A cross-sectional survey of women's views and preferences for preterm birth screening and treatment.

OBJECTIVES: Primary outcomes were to determine; 1) the desire for more patient information from healthcare professionals on preterm birth (PTB) prevention 2) the desire for PTB screening surveillance or participation in research or 3) the acceptability of transvaginal ultrasound (TVUS) or vaginal examinations to predict spontaneous PTB. METHODS: A 19-question, piloted, self-administered survey was completed by unselected pregnant women in a tertiary maternity hospital in Dublin, Ireland. Data was collected to include maternal socio-demographics, past obstetric history, and current pregnancy details, in addition to views and preferences on PTB screening and preventative treatments. Statistical analysis to include binary and multinomial regression was performed by IBM SPSS Statistics for Windows (Version 29.0). RESULTS: 277 women completed the study survey. 9.4% of women had attended the preterm birth surveillance clinic (PSC). 75.1% of respondents indicated a preference for more information from healthcare professionals about PTB. 65% reported that TVUS and vaginal examinations were acceptable in pregnancy. The acceptability of antenatal examinations was significantly influenced by ethnicity; white European (OR 2.58, CI 1.12-5.95, p = 0.003) and Asian (OR 3.39, CI 1.18-9.67, p = 0.02). Discomfort (25.3%) and vaginal bleeding (11.9%) were the most frequently reported concerns about TVUS. 95.7% of unselected women indicated that they would accept treatment to prevent PTB. Vaginal progesterone (53.8%) was preferred treatment compared to cervical cerclage (15.9%) or cervical pessary (16.6%). 55.6% of respondents stated they attend or wish to attend for additional appointments or research opportunities for PTB screening. Women with a previous PTB or second trimester miscarriage were more likely to attend or wish to attend for PTB screening (OR 3.23, CI 1.34-7.79, p = 0.009). CONCLUSION: PTB is an important healthcare priority for pregnant women in Ireland. However, women require more information, counselling and reassurance about the utility and safety of TVUS in PSCs.

Drainage status of grassland peat soils in Ireland: Extent, efficacy and implications for GHG emissions and rewetting efforts.

Peatlands have been artificially drained and degraded over 100s of years and have released huge amounts of carbon dioxide (CO2) as a result. In organic grassland soils, raising the water table to prevent such emissions is being proposed to meet national greenhouse gas emission targets for the land use sector. At present, all of these soils (335,000 ha) are assumed to be drained (as no information has been available on their drainage status) within national emission inventory reporting and are therefore responsible for significant emissions (8-9 million tonnes CO2-equivalent annually). The objective of the present study was to collate studies relating to the drainage status of peat soils in Ireland to present alternative scenarios with regard to actual drainage status of organic soils and their estimated emissions. From a drainage design perspective, evidence suggests that relatively small proportions of the grassland peat area was drained effectively using optimal in-field drain spacings required to control the water table at 0.4-0.5 m. Open drains excavated on such soils have limited capacity to laterally control the water table depth beyond short distances. Furthermore, the lack of long-term routine maintenance post installation ensures the redundancy of many drainage systems over time. New drainage installations are therefore likely replacing existing infrastructure and not necessarily increasing the drained area at any given time. This evidence supports literature from the 1980s which state that relatively low proportions of the grassland peat area has been subjected to effective drainage. Scenario testing results showed that likely emissions from the most probable scenario (with total area drained equating to 90,000-120,000 ha) are 3.6-4.7 million tonnes CO2-equivalent, approximately 40-53% of current national emission inventory estimates. The incorporation of such a refinement into the national inventory could offer a significant reduction in estimated GHG emissions from the grassland land use sector in national emission inventory reporting.

New insights for predicting surgery outcome in patients with temporal lobe epilepsy. A systematic review.

