East Of Ireland Research Articles

Caredoc Community Intervention Teams - Multidisciplinary Approaches to Delivering Care in the Community

Introduction: Caredoc Community Intervention Team (CIT) has been operating for 10 years and during that time has expanded its service to cover 6 regions in the South East of Ireland. A central objective of the service is delivering holistic and integrated care in the community that meets the needs of patients and their families. In 2021 the service model was enhanced to include Occupational Therapy and Physiotherapy professionals to the team to work collaboratively with Nursing colleagues, thereby reducing multiple hospital appointments and supporting early discharge from acute hospitals and community rehabilitation, particularly for elderly and clinically vulnerable patients, by shifting delivery of multidisciplinary care to patient’s homes.
 Aims, Objectives, Theory Or Methods: The CIT service is deployed 7 days a week, 365 days a year and bridges the gap between acute care and the patients who require it by providing access to timely, flexible, ongoing and personalised treatment in clients’ own homes for the duration of their illness, thus avoiding hospital admissions and enabling early supported discharge. For patients and their families this offers enormous relief and support, particularly while living with the Covid-19 pandemic, as the service provides a wide range of home-based assistance, from medication management to advice around necessary equipment and changes to the home environment to improve rehabilitation.
 Highlights Or Results Or Key Findings: Strong linkages with hospital and other community-based teams have been formed to ensure continuity of care for patients and optimisation of key healthcare resources – joint home visits with other CIT professionals involved in individual patients’ care have been coordinated to streamline and improve access to appropriate care. These links have also allowed for the co-design of structured referral pathways from local hospital clinics to the service, enabling the CIT Team to offer care to patients requiring regular monitoring at home, thereby reducing unnecessary hospital visits and supporting earlier supported discharge from acute hospitals. The impact of this interdisciplinary, collaborative approach has been hugely positive on patients’ health and wellbeing along with the additional benefit of decreasing pressure on hospital-based services.
 Conclusions: The diversity of disciplines within the CIT service ensures that all aspects of a patient’s recovery is managed, and the team’s on-going and effective communication strives to optimise individual treatment plans to achieve stabilisations, ensure patient safety, avoid hospital admission and enable supported earlier discharge. The team also provides acute nursing services to patients discharged to residential care, with the overall effect of increasing capacity and bed availability in local hospitals.
 Implications For Applicability/Transferability, Sustainability And Limitations: In just under a year of service the multidisciplinary CIT team carried out almost 10,000 visits to patient homes – each client referred to the service has an average of 3 encounters with the team, ensuring that multi-faceted reablement is achieved for patients while remaining in their own homes.

Risk and protective factors for cannabis use among young people - a population based survey

Abstract Background Cannabis is the most commonly used illicit substance in Ireland and globally, with its use most likely to occur in adolescence when the developing brain is more vulnerable to cannabis-related harm. This study aims to ascertain the prevalence of and determine the risk and protective factors for cannabis use among adolescents in the North East of Ireland. Methods This study is a cross-sectional, secondary analysis of the 2021 Planet Youth survey. The population comprised a sample of 4404 adolescents aged 15-16 in Cavan, Monaghan and North Dublin. The outcome of interest was cannabis use in the last 30 days. Independent variables were selected a priori following a literature review. Associations between cannabis use and the independent variables were explored using logistic regression. Results The prevalence of current cannabis use among study participants was 7.3%. The odds of cannabis use were higher among current alcohol users (aOR 2.68, CI 1.79-4.02), smokers (aOR 3.17, CI 2.18-4.60), e-cigarette users (aOR 2.72, CI 1.87-3.96), adolescents who did not perceive its use as harmful (aOR 2.24, CI 1.51-3.32), felt their parents were not against cannabis (aOR 3.71, CI 2.43-5.66), had cannabis-using peers (aOR 9.81, CI 5.76-16.71) or felt peer pressure to use cannabis (aOR 1.91, CI 1.09-3.33). Low parental supervision was associated with higher odds of cannabis use. There was no association between gender and cannabis use. Conclusions This study identified five risk factors and three protective factors associated with cannabis use which can be targeted by policymakers when designing drug prevention strategies.

