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Objectives: Development and validation of risk prediction models at mid-pregnancy and delivery to predict admission to the neonatal care unit. Methods: We used data from all singleton deliveries at Cork University Maternity Hospital (CUMH), Ireland during 2019. Admission to the neonatal care unit was assumed if length of stay in the unit was > 24 h. Multivariable logistic regression with backward stepwise selection was used to develop the models. Discrimination was assessed using the ROC curve C-statistic, and internal validation was assessed using bootstrapping techniques. We conducted temporal external validation using data from all singleton deliveries at CUMH during 2020. Results: Out of 6,077 women, 5,809 (95.6%) with complete data were included in the analyses. A total of 612 infants (10.54%) were admitted to the neonatal care unit for > 24 hours. Six variables were informative at mid-pregnancy: male infants, maternal smoking, advancing maternal age, maternal overweight/obesity, nulliparity and history of gestational diabetes (C-statistic: 0.600, 95% CI: 0.567, 0.614). Seven variables were informative at delivery: male infants, nulliparity, public antenatal care, gestational age < 39 weeks', non-spontaneous vaginal delivery, premature rupture of membranes and time of birth between 17:01–07.59 h (C-statistic: 0.738, 95% CI: 0.715, 0.760). Using these predictors, we developed nomograms to calculate individualised risk of neonatal care unit admission. Bootstrapping indicated good internal performance and external validation suggested good reproducibility. Discussion: Our nomograms allow the user to quickly estimate individualised risk of neonatal care unit admission. Future research should aim to improve accuracy in early pregnancy to better assist counselling of parents. Significance: What is already known on this subject?: Previous prediction models for admission to neonatal care units are often limited to specific populations, lack validation or use composite outcome criteria combining neonatal unit admission with adverse neonatal outcomes. What this study adds?: Using data from a general obstetric population, we developed and validated (internally and externally) two risk prediction models to predict admission to the neonatal care unit (one to be applied at mid-pregnancy, and a second to be applied at delivery). In addition, we developed nomograms which allow the user to quickly estimate individualised risk of neonatal care unit admission. [ABSTRACT FROM AUTHOR]

This evidence-based, procedural paper outlines academic writing peer review practices conducted by Pre-Master's Pathway and pre-undergraduate Foundation programme students at two Irish universities. The theoretical framework section presents the view that formative teacher feedback on student writing alone is insufficient, suggesting sustainable feedback through transmission of knowledge via student-generated feedback. We outline the peer review process, providing learners' reactions focusing on what went well and what can be improved. This provides an outline of possible processes for others to use in their context, with a discussion of relevant considerations. Issues discussed include how to enhance the quality of peer feedback and maximize its impact on student learning. The ultimate aim of the practices is to improve the experience of the learners, and better facilitate their readiness for forthcoming modules in Irish universities. Overall peer review practices develop emerging academic writers, and should be considered in foundational, pre-sessional and beginning stages of learning in undergraduate, and those returning to Masters programmes. Peer review practices require active involvement and collaboration, and can improve self-regulation capabilities of emerging academic writers. The practices effectively encourage the transmission of socially constructed knowledge regarding their capabilities, and ultimately lead to improved self-efficacy and general writing abilities of learners.

Background: Healthy nutritional status, appropriate gestational weight gain and a balanced diet are important predictors of perinatal health outcomes. However, gaps exist in the translation of nutrition recommendations into dietary practices of women before and during pregnancy. The present study explored the relationship between access to nutrition advice, nutrition knowledge, attitudes and practices among pregnant women. Methods: Pregnant women aged > 18 years in Ireland were eligible to complete a self‐administered survey consisting of four subsections (demographics, nutrition knowledge, attitudes and practices) delivered online through Qualtrics. Results: In this convenience sample (n = 334, median [interquartile range] gestation, 25.0 [16.0, 34.0] weeks), 85% had at least an honours bachelor degree and 88.9% planned their pregnancy. Two out of five women received nutrition advice during their pregnancy, mostly from a midwife. Based on the percentage of correct answers (of 15 questions), women with previous nutrition education (e.g., school home economics) had better median [interquartile range] nutrition knowledge than those with none (80.0% [66.7, 86.7%] vs. 73.3% [60.0, 80.0%], p < 0.001). Those who received nutrition advice during pregnancy did not score higher than those who did not (73.3% [66.7, 80.0%] vs. 73.3% [66.7, 80.0%], p = 0.6). Over three‐quarters of participants considered nutritional supplement use to be very or extremely important. Although 73.6% and 92.4% took supplements prior to and during pregnancy, only 25.7% reported compliance with periconceptional folic acid supplementation guidelines. Half of respondents considered healthy eating during pregnancy as very or extremely important. Conclusions: Access to nutrition advice during pregnancy was inadequate with poor nutrition knowledge, attitudes and practices observed. Accessible, evidence‐based nutrition education for women prior to and during pregnancy is required. Highlights: Access to nutrition advice and support during pregnancy was inadequate with poor nutrition knowledge, attitudes and practices observed in a highly educated, primarily low‐risk population of pregnant women in Ireland.Nutrition education for women both prior to and during pregnancy is essential to improving their own health and that of the next generation.Sources of accurate and easily accessible nutrition education and information outside of healthcare professionals need to be considered, as do methods of how best to reach pregnant women, where promising strategies include the use of validated online sources, new content formats such as short‐form videos or new technologies. [ABSTRACT FROM AUTHOR]

