Proposals for the reform of the Northern Ireland Wheelchair Service (PDF 3 MB)

Proposals for the reform of the Northern Ireland Wheelchair Service

Management of Private Practice in Health Service Hospitals in Northern Ireland: A Handbook November 2007 (PDF147KB)

Management of Private Practice in Health Services Hospitals in Northern Ireland: A Handbook

Report of the Working Group to examine the development of appropriate systems to determine nursing and midwifery staffing levels

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Poots launches £18m state-of-the-art Telemonitoring NI service

Health Minister Edwin Poots today marked the roll-out of a ground-breaking hi-tech scheme which will enable more patients to monitor their health in their own homes. Following funding of £18m from the Department of Health, the newly named Centre for Connected Health and Social Care (CCHSC), part of the Public Health Agency, worked in partnership with business consortium TF3to establish the innovative Telemonitoring NI service. The service is now being delivered by the TF3 consortium in partnership with the Health and Social Care Trusts.Remote telemonitoring combines technology and services that enable patients with chronic diseases to test their vital signs such as pulse, blood pressure, body weight, temperature, blood glucose and oxygen levels at home on a daily basis. The service will now be rolled out to 3,500 patients across Northern Ireland per annum for a period of six years.Mr Poots today visited the home of Larne pensioner Michael Howard who has Chronic Pulmonary Obstructive Disorder (COPD) to hear how Telemonitoring NI has changed his life.During the visit Mr Poots said: "Chronic diseases such as heart disease, diabetes and COPD affect around three quarters of people over the age of 75. This is the generation from whom transport and mobility pose the biggest problems. The Telemonitoring NI service will allow thousands to monitor their vital signs without having to leave their own homes."It means that patients are able to understand and manage their condition better. Many say it has improved their confidence and given them peace of mind. With a health professional monitoring each patient's health on a daily basis, there is less need for hospital admission. Carers are also better informed with the pro-active support provided. It means earlier intervention in, and the prevention of, deterioration of condition, acute illness and hospital admissions."Telemonitoring NI is an excellent example of how the Health Service can innovateusing modern technology to deliver a better service for our patients."Eddie Ritson, Programme Director of CCHSC, PHA, said: "The roll-out of Telemonitoring NI represents a significant step towards providing quality care for the growing number of people with heart disease, stroke, some respiratory conditions and diabetes who want to live at home while having their conditions safely managed."This new service will give people more information which combined with timely advice will enable patients to gain more control over their health while supporting them to live independently in their own homes for longer."A patient will take their vital sign measurements at home, usually on a daily basis. and these will automatically be transmited to the Tf3 system. The resulting readings are monitored centrally by a healthcare professional working in the Tf3 triage team. If the patient's readings show signs of deterioration to an unacceptable level, they will be contacted by phone by a nurse working in a central team and if appropriate a healthcare professional in the patient's local Trust will be alerted to enable them to take appropriate action."Families and carers will also benefit from the reassurance that chronic health conditions are being closely monitored on an ongoing basis. The information collected through the service can also be used by doctors, nurses and patients in making decisions on how individual cases should be managed. "Using the service, Mr Howard, 71, who has emphysema - a long-term, progressive disease of the lungs that primarily causes shortness of breath - monitors his vital signs using the new technology every weekday morning. The information is monitored centrally and if readings show signs of deterioration to an unacceptable level, Mr Howard's local healthcare professional is alerted."Taking my readings is such a simple process but one that gives me huge benefits as it is an early warning system to me and also for the specialist nurses in charge of my care. Without the remote telemonitoring I would be running back and forward to the GPs' surgery all the time to have things checked out," he explained."Having my signs monitored by a nurse means any changes in my condition are dealt with immediately and this has prevented me from being admitted to hospital - in the past I've had to spend six days in hospital any time I'm admitted with a chest infection."The telemonitoring is not only reassuring for me, it also gives me more control over managing my own condition and as a result I have less upheaval in my life, and I'm less of a cost to the health care system. Most importantly, it gives me peace of mind and one less thing to worry about at my age."Patients seeking further information about the new telemonitoring service should contact their healthcare professional.

Les vertébroplasties: point de vue du rhumatologue [Vertebro-plasty: a rheumatologist's point of view]

Percutaneous vertebro-plasty is an efficient treatment of the symptomatic vertebral compression fracture refractory to optimal medical therapy. The procedure is used for neoplastic lesions, aggressive angioma, but also osteoporotic compression fractures. In order to adequately advice our patients, it is essential to know its indications and possible complications. However, to practice a vertebro-plasty for an osteoporotic compression fracture without any long term management of the osteoporotic disease is useless. Unfortunately, it still happens too often and it is essential that orthopedic surgeons, general practitioner, radiologist, rheumatologist, and any practitioners work together to guarantee the optimal management of our patients.