Applying machine learning to model radon using topsoil geochemistry

Radon is classified as a Class 1 carcinogen, being the leading cause of lung cancer in non-smokers. Understanding the prominent sources of radon helps to mitigate against the adverse effects of radon exposure. Considering soil-gas radon is the main contributor to indoor radon, it is possible that soil geochemistry can be used as a proxy for the soil radon emanation potential or geogenic radon classes for a particular location. This paper investigates the relationship between soil geochemistry and geogenic radon. A large area of 17,983 km2 from the West, Midlands and East of Ireland was selected to represent a range of geology types and radon categories. A rigorous assessment is presented to investigate the relationship of geogenic radon and topsoil geochemistry; using univariate processes (i.e. r2, Pearson r and heatmaps) and multivariate techniques (i.e. principle component analysis (PCA) and machine learning (ML) algorithms including Gaussian process regression, logistic regression and random forest). Here, PCA and ML techniques were used to test the utility of soil geochemistry to predict geogenic radon classes. Gaussian Process Regression yielded the highest accuracy (74%) and f1-score (0.74) of all models. The feature importance (i.e. highest ranking elements for predicting geogenic radon class) from the ML models outputs elements including [Y, Tl, Mn, Cr, Co, Be, Sc and Rb]. The PCA biplot demonstrates that these elements cluster in conjunction with higher geogenic radon categories. Multivariate data analysis reveals that certain elements important for predicting higher geogenic radon classes, also covary together within topsoil samples; here these are termed “radon-prone elements”. Spatial covariance of radon-prone elements permits soil geochemistry to be used as a tool for understanding the distribution of geogenic radon. The methodology presented in this paper provides a comprehensive geo-statistical approach to investigate the relation between topsoil geochemistry and geogenic radon. This approach could be applied as a diagnostic tool to assist radon mitigation measures, hence adding value to legacy soil geochemistry datasets.

Tensions and dilemmas: a narrative inquiry account of a teacher-researcher

ABSTRACT This article reports on a teacher-researcher's efforts to understand tensions and dilemmas encountered during a doctoral narrative inquiry research project with eight children in an urban, multidenominational primary school in the east of Ireland. Using a narrative inquiry framework and focusing on the teacher-researcher's experiences, this article makes visible how tensions and dilemmas shaped the teacher-researcher's ongoing identity formation, the inquiry and offers insight to others so they may learn from these experiences. This article conceptualises tension as the bumping of lives [Clandinin, D. Jean, and Michael F. Connelly. 2000. Narrative Inquiry: Experience and Story in Qualitative Research. 1st ed. San Francisco: Jossey-Bass Publishers] and the irresolvable desire to have one's story told [Cavarero, Adriana. 2000. Relating Narratives: Storytelling and Selfhood. Florence: Routledge. https://doi.org/10.4324/9781315824574]. The narratives contained in this article were gathered across several arts-based workshops and include dialogue vignettes between children and the teacher-researcher, segments from the teacher-researcher’s fieldnotes and personal research journal. The article has implications for teachers who transition into doctoral studies and become teacher-researchers. Findings support the idea that problematic encounters faced while engaging in school-based research can be considered sites where new possibilities of understanding and knowing may emerge.

P59 Results of sentinel lymph node biopsies in thin melanomas (Breslow thickness 0.8–1.0 mm) and correlation with histopathological features

