Caregiver burden and resilience among Malaysian caregivers of individuals with severe mental illness

Little research has focused on caregiver burden experienced by Malaysian caregivers of individuals with mental illness, despite the fact that data in the Asian region shows almost threequarter of patients with mental illness live with family members. The aim of this research was to examine the levels of caregiver burden and resilience of caregivers of individuals with severe mental illness and to determine the influencing factors on caregiver burden. A quantitative, cross sectional, correlational design was used to measure burden and resilience and to explore the relationship between demographic variables, caregiver stressors, resilience and caregiver burden. This study was guided by the model of Carer Stress and Burden. Data collection was conducted over two months in summer 2014. A self-administered questionnaire that consisted of four sections measuring demographic data, primary stressors, caregiver burden and resilience was used to collect data. Two hundred and one caregivers of individuals with mental illness attending Psychiatric Outpatient Clinics in Malaysia were recruited. Samples were selected using non-probability, consecutive sampling. Factors that were found to be significantly associated with caregiver burden were caregivers’ age, gender, ethnic group, employment status, having a medical condition and current health status. The primary stressors found to be significantly associated with caregiver burden include the time spent for caregiving tasks, unavailability of support with caregiving tasks, lack of emotional support and patients’ behavioural disturbances. In addition, it was found that caregivers who were less resilient reported a higher level of caregiver burden. Findings from hierarchical multiple regression indicated that caregivers’ marital status, current health status, time spent for caregiving and resilience predicted caregiver burden. This research provides insight into caregiver burden among caregivers of individuals with mental illness in Malaysia. It highlights the important factors associated with caregiver burden and the significant role of resilience in reducing caregiver burden.

An investigation into reactivity and selectivity in cycloadditions of 1,3-dipoles with formamidines

The objective of this research was to investigate the synthesis of nitrile oxides and to study their reactivity in 1,3-dipolar cycloadditions with formamidines. Chapter one looks at the literature surrounding the 1,3-dipolar cycloaddition reaction. It explores the generation of 1,3-dipoles (mainly nitrile oxides) and dipolarophiles (predominantly amidines). It discusses the potential synthetic uses of the 1,3-dipolar cycloadducts. It examines both and inter- and intra-molecular cycloaddition reactions. It recognises the use of the 1,3-dipolar cycloadditions as a successful method in building natural products and oxadiazolines. The decomposition of oxadiazolines as a route to nitriles is also outlined in this chapter. Chapter two discusses the results of this research candidate. The preparation of nitrile oxide precursors - hydroximoyl halides - is outlined at first. The generation of nitrile oxides is then demonstrated, followed by the preparation of furoxans. Methods for preparing the reference materials (nitriles and ureas), which result from decomposition of oxadiazolines, then follow. The preparation of series of Δ2-1,2,4- oxadiazolines via the 1,3-dipolar cycloaddition reaction is illustrated in this chapter. The selectivity of the addition of nitrile oxides to dipolarophiles was tested by competition reactions, which are also described in this chapter. NMR techniques were used in the study of the kinetics of the 1,3-dipolar cycloadditions used for the preparation of a series of Δ2-1,2,4-oxadiazolines, which is addressed in this chapter. Chapter three charts the experimental procedures followed to gain results which are discussed in chapter two. It also outlines all analytical data produced during the course of this research.

Delivering mobile cloud services to the user: description, discovery, and consumption

The mobile cloud computing paradigm can offer relevant and useful services to the users of smart mobile devices. Such public services already exist on the web and in cloud deployments, by implementing common web service standards. However, these services are described by mark-up languages, such as XML, that cannot be comprehended by non-specialists. Furthermore, the lack of common interfaces for related services makes discovery and consumption difficult for both users and software. The problem of service description, discovery, and consumption for the mobile cloud must be addressed to allow users to benefit from these services on mobile devices. This paper introduces our work on a mobile cloud service discovery solution, which is utilised by our mobile cloud middleware, Context Aware Mobile Cloud Services (CAMCS). The aim of our approach is to remove complex mark-up languages from the description and discovery process. By means of the Cloud Personal Assistant (CPA) assigned to each user of CAMCS, relevant mobile cloud services can be discovered and consumed easily by the end user from the mobile device. We present the discovery process, the architecture of our own service registry, and service description structure. CAMCS allows services to be used from the mobile device through a user's CPA, by means of user defined tasks. We present the task model of the CPA enabled by our solution, including automatic tasks, which can perform work for the user without an explicit request.

