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The aim of this study is to investigate whether 25-hydroxyvitamin D (25(OH)D) is associated with periodontitis and tooth loss in older adults. A total of 2346 adults underwent a detailed dental examination as part of the health assessment of a national population study – The Irish Longitudinal Study of Ageing. 25(OH)D analysis was performed on frozen non-fasting total plasma using LC-MS. The analysis included both multiple logistic regression and multinominal logistic regression to investigate associations between 25(OH)D concentration, periodontitis and tooth loss, adjusting for a range of potential confounders. Results of the analysis found the mean age of participants was 65·3 years (sd 8·2) and 55·3 % of the group were female. Based on the quintile of 25(OH)D concentration, participants in the lowest v. highest quintile had an OR of 1·57 (95 % CI 1·16, 2·13; P < 0·01) of having periodontitis in the fully adjusted model. For tooth loss, participants in the lowest v. highest quintile of 25(OH)D had a RRR of 1·55 (95 % CI 1·12, 2·13; P < 0·01) to have 1–19 teeth and a RRR of 1·96 (95 % CI 1·20, 3·21; P < 0·01) to be edentulous, relative to those with ≥ 20 teeth in the fully adjusted models. These findings demonstrate that in this cross-sectional study of older men and women from Ireland, 25(OH)D concentration was associated with both periodontitis and tooth loss, independent of other risk factors.
Children with neurodevelopmental disorders (NDDs) commonly experience attentional and executive function (EF) difficulties that are negatively associated with academic success, psychosocial functioning, and quality of life. Access to early and consistent interventions is a critical protective factor and there are recommendations to deliver cognitive interventions in schools; however, current cognitive interventions are expensive and/or inaccessible, particularly for those with limited resources and/or in remote communities. The current study evaluated the school-based implementation of two game-based interventions in children with NDDs: 1) a novel neurocognitive attention/EF intervention (Dino Island; DI), and 2) a commercial educational intervention (Adventure Academy; AA). DI is a game-based attention/EF intervention specifically developed for children for delivery in community-based settings.
Participants and Methods:
Thirty five children with NDDs (ages 5-13 years) and 17 EAs participated. EAs completed on-line training to deliver the interventions to assigned students at their respective schools (3x/week, 40-60 minutes/session, 8 weeks, 14 hours in total). We gathered baseline child and EA demographic data, completed pre-intervention EA interviews, and conducted regular fidelity checks throughout the interventions. Implementation data included paper-pencil tracking forms, computerized game analytic data, and online communications.
Results:
Using a mixed methods approach we evaluated the following implementation outcomes: fidelity, feasibility, acceptability, and barriers. Overall, no meaningful between-group differences were found in EA or child demographics, except for total number of years worked as an EA (M = 17.18 for AA and 9.15 for DI; t (22) = - 4.34, p < .01) and EA gender (χ2 (1) = 6.11, p < .05). For both groups, EA age was significantly associated with the number of sessions played [DI (r = .847, p < .01), AA (r = .986, p < .05)]. EAs who knew their student better completed longer sessions [DI (r = .646), AA (r = .973)], all ps < .05]. The number of years worked as an EA was negatively associated with the total intervention hours for both groups. Qualitative interview data indicated that most EAs found DI valuable and feasible to deliver in their classrooms, whereas more implementation challenges were identified with AA. Barriers common to both groups included technical difficulties (e.g., game access, internet firewalls), environmental barriers (e.g., distractions in surroundings, time of the year), child factors (e.g., lack of motivation, attentional difficulties, frustration), and game-specific factors (e.g., difficulty level progression). Barriers specific to DI included greater challenges in motivating children as a function of difficulty level progression. Furthermore, given the comprehensive nature of training required for delivery, EAs needed a longer time to complete the training for DI. Nevertheless, many EAs in the DI group found the training helpful, with a potential to generalize to other children in the classroom.
Conclusions:
The availability of affordable, accessible, and effective cognitive intervention is important for children with NDDs. We found that delivery of a novel cognitive intervention by EAs was feasible and acceptable, with similarities and differences in implementation facilitators/barriers between the cognitive and commercialized academic intervention. Recommendations regarding strategies for successful school-based implementation of neurocognitive intervention will be elaborated on in the poster.
