Developing a health promoting university in Trinity College Dublin-overview and outline process evaluation.

Higher Education Institutions (HEIs) have the potential to impact positively on the health and wellbeing of their staff and students. Using and expanding on the 'health promoting university' (HPU) platform within HEIs, this article provides a description of 'Healthy Trinity', which is an initiative underway in Trinity College Dublin, the University of Dublin. First, Healthy Trinity is contextualized in background literature including international and national policy and practice. Second, an overview of Healthy Trinity is provided including its vision and goals. Third, the article describes the steps taken relating to the identification of stakeholders and use of a network and a co-lead model. Within this approach, the article describes a partnership approach whereby responsibilities regarding health and wellbeing are shared by individuals and the institution. Fourth, the design and implementation of Healthy Trinity is discussed by taking a 'settings approach', in which the emphasis for change is placed on individual behaviours, environment, policy and organizational culture. Consideration is given to the interplay between intervention, implementation strategy and context for successful systemic implementation. The fifth element presented is the early-stage challenges encountered during implementation, such as the need to secure recurrent funding and the importance of having a direct input to the governance of the University to enable systemic change. The sixth and final component of the article is an outline of Healthy Trinity's intention to utilize a process evaluation of the early implementation phases of this complex intervention within a settings approach. Potential deliverables and impacts of this HPU initiative are presented and discussed.

Universities, such as Trinity College Dublin, the University of Dublin, can be looked at as a community of staff and students. The university community has needs in terms of health and wellbeing. 'Healthy Trinity' attempted to build strategies and practices to meet these needs for its community. The approach taken was from multiple angles and involved students and staff, focusing on both individual and organizational responsibility to promote and encourage healthy behaviours. Healthy Trinity achieved some successes as well as encountering some challenges. This article explores how the university might build upon the successes of Healthy Trinity in order to embed a culture which prioritizes health and wellbeing for the entire university community. The article also looks at the broader impact of achieving this goal, namely the University's contribution to a healthier community beyond the university setting.

Development and proposed evaluation of an eHealth learning tool for undergraduate university students in Ireland.

Undergraduate university students are at a critical stage of development in terms of their academic, social, psychological and behavioural health. Patterns established during these formative years can last a lifetime. eHealth tools have the potential to be engaging, convenient and accessible to a wide range of students by providing health information and enhancing the uptake of positive health behaviours. The 'Healthy Trinity Online Tool' (H-TOT) was developed in collaboration with students and a transdisciplinary team with decades of experience between them in terms of research, clinical responsibility and service delivery. Developmental steps undertaken included: a literature review to formulate the topic content choices; a survey of students to check the relevance and suitability of topics identified; and, the tacit experience of the development team. This co-design model led to the development of content encompassing academic life, healthy eating, physical activity, mood, financial matters, alcohol, tobacco, drugs and relaxation. Qualitative focus groups were subsequently conducted for in-depth exploration of the usage and functionality of H-TOT. The theoretical underpinnings include the locus of control and social cognitive theory. Evidence-based behavioural change techniques are embedded throughout. During early pre-piloting of H-TOT, the team identified and solved content functionality problems. The tone of the content was also revised to ensure it was non-judgemental. To make the H-TOT as interactive as possible, video scenarios were included and all content was audio-recorded to allow playback for students with visual or learning difficulties. Evaluation plans for the pilot year of H-TOT are outlined.

Quantifying clogging patterns of infiltration systems to improve urban stormwater pollution reduction estimates.

Infiltration systems are among the most commonly implemented practices to control urban stormwater and to attenuate pollutant delivery to receiving waters, because they are relatively cheap to build and amenable to space constraints in urbanized areas. However, infiltration systems tend to clog with sediments, which can rapidly reduce their performance. While clogging has been consistently identified as a significant determinant on infiltration BMP (best management practice) performance and lifespan, there have been few methods reported to predict rates of clogging or incorporate insights to urban catchment water quality modeling. We ran a series of laboratory and field experiments to identify clogging mechanisms and quantify infiltration performance declines as a function of sediment loading. The results show rapid initial declines of infiltration rate, primarily due to accumulation of material at the bottom of the infiltration BMP. The performance decline trajectories were sensitive to BMP geometry, with BMPs that had greater lateral infiltration surface area declining less quickly. We integrated these experimental results to a spatially distributed stormwater model to illustrate how they can be used to predict BMP performance declines over time and assess cost trade-offs. Results will be used to adapt algorithms in a cloud-based stormwater management platform to better inform maintenance needs for cities and improve the accuracy of urban stormwater pollutant load reduction estimates that support regulatory compliance tracking.

Periosteal Electrical Dry Needling as an Adjunct to Exercise and Manual Therapy for Knee Osteoarthritis: A Multicenter Randomized Clinical Trial.

