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This study explores the lived experiences of adults with Pathological Demand Avoidance (PDA) in Ireland. There is a lack of research exploring the lived experience of those living with PDA and its intersection with autism. Detailed semi-structured interviews informed by Interpretative Phenomenological Analysis were completed with two adults with a diagnosis of/self-identifying with PDA and autism, complemented by statements extracted from open-ended survey responses. An IPA-based deductive approach discovered four superordinate themes: 1) Bidirectional social dislocation, 2) Life experiences, 3) Trust and safety, and 4) Accepting our truth; and subordinate leitmotifs of Early differences, Fear is my default setting, Coping, self-worth and survival, and Flexibility in education settings. This paper reveals the interplay between PDA, autism, and mental health for these participants, which contribute to significantly challenging life outcomes. Participants advised greater awareness of PDA among service providers, greater autonomy and flexibility of support was also a key recommendation.

Since its inception inclusive education in mainstream schools for pupils with Special Educational Needs and Disabilites (SEND) has not been without its challenges. For example, the term Special Educational Needs encompasses a wide range of pupils with varying disabilities who require specialised teaching and specific knowledge on the behalf of educators as to how best optimise their learning experience and educational outcomes. In addition, the landscape which has informed the development of policy changes in Special Education in the 21st Century has changed dramatically. Specifically, these changes have been informed by a Human Rights agenda in the areas of disability, education and health and are supported by the United Nations and World Health Organisation charters. As a result, they have become intrinsically linked to a “rights-based education system” where the individual needs of pupils must be recognised and supported in order to enable them to reach their potential. Consequently, schools are undergoing constant changes in an effort to develop inclusive policies and practices for all pupils. The purpose of this chapter is to review the international policies which have contributed to these changes and examine how schools have addressed the rights of pupils with special and additional needs to access and participate in education. Key Words: Human Rights: Individual Needs: Participation: Inclusive Education

Background: The principal destinations for school leavers with Intellectual Disabilities from special schools in Ireland are further education through providers such as the National Learning Network, or training within adult day services and rehabilitation centers. In 2015, a number of inherent barriers to participation in FETE for young people with ID was identified which were found to be linked to attitudes and stigma and low expectations of their capabilities. This resulted in the development of a supported transition model WALK PEER (Providing Equal Employment Routes). Method: This study explored the experiences of school leavers with ID, who were engaging with the WALK PEER model. Data was collected from a purposive sample of 31 students with ID from two special schools: Group 1 (Pre-transition) students in the penultimate year of formal education, Group 2 (Transitioning) students in the final year of formal education, and Group 3 (Post-transition) had left school two years previously. Results: Engaging in the supported transition programme provided young people with access to information, options, confidence and some of the hard and soft skills required for successful transition into education and employment contexts. Conclusions: The findings demonstrate a strong correlation between support programmes, transition planning, and positive transitions, which is critical if young people with intellectual disabilities are to realise their goals. The research proposes a newmodel of “Supported Transition” and has clear implications for the development of a national transition policy as directed by the Comprehensive Employment Strategy.

ObjectiveTo explore the acceptability of different bisphosphonate regimens for the treatment of osteoporosis among patients, clinicians and managers, payers and academics.DesignA systematic review of primary qualitative studies. Seven databases were searched from inception to July 2019. Screening, data extraction and quality assessment of full-articles selected for inclusion were performed independently by two authors. A framework synthesis was applied to extracted data based on the theoretical framework of acceptability (TFA). The TFA includes seven domains relating to sense-making, emotions, opportunity costs, burden, perceived effectiveness, ethicality and self-efficacy. Confidence in synthesis findings was assessed.SettingAny developed country healthcare setting.ParticipantsPatients, healthcare professionals, managers, payers and academics.InterventionExperiences and views of oral and intravenous bisphosphonates.ResultsTwenty-five studies were included, mostly describing perceptions of oral bisphosphonates. We identified, with high confidence, how patients and healthcare professionals make sense (coherence) of bisphosphonates by balancing perceptions of need against concerns, how uncertainty prevails about bisphosphonate perceived effectiveness and a number of individual and service factors that have potential to increase self-efficacy in recommending and adhering to bisphosphonates. We identified, with moderate confidence, that bisphosphonate taking induces concern, but has the potential to engender reassurance, and that both side effects and special instructions for taking oral bisphosphonates can result in treatment burden. Finally, we identified with low confidence that multimorbidity plays a role in people’s perception of bisphosphonate acceptability.ConclusionBy using the lens of acceptability, our findings demonstrate with high confidence that a theoretically informed, whole-system approach is necessary to both understand and improve adherence. Clinicians and patients need supporting to understand the need for bisphosphonates, and clinicians need to clarify to patients what constitutes bisphosphonate treatment success. Further research is needed to explore perspectives of male patients and those with multimorbidity receiving bisphosphonates, and patients receiving intravenous treatment.PROSPERO registration numberCRD42019143526.