The Great Irish Famine claimed the lives of one million people, mainly from the lower classes. More than a million others fled the stricken land between 1845 and 1851. In recent decades, its history has become the focus of considerable scholarly and popular attention, but much remains to be retrieved and reconstructed, particularly at the level of the rural poor. This book fills that gap. It is based on a large volume of reports on social conditions in the Irish localities, emanating from within those localities, that has never been used systematically by historians. It bears the compelling title of the 'Death Census'. Most historians are simply unaware of its existence. The outstanding feature of the Death Census is that it was authored by local clergymen who lived among the people they served, and were intimately involved with their lives. This book brings the Death Census together in composite form for the first time, and provides a detailed examination of its contents. The result is a new understanding of the Great Famine as it was experienced on the ground.
Background:Candida auris is a frequently drug-resistant yeast that can cause invasive disease and is easily transmitted in healthcare settings. Pediatric cases are rare in the United States, with <10 reported before 2022. In August 2021, the first C. auris case in Las Vegas was identified in an adult. By May 2022, 117 cases were identified across 16 healthcare facilities, including 3 pediatric cases at an acute-care hospital (ACH) with adult cases, representing the first pediatric cluster in the United States. The CDC and Nevada Division of Public and Behavioral Health (NVDPBH) sought to describe these cases and risk factors for C. auris acquisition. Methods: We defined a case as a patient’s first positive C. auris specimen. We reviewed medical records and infection prevention and control (IPC) practices. Environmental sampling was conducted on high-touch surfaces throughout affected adult and pediatric units. Isolate relatedness was assessed using whole-genome sequencing (WGS). Results: All 3 pediatric patients were born at the facility and had congenital heart defects. All were aged <6 months when they developed C. auris bloodstream infections; 2 developed C. auris endocarditis. One patient died. Patients overlapped in the pediatric cardiac intensive care unit; 2 did not leave between birth and C. auris infection. Mobile medical equipment was shared between adult and pediatric patients; lapses in cleaning and disinfection of shared mobile medical equipment and environmental surfaces were observed, presenting opportunities for transmission. Overall, 32 environmental samples were collected, and C. auris was isolated from 2 specimens from an adult unit without current cases. One was a composite sample from an adult patient’s bed handles, railings, tray table and call buttons, and the second was from an adult lift-assistance device. WGS of specimens from adult and pediatric cases and environmental isolates were in the same genetic cluster, with 2–10 single-nucleotide polymorphisms (SNPs) different, supporting within-hospital transmission. The pediatric cases varied by 0–3 SNPs; at least 2 were highly related. Conclusions:C. auris was likely introduced to the pediatric population from adults via inadequately cleaned and disinfected mobile medical equipment. We made recommendations to ensure adequate cleaning and disinfection and implement monitoring and audits. No pediatric cases have been identified since. This investigation demonstrates transmission can occur between unrelated units and populations and that robust infection prevention and control practices throughout the facility are critical for reducing C. auris environmental burden and limiting transmission, including to previously unaffected vulnerable populations, like children.
Drawing on examples from real life as well as fictional representations in literature, cinema, theatre, television and radio, this chapter interrogates the relationship of queerness to the British nation from the Great War to the present. Beginning with Rose Allatini’s 1918 novel Despised and Rejected, the first part documents how and why queers were framed as a suspect minority, a danger to the nation. The second part largely draws on the deliberations of the Wolfenden Committee in the 1950s in explaining why a shift towards a limited tolerance for discreet, respectable, ‘genuine’ homosexuals began to take place. The final part traces the proliferation of queer-themed representations in recent decades alongside the rise of gay liberation and the battle over gay civil liberties. It concludes that queers in Britain have made undeniable progress, but at the cost of co-option for a homonational consensus.