What's in that bun? Nutrition takeout series

The beef burger is a common food on both the kitchen and restaurant table since the 1800s and is one of the most common choices on fast food menus. The main reason for this is because it is tasty, easily accessible, customisable, affordable and portable. In ROI, composite foods (i.e. foods made up of more than one ingredient) are an important source of meat, especially burgers, with the majority of burgers either being fried or grilled, and many eaten from takeaway outlets. With such easy access and with limited nutritional information available to consumers at point of sale, many people may not be aware of the nutritional content of what they are consuming or of the healthier options that may be available to them. Given the diversity of products available, this survey was designed to provide an insight into the energy (calorie), total fat, saturated fat, protein and salt content of a range of burgers from various takeaway outlets.

Geographic patterns in the distribution of social systems in terrestrial arthropods.

The role of ecology in the evolution and maintenance of arthropod sociality has received increasing research attention in recent years. In some organisms, such as halictine bees, polistine wasps, and social spiders, researchers are investigating the environmental factors that may contribute to high levels of variation in the degree of sociality exhibited both among and within species. Within lineages that include only eusocial members, such as ants and termites, studies focus more on identifying extrinsic factors that may contribute to the dramatic variation in colony size, number of queens, and division of labour that is evident across these species. In this review, I propose a comparative approach that seeks to identify environmental factors that may have a common influence across such divergent social arthropod groups. I suggest that seeking common biogeographic patterns in the distribution of social systems or key social traits may help us to identify ecological factors that play a common role in shaping the evolution of sociality across different organisms. I first review previous studies of social gradients that form along latitudinal and altitudinal axes. Within families and within species, many organisms show an increasing degree of sociality at lower latitudes and altitudes. In a smaller number of cases, organisms form larger groups or found nests cooperatively at higher latitudes and altitudes. I then describe several environmental factors that vary consistently along such gradients, including climate variables and abundance of predators, and outline their proposed role in the social systems of terrestrial arthropods. Finally, I map distributions of a social trait against several climatic factors in five case studies to demonstrate how future comparative studies could inform empirical research.

Nouveautés thérapeutiques 2008 en médecine interne hospitalière: perspective des chefs de clinique [Highlights 2008 in a university hospital-based internal medicine: the point of view from the chief residents]

Doctors must regularly adjust their patients' care according to recent relevant publications. The chief residents from the Department of Internal Medicine of a university hospital present some major themes of internal medicine treated during the year 2008, such as heart failure, diabetes, COPD, and thromboembolic disease. Emphasis will be placed primarily on changes in the daily hospital practice induced by these recent studies. This variety of topics illustrates both the broad spectrum of the current internal medicine, and the many uncertainties associated with modem medical practice based on evidence.

Vulnerability assessment of distributed systems

In this project I have carried out a vulnerability assessment of a component of the Condor Middleware. In this assessment I have sought and found the more dangerous software vulnerabilities of this system, I have reported them to the development team such that they may be fixed, and thus improve the security of this distributed system, and the networks that use it.

Relationship of mating systems and metabolic rate with cycle length of spermatogenesis and sperm production rate in shrews

