part of Alcock, suggesting that any female author's exploitation of a heroine involves, in turn, an abrogation of femininity on their part. In other words, exploiting a heroine for commercial gain is a masculine pursuit, unsuitable for proper women writers. Of course, Alcock did this in the spirit of parody, in order to distance herself critically from the commercial exploitation of the Gothic heroine. Her recipe was one in a long line of parodies that targeted the unimaginative regurgitation of a heroine as virtuous and blue-eyed. ‘Terrorist Novel Writing’ (Anon. 1798), ‘The Terrorist System of Novel Writing’ (Anon. 1797) and Alcock's ‘Recipe’ all reproduced the stable set of ingredients for composing a Gothic novel, implying that if any author or reader was naive enough to devour these recipes, then they must already be lacking in imagination and enterprise.

Abrupt discontinuation of benzodiazepines often results in side effects including anxiety and insomnia, which can be barriers to discontinuation among long-term users. Melatonin improves the onset, duration, and quality of sleep. By preventing insomnia in those attempting to discontinue benzodiazepines, melatonin may facilitate benzodiazepine discontinuation. The primary objective was to determine the effect of melatonin compared with placebo on benzodiazepine discontinuation in adults attempting to discontinue benzodiazepines. The secondary objective was to determine the effect of melatonin on sleep quality in this population. We searched PubMed, MEDLINE, EMBASE, PsychINFO, and ClinicalTrials.gov from inception to November 2014. We included randomized controlled trials published in English comparing melatonin with placebo that reported benzodiazepine discontinuation or sleep quality. Two reviewers independently screened trials, extracted data, and assessed the risk of bias. We included six trials randomizing 322 participants. The mean age of participants was approximately 64 years. The trials used varied tapering strategies to discontinue benzodiazepines over 4–10 weeks while using melatonin. Melatonin had no effect on the odds of successfully discontinuing benzodiazepines (odds ratio 0.72, 95 % confidence interval 0.21–2.41, p = 0.59). There was important heterogeneity among the trials (I 2 = 76 %). The effect of melatonin on sleep quality was inconsistent. Melatonin had no effect on benzodiazepine discontinuation while the effect of melatonin on sleep quality was inconsistent. We cannot rule out a role of melatonin in improving benzodiazepine discontinuation or sleep quality owing to imprecise effect estimates. Larger, well-designed, and reported randomized controlled trials may provide more valid and precise estimates of the effect of melatonin on these outcomes.

Eleven colour-emotion scales, warm–cool, heavy–light, modern–classical, clean–dirty, active–passive, hard–soft, harmonious–disharmonious, tense–relaxed, fresh–stale, masculine–feminine, and like–dislike, were investigated on 190 colour pairs with British and Chinese observers. Experimental results show that gender difference existed in masculine–feminine, whereas no significant cultural difference was found between British and Chinese observers. Three colour-emotion factors were identified by the method of factor analysis and were labeled “colour activity,” “colour weight,” and “colour heat.” These factors were found similar to those extracted from the single colour emotions developed in Part I. This indicates a coherent framework of colour emotion factors for single colours and two-colour combinations. An additivity relationship was found between single-colour and colour-combination emotions. This relationship predicts colour emotions for a colour pair by averaging the colour emotions of individual colours that generate the pair. However, it cannot be applied to colour preference prediction. By combining the additivity relationship with a single-colour emotion model, such as those developed in Part I, a colour-appearance-based model was established for colour-combination emotions. With this model one can predict colour emotions for a colour pair if colour-appearance attributes of the component colours in that pair are known. © 2004 Wiley Periodicals, Inc. Col Res Appl, 29, 292–298, 2004; Published online in Wiley InterScience (www.interscience.wiley.com). DOI 10.1002/col.20024