Oxidation-reduction potential and its influence on Cheddar cheese quality

Oxidation-reduction (redox) potential is a fundamental physicochemical parameter that affects the growth of microorganisms in dairy products and contributes to a balanced flavour development in cheese. Even though redox potential has an important impact on the quality of dairy products, it is not usually monitored in dairy industry. The aims of this thesis were to develop practical methods for measuring redox potential in cheese, to provide detailed information on changes in redox potential during the cheesemaking and cheese ripening and how this parameter is influenced by starter systems and to understand the relationship between redox potential and cheese quality. Methods were developed for monitoring redox potential during cheesemaking and early in ripening. Changes in redox potential during laboratory scale manufacture of Cheddar, Gouda, Emmental, and Camembert cheeses were determined. Distinctive kinetics of reduction in redox potential during cheesemakings were observed, and depended on the cheese technology and starter culture utilised. Redox potential was also measured early in ripening by embedding electrodes into Cheddar cheese at moulding together with the salted curd pieces. Using this approach it was possible to monitor redox potential during the pressing stage. The redox potential of Emmental cheese was also monitored during ripening. Moreover, since bacterial growth drives the reduction in redox potential during cheese manufacture and ripening, the ability of Lactococcus lactis strains to affect redox potential was studied. Redox potential of a Cheddar cheese extract was altered by bacterial growth and there were strain-specific differences in the nature of the redox potential/time curves obtained. Besides, strategies to control redox potential during cheesemaking and ripening were developed. Oxidizing or reducing agents were added to the salted curd before pressing and results confirmed that a negative redox potential is essential for the development of sulfur compounds in Cheddar cheese. Overall, the studies described in this thesis gave an evidence of the importance of the redox potential on the quality of dairy products. Redox potential could become an additional parameter used to select microorganisms candidate as starters in fermented dairy products. Moreover, it has been demonstrated that the redox potential influences the development of flavour component. Thus, measuring continuously changes in redox potential of a product and controlling, and adjusting if necessary, the redox potential values during manufacture and ripening could be important in the future of the dairy industry.

Antimicrobial stewardship in Ireland, with a focus on long term care facilities

Background: Antimicrobial resistance is a major public health concern, and its increasing incidence in the Long Term Care Facility (LTCF) setting warrants attention (1). The prescribing of antimicrobials in this setting is often inappropriate and higher in Ireland than the European average (2). The aim of the study was to generate an evidence base for the factors influencing antimicrobial prescribing in LTCFs and to investigate Antimicrobial Stewardship (AMS) strategies for LTCFs. Methods: An initial qualitative study was conducted to determine the factors influencing antimicrobial prescribing in Irish LTCFs. This allowed for the informed implementation of an AMS feasibility study in LTCFs in the greater Cork region. Hospital AMS was also investigated by means of a national survey. A study of LTCF urine sample antimicrobial resistance rates was conducted in order to collate information for incorporation into future LTCF AMS initiatives. Results: The qualitative interviews determined that there are a multitude of factors, unique to the LTCF setting, which influence antimicrobial prescribing. There was a positive response from the doctors and nurses involved in the feasibility study as they welcomed the opportunity to engage with AMS and audit and feedback activities. While the results did not indicate a significant change in antimicrobial prescribing over the study period, important trends and patterns of use were detected. The antimicrobial susceptibility of LTCF urine samples compared to GPs samples found that there was a higher level of antimicrobial resistance in LTCFs. Conclusion: This study has made an important contribution to the development of AMS in LTCFs. The complexity of care and healthcare organisation, and the factors unique to LTCFs must be borne in mind when developing quality improvement strategies.

