Do Consultation Charges Deter General Practitioner Use Among Older People? A Natural Experiment. ESRI WP194. May 2007

Background: A change in the pricing of general practitioner care in the Republic of Ireland in 2001 provides a natural experiment of the influence of economic incentives on GP visiting. Methods: Social surveys (N=937 in 2000 & N=1053 in 2004) were carried out before and after the change in pricing arrangements. OLS and logistic regression were used to examine change in both the overall probability of attending the GP and the frequency of visiting in the previous year. Results: 93% in 2000 and 95% in 2004 visited their GP at least once. Where the proportion of those aged 65 to 69 visiting at least once fell by 1% between 2000 and 2004, the proportion aged 70 to 74 increased by 4.6%; those 75 to 79 increased by 6.3%; those aged 80 to 84 increased by 3.2%. Frequency of visiting remained stable at 5.3 visits per year but increased with age and worse health. Logistic regression models confirmed the increase in the probability of visiting for over 70s between 2000 and 2004

The Regional Dimension of Taxes and Public Expenditure in Ireland. ESRI WP195. May 2007

In Ireland as in many other countries there has been an ongoing debate on the nature, degree and trends of regional imbalance. However, relatively little is known about the effects of policies at the regional level in Ireland. This paper considers two aspects of public policy namely the fiscal system and public expenditure. In particular regional government accounts are constructed, which identify the level of taxation, subsidisation and public expenditure at the regional level. The analysis of this data confirms that the fiscal system does reduce relative income differences in Ireland. Furthermore there are substantial resource transfers across regions

Alternate metabolism during the dauer stage of the nematode Caenorhabditis elegans

When environmental conditions are unsuitable to support nematode reproduction, Caenorhabditis elegans arrests development before the onset of sexual maturity and specialised âdauerâ larvae, adapted for dispersal, and extended diapause are formed. Dauer larvae do not feed and their metabolism is dependent on internal food reserves. Adult worms which express defects in the insulin/insulin-like growth factor receptor DAF-2 also display enhanced longevity. Whole genome mRNA expression profiling has demonstrated that C. elegans dauer larvae and daf-2 adults have similar transcription profiles for a cohort of longevity genes. Important components of this enhanced longevity system are the a-crystallin family of small heat shock proteins, anti-ROS defence systems, increased activity of cellular detoxification processes and possibly also increased chromatin stability and decreased protein turnover. Anaerobic fermentation pathways are upregulated in dauer larvae, while long-lived daf-2 adults appear to have normal oxidative metabolism. Anabolic pathways are down regulated in dauer larvae (and possibly in daf-2 adults as well), and energy consumption appears to be diverted to enhanced cellular maintenance and detoxification processes in both systems

Transformative Pedagogies for Gaelic Revitalisation : Report to Soillse of a study of Gaelic-medium teachers' perspectives on the potential of translanguaging as a classroom pedagogy

