Asylum in Ireland - a public health perspective

This report has two elements, first a review of the literature on refugees and asylum seekrs, with particular to the legal and practical situation in Ireland, and secondly a report of a survey of refugees and asylum seekers carried out in part fulfillment of the requirments for the MPH. The survey had two elements, one a quantitaitve stuy carried out in Dublin and Ennis, and the second a series of focus groups

Current commands for high-efficiency torque control of DC shunt motor

The current commands for a high-efficiency torque control of a DC shunt motor are described. In the proposed control method, the effect of a magnetic saturation and an armature reaction are taken into account by representing the coefficients of an electromotive force and a torque as a function of the field current, the armature current and the revolving speed. The current commands at which the loss of the motor drive system becomes a minimum are calculated as an optimal problem. The proposed control technique of a motor is implemented on the microprocessor-based control system. The effect of the consideration of the magnetic saturation and the armature reaction on the produced torque and the minimisation of the loss are discussed analytically and experimentally </p

ENIGMA and global neuroscience: A decade of large-scale studies of the brain in health and disease across more than 40 countries

This review summarizes the last decade of work by the ENIGMA (Enhancing NeuroImaging Genetics through Meta Analysis) Consortium, a global alliance of over 1400 scientists across 43 countries, studying the human brain in health and disease. Building on large-scale genetic studies that discovered the first robustly replicated genetic loci associated with brain metrics, ENIGMA has diversified into over 50 working groups (WGs), pooling worldwide data and expertise to answer fundamental questions in neuroscience, psychiatry, neurology, and genetics. Most ENIGMA WGs focus on specific psychiatric and neurological conditions, other WGs study normal variation due to sex and gender differences, or development and aging; still other WGs develop methodological pipelines and tools to facilitate harmonized analyses of "big data" (i.e., genetic and epigenetic data, multimodal MRI, and electroencephalography data). These international efforts have yielded the largest neuroimaging studies to date in schizophrenia, bipolar disorder, major depressive disorder, post-traumatic stress disorder, substance use disorders, obsessive-compulsive disorder, attention-deficit/hyperactivity disorder, autism spectrum disorders, epilepsy, and 22q11.2 deletion syndrome. More recent ENIGMA WGs have formed to study anxiety disorders, suicidal thoughts and behavior, sleep and insomnia, eating disorders, irritability, brain injury, antisocial personality and conduct disorder, and dissociative identity disorder. Here, we summarize the first decade of ENIGMA's activities and ongoing projects, and describe the successes and challenges encountered along the way. We highlight the advantages of collaborative large-scale coordinated data analyses for testing reproducibility and robustness of findings, offering the opportunity to identify brain systems involved in clinical syndromes across diverse samples and associated genetic, environmental, demographic, cognitive, and psychosocial factors

The impact of COVID-19 on an Irish Emergency Department (ED): a cross-sectional study exploring the factors infuencing ED utilisation prior to and during the pandemic from the patient perspective

Background: The collateral damage of SARS-CoV-2 is a serious concern in the Emergency Medicine (EM) community,  specifcally in relation to delayed care increasing morbidity and mortality in attendances unrelated to COVID-19. The  objectives of this study are to describe the profle of patients attending an Irish ED prior to, and during the pandemic,  and to investigate the factors infuencing ED utilisation in this cohort. Methods: This was a cross-sectional study with recruitment at three time-points prior to the onset of COVID-19 in  December 2019 (n=47) and February 2020 (n=57) and post-Lockdown 1 in July 2020 (n=70). At each time-point all  adults presenting over a 24h period were eligible for inclusion. Clinical data were collected via electronic records and  a questionnaire provided information on demographics, healthcare utilisation, service awareness and factors infu?encing the decision to attend the ED. Data analysis was performed in SPSS and included descriptive and inferential  statistics. Results: The demographic and clinical profle of patients across time-points was comparable in terms of age  (p=0.904), gender (p=0.584) and presenting complaint (p=0.556). Median length of stay in the ED decreased from  7.25h (IQR 4.18–11.22) in February to 3.86h (IQR 0.41–9.14) in July (p≤0.005) and diferences were observed in dispo?sition (p≤0.001). COVID-19 infuenced decision to attend the ED for 31% of patients with 9% delaying presentation.  Post-lockdown, patients were less likely to attend the ED for reassurance (p≤0.005), for a second opinion (p≤0.005)  or to see a specialist (p≤0.05). Conclusions: Demographic and clinical presentations of ED patients prior to the frst COVID-19 lockdown and dur?ing the reopening phase were comparable, however, COVID-19 signifcantly impacted health-seeking behaviour and  operational metrics in the ED at this phase of the pandemic. These fndings provide useful information for hospitals  with regard to pandemic preparedness and also have wider implications for planning of future health service delivery </p

