Migrant health research in the Republic of Ireland: a scoping review

BACKGROUND

Migration to European countries has increased in number and diversity in recent years. Factors such as access to healthcare, language barriers and legal status can impact the health outcomes of migrant groups. However, little is known about the evidence base on the health status of migrants in the Republic of Ireland. Our aim was to scope existing peer-reviewed research on the health of migrants in Ireland and identify any gaps in the evidence.

METHODS

We conducted a scoping review of peer-reviewed research on the health of migrants in the Republic of Ireland. Eleven electronic databases were searched for peer-reviewed, empirical articles published between 2001 and 2017. Search terms were adapted from a World Health Organisation review. Findings were analysed using the 2016 World Health Organisation Strategy and Action Plan for Refugee and Migrant Health in the World Health Organisation European region, which outlines nine strategic areas that require collaborative action.

RESULTS

Of 9396 articles retrieved, 80 met inclusion criteria, with the majority (81%) published since 2009. More than half of the studies had a quantitative design (65%). Migrants studied came from Eastern Europe, Asia and Africa and included labour migrants, refugees and asylum seekers. Most studies related to two World Health Organisation strategic areas; 4: "achieving public health preparedness and ensuring an effective response", and 5: "strengthening health systems and their resilience".

CONCLUSION

There is growing attention to migrant health in Ireland with a balance of qualitative and quantitative research. While much of the identified research is relevant to three of the World Health Organisation strategic areas, there are significant gaps in the other six areas. The study design could be replicated in other countries to examine and inform migrant health research.

Tar yield and composition from poultry litter gasification in a fluidised bed reactor: effects of equivalence ratio, temperature and limestone addition

Air gasification of poultry litter was experimentally investigated in a laboratory scale bubbling fluidised bed gasifier. Gasification tests were conducted at atmospheric pressure using silica sand as the bed material. This paper examines the effect of the equivalence ratio (ER) in the range of 0.18-0.41, temperature between 700 and 800 °C, and the addition of limestone blended with the poultry litter on the yield and composition of tar. An off-line solid phase adsorption method was employed in order to quantify tar compounds heavier than styrene, whereas lighter species such as benzene and toluene were measured by means of on-line micro gas chromatography. Total tar yields were in the range from 15.7 to 30.7 gtotal tar kgpoultry litter (dry and ash free basis) -1. These values are considered low with respect to the feedstocks with a higher organic fraction. It also needs to be noted that the yields of benzene and toluene were measured by on-line micro gas chromatography, a technique which inherently delivers higher tar values compared to commonly employed off-line techniques. By varying the ER, poultry litter blended with limestone showed a reduction in total tar yield whereas poultry litter on its own showed an increasing tar yield over the ER range tested. In the presence of limestone, polycyclic aromatic hydrocarbons (PAHs), heterocyclic compounds, toluene and benzene showed a tendency to reduce over the ER range tested. Since the ER also plays a crucial role in tar reduction, the reduction in tar cannot be unambiguously attributed to calcined limestone/lime (CaCO3/CaO). Increasing the temperature was shown to be effective for reducing the total tar yield but the amounts of polycyclic aromatic hydrocarbons increased. However, no definitive correlation could be established between limestone/lime catalytic activity for tar reduction and elevated gasification temperature, because there was no possibility to study their effects separately. The chemical composition of the tar arising from poultry litter is distinctive compared with conventional lignocellulosic fuels linked to the fact that poultry litter has a higher nitrogen content (≈6.5% w/w (dry and ash free basis)). Nitrogen-containing hydrocarbons such as pyridine, 2-methylpyridine, 2-methyl-1H-pyrrole and benzonitrile were identified in significant amounts. This study has demonstrated that poultry litter gasified in a bubbling fluidised bed yielded a product gas with relatively low tar content while its composition reflects the chemical nature of the feedstock.

'It benefits patient care': the value of practice-based IPE in healthcare curriculums

BACKGROUND

Practice-based interprofessional education (IPE) is essential to prepare students for collaborative working. Pockets of practice-based IPE are integrated into healthcare curriculums in some regions. Yet practice-based IPE is not globally valued as a key element of healthcare curriculums. As students and clinical educators are key stakeholders, this study presents a case example of their experiences in a country where practice-based IPE is at an emergent stage. Their experiential knowledge generated important insights into how practice-based IPE is perceived. This learning can be applied, both locally and further afield, by those seeking to embed practice-based IPE in their placement curriculums.

METHODS

A qualitative case study was conducted at a school of allied health and partner placement sites in Ireland. Data collection comprised two participant observations, 13 interviews and 12 document analyses. Inductive thematic analysis and deductive framework analysis, underpinned by activity theory and Hofstede's cultural dimensions, informed data analysis and interpretations.