Background: This study, using real-world data, assesses the impact of RS testing on treatment pathways and the associated economic consequences of such testing. This paper pertains to lobular breast cancer. Methods: A retrospective, observational study was undertaken between 2011 and 2019 on a cross-section of hormone receptor-positive (HR+), HER2-negative, lymph node-negative, early-stage breast cancer patients. All patients had ILC and had RS testing in Ireland. The patient population is representative of the national population. Patients were classified as low (RS ≤ 25) or high (RS > 25) risk. Patients aged ≤50 were stratified as low (RS 0–15), intermediate (RS 16–25), or high risk (RS > 25). Results: A total of 168 patients were included, most of whom had grade 2 (G2) tumors (n = 154, 92%). Overall, 155 patients (92.3%) had low RS (≤25), 12 (7.1%) had high RS (>25), and 1 (0.6%) had unknown RS status. In 29 (17.5%) patients aged ≤50 at diagnosis, RS was ≤15 in 16 (55%), 16–20 in 6 (21%), 21–25 in 5 (17%), >25 in 1 (3.5%), and unknown in 1 (3.5%). Post RS testing, 126 patients (78%) had a change in chemotherapy recommendation; all to hormone therapy. In total, only 35 patients (22%) received chemotherapy. RS testing achieved a 75% reduction in chemotherapy use, resulting in savings of €921,543.84 in treatment costs, and net savings of €387,283.84. Conclusions: The use of this test resulted in a 75% reduction in chemotherapy and a significant cost savings in our publicly funded health system. [ABSTRACT FROM AUTHOR]

Introduction: Previous evidence examining the association between socioeconomic status and pregnancy complications are conflicted and often limited to using area‐based measures of socioeconomic status. In this study, we aimed to examine the association between individual‐level socioeconomic factors and a wide range of adverse pregnancy and neonatal outcomes using data from the IMPROvED birth cohort conducted in Sweden, the Netherlands and Republic of Ireland. Material and methods: The study cohort consisted of women who participated in the IMPROvED birth cohort between 2013 and 2017. Data on socioeconomic factors were self‐reported and obtained at 15 weeks' gestation, and included level of education, employment status, relationship status, and income. Data on pregnancy and neonatal outcomes included gestational hypertension, pre‐eclampsia, gestational diabetes mellitus, emergency cesarean section, preterm birth, post term delivery, small for gestational age and Apgar score at 1 min. These data were obtained within 72 h following delivery and confirmed using medical records. Multivariable logistic regression examined the association between each socioeconomic variable and each outcome separately adjusting for maternal age, maternal body mass index, maternal smoking, maternal alcohol consumption and cohort center. We also examined the effect of exposure to any ≥2 risk factors compared to none. Results: A total of 2879 participants were included. Adjusted results suggested that those with less than third level of education had an increased odds of gestational hypertension (OR: 1.74, 95% CI: 1.23–2.46), while those on a middle level of income had a reduced odds of emergency cesarean section (OR: 0.59, 95% CI: 0.42–0.84). No significant associations were observed between socioeconomic variables and neonatal outcomes. Exposure to any ≥2 socioeconomic risk factors was associated with an increased risk of preterm birth (OR: 1.75, 95% CI: 1.06–2.89). Conclusions: We did not find strong evidence of associations between individual‐level socioeconomic factors and pregnancy and neonatal outcomes in high‐income settings overall, with only few significant associations observed among pregnancy outcomes. [ABSTRACT FROM AUTHOR]

Introduction: Bone is the third most common site of metastatic cancer, of which the spine is the most frequently involved. As metastatic cancer prevalence rises and surgical techniques advance, operative intervention for spinal metastases is expected to rise. In the first operative cohort of spinal metastasis in Ireland, we describe the move towards less invasive surgery, the causative primary types and post-operative survival.Methods: This is a retrospective cohort study of all operative interventions for spinal metastasis in a tertiary referral centre over eight years. Primary spinal tumours and local invasion to the spine were excluded. Median follow up was 1895 days.Results: 225 operative procedures in 196 patients with spinal metastasis were performed over eight years. Average cases per year increased form 20 per year to 29 per year. Percutaneous procedures became more common, accounting for the majority (53%) in the final two years. The most common primary types were breast, myeloma, lung, prostate and renal. Overall survival at 1 year was 51%. Primary type was a major determinant of survival, with breast and the haematological cancers demonstrating good survival, while lung had the worst prognosis.Conclusion: This is the first descriptive cohort of operative interventions for spinal metastasis in an Irish context. Surgery for spinal metastasis is performed at an increasing rate, especially through minimally-invasive means. The majority of patients survive for at least one year post-operatively. Prudent resource planning is necessary to prepare for this growing need. [ABSTRACT FROM AUTHOR]

In Ireland, ritual events and parades have been a central part of civic and public life. However, there is limited understanding of the identity processes at work at these collective events. The present research aims to examine how participants attending collective events come to recognise shared social identification and the impact that this awareness is reported to have on intragroup processes. Interview data were collected over the course of two years at the St Patrick's Day parade and 1916 Easter Rising commemorations in Dublin and Belfast with both participants and attendees at the events. Thematic analysis revealed that to the extent that individuals saw the event as an identity event, they used attendance as their primary indication of shared identity, along with visual identity markers, shared experiences, and shared affects. Participants' accounts of the experience of shared identity focused upon a range of cognitive, affective, and social variables which together suggested a relational transformation in the crowd. These findings suggest that shared identity is an emergent state which plays a critical role in transforming social relations within the collective. [ABSTRACT FROM AUTHOR]