The “better data, better planning” census: a cross-sectional, multi-centre study investigating the factors influencing patient attendance at the emergency department in Ireland

Background: Internationally Emergency Department (ED) crowding is a signifcant health services delivery issue  posing a major risk to population health. ED crowding affects both the quality and access of health services and is  associated with poorer patient outcomes and increased mortality rates. In Ireland the practising of “Corridor Medicine”  and “Trolley Crises” have become prevalent. The objectives of this study are to describe the demographic and clinical  profle of patients attending regional EDs and to investigate the factors infuencing ED utilisation in Ireland. Methods: This was a multi-centre, cross-sectional study and recruitment occurred at a selection of urban and rural  EDs (n=5) in Ireland throughout 2020. At each site all adults presenting over a 24 h census period were eligible for  inclusion. Clinical data were collected via electronic records and a questionnaire provided information on demographics, healthcare utilisation, service awareness and factors infuencing the decision to attend the ED. Results: Demographics difered signifcantly between ED sites in terms of age (p≤0.05), socioeconomic status  (p≤0.001), and proximity of health services (p≤0.001). Prior to ED attendance 64% of participants accessed community health services. Most participants (70%) believed the ED was the “best place” for emergency care or attended due to lack of awareness of other services (30%). Musculoskeletal injuries were the most common reason for presentation  to the ED in this study (24%) and almost a third of patients (31%) reported presenting to the ED for an x-ray or scan. Conclusions: This study has identifed regional and socioeconomic diferences in the drivers of ED presentations  and factors infuencing ED attendance in Ireland from the patient perspective. Improved awareness of, and provision  of alternative care pathways could potentially decrease ED attendances, which would be important in the context of  reducing ED crowding during the COVID-19 pandemic. New strategies for integration of acute care in the community  must acknowledge and plan for these issues as a universal approach is unlikely to be implemented successfully due  to regional factors </p

Clinician consensus on “Inappropriate” presentations to the emergency department in the better data, better planning (BDBP) census: a cross-sectional multi-centre study of emergency department utilisation in Ireland

Background Utilisation of the Emergency Department (ED) for non-urgent care increases demand for services, therefore reducing inappropriate or avoidable attendances is an important area for intervention in prevention of ED crowding. This study aims to develop a consensus between clinicians across care settings about the “appropriateness” of attendances to the ED in Ireland. Methods The Better Data, Better Planning study was a multi-centre, cross-sectional study investigating factors influencing ED utilisation in Ireland. Data was compiled in patient summary files which were assessed for measures of appropriateness by an academic General Practitioner (GP) and academic Emergency Medicine Consultant (EMC) National Panel. In cases where consensus was not reached charts were assessed by an Independent Review Panel (IRP). At each site all files were autonomously assessed by local GP-EMC panels. Results The National Panel determined that 11% (GP) to 38% (EMC) of n=306 lower acuity presentations could be treated by a GP within 24-48 h (k=0.259; p<0.001) and that 18% (GP) to 35% (EMC) of attendances could be considered “inappropriate” (k=0.341; p<0.001). For attendances deemed “appropriate” the admission rate was 47% compared to 0% for “inappropriate” attendees. There was no consensus on 45% of charts (n=136). Subset analysis by the IRP determined that consensus for appropriate attendances ranged from 0 to 59% and for inappropriate attendances ranged from 0 to 29%. For the Local Panel review (n=306) consensus on appropriateness ranged from 40 to 76% across ED sites Conclusions Multidisciplinary clinicians agree that “inappropriate” use of the ED in Ireland is an issue. However, obtaining consensus on appropriateness of attendance is challenging and there was a significant cohort of complex heterogenous presentations where agreement could not be reached by clinicians in this study. This research again demonstrates the complexity of ED crowding, the introduction of evidence-based care pathways targeting avoidable presentations may serve to alleviate the problem in our EDs.</p