SUMMARY : The shrews are among the most ancient of living eutherian mammals. They represent an interesting comparative model because of their extreme divergent species. The two shrew subfamilies, Soricinae and Crocidurinae are characterized by fundamental differences concerning their metabolic rates, litter size, period of gestation and different mating pattern. In this study we established and compared the sperm characteristics in four species of different genera of shrews (Sorex araneus, Neomys fodiens, Crocidura russula and Suncus murinus) in the context of the sperm competition hypothesis. The sperm competition concerns the competition between ejaculates of different males for fertilization of ova of a female within a single estrus period. As expected, a greater relative testis size (indicating the importance of polyandry) was associated with a higher number of cauda epididymal spermatozoa, higher level of circulating testosterone and a higher percentage of progressive sperm motility. In addition, we investigated if the basal metabolic rate (BMR) and relative testis size (RTS) may be correlated with the cycle length of spermatogenesis. In this purpose, we determined and compared the cycle length of spermatogenesis in six species of shrews belonging to two subfamilies: Soiricinae (Sorex araneus, Sorex coronatus, Sorex minutus, Neomys fodiens) and Crocidurinae (Crocidura russula, Sunctes murinus). Our results indicate that sperm competition and metabolic rate may act independently or together reducing cycle length of spermatogenesis and thus increase sperm production. We finally investigated this correlation across 32 mammalian species. After testing the data for phylogenetic independence, our results showed that BMR explained only 21 % of the variation, while the RTS explained 44% of the variation of the cycle length of spermatogenesis. The level of the sperm competition, indicated by RTS, is thus to our knowledge the most important factor influencing the speed of spermatogenesis in mammals. RESUME : Les musaraignes sont parmi les plus anciens mammifères vivants. Grâce à leurs extrêmes divergences, ils sont souvent utilisés comme modèles dans des études comparatives. Les deux sous-familles Soricinae et Crocidurinae sont caractérisées par des différences fondamentales, notamment en termes d'intensité du métabolisme, des stratégies de reproduction et du comportement social. Dans la première partie de cette étude, nous avons établi et comparé certaines "caractéristiques des spermatozoïdes chez quatre espèces de musaraignes appartenant à des genres différents (Sorex araneus, Neomys fodiens, Crocidura russula et Suncus murinus). Les résultats ont été interprétés dans le contexte de la théorie de la compétition spermatique, c'est-à-dire la compétition entre le sperme de deux ou plusieurs mâles pour féconder un maximum d'ovules de la même femelle. Cette compétition spermatique peut amener à certaines adaptations biologiques afin de produire plus de sperme. Comme attendu, une grande taille relative des testicules est associée à un nombre élevé de spermatozoïdes, dont la majorité présente une mobilité progressive. Un taux élévé de testostérone a également été observé. De plus, nous avons étudié l'influence du métabolisme basal ainsi que l'intensité de la compétition spermatique sur la durée du cycle de la spermatogenèse. Dans ce but, nous avons déterminé et comparé les durées de la spermatogenèse chez six espèces de musaraignes appartenant à deux sous-familles : Soricinae (Sorex araneus, Sorex coronatus, Sorex minutus, Neomys fodiens) et Crocidurinae (Crocidura russula, Suncus murinus). Les résultats obtenus indiquent que ces deux facteurs (l'intensité du métabolisme basal et de la compétition spermatique) agissent d'une manière dépendante ou indépendante dans le même sens. La conséquence de ces actions est une diminution de la durée de la spermatogenèse entraînant une augmentation de la production de spermatozoïdes. Nous avons finalement étudié ce phénomène dans l'ensemble des mammifères. Après avoir testé l'indépendance phylogénétique, nos résultats montrent que l'intensité de la compétition spermatique indiquée par le RTS est mieux corrélée avec la régulation de la durée de la spermatogenèse qu'avec l'intensité du métabolisme.

Predictive value of Glasgow Coma Scale after brain trauma: change in trend over the past ten years.

BACKGROUND: Age and the Glasgow Coma Scale (GCS) score on admission are considered important predictors of outcome after traumatic brain injury. We investigated the predictive value of the GCS in a large group of patients whose computerised multimodal bedside monitoring data had been collected over the previous 10 years. METHODS: Data from 358 subjects with head injury, collected between 1992 and 2001, were analysed retrospectively. Patients were grouped according to year of admission. Glasgow Outcome Scores (GOS) were determined at six months. Spearman's correlation coefficients between GCS and GOS scores were calculated for each year. RESULTS: On average 34 (SD: 7) patients were monitored every year. We found a significant correlation between the GCS and GOS for the first five years (overall 1992-1996: r = 0.41; p<0.00001; n = 183) and consistent lack of correlations from 1997 onwards (overall 1997-2001: r = 0.091; p = 0.226; n = 175). In contrast, correlations between age and GOS were in both time periods significant and similar (r = -0.24 v r = -0.24; p<0.002). CONCLUSIONS: The admission GCS lost its predictive value for outcome in this group of patients from 1997 onwards. The predictive value of the GCS should be carefully reconsidered when building prognostic models incorporating multimodality monitoring after head injury.

Modeling of hybrid systems by piecewise decomposition

Piecewise linear models systems arise as mathematical models of systems in many practical applications, often from linearization for nonlinear systems. There are two main approaches of dealing with these systems according to their continuous or discrete-time aspects. We propose an approach which is based on the state transformation, more particularly the partition of the phase portrait in different regions where each subregion is modeled as a two-dimensional linear time invariant system. Then the Takagi-Sugeno model, which is a combination of local model is calculated. The simulation results show that the Alpha partition is well-suited for dealing with such a system