Abstract In July 2022, the National Institute for Health and Care Excellence (NICE) melanoma guidelines were updated to include recommendation for a sentinel lymph node (SLN) biopsy for those with a Breslow thickness of 0.8–1 mm and at least one of the following: ulceration, lymphovascular invasion and/or a mitotic index of ≥ 2 mm². SLN biopsy is a staging procedure and therefore has an impact on prognosis. However, SLN biopsy is an invasive procedure with associated morbidity. A 5-year retrospective review of melanoma data in the south east of Ireland was undertaken to establish the correlation between positive sentinel lymph node biopsies in 0.8–1.0-mm-thick melanomas and the risk factors outlined above. Melanoma outcomes, histopathology reports and outpatient clinic letters were assessed and data were extracted from 1 January 2018 to 31 December 2022 inclusive. A total of 52 patients were identified with a melanoma of Breslow thickness of 0.8–1 mm from the predetermined timeframe. Eight per cent (n = 4) of lesions were ulcerated. Thirteen per cent (n = 7) had a mitotic index of ≥ 2 mm². One lesion was both ulcerated and had a mitotic index of ≥ 2 mm². No lesions demonstrated lymphovascular invasion. Nineteen (36%) patients underwent SLN biopsy. All patients who underwent SLN biopsy were negative. One patient with an ulcerated melanoma did not undergo SLN biopsy and five with a mitotic index of ≥ 2 did not undergo SLN biopsy. There was no evidence of disease recurrence within the follow-up period (2 months–5 years). This population showed a 0% positivity rate on SLN biopsy. No correlation with mitotic index or ulceration and SLN biopsy was identified. No patients have developed local recurrence or metastatic disease within the follow-up period. This study supports the updated NICE guidance recommending SLN biopsies for thicker melanomas (i.e. Breslow thickness > 1.0 mm) and SLN biopsy in thinner melanomas (Breslow thickness 0.8–1 mm) only if concerning features are present on histology (i.e. ulceration, lymphovascular invasion and/or a mitotic index of ≥ 2).

Lessons from inter-disciplinary collaboration to mitigate SARS-CoV-2 transmission in schools, Ireland, 2020/2021, to inform health systems and multisectoral recovery.

School closures associated with the COVID-19 pandemic resulted in the loss of educational and social supports for up to 1,000,000 students in Ireland and disproportionately affected students from lower socio-economic backgrounds. For the 2020/2021 school year, multisectoral and interdisciplinary "Schools Teams" were established within Public Health departments to maintain in-person education by minimizing transmission of SARS-CoV-2 in schools. This study aimed to describe this model and explore the experiences of Schools Team members in the East of Ireland to identify factors that influenced effective working that can be sustained in the context of health systems and multisectoral recovery. Schools Teams were comprised of multidisciplinary staff from regional Public Health departments and redeployed staff from the Education sector. Governance rested with Public Health departments. All staff operated to nationally agreed protocols following training. The experiences of the East Schools Team members were explored through an online survey and semi-structured interviews. The survey response rate was 53/70 (75.7%). Participants reported clear channels of communication within the team (44, 83.0%), feeling comfortable in their role following training (43, 82.7%) and a positive team culture (51, 96.2%) as key facilitators of effective inter-disciplinary working. Insufficient administrative support and mixed messaging to schools were identified as barriers to efficient team collaboration. The Schools Team model illustrates the potential for multisectoral partnerships to effectively address complex public health priorities and contribute toward health system resilience to health threats. By recognizing and leveraging the ability of allied sectors such as the education sector, to contribute to public health goals, countries can move toward the kind of whole-of-government approach to health recognized as key to health system resilience. The strong links between the education and public health sectors developed through this collaboration could be extended and strengthened to more effectively pursue public health priorities in school settings. More broadly, mechanisms to support multisectoral working should be developed, expanding beyond reactive interventions to proactively address key health priorities and build resilience across health systems and communities. Such collaborations would promote healthier populations by promoting and encouraging a public health perspective among other sectors and embedding "health in all policies".

Genome Sequence of an Ungulate Tetraparvovirus 1 from a Nasal Swab of an Irish Beef-Suckler Calf.

Here, we report the genome sequence of strain UTPV1/AB belonging to the species Ungulate tetraparvovirus 1 (UTPV1). UTPV1/AB was isolated in the east of Ireland, directly from a nasal swab of a beef-suckler calf diagnosed with bovine respiratory disease on a farm in County Meath (longitude, 6°65'W; latitude, 53°52'N).