RESULTS

Participants are grappling to establish the value of practice-based IPE, illustrated in three themes: clarifying the concept of practice-based IPE, mapping IPE activities and diversifying interprofessionalism. First, ambiguous conceptualisation of why and how to implement practice-based IPE was identified. Highlighting how practice-based IPE improved patient care and safety created a clear rationale for implementation. It was also helpful to demonstrate how adaptations to existing practice education models, rather than entirely new models, could achieve high-quality practice-based IPE. Second, the positioning of practice-base IPE in the placement curriculum was unclear. Overt mapping of practice-based IPE activities onto learning outcomes within assessment tools enhanced its value within practice education. Third, varying levels of professional engagement were noted, perpetuating stereotypes. Creating diverse educator networks and embedding practice-based IPE in organisational strategy may incentivise engagement across a greater range of professions.

CONCLUSIONS

Implementing these recommendations could enhance the value of practice-based IPE and optimise student preparation for collaborative working. Practice-based IPE remains a complex model and the trajectory of embedding in healthcare curriculums will differ globally.

Emerging scaffold- and cellular-based strategies for brain tissue regeneration and imaging

Stimulating brain tissue regeneration is a major challenge after central nervous system (CNS) injury, such as those observed from trauma or cerebrovascular accidents. Full regeneration is difficult even when a neurogenesis-associated repair response may occur. Currently, there are no effective treatments to stimulate brain tissue regeneration. However, biomaterial scaffolds are showing promising results, where hydrogels are the materials of choice to develop these supportive scaffolds for cell carriers. Their combination with growth factors, such as brain-derived neurotrophic factor (BDNF), basic fibroblast growth factor (bFGF), or vascular endothelial growth factor (VEGF), together with other cell therapy strategies allows the prevention of further neuronal death and can potentially lead to the direct stimulation of neurogenesis and vascularisation at the injured site. Imaging of the injured site is particularly critical to study the reestablishment of neural cell functionality after brain tissue injury. This review outlines the latest key advances associated with different strategies aiming to promote the neuroregeneration, imaging, and functional recovery of brain tissue.

Graphical abstract

Glioblastoma Multiforme Selective Nanomedicines for Improved Anti-Cancer Treatments

Glioblastoma Multiforme (GBM) is a devastating disease with a low survival rate and few efficacious treatment options. The fast growth, late diagnostics, and off-target toxicity of currently used drugs represent major barriers that need to be overcome to provide a viable cure. Nanomedicines (NMeds) offer a way to overcome these pitfalls by protecting and loading drugs, increasing blood half-life, and being targetable with specific ligands on their surface. In this study, the FDA-approved polymer poly (lactic-co-glycolic) acid was used to optimise NMeds that were surface modified with a series of potential GBM-specific ligands. The NMeds were fully characterised for their physical and chemical properties, and then in vitro testing was performed to evaluate cell uptake and GBM cell specificity. While all targeted NMeds showed improved uptake, only those decorated with the-cell surface vimentin antibody M08 showed specificity for GBM over healthy cells. Finally, the most promising targeted NMed candidate was loaded with the well-known chemotherapeutic, paclitaxel, to confirm targeting and therapeutic effects in C6 GBM cells. These results demonstrate the importance of using well-optimised NMeds targeted with novel ligands to advance delivery and pharmaceutical effects against diseased cells while minimising the risk for nearby healthy cells.

Pharmaceutical design of a delivery system for the bacteriocin lacticin 3147

Lacticin 3147 is a dual-acting two-peptide bacteriocin which is generally active against Gram-positive bacteria, including Listeria monocytogenes and antimicrobial-resistant bacteria such as Closteroides difficile in the colon. L. monocytogenes infections can cause life-long effects in the elderly and vulnerable and can cause severe complications in pregnant women. C. difficile causes one of the most common healthcare-associated infections and can be fatal in vulnerable groups such as the elderly. Although lacticin 3147 is degraded by intestinal proteases and has poor aqueous solubility, encapsulation of the bacteriocin could enable its use as an antimicrobial for treating these bacterial infections locally in the gastrointestinal tract. Lacticin 3147 displayed activity in aqueous solutions at a range of pH values and in gastric and intestinal fluids. Exposure to trypsin and α-chymotrypsin resulted in complete inactivation, implying that lacticin 3147 should be protected from these enzymes to achieve successful local delivery to the gastrointestinal tract. The amount of lacticin 3147 dissolved, i.e. its solution concentration, in water or buffered solutions at pH 1.6 and 7.4 was low and varied with time but increased and was stabilized in gastrointestinal fluids by the phospholipid and bile salt components present. Thus, the feasibility of a solid lipid nanoparticle (SLN) delivery system for local administration of lacticin 3147 was investigated. Bacteriocin activity was observed after encapsulation and release from a lipid matrix. Moreover, activity was seen after exposure to degrading enzymes. Further optimization of SLN delivery systems could enable the successful pharmaceutical development of active lacticin 3147 as an alternative to traditional antibiotics.