Summary: This report This report presents the findings from a small-scale study of teachers’ views on the potential of translanguaging as a classroom pedagogy in Gaelic-medium education (GME). What is translanguaging? Translanguaging refers to the pedagogical use of two languages in a language immersion classroom: both the target language (i.e. Gaelic in Gaelic-medium classrooms), and the other language widely spoken by pupils in the class (i.e. English in the case of most Gaelic-medium pupils). Interest in translanguaging as a pedagogical strategy initially emerged in Welsh-medium education in the 1990s, but has grown world-wide, particularly over the last decade. Several studies have been conducted in Wales and in the USA, and researchers in the Basque Country and in Ireland are beginning to explore the potential of this approach. As far as we are aware, there have been no Scottish studies to date. What are the potential benefits of translanguaging as a pedagogical strategy? It is argued that translanguaging benefits learners in language immersion settings because it facilitates the development of flexible bilingualism – the ability to move easily between two languages – and that this is a factor underpinning certain cognitive advantages that bilinguals are known to acquire by virtue of using two languages from an early age. More pragmatically, proponents of translanguaging argue that it supports both content and language learning in immersion settings, because pupils learn to draw on both their languages to understand and process information. Research methods: As translanguaging is not currently in use as a pedagogical strategy in GME schools, this study set out to explore teachers’ perspectives on its potential. Six groups of practising and prospective GME teachers were invited to take part in professional development sessions run by the researchers. Following a pre-session reading from Colin Baker’s Foundations of Bilingual Education and Bilingualism (2011) on translanguaging (pp 288-291), each session consisted of a presentation in which the researchers introduced translanguaging to the group; and a focus group discussion, facilitated by the researchers, in which the participants were asked to comment and explore the ideas they had encountered. There were 17 participants in total, from two primary and two secondary schools, and in each case, one from an urban and one from an island location; and a group of future GME teachers, which included prospective primary and secondary teachers. Teachers in this group were adult learners of Gaelic. Analysis: The focus group discussions, which largely took place in Gaelic, were recorded and transcribed, and have been analysed, using a thematic content analysis approach. Findings: concerns and questions The findings indicate that participants had significant concerns about translanguaging. They also raised a number of questions about possible use in GME classrooms. Their concerns derived from a sense that translanguaging is counter-intuitive in the context of language immersion, where the assumption is that the greater the exposure to Gaelic, the better children will acquire it. It contradicts current policy and practice, which mandate Gaelic at all times in the early years and a gradual, but strictly limited introduction of English from the mid primary years onwards. There is a strong consensus among teachers, policy-makers, parents, pupils and the wider community concerned with GME that this approach effectively secures GME pupils’ Gaelic and supports Gaelic revitalisation. Their questions reflect a recognition that English is, nevertheless, in use in GME classrooms, principally because a lack of resources in Gaelic sometimes entails the use of resources in English (particularly online resources). The discussion focused on how these resources are used, and how teachers scaffold the work based on them, to enable pupils to move from English to Gaelic in discussions and written outputs. This led to consideration of whether particular subject areas or particular stages in pupils’ careers are more suited to translanguaging, and whether translanguaging could mediate tensions that teachers sometimes encounter between the demands of ensuring that pupils develop high standards of competence in Gaelic and expectations that pupils will cover the same curriculum as their peers in English-medium classrooms. Participants recognised that the emphasis that proponents of translanguaging place on pupils’ emerging bilingualism differs in some respects from the current focus in GME on pupils’ competence in Gaelic. They considered whether there would be advantages in adopting a pedagogical approach which more overtly addresses this aspect of immersion pupils’ learning. They identified a number of areas in which translanguaging might be of benefit, including helping pupils to make connections between Gaelic and English; helping them to develop metalinguistic awareness in relation to both languages; supporting the learning of a third language; helping pupils to learn through another language; and engaging parents more effectively in their children’s learning. However, they concluded that more research would be needed to demonstrate that translanguaging effectively delivers these kinds of benefits; and that much work would be needed to change current attitudes, given the consensus that current provision meets both learner needs and revitalisation goals. Discussion: In our discussion of the findings, we focus on the following questions that the work has raised for us: •Why is translanguaging on the rise? •What are the goals of Gaelic-medium education and to what extent do current policy and practice achieve these? •How is English currently used in GME classrooms? What are the implications a) for the development of children’s Gaelic; b) for the development of their bilingualism; c) for children’s learning? •Can translanguaging benefit minoritised languages? Conclusions and recommendations In conclusion, we briefly review the most recent literature on translanguaging as a transformative pedagogical strategy noting, critically, that this entails a move from a language immersion model based on the concept of additive bilingualism (where learners add new languages without detriment to those they already know) to dynamic bilingualism (where learners use and expand their full linguistic repertoire to learn). In line with this literature, participants in our study recognised their responsibilities to GME pupils in relation to supporting content learning and providing opportunities to develop appropriate linguistic practices for academic purposes; and expressed a cautious interest in the potential of translanguaging to enhance this work. They also noted challenges in relation to opportunities for recognising pupils’ bilingualism and emerging bilingual identities. Participants felt that further research was needed to establish the effectiveness of translanguaging and we support this view, recommending, therefore, that a research agenda is developed in collaboration with all stakeholders

Stroke awareness in the general population: knowledge of stroke risk factors and warning signs in older adults