Introduction Sarcopenia is a progressive loss in muscle mass, strength and function, the adverse consequences of which are severe, affecting quality of life and placing an increasing burden on social and healthcare systems. Vitamin D status is known to be associated with markers of sarcopenia, namely muscle mass, strength and function. Also, resistance exercise training (RET) is currently the only proven intervention to treat sarcopenia. However, very little data exist on the influence of combining the two interventions of vitamin D supplementation and resistance exercise training, although a recent systematic review provides tentative support for the current study’s hypothesis that the combined intervention may further improve musculoskeletal function above exercise training alone. The aim of the present study is to determine whether vitamin D3 supplementation is any more effective in improving musculoskeletal function when combined with RET compared with exercise training alone in older adults. Methods and analysis This double-blinded randomised placebo-controlled trial will recruit a target of 127 eligible men and women aged ≥65 years living independently or in sheltered housing within the Birmingham area to two groups: (1) 6 months RET and placebo or (2) 6 months RET and 800 IU/d vitamin D3. Measures of muscle power (Nottingham Power Rig), body composition (dual energy X-ray absorptiometry), muscle function (short physical performance battery, timed up and go), falls and fractures as events will be assessed. Assessments will take place at baseline and postintervention, with intermittent monitoring of bone turnover, calcium and vitamin D. The primary outcome will be lower limb extensor power output. Analyses of within-group changes and between-group differences in outcome measures are planned. Ethics and dissemination The EXVITD study has ethical approval granted by the Black Country National Health Service Research Ethics Committee (14/WM/1220). Results of this trial will be submitted for publication in peer-reviewed journals and presented at conferences. The study is being conducted according to the principles of the Declaration of Helsinki. Trial registration number NCT02467153; Post-results.

IntroductionSarcopenia is a progressive loss in muscle mass, strength and function, the adverse consequences of which are severe, affecting quality of life and placing an increasing burden on social and healthcare systems. Vitamin D status is known to be associated with markers of sarcopenia, namely muscle mass, strength and function. Also, resistance exercise training (RET) is currently the only proven intervention to treat sarcopenia. However, very little data exist on the influence of combining the two interventions of vitamin D supplementation and resistance exercise training, although a recent systematic review provides tentative support for the current study’s hypothesis that the combined intervention may further improve musculoskeletal function above exercise training alone. The aim of the present study is to determine whether vitamin D3supplementation is any more effective in improving musculoskeletal function when combined with RET compared with exercise training alone in older adults.Methods and analysisThis double-blinded randomised placebo-controlled trial will recruit a target of 127 eligible men and women aged ≥65 years living independently or in sheltered housing within the Birmingham area to two groups: (1) 6 months RET and placebo or (2) 6 months RET and 800 IU/d vitamin D3. Measures of muscle power (Nottingham Power Rig), body composition (dual energy X-ray absorptiometry), muscle function (short physical performance battery, timed up and go), falls and fractures as events will be assessed. Assessments will take place at baseline and postintervention, with intermittent monitoring of bone turnover, calcium and vitamin D. The primary outcome will be lower limb extensor power output. Analyses of within-group changes and between-group differences in outcome measures are planned.Ethics and disseminationThe EXVITD study has ethical approval granted by the Black Country National Health Service Research Ethics Committee (14/WM/1220). Results of this trial will be submitted for publication in peer-reviewed journals and presented at conferences. The study is being conducted according to the principles of the Declaration of Helsinki.Trial registration numberNCT02467153; Post-results.

Students with Special Educational Needs and Disabilities encounter complex and circuitous transitions from post-primary settings to Higher Education. In Ireland, inequitable access to Individual Education Plans, and a lack of policy infrastructure to provide formal transition planning, means that these journeys are varied and uncertain. This study presents findings from surveys completed by parents supporting students with disabilities in their final 3 years of mainstream secondary school (n = 69), and in-depth interviews with a self-selected subset of parents (n = 8). Results point to: (i) disparate levels and quality of support and guidance, (ii) fissures in communication channels between parents and schools, (iii) insufficient awareness and understanding of the interplay between disability and successful post-school outcomes, and (iv) high levels of stress, anxiety and frustration experienced by students, parents and carers.