Exploring how patients, carers and members of the public are recruited to advisory boards, groups and panels as partners in public and patient involved health research: a scoping review protocol

INTRODUCTION

Engaging patients, carers and members of the public in health research has become widely recognised as an important approach for bridging the gap between research, and health and social care by increasing the relevance of research for those who benefit from its findings. Specific approaches to engagement vary, but commonly include advisory boards, groups or patient panels that are active throughout all stages of research. The breadth of and optimal strategies for recruiting patients, carers and members of the public to such boards, groups or panels remains unclear. The objective of this manuscript is to identify the breadth of and optimal strategies used to recruit patients, carers and members of the public to advisory boards, groups or panels, within public and patient involvement (PPI) research.

METHODS AND ANALYSIS

This review follows the scoping review framework by Peters et al, an elaboration on the framework by Arksey and O'Malley. The search strategy was co-developed among the research team, PPI research experts and a faculty librarian. The review will take place between July 2021 and June 2022. In July and August 2021, eight electronic databases, MEDLINE (PubMed), MEDLINE (OVID), Embase, CINAHL, PsychINFO, Scopus, Web of Science and Cochrane Library, will be explored to capture all available literature. Two independent reviewers will screen articles by title and abstract and then at full text based on predetermined criteria. The data will be presented in a tabular format with a narrative summary discussing how the research findings relate to the overarching research question. A thematic analysis will also be completed using qualitative description, identifying key themes and gaps in the literature.

ETHICS AND DISSEMINATION

Ethics is not required for this review. We aim to disseminate the information gathered through presentations at academic conferences, peer-reviewed publications and consultations with lay audiences.

How do delirium motor subtypes differ in phenomenology and contributory aetiology? a cross-sectional, multisite study of liaison psychiatry and palliative care patients

OBJECTIVES

To investigate whether delirium motor subtypes differ in terms of phenomenology and contributory aetiology.

DESIGN

Cross-sectional study.

SETTING

International study incorporating data from Ireland and India across palliative care, old age liaison psychiatry and general adult liaison psychiatry settings.

PARTICIPANTS

1757 patients diagnosed with delirium using criteria from the Diagnostic and Statistical Manual of Mental Disorders, Fourth edition (DSM IV).

PRIMARY AND SECONDARY OUTCOME MEASURES

Hyperactive, mixed and hypoactive delirium subtypes were identified using the abbreviated version of the Delirium Motor Subtype Scale. Phenomenology was assessed using the Delirium Rating Scale Revised. Contributory aetiologies were assessed using the Delirium Aetiology Checklist (DEC), with a score >2 indicating that the aetiology was likely or definitely contributory.

RESULTS

Hypoactive delirium was associated with dementia, cerebrovascular and systemic infection aetiologies (p<0.001) and had a lower overall burden of delirium symptoms than the other motor subtypes. Hyperactive delirium was associated with younger age, drug withdrawal and the DEC category other systemic aetiologies (p<0.001). Mixed delirium showed the greatest symptom burden and was more often associated with drug intoxication and metabolic disturbance (p<0.001). All three delirium motor subtypes had similar levels of impairment in attention and visuospatial functioning but differed significantly when compared with no subtype (p<0.001).

CONCLUSIONS

This study indicates a pattern of aetiology and symptomatology of delirium motor subtypes across a large international sample that had previously been lacking. It serves to improve our understanding of this complex condition and has implications in terms of early detection and management of delirium.

A national survey of publicly funded chronic pain management services in Ireland

BACKGROUND

Chronic pain management services have historically been under-resourced in Ireland. There is no agreed model of care for chronic pain management services in Ireland. Previous studies have assessed the extent of services in Ireland without examining waiting times for access to services.

AIMS

This study aimed to quantify the extent of, geographical distribution of and waiting times for access to publicly funded chronic pain management services in Ireland.

METHODS

Using the British Pain Society's Core Standards for Pain Management Services in the UK (2015) and International Association for the Study of Pain (IASP) recommendations, a questionnaire was devised. Publically funded departments in Ireland were contacted and questionnaires completed. Waiting list data was publicly available and obtained from the National Treatment Purchase Fund website.

