Housing and sustaining communities on the West Cork islands

Government policy recognises the Irish islands as integral to Ireland’s cultural heritage, identity and economy. Within the context of a national housing crisis which is recognised as having reached the status of a national emergency, this report examines the impact of the availability, affordability and quality of housing on the sustainability of life on the seven inhabited West Cork islands. The research was undertaken using an innovative research process which foregrounds the voices of island residents through a participatory mixed methods approach, involving a survey that was co-constructed with island residents and in-depth focus groups

M-Coffee: combining multiple sequence alignment methods with T-Coffee

We introduce M-Coffee, a meta-method for assembling multiple sequence alignments (MSA) by combining the output of several individual methods into one single MSA. M-Coffee is an extension of T-Coffee and uses consistency to estimate a consensus alignment. We show that the procedure is robust to variations in the choice of constituent methods and reasonably tolerant to duplicate MSAs. We also show that performances can be improved by carefully selecting the constituent methods. M-Coffee outperforms all the individual methods on three major reference datasets: HOMSTRAD, Prefab and Balibase. We also show that on a case-by-case basis, M-Coffee is twice as likely to deliver the best alignment than any individual method. Given a collection of pre-computed MSAs, M-Coffee has similar CPU requirements to the original T-Coffee. M-Coffee is a freeware open-source package available from

Agency and ageing in place in rural Ireland

This report explores the experiences and preferences of older adults on ageing in place in rural Ireland. This exploration is undertaken through a participatory mixed-methods approach that seeks to foreground the voices of older adults themselves. The research study involved two phases. Phase one entailed a nationwide online and postal survey co-constructed with Age Action’s Glór advocacy group and University of the Third Age (U3A) membership and distributed to Age Action members living in rural areas across Ireland. 218 people aged 55 and older who live in rural areas took part in the survey and every county was represented, with 45% of respondents from Munster, 36% from Leinster, 12% from Connaught, and 7% from Ulster. Phase two involved a series of four focus groups in which 19 people took part. The focus groups explored the survey themes in more depth. The research highlights the diversity of experience of home and community among the older adults in rural Ireland who took part. Most participants expressed a strong desire to remain in their homes and communities as they age. The sense of attachment to home and place had, for many, strengthened since the pandemic. Some participants, however, highlighted the tenuous nature of their living arrangements and their sense of alienation from place. This was particularly the case for the participants who were renting, who had recently moved locations to be closer to children, or who found the limited facilities and social opportunities in their rural environments restrictive. Whether they were settled in their homes and communities or not, all participants highlighted the uncertainty of their positions and their fears for being able to have their preference for remaining in place realised as they aged. This was related to unpredictable factors such as their future health needs and availability of home care, their ongoing ability to drive, or their capacity to afford to live independently given the ambiguity surrounding future pension provision and the escalating costs associated with utilities, healthcare, home maintenance and expenses related to rural living, such as security, water, and sewerage costs. The general decline of towns and villages was highlighted by participants, as was the poor coverage of public transport in rural areas. These aspects not only heightened the sense of isolation of participants in terms of access to services and social activities; they also served to heighten their sense of marginalisation and perceived loss of agency in terms of policy formation and political representation. Participants also noted the limited options available to them should they consider moving from their rural locations, something that would be particularly challenging for most given their emotional connection to their homes and communities. The lack of affordable and suitable housing for older adults was a particular concern. Most participants were strongly opposed to nursing homes, a view which the experience of the pandemic had often reinforced. While a small number saw their benefit in cases of critical care, most were dissatisfied with the current ‘Fair Deal’ Scheme for funding nursing home care. They argued that, instead of focussing resources on a nursing home option not favoured by older adults, the government should develop an alternative statutory home care scheme that would support older adults to remain in their homes as they age. The supports which were noted as important in relation to allowing adults to age in their homes included a more accessible and fit-for-purpose grant system to fund modifications to the home – the most popular of these being an emergency response system, bathroom modifications, and improved heating. The need for a properly paid and resourced home help service, as well as a home and garden maintenance service, was emphasised. This was especially the case given the changing reality of ageing in Irish society and the fact that many older adults cannot rely on the availability or ability of family members to care for them in their homes. Access to broadband in rural areas was also noted as crucial, not only given the fact that more aspects of daily services are being conducted online but also given the importance of a reliable broadband connection in facilitating isolated rural older adults to connect to others. Participants highlighted their enjoyment of meeting each other and realising their difficulties were shared despite their diverse locations as benefits of the research process in the current study. They argued for the need for training in technology which could be a significant enabler to their remaining in place, as opposed to presenting a barrier to their doing so. They also argued that there was a need to tackle the covert ageism which was seen as endemic in institutions and everyday interactions, and which served to marginalise older adults further. Participants noted their preferences were they to need additional supports which could not be provided in their homes in the future. In this case, their favoured options would be co-operative or sheltered housing and retirement villages. These options were available for very few participants locally, however, meaning that they would be required to move from their communities, as well as their homes. The research, while small in scale resonates with global research on the theme,1 and highlights that the ability of older adults to age in place requires coordination among several different policy areas, not least housing, transport, technology, and healthcare. There is a need to adjust the funding focus from moving people who need help out of their homes to ensuring that the help they need is available to them in their homes for as long as possible. There is also a need to develop housing options, other than nursing homes, to address people’s preferences should staying at home be no longer a feasible option. Finally, and most importantly, there is a requirement to listen to older people in rural areas about where and how they wish to age in ways that support their sense of agency and challenge flawed assumptions about ageing. This research seeks to contribute to that aim both through its focus and its process