<p>Abstract</p> <p>Background</p> <p>Stroke is a leading cause of death and functional impairment. While older people are particularly vulnerable to stroke, research suggests that they have the poorest awareness of stroke warning signs and risk factors. This study examined knowledge of stroke warning signs and risk factors among community-dwelling older adults.</p> <p>Methods</p> <p>Randomly selected community-dwelling older people (aged 65+) in Ireland (n = 2,033; 68% response rate). Participants completed home interviews. Questions assessed knowledge of stroke warning signs and risk factors, and personal risk factors for stroke.</p> <p>Results</p> <p>Of the overall sample, 6% had previously experienced a stroke or transient ischaemic attack. When asked to identify stroke risk factors from a provided list, less than half of the overall sample identified established risk factors (e.g., smoking, hypercholesterolaemia), hypertension being the only exception (identified by 74%). Similarly, less than half identified established warning signs (e.g., weakness, headache), with slurred speech (54%) as the exception. Overall, there were considerable gaps in awareness with poorest levels evident in those with primary level education only and in those living in Northern Ireland (compared with Republic of Ireland).</p> <p>Conclusion</p> <p>Knowledge deficits in this study suggest that most of the common early symptoms or signs of stroke were recognized as such by less than half of the older adults surveyed. As such, many older adults may not recognise early symptoms of stroke in themselves or others. Thus, they may lose vital time in presenting for medical attention. Lack of public awareness about stroke warning signs and risk factors must be addressed as one important contribution to reducing mortality and morbidity from stroke.</p

Cross-sectional validation of the Aging Perceptions Questionnaire: a multidimensional instrument for assessing self-perceptions of aging

<p>Abstract</p> <p>Background</p> <p>Self-perceptions of aging have been implicated as independent predictors of functional disability and mortality in older adults. In spite of this, research on self-perceptions of aging is limited. One reason for this is the absence of adequate measures. Specifically, there is a need to develop a measure that is theoretically-derived, has good psychometric properties, and is multidimensional in nature. The present research seeks to address this need by adopting the Self-Regulation Model as a framework and using it to develop a comprehensive, multi-dimensional instrument for assessing self-perceptions of aging. This study describes the validation of this newly-developed instrument, the Aging Perceptions Questionnaire (APQ).</p> <p>Methods</p> <p>Participants were 2,033 randomly selected community-dwelling older (+65 yrs) Irish adults who completed the APQ alongside measures of physical and psychological health. The APQ assesses self-perceptions of aging along eight distinct domains or subscales; seven of these examine views about own aging, these are: timeline chronic, timeline cyclical, consequences positive, consequences negative, control positive, control negative, and emotional representations; the eighth domain is the identity domain and this examines the experience of health-related changes.</p> <p>Results</p> <p>Mokken scale analysis showed that the majority of items within the views about aging subscales were strongly scalable. Confirmatory factor analysis also indicated that the model provided a good fit for the data. Overall, subscales had good internal reliabilities. Hierarchical linear regression was conducted to investigate the independent contribution of APQ subscales to physical and psychological health and in doing so determine the construct validity of the APQ. Results showed that self-perceptions of aging were independently related to physical and psychological health. Mediation testing also supported a role for self-perceptions of aging as partial mediators in the relationship between indices of physical functioning and physical and psychological health outcomes.</p> <p>Conclusion</p> <p>Findings support the complex and multifaceted nature of the aging experience. The good internal reliability and construct validity of the subscales suggests that the APQ is a promising instrument that can enable a theoretically informed, multidimensional assessment of self-perceptions of aging. The potential role of self-perceptions of aging in facilitating physical and psychological health in later life is also highlighted.</p

Genome-wide imputation identifies novel associations and localises signals in idiopathic inflammatory myopathies.

OBJECTIVES The idiopathic inflammatory myopathies (IIM) are heterogeneous diseases, thought to be initiated by immune activation in genetically predisposed individuals. In this study we imputed variants from the Immunochip array using a large reference panel to fine-map associations and identify novel associations in IIM. METHODS We analysed 2,565 Caucasian IIM samples collected through the Myositis Genetics Consortium (MYOGEN) and 10,260 ethnically-matched controls. We imputed 1,648,116 variants from the Immunochip array using the Haplotype Reference Consortium panel and conducted association analysis on IIM, and clinical and serological subgroups. RESULTS The human leukocyte antigen (HLA) locus was consistently the most significantly associated region. Four non-HLA regions reached genome-wide significance, three in the whole IIM cohort (SDK2 and LINC00924 - both novel, and STAT4), with evidence of independent variants in STAT4, and NAB1 in the polymyositis (PM) subgroup. We also found suggestive evidence of association with loci previously associated with other autoimmune rheumatic diseases (TEC and LTBR). We identified more significant associations than those previously reported in IIM, for STAT4 and DGKQ in the total cohort, for NAB1 and FAM167A-BLK loci in PM, and CCR5 in inclusion body myositis. We found enrichment of variants among DNase I hypersensitivity sites and histone marks associated with active transcription within blood cells. CONCLUSIONS We report novel and strong associations in IIM and PM, and localise signals to single genes and immune cell types. This article is protected by copyright. All rights reserved

