Report on the Independent Review of Symptomatic Breast Care Services at Barringtons Hospital, Limerick

Report on the Independent Review of Symptomatic Breast Care Services at Barringtons Hospital, Limerick This independent review was established by Barringtons Hospital and the Department of Health and Children following concerns which had been raised about the standard of symptomatic breast care including cancer services at the Hospital. The terms of reference for the review are included at Appendix 1. An independent review team was established under the chairmanship of Dr Henrietta Campbell. The membership is listed at Appendix 2. Click here to download PDF 152kb

Estudi del sistema reptroductor de la guatlla (Coturnix coturnix) i de la hibridació amb la guatlla japonesa (Coturnix japonica) domèstica i híbrids

La guatlla (Coturnix coturnix) és actualment una espècie amb un estat de conservació desfavorable. Una amenaça per a la seva conservació és la hibridació que pot produir-se degut als alliberaments massius amb finalitats cinegètiques de la guatlla japonesa (Coturnix japonica) o híbrids provinents de granges de cria. Els objectius d’estudi són: a) Aprofundir en el sistema sexual de la guatlla, ja que el seu coneixement pot permetre entendre els mecanismes d’hibridació amb la guatlla japonesa o híbrids. b) Conèixer la taxa de supervivència i l’eficàcia biològica dels individus no nadius a àrees de reproducció de la guatlla. c) Buscar evidències directes d’hibridació en condicions naturals i caracteritzar-la. d) Determinar si existeix competència espermàtica interespecífica mitjançant experiments en captivitat. S’ha seguit el comportament en condicions naturals de parelles homospecífiques i heterospecífiques de mascles i femelles de guatlla i de guatlla japonesa o híbrids. S’ha analitzat la paternitat dels polls d’aquestes parelles i s’ha pogut conèixer quins aspectes del comportament (segons l’espècie) es relacionen amb l’eficàcia biològica dels adults. S’han analitzat el mateix tipus de dades obtingudes durant cinc temporades reproductives, en les que hi van participar només individus de guatlla. Així s’ha pogut comparar el comportament de l’espècie en presència i absència dels individus al•lòctons. Els resultats indiquen que existeixen dues estratègies sexuals entre els mascles de guatlla. L’estat físic del mascle en relació al dels altres mascles coetanis i el temps de permanència amb la femella determinen la seva taxa de paternitat. Existeix una fracció relativament petita però significativa de guatlla japonesa de granja que sobreviu en condicions naturals i s’hibrida amb la guatlla silvestre, predominantment de forma unidireccional, entre femella japonesa i mascle de guatlla. Aquestes femelles presenten un sistema d’aparellament majoritàriament monògam. Els anàlisis sobre els experiments de competència espermàtica s’estan realitzant a l’actualitat.

Viatge als país dels somnis...perduts? : Aspectes de la sociabilitat nord-americana

Els objectius finals són diversos: comprovar els diferents punts de vista i les diferents perspectives socials dels autors esmentats, comparar-los amb les situacions reals que es donen cada dia, mirar d'esbrinar el perquè d'aquestes situacions, fer un estudi comparatiu des del punt de vista d'un europeu que visita els Estats Units i, sobretot, mirar d'entendre què porta els nord-americans a comportar-se d'aquesta manera i què porta autors com Leavitt i Ellis a reproduir o desdibuixar els trets més significatius de la societat nord-americana.

Molluscicidal action of the latex of Euphorbia splendens var. hislopii N.E.B. ("Christ's Crown") (Euphorbiaceae) against Lymnaea columella (Say, 1817) (Pulmonata: Lymnaeidae), intermediate host of Fasciola hepatica Linnaeus, 1758 (Trematode: Fasciolidae): 1- test in laboratory