Objective: To explore differences in position emission tomography-computed tomography (PET-CT) service provision internationally to further understand the impact variation may have upon cancer services. To identify areas of further exploration for researchers and policymakers to optimize PET-CT services and improve the quality of cancer services.Design: Comparative analysis using data based on pre-defined PET-CT service metrics from PET-CT stakeholders across seven countries. This was further informed via document analysis of clinical indication guidance and expert consensus through round-table discussions of relevant PET-CT stakeholders. Descriptive comparative analyses were produced on use, capacity and indication guidance for PET-CT services between jurisdictions.Setting: PET-CT services across 21 jurisdictions in seven countries (Australia, Denmark, Canada, Ireland, New Zealand, Norway and the UK).Participants: None.Intervention(s): None.Main Outcome Measure(s): None.Results: PET-CT service provision has grown over the period 2006-2017, but scale of increase in capacity and demand is variable. Clinical indication guidance varied across countries, particularly for small-cell lung cancer staging and the specific acknowledgement of gastric cancer within oesophagogastric cancers. There is limited and inconsistent data capture, coding, accessibility and availability of PET-CT activity across countries studied.Conclusions: Variation in PET-CT scanner quantity, acquisition over time and guidance upon use exists internationally. There is a lack of routinely captured and accessible PET-CT data across the International Cancer Benchmarking Partnership countries due to inconsistent data definitions, data linkage issues, uncertain coverage of data and lack of specific coding. This is a barrier in improving the quality of PET-CT services globally. There needs to be greater, richer data capture of diagnostic and staging tools to facilitate learning of best practice and optimize cancer services. [ABSTRACT FROM AUTHOR]

Background Transplantation is a well-known risk factor for malignancy. However, outcomes of cancer in transplant recipients compared with non-transplant recipients are less well studied. We aim to study the survival in kidney transplant recipients who develop cancer and compare this with cancer outcomes in the general population. Methods We linked data from the National Cancer Registry Ireland with the National Kidney Transplant Database. The period of observation was from 1 January 1994 until 31 December 2014. Transplant recipients were considered at risk from the time of diagnosing cancer. We administratively censored data at 10 years post-cancer diagnosis. Survival was compared with all patients in the general population that had a recorded diagnosis of cancer. Results There were 907 renal transplant recipients and 426679 individuals in the general population diagnosed with cancer between 1 January 1994 and 31 December 2014. In those with non-melanoma skin cancer, the hazard ratio (HR) for 10-year, all-cause mortality [HR = 3.06, 95% confidence interval (CI) 2.66–3.52] and cancer-specific mortality (HR = 3.91, 95% CI 2.57–5.96) was significantly higher among transplant recipients than the general population. Patients who developed non-Hodgkin lymphoma (HR = 2.89, 95% CI 1.96–4.25) and prostate cancer (HR = 4.32, 95% CI 2.39–7.82) had increased all-cause but not cancer-specific mortality. Colorectal, lung, breast and renal cell cancer did not show an increased risk of death in transplant recipients. Conclusion Cancer-attributable mortality is higher in kidney transplant recipients with non-melanoma skin cancer compared with non-transplant patients. The American Joint Committee on Cancer staging should reflect the increased hazard of death in these immunosuppressed patients. [ABSTRACT FROM AUTHOR]

Objectives: To examine the associations between preeclampsia and longitudinal child developmental and behavioural outcomes using data from a nationally representative study of children living in Ireland. Methods: We used maternal-reported data from the Growing Up in Ireland longitudinal study of children. Data on preeclampsia and preeclampsia + small for gestational age (SGA) were collected when children were 9-months old. Data on child development and behavioural outcomes were collected at 9-months using the Ages and Stages Questionnaire (ASQ), and at 3 years, 5 years and 7–8 years using the Strengths and Difficulties Questionnaire (SDQ). Multivariate logistic regression analysis was used to examine the association between preeclampsia exposure and failure of ASQ domains, and abnormal SDQ domains. Linear spline multilevel models were used to examine the association between preeclampsia and preeclampsia + SGA and repeated measures of SDQ. All models controlled for several perinatal and sociodemographic factors. Results: A total of 10,692 children were included in the study at baseline, representing a weighted total of 70,791. Multivariate logistic regression suggested that preeclampsia was not associated with failing any ASQ domain. Preeclampsia was associated with abnormal SDQ cut-off of emotional (≥ 5) and hyperactivity (≥ 7) domains at age 5 years only. In the linear spline model, mean SDQ score was higher at each time point in exposed groups. Conclusions for Practice: While we did not find strong evidence of associations between preeclampsia and child developmental and behavioural outcomes overall, some associations between preeclampsia-exposure and subtle behavioural issues did persist. Further research is needed to replicate these findings, and determine the clinical significance of changes in SDQ scores. [ABSTRACT FROM AUTHOR]