Resective surgery is the treatment of choice for one-third of adult patients with focal, drug-resistant epilepsy. This procedure is associated with substantial clinical and cognitive risks. In clinical practice, there is no validated model for epilepsy surgery outcome prediction (ESOP). Meta-analyses on ESOP studies assessing prognostic factors report discrepancies in terms of study design. Our review aims to systematically investigate methodological and analytical aspects of studies predicting clinical and cognitive outcomes after temporal lobe epilepsy surgery. A systematic review of ESOP studies published between 2000 and 2022 from three databases (MEDLINE, Web of Science, and PsycINFO) was completed by following the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines. It yielded 4867 articles. Among them, 21 corresponded to our inclusion criteria and were therefore retained in the final review. The risk of bias was assessed using A Tool to Assess Risk of Bias and Applicability of Prediction Model Studies (PROBAST). Data extracted from the 21 studies were analyzed using narrative synthesis and descriptive statistics. Our findings show an increase in the use of multimodal datasets and machine learning analyses in recent ESOP studies, although regression remained the most frequently used approach. We also identified a more frequent use of network notions in recent ESOP studies. Nevertheless, several methodological issues were noted, such as small sample sizes, lack of information on the follow-up period, variability in seizure outcome, and the definition of neuropsychological postoperative change. Of 21 studies, only one provided a clinical tool to anticipate the cognitive outcome after epilepsy surgery. We conclude that methodological issues should be overcome before we move towards more complete models to better predict clinical and cognitive outcomes after epilepsy surgery. Recommendations for future studies to harness the possibilities of multimodal datasets and data fusion, are provided. A stronger bridge between fundamental and clinical research may result in developing accessible clinical tools.

SARS-CoV-2 Testing and Patient Waiting Times in the Emergency Department.

Aim Emergency Departments (EDs) were impacted early in the coronavirus disease 2019 (COVID-19) pandemic, with high attendance numbers. EDs relied upon SARS-CoV-2 reverse-transcriptase polymerase chain reaction (RT-PCR) tests to triage patients and facilitate admission to appropriate wards, meaning positive patients were isolated as early as possible. In October 2020, we introduced a 24-hour SARS-CoV-2 testing service. We examined the impact of this on patient experience times (PETs) in the ED, and on healthcare-associated (HA) COVID-19 infections. Methods Data on PETs before and after the introduction of 24-hour testing were available from the ED. HA COVID-19 infections were reported weekly to the Health Services Executive as a key performance indicator. Results Mean PET prior to the pandemic was 20 hours and dropped to 10 and 13 hours respectively in the first and second wave. A surge in case numbers and ED attendances during the third wave was not reflected in a rise in PETs, with a mean PET of 11 hours, significantly below pre-pandemic levels. HA-COVID-19 infections remained stable between wave one and three (83 v 92). Conclusion The introduction of 24-hour SARS-CoV-2 testing in our ED contributed to a reduction in PETs, facilitated appropriate patient placement at ward level, and kept HA-COVID-19 infections at acceptably low levels.

Temporal changes in cortical microporosity during estrogen deficiency associated with perilacunar resorption and osteocyte apoptosis: A pilot study.

Osteocytes can actively regulate bone microporosity, through either perilacunar resorption or micropetrosis following apoptosis. Osteocyte apoptosis is more prevalent in estrogen deficiency and changes in the lacunar-canalicular network of osteocytes have been reported. Temporal changes in bone mineralisation and osteocytes cellular strains occur, which might be associated with osteocyte-driven microporosity changes, although time dependant changes in bone microporosity are not yet fully understood. In this pilot study we conducted micro-CT analysis, backscatter electron imaging and histological analysis of femoral cortical bone form an ovariectomized rat model of osteoporosis to investigate whether estrogen deficiency causes temporal changes in lacunar and vascular porosity. We also assessed MMP14 expression, lacunar occupancy and mineral infilling, as indicators of perilacunar resorption and micropetrosis. We report temporal changes in cortical microporosity in estrogen deficiency. Specifically, canalicular and vascular porosity initially increased (4 weeks post-OVX), coinciding with the period of rapid bone loss, whereas in the longer term (14 weeks post-OVX) lacunar and canalicular diameter decreased. Interestingly, these changes coincided with an increased prevalence of empty lacunae and osteocyte lacunae were observed to be more circular with a mineralised border around the lacunar space. In addition we report an increase in MMP14+ osteocytes, which also suggests active matrix degradation by these cells. Together these results provide an insight into the temporal changes in cortical microporosity during estrogen deficiency and suggest the likelihood of occurrence of both perilacunar resorption and osteocyte apoptosis leading to micropetrosis. We propose that microporosity changes arise due to processes driven by distinct populations of osteocytes, which are either actively resorbing their matrix or have undergone apoptosis and are infilling lacunae by micropetrosis.