10 ASSISTED DECISION-MAKING, THE OLDER ADULT, AND LOCUS OF CONTROL

Abstract Background The Assisted Decision-making (Capacity) Act (ADMCA) (2015) will be fully commenced later in 2022. At its core, the legislation seeks to encourage the older adult to express their will and preferences regarding their healthcare decisions. The legislation removes healthcare decision-making powers from family members and healthcare professionals unless expressly nominated by the patient to make decisions on their behalf. However, a lack of clarity and professional uncertainty pervades this area in Ireland that is mirrored in the global research. Methods This qualitative study comprised 5 focus groups of hospital discharge coordinators in the South East of Ireland. It sought to examine the issues that exist for the older patient when they return home following a hospital stay. It also examined who really has responsibility for healthcare decision-making and who is responsible for providing the care? Thematic analysis was used to analyse the findings. Results The findings revealed a significant incongruence of beliefs among patients, family members and healthcare professionals when it comes to locus of control. Conclusion This study’s findings on locus of control – both in terms of where the discharge coordinators believe the locus is, and where they believe the families think it is - are the first of their kind in Irish Healthcare and are therefore highly significant in several respects. The substantive areas of disagreement in beliefs among the groups, represent real barriers to supporting ADMCA going forward.

Intrapreneurship and regional development in the South East of Ireland

ABSTRACT Intrapreneurship is known to play an important role in enhancing innovation and competitiveness within firms. However, there remains a dearth of literature on the workings of intrapreneurship at the regional level. Based on a qualitative analysis of intrapreneurship in the South East Region of Ireland, this paper explores the link between intrapreneurship and regional development. It makes several contributions that further the understanding of intrapreneurship at the regional level: (1) we detail the manner in which intrapreneurship emerges in distinct corporate contexts; (2) we identify the main barriers and challenges to intrapreneurship in these different contexts; and (3) we provide evidence that sets out the relative importance of the two key routes through which intrapreneurship stimulates regional development: firm growth and new firm formation.

Quantifying the role of the large-scale circulation on European summer precipitation change

Regional climate projections indicate that European summer precipitation may change considerably in the future. Southern Europe can expect substantial drying while Northern Europe could actually become wetter. Model spread and internal variability in these projections are large, however, and unravelling the processes that underlie the changes is essential to get more confidence in these projections. Large-scale circulation change is one of the contributors to model spread. In this paper we quantify the role of future large-scale circulation changes to summer precipitation change, using a 16-member single-model ensemble obtained with the regional climate model RACMO2, forced by the global climate model EC-Earth2.3 and the RCP8.5 emission scenario. Using the method of circulation analogues three contributions to the future precipitation change are distinguished. The first is the precipitation change occurring without circulation change (referred to as the thermodynamic term). This contribution is characterised by a marked drying-to-wetting gradient as one moves north from the Mediterranean. The second contribution measures the effects of changes in the mean circulation. It has a very different spatial pattern and is closely related to the development of a region of high pressure (attaining its maximum west of Ireland) and the associated anti-cyclonic circulation response. For a large area east of Ireland including parts of western Europe, it is the major contributor to the overall drying signal, locally explaining more than 90% of the ensemble-mean change. In regions where the patterns overlap, the signal-to-noise ratio of the total change is either enhanced or reduced depending on their relative signs. Although the second term is expected to be particularly model dependent, the high-pressure region west of Ireland also appears in CMIP5 and CMIP6 ensemble-mean projections. The third contribution records the effects of changes in the circulation variability. This term has the smallest net contribution, but a relatively large uncertainty. The analogues are very good in partitioning the ensemble-mean precipitation change, but describe only up to 40% of the ensemble-spread. This demonstrates that other precipitation-drivers (SST, spring soil moisture etc.) will generally strongly influence trends in single climate realisations. This also re-emphasises the need for large ensembles or using alternative methods like the Pseudo Global Warming approach where signal to noise ratios are higher. Nevertheless, identifying the change mechanisms helps to understand the future uncertainties and differences between models.