The population of this parish at the commencement of last year was nearly 12,000; it is now reduced to 9,860 persons – 478 died of famine and its immediate consequences since 1 October 1846. There are at present 138 families suffering from fever. The great bulk of the people hold very little land, which is of inferior quality; it barely supplied potatoes in past years, and now that the potato crop is gone the poor are in the greatest distress. I find that 129 families were obliged to desert their little holdings and cabins. There are at present 470 families, consisting of 2,246 persons, in extreme want, living on turnips and a little Indian meal; no language can describe the miserable condition of most of them …
No private charities can meet the crisis. If the government do not give immediate and extensive employment the people will be lost.
Denis Tighe, Parish Priest, Ballaghaderrin, 1847
Prelude
It was the summer of 1845, the weather not very different from the usual pattern of intermittent rain, sunshine and seasonal temperatures. Thoughts were turning naturally enough towards prospects for the harvest, the vital bounty of grain and potatoes that sustained the Irish people. The signs were good and expectations high after some poor harvests earlier in the decade. Beyond the horizon but unknown to the eight and a half million inhabitants of the island, invading forces, this time in the biosphere, were gathering strength. Two years earlier, a mysterious disease had ravaged potato crops in North America. From there, transatlantic traffic carried the disease to Europe. Geography was no barrier. By the early summer of 1845, the infection had reached Belgium and some other parts of continental Europe. With remarkable rapidity, the disease crossed the Channel. By August 1845, it was debilitating potato crops in the south of England. The following month, it had reached several parts of eastern Ireland. From Waterford and Wexford, there were alarming newspaper reports of a pestilence, as yet unnamed, attacking the potato fields. The nauseous stench of decay marked the progress of the disease. The leaves on potato stalks were turning black and the infection was spreading in all directions.
[…] the death census of 1846 and 1847 will form a new and astounding era in Irish history, and will be transmitted through generations yet unborn with increasing execrations of the present period and its policy, until the dead are summoned to rise again, and come to judgement.
During the depths of the harshest year of the Famine, ‘Black ‘47’, it may seem a little curious that leading Irish members of parliament were occupying themselves with matters of population and population counts. Such interests were not of recent vintage. The Irish were a much-counted people. Censuses and census-type surveys dated back to the seventeenth century and continued into the eighteenth century in large part driven by the insecurities of the British state and the Established Church in Ireland. Unlike Britain, the great majority of the inhabitants was Roman Catholic, of Gaelic and Old English stock, and hence suspect on grounds of religion and loyalty. The penal laws against Catholics and Protestant dissenters were progressively relaxed during the eighteenth century. By the end of that century, individuals within the Catholic community were expressing an interest in ascertaining the size and relative strength of the Catholic population. The first initiative of this kind was formulated by Edward Hay, scion of a prosperous landed family and later a leading advocate of Catholic rights, who in 1795 proposed a national religious census. The outbreak of regional rebellions in Ireland in 1798 put paid to this idea.
But the spirit of the age favoured such empirical inquiries, in part stimulated by the contributions of Thomas Malthus and his critics on the progress of population. Early in the new century, the political economist Thomas Newenham arranged with southern Catholic clergymen the collection of population estimates for their parishes. These partial surveys were published in his Population of Ireland and View of Ireland. A series of other informal surveys followed. There was even a suggestion that the Catholic clergy were especially well placed to conduct population counts. A prefiguration of later, Famine-time initiatives was the attempt by Daniel O’Connell's ‘Popish Parliament’ to organise a national religious census in Ireland in the 1820s. O’Connell was a strong critic of the 1821 statutory census which had reported a national population of 6.8 million.
The Catholic parish of Ardrahan was in Kilmacduagh diocese at the time of the Death Census. The Catholic parish was coextensive with the civil parish of the same name. Its population was reported in the statutory censuses at 3,805 in 1831, and 4,191 in 1841 (about 1,000 more than the 3,200 inhabitants that Revd Quin estimated for his parish in 1847). This implies a rate of increase of about 1 per cent per year between 1831 and 1841. In 1841, 44 per cent of the housing was classified as fourth class and the female illiteracy rate was 81 per cent. These two measures of poverty and disadvantage are included in this and later commentaries to give a rough indication of living standards in the localities. It should be noted, however, that it is not always possible to map data precisely from civil parishes, as in the population censuses, on to Catholic parishes. This qualification is unlikely to make much difference in practice to the patterns of literacy or housing quality locally.
