The significance of the meal in Luke’s gospel

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Introduction: Reflections on the provision, organisation and management of social care in Ireland

This special edition of Administration is intended as a contribution to ongoing debates at a time when the policy and regulatory framework for social care in Ireland is undergoing significant reform. This reform is necessary in order to both rectify the deficiencies and gaps resulting from past failures as well as enhance capacity to address current and future demands. Future challenges will arise from economic, cultural and socio-demographic changes, but no doubt some will be due to the consequences (intended and unintended) of measures being put in place today or indeed due to failure by policymakers to act on certain issues

Identification of paper by stationary phase performance

Paper is an extraordinary example of a composite engineering material with practical use in a huge variety of applications. Since its invention in China there have been many alterations to manufacturing techniques, component formulation and surface finishing, but the essential characteristics of the product have not changed greatly. The objective of this experiment is to demonstrate that the chromatographic performance of paper as a stationary phase may be used to distinguish between externally-similar materials. The procedure developed is so simple that even students with little exposure to practical chemistry and limited chemical knowledge can understand the essential content. Because of the ubiquitous nature of paper, it is often recovered from crime scenes as evidence for analysis. However, the variety of sources and the mechanical or chemical properties often make demonstration of unequivocal correlation between “questioned” and “known” or “reference” samples a complex task. Introducing the practical session as a crime scene investigation, and presenting the laboratory exercise as an accessible forensic technique for paper identification, adds an exciting dimension to the practical experience for young people.Centro de Química (FEDER-COMPETE/QREN/EU and PEst C/QUI/U1686/2013, Fundação para a Ciência e Tecnologia)

OPTIMAL, an occupational therapy led self-management support programme for people with multimorbidity in primary care: a randomized controlled trial.

BACKGROUND: We investigated the effectiveness of an occupational therapy led self-management support programme, OPTIMAL, designed to address the challenges of living with multiple chronic conditions or multimorbidity in a primary care setting. METHODS: Pragmatic feasibility randomised controlled trial including fifty participants with multimorbidity recruited from family practice and primary care settings. OPTIMAL is a six-week community-based programme, led by occupational therapy facilitators and focuses on problems associated with managing multimorbidity. The primary outcome was frequency of activity participation. Secondary outcomes included self-perception of, satisfaction with and ability to perform daily activities, independence in activities of daily living, anxiety and depression, self-efficacy, health-related quality of life, self-management support, healthcare utilisation and individualised goal attainment. Outcomes were collected within two weeks of intervention completion. RESULTS: There was a significant improvement in frequency of activity participation, measured using the Frenchay Activities Index, for the intervention group compared to the control group (Adjusted Mean Difference at follow up 4.22. 95% Confidence Interval 1.59-6.85). There were also significant improvements in perceptions of activity performance and satisfaction, self-efficacy, independence in daily activities and quality of life. Additionally, the intervention group demonstrated significantly higher levels of goal achievement, following the intervention. No significant differences were found between the two groups in anxiety, depression, self-management scores or healthcare utilisation. CONCLUSIONS: OPTIMAL significantly improved frequency of activity participation, self-efficacy and quality of life for patients with multimorbidity. Further work is required to test the sustainability of these effects over time but this study indicates that it is a promising intervention that can be delivered in primary care and community settings. TRIAL NUMBER: ISRCTN67235963

The relational spaces of mentoring with young people 'at risk'

What is the political allure, value and currency of emotions within contemporary cultures of governance? What does it mean to govern more humanely? Since the emergence of an emotional turn in human geography over the last decade, the notion that our emotions matter in understanding an array of social practices, spatial formations and aspects of everyday life is no longer seen as controversial. This book brings recent developments in emotional geography into dialogue with social policy concerns and contemporary issues of governance. It sets the intellectual scene for research into the geographical dimensions of the emotionalized states of the citizen, policy maker and public service worker, and highlights new research on the emotional forms of governance which now characterise public life

Risk prediction models for melanoma: a systematic review.

Melanoma incidence is increasing rapidly worldwide among white-skinned populations. Earlier diagnosis is the principal factor that can improve prognosis. Defining high-risk populations using risk prediction models may help targeted screening and early detection approaches. In this systematic review, we searched Medline, EMBASE, and the Cochrane Library for primary research studies reporting or validating models to predict risk of developing cutaneous melanoma. A total of 4,141 articles were identified from the literature search and six through citation searching. Twenty-five risk models were included. Between them, the models considered 144 possible risk factors, including 18 measures of number of nevi and 26 of sun/UV exposure. Those most frequently included in final risk models were number of nevi, presence of freckles, history of sunburn, hair color, and skin color. Despite the different factors included and different cutoff values for sensitivity and specificity, almost all models yielded sensitivities and specificities that fit along a summary ROC with area under the ROC (AUROC) of 0.755, suggesting that most models had similar discrimination. Only two models have been validated in separate populations and both also showed good discrimination with AUROC values of 0.79 (0.70-0.86) and 0.70 (0.64-0.77). Further research should focus on validating existing models rather than developing new ones.This report is independent research arising from a Clinician Scientist award supported by the National Institute for Health Research (RG 68235) and J Usher-Smith is funded by a National Institute for Health Research Clinical LectureshipThis is the author accepted manuscript. The advanced access published version can be found on the publisher's website at: http://cebp.aacrjournals.org/content/early/2014/06/03/1055-9965.EPI-14-0295.abstrac

Beliefs about prescribed medication among older patients with polypharmacy: a mixed methods study in primary care

Background: Polypharmacy (≥5 medications) is common in older patients and is associated with adverse outcomes. Patients’ beliefs about medication can influence their expectations for medication, adherence, and willingness to deprescribe. Few studies have examined beliefs about prescribed medication among older patients with polypharmacy in primary care.Aim: To explore medication-related beliefs in older patients with polypharmacy and factors that might influence beliefs.Design and setting: A mixed methods study utilising data from a randomised controlled trial aiming to decrease potentially inappropriate prescribing in older patients (≥70 years) in Ireland.Method: Beliefs were assessed quantitatively and qualitatively. Participants completed the Beliefs about Medicines Questionnaire by indicating their degree of agreement with individual statements about medicines on a 5-point Likert scale. Semi-structured qualitative interviews were conducted with a purposive sample of participants. Interviews were transcribed verbatim and a thematic analysis conducted. Quantitative and qualitative data were analysed separately and triangulated during the interpretation stage.Results: In total, 196 patients were included (mean age 76.7 years, SD 4.9, 54% male), with a mean of 9.5 (SD 4.1) medications per patient. The majority (96.3%) believed strongly in the necessity of their medication, while 33.9% reported strong concerns. Qualitative data confirmed these coexisting positive and negative attitudes to medications and suggested the importance of patients’ trust in GPs in establishing positive beliefs and potential willingness to deprescribe.Conclusion: Participants reported strong beliefs in medications with coexisting positive and negative attitudes. The doctor–patient relationship may have influenced beliefs and attitudes towards medicines, highlighting the importance of strong doctor–patient relationships, which need to be considered in the context of deprescribin