To what extent does the Health Professions Admission Test-Ireland predict performance in early undergraduate tests of communication and clinical skills? – An observational cohort study

Background: Internationally, tests of general mental ability are used in the selection of medical students. Examples include the Medical College Admission Test, Undergraduate Medicine and Health Sciences Admission Test and the UK Clinical Aptitude Test. The most widely used measure of their efficacy is predictive validity.A new tool, the Health Professions Admission Test- Ireland (HPAT-Ireland), was introduced in 2009. Traditionally, selection to Irish undergraduate medical schools relied on academic achievement. Since 2009, Irish and EU applicants are selected on a combination of their secondary school academic record (measured predominately by the Leaving Certificate Examination) and HPAT-Ireland score. This is the first study to report on the predictive validity of the HPAT-Ireland for early undergraduate assessments of communication and clinical skills. Method. Students enrolled at two Irish medical schools in 2009 were followed up for two years. Data collected were gender, HPAT-Ireland total and subsection scores; Leaving Certificate Examination plus HPAT-Ireland combined score, Year 1 Objective Structured Clinical Examination (OSCE) scores (Total score, communication and clinical subtest scores), Year 1 Multiple Choice Questions and Year 2 OSCE and subset scores. We report descriptive statistics, Pearson correlation coefficients and Multiple linear regression models. Results: Data were available for 312 students. In Year 1 none of the selection criteria were significantly related to student OSCE performance. The Leaving Certificate Examination and Leaving Certificate plus HPAT-Ireland combined scores correlated with MCQ marks.In Year 2 a series of significant correlations emerged between the HPAT-Ireland and subsections thereof with OSCE Communication Z-scores; OSCE Clinical Z-scores; and Total OSCE Z-scores. However on multiple regression only the relationship between Total OSCE Score and the Total HPAT-Ireland score remained significant; albeit the predictive power was modest. Conclusion: We found that none of our selection criteria strongly predict clinical and communication skills. The HPAT- Ireland appears to measures ability in domains different to those assessed by the Leaving Certificate Examination. While some significant associations did emerge in Year 2 between HPAT Ireland and total OSCE scores further evaluation is required to establish if this pattern continues during the senior years of the medical course.

Using parent report to assess bilingual vocabulary acquisition: a model from Irish

This chapter describes the adaptation of a parent report instrument on early language development to a bilingual context. Beginning with general issues of adapting tests to any language, particular attention is placed on the issue of using parents as evaluators of child language acquisition of a minority language in a bilingual context. In Ireland, Irish is the first official language and is spoken by about 65,000 people on a daily basis. However all Irish speakers are bilingual, and children are exposed to the dominant English language at an early age. Using an adaptation of a parent report instrument, 21 typically developing children between 16 and 40 months were assessed repeatedly over two years to monitor their language development. The form allowed parents to document their children’s vocabulary development in both languages. Results showed that when knowledge of both languages was accounted for, the children acquired vocabulary at rates similar to those of monolingual speakers and used translational equivalents relatively early in language development. The study also showed that parents of bilingual children could accurately identify and differentiate language development in both of the child’s languages. Recommendations for adapting and using parent report instruments in bilingual language acquisition contexts are outlined.

Using parent report to assess early lexical production in children exposed to more than one language

