Keeping Faith in Humanitarianism

Compassion that drives the humanitarian service of Christian, faith-based agencies transcends process and policy through informed practices leading to positive and compassionate engagement bringing transformational change among people in calamity and unjust systems. This dissertation explores the transformative role that faithbased agencies need to play in contemporary humanitarianism in order to span the gap between procedure and mercy in action. Further, it is an examination of theological, historical and practical applications of compassion at work demonstrating God’s unconditional love to all of humanity. Faith-based humanitarian agencies struggle to serve marginalized communities and people groups, but are pulled in different directions by stakeholders. Donors who are highly motivated toward proclamation, expect a strong Gospel message. Local communities desire significant inputs to bring visible and tangible change. Institutional donors expect clear goals and outputs that belie evidence-based results. Local governments may welcome faith-based agencies but forbid religious proclamation especially where Christianity is a minority religion. Faith-based agencies are held to the same standards which govern all humanitarian agencies, creating new and complex challenges to serving the poor as ambassadors of God’s good will and love. Part One deals with the unique historical and contemporary context within which faith-based humanitarian agencies operate. The reality and complexity of structure and policy, and the demand to meet greater humanitarian needs creates an environment of scrutiny and competition to fund, staff, resource and implement larger and more complex interventions. These developments are examined and reviewed in the light of contemporary agencies that have developed along parallel paths yet compete for resources. Part Two reviews theological underpinnings of faith-based humanitarianism. Beginning with a biblical reflection on the design and concept of neighborliness and concludes with three case studies along the themes of Justice, Policy and Mission providing a framework for understanding practical applications of mercy in action. Content Reader: Kurt Fredrickson, Ph

Investigating post-stroke fatigue: An individual participant data meta-analysis

The prevalence of post-stroke fatigue differs widely across studies, and reasons for such divergence are unclear. We aimed to collate individual data on post-stroke fatigue from multiple studies to facilitate high-powered meta-analysis, thus increasing our understanding of this complex phenomenon.Methods: We conducted an Individual Participant Data (IPD) meta-analysis on post-stroke fatigue and its associated factors. The starting point was our 2016 systematic review and meta-analysis of post-stroke fatigue prevalence, which included 24 studies that used the Fatigue Severity Scale (FSS). Study authors were asked to provide anonymised raw data on the following pre-identified variables: (i) FSS score, (ii) age, (iii) sex, (iv) time post-stroke, (v) depressive symptoms, (vi) stroke severity, (vii) disability, and (viii) stroke type. Linear regression analyses with FSS total score as the dependent variable, clustered by study, were conducted.Results: We obtained data from 14 of the 24 studies, and 12 datasets were suitable for IPD meta-analysis (total n = 2102). Higher levels of fatigue were independently associated with female sex (coeff. = 2.13, 95% CI 0.44–3.82, p = 0.023), depressive symptoms (coeff. = 7.90, 95% CI 1.76–14.04, p = 0.021), longer time since stroke (coeff. = 10.38, 95% CI 4.35–16.41, p = 0.007) and greater disability (coeff. = 4.16, 95% CI 1.52–6.81, p = 0.010). While there was no linear association between fatigue and age, a cubic relationship was identified (p < 0.001), with fatigue peaks in mid-life and the oldest old.Conclusion: Use of IPD meta-analysis gave us the power to identify novel factors associated with fatigue, such as longer time since stroke, as well as a non-linear relationship with age

Identification and Genome-Wide Prediction of DNA Binding Specificities for the ApiAP2 Family of Regulators from the Malaria Parasite

The molecular mechanisms underlying transcriptional regulation in apicomplexan parasites remain poorly understood. Recently, the Apicomplexan AP2 (ApiAP2) family of DNA binding proteins was identified as a major class of transcriptional regulators that are found across all Apicomplexa. To gain insight into the regulatory role of these proteins in the malaria parasite, we have comprehensively surveyed the DNA-binding specificities of all 27 members of the ApiAP2 protein family from Plasmodium falciparum revealing unique binding preferences for the majority of these DNA binding proteins. In addition to high affinity primary motif interactions, we also observe interactions with secondary motifs. The ability of a number of ApiAP2 proteins to bind multiple, distinct motifs significantly increases the potential complexity of the transcriptional regulatory networks governed by the ApiAP2 family. Using these newly identified sequence motifs, we infer the trans-factors associated with previously reported plasmodial cis-elements and provide evidence that ApiAP2 proteins modulate key regulatory decisions at all stages of parasite development. Our results offer a detailed view of ApiAP2 DNA binding specificity and take the first step toward inferring comprehensive gene regulatory networks for P. falciparum

Irish National Audit of Stroke organisational audit report 2021

This is the third national audit of the organisation of acute hospital stroke services in Ireland and the first under the governance of the National Office of Clinical Audit. The first audit examining the organisation of stroke care took place in 2006 and it found that only one hospital had a stroke unit, that access to acute treatments such as thrombolysis  was very limited, and that the patient journey was fragmented and poorly organised.</p