The latex action of Euphorbia splendens var. hislopii (Christ's Crown) against snails Lymnaea columella, intermediate host of Fasciola hepatica, derived from irrigation ditches of the Station of Pisciculture at Universidade Federal Rural do Rio de Janeiro, was studied in the laboratory. Lab bioassays, using aqueous solutions of the latex, varying between 0.1 and 10 mg/l, have proven molluscicidal activity of the product collected on the same day the tests were performed, during the four seasons of the year, finding the following lethal concentrations (LC90): 1.51 mg/l in the spring; 0.55 mg/l in the summer; 0.74 mg/l in the fall and 0.93 mg/l in winter, after 24 h exposure of the snails, showing significant differences among the seasons of the year (ANOVA test, F = 11.01, G.L.= 3/33, p < 0.05), as well as among the concentrations (ANOVA test, F = 27.38, G.L.= 11/33, p < 0.05). In the summer, mortality reached 100% from concentration at 0.6 mg/l, the same during fall and in winter as of 1 mg/l, while in spring it only reached 100% mortality as of 2 mg/l. Mortality in the controls was low, reaching 5% in the summer and winter and 10% in the fall and spring. None of the samples died. During the assay, with an aqueous solution of the latex at a concentration of 5 mg/l, in order to check the time of duration of the product effect, in the laboratory, it was observed that the molluscicidal activity remained stable up to the 15th day after the beginning of the test with 100% mortality of L. columella, gradually losing its effect until the 23rd day, when we no longer observed animal mortality. In the control group, there was a random daily variation in mortality rate ranging 0-50% after 48 h of observation for 30 days.

In vitro susceptibility characteristics of Cryptococcus neoformans varieties from AIDS patients in Goiânia, Brazil

Sixty clinical isolates of Cryptococcus neoformans from AIDS from Goiânia, state of Goiás, Brazil, were characterized according to varieties, serotypes and tested for antifungal susceptibility. To differentiate the two varieties was used L-canavanine-glycine-bromothymol blue medium and to separate the serotypes was used slide agglutination test with Crypto Check Iatron. The Minimal Inhibitory Concentration (MIC) of fluconazole, itraconazole, and amphotericin B were determined by the National Committee for Clinical Laboratory Standards macrodilution method. Our results identified 56 isolates as C. neoformans var. neoformans serotype A and 4 isolates as C. neoformans var. gattii serotype B. MIC values for C. neoformans var. gattii were higher than C. neoformans var. neoformans. We verified that none isolate was resistant to itraconazole and to amphotericin B, but one C. neoformans var. neoformans and three C. neoformans var. gattii isolates were resistant to fluconazole. The presence of C. neoformans var. gattii fluconazole resistant indicates the importance of determining not only the variety of C. neoformans infecting the patients but also measuring the MIC of the isolate in order to properly orient treatment.

Don't gamble with your sexual health

This booklet explains the importance of having a check up at a Genito Urinary Medicine (GUM) clinic and what happens at the clinic.

Breast awareness: looking out for changes

This leaflet is used to support the Northern Ireland breast screening programme and describes how women should check their breasts regularly for any changes that are new to them

PHA urges parents to get 'at risk' children vaccinated against seasonal flu

The Public Health Agency is urging Northern Ireland parents to make sure children in 'at risk' groups get their flu vaccine early.The message has been issued to parents and carers of children as the PHA's seasonal flu vaccination programme gets underway for 2011/12.It is very important that children with any condition that puts them more at risk of the complications of flu get the vaccine.These 'at risk' conditions include:chronic lung conditions such as asthma;chest infections that have required hospital admission;chronic heart conditions;chronic liver disease;chronic kidney disease;diabetes;lowered immunity due to disease or treatment such as steroids or cancer therapy;chronic neurological conditions such as stroke, multiple sclerosis or a condition that affects the nervous system, such as cerebral palsy;hereditary and degenerative diseases of the central nervous system or muscles.Children who attend special schools for severe learning or physical disabilities are considered to be particularly at risk, as well as those with other complex health needs.The PHA has written to principals of local special schools, as well as parents of children at these schools, to raise awareness of the importance of getting vaccinated early.Dr Richard Smithson, PHA Flu Vaccination Lead, said: "For many people, flu is a short, unpleasant illness, but it does not usually cause any serious problems. However, for others, it can have very serious complications including, in rare cases, being fatal."We have been particularly reminded over the last two winters that children with chronic neurological problems and other complex health needs are very vulnerable to these complications. We have seen children become very seriously ill and, tragically, there have even been a few deaths in children who attend special schools."For this reason, we recommend that all children who attend special schools for severe learning disability, and special schools for physical disability, are offered the flu vaccine early in the autumn, before the flu viruses start circulating."The vaccine is now available from GP surgeries and the PHA recommends that parents check arrangements with their own GP's surgery so that their child can get the jab.The earlier you get vaccinated the better, as it takes the body about 10-14 days after the jab to develop antibodies. These will then protect you against the same or similar viruses if the body is exposed to them. The vaccine contains three strains of the flu virus, which are considered the most likely to be circulating this winter, including the H1N1 (swine flu) virus."Your child needs to get the flu jab every year - the protection it gives only lasts for one winter, so even if they got it last year, they still need to get it this year," added Dr Smithson."Also, if your child has been diagnosed with flu or swine flu in the past couple of years, they will still need the jab this year as there are different types of flu that the jab will protect against. Getting the flu jab is the best way to protect your child against flu and we would strongly recommend that you arrange for them to have it."Although the vaccine gives good protection, no vaccine gives total protection, so if your child develops flu-like symptoms (such as fever, cough, aches and pains, and sore throat) you should contact your GP for advice. If your child has any of these symptoms, they should be kept at home until they feel better."For more information on seasonal flu, go to www.fluawareni.info and follow us on Facebook and Twitter.