RESULTS

There was a 100% response rate. Sixteen publicly funded chronic pain management services were identified. There are 27 chronic pain management consultants (16.6 whole time equivalents (WTE)) practicing chronic pain management, amounting to 0.55 specialists (0.34 WTEs)/100,000 of the population. There are 21 WTE for non-consultant hospital doctors (NCHDs), 26.5 WTEs for nursing, 8 WTEs for physiotherapy and 6.2 WTEs for psychology, nationally. A percentage of 93.75% of departments (n = 15) provide interventional therapies, 37.5% (n = 6) provide advanced neuromodulation and 43.75% (n = 7) are managing intrathecal pump therapies. There are five pain management programmes nationally. As of January 2020, ~ 25% patients on waiting lists for outpatient appointments were waiting > 18 months, with ~ 17% patients on waiting lists for interventional treatments waiting > 12 months.

CONCLUSIONS

Shortage of multidisciplinary staff is of particular concern for Irish services. Patient access is limited as evidenced by significant waiting lists. In order to improve access to care and bring services in line with international recommendations, increased resources are needed.

Cyber risk and cybersecurity: a systematic review of data availability

Cybercrime is estimated to have cost the global economy just under USD 1 trillion in 2020, indicating an increase of more than 50% since 2018. With the average cyber insurance claim rising from USD 145,000 in 2019 to USD 359,000 in 2020, there is a growing necessity for better cyber information sources, standardised databases, mandatory reporting and public awareness. This research analyses the extant academic and industry literature on cybersecurity and cyber risk management with a particular focus on data availability. From a preliminary search resulting in 5219 cyber peer-reviewed studies, the application of the systematic methodology resulted in 79 unique datasets. We posit that the lack of available data on cyber risk poses a serious problem for stakeholders seeking to tackle this issue. In particular, we identify a lacuna in open databases that undermine collective endeavours to better manage this set of risks. The resulting data evaluation and categorisation will support cybersecurity researchers and the insurance industry in their efforts to comprehend, metricise and manage cyber risks.

SUPPLEMENTARY INFORMATION

The online version contains supplementary material available at 10.1057/s41288-022-00266-6.

Hand hygiene practices for prevention of health care-associated infections associated with admitted infectious patients in the emergency department: a systematic review

Background

In most high-income countries, emergency departments (ED) represent the principal point of access forcer by critically ill or injured patients. Unlike inpatient units, ED healthcare workers (ED HCWs) have demonstrated relative lack of adherence to hand hygiene (HH) guidelines, commonly citing frequency of intervention and high rates of admission, which reflect severity of cases encountered.

Aim

Assessment of studies on hand hygiene compliance (HHC) by ED HCWs conducted between 2010 and 2020, seeking to estimate HHC rates and intervention strategies utilised to improve HHC in EDs.

Methods

Searches conducted in Web of Science, EBSCO HOST (CINHAL & Medline), PubMed, Embase, and Cochrane for full studies published between 2010 and 2020 on the topic of HHC in the ED.

Results

One hundred twenty-nine eligible articles were identified of which 79 were excluded. Fifty-one underwent full-text screening before 20 studies were deemed relevant. Of the eligible studies, fifteen (75%) had, as the primary outcome, HHC according to the WHO-recommended 5-moments. Twelve studies (60%) implemented multimodal or single intervention strategies. Eight studies were ambiguous regarding the nature of the approach adopted. In the nine observational studies where HHC was documented, an overall post-intervention median HHC rate of 45% (range 8–89.7%).

Conclusion

Multimodal approaches appear to have enhanced HHC moderately among ED HCWs. Elevated complexity associated with critically ill patients, and ED overcrowding, are contributing factors to relatively low compliance rates observed. Strategies to improve HHC rates may need to acknowledge, and cater for, the context of an unpredictable environment.

Precursor-Mediated Colloidal Synthesis of Compositionally Tunable Cu-Sb-M-S (M = Zn, Co, and Ni) Nanocrystals and Their Transport Properties