To determine whether new national guidance on the specifications of a fracture liaison service are realistically deliverable, 1 year of data on the performance of such a service were audited. Audit targets were mostly met. This audit demonstrates that these standards are deliverable in a real world setting. UK service specifications for a fracture liaison service (FLS) have been produced (National Osteoporosis Society, NOS) to promote effective commissioning and delivery of the highest quality care to patients with fragility fractures. How deliverable these standards are has not as yet been methodically reported. Our FLS was modelled on the ten NOS standards; performance was audited after 1 year to determine whether these standards could be delivered and to describe the lessons learnt. Performance was audited against the NOS FLS Service Standards, with management based on the Fracture Risk Assessment Tool (FRAX®), the four-item Falls Risk Assessment Tool (FRAT), National Institute for Health and Care Excellence (NICE) and the National Osteoporosis Guideline Groups (NOGG) guidance. Data were recorded prospectively on a database. The FLS commenced in May 2014, was fully operational in August 2014 and data were captured from 1 September 2014 to 1 September 2015. The FLS detected 1773 patients and standards were largely achieved. Most, 94 %, patients were seen within 6 weeks, 533 DXA requests were generated, 804 outpatient FRAT assessments were recorded (134 required falls intervention) and 773 patients had bone treatments started. On follow-up at 3 months, between 78–79 % were still taking medication. Preliminary evaluation of a FLS implemented according to UK NOS standards demonstrates that the model is practical to apply to a large teaching hospital population. Collection and review of outcome and cost effectiveness data is required to determine the performance of this model in comparison with existing models.

BackgroundThe number of falls in hospital ranges from 3.8 to 8.6 falls per 1000 bed days. 1 Around 30% of falls as inpatients are injurious, and 4%–6% can result in serious and life-threatening injury. 2 3 This results in significant health burdens and economic burdens due to increased hospital stays following a fall. Junior doctors are usually the first point of contact for managing patients who fall in hospital. It is therefore important they understand the preventative measures and postfalls management.AimTo assess the retention of knowledge regarding falls management in foundation year 1 (FY1) doctors before and after a short educational intervention.MethodsA 3-stage quality improvement project was conducted at a West Midlands teaching hospital to highlight issues regarding falls management. A questionnaire assessing areas of knowledge regarding assessment and management of falls was delivered to 31 F1s. This was followed by a short presentation regarding falls management. The change in knowledge was assessed at 6 and 16 weeks postintervention. The questionnaire results were analysed using unpaired t-tests on STATA (V.14.2).ResultsThe mean score for knowledge regarding falls management in the preintervention, early postintervention and late postintervention were 73.7%, 85.2% and 76.4%, respectively. Although there was an improvement in the knowledge at 6 weeks’ postintervention, this returned to almost baseline at 16 weeks. The improvement in knowledge did not translate to clinical practice of falls management during this period.ConclusionAlthough educational interventions improve knowledge, the intervention failed to sustain over period of time or translate in clinical practice. Further work is needed to identify alternative methods to improve sustainability of the knowledge of falls and bring in the change in clinical practice.

Students with specific learning difficulties (SpLD) in higher education institutions (HEIs) in the Republic of Ireland are required to have a formal psycho-educational assessment from an educational psychologist to register with Disability Services in HEIs, to be eligible for support through the Fund for Students with Disabilities (FSD). Such assessments are expensive and often beyond the financial means of students and their families. However, there is a sustained demand from students experiencing academic difficulties for diagnostic assessment of SpLD (Association for Higher Education Access and Disability [AHEAD], 2012). This study describes the SpLD screening and assessment practices implemented by HEIs in Ireland (n = 14), finding that (a) there are no defined parameters for assessment of SpLD in higher education (HE), meaning that methods and accuracy of identification of positive indicators may vary across HEIs; and (b) the majority of HEIs screen for dyslexia only, with little or no recognition of the need to assess for comorbidity of learning disabilities. Findings support the requirement for a reliable and valid standardised assessment procedure for Irish HEIs, which would provide equitable access to an initial diagnosis. Finally, a screening model is proposed, which is currently provided by one HEI.