Fish pedicures: Information for the Public

Although the risk of catching an infection as a result of a fish spa pedicure is likely to be very low, it cannot be completely excluded. However, there are certain things you can do to further reduce your risk of catching or spreading an infection when having one of these treatments.Choosing a salonUse your personal judgment: as with all beauty salons, if it looks unsanitary, do not go there for your treatment. If you are very concerned about the cleanliness of a salon you visit, you can report this to your local Environmental Health department, who will be able to perform an inspection of the premises.When having a treatment, a trained member of staff should perform an inspection of your feet both beforehand, to check for any broken skin / infections, and afterwards, to check for signs of bleeding. They should also ask you to wash your feet with soap and water before putting them in the tank, to make sure that any products you have used that could be harmful to the fish are washed away, and to reduce the risk of spreading any infection.Ask your therapist what other procedures the salon has in place to minimise the risk of infection. The Health Protection Agency, England has produced a set of guidelines for salons which, if followed, will ensure any potential risk of infection is kept to an absolute minimum.Before having the treatment The HPA has identified a number of health conditions or prior treatments which may mean that you should not have a fish pedicure. These are:Leg waxing or shaving in last 24 hoursAny open cuts/wounds/abrasions/broken skin on the feet or lower legsInfection on the feet (including athlete's foot, verruca)Psoriasis, eczema or dermatitis affecting the feet or lower legsDiabetes (increased risk of infection)Infection with a blood borne virus such as Hepatitis B or Hepatitis C or HIVAny immune deficiency due to illness or medicationBleeding disorders or on anticoagulant medication (e.g. heparin or warfarinMore information and advice on fish spa pedicures and the full set of guidance can be found on the Health Protection website www.hpa.org.uk

Think... before you drink... unpasteurised milk

Milk produced on farms on the island of Ireland is generally acknowledged to be of very high standard. The microbiological standards demanded of milk at EU level have been consistently improving over recent years. What you may not know, however, is that these routine tests do not specifically check for E. coli, Salmonella and other potentially harmful bacteria which may be present in unpasteurised milk. There are, therefore, potential risks associated with the consumption of unpasteurised milk and farming families who frequently drink unpasteurised milk produced on the farm should be aware of the possible risks.

Burnt outside raw in the middle

Sometimes it's hard to tell when burgers and sausages are properly cooked and ready to eat. These meats can contain harmful bacteria throughout and it is important that they are cooked thoroughly to make them safe to eat. To check that a burger or sausage is properly cooked, cut into the middle with a clean knife and check that it is piping hot all the way through, there is no pink meat left and the juices run clear.