Chemistry and synthesis of 3(2H)-furanones and 4,5-dihydro analogues: mechanistic investigations and stereochemical control

The subject matter of this thesis relates to the chemistry of the five-membered oxygen heterocycles – 3(2H)-furanones and their 4, 5-dihydro analogues. Chapter one of the thesis is a review of the relevant chemistry of the compounds: their synthesis and key transformations. In chapter two, new research on 3(2H)-furanones is outlined in two parts. The first describes an investigation into the cyclisation of α'-trialkylsilyloxyenone adducts with arenesulfenyl and selenenyl chlorides into the corresponding sulfur and selenium substituted 3(2H)-furanones without the involvement of a Lewis acid catalyst. The study, largely involving in situ NMR techniques, identified key features associated with the formation and reaction of the chlorosulfide and chloroselenide intermediates, including operation of the Thorpe-Ingold effect. The knowledge gained in this study was applied (the second part) to the synthesis of vinyl substituted furanone systems from α'-trialkylsilyloxydienones where choice of the reaction conditions and electrophilic reagent was a key feature. An important difference in the behaviour of arenesulfenyl and selenenyl halides towards conjugated dienes emerged from this work. This phase of the research concluded with a new synthesis of geiparvarin, a natural product possessing anti-tumour properties.

An examination of the impact of dietary lipids on behaviour and neurochemistry

The molecular and cellular basis of stress pathology remains an important research question in biological science. A better understanding of this may enable the development of novel approaches for the treatment of stress-related disorders. There is a considerable body of scientific evidence suggesting that dietary lipids, phospholipids and omega-3 polyunsaturated fatty acids (n-3 PUFAs), have therapeutic potential for certain psychiatric disorders. Thus, we proposed n-3 PUFAs as a novel strategy for the prevention or amelioration of stress-related disorders. We hypothesised that these compounds would improve behavioural and neurobiological responses and alter gut microbial composition. Furthermore, we proposed a new mechanism of action exerted by n-3 PUFAs using an in vitro model of stress. Lastly, we explored the protective effects of both phospholipids and n-3 PUFAs against neuroinflammation, which has been shown to contribute to the development of stress-related disorders. We provide further evidence that glucocorticoids, inflammation and early-life stress induce vulnerability to psychopathologies. Specifically, we have demonstrated that corticosterone (CORT) alters cortical neuron and astrocyte percentage composition, reduces brain-derived-neuronal factor (BDNF) expression, and induces glucocorticoid receptor (GR) down-regulation in mixed cortical cultures. Interestingly, we found that lipopolysaccharide (LPS) treatment resulted in an over-expression of pro-inflammatory cytokines in cortical astrocyte cultures. Moreover, we demonstrate that early-life stress induces changes to the monoaminergic and immune systems as well as altered neuroendocrine response to stressors later in life. In addition, we found that early-life stress alters the gut microbiota in adulthood. These data demonstrate that n-3 PUFAs can attenuate CORT-induced cellular changes, but not those caused by LPS, within the cerebral cortex. Similarly, phospholipids were unable to reverse LPS-induced inflammation in cultured astrocytes. In addition, this thesis proposes that n-3 PUFAs may prevent the development or lessen the symptoms of mental illnesses, ameliorating anxiety- and depressive-like symptoms as well as cognitive effects, particularly when administered during neurodevelopment. Such effects may be mediated by GR activation as well as by modification of the gut microbiota composition. Taken together, our findings suggest that n-3 PUFAs have therapeutic potential for stress-related disorders and we provide evidence for the mechanisms by which they may exert these effects. These findings contribute to an exciting and growing body of research suggesting that nutritional interventions may have an important role to play in the treatment of stress-related psychiatric conditions.