Limited expressive vocabulary skills in young children are considered to be the first warning signs of a potential Specific Language Impairment (SLI) (Ellis & Thal, 2008). In bilingual language learning environments, the expressive vocabulary size in each of the child’s developing languages is usually smaller compared to the number of words produced by monolingual peers (e.g. De Houwer, 2009). Nonetheless, evidence shows children’s total productive lexicon size across both languages to be comparable to monolingual peers’ vocabularies (e.g. Pearson et al., 1993; Pearson & Fernandez, 1994). Since there is limited knowledge as to which level of bilingual vocabulary size should be considered as a risk factor for SLI, the effects of bilingualism and language-learning difficulties on early lexical production are often confounded. The compilation of profiles for early vocabulary production in children exposed to more than one language, and their comparison across language pairs, should enable more accurate identification of vocabulary delays that signal a risk for SLI in bilingual populations. These considerations prompted the design of a methodology for assessing early expressive vocabulary in children exposed to more than one language, which is described in the present chapter. The implementation of this methodological framework is then outlined by presenting the design of a study that measured the productive lexicons of children aged 24-36 months who were exposed to different language pairs, namely Maltese and English, Irish and English, Polish and English, French and Portuguese, Turkish and German as well as English and Hebrew. These studies were designed and coordinated in COST Action IS0804 Working Group 3 (WG3) and will be described in detail in a series of subsequent publications. Expressive vocabulary size was measured through parental report, by employing the vocabulary checklist of the MacArthur-Bates Communicative Development Inventory: Words and Sentences (CDI: WS) (Fenson et al., 1993, 2007) and its adaptations to the participants’ languages. Here we describe the novelty of the study’s methodological design, which lies in its attempt to harmonize the use of vocabulary checklist adaptations, together with parental questionnaires addressing language exposure and developmental history, across participant groups characterized by different language exposure variables. This chapter outlines the various methodological considerations that paved the way for meaningful cross-linguistic comparison of the participants’ expressive lexicon sizes. In so doing, it hopes to provide a template for and encourage further research directed at establishing a threshold for SLI risk in children exposed to more than one language.

Tooth wear in Irish teenagers: a laboratory and epidemiological study

Aim: To investigate the characteristics, development and determinants of toothwear among Irish schoolchildren. Methods: A cross-sectional (examination at 16-years-old) and longitudinal (examinations at 5-,12-,14-years) study were conducted. Two indices were used to measure toothwear, children/parents completed a demographic profile and questionnaire on oral hygiene and dietary practices, health, and lifestyle in both studies. Saliva was collected from consenting 16-year-olds. The explanatory variables for the cross-sectional and longitudinal study were derived from children/parents responses. Differences in salivary profiles were determined for subsets; the protein concentration was determined with Bradford protein assay and protein carbonyl concentration (a protein oxidation marker) was determined spectrophotometrically. Gel-electrophoresis and mass spectrometry determined proteins and ion chromatography inorganic ions. Statistical significance was accepted at p<0.05. Results: At 16-years-old the prevalence of toothwear with dentine visible was 44%. No difference in salivary flow rates existed. In unstimulated saliva a higher mean, protein carbonyl (p<0.0001) and total calcium concentration (p<0.002) existed for the group with moderate toothwear. In stimulated saliva the moderate toothwear group had a lower mean protein concentration(p<0.0001). The 2-DE protein spots prepared for a sub-group differed between those with toothwear and without. Mass spectrometry, identified one of the different proteins as IgA. For 16-year-olds, the self-reported factors indicated that brushing after breakfast was associated with lower toothwear scores(p<0.03). Nail-biting, being asthmatic or reporting a dry mouth were associated with higher toothwear scores(all p<0.05). Eating an apple daily or less was associated with less toothwear(p<0.002). In the longitudinal study toothwear into dentine at age five or 12-years was associated with more toothwear at age 14(all p<0.05). Discussion: The results illustrate the multifactorial aetiology of toothwear. The biochemical and physical correlates of saliva with toothwear requires further research. Conclusion: The impact of previous toothwear, salivary, dietary and personal factors on toothwear in the early permanent dentition is demonstrated.

The implementation of a literacy intervention 'Station Teaching' in infant classes in Irish primary schools