Patrick Bodkin Quin had long-standing connections with Ardrahan. Arriving from Peterswell parish, he had been parish priest of Ardrahan from at least as early as 1834, when he is recorded as contributing £1 to the O’Connell annuity that year. He farmed locally, was a supporter of the Repeal Association, was a prominent advocate of Catholic rights, and was a member of the Ardrahan Relief Committee during Black ‘47, when he signed a memorial to the Lord Lieutenant protesting at the temporary termination of Public Works (the memorial is replicated below). It seems reasonable, therefore, to infer that his knowledge of the locality was extensive, and he was a prime candidate to report on Famine deaths in the area. Quin did not live long beyond the submission of his report, for in early September 1847 the Galway Mercury announced his death:
We sincerely regret to be obliged to state, that another of the venerated Priesthood of Ireland has fallen a victim to that most dreadful malady, fever, and yielded up his soul into the hands of his Creator, on the morning of Sunday last [29 August].
We have this day to announce the death at Cootehill, in the 25th year of his age, and the 5th of his ministry, the Rev. John Smith, R.C.C. of Drumgoon, deservedly regretted by all who came within the compass of his ministration. Stricken by typhus fever whilst in the discharge of his duties to which so many of the faithful clergy of the people have fallen martyrs, he expired on the 22nd instant, in the fervent hope of a blessed Resurrection. How is all this desolation to be accounted for? Surely it was not caused by the visitation of an angry Providence, but by the crying injustice of our earthly rulers.
Revd P. Mullins, Killeely, Galway
The botanical image that so transfixed the Irish public in the autumn-winter of 1845 was that of the putrefying tuber. The sense of foreboding and despair this inspired was captured in a contemporary oil painting – ‘The discovery of the Potato Blight’ – by the Cork-born artist, Daniel McDonald (1821–53). It has graced the cover of several histories of the Irish Famine. Yet the image of the mess of potatoes was symptomatic of a deeper malaise, of a social system that accommodated runaway population increase, leaving its people vulnerable to harvest failure. George Nicholls’ hastily compiled reports on a Poor Law for Ireland in 1838 spoke of a ‘reckless disregard of the future’. Weak landlordism, which might be seen as a consequence, though not a necessary consequence of seventeenth-century colonialism, had accepted or acquiesced in the proliferation of cottier and labouring households, most notably in mountainous localities and west of the Shannon. Strong landlordism would have meant a more interventionist ruling class exercising tighter control over household formation, accompanied by periodic evictions of squatters and smallholders as market conditions changed. To take a nearby comparator, this would have meant a tenurial regime more akin to that of Scotland where landlords were vigilant in controlling access to land and housing. This had a ruthless edge, so the Scottish historical alternative had its downside, particularly in the shorter term. .
The Death Census provides quantitative evidence on deaths in normal times and deaths during the early course of the Famine. This is the statistical spine of the work, and the numbers are potentially of great significance, relating to different parts of the country and different social and economic conditions. But some problems need to be addressed. In the first place, many parish priests were not in the habit of keeping burial registers, which helps explain why so few records are to be found in the archives. Of those that did keep registers, we might wonder if the priests were providing a comprehensive record of burials, even in ordinary times. When famine was ravaging their local communities, it is easy to imagine that overworked clergymen, some themselves weakened by faminerelated disease, might feel they had more urgent tasks than keeping a record of deaths and burials. As we noted, John O’Connell acknowledged as much when first introduced to the idea of a mortality count. We might also wonder if some clergymen failed to understand fully the instructions issued by the Repeal Association. Moreover, some might have been tempted to exaggerate famine mortality to score a political point or to secure financial or food aid for the famished amongst their parishioners. Clearly, the validity of the survey needs to be appraised.