Self-management strategies used by head and neck cancer survivors following completion of primary treatment:a directed content analysis

Objective: Head and neck cancer (HNC) survivors encounter unique challenges following treatment. This study aimed to identify self‐management strategies that HNC survivors use to overcome these posttreatment challenges. Methods: Twenty‐seven individuals from 4 designated cancer centres in Ireland were interviewed about self‐management strategies that helped them overcome challenges following HNC treatment. Interviews were audio‐recorded, transcribed, and analysed using directed content analysis. Results: Twenty self‐management strategy types (encompassing 77 specific strategies) were identified. The most frequently used self‐management strategy types were self‐sustaining (used by 26 survivors), self‐motivating (n = 25), and proactive problem solving (n = 25). The most frequently used specific strategies were adaptive approaches to ongoing physical consequences of HNC and its treatment (n = 24), customising dietary practices (n = 24), and maintaining a positive outlook (n = 22). Conclusions: The study identified strategies that helped HNC survivors to self‐manage posttreatment challenges. This information could inform the design/development of self‐management interventions tailored towards HNC survivors

The aesthetic and cultural pursuits of patients with stroke

peer-reviewedTables to accompany this article on second fileGOAL: There has been an increasing interest in the arts in healthcare, with a suggestion that the arts and aesthetics can augment patient outcomes in stroke and other illnesses. Designing such programmes requires better knowledge of the artistic, aesthetic and cultural pursuits of people affected by stroke. The aim of this study was to obtain the insights of this group about the profile of arts and aesthetics activities in their lives as well as the influence of stroke on these aspects. MATERIALS AND METHODS: Patients attending a stroke service were administered questions adapted from the Irish Arts Council’s 2006 questionnaire on participation in aesthetics and cultural pursuits, Information was also collected on stroke type and present functional and cognitive status. Thirty-eight patients were interviewed. Of these, twenty were inpatients in hospital at the time of the interview and eighteen were interviewed in an outpatient setting. FINDINGS: Popular activities included mainstream cinema, listening to music, dancing, attending plays or musicals and being outdoors. Many patients ceased these activities after their stroke, mostly due to health issues and inaccessibility. The majority of patients valued the importance of the arts in the healthcare setting. CONCLUSION: This study gives a perspective for the first time on the aesthetic and cultural pursuits of stroke patients prior to their stroke. It portrays a wide variety of cultural and leisure activities, and the cessation of these post-stroke. It revealed the restrictions patients felt on gaining access to leisure pursuits both while in hospital and following discharge.Acceptedpeer-reviewe

Cerebral Autosomal Dominant Arteriopathy with Subcortical Infarcts and Leukoencephalopathy: A Genetic Cause of Cerebral Small Vessel Disease

Cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy (CADASIL) is a single-gene disorder of the cerebral small blood vessels caused by mutations in the Notch3 gene. The exact prevalence of this disorder was unknown currently, and the number of reported CADASIL families is steadily increasing as the clinical picture and diagnostic examinations are becoming more widely known. The main clinical manifestations are recurrent stroke, migraine, psychiatric symptoms, and progressive cognitive impairment. The clinical course of CADASIL is highly variable, even within families. The involvement of the anterior temporal lobe and the external capsule on brain magnetic resonance imaging was found to have high sensitivity and specificity in differentiating CADASIL from the much more common sporadic cerebral small-vessel disease (SVD). The pathologic hallmark of the disease is the presence of granular osmiophilic material in the walls of affected vessels. CADASIL is a prototype single-gene disorder that has evolved as a unique model for studying the mechanisms underlying cerebral SVD. At present, the incidence and prevalence of CADASIL seem to be underestimated due to limitations in clinical, neuroradiological, and genetic diagnoses of this disorder

Is primary care a neglected piece of the jigsaw in ensuring optimal stroke care? Results of a national study

<p>Abstract</p> <p>Background</p> <p>Stroke is a major cause of mortality and morbidity with potential for improved care and prevention through general practice. A national survey was undertaken to determine current resources and needs for optimal stroke prevention and care.</p> <p>Methods</p> <p>Postal survey of random sample of general practitioners undertaken (N = 204; 46% response). Topics included practice organisation, primary prevention, acute management, secondary prevention, long-term care and rehabilitation.</p> <p>Results</p> <p>Service organisation for both primary and secondary prevention was poor. Home management of acute stroke patients was used at some stage by 50% of responders, accounting for 7.3% of all stroke patients. Being in a structured cardiovascular management scheme, a training practice, a larger practice, or a practice employing a practice nurse were associated with structures and processes likely to support stroke prevention and care.</p> <p>Conclusion</p> <p>General practices were not fulfilling their potential to provide stroke prevention and long-term management. Systems of structured stroke management in general practice are essential to comprehensive national programmes of stroke care.</p