Climate Change and Water Resources in Ireland: Initial investigations using downscaled GCMS and hydrological modelling techniques.

Predictions are made of changes in effective runoff at a high spatial resolution for the island of Ireland under different climate change scenarios. Although previous studies have examined the response of selected Irish catchments to future climate scenarios this is the first time that the whole area of the island has been considered. This paper discusses the initial investigation that has been carried out and outlines research currently in progress. Polynomial regression techniques are used to derive a baseline climatology for Ireland. Downscaled precipitation and evaporation data from the United Kingdom Climate Program (UKCIP)for the Medium-low 2080 scenario is used together with the baseline data for the initial investigation. The precipitation and potential evaporation (PE) data are converted to a suitable form for input to HYSIM. Two sets of simulations are carried out for 825 JO x JO km grid squares covering the land area of the island of Ireland for the baseline period and the 2080 scenario. The hydrological parameters for each of these squares are considered to be identical for this initial investigation. The results of this investigation are presented. Future work is considered, focusing on the parameterisation of HYSIM for individual grid cells. The initial investigation demonstrates that the representation of storage is of particular importance. Parameter values are derived for each square using data from the Soil Survey of Ireland, the CORINE land use database and information on major aquifers provided by the Geological Survey of Ireland. The flexible data requirements of HYSIM allow some representation of the diverse hydrological conditions found within Ireland. For example, approximately 40% of Ireland is underlain by limestones, many of which are karstified. These karst aquifers are an important water resource and can respond very rapidly to precipitation inputs. There are also extensive areas of lakes and wetlands. The land area is divided into broad hydrological zones to provide some representation of this variability

Faster Blood Flow Rate Does Not Improve Circuit Life in Continuous Renal Replacement Therapy: A Randomized Controlled Trial

Objectives: To determine whether blood flow rate influences circuit life in continuous renal replacement therapy. Design: Prospective randomized controlled trial. Setting: Single center tertiary level ICU. Patients: Critically ill adults requiring continuous renal replacement therapy. Interventions: Patients were randomized to receive one of two blood flow rates: 150 or 250 mL/min. Measurements and Main Results: The primary outcome was circuit life measured in hours. Circuit and patient data were collected until each circuit clotted or was ceased electively for nonclotting reasons. Data for clotted circuits are presented as median (interquartile range) and compared using the Mann-Whitney U test. Survival probability for clotted circuits was compared using log-rank test. Circuit clotting data were analyzed for repeated events using hazards ratio. One hundred patients were randomized with 96 completing the study (150 mL/min, n = 49; 250 mL/min, n = 47) using 462 circuits (245 run at 150 mL/min and 217 run at 250 mL/min). Median circuit life for first circuit (clotted) was similar for both groups (150 mL/min: 9.1 hr [5.5–26 hr] vs 10 hr [4.2–17 hr]; p = 0.37). Continuous renal replacement therapy using blood flow rate set at 250 mL/min was not more likely to cause clotting compared with 150 mL/min (hazards ratio, 1.00 [0.60–1.69]; p = 0.68). Gender, body mass index, weight, vascular access type, length, site, and mode of continuous renal replacement therapy or international normalized ratio had no effect on clotting risk. Continuous renal replacement therapy without anticoagulation was more likely to cause clotting compared with use of heparin strategies (hazards ratio, 1.62; p = 0.003). Longer activated partial thromboplastin time (hazards ratio, 0.98; p = 0.002) and decreased platelet count (hazards ratio, 1.19; p = 0.03) were associated with a reduced likelihood of circuit clotting. Conclusions: There was no difference in circuit life whether using blood flow rates of 250 or 150 mL/min during continuous renal replacement therapy

Mitochondrial Utilization of Competing Fuels Is Altered in Insulin Resistant Skeletal Muscle of Non-obese Rats (Goto-Kakizaki)