In this study three colour preference models for single colours were developed. The first model was developed on the basis of the colour emotions, clean–dirty, tense–relaxed, and heavy–light. In this model colour preference was found affected most by the emotional feeling “clean.” The second model was developed on the basis of the three colour-emotion factors identified in Part I, colour activity, colour weight, and colour heat. By combining this model with the colour-science-based formulae of these three factors, which have been developed in Part I, one can predict colour preference of a test colour from its colour-appearance attributes. The third colour preference model was directly developed from colour-appearance attributes. In this model colour preference is determined by the colour difference between a test colour and the reference colour (L*, a*, b*) = (50, −8, 30). The above approaches to modeling single-colour preference were also adopted in modeling colour preference for colour combinations. The results show that it was difficult to predict colour-combination preference by colour emotions only. This study also clarifies the relationship between colour preference and colour harmony. The results show that although colour preference is strongly correlated with colour harmony, there are still colours of which the two scales disagree with each other. © 2004 Wiley Periodicals, Inc. Col Res Appl, 29, 381–389, 2004; Published online in Wiley InterScience (www.interscience.wiley.com). DOI 10.1002/col.20047

In today’s global environment, the dairy farmer and his herd have lost major importance and influence as a consequence of a variety of factors, among them the Industrial revolution, continued and increasing consumerism, the technological explosion, and the ever-expanding concentration of people in urban areas. This research study examines the Irish dairy industry in its current format. The objective of this study is to look at what dairy farmers need to do to grow and expand their business efficiently and effectively. The major challenge for the industry is to attract a new generation of knowledgeable workers to the land. This needs to be balanced by ensuring that both the deep traditions and the experienced culture of farming generations remain at the heart of agricultural practice. The future of the Irish Dairy industry will be scrutinised over the next few years as reforms take place and economies adjust, amid the expectation that world markets will stabilise. The proposed abolition of milk quotas in 2015 will be one of the most significant landmarks in farming history since Ireland’s entry into the European Union in 1973, and the introduction of milk quotas in 1984. This study also examines whether Ireland will remain on its current trend of a steady decline of individuals holding farms, and if the industry will become a gathering of “multi-nationals”, similar to other commodity markets. Can the Irish dairy farming community formalise a strategy together to ensure that all members make a substantial contribution and have an input in its future success? After an extensive review of the relevant pertinent literature, a qualitative methodology was applied for this current research. Face to face interviews were conducted with relevant and appropriate people, including the current Irish Minister for Agriculture, Mr. Simon Coveney T.D. Nine interviews were completed for the purpose of this study, and contributors were purposely chosen because of their expertise in the area. The study reveals that the outlook for the Irish dairy industry is a positive one, but it will be important for the industry to closely examine comparative situations, in particular to give attention to the New Zealand model. Findings suggest that dairying post 2015 can do the same for rural Ireland as it did for the South Island of New Zealand 20 years ago. Caution must also be exercised that Ireland does not experience the same social implications as the New Zealanders did. This study has found that grass-based milk production is an area where Ireland has a real, sustainable, competitive, and international advantage. The focus and ambition of the future should be for the dairy industry to turn the land of green hills and mountains into the land of the green ‘notes’, preferably euro notes. This study will benefit the dairy industry, farming organisations, entrepreneurs, legislators and political leaders in analysing the industry and determining its future.

Branding aids companies in the acquisition of new customers, allows them to build a favourable reputation, leads to increased customer loyalty and, ultimately, is a driver of profitability. Although there is an impressive quantity of academic literature related to both large corporate and product line branding, there has been less focus regarding the research on branding of small businesses, despite their economic importance. In the specific case of SMEs in Ireland, branding studies are scant. There is little understanding of the branding practices of SME founder-owners in Ireland, and, moreover, a lack of clarity as to their knowledge levels apropos the strategic brand management process. Essentially, many small business owners may not even realise that their business is a brand, partly due to a lack of understanding of what the concepts of a brand and branding actually mean. This paper presents findings from research associated with the brand development practices of Irish micro and small enterprises. A qualitative data collection tool, leveraging semi-structured interviews is employed to collect substantive and relevant data from 10 Irish micro and small business owners. The study extends the knowledge of the brand development process being undertaken by these companies. The findings in this study reveal an unfavourable picture in terms of branding practices in Irish SME’s and demonstrates a lack of understanding and devotion on behalf of founder-owners towards the process. These conclusions have direct implications for branding literature, specifically in relation to Irish and international SMEs and also for managerial practice within those organisations.