Effects of sarcoptic mange on the behaviour of the red fox and influence on other fox-born zoonoses in Geneva, Switzerland

Résumé : Une épidémie de gale sarcoptique (Sarcoptes scabiei) touche le canton de Genève depuis 1996. Nous avons étudié l'impact de cette maladie sur différents caractères comportementaux du renard roux (Vulpes vulpes) : l'écologie alimentaire, les comportements spatiaux et l'activité, ainsi que les contacts sociaux. Nous avons également évalué si la gale pouvait influencer la composition et la transmission de la communauté helminthique intestinale du renard. En effet, cette espèce est l'hôte de parasites qui sont liés à des zoonoses importantes, en particulier le ténia échinocoque du renard (Echinococcus multilocularis) pour lequel Genève est considérée comme une zone de haute endémie. Durant 5 années, des carcasses de renards ont été récoltées sur l'ensemble du canton. Nous les avons disséquées et avons conservé différents échantillons pour des analyses ultérieures. Des données sur le poids, l'âge et le statut reproductif des femelles ont ainsi pu être obtenues. Les contenus stomacaux ont été analysés pour déterminer le régime alimentaire, les intestins pour collecter des helminthes, des échantillons de sang pour faire des sérologies et des échantillons de peau pour récupérer les sarcoptes. Des renards sauvages ont également été capturés et équipés de colliers émetteurs afin de déterminer leur activité et leur utilisation de l'espace. Finalement, nous avons réalisé des affûts sur des terriers et des observations nocturnes à l'aide d'un détecteur thermique afin d'étudier les contacts sociaux. Nous avons ensuite considéré tous ces aspects pour comparer les renards galeux aux individus sains. Trois catégories de gale ont été prises en compte selon l'importance de l'infection. L'épidémie a traversé le canton en 8 ans environ et elle a provoqué une forte diminution des populations de renard. Les animaux malades étaient caractérisés par un poids réduit, ils utilisaient des domaines vitaux réduits et présentaient un rythme d'activité irrégulier. En ce qui concerne le régime alimentaire, les renards galeux avaient souvent des estomacs vides ou contenant peu d'aliments d'origine animale. Cette réduction de l'alimentation ne semble pas seulement être liée à des capacités de prédation réduite, mais également à un désintérêt face à la nourriture. Tous les changements de comportement cités étaient plus marqués chez les animaux soumis à une forte infestation. Dix taxons d'helminthes ont été identifiés dans les intestins des renards analysés. Deux d'entre eux représentent un risque de santé publique: Echinococcus multilocularis et Toxocara carvis. Pour ces helminthes, nous n'avons pas identifié de différences de prévalence entre les renards galeux et les animaux sains, mais la charge parasitaire était significativement supérieure chez les individus galeux, en particulier ceux souffrant d'une infestation importante. Ceci est probablement lié à une susceptibilité accrue des individus qui présentent une condition physique amoindrie et des défenses immunitaire affaiblies. Selon nos résultats, nous pouvons conclure que la gale induit des changements comportementaux importants et que ces changements ont une influence potentielle sur la transmission de la gale elle-même, mais également sur la transmission du reste de la communauté parasitaire de l'hôte. Les individus qui souffrent d'une infestation importante sont susceptibles de provoquer une contamination de l'environnement accrue en ce qui concerne des helminthes pouvant provoquer des zoonoses. La gale apparaît être un facteur à ne pas négliger dans le cadre de la gestion de la faune sauvage, mais également en ce qui concerne des problématiques de santé publique. Summary An epidemic outbreak of sarcoptic mange (Sarcoptes scabiei) has struck the canton of Geneva since 1996. The impact of the disease on various behavioural traits of the main host, the red fox (Vulpes vulpes), was investigated: feeding ecology, spatial behaviour and activity, and social contacts. We also evaluated if mange might have an influence on the composition and transmission of the intestinal helminth community of foxes. Indeed, this species is host of parasites with potential zoonotic importance, particularly the fox tapeworm (Echinococcus multilocularis) for which Geneva is reported as endemic area. During 5 years, red fox carcasses have been collected throughout the canton. They were then dissected and various samples conserved for further analysis. Data on weight, age, and reproductive status of females were obtained. Stomach content were analysed for diet analysis, intestines to recover helminths, blood to proceed to ELISAs and skin samples to check for the presence of Sarcoptes mites. Further, wild foxes were captured and fitted with transmitters in order to determine their activity pattern and space use. Finally, we proceeded to direct observations at dens and using a thermal imaging sensor at night to gain information about social contacts. A comparison between healthy and mangy foxes was made for all these aspects. Three categories of mangy foxes were considered from moderately to severely infected. The epidemic wave crossed the canton in about 8 years and induced a significant reduction in fox densities. Mangy individuals appeared to have reduced body weights, to use more restricted home ranges and exhibited an irregular activity pattern. Regarding food, sick foxes often had empty stomachs and consumed less food items of animal origin. The reduction in food intake appeared to be linked not only to a reduced ability to hunt, but also to a reduced interest in food. The changes observed were particularly pronounced in individuals with severe infestation. Ten helminth taxa were recovered from the intestines on the analysed fox carcasses. Two of them have an importance with regard to human public health: Echinococcus multilocularis and Toxocara cams. The prevalence of these helminths did not differ between healthy and mangy foxes, however the worm burden was significantly higher in mangy foxes, particularly those with severe mange. This is probably linked to an increased susceptibility in individuals with a reduced body condition and weakened immune defences. From our observations, we can conclude that mange induces pronounced behavioural changes in the red fox, and that those changes influence the transmission risks of mange itself, but also of the rest of the parasite community of the host. Individuals with severe mange are for example likely to increase the environment contamination of free living stages of helminths with zoonotic importance. Mange appears thus to represent a factor not to be neglected for the management of wild species and for public health issues.

