A systematic review of the literature reporting on remote monitoring epileptic seizure detection devices.

BACKGROUND: Early detection and alert notification of an impending seizure for people with epilepsy have the potential to reduce Sudden Unexpected Death in Epilepsy (SUDEP). Current remote monitoring seizure detection devices for people with epilepsy are designed to support real-time monitoring of their vital health parameters linked to seizure alert notification. An understanding of the rapidly growing literature on remote seizure detection devices is essential to address the needs of people with epilepsy and their carers. AIM: This review aims to examine the technical characteristics, device performance, user preference, and effectiveness of remote monitoring seizure detection devices. METHODOLOGY: A systematic review referenced to PRISMA guidelines was used. RESULTS: A total of 1095 papers were identified from the initial search with 30 papers included in the review. Sixteen non-invasive remote monitoring seizure detection devices are currently available. Such seizure detection devices were found to have inbuilt intelligent sensor functionality to monitor electroencephalography, muscle movement, and accelerometer-based motion movement for detecting seizures remotely. Current challenges of these devices for people with epilepsy include skin irritation due to the type of patch electrode used and false alarm notifications, particularly during physical activity. The tight-fitted accelerometer-type devices are reported as uncomfortable from a wearability perspective for long-term monitoring. Also, continuous recording of physiological signals and triggering alert notifications significantly reduce the battery life of the devices. The literature highlights that 3.2 out of 5 people with epilepsy are not using seizure detection devices because of the cost and appearance of the device. CONCLUSION: Seizure detection devices can potentially reduce morbidity and mortality for people with epilepsy. Therefore, further collaboration of clinicians, technical experts, and researchers is needed for the future development of these devices. Finally, it is important to always take into consideration the expectations and requirements of people with epilepsy and their carers to facilitate the next generation of remote monitoring seizure detection devices.

The relationship between direct care providers' physical activity behaviour and perceived physical activity needs for people with intellectual disabilities.

BACKGROUND: The promotion of physical activity and the decrease of inactivity and sedentary behaviour are crucial for a healthy lifestyle and positive quality of life. People with intellectual disabilities are at increased risk of inactivity and sedentary behaviour. Therefore, it is important to increase their physical activity by implementing physical activity guidelines in their daily life. Professional direct care providers can play a decisive role in supporting people with intellectual disabilities to participate in physical activity, but the engagement of direct care providers with this role may be reflective of their own attitudes and beliefs towards physical activity. Therefore, the link between the implementation of current physical activity guidelines for people with intellectual disabilities and direct care providers' own beliefs and behaviour with regard to physical activity is investigated. METHOD: A total of 104 direct care providers completed self-reported questionnaires about their own physical activity behaviour (IPAQ-SF), recommendations for people with intellectual disabilities (adaption of EMIQ-HP) and questions regarding global physical activity guidelines. They were also asked about potential barriers and facilitators for the recommendation of physical activity in open-ended questions. RESULTS: Personal physical activity behaviour is related to the recommended physical activity for people with intellectual disabilities (moderate-to-vigorous physical activity: rs  = 0.408, P = 0.005). However, recommended physical activity behaviour for people with intellectual disabilities is significantly lower than direct care providers' own physical activity behaviour (P < 0.001). 47.1% of the respondents recommended people with intellectual disabilities to participate in less than the 150 min of moderate intensity physical activity per week for that is recommended in global physical activity guidelines. CONCLUSION: Direct care providers may hold stereotypical views and insecurities about the potential harms associated with people with intellectual disabilities participating in physical activity. Therefore, the dissemination of physical activity recommendations for people with intellectual disabilities should be a major target for health professionals, social workers and scientists to address direct care providers' concerns. Furthermore, we need to emphasise the benefits of regular physical activity to professional direct care providers and directly to people with intellectual disabilities.

Determination of Total Lipid and Lipid Classes in Marine Samples.

Lipids are largely composed of carbon and hydrogen and, therefore, provide a greater specific energy than other organic macromolecules in the sea. Being carbon- and hydrogen-rich they are also hydrophobic and can act as a solvent and absorption carrier for organic contaminants and thus can be drivers of pollutant bioaccumulation in marine ecosystems. Their hydrophobic nature facilitates their isolation from seawater or biological specimens: marine lipid analysis begins with sampling and then extraction in non-polar organic solvents, providing a convenient method for their separation from other substances in an aquatic matrix. If seawater has been sampled, the first step usually involves separation into operationally defined 'dissolved' and 'particulate' factions by filtration. Samples are collected and lipids isolated from the sample matrix typically with chloroform for truly dissolved matter and colloids, and with mixtures of chloroform and methanol for solids and biological specimens. Such extracts may contain several classes from biogenic and anthropogenic sources. At this time, total lipids and lipid classes may be determined. Total lipid can be measured by summing individually determined lipid classes which customarily have been chromatographically separated. Thin-layer chromatography (TLC) with flame ionization detection (FID) is regularly used for the quantitative analysis of lipids from marine samples. TLC-FID furnishes synoptic lipid class information and, by summing classes, a total lipid measurement. Lipid class information is especially useful when combined with measurements of individual components e.g., fatty acids and/or sterols, after their release from lipid extracts. The wide variety of lipid structures and functions means they are used broadly in ecological and biogeochemical research assessing ecosystem health and the degree of influence by anthropogenic impacts. They have been employed to measure substances of dietary value to marine fauna (e.g., aquafeeds and/or prey), and as an indicator of water quality (e.g., hydrocarbons).