Background: I conducted my research in the context of The National Literacy Strategy (DES, 2011), which maintains that every young person should be literate and it outlines targets for improving literacy in schools from 2011 to 2020. There has been much debate on the teaching of literacy and in particular the teaching of reading. Clark (2014) outlines how learning to read should be a developmental language process and that the approaches in the early years of schooling will colour the children’s motivation and their perception of reading as a purposeful activity. The acquisition of literacy begins in the home but this study focuses on the implementation of a literacy intervention Station Teaching in the infant classes in primary school. Station Teaching occurs when a class is divided into four or five small groups of pupils and they receive intensive tuition at four or five different Stations with the help of Support teachers: New Reading, Familiar Reading, Phonics, Writing and Oral Language. Research Questions: These research questions frame my study: How is Station Teaching implemented? What is the experience of the intervention Station Teaching from the participants’ point of view: teachers, pupils, parents? What notion of literacy is Station Teaching facilitating? Methods: I chose a pragmatic parallel mixed methods design as suggested by Mertens (2010). I collected and analysed both the quantitative and qualitative data to answer the study’s research questions. In the study the quantitative data were collected from a questionnaire issued to 21 schools in Ireland. I used Excel as a data management package and thematic analysis to analyse and present the data in themes. I collected qualitative data from a case study in a school. This data included observations of two classes over a period of a year; interviews with teachers, pupils and parents; children’s drawings, photographs, teachers’ diaries and video evidence. I analysed and presented the evidence from the qualitative data in themes. Main Findings: There are many skills and strategies that are essential to effective literacy teaching in the early years including phonological awareness, phonics, vocabulary, fluency, comprehension and writing. These skills can be taught during Station Teaching. Early intervention in the early years is essential to pupils’ acquisition of literacy. The expertise of the teacher is key to improving the literacy achievement of pupils Teachers and pupils enjoy participating in ST. Pupils are motivated to read and engage in meaningful activities during ST. Staff collaboration is vital for ST to succeed ST facilitates small group work and teachers can differentiate accordingly while including all pupils in the groups. Pupils’ learning is extended in ST but extension activities need to be addressed in the Writing Station. More training should be provided for teachers on the implementation of ST and more funding for resources should be available to schools Significant contribution of the work: The main significance of the study includes: insights into the classroom implementation of Station Teaching in infant classes and extensive research into characteristics of an effective teacher of literacy.

The framework for REVIEWS: an exploration into design principles for an electronic medical early warning system observation chart

The observation chart is for many health professionals (HPs) the primary source of objective information relating to the health of a patient. Information Systems (IS) research has demonstrated the positive impact of good interface design on decision making and it is logical that good observation chart design can positively impact healthcare decision making. Despite the potential for good observation chart design, there is a paucity of observation chart design literature, with the primary source of literature leveraging Human Computer Interaction (HCI) literature to design better charts. While this approach has been successful, this design approach introduces a gap between understanding of the tasks performed by HPs when using charts and the design features implemented in the chart. Good IS allow for the collection and manipulation of data so that it can be presented in a timely manner that support specific tasks. Good interface design should therefore consider the specific tasks being performed prior to designing the interface. This research adopts a Design Science Research (DSR) approach to formalise a framework of design principles that incorporates knowledge of the tasks performed by HPs when using observation charts and knowledge pertaining to visual representations of data and semiology of graphics. This research is presented in three phases, the initial two phases seek to discover and formalise design knowledge embedded in two situated observation charts: the paper-based NEWS chart developed by the Health Service Executive in Ireland and the electronically generated eNEWS chart developed by the Health Information Systems Research Centre in University College Cork. A comparative evaluation of each chart is also presented in the respective phases. Throughout each of these phases, tentative versions of a design framework for electronic vital sign observation charts are presented, with each subsequent iteration of the framework (versions Alpha, Beta, V0.1 and V1.0) representing a refinement of the design knowledge. The design framework will be named the framework for the Retrospective Evaluation of Vital Sign Information from Early Warning Systems (REVIEWS). Phase 3 of the research presents the deductive process for designing and implementing V0.1 of the framework, with evaluation of the instantiation allowing for the final iteration V1.0 of the framework. This study makes a number of contributions to academic research. First the research demonstrates that the cognitive tasks performed by nurses during clinical reasoning can be supported through good observation chart design. Secondly the research establishes the utility of electronic vital sign observation charts in terms of supporting the cognitive tasks performed by nurses during clinical reasoning. Third the framework for REVIEWS represents a comprehensive set of design principles which if applied to chart design will improve the usefulness of the chart in terms of supporting clinical reasoning. Fourth the electronic observation chart that emerges from this research is demonstrated to be significantly more useful than previously designed charts and represents a significant contribution to practice. Finally the research presents a research design that employs a combination of inductive and deductive design activities to iterate on the design of situated artefacts.