Whatever else it may have contained, Isabella Thorpe’s pocket-book does not register, record or establish a ‘Female Gothic’. It contains the titles of seven novels, not their authors. Consequently, this pocket-book reading list conveys no information about the gender of the authors. By contrast, John Thorpe responds to Catherine Morland’s query ‘Have you ever read Udolpho, Mr Thorpe?’ with ‘Not I, faith! No, if I read any it shall be Mrs. Radcliff’s [sic];’ (45), and Henry Tilney praises the ‘hair-raising’ prose of ‘Mrs. Radcliffe’ (95). It is the reading minds of John and Henry, not those of Isabella and Catherine, which respond to authorship, and the gendering of a text through authorship.

The Gothic’s novel’s liberal nourishment from a range of foreign, domestic, literary, aesthetic and scientific sources has been acknowledged by both its authors and critics since its first apologetic beginnings in the 1760s. Horace Walpole inaugurated this confessional tradition with his Preface to the second edition of The Castle of Otranto (1765). There, in a bid to excuse the literary hoax established in the first Preface, where he had posed as the putative translator of the text, William Marshall, Gent., Walpole adopted a more considered literary approach to his novel. Citing ‘diffidence of his own abilities’ as the reason for his initial disguise, he proceeded to defend Otranto as ‘an attempt to blend the two kinds of romance, the ancient and the modern’. He justified his new hybrid creation by acknowledging his indebtedness to Shakespeare: The result of all I have said is to shelter my own daring under the cannon of the brightest genius this country, at least, has produced. I might have pleaded, that having created a new species of romance, I was at liberty to lay down what rules I thought fit for the conduct of it: but I should be more proud of having imitated, however faintly, weakly, and at a distance, so masterly a pattern, than to enjoy the entire merit of invention, unless I could have marked my work with genius as well as originality.1

Introduction An exercise which started out as an aide memoir for medication administration/documentation was recognised and adapted to become an audit tool to measure the amount of breakthrough medications given. It was recognised that administering these medications takes a huge amount of time on a daily basis and so has other implications. Aims The purpose of this presentation is to highlight the issues surrounding breakthrough medication needs of patients in a hospice inpatient unit. This will highlight issues surrounding symptom control, drug rounds as well as quantifying a huge part of the nursing role making it easier to measure. Method Staff document every breakthrough drug given over a 24 period, this includes the type of drug, time given and number of inpatients. Data it is divided in to 4 h blocks to give a clearer picture of when breakthrough medication is needed. Results A snapshot comparison between January 2010 and January 2011 is given. Although the results demonstrate a correlation between the number of patients and number of breakthroughs given, other patterns have emerged. Most breakthroughs consistently occurred between 10:00 and 14:00, the least between 02:00 and 06:00. Total number for January 2010 was 617, for January 2011 745. This on average equates to around 227 h of nursing time over the 2 months. Conclusion The amount of breakthrough medications given is huge, the impact of which on patients is difficult to measure. Specific times when breakthrough needs are greater have been assessed and the morning drug round time changed. This has been helpful to quantify a complex part of the nursing role which may be helpful particularly to non-clinicians. Recommendations Further studies are recommended to include more detailed analysis of specific data. Suggestions are specific symptoms, methods of administration, effectiveness of end of life care, prescribing and implications for staff.