Aim: Insulin-resistant skeletal muscle is characterized by metabolic inflexibility with associated alterations in substrate selection, mediated by peroxisome-proliferator activated receptor δ (PPARδ). Although it is established that PPARδ contributes to the alteration of energy metabolism, it is not clear whether it plays a role in mitochondrial fuel competition. While nutrient overload may impair metabolic flexibility by fuel congestion within mitochondria, in absence of obesity defects at a mitochondrial level have not yet been excluded. We sought to determine whether reduced PPARδ content in insulin-resistant rat skeletal muscle of a non-obese rat model of T2DM (Goto-Kakizaki, GK) ameliorate the inhibitory effect of fatty acid (i.e., palmitoylcarnitine) on mitochondrial carbohydrate oxidization (i.e., pyruvate) in muscle fibers. Methods: Bioenergetic function was characterized in oxidative soleus (S) and glycolytic white gastrocnemius (WG) muscles with measurement of respiration rates in permeabilized fibers in the presence of complex I, II, IV, and fatty acid substrates. Mitochondrial content was measured by citrate synthase (CS) and succinate dehydrogenase activity (SDH). Western blot was used to determine protein expression of PPARδ, PDK isoform 2 and 4. Results: CS and SDH activity, key markers of mitochondrial content, were reduced by ∼10–30% in diabetic vs. control, and the effect was evident in both oxidative and glycolytic muscles. PPARδ (p < 0.01), PDK2 (p < 0.01), and PDK4 (p = 0.06) protein content was reduced in GK animals compared to Wistar rats (N = 6 per group). Ex vivo respiration rates in permeabilized muscle fibers determined in the presence of complex I, II, IV, and fatty acid substrates, suggested unaltered mitochondrial bioenergetic function in T2DM muscle. Respiration in the presence of pyruvate was higher compared to palmitoylcarnitine in both animal groups and fiber types. Moreover, respiration rates in the presence of both palmitoylcarnitine and pyruvate were reduced by 25 ± 6% (S), 37 ± 6% (WG) and 63 ± 6% (S), 57 ± 8% (WG) compared to pyruvate for both controls and GK, respectively. The inhibitory effect of palmitoylcarnitine on respiration was significantly greater in GK than controls (p < 10–3). Conclusion: With competing fuels, the presence of fatty acids diminishes mitochondria ability to utilize carbohydrate derived substrates in insulin-resistant muscle despite reduced PPARδ content

Developing and sustaining specialist and advanced practice roles in nursing and midwifery: A discourse on enablers and barriers

Aims and objectives To collate, synthesise and discuss published evidence and expert professional opinion on enablers and barriers to the development and sustainability of specialist and advanced practice roles in nursing and midwifery. Background Expanded practice is a response to population health needs, healthcare costs and practitioners’ willingness to expand their scope of practice through enhanced responsibility, accountability and professional autonomy. Design This discursive paper is based on a rapid review of literature on enablers and barriers to the development and sustainability of specialist and advanced practice roles and is part of a wider policy analysis. Methods We analysed and synthesised of 36 research articles, reviews and discussion papers on enablers and barriers in the development and sustainability of expanded practice roles. Results Several factors enable role expansion, including: role clarity; credentialing and endorsement; availability of education for expanded roles; individual practitioners’ dispositions towards role expansion; support from peers, other professionals and the work organisation; and costs. Where limited or absent, these same factors can constrain role expansion. Conclusions Enabling nurses and midwives to practice to their full scope of education and expertise is a global challenge for disciplinary leadership, a national challenge for professional regulation and a local challenge for employers and individual clinicians. These challenges need to be addressed through multistakeholder coordinated efforts at these four levels. Relevance to clinical practice This discursive paper synthesises empirical evidence and expert professional opinion on the factors that enable or hinder the development and sustainability of specialist and advanced practice roles. Providing a critical appraisal of current knowledge, it provides a reference source for disciplinary debate and policy development regarding the nursing and midwifery resource and informs clinicians of the myriad issues that can impact on their capacity to expand their scope of practice

Case report: intra-tendinous ganglion of the anterior cruciate ligament in a young footballer

A 20-year-old male medical student and keen rugby player presented with a 12-month history of progressively worsening right knee pain and stiffness with no history of trauma. Clinical examination revealed effusion and posterior knee pain exacerbated by end range movement and an extension lag of 15 degrees. Physiotherapy to improve the range of motion proved unsuccessful. Magnetic resonance imaging showed that the ACL was grossly thickened and displaced by material reported as mucoid in nature. There were also areas of focally high signal in relation to its tibial attachment and intra osseous small cysts. Arthroscopic examination revealed a ganglion related to the tibial attachment of the ACL and gross thickening and discoloration of the ACL. Biopsies were taken showing foci of mucoid degeneration in the ACL. A large intra-ACL mass of brownish coloured tissue was excised arthroscopically. Already at 2 weeks follow up the patient had greatly improved range of movement and was pain free. However, upon returning to rugby, joint instability was noticed and a tear of the ACL was confirmed. This rare clinical condition can be diagnosed with MRI and arthroscopic debridement effectively relieves symptoms. This case report illustrates that augmentation or reconstruction may end up being the definitive treatment for athletes. It may also offer some support to the argument that mucoid degeneration and ganglion cyst formation share a similar pathogenesis to intra-osseous cyst formation