The solution-based colloidal synthesis of multinary semiconductor compositions has allowed the design of new inorganic materials impacting a large variety of applications. Yet there are certain compositions that have remained elusive-particularly quaternary structures of transition metal-based (e.g., Co, Zn, Ni, Fe, Mn, and Cr) copper antimony chalcogenides. These are widely sought for tuning the electrical and thermal conductivity as a function of the size, composition, and crystal phase. In this work, a facile hot injection approach for the synthesis of three different tetrahedrite-substituted nanocrystals (NCs) (Cu₁₀Zn₂Sb₄S₁₃, Cu₁₀Co₂Sb₄S₁₃, and Cu₁₀Ni_1.5Sb₄S₁₃) and their growth mechanisms are investigated. We reveal that the interplay between the Zn, Ni, and Co precursors on the basis of thiophilicity is key to obtaining pure phase NCs with controlled size and shape. While all of the synthesized crystal phases display outstanding low thermal conductivity, the Cu_10.5Sb₄Ni_1.5S₁₃ system shows the most enhanced electrical conductivity compared to Cu₁₀Zn₂Sb₄S₁₃ and Cu₁₀Co₂Sb₄S₁₃. This study highlights an effective synthesis strategy for the growth of complex quaternary nanocrystals and their high potential for application in thermoelectrics.

Social Identity and Online Support Groups: A Qualitative Study with Family Caregivers

BACKGROUND

The purpose of this study was to explore whether a sense of collective or shared group identity was developed in one established online social support group for family caregivers and, if so, what did group identification mean for the group members and how was this cultivated in the group.

METHODS

Eighteen semi-structured interviews were carried out with members of a family caregiver online support group in Ireland. Inductive and deductive reflexive thematic analysis drawing on the social identity approach (SIA) generated four main themes and several related subthemes.

RESULTS

The first main theme generated was The group are a Tribe and the Tribe gets it, with subthemes: Invisibility as a common experience, my Tribe understands I am more than just a carer and Just being part of the Tribe can be enough. The second main theme generated was the Tribe is a lifeline and life-changing, with related subthemes: Our connection relieves experiences of loneliness and social isolation and Sharing knowledge, experience and support made me feel visible. The third and fourth main themes generated were The leadership of group moderators helped create the Tribe identity and Lessons that can be learnt. These findings are discussed in relation to the social identity approach, social isolation and loneliness.

CONCLUSIONS

We concluded that group identity can be cultivated through considered, active and balanced moderation, creating a safe, welcoming and supportive space where family caregivers are able to have fun and seek information, advice and emotional support, which helps relieve loneliness and social isolation.

'Doctors can't be doctors all of the time': a qualitative study of how general practitioners and medical students negotiate public-professional and private-personal realms using social media

OBJECTIVE

The objective of this study is to explore the experiences and perspectives of general practitioners' and medical students' use of, and behaviour on, social media and to understand how they negotiate threats to professional and personal life on social media.

DESIGN

A two-phase qualitative design was used, consisting of semistructured interviews and follow-up vignettes, where participants were asked to respond to vignettes that involved varying degrees of unprofessional behaviour. Data were analysed using template analysis.

SETTING AND PARTICIPANTS

Participants were general practitioner tutors and third year medical students who had just completed placement on the University of Limerick longitudinal integrated clerkship. Five students and three general practitioners affiliated with the medical school were invited to participate in one-to-one interviews.

RESULTS

Three overarching themes, each containing subthemes were reported. 'Staying in contact and up to date' outlines how social media platforms provide useful resources and illustrates the potential risks of social media. 'Online persona' considers how social media has contributed to changing the nature of interpersonal relationships. 'Towards standards and safety' raises the matter of how to protect patients, doctors and the medical profession.

CONCLUSION

Guidance is required for students and medical practitioners on how to establish reasonable boundaries between their personal and professional presence on social media and in their private life so that poorly judged use of social media does not negatively affect career prospects and professional efficacy.

ASD-Net: a novel U-Net based asymmetric spatial-channel convolution network for precise kidney and kidney tumor image segmentation

Early intervention in tumors can greatly improve human survival rates. With the development of deep learning technology, automatic image segmentation has taken a prominent role in the field of medical image analysis. Manually segmenting kidneys on CT images is a tedious task, and due to the diversity of these images and varying technical skills of professionals, segmentation results can be inconsistent. To address this problem, a novel ASD-Net network is proposed in this paper for kidney and kidney tumor segmentation tasks. First, the proposed network employs newly designed Adaptive Spatial-channel Convolution Optimization (ASCO) blocks to capture anisotropic information in the images. Then, other newly designed blocks, i.e., Dense Dilated Enhancement Convolution (DDEC) blocks, are utilized to enhance feature propagation and reuse it across the network, thereby improving its segmentation accuracy. To allow the network to segment complex and small kidney tumors more effectively, the Atrous Spatial Pyramid Pooling (ASPP) module is incorporated in its middle layer. With its generalized pyramid feature, this module enables the network to better capture and understand context information at various scales within the images. In addition to this, the concurrent spatial and channel squeeze & excitation (scSE) attention mechanism is adopted to better comprehend and manage context information in the images. Additional encoding layers are also added to the base (U-Net) and connected to the original encoding layer through skip connections. The resultant enhanced U-Net structure allows for better extraction and merging of high-level and low-level features, further boosting the network's ability to restore segmentation details. In addition, the combined Binary Cross Entropy (BCE)-Dice loss is utilized as the network's loss function. Experiments, conducted on the KiTS19 dataset, demonstrate that the proposed ASD-Net network outperforms the existing segmentation networks according to all evaluation metrics used, except for recall in the case of kidney tumor segmentation, where it takes the second place after Attention-UNet.

