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This study examined the effects of daily intensive tact instruction on the emission of verbal operants in non-instructional settings by two preschool aged children with autism. A delayed multiple probe design across participants was used to assess the effects of intensive tact instruction on the number of pure tacts, mands and, conversational units emitted in three non-instructional settings. Daily tact instruction included 100 tact learn units presented above the participants' daily instruction. Five categories of tacts were selected for intensive instruction and were presented as sets of twodimensional stimuli. Probe sessions of 15 minutes each were conducted as pre- and post- tests following mastery of each set of tacts. Results demonstrated a functional relationship between daily intensive tact instruction and increases in the number of pure tacts emitted in non-instructional settings. [ABSTRACT FROM AUTHOR]

Primary reflexes are highly stereotypical, automatic movements comprising much of the motor repertoire of newborns. The current study examined rates of presence of five primary reflexes (snout, visual rooting, sucking, tactile rooting, and grasp) and variables predictive of their persistence for children with ASD (n = 35), developmental disability (n = 30), and typically developing children matched to participants with ASD on chronological age (n = 30). There was a higher prevalence of snout and visual rooting reflex among children with ASD. These data suggest that the persistence of primary reflexes holds promise as a biomarker for autism spectrum disorder (ASD)., (© 2022. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)

Objectives: Dental behaviour support (DBS) describes all specific techniques practiced to support patients in their experience of professional oral healthcare. DBS is roughly synonymous with behaviour management, which is an outdated concept. There is no agreed terminology to specify the techniques used to support patients who receive dental care. This lack of specificity may lead to imprecision in describing, understanding, teaching, evaluating and implementing behaviour support techniques in dentistry. Therefore, this e-Delphi study aimed to develop a list of agreed labels and descriptions of DBS techniques used in dentistry and sort them according to underlying principles of behaviour., Methods: Following a registered protocol, a modified e-Delphi study was applied over two rounds with a final consensus meeting. The threshold of consensus was set a priori at 75%. Agreed techniques were then categorized by four coders, according to behavioural learning theory, to sort techniques according to their mechanism of action., Results: The panel (n = 35) agreed on 42 DBS techniques from a total of 63 candidate labels and descriptions. Complete agreement was achieved regarding all labels and descriptions, while agreement was not achieved regarding distinctiveness for 17 techniques. In exploring underlying principles of learning, it became clear that multiple and differing principles may apply depending on the specific context and procedure in which the technique may be applied., Discussion: Experts agreed on what each DBS technique is, what label to use, and their description, but were less likely to agree on what distinguishes one technique from another. All techniques were describable but not comprehensively categorizable according to principles of learning. While objective consistency was not attained, greater clarity and consistency now exists. The resulting list of agreed terminology marks a significant foundation for future efforts towards understanding DBS techniques in research, education and clinical care., (© 2024 The Authors. Community Dentistry and Oral Epidemiology published by John Wiley & Sons Ltd.)

Introduction: There is no agreed taxonomy of the techniques used to support patients to receive professional oral healthcare. This lack of specification leads to imprecision in describing, understanding, teaching and implementing behaviour support techniques in dentistry (DBS)., Methods: This review aims to identify the labels and associated descriptors used by practitioners to describe DBS techniques, as a first step in developing a shared terminology for DBS techniques. Following registration of a protocol, a scoping review limited to Clinical Practice Guidelines only was undertaken to identify the labels and descriptors used to refer to DBS techniques., Results: From 5317 screened records, 30 were included, generating a list of 51 distinct DBS techniques. General anaesthesia was the most commonly reported DBS (n = 21). This review also explores what term is given to DBS techniques as a group (Behaviour management was most commonly used (n = 8)) and how these techniques were categorized (mainly distinguishing between pharmacological and non-pharmacological)., Conclusions: This is the first attempt to generate a list of techniques that can be selected for patients and marks an initial step in future efforts at agreeing and categorizing these techniques into an accepted taxonomy, with all the benefits this brings to research, education, practice and patients., (© 2023 The Authors. Community Dentistry and Oral Epidemiology published by John Wiley & Sons Ltd.)