Nutrition, growth and body composition in infancy

This thesis is presented in two parts. Data for this research is from the Cork BASELINE (Babies after SCOPE, Evaluating Longitudinal Impact using Neurological and Nutritional Endpoints) Birth Cohort Study (n = 2137). In this prospective birth cohort study, pediatric follow-up with in-person appointments were repeated from the time of birth through to 2, 6 and 12 months, and at 2 years. Body composition was measured by air displacement plethysmography at birth and at 2 months using the PEA POD Infant Body Composition Tracking System. This thesis provides the first extensive report on the study’s 2 year assessment. In part one, the aims were to investigate potential early-life risk factors for childhood overweight and obesity, including rapid growth and body composition in infancy and umbilical cord concentrations of leptin and high molecular weight (HMW) adiponectin. This research is the first to describe rapid growth in early infancy in terms of changes in direct measures of body composition. These are also the first data to examine associations between umbilical cord leptin and HMW adiponectin concentrations and changes in fat and lean mass in early infancy. These data provide additional insight into characterising the growth trajectory in infancy and into the role of perinatal factors in determining infant growth and subsequent overweight/obesity risk. In part two of this thesis, the aims were to quantify vitamin D intake and status at 2 years and to investigate whether 25-hydroxyvitamin D [25(OH)D] concentrations in early pregnancy and in umbilical cord blood are associated with infant growth and body composition. There was a low prevalence of vitamin D deficiency among Irish 2 year olds (n = 742) despite a high prevalence of inadequate intakes and high latitude (51°N). Maternal 25(OH)D concentrations at 15 weeks gestation and cord 25(OH)D concentrations at delivery were not associated with infant growth or adiposity.

Studies on the texture, functionality, rheology and sensory properties of Cheddar and Mozzarella cheeses

The effect of fortification of skim milk powder and sodium caseinate on Cheddar cheeses was investigated. SMP fortification led to decreased moisture, increased yield, higher numbers of NSLAB and reduced proteolysis. The functional and texture properties were also affected by SMP addition and formed a harder, less meltable cheese than the control. NaCn fortification led to increased moisture, increased yield, decreased proteolysis and higher numbers of NSLAB. The functional and textural properties were affected by fortification with NaCn and formed a softer cheese that had similar or less melt than the control. Reducing the lactose:casein ratio of Mozzarella cheese by using ultrafiltration led to higher pH, lower insoluble calcium, lower lactose, galactose and lactic acid levels in the cheese. The texture and functional properties of the cheese was affected by varying the lactose:casein ratio and formed a harder cheese that had similar melt to the control later in ripening. The flavour and bake properties were also affected by decreased lactose:casein ratio; the cheeses had lower acid flavour and blister colour than the control cheese. Varying the ratio of αs1:β-casein in Cheddar cheese affected the texture and functionality of the cheese but did not affect insoluble calcium, proteolysis or pH. Increasing the ratio of αs1:β-casein led to cheese with lower meltability and higher hardness without adverse effects on flavour. Using camel chymosin in Mozzarella cheese instead of calf chymosin resulted in cheese with lower proteolysis, higher softening point, higher hardness and lower blister quantity. The texture and functional properties that determine the shelf life of Mozzarella were maintained for a longer ripening period than when using calf chymosin therefore increasing the window of functionality of Mozzarella. In summary, the results of the trials in this thesis show means of altering the texture, functional, rheology and sensory properties of Mozzarella and Cheddar cheeses.

Justifying jihad: US politics, propaganda and the Afghan mujahedeen

Hard-line anti-communists in the United States recognised the potential for the Soviet invasion of Afghanistan in 1979 to embroil their super-power rival in a ‘Vietnam-like quagmire.’ Their covert operation to arm the mujahedeen is well documented. This dissertation argues that propaganda and public diplomacy were powerful and essential instruments of this campaign. It examines the protagonists of this strategy, their policies, initiatives and programmes offering a comprehensive analysis heretofore absent. It stretches from the dying days of the Carter administration when Zbigniew Brzezinski saw the ‘opportunity’ presented by the invasion to the Soviet’s withdrawal in 1989. The aim of these information strategies was to damage Soviet credibility and enhance that of the US, considered under threat from growing ‘moral equivalence’ amongst international publics. The conflict could help the US regain strategic advantage in South Asia undermined by the ‘loss’ of Iran. The Reagan administration used it to justify the projection of US military might that it believed was eviscerated under Carter and emasculated by the lingering legacy of Vietnam. The research engages with source material from the Reagan Presidential Library, the United States Information Agency archives and the Library of Congress as well as a number of online archives. The material is multi-archival and multi-media including documentaries, booklets, press conferences, summit programmes and news-clips as well as national security policy documents and contemporaneous media commentary. It concludes that propaganda and public diplomacy were integral to the Reagan administration and other mujahedeen supporters’ determination to challenge the USSR. It finds that the conflict was used to justify military rearmament, further strategic aims and reassert US power. These Cold War machinations had a considerable impact on the course of the conflict and undermined efforts at resolution and reconciliation with profound implications for the future stability of Afghanistan and the world.