Background The increase in the number of people with dementia in the coming years will be significant and could be as high as 132,000 people by 2041. There is a growing need for enhanced post diagnostic supports for patients living with dementia and their families. We identified the need for a localised educational resource for families and supportive others attending our specialist memory service Methods Staff from the Integrated Care Team, Specialist Memory Service and Primary Care were trained by the Alzheimer's Society of Ireland to deliver a 6 week 'Insights Into Dementia' carers course. Tutors and dementia advisors from the Alzheimer's Society of Ireland provided in-depth training prior to course delivery and feedback to the facilitators on a weekly basis. The course included advice and education on Dementia; Changing Relationships, Communication; Responding to changes in behaviour; Nutrition; Engaging in activities; Assisting with personal care and Safety in the home. Families gained advice regarding their self-care needs and learned how to access information and support.  All services involved worked together to identify, refer and support families with dementia in the local area. The group took place in an accessible location at a time which accommodated families to attend. Each course attendee completed a questionnaire prior to and after commencing the group. Results The group has delivered education and support to 48 families to date. Feedback from participants was very positive with self-reported increase in confidence, knowledge and awareness about dementia. Waiting time to access support has significantly decreased. Every course has led to a support group who meet up on a regular basis in their community. Conclusion This novel collaboration has become a key part of the integrated care pathway we have developed to support people living with dementia and their supportive others in our catchment area. The Integrated Care approach has served to enrich the programme and allow for timely signposting to localised supports. [ABSTRACT FROM AUTHOR]

Background Older patients post hip fracture benefit from specialist orthogeriatric care. Best practice tariffs incentivising compliance with the Irish Hip Fracture Standards (IHFS) have been introduced in Ireland(1). We compared levels of compliance to IHFS before and after introduction of a dedicated orthogeriatric service in a tertiary referral hospital. We also hypothesized that improved continuity of care by regular orthogeriatric review would result in less general medical consults to medical teams. We looked at the number of inpatient consults sent for each time period and compared the number of general medical consults sought by orthopaedic teams for similar time periods. Methods Data was prospectively collected on all hip fracture patients seen by the orthogeriatric service from Aug 2018-Feb 2019 and was retrospectively compared with patients admitted with hip fractures from Aug 2017-Feb2018. Results Similar numbers of patients were seen in each time period (n=146 v n=139) with similar age profiles (81.8 vs 79.6 years). Improvements were seen in all of the six IHFS. The most significant improvements were an increase from 31.2% to 96.5% in the proportion of patients seen by a Geriatrician, and an increase from 7.4% to 98.5% in those who had a formal falls assessment. Fewer patients required medical team consults after the service began (32.2% vs 46.8%, p=0.016). The resultant total number of consults sent fell from 120 consults to 59 consults. Conclusion Introduction of an orthogeriatric service has substantially improved compliance with IHFS. The reduction in the number of medical consults requested by orthopaedic teams reflects the improved quality and continuity of care for these patients. [ABSTRACT FROM AUTHOR]

Background Orthogeriatric services have been shown to improve quality of care for older patients post hip fracture and have an impact on length of stay (LOS), both acutely and in the rehab setting(1) but other key performance indicators (KPIs) have not been examined in detail. Methods Data was prospectively collected on all hip fracture patients seen by the Orthogeriatric service from Aug 2018-Feb 2019 and was retrospectively compared with patients admitted with hip fractures from Aug 2017-Feb 2018. We examined KPIs including LOS on the orthopaedic ward, rehab admissions, rehab LOS, new nursing home (NH) admissions. We compared the proportions discharged directly home instead of to convalescence, and conducted a preliminary cost benefit analysis. Results Similar numbers of patients were seen in each time period (n=146 v n=139). Mean reduction in LOS on the orthopedic ward was 3.5 days (15.5 days vs 19 days). The proportion of patients admitted to rehabilitation increased from 8.8% to 17.5% (p = 0.02). Patients got to rehabilitation faster and for those patients who availed of rehabilitation they had significantly shorter total length of stays (51.1 days vs 71.6 days, p=0.029). Fewer patients went to convalescence. Although not statistically significant there was a trend towards an increased proportion of patients discharged directly home (32.7% to 43.6%) and less new nursing home admissions (6.8% vs 8.4%). A cost benefit analysis incorporating shortened acute and rehab LOS and a reduction in spending on convalescence resulted in a projected saving of €480,390 over a six month period. Conclusion Introduction of OrthoGeriatric services has improved care for older people with hip fractures and has resulted in positive improvements to KPIs, resulting in meaningful improvements in clinical outcomes for patients in a cost effective manner. Monies saved should be redirected into further developing orthogeriatric services. [ABSTRACT FROM AUTHOR]

The author discusses his quest of a new vision for rural Ireland as he invokes the insights of Irish poets Oliver Goldsmith, Patrick Kavanagh and Seamus Heaney.