The association between increasing oral anticoagulant prescribing and atrial fibrillation related stroke in Ireland

Aims: Recent increases in the number of patients with atrial fibrillation (AF) prescribed oral anticoagulants (OAC) are evident in Ireland and internationally, largely due to the availability of direct oral anticoagulants (DOACs). This study aimed to determine the rate of stroke in the context of increasing anticoagulation utilisation, with a focus on AF-related ischaemic stroke (IS).Methods: Dispensing data for OACs were identified for the period 2010-2018 as well as hospital discharges for IS (2005-2018). Irish National Stroke Register data were used to elucidate the characteristics of patients with acute ischaemic stroke.Results: The number of patients prescribed OACs increased by 94% from 2010-2018 with a significant change from 2013 (β = 2.57, P = .038), associated with a large increase in the number of patients on DOACs. There was 3.3-fold increase in expenditure on OACs nationally from 2013 to 2018, of which 94% was DOAC related. Using the 2013 timepoint, ischaemic stroke rates until 2018 did not show a significant deviation from the previous trend (β = 0.00, P = .898). The percentage of AF-related ischaemic stroke was stable from 2013 to 2017 with a 4.5% decrease in 2018. The percentage of ischaemic stroke patients with previously diagnosed AF decreased from 2013 to 2018; however, there was an increase in the percentage of ischaemic strokes while on OAC in this cohort.Conclusion: Large increases in OAC utilisation have not resulted in changes in ischaemic stroke rates at a national level. The percentage of ischaemic strokes with a previous diagnosis of AF has decreased indicating a possible benefit from greater OAC utilisation. However, the percentage presenting with an ischaemic stroke while on OAC treatment is increasing. The increase in patients presenting with stroke while treated with OAC may largely reflect the national increase in patients prescribed DOACs but the findings raise concerns about treatment failures. The real-world effectiveness of DOACs requires further examination.</div

Irish National Audit of Stroke: a critical review of national stroke data for Ireland from 2013 to 2021

In the European Union (EU) stroke is the second most common  cause of death and a leading cause of adult disability. As populations continue to grow and live to an older age, stroke and the long-term sequelae, along with the corresponding costs, are expected to increase dramatically (The Stroke Alliance for Europe, 2020; Bennett et al., 2014). Treatment for stroke has advanced greatly since the 1990s, and there is strong evidence that stroke unit care with multidisciplinary team input will reduce disability and mortality and will benefit all patients with a stroke. Patients with ischaemic stroke who present early after symptom  onset will benefit from emergency  treatments such as thrombolysis and thrombectomy (Organisation for Economic Co-operation and Development, 2015). </p

Irish National Audit of Stroke National Report 2022

This is the fourth Irish National Audit of Stroke (INAS) annual report and is presented in a condensed format with hyperlinks to the appendices and supporting documentation. The  report  presents  the  key  findings  from  analysis  of  the  complete  dataset,  which  is  available in the INAS National Reporting Table 2022.</p

Irish National Audit of Stroke National Report 2020

Stroke remains the third leading cause of death in Ireland and Western Europe, and the leading cause of severe, adult-onset physical disability. We report on patients aged 17 years and over who were treated in the 24 public hospitals that provide acute stroke care in Ireland and that admit more than 25 stroke cases annually. Data are typically collected by stroke services on behalf of the participating hospitals. In order to be included in the audit report, hospitals must have collected data on more than 80% of patients with a stroke. This year’s report incorporates data from the 23 participating hospitals that met the mandatory 80% coverage threshold; overall, despite the effects of the coronavirus disease 2019 (COVID-19) pandemic, coverage improved from 83% to 93% across the hospital system for patients with a stroke identified through the Hospital In-Patient Enquiry (HIPE) system as having been admitted with acute stroke, either ischaemic or haemorrhagic. The audit does not currently collect data on subarachnoid haemorrhage; however, we are exploring how these data may be effectively incorporated in future years’ audits. Because of the increased coverage, the number of individuals on whom data have been collected increased by more than 20% in 2020 from 2019. This important increase in coverage does appear to have led to substantial changes in proportional outcomes for most variables, but caution should be exercised in interpretation of minor changes from previous years.</div

Irish National Audit of Stroke National Report 2019

INTRODUCTION Stroke is the third leading cause of death in Western Europe and is the leading cause of severe long-term adult disability (The Stroke Alliance for Europe, 2020). Stroke is an important health issue for people in Ireland, with approximately 5,500 adults admitted to hospitals with a stroke in 2019. Stroke can affect people physically, emotionally and socially. It has a significant impact on Health Service Executive (HSE) resources, accounting for up to 4% of total health expenditure annually (Health Information and Quality Authority, 2017a). Although the economic costs of stroke in terms of lost employment and the cost of support in the community are significant, the impact on family members or friends who care for stroke survivors is massive. It is therefore important that all hospitals providing acute stroke services deliver high-quality and equitable stroke care. </p