OBJECTIVES: To compare the effects of adding electrical dry needling into a manual therapy (MT) and exercise program on pain, stiffness, function, and disability in individuals with painful knee osteoarthritis (OA). MATERIALS AND METHODS: In total, 242 participants (n=242) with painful knee OA were randomized to receive 6 weeks of electrical dry needling, MT, and exercise (n=121) or MT and exercise (n=121). The primary outcome was related-disability as assessed by the Western Ontario and McMaster Universities (WOMAC) Osteoarthritis Index at 3 months. RESULTS: Individuals receiving the combination of electrical dry needling, MT, and exercise experienced significantly greater improvements in related-disability (WOMAC: F=35.504; P<0.001) than those receiving MT and exercise alone at 6 weeks and 3 months. Patients receiving electrical dry needling were 1.7 times more likely to have completely stopped taking medication for their pain at 3 months than individuals receiving MT and exercise (OR, 1.6; 95% confidence interval, 1.24-2.01; P=0.001). On the basis of the cutoff score of ≥5 on the global rating of change, significantly (χ=14.887; P<0.001) more patients (n=91, 75%) within the dry needling group achieved a successful outcome compared with the MT and exercise group (n=22, 18%) at 3 months. Effect sizes were large (standardized mean differences >0.82) for all outcome measures in favor of the electrical dry needling group at 3 months. DISCUSSION: The inclusion of electrical dry needling into a MT and exercise program was more effective for improving pain, function, and related-disability than the application of MT and exercise alone in individuals with painful knee OA. LEVEL OF EVIDENCE: Level 1b-therapy. Prospectively registered February 10, 2015 on www.clinicaltrials.gov (NCT02373631).

Indications for tonsillectomy: a 10 year retrospective review.

OBJECTIVE: Recurrent tonsillitis and obstructive sleep apnea (OSA) are the most common indications for tonsillectomy. This study was undertaken to determine if recurrent tonsillitis is increasing as an indication for tonsillectomy by reviewing the recent trend at a single institution. METHODS: A retrospective chart review of patients undergoing tonsillectomy from 2003 to 2012 was performed. Data was gathered from pre-operative symptoms and sleep study results. Patients were categorized by the following indications: (1) obstructive sleep apnea, (2) recurrent tonsillitis and OSA, (3) recurrent tonsillitis alone and (4) other. Literature review was conducted to find similar studies; the results of the literature review were compared to our results. RESULTS: A total of 2369 patients were included, 52% were boys. Over the study period OSA was the indication for surgery for 67% of patients. There was an increasing trend in OSA as the indication for tonsillectomy (p<0.0001). Girls were more likely to have tonsillitis as an indication for tonsillectomy (21% vs. 17%, OR: 1.32, p<0.0001). Children younger than 2 or 2-5 are less likely than those older than 5 to have tonsillitis as an indication for surgery (2.30% and 6.26% vs. 27.46%, OR=0.06 and 0.18, p<0.0001). 987 of 2370 (42%) patients undergoing tonsillectomy had a pre-operative sleep study. Younger children were more likely to have had a sleep study. CONCLUSION: There were mild variations from year to year; however, obstructive sleep apnea is the most common reason for tonsillectomy.

Does melatonin have therapeutic use in tinnitus?

Melatonin, a hormone produced by the pineal gland, may be a promising treatment option for tinnitus. The primary functions of this hormone are believed to be the initiation and maintenance of sleep because its secretions coincide with circadian rhythms. Some investigators have noted that melatonin may alleviate subjective symptoms of tinnitus. Moreover, melatonin may have properties protective against ototoxic drugs such as amikacin, gentamicin, or cancer therapeutic agents that are dose dependent. In vitro, melatonin has demonstrated antioxidative properties and it has been postulated that these antioxidative properties contribute to the alleviation of tinnitus. Melatonin levels used to obtain these findings in vitro, however, are at supraphysiologic levels; therefore, it is more likely that the benefits from taking supplemental melatonin occur from minimal antioxidative properties, sleep enhancement, or other potential methods of action that are not yet understood. Melatonin offers minimal risk of toxicity with modest daily doses such as 1 to 3 mg, as well as a low cost and favorable adverse effect profile for older adults. In addition to potential benefits in the treatment of tinnitus, melatonin also may have beneficial neurogenerative properties. We recommend that melatonin be considered for use in patients with significant tinnitus.

Meaning of caring to 7 novice physical therapists during their first year of clinical practice.

BACKGROUND AND PURPOSE: Caring has been identified as a rules-based approach to good patient care, as a core value in physical therapist professional behavior, as a part of experienced and expert practice, as a virtue, and as a moral orientation. Previous research showed that experienced and expert female physical therapists value compassion and caring in clinical practice. However, little is known about how novice physical therapists care for their patients. The purpose of this study was to explore the meaning of caring from the perspectives of novice physical therapists. SUBJECTS: Seven novice physical therapists (with less than 1 year of clinical experience) working in either an outpatient or an inpatient facility were recruited. METHODS: A qualitative method (phenomenology) was used, with data being obtained from retrospective interviews of the novice physical therapists regarding their experiences in the clinic. RESULTS: Three common themes relating to the nature of caring emerged: learning to care (with the following subthemes: barriers to caring, the "difficult" patient, finding a balance, and time constraints), patients as subjects, and the culture of the clinic. DISCUSSION AND CONCLUSION: The novice physical therapists in this study expressed difficulty in dealing with difficult patients, with time management, and with balancing their professional and personal lives. However, despite the barriers to caring, many of these participants viewed caring not just as a rules-based approach but as a core value and, in some cases, a moral orientation that guided their first year of clinical practice. The findings suggest that caring requires certain skills and attitudes that accrue over time and that physical therapist education programs should integrate learning experiences (including clinical experiences) throughout the curriculum that foster caring behaviors in order to prepare students for the first-year transition in the clinic. In addition, experienced clinicians should appreciate how their clinic's culture and their behaviors can help model caring attitudes in novice physical therapists.