Deep accidental hypothermia with core temperature below 24°c presenting with vital signs.

Abstract Pasquier, Mathieu, Noemi Zurron, Barbara Weith, Pierre Turini, Fabrice Dami, Pierre-Nicolas Carron, and Peter Paal. Deep accidental hypothermia with core temperature below 24°C presenting with vital signs. High Alt Med Biol. 15:58-63, 2014.-Background: According to the Swiss hypothermia clinical staging, patients with stage III are unconscious with preserved vital signs, with core temperature usually between 24° and 28°C. With stage IV, vital signs are absent with core temperature <24°C. Aims: To describe a patient presenting with HT stage III with vital signs but a core temperature of <24°C, and to search for similar patients in the medical literature. Materials and methods: MEDLINE was used to search for cases of deep accidental hypothermia (<24°C) and preserved vital signs. Results: We found 22 cases in addition to our case (n=23). Median age was 44 years (IQR 36; range 4-83) and median core temperature 22°C (IQR 1.7; 17-23.8). Vital signs were often minimal. Seven patients developed ventricular fibrillation (VF). Twenty patients survived with excellent neurological outcome. Conclusions: Vital signs can be present in hypothermic patients with core temperature <24°C. In deeply hypothermic patients, a careful check and prolonged check of vital functions should be made, as vital signs may be minimal. The clinical Swiss staging remains valuable in the prehospital evaluation of hypothermic patients; its correlation with core temperature should be better defined.

Your result shows a small abdominal aortic aneurysm (AAA)

This leaflet is given to all men who have attended screening through the Northern Ireland Abdominal Aortic Aneurysm (AAA) Screening Programme and been diagnosed with a small AAA.The leaflet provides: �background information on the AAA screening programme; details on what a small AAA is; information on the monitoring process to regularly check the size of the AAA;lifestyle advice that may help those men diagnosed with an AAA. �Men who have been diagnosed with a small AAA will be invited to a monitoring scan once a year, unless their AAA increases in size to a medium AAA, at which point they will be invited to a monitoring scan once every three months.

Your result shows a medium abdominal aortic aneurysm (AAA)

This leaflet is given to all men who have attended screening through the Northern Ireland Abdominal Aortic Aneurysm (AAA) Screening Programme and been diagnosed with a medium AAA.The leaflet provides: background information on the AAA screening programme; details on what a medium AAA is; information on the monitoring process to regularly check the size of the AAA;lifestyle advice that may help those men diagnosed with an AAA. Men who have been diagnosed with a medium AAA will be invited to a monitoring scan once every three months, unless their AAA increases in size to a large AAA, at which point they will be referred to a team of vascular specialists for further assessment and the possible offer of surgery.