Identification of Novel Associations and Localization of Signals in Idiopathic Inflammatory Myopathies Using Genome-Wide Imputation

OBJECTIVES: The idiopathic inflammatory myopathies (IIM) are heterogeneous diseases, thought to be initiated by immune activation in genetically predisposed individuals. In this study we imputed variants from the Immunochip array using a large reference panel to fine-map associations and identify novel associations in IIM. METHODS: We analysed 2,565 Caucasian IIM samples collected through the Myositis Genetics Consortium (MYOGEN) and 10,260 ethnically-matched controls. We imputed 1,648,116 variants from the Immunochip array using the Haplotype Reference Consortium panel and conducted association analysis on IIM, and clinical and serological subgroups. RESULTS: The human leukocyte antigen (HLA) locus was consistently the most significantly associated region. Four non-HLA regions reached genome-wide significance, three in the whole IIM cohort (SDK2 and LINC00924 - both novel, and STAT4), with evidence of independent variants in STAT4, and NAB1 in the polymyositis (PM) subgroup. We also found suggestive evidence of association with loci previously associated with other autoimmune rheumatic diseases (TEC and LTBR). We identified more significant associations than those previously reported in IIM, for STAT4 and DGKQ in the total cohort, for NAB1 and FAM167A-BLK loci in PM, and CCR5 in inclusion body myositis. We found enrichment of variants among DNase I hypersensitivity sites and histone marks associated with active transcription within blood cells. CONCLUSIONS: We report novel and strong associations in IIM and PM, and localise signals to single genes and immune cell types

Focused HLA analysis in Caucasians with myositis identifies significant associations with autoantibody subgroups

Objectives: Idiopathic inflammatory myopathies (IIM) are a spectrum of rare autoimmune diseases characterised clinically by muscle weakness and heterogeneous systemic organ involvement. The strongest genetic risk is within the major histocompatibility complex (MHC). Since autoantibody presence defines specific clinical subgroups of IIM, we aimed to correlate serotype and genotype, to identify novel risk variants in the MHC region that co-occur with IIM autoantibodies. Methods: We collected available autoantibody data in our cohort of 2582 Caucasian patients with IIM. High resolution human leucocyte antigen (HLA) alleles and corresponding amino acid sequences were imputed using SNP2HLA from existing genotyping data and tested for association with 12 autoantibody subgroups. Results: We report associations with eight autoantibodies reaching our study-wide significance level of p<2.9x10(-5). Associations with the 8.1 ancestral haplotype were found with anti-Jo-1 (HLA-B*08:01, p=2.28x10(-53) and HLA-DRB1*03:01, p=3.25x10(-9)), anti-PM/Scl (HLA-DQB1*02:01, p=1.47x10(-26)) and anti-cN1A autoantibodies (HLA-DRB1*03:01, p=1.40x10(-11)). Associations independent of this haplotype were found with anti-Mi-2 (HLA-DRB1*07:01, p=4.92x10(-13)) and anti-HMGCR autoantibodies (HLA-DRB1*11, p=5.09x10(-6)). Amino acid positions may be more strongly associated than classical HLA associations; for example with anti-Jo-1 autoantibodies and position 74 of HLA-DRB1 (p=3.47x10(-64)) and position 9 of HLA-B (p=7.03x10(-11)). We report novel genetic associations with HLA-DQB1 anti-TIF1 autoantibodies and identify haplotypes that may differ between adult-onset and juvenile-onset patients with these autoantibodies. Conclusions: These findings provide new insights regarding the functional consequences of genetic polymorphisms within the MHC. As autoantibodies in IIM correlate with specific clinical features of disease, understanding genetic risk underlying development of autoantibody profiles has implications for future research