Clinician consensus on "inappropriate" presentations to the Emergency Department in the Better Data, Better Planning (BDBP) census: a cross-sectional multi-centre study of Emergency Department utilisation in Ireland

Background: Utilisation of the Emergency Department (ED) for non-urgent care increases demand for services, therefore reducing inappropriate or avoidable attendances is an important area for intervention in prevention of ED crowding. This study aims to develop a consensus between clinicians across care settings about the "appropriateness" of attendances to the ED in Ireland. Methods: The Better Data, Better Planning study was a multi-centre, cross-sectional study investigating factors influencing ED utilisation in Ireland. Data was compiled in patient summary files which were assessed for measures of appropriateness by an academic General Practitioner (GP) and academic Emergency Medicine Consultant (EMC) National Panel. In cases where consensus was not reached charts were assessed by an Independent Review Panel (IRP). At each site all files were autonomously assessed by local GP-EMC panels. Results: The National Panel determined that 11% (GP) to 38% (EMC) of n = 306 lower acuity presentations could be treated by a GP within 24-48 h (k = 0.259; p Conclusions: Multidisciplinary clinicians agree that "inappropriate" use of the ED in Ireland is an issue. However, obtaining consensus on appropriateness of attendance is challenging and there was a significant cohort of complex heterogenous presentations where agreement could not be reached by clinicians in this study. This research again demonstrates the complexity of ED crowding, the introduction of evidence-based care pathways targeting avoidable presentations may serve to alleviate the problem in our EDs.</p

Clinician consensus on "inappropriate" presentations to the Emergency Department in the Better Data, Better Planning (BDBP) census: a cross-sectional multi-centre study of Emergency Department utilisation in Ireland

Background: Utilisation of the Emergency Department (ED) for non-urgent care increases demand for services, therefore reducing inappropriate or avoidable attendances is an important area for intervention in prevention of ED crowding. This study aims to develop a consensus between clinicians across care settings about the "appropriateness" of attendances to the ED in Ireland. Methods: The Better Data, Better Planning study was a multi-centre, cross-sectional study investigating factors influencing ED utilisation in Ireland. Data was compiled in patient summary files which were assessed for measures of appropriateness by an academic General Practitioner (GP) and academic Emergency Medicine Consultant (EMC) National Panel. In cases where consensus was not reached charts were assessed by an Independent Review Panel (IRP). At each site all files were autonomously assessed by local GP-EMC panels. Results: The National Panel determined that 11% (GP) to 38% (EMC) of n = 306 lower acuity presentations could be treated by a GP within 24-48 h (k = 0.259; p Conclusions: Multidisciplinary clinicians agree that "inappropriate" use of the ED in Ireland is an issue. However, obtaining consensus on appropriateness of attendance is challenging and there was a significant cohort of complex heterogenous presentations where agreement could not be reached by clinicians in this study. This research again demonstrates the complexity of ED crowding, the introduction of evidence-based care pathways targeting avoidable presentations may serve to alleviate the problem in our EDs.</p

ENIGMA and the individual: Predicting factors that affect the brain in 35 countries worldwide.

In this review, we discuss recent work by the ENIGMA Consortium (http://enigma.ini.usc.edu) - a global alliance of over 500 scientists spread across 200 institutions in 35 countries collectively analyzing brain imaging, clinical, and genetic data. Initially formed to detect genetic influences on brain measures, ENIGMA has grown to over 30 working groups studying 12 major brain diseases by pooling and comparing brain data. In some of the largest neuroimaging studies to date - of schizophrenia and major depression - ENIGMA has found replicable disease effects on the brain that are consistent worldwide, as well as factors that modulate disease effects. In partnership with other consortia including ADNI, CHARGE, IMAGEN and others1, ENIGMA's genomic screens - now numbering over 30,000 MRI scans - have revealed at least 8 genetic loci that affect brain volumes. Downstream of gene findings, ENIGMA has revealed how these individual variants - and genetic variants in general - may affect both the brain and risk for a range of diseases. The ENIGMA consortium is discovering factors that consistently affect brain structure and function that will serve as future predictors linking individual brain scans and genomic data. It is generating vast pools of normative data on brain measures - from tens of thousands of people - that may help detect deviations from normal development or aging in specific groups of subjects. We discuss challenges and opportunities in applying these predictors to individual subjects and new cohorts, as well as lessons we have learned in ENIGMA's efforts so far