Effect of plasma rich in growth factors on quality of life following mandibular third molar removal: a double-blind randomized controlled trial.

The objective of this study was to investigate the effect of plasma rich in growth factors (PRGF) on patient- and clinician-reported outcomes following mandibular third molar removal. Seventy-four patients requiring surgical removal of a unilateral impacted mandibular third molar under local anaesthesia were recruited into the study. PRGF was prepared for all patients irrespective of study arm allocation. Reviews were conducted 3 days (T1) and 7 days (T2) postoperatively. Primary outcome measures were pain (numerical rating scale, NRS), OHIP-14 (Oral Health Impact Profile-14), and postoperative symptom severity scale (PoSSe) data. Secondary outcome measures including mouth opening, dry socket, socket healing, and analgesic consumption were also explored. The statistical analysis was performed using analysis of covariance and the χ2 test. NRS pain scores were higher in the PRGF group at T1, demonstrating borderline significance (mean difference 1.0; P = 0.06), with no difference at T2. PoSSe scores did not differ between the groups, with the exception of the 'interference with daily activities' subscale at T1, where PRGF group patients scored 1.2 units higher (P = 0.02). OHIP-14 scores demonstrated a 25% increased likelihood of PRGF patients reporting discomfort on eating at T1 (P = 0.02), with no statistical significance at T2. Secondary outcomes did not differ between the groups. No difference in clinical or quality of life outcomes was observed for patients receiving adjunctive PRGF in third molar sockets.

Assessment of the microbial load of airway clearance devices used by a cohort of children with cystic fibrosis.

BACKGROUND: Positive expiratory pressure (PEP) devices are an important element of the management of cystic fibrosis, and of other respiratory diseases. Whereas there have been reports in the literature of contamination of airway clearance devices and their surfaces by microbial pathogens, there is little evidence available regarding such contamination and its contribution to respiratory infection. AIM: To establish whether pathogenic bacteria can contaminate PEP devices in the context of normal cleaning and maintenance practices. METHODS: Patients' home-use clearance devices were brought to a routine clinic appointment and collected for microbiology sampling and analysis. The patients were provided with replacement devices. Nineteen such devices were collected from 17 patients, reflecting use of multiple devices by some patients. Swabs were taken and cultured from each patient's used device, the patient's airway, as well as from new unopened and unused devices that acted as controls. RESULTS: Seven of 19 devices (37%) tested positive for presence of pathogenic bacteria. Device-cleaning methods varied among patients and non-sterilization methods were found to be ineffective at removing pathogens. Microbial species found on the devices did not correlate with those identified from airway swabs. CONCLUSION: This study demonstrates the presence of pathogens on positive expiratory pressure devices. The potential for transmission of these pathogens to the patient's airway and the risk of infection remains unclear and requires further study.

Field scale estimates of soil carbon stocks on ten heavy textured farms across Ireland.

The world's soils store vast amounts (≈2,500 GT) of Carbon which acts as a vital sink to counterbalance the effects of increasing atmospheric carbon dioxide. There have been fruitful efforts to quantify soil Carbon stocks at national scales, which are required for policy level decisions but lack the high resolution required to support farm specific decisions. It is hypothesised that farm scale evaluations of soils can provide insight that is masked in national scale studies and can allow for spatially explicit management approaches to optimise soil Carbon storage and sequestration, such that it can be prioritized within profitable production systems. The objective of the present study was to estimate Carbon stocks on a range of heavy textured soils at field and farm scale and to quantify Carbon storage relative to national scale estimates. Ten grassland dairy farms (mean area of 52.2 Ha) were surveyed, sampled and classified to determine soil types and quantify soil Carbon stores. The level of Carbon present (mean: 346.0 T/Ha) at these sites was greater than previous averages on such soils quantified at national scale (by a factor of 1.1-3.9 depending on soil type). Furthermore, if Carbon saturation potential was realised, the amount of Carbon stored could be increased by an average of 792.1 T/Ha in each profile (from 346.0 to 1138.1 T/Ha). Current management has fostered the retention of large stores of soil Carbon on such soils/farms which co-exist within highly productive farm systems. As there is a societal demand to retain and enhance soil carbon stores to mitigate climate change, high Carbon soils should be identified and, under appropriate policies, commodified to offer a direct incentive to retain soil Carbon. The value of this resource should be recognised and polices to ensure a spatially explicit approach for soil Carbon management should be adopted.