Objective: To assess the comparative cost effectiveness of day care over inpatient management of nausea and vomiting of pregnancy (NVP).Study Design: A cost utility analysis was performed using a decision analytical model in which a Markov model was constructed. The Markov model was primarily populated with data from a recently published randomised controlled trial. Which included pregnant women presenting to Cork University Maternity Hospital, a tertiary referral maternity hospital, seeking treatment for NVP. Costs and outcomes were estimated from the perspective of the Irish health service (HSE) and patients. A probabilistic sensitivity analysis, using a Monte Carlo simulation, was also performed. A Bayesian Value of Information analysis was used to estimate the value of collecting additional information.Results: When both the healthcare provider and patient's perspective was considered, day care management of NVP remained less costly (mean €985; 95% C.I. 705-1456 vs. €3837 (2124-8466)) and more effective (9.42; 4.19-12.25 vs. 9.49; 4.32-12.39 quality adjusted life years) compared with inpatient management. The Cost Effectiveness Acceptability Curve indicates the probability that day care management is 70% more cost effective compared to inpatient management at a ceiling ratio of €45,000 per QALY, indicating little decision uncertainty. The Bayesian Value of Information analysis indicates there is value in collecting further information; the Expected Value of Perfect Information (EVPI) is estimated to be €5.4 million.Conclusion: Day care management of NVP is cost effective compared to inpatient management. [ABSTRACT FROM AUTHOR]

A biography of Irish engineer William Dargan is presented. It mentions that he was born in 1799 near Tullow town in Ireland. Topics discussed include his travel to London, England for Commons sessions, his appointment to rebuild the entire road with Scottish engineer Thomas Telford, and his works and acquiring the experience of canal construction in England. It discusses the construction of Ireland's first railway, the Dublin & Kingstown, the Ulster Canal, and Belfast port.

Objective: To examine day care treatment of nausea and vomiting of pregnancy compared with the traditional inpatient management of this condition.Methods: We conducted an open-label, single-center, randomized controlled trial to examine the differences between day care and inpatient management of pregnant women with nausea and vomiting of pregnancy. Primary outcome was total number of inpatient nights related to nausea and vomiting of pregnancy.Results: Ninety-eight women were randomized to initial day care management (n=42) or inpatient management (n=56). Results are calculated from the time of randomization until resolution of nausea and vomiting of pregnancy. Women randomized to inpatient care experienced a median (interquartile range) of 2 (1-4) inpatient days compared with 0 (0-2) inpatient days for women randomized to day care (P<.001). Women randomized to initial treatment as an inpatient had significantly more median total number of inpatient admissions (one [1-2] compared with zero [0-1] admissions; P<.001) compared with women randomized to day care. No significant differences were observed in day care visits (median [interquartile range] one [1-4] compared with two [1-4]; P=.30). Women randomized to inpatient care were as satisfied with their care as those randomized to day care (median [interquartile range]: 67 [57-69] compared with 63 [58-71] Client Satisfaction Questionnaire score; P=.7).Conclusion: Day care treatment of nausea and vomiting of pregnancy reduced hospital inpatient stay and was acceptable to patients.Clinical Trial Registration: ISRCTN Register, http://www.isrctn.org, ISRCTN05023126.Level Of Evidence: : I. [ABSTRACT FROM AUTHOR]

Background: Recent studies have reported beneficial effects of probiotics on maternal glycemia in healthy pregnant women. Obesity significantly increases risk of impaired glucose tolerance in pregnancy, but glycemic effects of probiotics in this specific obstetric group require additional investigation. Objective: The aim of the Probiotics in Pregnancy Study was to investigate the effect of a probiotic capsule on maternal fasting glucose in obese pregnant women. Design: In this placebo-controlled, double-blind, randomized trial, 175 pregnant women with an early pregnancy body mass index (BMI; in kg/m²) from 30.0 to 39.9 were recruited from antenatal clinics at the National Maternity Hospital, Dublin, Ireland. Exclusion criteria were BMI <30.0 or >39.9, prepregnancy or gestational diabetes, age <18 y, multiple pregnancy, and fetal anomaly. Women were randomly assigned to receive either a daily probiotic or a placebo capsule from 24 to 28 wk of gestation in addition to routine antenatal care. The primary outcome was the change in fasting glucose between groups from preintervention to postintervention. Secondary outcomes were the incidence of gestational diabetes and neonatal anthropometric measures. Results: In 138 women who completed the study (63 women in the probiotic group; 75 women in the placebo group), mean (±SD) early pregnancy BMI was 33.6 ± 2.6, which differed significantly between probiotic (32.9 ± 2.4) and placebo (34.1 ± 2.7) groups. With adjustment for BMI, the change in maternal fasting glucose did not differ significantly between treated and control groups [-0.09 ± 0.27 compared with -0.07 ± 0.39 mmol/L; P = 0.391; B = -0.05 (95% CI: -0.17, 0.07)]. There were also no differences in the incidence of impaired glycemia (16% in the probiotic group compared with 15% in the placebo group; P = 0.561), birth weight (3.70 kg in the probiotic group compared with 3.68 kg in the placebo group; P = 0.723), or other metabolic variables or pregnancy outcomes. A secondary analysis of 110 women, excluding antibiotic users and poor compliers, also revealed no differences in maternal glucose or other outcomes between groups. Conclusion: Probiotic treatment of 4 wk during pregnancy did not influence maternal fasting glucose, the metabolic profile, or pregnancy outcomes in obese women. This trial was registered at Current Controlled Trials as ISRCTN97241163 (part A). [ABSTRACT FROM AUTHOR]

This article explores the way in which episodes that took place during the “long” land war of 1879–1909 have been remembered or forgotten in Craughwell, Co. Galway, between 1881 and 2013. By exploring those episodes and individuals that are remembered locally in monuments, published oral histories and in oral histories conducted by the author, this article explores the complex patterns of remembering in rural Irish communities. The article concludes by reflecting on the implications of this study for how we interpret oral histories, and on how a culture of remembering and not remembering might have affected twentieth-century Irish society. [ABSTRACT FROM PUBLISHER]