Career choice in medicine

Background: Career Choice in Medicine is an important and problematic topic. Medical education has been framed as professional identity development, yet career choice has not been viewed as a matter of identity. My primary aim was to offer new insights by exploring career choice using Figured Worlds theory, a socio-cultural theory of identity. Graduate retention is a challenge for many countries, including Ireland. My secondary aim was to address a gap in the data on postgraduate trainees in Ireland and to use the Irish case to illustrate points transferable to other contexts. Methodology & Methods: This was a predominantly qualitative Mixed Methods programme of research. My qualitative studies were oriented towards social constructionism. I collated existing data from the Royal College of Physicians of Ireland (RCPI) and HSE-MET to describe trainees and their career paths. I surveyed Basic Specialist Training trainees (n=333) about their career plans. I surveyed new trainees (n=527) about their expectations of training and all RCPI trainees about their experiences of training (n=1246). I conducted semi-structured interviews with 18 medical students and doctors. A subgroup (n=6) provided longitudinal data. Figured Worlds theory and Gee’s discourse tools were used for analysis. Results: I have used the case of medical training and career choice in Ireland to explain how social, political and cultural context, and day to day experiences in the cultural world of medicine, shaped doctors’ career choices. My qualitative findings described a unifying model of career choice, consisting of priming, exposure, positioning and open-endedness, which can guide the design of interventions to shape and support career choice. Conclusion: My original contribution has been to demonstrate the fruitfulness of framing career choice in terms of identity development. This represents a turn in the conversation about career choice, which brings new starting points and moves the dialogue forward.

ENVIRON 2011: 21st Irish Environmental Researchers Colloquium

The theme of this year’s colloquium is “Towards 2020: Environmental challenges and opportunities for the next decade” which reflects the many environmental targets that have been set for the year 2020 in areas of climate change, renewable energy, water protection and biodiversity. In relation to the latter, we are delighted to have Professor Michael Depledge (Former Chairman of UK Science Advisory Committee on the Environment & Climate Change) at ENVIRON 2011 to deliver the colloquium keynote address on “Health and the Value of Nature”. The colloquium plenary session has a number of high profile speakers who will address the colloquium theme of environmental challenges and opportunities for the next decade including Professor John Sweeney (NUI Maynooth), Ms Laura Burke (Director of EPA’s Office of Climate, Licensing Research and Resource Use) and Mr John Mullins (CEO of Bord Gais). The research programme has 95 oral presentations and 60 poster presentations in the themes of water quality, energy and climate change, marine and coastal research, environmental management, environmental technologies, environment and health, and biodiversity and ecosystems. In addition, for the first year, poster presenters have the opportunity to make a 1 minute oral presentation on their poster during the oral sessions in the relevant theme. The 2011 colloquium also sees an increase the number of workshops and seminars accompanying the programme with an emphasis on training and development for postgraduates in the environmental area. We are particularly pleased to have a link with the Environment Graduate Programme in the “Ocean Studies Workshop” which illustrates how the ENVIRON colloquium can support and benefit from the various graduate programmes currently being developed within Universities. Finally ENVIRON 2011 and the UCC 2011 Law and the Environment symposium have been deliberately scheduled together at the same time and location to allow delegates from both conferences to benefit from each other’s programmes.

Valuing maternity care: a comparison of stated preference methods with an application to cost-benefit analysis

This research investigates whether a reconfiguration of maternity services, which collocates consultant- and midwifery-led care, reflects demand and value for money in Ireland. Qualitative and quantitative research is undertaken to investigate demand and an economic evaluation is performed to evaluate the costs and benefits of the different models of care. Qualitative research is undertaken to identify women’s motivations when choosing place of delivery. These data are further used to inform two stated preference techniques: a discrete choice experiment (DCE) and contingent valuation method (CVM). These are employed to identify women’s strengths of preferences for different features of care (DCE) and estimate women’s willingness to pay for maternity care (CVM), which is used to inform a cost-benefit analysis (CBA) on consultant- and midwifery-led care. The qualitative research suggests women do not have a clear preference for consultant or midwifery-led care, but rather a hybrid model of care which closely resembles the Domiciliary Care In and Out of Hospital (DOMINO) scheme. Women’s primary concern during care is safety, meaning women would only utilise midwifery-led care when co-located with consultant-led care. The DCE also finds women’s preferred package of care closely mirrors the DOMINO scheme with 39% of women expected to utilise this service. Consultant- and midwifery-led care would then be utilised by 34% and 27% of women, respectively. The CVM supports this hierarchy of preferences where consultant-led care is consistently valued more than midwifery-led care – women are willing to pay €956.03 for consultant-led care and €808.33 for midwifery-led care. A package of care for a woman availing of consultant- and midwifery-led care is estimated to cost €1,102.72 and €682.49, respectively. The CBA suggests both models of care are cost-beneficial and should be pursued in Ireland. This reconfiguration of maternity services would maximise women’s utility, while fulfilling important objectives of key government policy.