Background: In May 2021, the Irish public health service was the target of a cyber-attack. The response by the health service resulted in the widespread removal of access to ICT systems. While services including radiology, diagnostics, maternity, and oncology were prioritised for reinstatement, recovery efforts continued for over four months. This study describes the response of health service staff to the loss of ICT systems, and the risk mitigation measures introduced to safely continue health services. The resilience displayed by frontline staff whose rapid and innovative response ensured continuity of safe patient care is explored., Methods: To gain an in-depth understanding of staff experiences of the cyber-attack, eight focus groups (n = 36) were conducted. Participants from a diverse range of health services were recruited, including staff from radiology, pathology/laboratories, radiotherapy, maternity, primary care dental services, health and wellbeing, COVID testing, older person's care, and disability services. Thematic Analysis was applied to the data to identify key themes., Results: The impact of the cyber-attack varied across services depending on the type of care being offered, the reliance on IT systems, and the extent of local IT support. Staff stepped-up to the challenges and quickly developed and implemented innovative solutions, exhibiting great resilience, teamwork and adaptability, with a sharp focus on ensuring patient safety. The cyber-attack resulted in a flattening of the healthcare hierarchy, with shared decision-making at local levels leading to an empowered frontline workforce. However, participants in this study felt the stress placed on staff by the attack was more severe than the cumulative effect of the COVID-19 pandemic., Conclusions: Limited contingencies within the health system IT infrastructure - what we call a lack of system resilience - was compensated for by a resilient workforce. Within the context of the prevailing COVID-19 pandemic, this was an enormous burden on a dedicated workforce. The adverse impact of this attack may have long-term and far-reaching consequences for staff wellbeing. Design and investment in a resilient health system must be prioritised., (© 2023. BioMed Central Ltd., part of Springer Nature.)

This case describes a woman in her 50s who presented with recurrent lower respiratory tract infections. She was an ex-smoker and had worked on a livestock farm for many years. Chest radiograph and CT of the chest revealed multiple bilateral pulmonary nodules. Bronchoalveolar lavage and transbronchial biopsy did not confirm a unifying diagnosis and thus, surgical biopsy was pursued. Video-assisted thoracoscopic surgical guided biopsy of the right upper, middle and lower lobes demonstrated intraparenchymal minute nodules, consisting of bland epithelioid cells without any evidence of malignancy. The nodules stained positive for neural cell adhesion molecule (CD56) and progesterone receptor with weakly positive epithelial membrane antigen and smooth muscle actin. The combination of this characteristic staining pattern, the diffuse subcentimetre nature of the nodules and this clinical presentation fit with a diagnosis of the ultra-rare pulmonary disease, diffuse pulmonary meningotheliomatosis (DPM). This case highlights a rare cause of bilateral diffuse pulmonary nodules and thus, the breadth of differential diagnoses that need to be considered when approaching such a finding. Careful history-taking and thorough workup is often needed, typically requiring input from multiple specialties. DPM, while rare, should not be overlooked when considering the underlying cause of this presentation, especially in female patients. This case reiterates how common clinical presentations can unveil rare conditions and the contributions of physicians, pathologists and radiologists in the diagnosis and management of these complex diseases., Competing Interests: Competing interests: None declared., (© BMJ Publishing Group Limited 2023. No commercial re-use. See rights and permissions. Published by BMJ.)

Groundwater uranium (U) concentrations have been measured above the U.S. EPA maximum contaminant level (30 μg/L) in many U.S. aquifers, including in areas not associated with anthropogenic contamination by milling or mining. In addition to carbonate, nitrate has been correlated to uranium groundwater concentrations in two major U.S. aquifers. However, to date, direct evidence that nitrate mobilizes naturally occurring U from aquifer sediments has not been presented. Here, we demonstrate that the influx of high-nitrate porewater through High Plains alluvial aquifer silt sediments bearing naturally occurring U(IV) can stimulate a nitrate-reducing microbial community capable of catalyzing the oxidation and mobilization of U into the porewater. Microbial reduction of nitrate yielded nitrite, a reactive intermediate, which was further demonstrated to abiotically mobilize U from the reduced alluvial aquifer sediments. These results indicate that microbial activity, specifically nitrate reduction to nitrite, is one mechanism driving U mobilization from aquifer sediments in addition to previously described bicarbonate-driven desorption from mineral surfaces, such as Fe(III) oxides.