This article re-examines the satirical writings of the Irish wit, essayist and journalist, Francis Sylvester Mahony (1804–1866) (“Father Prout”), who in the 1830s authored a series of comic articles for the conservative London periodical, Fraser's Magazine. It focuses on his best-known essay, “The Rogueries of Thomas Moore” (1834), which provides an ironic commentary on the politicization of historical debate in post-Emancipation Ireland. The article looks afresh at his nuanced critique of the patriotic verse of Thomas Moore (1779–1852). The concept of “original translation,” or translation as “transformation,” is explored in relation to Mahony's supposed discovery of foreign-language precursors to Moore's nationalist ballad collection, the Irish Melodies. In addition, the article explores Mahony's parodic upending of Moore's efforts to recreate an authentic Gaelic past in his English-language poetry, as well as Mahony's subtle critique of the role played by translation in the politicized rewriting of Irish history. It also uses critical theory to examine Mahony's ironic conception of textual transformation in his reworked ballads, resituating his comic re-assessment of Moore's poetry in the broader context of the emergence of a post-Romantic literature in 1830s Ireland. [ABSTRACT FROM PUBLISHER]

Background: We previously showed that microbial metabolism in the gut influences the composition of bioactive fatty acids in host adipose tissue. Objective: This study compared the effect of dietary supplementation for 8 wk with human-derived Bifidobacterium breve strains on fat distribution and composition and the composition of the gut microbiota in mice. Methods: C57BL/6 mice (n = 8 per group) received B. breve DPC 6330 or B. breve NCIMB 702258 (109 microorganisms) daily for 8 wk or no supplement (controls). Tissue fatty acid composition was assessed by gas-liquid chromatography while 16S rRNA pyrosequencing was used to investigate microbiota composition. Results: Visceral fat mass and brain stearic acid, arachidonic acid, and DHA were higher in mice supplemented with B. breve NCIMB 702258 than in mice in the other 2 groups (P < 0.05). In addition, both B. breve DPC 6330 and B. breve NCIMB 702258 supplementation resulted in higher propionate concentrations in the cecum than did no supplementation (P < 0.05). Compositional sequencing of the gut microbiota showed a tendency for greater proportions of Clostridiaceae (25%, 12%, and 18%; P = 0.08) and lower proportions of Eubacteriaceae (3%, 12%, and 13%; P = 0.06) in mice supplemented with B. breve DPC 6330 than in mice supplemented with B. breve NCIMB 702258 and unsupplemented controls, respectively. Conclusion: The response of fatty acid metabolism to administration of bifidobacteria is strain-dependent, and strain-strain differences are important factors that influence modulation of the gut microbial community by ingested microorganisms. [ABSTRACT FROM AUTHOR]

The article discusses the challenges facing the Irish government in reforming the healthcare system in Ireland. It cites several aspects of the country's dysfunctional health system including unfairness to public patients, inefficiency in relating outcomes to financial allocations, and poor value for supplemental private health insurance payers. It stresses the importance of an investment program in primary care centers in making the transition to better care at lower cost.

The article looks into the design and construction of the new Aviva Stadium in Dublin, Ireland. It depicts the significant engineering challenges for the boundary issues as well as the strategic masterplanning of its design and construction sequencing around a rail line and environmental wind engineering. It states that the appropriate design of the stadium was created through the application of knowledge and experience of engineering expertise and it was completed on schedule.

Catholic Ireland, if not dead and gone, has changed dramatically in the last twenty-five years. Sin and guilt are words or ideas that are heard less and less as fewer and fewer attend the sacrament of confession. Forgiveness as a concept stills holds place though now more so in private relationships or in therapeutic and restorative justice contexts. This paper attempts to hold together three tangentially related concerns. It begins with an overview of the shifting sociological landscape of religion in modern Ireland. The secularisation of society and the privatisation of Irish people's religiosity is explored as a background for the second concern of the paper which explores the meaning that Irish people now attach to considerations such sin, guilt and forgiveness. The concluding section of the paper draws from my recent qualitative study of men's experiences of unplanned and crisis pregnancies; specifically, eight men's stories of abortion experiences are shared in an exploration of how sin and guilt are carried differently and how the search and process of forgiveness is still important in modern times. [ABSTRACT FROM AUTHOR]

Background: Estimating the supply of GPs into the future is important in forecasting shortages. The lengthy training process for medicine means that adjusting supply to meet demand in a timely fashion is problematic. This study uses Ireland as a case study to determine the future demand and supply of GPs and to assess the potential impact of several possible interventions to address future shortages. Methods: Demand was estimated by applying GP visit rates by age and sex to national population projections. Supply was modelled using a range of parameters derived from two national surveys of GPs. A stochastic modelling approach was adopted to determine the probable future supply of GPs. Four policy interventions were tested: increasing vocational training places; recruiting GPs from abroad; incentivising later retirement; increasing nurse substitution to enable practice nurses to deliver more services. Results: Relative to most other European countries, Ireland has few GPs per capita. Ireland has an ageing population and demand is estimated to increase by 19% by 2021. Without intervention, the supply of GPs will be 5.7% less than required in 2021. Increasing training places will enable supply to meet demand but only after 2019. Recruiting GPs from overseas will enable supply to meet demand continuously if the number recruited is approximately 0.8 per cent of the current workforce per annum. Later retirement has only a short-term impact. Nurse substitution can enable supply to meet demand but only if large numbers of practice nurses are recruited and allowed to deliver a wide range of GP services. Conclusions: A significant shortfall in GP supply is predicted for Ireland unless recruitment is increased. The shortfall will have numerous knock-on effects including price increases, longer waiting lists and an increased burden on hospitals. Increasing training places will not provide an adequate response to future shortages. Foreign recruitment has ethical considerations but may provide a rapid and effective response. Increased nurse substitution appears to offer the best long-term prospects of addressing GP shortages and presents the opportunity to reshape general practice to meet the demands of the future. [ABSTRACT FROM AUTHOR]