Ninety-four volunteers participated in a three-day weighed dietary survey and had their blood pressures measured once. They were classified according to their fibre intake. Subjects with a high-fibre intake were found to have lower mean blood pressures than those with a low-fibre intake. Forty-two of the volunteers further participated in a group of experiments. Those eating a high-fibre diet decreased their dietary fibre, and those eating a low-fibre diet increased their dietary fibre. The first group (11 subjects) showed increased mean blood pressures after four weeks of eating the experimental diet. The last group (31 subjects) showed decreased mean blood pressures after four weeks of eating the experimental diet. The 11 subjects consuming the low-fibre experimental diet showed a decrease in mean blood pressure when some of the saturated fat in their diet was replaced by polyunsaturated fat. A similar substitution carried out by 14 of the subjects consuming the high-fibre experimental diet also resulted in decreased mean blood pressure, but this was not statistically significant. Twelve more volunteers, with hypertension, were all found to have low-fibre diets. They consumed a high-fibre diet for a six-week experimental period, but their mean blood pressures did not decrease significantly; individual recordings varied substantially during this period.It is suggested that differences in the type and quantity of dietary fibre and fat may be responsible for the lower mean blood pressures of groups of vegetarians compared with similar groups of non-vegetarians.

Nutritional Supplements have been available in Ireland for over thirty years. Originally available in health food stores only, supplements now have several distribution channels including pharmacy, practitioner, and online. Recommendations for consumption can come from many sources including general physicians, alternative practitioners, dieticians and nutritionists. The demand for Nutritional Supplements has increased over the years, and the industry has expanded exponentially. Nutritional Supplements provide an important opportunity to optimize illness prevention. As scientists and health professionals start to understand the value of Nutritional Supplements in terms of the prevention and treatment of disease, consumers follow suit. Market growth of Nutritional Supplements is reliant both on market positioning and the distribution strategies and channels chosen by the industry. The success or failure is dependent on how effectively and efficiently their products are sold through marketing channel members (e.g., agents, wholesalers, distributors, and retailers). An examination of the distribution channel most appropriate to the purchase of Nutritional Supplements, and advice on their consumption has never been investigated in Ireland to date; hence, this research will be applicable to those involved in this specific industry. A mixed method research approach was undertaken in this study to enable a thorough overview of the industry as it currently stands in Ireland. This research examines the quality of education of those who are distributing, retailing and/or recommending Nutritional Supplements. Qualitative data was collected through semi-structured interviews with twelve participants working within the Nutritional Supplement sector. This research also examines the thoughts of the consumer, relative to preferred distribution channels and who they deem most appropriate as advisors of Nutritional Supplements in Ireland. This was executed through a quantitative process and the consumer data was collated via an online survey. A key finding of this study is that those who are considered best qualified for consultation (general practitioner, dietician and pharmacist), are actually not qualified enough to distribute Nutritional Supplement advice. Health food stores are the preferred distribution channel by consumers; however, Health store workers are not recognised as the most trustworthy for advice. This research will benefit those involved in the manufacture and distribution of Nutritional Supplements in Ireland.

Ninety-four volunteers participated in a three-day weighed dietary survey and had their blood pressures measured once. They were classified according to their fibre intake. Subjects with a high-fibre intake were found to have lower mean blood pressures than those with a low-fibre intake. Forty-two of the volunteers further participated in a group of experiments. Those eating a high-fibre diet decreased their dietary fibre, and those eating a low-fibre diet increased their dietary fibre. The first group (11 subjects) showed increased mean blood pressures after four weeks of eating the experimental diet. The last group (31 subjects) showed decreased mean blood pressures after four weeks of eating the experi mental diet. The 11 subjects consuming the low-fibre experimental diet showed a decrease in mean blood pressure when some of the saturated fat in their diet was replaced by polyunsaturated fat. A similar sub stitution carried out by 14 of the subjects consuming the high-fibre experimental diet also resulted in decreased mean blood pressure, but this was not statistically significant. Twelve more volunteers, with hypertension, were all found to have low-fibre diets. They consumed a high-fibre diet for a six-week experimental period, but their mean blood pressures did not decrease significantly; individual recordings varied substantially during this period. It is suggested that differences in the type and quantity of dietary fibre and fat may be responsible for the lower mean blood pressures of groups of vegetarians compared with similar groups of non-vegetarians.