Do established infection prevention and control measures prevent spread of SARS-CoV-2 to the hospital environment beyond the patient room?

The role of the hospital environment in the transmission of infection is well described. With an emerging infection whose mode of transmission is under investigation, strict infection prevention and control measures, including patient isolation, hand hygiene, personal protective equipment that is doffed on exiting the patient room, and environmental cleaning should be implemented to prevent spread. Environmental testing demonstrated that COVID-19 patients contaminated the patient area (11/26, 42.3% of tests) but contamination of general ward areas was minimal (1/30, 3%) and the virus was detected after cleaning on one item only (1/25, 4%) which was noted to be in disrepair.

Secondary alterations in bone mineralisation and trabecular thickening occur after long-term estrogen deficiency in ovariectomised rat tibiae, which do not coincide with initial rapid bone loss.

This study delineates the time sequence of changes in bone tissue mineralisation in ovariectomised rats. We report that changes in bone mineral distribution arise secondary to the initial rapid bone loss but coincide with trabecular thickening. We propose that these changes compensate for elevated stresses in remaining trabeculae after bone resorption. INTRODUCTION: Recent studies have shown that osteoporosis is not simply a disease of bone loss and microarchitectural degradation but that important changes in tissue composition also occur. Such changes may be a secondary response to early bone loss, but the time sequence of changes in bone mineral distribution is not fully understood. The objective of this study was to quantify the temporal effects of estrogen deficiency on trabecular mineral distribution in the tibia of ovariectomised (OVX) rats. METHODS: Weekly in vivo micro-CT scans and morphometric and bone mineral density distribution analyses of the proximal tibia were conducted for the first 4 weeks of estrogen deficiency and then at 8, 14 and 34 weeks. RESULTS: Here we report that although trabecular bone volume and architecture are significantly deteriorated within the first 4 weeks of estrogen deficiency, there is no change in the distribution of bone mineral within trabeculae during this initial period. The rate of bone loss in OVX animals dramatically reduced between week 4 and week 14, which coincided with the initiation of increases in trabecular thickness and mineralisation in the OVX group. CONCLUSIONS: Together this study reveals for the first time that alterations in bone mineralisation and trabecular thickening arise secondary to the initial rapid bone loss. We propose that these secondary mineralisation changes act to reinforce the trabecular network in an attempt to compensate for the increased loading that ensues after severe bone loss. This study provides an insight into temporal changes in bone mineral distribution in estrogen deficiency.

Effects of cognitive loading and force on upper trapezius fatigue.

Background: Musculoskeletal disorders (MSDs) are particularly common in the shoulder/neck region for some tasks that involve low force exertions, for example computer work. It has been demonstrated that muscle activity may be stimulated by cognitively demanding tasks. There is a lack of studies on the relationship between qualitative levels of cognitive loading, level of muscle activity, and muscle fatigue. Aims: To investigate the effects of quantitative levels of cognitive loading on conduction velocity changes and isometric endurance times for the upper trapezius. Methods: Participants performed a combination of three levels of a cognitively demanding computer task (0, 1.59 and 3 Bits) while simultaneously performing either of two isometric endurance tests (20 and 40% MVC) for the upper trapezius. Results: Information load had a significant effect (P < 0.05) on normalized conduction velocity slopes for the 40% but not for the 20% maximum voluntary contraction conditions. Information load had a highly significant effect on endurance times for both exertion levels (P < 0.01). Conclusions: This study found that performing a high-difficulty cognitive task while simultaneously performing increasingly higher levels of static isometric shoulder abduction exertions, fatigued the trapezius muscle quicker than performing an equivalent exertion with low cognitive load. This is particularly relevant to workplaces with increasing levels of automation that require high levels of decision making and computer use.