Systematic Review of Active Surveillance for Clinically Localised Prostate Cancer to Develop Recommendations Regarding Inclusion of Intermediate-risk Disease, Biopsy Characteristics at Inclusion and Monitoring, and Surveillance Repeat Biopsy Strategy

none38siContext: There is uncertainty regarding the most appropriate criteria for recruitment, monitoring, and reclassification in active surveillance (AS) protocols for localised prostate cancer (PCa). Objective: To perform a qualitative systematic review (SR) to issue recommendations regarding inclusion of intermediate-risk disease, biopsy characteristics at inclusion and monitoring, and repeat biopsy strategy. Evidence acquisition: A protocol-driven, Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA)-adhering SR incorporating AS protocols published from January 1990 to October 2020 was performed. The main outcomes were criteria for inclusion of intermediate-risk disease, monitoring, reclassification, and repeat biopsy strategies (per protocol and/or triggered). Clinical effectiveness data were not assessed. Evidence synthesis: Of the 17 011 articles identified, 333 studies incorporating 375 AS protocols, recruiting 264 852 patients, were included. Only a minority of protocols included the use of magnetic resonance imaging (MRI) for recruitment (n = 17), follow-up (n = 47), and reclassification (n = 26). More than 50% of protocols included patients with intermediate or high-risk disease, whilst 44.1% of protocols excluded low-risk patients with more than three positive cores, and 39% of protocols excluded patients with core involvement (CI) >50% per core. Of the protocols, ≥80% mandated a confirmatory transrectal ultrasound biopsy; 72% (n = 189) of protocols mandated per-protocol repeat biopsies, with 20% performing this annually and 25% every 2 yr. Only 27 protocols (10.3%) mandated triggered biopsies, with 74% of these protocols defining progression or changes on MRI as triggers for repeat biopsy. Conclusions: For AS protocols in which the use of MRI is not mandatory or absent, we recommend the following: (1) AS can be considered in patients with low-volume International Society of Urological Pathology (ISUP) grade 2 (three or fewer positive cores and cancer involvement ≤50% CI per core) or another single element of intermediate-risk disease, and patients with ISUP 3 should be excluded; (2) per-protocol confirmatory prostate biopsies should be performed within 2 yr, and per-protocol surveillance repeat biopsies should be performed at least once every 3 yr for the first 10 yr; and (3) for patients with low-volume, low-risk disease at recruitment, if repeat systematic biopsies reveal more than three positive cores or maximum CI >50% per core, they should be monitored closely for evidence of adverse features (eg, upgrading); patients with ISUP 2 disease with increased core positivity and/or CI to similar thresholds should be reclassified. Patient summary: We examined the literature to issue new recommendations on active surveillance (AS) for managing localised prostate cancer. The recommendations include setting criteria for including men with more aggressive disease (intermediate-risk disease), setting thresholds for close monitoring of men with low-risk but more extensive disease, and determining when to perform repeat biopsies (within 2 yr and 3 yearly thereafter).noneWillemse, Peter-Paul M; Davis, Niall F; Grivas, Nikolaos; Zattoni, Fabio; Lardas, Michael; Briers, Erik; Cumberbatch, Marcus G; De Santis, Maria; Dell'Oglio, Paolo; Donaldson, James F; Fossati, Nicola; Gandaglia, Giorgio; Gillessen, Silke; Grummet, Jeremy P; Henry, Ann M; Liew, Matthew; MacLennan, Steven; Mason, Malcolm D; Moris, Lisa; Plass, Karin; O'Hanlon, Shane; Omar, Muhammad Imran; Oprea-Lager, Daniela E; Pang, Karl H; Paterson, Catherine C; Ploussard, Guillaume; Rouvière, Olivier; Schoots, Ivo G; Tilki, Derya; van den Bergh, Roderick C N; Van den Broeck, Thomas; van der Kwast, Theodorus H; van der Poel, Henk G; Wiegel, Thomas; Yuan, Cathy Yuhong; Cornford, Philip; Mottet, Nicolas; Lam, Thomas B LWillemse, Peter-Paul M; Davis, Niall F; Grivas, Nikolaos; Zattoni, Fabio; Lardas, Michael; Briers, Erik; Cumberbatch, Marcus G; De Santis, Maria; Dell'Oglio, Paolo; Donaldson, James F; Fossati, Nicola; Gandaglia, Giorgio; Gillessen, Silke; Grummet, Jeremy P; Henry, Ann M; Liew, Matthew; Maclennan, Steven; Mason, Malcolm D; Moris, Lisa; Plass, Karin; O'Hanlon, Shane; Omar, Muhammad Imran; Oprea-Lager, Daniela E; Pang, Karl H; Paterson, Catherine C; Ploussard, Guillaume; Rouvière, Olivier; Schoots, Ivo G; Tilki, Derya; van den Bergh, Roderick C N; Van den Broeck, Thomas; van der Kwast, Theodorus H; van der Poel, Henk G; Wiegel, Thomas; Yuan, Cathy Yuhong; Cornford, Philip; Mottet, Nicolas; Lam, Thomas B