The article presents an historical examination into the composition and conditions of the Royal Irish Constabulary (RIC) at the turn of the 20th-century. Introductory comments are given highlighting historiographical debates over the "domestication" of the RIC between 1881 and 1911. The author provides an analysis of the social backgrounds of multiple senior officers of the RIC during the period, highlighting his findings concerning the larger uniform characteristics of the RIC's command culture.

In an influential monograph, The greening of Dublin Castle (1991), Lawrence McBride argued that the Irish administration was in a rapid state of transformation between 1892 and 1922. Broadly speaking, he argued that the Protestant and unionist senior administrators were gradually replaced by Catholic and nationalist civil servants during this period. However, a significant body of evidence suggests that McBride may have overstated the changes taking place in the Irish civil service. Using a prosopographical study of the senior civil servants in Ireland in 1891 and 1911, this article suggests that there was significantly less ‘greening’ than McBride claimed. The British state appears to have regarded Irish-born Catholics as potentially disloyal, and to have implemented a subtle system of ethnic discrimination at the upper levels of the Irish civil service. It is argued that the existence of this glass ceiling provided young educated Catholic professionals with a powerful motive for participation in the Irish revolution (1916-23) [ABSTRACT FROM AUTHOR]

The alkaline single-cell gel electrophoresis (comet) assay was used to investigate the genotoxicity of fecal water (FW) isolated from 47 Irish subjects using Caco-2 colonocytes as target cells. Two methods of comet assay analysis were compared to determine the extent of DNA damage and to categorize the samples as having no, low-to-moderate, or high genotoxicity. FW was isolated from stool samples by centrifugation and tested for its ability to induce DNA damage in Caco-2 cells. DNA damage was assessed using the comet assay by measuring the extent of DNA migration from the nucleus (?m, tail length) or by classifying the nuclei into five different categories depending on their morphology. Data collected from the two methods were used to categorize the FW samples on the basis of their genotoxic activity. Both methods showed good agreement. There was an approximately 50:50 split, with half the samples having some level of genotoxic activity and half having no genotoxicity. About one-third of the samples were considered to be highly genotoxic. There was a trend for low pH of the FW to be associated with increased DNA damage, but this was not significant. The results presented in this report show a relatively high incidence of genotoxic FW in samples derived from a free-living Irish population. Our data demonstrate the suitability of classifying nuclei on the basis of their morphology as a means of determining DNA damage. This procedure is very rapid and, therefore, advantageous in analyzing a large number of slides in the absence of an image analysis system. [ABSTRACT FROM AUTHOR]

Examines the prevalence of celiac disease in Ireland. Definition and clinical manifestations; Impact of Celtic heritage on disease incidence; Correlation of food diet with celiac disease.

The author offers some insights on how pricing works in the single electricity market (SEM) and the potential impact of renewable energy sources on price levels. He explains that SEM is based on a half hourly pool price where each generator must sell into a poll and each customer must buy from the pool at the system marginal price (SMP). He mentions that the Irish government is targeting 42% electricity generation from renewable sources by 2020. He notes the increasing influence by wind on wholesale electricity prices.

This point-prevalence study was conducted to establish rates of meticillin-resistant Staphylococcus aureus (MRSA) nasal carriage in GPs in three counties in the West of Ireland. One hundred and twenty GPs were randomly selected for the study and 78 participated. The prevalence rate of nasal carriage of MRSA in these participants was 7.7%. A number of GPs in the West of Ireland have nasal carriage of MRSA. The results emphasise the need for high standards of infection control in primary care. [ABSTRACT FROM AUTHOR]

Zymoseptoria tritici is the causative fungal pathogen of septoria tritici blotch (STB) disease of wheat (Triticum aestivum L.) that continuously threatens wheat crops in Ireland and throughout Europe. Under favorable conditions, STB can cause up to 50% yield losses if left untreated. STB is commonly controlled with fungicides; however, a combination of Z. tritici populations developing fungicide resistance and increased restrictions on fungicide use in the EU has led to farmers relying on fewer active substances. Consequently, this serves to drive the emergence of Z. tritici resistance against the remaining chemistries. In response, the use of resistant wheat varieties provides a more sustainable disease management strategy. However, the number of varieties offering an adequate level of resistance against STB is limited. Therefore, new sources of resistance or improved stacking of existing resistance loci are needed to develop varieties with superior agronomic performance. Here, we identified quantitative trait loci (QTL) for STB resistance in the eight-founder "NIAB Elite MAGIC" winter wheat population. The population was screened for STB response in the field under natural infection for three seasons from 2016 to 2018. Twenty-five QTL associated with STB resistance were identified in total. QTL either co-located with previously reported QTL or represent new loci underpinning STB resistance. The genomic regions identified and the linked genetic markers serve as useful resources for STB resistance breeding, supporting rapid selection of favorable alleles for the breeding of new wheat cultivars with improved STB resistance. [ABSTRACT FROM AUTHOR]