Due to dramatic improvements in life expectancy we are seeing a rapidly growing population of older people. Increasing frailty and susceptibility to fragility fractures are becoming pressing issues for both the individuals that suffer them as well as society, through pressures on health and social care budgets. The success of fracture liaison services, co-ordinated programmes enhancing the management of the fracture, osteoporosis, frailty and falls risk, is undisputed. To achieve optimal outcomes, however, it is important to have a standardisation of design, scope and structure of the service. Experience has taught us that by delegating responsibility for the holistic care of the patient to a trained and adequately resourced professional/team (fracture prevention practitioner) with clear standards against which benchmarking occurs, is the optimal model of delivery. Future challenges include how best to measure the success of services in imparting a reduction in fractures at a local population level as well as how to detect those patients with unmet need who do not uniformly present to health care services, such as those with vertebral fractures. The implementation of fracture liaison services however, is a clear demonstration of how collaboration between health care, social care and charity organisations, among others, has materially improved the health and well-being of the population.

Atypical femoral fractures (AFFs) are important to diagnose early to avoid progression to complete fracture. We set out to determine the reporting accuracy of AFFs.We conducted a retrospective analysis of imaging performed between November 2010 and June 2013 to analyse the X-ray reporting of AFFs and to describe the key clinical considerations. Radiological reports were reviewed from the 3805 separate femoral images for search terms thought likely to identify AFFs. This identified 1558 patients. The identified radiographs were reviewed by radiologists with reference to the 2010 American Society of Bone and Mineral Research (ASBMR) criteria.Within these 1558 patients, 16 patients met the radiological criteria for AFF according to the 2010 ASBMR task force statement of which, although all were identified as fractures, 15 were not reported as "atypical" by the original reporting author and none was formally classified as AFF by the original reporting author. Within the 1558 patients, there were an additional 17 patients labelled as having "atypical" fracture features originally, although only 1 patient met the 2010 ASBMR task force criteria for AFF. Only 13 of 16 patients had imaging of the contralateral femur, and there was a significant delay for those who were imaged (111 ± 44 days). Furthermore, two of the patients with an AFF had previous radiographs demonstrating cortical changes indicative of AFFs prior to formal diagnosis.Whilst AFFs are rare diagnoses, the compliance with published guidelines for their radiological classification is low.We have raised awareness of the importance of recognizing AFFs to guide management.

Study of the uptake of sulphate and methionine by an ale yeast from a range of media showed that utilisation of sulphate was fairly strictly controlled but assimilation of methionine was not. Cells never took up more than about 0.3 mMol sulphate per litre whilst methionine, up to an initial concentration of 10 mMol per litre, was completely absorbed. Sulphate-grown cells had low intracellular pools of amino acids and methinonine was never detected. Methionine-grown cells contained methionine in both cytosol and vacuole and the concentration of several other amino acids also increased in such a way to suggest that methionine catabolism was occurring. With mixed sulphur sources methionine prevented uptake of sulphate when the concentration of sulphate was high but not when it was low suggesting the presence of two sulphate transporters with different control properties. Sulphate did not influence uptake of methionine. Addition of other amino acids to the medium did reduce the rate and extent of methionine uptake but not the intracellular pool sizes. Pilot plant studies suggested that SO 2 production in a brewery is more likely to be a reflection of the overall nutritive status of the wort rather than be connected to the initial methionine concentration.

A probed memory task was used to investigate children's short-term visual memory for an object's spatial location or colour. In Experiment 1, 5-yearolds recognised the location of one of three coloured shapes that had appeared in a random spatio-temporal order. Two aspects of the children's performance confirmed their reliance on visual memory. First, performance was impaired when the shapes were visually similar. Secondly, the serial position curve was characteristic of visual memory, with a final-item recency effect and no primacy effect. Experiment 2 assessed 5and 7-year-old children's memory for a shape's colour or its spatial location. Although there was developmental improvement in memory for spatial location, that was confined to pre-recency items, there was no effect of age with regard to the recall of colour. The results go against Hasher and Zacks' (1979) proposal that, in contrast to colour, spatial location would not show developmental improvement because it is remembered automatically. The concept of an object file, that was devised specifically to explain how different visual features of an object are represented (Kahneman & Treisman, 1984), is considered as a potential explanation of both the serial position curve and the distinctive behaviour of different visual features. It is suggested that although 5-year-olds are as adept as 7-year-olds at creating and immediately accessing an object file, they are less able to access information about the visual features of objects whose files are no longer current.