Early detection of delirium in older medical inpatients: prodrome, predictors and motor subtyping

Background Delirium is highly prevalent, especially in older patients. It independently leads to adverse outcomes, but remains under-detected, particularly hypoactive forms. Although early identification and intervention is important, delirium prevention is key to improving outcomes. The delirium prodrome concept has been mooted for decades, but remains poorly characterised. Greater understanding of this prodrome would promote prompt identification of delirium-prone patients, and facilitate improved strategies for delirium prevention and management. Methods Medical inpatients of ≥70 years were screened for prevalent delirium using the Revised Delirium Rating Scale (DRS--‐R98). Those without prevalent delirium were assessed daily for delirium development, prodromal features and motor subtype. Survival analysis models identified which prodromal features predicted the emergence of incident delirium in the cohort in the first week of admission. The Delirium Motor Subtype Scale-4 was used to ascertain motor subtype. Results Of 555 patients approached, 191 patients were included in the prospective study. The median age was 80 (IQR 10) and 101 (52.9%) were male. Sixty-one patients developed incident delirium within a week of admission. Several prodromal features predicted delirium emergence in the cohort. Firstly, using a novel Prodromal Checklist based on the existing literature, and controlling for confounders, seven predictive behavioural features were identified in the prodromal period (for example, increasing confusion; and being easily distractible). Additionally, using serial cognitive tests and the DRS-R98 daily, multiple cognitive and other core delirium features were detected in the prodrome (for example inattention; and sleep-wake cycle disturbance). Examining longitudinal motor subtypes in delirium cases, subtypes were found to be predominantly stable over time, the most prevalent being hypoactive subtype (62.3%). Discussion This thesis explored multiple aspects of delirium in older medical inpatients, with particular focus on the characterisation of the delirium prodrome. These findings should help to inform future delirium educational programmes, and detection and prevention strategies.

Irish and Jordanian general student nurses’ attitudes towards people with mental illness (PWMI) and their relationship to cultural and religious beliefs

Background Attitudes held and cultural and religious beliefs of general nursing students towards individuals with mental health problems are key factors that contribute to the quality of care provided. Negative attitudes towards mental illness and to individuals with mental health problems are held by the general public as well as health professionals. Negative attitudes towards people with mental illness have been reported to be associated with low quality of care, poor access to health care services and feelings of exclusion. Furthermore, culture has been reported to play a significant role in shaping people’s attitudes, values, beliefs, and behaviours, but has been poorly investigated. Research has also found that religious beliefs and practices are associated with better recovery for individuals with mental illness and enhanced coping strategies and provide more meaning and purpose to thinking and actions. The literature indicated that both Ireland and Jordan lack baseline data of general nurses’ and general nursing students’ attitudes towards mental illness and associated cultural and religious beliefs. Aims: To measure general nursing students’ attitudes towards individuals with mental illness and their relationships to socio-demographic variables and cultural and religious beliefs. Method: A quantitative descriptive study was conducted (n=470). 185 students in Jordan and 285 students in Ireland participated, with a response rate of 86% and 73%, respectively. Data were collected using the Community Attitudes towards the Mentally Ill instrument and a Cultural and Religious Beliefs Scale to People with Mental Illness constructed by the author. Results: Irish students reported more positive attitudes yet did not have strong cultural and religious beliefs compared to students from Jordan. Country of origin, considering a career in mental health nursing, knowing somebody with mental illness and cultural and religious beliefs were the most significant variables associated with students’ attitudes towards people with mental illness. In addition, students living in urban areas reported more positive attitudes to people with mental illness compared to those living in rural areas.