Competing Interests: None declared

Background: Legal cases involving the National Cervical Screening Programme in Ireland following non-disclosure of an interval cervical cancer audit prompted this first international comparative survey of interval cervical cancer audit., Methods: A survey of 22 international population-based cervical screening programmes was conducted, to determine if they undertook audit of invasive cervical cancers. Those countries/regions that perform reviews were asked (i) how the audit was undertaken, including how the reviews were performed and how they controlled for retrospective bias, (ii) how women are informed of the audit process and how their consent is obtained, and (iii) how audit results were disclosed to patients., Results: Seventeen countries/regions invited completed the survey (77%); 65% (11/17) have an audit process for interval cervical cancers. Five perform individual patient reviews; three perform programme-wide review, with calculation of interval cancer detection rates; one routinely performs programme-wide review with calculation of interval cancer detection rates and offers individual reviews, and one routinely performs local hospital-level reviews. In the remaining country/region, hospital laboratories audit cancers, with a national audit process for all cervical cancers. Varying methodologies for retrospective cytology review were employed; four include control samples, with a ratio varying from 1:1 to 1:2. Three conduct a blinded review. Most countries/regions do not discuss interval cancer audit with participants and 3/11 (27.3%) inform women when a cervical cancer audit takes place. Disclosure is limited and variable., Conclusion: The responses suggest that there is no consistent approach to audit of interval cervical cancers or to disclosure of audit results.

Improving quality of life (QoL) is the goal of behavior analytic services, but there can be barriers to assessing the QoL of autistic children due to characteristics inherent in the condition. Given that happiness is a fundamental element of QoL, previous research has relied on behavioral indicators of mood (e.g., smiling, crying) to evaluate the overall QoL of disabled individuals. However, the use of these traditional indices may not accurately reflect the emotional well-being of autistic individuals, who are known to engage in idiosyncratic mood indicators. The current study replicated selected procedures from Parsons et al. (2012) to identify and validate the unique mood indicators of young autistic children. The study showed that individualized indices of happiness and unhappiness could be operationally defined and reliably measured among these children. Key findings and limitations of this study are discussed, and the implications of these findings are presented., Supplementary Information: The online version contains supplementary material available at 10.1007/s40617-022-00710-y., Competing Interests: Conflict of InterestThe authors have no conflicts of interest that are relevant to this study to disclose., (© The Author(s) 2022.)

Aims: To share the need for agreement in terminology around how people are supported to receive dental care., Method: In this position paper, we make the case for a shift in behavior support in dentistry from an art to a science., Results: We outline why we need agreement on the definition of behavior support across dentistry, agreement on underlying theory, aims and values, and why we need agreement on terms for specific techniques., Conclusions: We share how patients and dental teams can benefit through better science, education and practice of dental behaviour support., (© 2021 The Authors. Special Care in Dentistry published by Special Care Dentistry Association and Wiley Periodicals LLC.)

Children with autism spectrum disorder (ASD) are considered an at-risk population for reading delays and challenges. In recent years, there has been emerging support for the computer-assisted instruction (CAI) Headsprout with respect to reading outcomes in children with ASD. CAI, often used within classrooms, is designed using automated and carefully sequenced instruction. A randomized controlled trial was used to explore the implementation of Headsprout by parents, including a treatment package (i.e., behavioral skills training, an online support group, and a consultative model) within the home environment, with their children with ASD. A between-groups design was used to evaluate the effects of Headsprout on the reading outcomes and print motivation of a sample of 26 children with ASD. Thirteen children were in the experimental (Headsprout) group, and thirteen were in the control group receiving treatment as usual. Supplementary online supports were provided to parents based on specific learning problems identified during the intervention. Results demonstrated that participants who received Headsprout showed greater gains in reading rate, word reading, non-word reading, and target sounds and words within Headsprout than the control group. The results of print motivation demonstrated that only Headsprout-specific print material resulted in an increase in assessed preference at posttests., Competing Interests: Conflicts of interest/Competing interestThe authors declare that they have no conflict of interest., (© Crown 2021.)

Introduction: Interval breast cancers occur following a negative breast screening mammogram and before the next scheduled appointment within screening programmes. Radiological review classifies them as cancers that develop between screens, cancers with no obvious malignant abnormalities on prior screens or cancers not detected at screening. This study aimed to systematically review published literature on the occurrence of open disclosure following interval cancer radiological reviews by breast screening programmes internationally in a retrospective setting and examine methodologies used for radiological reviews for the purposes of disclosure., Methods: A search for relevant articles published (January 2000 - May 2019) was conducted according to PICO and PRISMA guidelines. The databases Pubmed, Scopus, Google Scholar, Cinahl, Web of Science, Embase, Science Direct and Global Health were searched. Relevant studies were reviewed if they had completed a retrospective review and classification of interval breast cancers., Results: Of 46 relevant articles included, no study was identified that conducted a retrospective review purposely for open disclosure. Retrospective reviews were conducted for audit/quality assurance, and research including for radiologist education and learning. Variation in methodology was found across review type (non-blinded/semi-informed approach), number of reviewers and classification categories. The proportion of false negative cancers classified among the studies ranged from 4 to 40 %., Discussion: Variation among radiological review practices were observed, which likely impacts classification results. To ensure standardised classification of interval breast cancers are employed for the purposes of open disclosure in screening settings, reproducible and consistent methodology is required., (Copyright © 2021 The Author(s). Published by Elsevier B.V. All rights reserved.)