Objective: Solid organ transplant recipients are at increased risk of cancer compared to the general population. To date, this risk in Ireland has not been investigated. We conducted a national registry study of cancer incidence following solid organ transplantation. Methods: National centers for solid organ transplantation supplied their respective registry databases to cross‐reference with episodes of malignancy from the National Cancer Registry Ireland (NCRI) between 1994 and 2014. Standardized incidence of cancer post‐transplant was compared to the general population by means of standardized incidence ratios (SIRs), and between solid organ transplant types by incidence rate ratios. Results: A total of 3346 solid organ transplant recipients were included in this study. Kidney transplant recipients constituted the majority of participants (71.2%), followed by liver (16.8%), heart (6.4%), and lung (5.6%) transplants. The most common cancers within the composite of all transplant recipients included the following (SIR [95% CI]): squamous and basal cell carcinoma (20.05 [17.97, 22.31] and 7.16 [6.43, 7.96], respectively), non‐Hodgkin lymphoma (6.23 [4.26, 8.59]), and renal cell carcinoma (3.36 [1.96, 5.38]). Conclusions: This study reports the incidence of cancer following solid organ transplantation in Ireland. These results have significant national policy implications for surveillance, and early diagnosis in this patient group. [ABSTRACT FROM AUTHOR]

Background: Problematic translational gaps continue to exist between demonstrating the positive impact of healthcare interventions in research settings and their implementation into routine daily practice. The aim of this qualitative evaluation of the SMART MOVE trial was to conduct a theoretically informed analysis, using normalisation process theory, of the potential barriers and levers to the implementation of a mhealth intervention to promote physical activity in primary care. Methods: The study took place in the West of Ireland with recruitment in the community from the Clare Primary Care Network. SMART MOVE trial participants and the staff from four primary care centres were invited to take part and all agreed to do so. A qualitative methodology with a combination of focus groups (general practitioners, practice nurses and non-clinical staff from four separate primary care centres, n = 14) and individual semi-structured interviews (intervention and control SMART MOVE trial participants, n = 4) with purposeful sampling utilising the principles of Framework Analysis was utilised. The Normalisation Process Theory was used to develop the topic guide for the interviews and also informed the data analysis process. Results: Four themes emerged from the analysis: personal and professional exercise strategies; roles and responsibilities to support active engagement; utilisation challenges; and evaluation, adoption and adherence. It was evident that introducing a new healthcare intervention demands a comprehensive evaluation of the intervention itself and also the environment in which it is to operate. Despite certain obstacles, the opportunity exists for the successful implementation of a novel healthcare intervention that addresses a hitherto unresolved healthcare need, provided that the intervention has strong usability attributes for both disseminators and target users and coheres strongly with the core objectives and culture of the health care environment in which it is to operate. Conclusion: We carried out a theoretical analysis of stakeholder informed barriers and levers to the implementation of a novel exercise promotion tool in the Irish primary care setting. We believe that this process amplifies the implementation potential of such an intervention in primary care. The SMART MOVE trial is registered at Current Controlled Trials (ISRCTN99944116; Date of registration: 1st August 2012). [ABSTRACT FROM AUTHOR]

The author reflects on the Irish politicians' improper spending of money on educational and health services in Ireland in 2011. He stresses that the political class did not worry about the sicker and shorter lives endured by the poor people as well as about the country's unequal educational system. He contends that State and Church leaders were already infected with cynicism and a lack of idealism that led politicians to take the electorate for granted.

The author reflects on the Irish society's spiritual values and beliefs emphasizing some people's denial to discuss their religion, particularly Chirstianity in Ireland. He points out on the bishops' reaction on secular issues in the country due to the Green politicians' influence. He stresses the death of the Irish catholic intellectual tradition, depicting the European society's respect of their Christian values. He also explains the meaning of the current obsession with Islam.

The author reflects on issues facing the present day Ireland. He talks about the relationship between the country and Northern Ireland. He also mentions the tendency of the citizens to blame former taoiseach, Bertie Ahern, in leading the country to the financial ruins it is currently facing. He further comments on the failure of politicians to act and try to address economic concerns of the country.

The author reflects on the Irish's perception about death. According to the author, the fact of mortality remains a difficult acceptance because of its sudden occurrence. He also points out that modern medicine is carefully formulated for longevity. Moreover, he states that euphemisms are used since dying cannot be freely discussed in the Western societies. He believes that ensuring adequate health services and implementing proper health policies can consider death as a gain rather than a loss.

The author reflects on economic stability of Ireland emphasizing the extent of the national crisis that happened in October 2008. He notes the mismanagement of government finances that left the country in debt and misery. He mentions the potential of Ireland to be part of the regional American economy which has been slow in appreciating European roots.

The author reflects on the human history in Ireland. The author states that the knowledge of Irish people on history has been weakened and has been replaced by a fascination of general research. He adds that constitutional and revolutionary are the two traditions in Irish nationalism, which arise as an enraged response to systematic injustice. He emphasizes that a healthy democracy is assured with the acceptance of the many-sided past and a critical attitude towards the present.