Human health risk assessment of lead (Pb) through the environmental-food pathway

Drinking water and farm-to-fork pathways have been identified as the predominant environmental pathways associated with human exposure (HE) to Pb. This study integrates a GIS-based survey of metal concentrations in soil and a probabilistic quantitative risk assessment of Pb through the food chain. The case study area was selected in the east of Ireland. A step-wise exposure assessment collated the data for Pb concentration in soil and water media, bioaccumulation of Pb in unprocessed food products, such as potatoes, carrots, green vegetables, and salad vegetables. The daily mean HE to Pb through selected food products was found to be 0.073 mg day−1, where a mean weekly exposure was estimated as 0.0065 mg kg body weight−1 week−1. Multiple risk estimates were used. Hazard Quotient (HQ), Daily Dietary Index (DDI), Daily Intake of Metal (DIM), Health Risk Index (HRI), Target Hazard Quotient (THQ) and Cancer Risk (CR) were found as 0.234 to 0.669, 0.002, 0.0002, 0.020 to 0.057, 0.234 to 0.669, and 0.00001, respectively which signify a low to moderate risk. A sensitivity analysis revealed that intake of potato is the most sensitive parameter of the model, which is positively correlated (coeff. + 0.66) followed by concentration of Pb in the arable soil (+0.49), bioaccumulation in tubers (+0.37), consumption of salad vegetables (+0.20), and consumption of green vegetables (+0.13) (top 5). A back-calculated limit of Pb in the soil (51 mg kg−1) justifies the lower threshold limit of Pb (50–300 mg kg−1) in agricultural soil set by the European Union to mitigate potential bio-transfer into food products. The study concludes there is a low to moderate risk posed by Pb, within the system boundary of the probabilistic model, and highlights the significance of limiting Pb concentrations in the vegetable producing agricultural soil.

921 Audit of Pre-Radiation Therapy Extractions at Dublin Dental University Hospital

Abstract Introduction The time between diagnosis of head and neck cancer and commencing treatment involves multi – disciplinary input from several specialities. Dental assessments are carried out prior to radiotherapy in order to instigate preventive care and remove all unrestorable teeth. Post – radiation dental extractions have been shown to increase the risk of osteoradionecrosis (ORN). Method Our hospital handles the majority of the pre - radiotherapy dental assessments in the east of Ireland. We examined the patient records of all patients attending the radiotherapy clinics between January 2018 and December 2019, assessing the time interval between the removal of teeth prior to radiotherapy and the start of radiotherapy. A secondary aim was to determine from the patient records whether any diagnosis of ORN was established post – radiation. Results 15 out of 147 patients had extractions less than 2 weeks prior to radiotherapy. In total, three patients developed ORN. One had extractions less than 2 weeks prior to radiotherapy, one had post radiotherapy extractions, while the other’s timing was unknown. Conclusions Most patients received timely care. A referral for dental assessment early in treatment planning is desirable. Despite the small sample size, an association between ORN and extractions just before and following radiotherapy was found.

Navigating indifference: Irish jobseekers’ experiences of welfare conditionality

Abstract This paper analyses the impact of the intensification of work-related conditionality on the lived experience of jobseekers in Ireland. Post-crisis Ireland has witnessed the emergence of a definitive policy trajectory which seeks to enable a lifelong attachment to the labour force through work-related conditionality buttressed by sanctions. This mode of governing unemployment attempts a restructuring of the caseworker–claimant relationship through increased engagement, claimant adherence to mandatory conditions, and surveillance underpinned by potential reduction, suspension or loss of benefit. The paper provides a qualitative investigation of the lived experience of this impact through a thematic analysis of forty-two interviews with jobseekers in a county in the east of Ireland. The focus on the agency of jobseekers illustrates a system based on superficial engagement in which conditionality primarily operates as bureaucratic formality. This is reflective of a systemic indifference to claimants’ needs and circumstances, producing a performance of feigned compliance in response.