Objectives: To understand the impact of emergency department (ED) reconfiguration on the number of patients waiting for hospital beds on trolleys in the remaining EDs in four geographical regions in Ireland using time-series analysis., Setting: EDs in four Irish regions; the West, North-East, South and Mid-West from 2005 to 2015., Participants: All patients counted as waiting on trolleys in an ED for a hospital bed in the study hospitals from 2005 to 2015., Intervention: The system intervention was the reconfiguration of ED services, as determined by the Department of Health and Health Service Executive. The timing of these interventions varied depending on the hospital and region in question., Results: Three of the four regions studied experienced a significant change in ED trolley numbers in the 12-month post-ED reconfiguration. The trend ratio before and after the intervention for these regions was as follows: North-East incidence rate ratio (IRR) 2.85 (95% CI 2.04 to 3.99, p<0.001), South IRR 0.68 (95% CI 0.51 to 0.89, p=0.006) and the Mid-West IRR 0.03 (95% 1.03 to 2.03, p=0.03). Two of these regions, the South and the Mid-West, displayed a convergence between the observed and expected trolley numbers in the 12-month post-reconfiguration. The North-East showed a much steeper increase, one that extended beyond the 12-month period post-ED reconfiguration., Conclusions: Findings suggest that the impacts of ED reconfiguration on regional level ED trolley trends were either non-significant or caused a short-term shock which converged on the pre-reconfiguration trend over the following 12 months. However, the North-East is identified as an exception due to increased pressures in one regional hospital, which caused a change in trend beyond the 12-month post reconfiguration., Competing Interests: Competing interests: Dr OH is member of the Reconfiguration Forum for Cork and Kerry (having been a member of the Project Team 2008–2011)., (© Author(s) (or their employer(s)) 2019. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Background: A key challenge for most systems is how to provide effective access to urgent and emergency care across rural and urban populations. Tensions about the placement and scope of hospital emergency services are longstanding in Irish political life and there has been recent reform to centralise hospital services in some regions. The focus of this paper is a system approach to examine the geographic variation in resourcing and utilisation of such care across GP practices, out-of-hours care, ambulance services, Emergency Departments and Local Injury Units in Ireland., Methods: We used a cross-sectional study design to evaluate variation in resource allocation by aggregating geographic funding to various elements of the urgent and emergency care system and assessing patterns in hospital resource utilisation across the population. Expenditure, staffing, access and activity data were gathered from government sources, individual facilities and service providers, health professional bodies, private firms and central statistics. Data on costs and activity in 2014 are collated and presented at both county and regional levels. Analyses focus on resources spent on urgent and emergency care across geographic areas, the role of population concentration in allocation, the relationship between pre-hospital spending and in-hospital spending, and the utilisation of hospital-based emergency care resources by residents of each county., Results: An array of funding mechanisms exists, resulting in a fragmented approach to the resourcing of urgent and emergency care. There are large differences in spending per capita at the county-level, ranging from between €50 and €200 per capita; however, these are less pronounced regionally. Distribution of hospital emergency care resources is highly skewed to the North East of the country, and away from the recently reconfigured South and Mid-West regions., Conclusions: This analysis advances the traditional approach of evaluating individual services or hospital resourcing. There are notable differences in utilisation of hospital-based emergency care resources at the regional level, indicating that populations within those regions which have been reconfigured have lower utilisation of hospital resources. There is a clear case for more integration in decision-making around funding and consideration of key principles, such as equity, to guide that process.

Research related to parental satisfaction with early intensive behavioral intervention (EIBI) remains limited. A 35-item questionnaire called the parental satisfaction scale-EIBI (PSS-EIBI) was developed with four subdomains (child outcomes, family outcomes, quality of the model, and relationship with the team). Study 1 assessed levels of satisfaction for 48 parents with their child's EIBI program after approximately 1 year of intervention. Study 2 examined the relationship between parental satisfaction, length of child participation in EIBI, and the relationship between parental satisfaction and actual outcomes for their child as assessed by the Verbal Behavior Milestones Assessment and Placement Program after approximately 2 years. Results indicate that parental satisfaction with EIBI was consistently high in all four domains of the PSS-EIBI in both studies. Parental satisfaction was found to be associated with gains in child functioning after 1 year of intervention.