Patent ductus arteriosus in cats (Felis catus): 50 cases (2000-2015).

OBJECTIVES: To describe signalment, clinical characteristics, diagnostic, treatment, and outcome data in a large case series of cats with patent ductus arteriosus (PDA). ANIMALS: Fifty cats with confirmed PDA. METHODS: Retrospective review of medical records from five referral veterinary hospitals for cats with PDA between 2000 and 2015. Cats were included if a PDA was visualized echocardiographically, during surgery, or on post-mortem examination. RESULTS: Median age at presentation was 6 months (range: 36 days-9.7 years; n = 50), and sex distribution was approximately equal (27 male, 23 female). Most cats did not have clinical signs (70.2%; 33/47) at the time of presentation. Murmurs were classified as continuous (55%; 22/40) or systolic (45%; 18/40). Echocardiography confirmed left-to-right shunting in 33 cats (82.5%; 33/40) and right-to-left shunting in 7 (17.5%; 7/40). Concurrent cardiac anomalies were identified in 54.5% (18/33) and pulmonary hypertension in 45.7% (16/35). Closure was pursued in 68% (34/50), and complications associated with the procedure occurred in 14.7% (5/34) of cats, including one intraoperative mortality. Long-term follow up was available in 80% (40/50) of cats. CONCLUSIONS: Cats with PDA often do not display clinical signs and may not have the characteristic physical examination findings typical of PDA in dogs. An increased prevalence of concurrent cardiac anomalies and pulmonary hypertension were found relative to previous reports. Thoracic radiographs and echocardiogram may provide the most comprehensive information for making a diagnosis and treatment recommendations. PDA closure was associated with a favorable long-term outcome in cats included in this study.

Are Irish therapists at heightened risk for low back pain?

BACKGROUND: Within the international literature, no studies have been identified that compare prevalence rates of low back pain (LBP) in chartered physiotherapists, physical and athletic therapists and those in the national working population, making it unclear whether such therapists are an occupational group at high risk of developing LBP. AIMS: To establish the prevalence of LBP among therapists (both employed and self-employed) in Ireland, to compare the employment status-, gender- and age-specific LBP prevalence rates between therapists and the national working population and to estimate the adjusted odds of developing LBP among therapists relative to the national working population. METHODS: An analysis of data from the Health In Hand Intensive Tasks and Safety (HITS) study and the third national Survey on Lifestyle, Attitudes and Nutrition (SLÁN). The HITS study was a cross-sectional study investigating work-related musculoskeletal disorders in practising therapists. The SLÁN 2007 was a face-to-face interview study of adults. RESULTS: LBP prevalence in therapists was 49% with no significant difference by employment status. Therapists had a much higher prevalence compared with the national working population across all demographic strata, with therapists nearly five times more likely to suffer from LBP than the national working population after careful adjustment for differences in sociodemographic factors. CONCLUSIONS: Therapists in Ireland are an occupational group at high risk of developing LBP, warranting further research into their physical and psychosocial work-related risk factors.

A Quality Improvement Approach to Reducing the Caesarean section Surgical Site Infection Rate in a Regional Hospital.

Surgical site infection (SSI) rates are used extensively by hospitals as a basis for quality improvement. A 30-day post-discharge SSI programme for Caesarean section operations has been implemented in Our Lady of Lourdes Hospital since 2011. It has been shown that skin antisepsis and antibiotic prophylaxis are key factors in the prevention of SSI. Using quality improvement methodology, an infection prevention bundle was introduced to address these two factors. Skin antisepsis was changed from povidone-iodine to chlorhexidine-alcohol. Compliance with choice of antibiotic prophylaxis increased from 89.6% in 2014 to 98.5% in 2015. Compliance with timing also improved. The SSI rate of 7.5% was the lowest recorded to date, with the majority of SSIs (64%) diagnosed after hospital discharge. The level of variation was also reduced. However, the continued presence of variation and possibility of lower infection rates from the literature imply that further improvements are required.

The neonatal gut harbours distinct bifidobacterial strains.