The Death Census
Although the Death Census was conceived originally as a national survey, these plans were quickly scaled back; and, in the end, responses were received from one hundred parishes. This represents one in ten parishes, as there were just over one thousand Catholic parishes in the country in the 1840s. Viewed as a sample of the total this is quite a respectable sampling fraction. A more significant limitation is that the sample is far from being a representative one. A glance back at Map 2.1 confirms that the returns were geographically skewed. The constituent parts of the western archbishopric of Tuam are well covered – helpful as western parishes suffered heavily – and the south and south-west of the country are reasonably well represented. There are scattered returns from the north of Ireland.
On 5 April 1847 John O’Connell announced at a regular meeting of the Repeal Association that steps were being taken to ‘procure a census of deaths which have occurred and are occurring in Ireland from starvation’. He continued:
The secretary has received instructions […] to address the Catholic clergy, and other influential individuals, who have local knowledge, requesting that, as far as is consistent with the discharge of their most onerous duties, which have been greatly increased by the famine, they will furnish us with the means of presenting to the world the appalling loss of human life in our unfortunate country, which has occurred in consequence of the misgovernment of England in former times, and which her present legislation falls far short of remedying.
O’Connell had recently assumed the role of de facto leader of the Repeal Association. The organisation had been formed in 1840 by his father, Daniel, and enjoyed widespread support at both national and local level. Shopkeepers, priests, and other professionals filled the local leadership roles. While the elderly O’Connell remained the unchallenged figurehead of the Repeal movement, declining health impaired his effectiveness and in early 1847, sick and weary, he embarked on a pilgrimage to Rome. The ‘Liberator’, as he was known to his faithful followers, died en route at Genoa, Italy, in May 1847, aged 71. True to the principle of dynastic succession – a deeply ingrained feature of Irish life – his son John took control of the Association.
The case for a Death Census, as John O’Connell's pronouncement makes clear, locates it within both the immediate crisis of the Great Famine and the longer-term demand for repeal of the Act of Union of 1800. Its genesis was, therefore, deeply political, and drenched in criticism of the British parliament. John's stated intention was to reveal to the world the terrible events unfolding in Ireland, and reflected his view that many people in Britain, including most MPs, were failing to recognise the severity of the crisis. This was despite the fact that the O’Connells and other Irish MPs had been informing parliament about the Irish situation for the best part of a year.
The year 1847 has gone down in history and memory as Black ‘47. It was the second year of the Great Famine. Hunger, destitution and death were everyday occurrences. Among those best placed to convey a picture of the unfolding tragedy were the priests of the Catholic Church who ministered to three-quarters of the population. Living among people, many of whom were illiterate, particularly so in the Gaelic-speaking areas west of the Shannon and in south Munster, they were articulate witnesses for their people. They saw the Famine at its worst and some of them died in the course of their duties, mainly from epidemic fevers. This was true also of clergymen of other denominations, medical doctors and poor-law administrators, whose professions brought them in close contact with the disease-infected victims of hunger. We have seen in the last chapter that the Death Census was fundamentally a statistical survey, though one that needs to be handled with care. Its proponents wanted to quantify the effects of famine on mortality across Ireland by comparing the number of deaths between October 1846 and April 1847 against the same period a year earlier. However, in addition to providing this information most of the respondents included vivid testimony, often running into many hundreds of words on conditions in each of their parishes. They wrote about hunger, disease, swollen stomachs, insanity, emigration, death; a few even included lists of the names of the dead. Some spoke critically of political economy, proselytism, outrages, inadequate soup rations, tight-fisted rate payers, and of course of landlords, particularly if absentee. Some wrote haunting individual stories of the suffering they had witnessed, of parishioners unburied by the roadside, of workers collapsing on the public works, of families dying in the filth and cold of their cabins. They might also acknowledge acts of charity and benevolence, and profess loyalty to their ‘gracious Queen’. The panacea of repeal of the Union found frequent expression, as well as words of heartfelt devotion to the ‘Liberator’, Daniel O’Connell. Politics aside, these eyewitness accounts offer unique, personal, and frequently harrowing insights into the ravages of the Great Famine at one of its worst stages.