Background: Many emergency admissions are deemed to be potentially avoidable in a well-performing health system., Objective: To measure the impact of population and health system factors on county-level variation in potentially avoidable emergency admissions in Ireland over the period 2014-2016., Methods: Admissions data were used to calculate 2014-2016 age-adjusted emergency admission rates for selected conditions by county of residence. Negative binomial regression was used to identify which a priori factors were significantly associated with emergency admissions for these conditions and whether these factors were also associated with total/other emergency admissions. Standardised incidence rate ratios (IRRs) associated with a 1 SD change in risk factors were reported., Results: Nationally, potentially avoidable emergency admissions for the period 2014-2016 (266 395) accounted for 22% of all emergency admissions. Of the population factors, a 1 SD change in the county-level unemployment rate was associated with a 24% higher rate of potentially avoidable emergency admissions (IRR: 1.24; 95% CI 1.04 to 1.41). Significant health system factors included emergency admissions with length of stay equal to 1 day (IRR: 1.20; 95% CI 1.11 to 1.30) and private health insurance coverage (IRR: 0.92; 95% CI 0.89 to 0.96). The full model accounted for 50% of unexplained variation in potentially avoidable emergency admissions in each county. Similar results were found across total/other emergency admissions., Conclusion: The results suggest potentially avoidable emergency admissions and total/other emergency admissions are primarily driven by socioeconomic conditions, hospital admission policy and private health insurance coverage. The distinction between potentially avoidable and all other emergency admissions may not be as useful as previously believed when attempting to identify the causes of regional variation in emergency admission rates., Competing Interests: Competing interests: OH is a member of the Reconfiguration Forum for Cork and Kerry (having been a member of the Project Team 2008–2011) and is currently seconded to the Department of Health as part of the National Establishment of Hospital Groups project team., (© Author(s) (or their employer(s)) 2019. No commercial re-use. See rights and permissions. Published by BMJ.)

Objective: This study examined the efficacy of an inhibitory stimulus control procedure (ISCP) for the management of vocal stereotypy in three children with autism., Method: During discrimination training, implemented within a changing criterion design, participants were taught that there were no consequences for vocal stereotypy in the absence of an inhibitory stimulus but that differential reinforcement procedures were in effect in the presence of the stimulus. Functional control of the inhibitory stimulus was subsequently assessed within a reversal design., Results: Inhibitory stimulus control was established during discrimination training, with participants inhibiting vocal stereotypy for 30 min periods in the presence of the inhibitory stimulus. Reductions in vocal stereotypy were maintained in the presence of the inhibitory stimulus and in the absence of further programmed consequences., Discussion: This study extends current knowledge by demonstrating the efficacy of ISCPs paired with reinforcement only, and illustrating the functional control of the inhibitory stimulus.

This study employs a multiple baseline across individual design to describe the implementation of positive behavioural supports for seven children and adolescents in residential community settings over a period of 24 months. These individuals with intellectual disability are residing in one county with long-standing challenging behaviour resulting in home breakdown and serious physical injury. Four types of outcome are presented: rates of behaviour, rates of medication, psychiatric symptomatology and quality of life (QoL). Behaviours reduced to lower levels for the majority of participants following the implementation of positive behavioural supports, and improvements were largely sustained. The use of psychotropic medications reduced or stabilized for the majority of individuals over the same period. QoL Questionnaire scores improved substantially for four participants. The results are discussed in the context of a framework for supporting children with severe challenging behaviours in the community.

Highly luminescent thin films of zinc tungstate (ZT) have been deposited on top of conventional scintillators (Yttrium Aluminum Perovskite, Yttrium Aluminum Garnet) for electron detection in order to replace the need for a top conducting layer, such as indium tin oxide (ITO) or aluminum, which is non-scintillating and electron absorbing. Such conventional conducting layers serve the single purpose of eliminating electrical charge build-up on the scintillator. The ZT film also eliminates charging, which has been verified by measuring the Duane-Hunt limit and electron emission versus accelerating voltage. The luminescent nature of the ZT film ensures effective detection of low energy electrons from the very top surface of the structure ZT/scintillator, which we call "first-surface scintillator". The cathodoluminescence has been measured directly with a photodetector and spectrally resolved at different accelerating voltages. All results demonstrate the extended range of operation of the first-surface scintillator, while the conventional scintillators with a top ITO layer decline below 5 kV and have practically no output below 2 kV. Scintillators of different types were integrated in a detection system for backscattered electrons (BSE). The quality of the image at high accelerating voltages is comparable with the conventional scintillator and commercial BSE detector, while the image quality at 1 kV from the first-surface scintillator is superior.