Risk factors for macro- and microvascular complications among older adults with diagnosed type 2 diabetes: findings from The Irish Longitudinal Study on Ageing

Objective. To explore risk factors for macro- and microvascular complications in a nationally representative sample of adults aged 50 years and over with type 2 diabetes in Ireland. Methods. Data from the first wave of The Irish Longitudinal Study on Ageing (TILDA) (2009–2011) was used in cross-sectional analysis. The presence of doctor diagnosis of diabetes, risk factors, and macro and microvascular complications were determined by self-report. Gender-specific differences in risk factor prevalence were assessed with the chi-squared test. Binomial regression analysis was conducted to explore independent associations between established risk factors and diabetes-related complications. Results. Among 8175 respondents, 655 were classified as having type 2 diabetes. Older age, being male, a history of smoking, a lower level of physical activity, and a diagnosis of high cholesterol were independent predictors of macrovascular complications. Diabetes diagnosis of 10 or more years, a history of smoking, and a diagnosis of hypertension were associated with an increased risk of microvascular complications. Older age, third-level education, and a high level of physical activity were protective factors (

Cross-sectoral differences in the drivers of innovation: evidence from the Irish Community Innovation Survey

Purpose: The purpose of this paper is to analyse differences in the drivers of firm innovation performance across sectors. The literature often makes the assumption that firms in different sectors differ in their propensity to innovate but not in the drivers of innovation. The authors empirically assess whether this assumption is accurate through a series of econometric estimations and tests. Design/methodology/approach: The data used are derived from the Irish Community Innovation Survey 2004-2006. A series of multivariate probit models are estimated and the resulting coefficients are tested for parameter stability across sectors using likelihood ratio tests. Findings: The results indicate that there is a strong degree of heterogeneity in the drivers of innovation across sectors. The determinants of process, organisational, new to firm and new to market innovation varies across sectors suggesting that the pooling of sectors in an innovation production function may lead to biased inferences. Research limitations/implications: The implications of the results are that innovation policies targeted at stimulating innovation need to be tailored to particular industries. One size fits all policies would seem inappropriate given the large degree of heterogeneity observed across the drivers of innovation in different sectors. Originality/value: The value of this paper is that it provides an empirical test as to whether it is suitable to group sectoral data when estimating innovation production functions. Most papers simply include sectoral dummies, implying that only the propensity to innovate differs across sectors and that the slope of the coefficient estimates are in fact consistent across sectors.

Irish state infrastructural investment: an analysis of past patterns, and an outline of a future integrated systems of systems evaluation methodology

The literature clearly links the quality and capacity of a country’s infrastructure to its economic growth and competitiveness. This thesis analyses the historic national and spatial distribution of investment by the Irish state in its physical networks (water, wastewater and roads) across the 34 local authorities and examines how Ireland is perceived internationally relative to its economic counterparts. An appraisal of the current status and shortcomings of Ireland’s infrastructure is undertaken using key stakeholders from foreign direct investment companies and national policymakers to identify Ireland's infrastructural gaps, along with current challenges in how the country is delivering infrastructure. The output of these interviews identified many issues with how infrastructure decision-making is currently undertaken. This led to an evaluation of how other countries are informing decision-making, and thus this thesis presents a framework of how and why Ireland should embrace a Systems of Systems (SoS) methodology approach to infrastructure decision-making going forward. In undertaking this study a number of other infrastructure challenges were identified: significant political interference in infrastructure decision-making and delivery the need for a national agency to remove the existing ‘silo’ type of mentality to infrastructure delivery how tax incentives can interfere with the market; and their significance. The two key infrastructure gaps identified during the interview process were: the need for government intervention in the rollout of sufficient communication capacity and at a competitive cost outside of Dublin; and the urgent need to address water quality and capacity with approximately 25% of the population currently being served by water of unacceptable quality. Despite considerable investment in its national infrastructure, Ireland’s infrastructure performance continues to trail behind its economic partners in the Eurozone and OECD. Ireland is projected to have the highest growth rate in the euro zone region in 2015 and 2016, albeit that it required a bailout in 2010, and, at the time of writing, is beginning to invest in its infrastructure networks again. This thesis proposes the development and implementation of a SoS approach for infrastructure decision-making which would be based on: existing spatial and capacity data of each of the constituent infrastructure networks; and scenario computation and analysis of alternative drivers eg. Demographic change, economic variability and demand/capacity constraints. The output from such an analysis would provide valuable evidence upon which policy makers and decision makers alike could rely, which has been lacking in historic investment decisions.