BACKGROUND: Recent studies have described the bifidobacterial composition of neonates at a species level; however, with advancing technologies we can gain insight into the diversity of the bifidobacterial microbiota residing within the infant gut. OBJECTIVE: To compare species and strain diversity of culturable bifidobacterial populations in faecal samples obtained from healthy term infants on three different feeding regimes. STUDY DESIGN: In total, 51 healthy term infants were recruited for this study and divided equally into three different groups (n=17) based on their feeding regime during the first 4 weeks of life. Culturable bifidobacterial populations were analysed at week 1, week 4 and 6 months of age. Isolates were characterised to species level by 16s rRNA-internally transcribed spacer (ITS) gene sequence analysis and to strain level by pulsed field gel electrophoresis (PFGE). RESULTS: In total,173 bifidobacterial strains were detected across all three groups from 2295 isolates, 42% (72 of 173) of which were detected in the prebiotic-fed group, followed by 30% (52 of 173) and 28% (49 of 173) in the breastfed and non-prebiotic-fed groups, respectively. Surprisingly, only two of the 51 infants harboured an identical bifidobacterial strain which was not present in the other 49 infants. Prebiotic supplementation in the early neonatal period increased the prevalence of Bifidobacterium longum in infants, in addition to promoting strain diversity. B. longum was the dominant species recovered from all three groups during the first 6 months of life, followed by Bifidobacterium breve and Bifidobacterium bifidum. CONCLUSIONS: This study reveals a hitherto unknown level of diversity at the strain level among bifidobacteria isolated from different infants and the influence prebiotic formula feeding has on the bifidobacterial population.

Maternal corticosterone exposure in the mouse has sex-specific effects on placental growth and mRNA expression.

Maternal exposure to increased synthetic glucocorticoids (GC) during pregnancy is known to disturb fetal development and increase the risk of long-term disease. Maternal exposure to elevated levels of natural GC is likely to be common yet is relatively understudied. The placenta plays an important role in regulating fetal exposure to maternal GC but is itself vulnerable to maternal insults. This study uses a mouse model of maternal corticosterone (Cort) exposure to investigate its effects on the developing placenta. Mice were treated with Cort (33 µg/kg·h) for 60 h starting at embryonic d 12.5 (E12.5) before collection of placentas at E14.5 and E17.5. Although Cort exposure did not affect fetal size, placentas of male fetuses were larger at E17.5 in association with changes in placental Igf2. This increase in size was associated with an increase in placental thickness and an increase in placental junctional zone volume. Placentas from female fetuses were of normal size and had no changes in growth factor mRNA levels. The expression of the protective enzyme 11ß-hydroxysteroid dehydrogenase type 2 was increased at E14.5 but was decreased in males at E17.5. In contrast, the expression of Nr3c1 (which encodes the GC receptor) was increased during the Cort exposure and remained elevated at E17.5 in the placentas of male fetuses. Our study has shown that maternal Cort exposure infers a sex-specific alteration to normal placental growth and growth factor expression, thus further adding to our understanding of the mechanisms of male dominance of programmed disease.

Can a clinical prediction tool guide HIV-testing decisions? Experience at a national hospital in Guatemala.

The USA and international recommendations no longer emphasize using risk factors to target groups for HIV-testing. Using a Guatemalan database of HIV tests, we developed a clinical prediction rule to guide decisions on HIV-testing. Prior to HIV-testing, data were collected on demographics, risk factors and prior testing. Based on a theoretical construct incorporating demographics, known HIV risk factors and symptoms, we developed a logistic regression model to predict HIV seropositivity. Between 2000 and 2005, 16,471 tests were performed, of which 19.8% were positive. The algorithm successfully predicted 1883 of 2489 HIV-positive tests (sensitivity 76%, likelihood ratio [LR]-positive 2.45) and 6282 of 9086 HIV-negative tests (specificity 69%, LR-negative 0.35). Although the model indices are robust, applying the model in a clinical setting would have little impact on improving selective testing practices. Our findings support current recommendations for universal HIV-testing, not selective testing based on risk factors. Before these recommendations can be adopted widely in Guatemala, treatment access needs to be assured and protections put in place for people diagnosed with HIV infection.