Latch On: A protocol for a multi-centre, randomised controlled trial of perinatal support to improve breastfeeding outcomes in women with a raised BMI

IntroductionBreastfeeding is associated with improved maternal and child outcomes. Women with a higher body mass index (BMI), who comprise about 50% of the population, are at increased risk of poorer breastfeeding practices and are a population who would benefit from breastfeeding. MethodsThis protocol is for a multi-centre, randomised controlled trial of perinatal breastfeeding support among primiparous women with a BMI >25 kg/m2, using a previously-tested, multi-component intervention. The primary outcome is any breastfeeding at 3 months. The intervention will support mothers and their partners and spans from late pregnancy to six weeks postpartum. Intervention components include group antenatal breastfeeding education, individual face-to-face education in the immediate postnatal period, professional support to six weeks’ postpartum and weekly phone calls in the immediate postpartum period from an International Board Certified Lactation Consultant (IBCLC). The intervention will target attitudes towards breastfeeding, breastfeeding self-efficacy, and subjective norms around infant feeding with the aim to normalise the behaviour. ResultsWe anticipate that the intervention will be well-accepted and feasible to carry out within four maternity units in the East of Ireland. Furthermore, essential formative qualitative work has been conducted to inform the intervention design and to ensure that it is contextually appropriate. ConclusionThe proposed intervention will be invaluable to policy-makers in providing insights into what specific interventions are effective in improving breastfeeding rates for women with a raised BMI.

Adoption of Collaborative Robotics in Industry 5.0. An Irish industry case study

It is widely accepted that every country needs to be forward thinking to remain competitive in manufacturing in the twenty first century. Some European countries have the advantage of a rich history in automation and robotics in their manufacturing industries. Looking forward, Industry 5.0 will be the next industrial revolution, and will emanate from Industry 4.0. Collaborative Robotics will play a significant role by enabling humans and robots to work together in harmony. In 2021, as part of a doctoral thesis titled “Collaborative robotics in Industry 5.0” data were gathered for a case study in the south east of Ireland by the author of this paper. The results serve to provide an interesting benchmark for collaborative robotics in Irish industry. A brief summary of some of these results is shared here as well as ta novel conceptual framework and definition of Industry 5.0.

A comparison of high-end methods for topographic modelling of a coastal dune complex

In recent years, increasing tourism and development in the coastal dune area of the South East of Ireland have resulted in greater pressure on the environment, resulting in issues including soil erosion, flooding and habitat loss. Topographic mapping across a dune field is important for the development of targeted land management actions that maintain biodiversity and ecological functions. Developments in surveying technology, including LiDAR, terrestrial laser scanners (TLS) and aerial surveying from Remotely Piloted Aircraft Systems (RPAS), have enabled high-resolution and high-accuracy spatial data to be gathered quickly and relatively easily for 3D topographic modelling of a coastal dune complex. To-date, however, the relative efficacies of these three modelling methods, in the context of coastal dune modelling, has not been explored. This paper compares high-end methods based on LiDAR, TLS and RPAS technologies, for the topographic modelling of coastal dune complexes with particular reference to the Brittas-Buckroney dune complex in the South East of Ireland. The results identify the advantages and disadvantages of the respective technologies and highlight the efficacy of RPAS, in particular, for topographic modelling of coastal dune complexes. These results can provide reference information for others when selecting suitable methods for topographic modelling of similar environments.

Hydroptila lotensis Mosely, 1930, new to Ireland and a second Irish record of Hydroptila vectis Curtis, 1834, (Trichoptera: Hydroptilidae)

The caddisfly Hydroptila lotensis Mosely, 1930, (Trichoptera: Hydroptilidae) is added to the Irish list based on males and females collected on the River Liffey, Co. Kildare, in the east of Ireland. In addition, males and females of the caddisfly Hydroptila vectis Curtis, 1834, were taken on the River Dodder in Dublin City. This species was previously only known from Co. Donegal in north-west Ireland.