Stakeholder Perceptions of the Acceptability of Peer-Mediated Intervention for Minimally Speaking Preschoolers on the Autism Spectrum

Peer mediated intervention (PMI) is an evidence-based approach to supporting social and communication development for children on the autism spectrum. For PMI to be integrated into everyday practice, it needs to be acceptable to stakeholders. This article engaged with autistic individuals, early childhood educators, parents, and speech and language pathologists on the prospective acceptability of implementing PMI with minimally speaking preschoolers in inclusive preschool settings. Focus groups and semi-structured interviews were conducted. The transcriptions were analyzed qualitatively using reflexive thematic analysis. Stakeholders described PMI as an acceptable intervention approach for this population and provided valuable insights to inform the development and implementation of PMIs. Attention needs to be paid to how to support preschools to adopt a PMI-friendly philosophy.

Contribution of a C-Terminal Extension to the Substrate Affinity and Oligomeric Stability of Aldehyde Dehydrogenase from Thermus thermophilus HB27

Aldehyde dehydrogenase enzymes (ALDHs) are widely studied for their roles in disease propagation and cell metabolism. Their use in biocatalysis applications, for the conversion of aldehydes to carboxylic acids, has also been recognized. Understanding the structural features and functions of both prokaryotic and eukaryotic ALDHs is key to uncovering novel applications of the enzyme and probing its role in disease propagation. The thermostable enzyme ALDHTt originating fromThermus thermophilus, strain HB27, possesses a unique extension of its C-terminus, which has been evolutionarily excluded from mesophilic counterparts and other thermophilic enzymes in the same genus. In this work, the thermophilic adaptation is studied by the expression and optimized purification of mutant ALDHTt-508, with a 22-amino acid truncation of the C-terminus. The mutant shows increased activity throughout production compared to native ALDHTt, indicating an opening of the active site upon C-terminus truncation and giving rationale into the evolutionary exclusion of the C-terminal extension from similar thermophilic and mesophilic ALDH proteins. Additionally, the C-terminus is shown to play a role in controlling substrate specificity of native ALDH, particularly in excluding catalysis of certain large and certain aromatic ortho-substituted aldehydes, as well as modulating the protein's pH tolerance by increasing surface charge. Dynamic light scattering and size-exclusion HPLC methods are used to show the role of the C-terminus in ALDHTt oligomeric stability at the cost of catalytic efficiency. Studying the aggregation rate of ALDHTt with and without a C-terminal extension leads to the conclusion that ALDHTt follows a monomolecular reaction aggregation mechanism.

Barriers and facilitators to implementation of an exercise and education programme for osteoarthritis: a qualitative study using the consolidated framework for implementation research

Targeted efforts to better understand the barriers and facilitators of stakeholders and healthcare settings to implementation of exercise and education self-management programmes for osteoarthritis (OA) are needed. This study aimed to explore the barriers and facilitators to the implementation of Good Life with osteoArthritis in Denmark (GLA:D), a supervised group guideline-based OA programme, across Irish public and private healthcare settings. Interviews with 10 physiotherapists (PTs; 8 public) and 9 people with hip and knee OA (PwOA; 4 public) were coded by the Consolidated Framework for Implementation Research (CFIR) constructs in a case memo (summary, rationale, quotes). The strong positive/negative implementation determinants were identified collaboratively by rating the valence and strength of CFIR constructs on implementation. Across public and private settings, PTs and PwOA strongly perceived GLA:D Ireland as evidence-based, with easily accessible education and modifiable marketing/training materials that meet participants' needs, improve skills/confidence and address exercise beliefs/expectations. Despite difficulties in scheduling sessions (e.g., work/caring responsibilities), PTs in public and private settings perceived advantages to implementation over current clinical practice (e.g., shortens waiting lists). Only PTs in public settings reported limited availability of internal/external funding, inappropriate space, marketing/training tools, and inadequate staffing. Across public and private settings, PwOA reported adaptability, appropriate space/equipment and coaching/supervision, autonomy, and social support as facilitators. Flexible training and tailored education for stakeholders and healthcare settings on guideline-based OA management may promote implementation. Additional support on organising (e.g., scheduling clinical time), planning (e.g., securing appropriate space, marketing/training tools), and funding (e.g., accessing dedicated internal/external grants) may strengthen implementation across public settings.