Improved kinematic sensing for motion control applications

New compensation methods are presented that can greatly reduce the slit errors (i.e. transition location errors) and interval errors induced due to non-idealities in optical incremental encoders (square-wave). An M/T-type, constant sample-time digital tachometer (CSDT) is selected for measuring the velocity of the sensor drives. Using this data, three encoder compensation techniques (two pseudoinverse based methods and an iterative method) are presented that improve velocity measurement accuracy. The methods do not require precise knowledge of shaft velocity. During the initial learning stage of the compensation algorithm (possibly performed in-situ), slit errors/interval errors are calculated through pseudoinversebased solutions of simple approximate linear equations, which can provide fast solutions, or an iterative method that requires very little memory storage. Subsequent operation of the motion system utilizes adjusted slit positions for more accurate velocity calculation. In the theoretical analysis of the compensation of encoder errors, encoder error sources such as random electrical noise and error in estimated reference velocity are considered. Initially, the proposed learning compensation techniques are validated by implementing the algorithms in MATLAB software, showing a 95% to 99% improvement in velocity measurement. However, it is also observed that the efficiency of the algorithm decreases with the higher presence of non-repetitive random noise and/or with the errors in reference velocity calculations. The performance improvement in velocity measurement is also demonstrated experimentally using motor-drive systems, each of which includes a field-programmable gate array (FPGA) for CSDT counting/timing purposes, and a digital-signal-processor (DSP). Results from open-loop velocity measurement and closed-loop servocontrol applications, on three optical incremental square-wave encoders and two motor drives, are compiled. While implementing these algorithms experimentally on different drives (with and without a flywheel) and on encoders of different resolutions, slit error reductions of 60% to 86% are obtained (typically approximately 80%).

Ford, Carter and Cambodia: US foreign policy and the Khmer Rouge

This thesis is an investigation into the US response to the Khmer Rouge regime in Cambodia between 1974 and 1981. It argues that the US experience in the Vietnam War acted as a causal factor in the formulation of its Cambodian policy during the presidencies of Gerald Ford and Jimmy Carter. From taking power in April 1975 to their removal by the Vietnamese in January 1979, the Khmer Rouge initiated a revolution unrivalled in the 20th Century for its brutality and for the total eradication of modern society. This thesis demonstrates that the Ford administration viewed Cambodia only as it pertained to their strategy in Vietnam and, following US disengagement from Indochina all but ignored the atrocities occurring there as they instead pursued informal relations with the Khmer Rouge as a means of punishing the Vietnamese. The Carter administration formulated a foreign policy based on human rights yet failed to adequately address the genocide that occurred in Cambodia due to its temporal and regional proximity to Vietnam. Instead, this collective reluctance to reengage with the region and the resulting anti-Vietnamese attitude reinforced Brzezinski’s broader global strategy that allied the US with China in support of an independent Cambodia to further isolate Hanoi. Thus this thesis argues that the distorting impact of the Vietnam War, as well as global Cold War calculations, undermined any appreciation of the Cambodian conflict and caused both administrations to pursue policies in Cambodia that ultimately supported the Khmer Rouge regime. This project incorporates declassified material from the Ford and Carter Presidential Libraries, supplemented by the material from the National Archives and Library of Congress, and relevant newspapers and periodicals. It demonstrates that the limitations placed upon US foreign policy by their experience in the Vietnam War may be used to reveal unexplored elements in US-Cambodian relations.