Electricity autoproduction, storage and billing: A case study at Dundalk Institute of Technology, Ireland

Dundalk Institute of Technology (DkIT) is a third-level college in the east of Ireland with approximately 5000 registered students. The college is an autoproducer with an 850-kW wind turbine in operation on campus. In this study, DkIT’s half-hourly electricity usage over the 2017/18 academic year was measured and the benefit of the wind turbine was assessed in terms of energy, cost and carbon savings. In the period studied, the college imported electricity at fixed time-of-use (TOU) rates, although an alternative billing approach that was analysed is half-hourly pricing (HHP) based on the system marginal price (SMP). Furthermore, after a sizing study, the operation of a large Li-ion battery to be used for time-shifting was modelled. Over the study year, the wind turbine was found to reduce the college’s required import of electricity substantially, while also creating some export. This decreased the net electricity cost and net carbon emissions considerably. Irrespective of this, switching to HHP would also have provided further substantial economic savings. Conversely, the modelled time-shifting using the battery generated far too little revenue to cover the associated costs, although reserving the battery for use in the Irish grid-response markets appears to be an economically viable option.

The effect of seeding rate on radiation interception, grain yield and grain quality of autumn sown oats

Abstract Oats are attracting increasing interest as a result of their nutritional and health benefits but increasing financial pressures are forcing growers to review all inputs including seed costs. High seeding rates are traditionally used for autumn sown oats in Ireland but it may be possible to use lower seed rates with resultant savings if oat plants can compensate for lower plant populations. A series of experiments were conducted in Ireland from 2015 to 2017 to investigate if lower seed rates could be used for autumn sown oats without compromising yield or quality. Experiments were conducted on both light and heavy soils at sites near Carlow in the centre of Ireland in which three oat varieties (Barra, Husky and Vodka) were grown at five seeding rates (100, 200, 300, 400 and 500 seeds/m2). Experiments were also conducted at Kildalton in the south east of Ireland in which the same three oat varieties were grown at five different seeding rates (125, 250, 375, 500 and 625 seeds/m2). Establishment decreased significantly with seeding rate. Oat plants at low plant populations developed additional grains primarily through an increase in the number of grains per panicle. At GS32, there was no significant difference in radiation interception between seeding rates from 200 seeds/m2 to 500 seeds/m2. The difference in yield between the lowest and highest seeding rate treatments was 1.1 t/ha at the Carlow sites and 0.7 t/ha at the Kildalton site. There were no significant difference in margin between seeding rate treatments at a grain price of €125/tonne. Grain quality was not affected by seeding rate. Autumn sown oats can compensate for low plant populations with the result that the seeding rates used in good sowing conditions can be reduced without any impact on margin or on grain quality.

Health system changes needed to support people consulting general practice out of hours services in Ireland

BackgroundMental illness acts as a barrier to accessing and obtaining effective medical care. It has been shown that out of hours services are an important first stop for emergency care for people experiencing mental health difficulties. However, little is in fact known about the use of out of hours general practice services by people experiencing mental health difficulties.AimTo establish the number and range of consultations that have a primary or related mental health issue attending general practitioner (GP) out of hours and to document adherence to their follow-up care referral.Design and settingDescriptive study in one large out of hours primary care service in the South East of Ireland (Caredoc).MethodsAn anonymous extraction of retrospective data from 1 year of the out of hours’ electronic database was undertaken. Patients who attended the out of hours with a possible mental health issue and were referred to the psychiatric services or back to their own GP, were tracked via phone follow-up with hospitals and GPs over 6 months to establish if they attended for the recommend follow-up care.ResultsOver a 1 year period, there were 3844 out of hours presentations with a mental health component. Overall, 9.3% were referred by the out of hours GP for follow-up to a hospital emergency department (ED) or were advised to attend their own GP. A total of 104 patients who were advised to attend their GP or ED following their consultation with the out of hours GP were tracked. Twenty-seven patients were referred back to their GP of which the follow-up call to the GP revealed that 44.5% did not attend. Seventy-seven patients were referred to the hospital services, of whom 37.7% did not attend.ConclusionsThere are significant challenges at the interface of primary care and secondary mental health services in Ireland. As expounded by the WHO and WONCA, in order to be effective and efficient, care for mental health must be coordinated with services at different levels of care complemented by the broader health system.