An Investigation into the Growth of Lolium perenne L. and Soil Properties Following Soil Amendment with Phosphorus-Saturated Bauxite Residue

Reuse options for bauxite residue include treatment of phosphorus (P)-enriched wastewaters where the P-saturated media offers fertiliser potential. However, few studies have assessed the impact on soil properties. Two types of spent P-saturated bauxite residue were applied to soil and compared to conventional superphosphate fertiliser as well as a control soil. Soil physico-chemical properties, worm Eisenia fetida L. choice tests, and Lolium perenne L. growth and elemental uptake were examined. Comparable biomass and plant content for L. perenne in the P-saturated bauxite residue treatments and those receiving superphosphate, indicated no phytotoxic effects. E. fetida L. showed a significant preference for the control soil (58 %± 2.1%) over the amended soils, indicating some form of salt stress. Overall, P-saturated bauxite residue was comparable to the superphosphate fertiliser in terms of the plant performance and soil properties, indicating the potential recycling of P from wastewaters using bauxite residue as a low-cost adsorbent.

(Re)Conceptualizing decision-making tools in a risk governance framework for emerging technologies-the case of nanomaterials

The utility of decision-making tools for the risk governance of nanotechnology is at the core of this paper. Those working in nanotechnology risk management have been prolific in creating such tools, many derived from European FP7 and H2020-funded projects. What is less clear is how such tools might assist the overarching ambition of creating a fair system of risk governance. In this paper, we reflect upon the role that tools might and should play in any system of risk governance. With many tools designed for the risk governance of this emerging technology falling into disuse, this paper provides an overview of extant tools and addresses their potential shortcomings. We also posit the need for a data readiness tool. With the EUs NMP13 family of research consortia about to report to the Commission on ways forward in terms of risk governance of this domain, this is a timely intervention on an important element of any risk governance system.

Pyrolysis, a recovery solution to reduce landfilling of residual organic waste generated from mixed municipal waste

Despite policies to restrict the mixing of organic waste with other general waste and improve its separation at source, municipal solid waste still contains a high proportion of organic waste. The residual organic waste is generated as a by-product of the mechanical treatment of municipal solid waste (MSW) and is mainly disposed in landfills after composting. Its reuse and recovery status varies across European countries. Most countries restrict the use of biostabilised residual waste (BSRW) to landfill cover, whereas others have regulated it as marketable compost. Crucially, BSRW is set to lose its "recycled" status under the revised European Union waste framework, with probably tighter restrictions and increased costs imposed for the landfilling of organic waste. Our research aimed to investigate pyrolysis as an alternative technology to treat the 10-40 mm fraction of BSRW (representing 50% of BSRW generated). Pyrolysis at 700 °C was carried out and feedstock and pyrolysis products were characterized. Mass and energy balances showed that pyrolysis produced hot vapour/gas whose combustion may render the pyrolysis process energetically sustainable. Biochar comprises 30-50% of BRSW mass after removal of glass, metal and stones. Our results indicate that pyrolysis has the potential to create options for contributing to reduce the landfilling of BSRW; however, the presence of residual impurities may limit biochar applications.

Dynamic Grammar Pruning for Program Size Reduction in Symbolic Regression

Grammar is a key input in grammar-based genetic programming. Grammar design not only influences performance, but also program size. However, grammar design and the choice of productions often require expert input as no automatic approach exists. This research work discusses our approach to automatically reduce a bloated grammar. By utilizing a simple Production Ranking mechanism, we identify productions which are less useful and dynamically prune those to channel evolutionary search towards better (smaller) solutions. Our objective in this work was program size reduction without compromising generalization performance. We tested our approach on 13 standard symbolic regression datasets with Grammatical Evolution. Using a grammar embodying a well-defined function set as a baseline, we compare effective genome length and test performance with our approach. Dynamic grammar pruning achieved significantly better genome lengths for all datasets, while significantly improving generalization performance on three datasets, although it worsened in five datasets. When we utilized linear scaling during the production ranking stages (the first 20 generations) the results dramatically improved. Not only were the programs smaller in all datasets, but generalization scores were also significantly better than the baseline in 6 out of 13 datasets, and comparable in the rest. When the baseline was also linearly scaled as well, the program size was still smaller with the Production Ranking approach, while generalization scores dropped in only three datasets without any significant compromise in the rest.