Blood flow rate and circuit life in continuous renal replacement therapy (CRRT): a randomised controlled trial (RCT)

Abstract of a paper presented to 'The 41st Australian and New Zealand Scientific meeting on Intensive Care', Perth, Australia, October 201

The universal, collaborative and dynamic model of specialist and advanced nursing and midwifery practice: A way forward?

Aims and objectives To inform and guide the development of a future model of specialist and advanced nursing and midwifery practice. Background There is a sizable body of empirical literature supporting the unique contributions of specialist and advanced practice roles to health care. However, there is very little international evidence to inform the integration of a future model for advanced or specialist practice in the Irish healthcare system. Design A qualitative study was conducted to initiate this important area of inquiry. Methods Purposive sampling was used to generate a sample of informants (n = 15) for the interviews. Nurses and midwives working in specialist and advanced practice and participants from other areas such as legislative, regulatory, policy, medicine and education were included in the sampling frame. Results Arguments for a new model of specialist and advanced practice were voiced. A number of participants proposed that flexibility within specialist and advanced practitioner career pathways was essential. Otherwise, there existed the possibility of being directed into specialised “silos,” precluding movement to another area of integrated practice. Future specialist and advanced practice education programmes need to include topics such as the development of emotional and political intelligence. Conclusion The contribution of specialist and advanced practice roles to the health service includes providing rapid access to care, seamless patient flow across services, early discharge and lead coordinator of the patient\u27s care trajectory. There was a recommendation of moving towards a universal model to cultivate specialist and advanced nurse and midwife practitioners

Mapping Soils in Ireland

peer-reviewedThis project is jointly funded by Teagasc and EPA STRIVE funding.Harmonised soil data across Europe with a 1:250 000 geo-referenced soil database will allow for exchange of data across member states and the provide the information needed for reporting on issues re-lating to soil quality under a future Soil Framework Directive. The current status of soils data available in Eu-rope is inconsistent at best. The Irish Soil Information System (ISIS) project is currently developing a national soil map of 1:250,000 and an associated digital soil information system, providing both spatial and quantita-tive information on soil types and properties across Ireland. Both the map and the information system will be freely available to the public through a designated website.This project is jointly funded by Teagasc and EPA STRIVE funding

Using historical documentary methods to explore the history of occupational therapy

peer-reviewed.Introduction: Historical research can benefit health professions by providing a basis for understanding how current beliefs and practices developed over time. From an occupational therapy perspective, a need for deeper critical understandings of the profession has been identified; historical research can facilitate this process. Documentary research is a significant methodology in historical inquiry, but there is a dearth of guidance for occupational therapists wishing to employ this method. Method: A conceptual literature review was conducted to describe how to use documentary sources to understand the development of the profession, drawing on literature from the disciplines of history and occupational therapy. Results: The stages of historical documentary research are described: choosing a topic, sourcing and selecting evidence, and managing sources. How to consider the authenticity, credibility and representativeness of historical material is discussed. Various means to determine the meaning of historical evidence are considered, with chronological, thematic and theoretical approaches proposed. Conclusion: Methodological transparency is central to the process of historical documentary research. To enhance understanding of the quality of historical source material, adoption of the guidelines outlined is recommended. Adopting a clearly defined questioning perspective promotes more substantial conclusions and professional understandingspeer-reviewe

Flood Risk Assessment for Urban Drainage System in a Changing Climate Using Artificial Neural Network

Changes in rainfall patterns due to climate change are expected to have negative impact on urban drainage systems, causing increase in flow volumes entering the system. In this paper, two emission scenarios for greenhouse concentration have been used, the high (A1FI) and the low (B1). Each scenario was selected for purpose of assessing the impacts on the drainage system. An artificial neural network downscaling technique was used to obtain local-scale future rainfall from three coarse-scale GCMs. An impact assessment was then carried out using the projected local rainfall and a risk assessment methodology to understand and quantify the potential hazard from surface flooding. The case study is a selected urban drainage catchment in northwestern England. The results show that there will be potential increase in the spilling volume from manholes and surcharge in sewers, which would cause a significant number of properties to be affected by flooding