Insights into product design students' perception of, and engagement with, creativity in design education

Creativity is acknowledged as an essential component of the design process and considered a key design graduate attribute. Despite this assertion, several studies have highlighted that the teaching of creativity in design education is often implicit rather than explicit. Moreover, there is a paucity of research on product design students' experience of creativity in design education, leaving a gap in knowledge relevant to how creativity may be better fostered in design education. In this study, reflexive thematic analysis was used to analyse the data from online focus groups conducted with product design students. The three themes constructed provide insights into how students perceive and engage with creativity. Theme 1, the influence of social factors on creativity, uncovers the diametric effect students' social eco-system can have on their creativity. These include an aversion to being associated with it due to weight of expectation and negative perceptions around creativity, as well as the 'invisible support system' created by peers. Theme 2, sanctuary seeking tendencies of novice design students, reveals behaviours that oppose essential creative attributes: a freedom from risk and ambiguity and desire for certainty and achievability. Theme 3, tension between passion for and pursuit of creativity, outlines the conflict between participants' ideologies and actions when pursuing creativity highlighting a reluctance to utilise structured creativity tools while gravitating towards unstructured methods such as 'relaxed attention'. Together, the three themes form a picture of product design students' complex relationship with creativity and importance of self-efficacy. The findings of this study make an important contribution to our understanding of design students' perception of, and engagement with, creativity in design education. As such these findings are relevant for both design education and future creativity tool development.

Psychotherapeutic interventions for burns patients and the potential use with Stevens-Johnson syndrome and toxic epidermal necrolysis patients: A systematic integrative review

Background

The existing evidence demonstrates that survivors of SJS/TEN have reported long-lasting psychological effects of their condition. Burns patients experience similar psychological effects. It is important to look at ways to help allay the psychological complications of SJS/TEN. As there is an absence of evidence on SJS/TEN psychotherapeutic interventions, it was judged to be beneficial to determine the evidence underpinning psychotherapeutic interventions used with burns patients.

Aims and objectives

The aim of this systematic integrative review was to synthesize the evidence relating to psychotherapeutic interventions used with adult burns patients and patients with SJS/TEN.

Method

The systematic review was guided by Whittemore and Knafl’s integrative review process and the PRISMA guidelines. Nine databases were searched for English and French language papers published January 2008 to January 2021. The protocol for the review was registered with PROSPERO.

Results

Following a screening process, 17 studies were included in the review. Two themes were identified using content analysis, (i) Empirically supported psychotherapeutic treatments, (ii) Alternative psychotherapeutic treatments. This review revealed no evidence on specific psychotherapeutic interventions for patients with SJS/TEN. Some of the interventions used with burns patients, viz. relaxation therapy, hypnosis and cognitive behavioral therapy showed some significant benefits. However, the evidence for burns patients is mainly focused on pain and pain anxiety as outcomes.

Conclusion

Following further research, some of the interventions deployed in burns patients may be applicable to SJS/TEN patients, particularly stress reduction techniques. In addition, the caring behaviours such as compassion, respect, and getting to know the patient as a person are important components to psychological care.

Irish general practitioner (GP) perspectives on impact of direct access radiology on patient care in the community: results from a mixed-methods study

BACKGROUND

Since winter 2020/21, general practitioners (GPs) in the Republic of Ireland (RoI) have been granted access to diagnostic imaging studies on a new publicly funded pathway, expediting access to services previously obtained via hospital-based doctors.

AIMS

Outline GP perspectives on imaging studies obtained via the new "GP Access to Community Diagnostics" initiative.

METHODS

A mixed-methods design was employed. Referrals over the first six months of 2019 and 2021 were collated by a private imaging provider, and a randomly selected subset of 2021 studies (maximum 30 referrals per GP) was returned to participating GPs to provide detail on the impact on each patient's care. In-depth qualitative interviews were also conducted with participating GPs.

RESULTS

Eleven GPs supplied detailed information on 81 studies organized through the new initiative. GPs reported that the initiative had led to a large proportion of cases being managed solely in general practice, with an 81% reduction in referrals to acute hospital settings and a 58% reduction in referrals to secondary care clinics. GPs felt imaging studies improved patient care in 86% of cases and increased GP workload in 58% of cases. GP qualitative interviews revealed four key themes: improved patient care, increased GP workload, reduction in hospital referrals, and opinions on ongoing management of such initiatives, including guidelines.

CONCLUSIONS

GPs felt enhancing access to diagnostics improved patient care by expediting diagnosis, decision-making, and treatment and by reducing hospital referrals. GPs were generally positive about the initiative and made some suggestions on future management of the initiative.