The right to health, public health and COVID-19: a discourse on the importance of the enforcement of humanitarian and human rights law in conflict settings for the future management of zoonotic pandemic diseases.

OBJECTIVES: The catastrophic effects of armed conflict, particularly prolonged armed conflict, on individual and public health are well established. The 'right' to healthcare during armed conflict and its lack of enforcement despite a range of United Nations mandated requirements regarding health and healthcare provisions is likely to be a significant feature in future conflicts, as zoonotic-induced pandemics become a more common global public health challenge. The issue of enforcement of health rights assurance and its implications for the public health management of global pandemics such as coronavirus disease 2019 (COVID-19) in and between countries and regions in conflict is the objective of this Review. STUDY DESIGN: A narrative review was conducted. METHODS: Referenced to the framework of International humanitarian law (IHL) and International human rights law (IHRL) to explore and discuss the deficits in health rights assurances in conflict settings and illustrate how gaps in protection and lack of enforcement compounds the disease response. Both IHL, and IHRL can be leveraged to ensure human and health rights are assured in conflict settings. There is a distinct lack of international criteria with regard to standards of healthcare coverage, infrastructure and service preservation to the civilian population during times of armed conflict. This has far reaching consequences when confounded by a pandemic or even localised disease outbreak. RESULTS: We illustrate how in a pandemic disease emergency, such as COVID-19, all life is threatened; and how leaving the citizen population exposed to this contagion is a human rights breach and an indirect method of warfare. The consequences of failure to effectively address such pandemic infections, (i.e. COVID-19), in a conflict setting are potentially catastrophic as prevention and containment responses are severely constrained by state insecurity, political instability, terrorism, repression, rights abuses, and displacement of citizens. Neglect by State actors potentially constitutes a breach of the universal right to life. States cannot justify their failures to mitigate disease based on claims of lack of resources, even when available resources are minimal. Where discrimination of people with a disease, such as COVID-19, or minority groups at the point of access to health facilities occurs, this further breaches the principle of medical neutrality. CONCLUSIONS: The example of the COVID-19 response may offer a viable route to leverage greater access and coverage of healthcare in conflict and humanitarian settings. A radicalised partnership approach during these times of emergency is warranted, based on an ethical 'humanitarian intervention' approach to provide care to all affected by contagious disease in conflict settings.

Ageing in the nursing workforce - a global challenge in an Irish context.

BACKGROUND: The 2008 financial crisis exacerbated an already mounting workforce challenge faced by most health services in the western world, namely the recruitment and retention of qualified nurses. AIM: This paper examines two additional challenges of relevance to workforce planning in health care, an ageing nursing workforce and reliance upon migrant nurses to solve short-term workforce issues. METHODS: Using Ireland as a case exemplar of these issues, this paper argues that policy makers and service providers should seek not only to address the challenge of retaining trained newly qualified and younger nurses but also focus on supporting older nurses and migrant nurses to remain within the workforce. FINDINGS: The findings of this paper highlight the need for workforce planners, policy makers and service providers to take account of an ageing nursing workforce and reliance on foreign-trained nurses as a solution to short-term planning difficulties. CONCLUSION: Failure to address this need is likely to lead to significant workforce difficulties for health services into the future and undermine current efforts to increase the number and long-term retention of qualified nursing staff. IMPLICATIONS FOR NURSING POLICY: Policy makers and service providers should focus on the retention of trained older nurses as an important element of workforce planning.

Valuable yet Vulnerable-A review of the challenges encountered by older nurses in the workplace.

OBJECTIVE: As the global nursing workforce ages, developing a comprehensive understanding of the experiences, needs and values specific to older nurses is increasingly significant. This paper reviews the evidence with regard to the specific challenges encountered by older nurses in the workplace. DESIGN: A scoping review of the published literature was conducted using the electronic databases Medline, CINAHL, PsycINFO, Science Direct and Google Scholar. A total of 20 papers were included in this review, most of which were qualitative (n=14). Three quantitative studies were identified (including one study which combined a physical exam with survey methods) as well as three mixed method studies. RESULTS: The challenges faced by older nurses in their practice are synthesised across three primary domains: Nursing and the ageing body; Recognition and support of the older nurse and Demands associated with middle-age. CONCLUSION: As older nurses form a substantial proportion of the healthcare workforce in many countries, the development and implementation of strategies to address these challenges is of utmost importance.

Hospital-based industrial therapy units and the people who work within them - an Irish case analysis using a soft-systems approach.

Occupational training and employment is seen as a central concern in the delivery of community-orientated mental health services aimed at enhancing the quality of life of people with enduring mental illness. A range of schemes from sheltered to open employment now operates in a number of countries, with a concomitant growth of interest in their evaluation. At the same time, hospital-based workshops, often referred to as industrial therapy units (ITUs), have steadily declined because they are seen as outdated and less efficacious compared with community-located training and employment. However, whether the total disappearance of the traditional ITU is a positive development may be open to question. This paper reports on a study of five mental health hospital-based sheltered workshops located in one Health Board area in Ireland, which catered for the needs of people with enduring mental health problems. Utilizing a soft-systems methodological approach, it examined their role and significance to 'users' who spent occupational time in them, the staff who worked in them and the clinicians who referred users to them.

The meaning of respite care to mothers of children with learning disabilities: two Irish case studies.

There is a growing interest in Ireland in the nature and significance of respite care for carers and those for whom they care. The relationship of individual stress with caring full time for a child who is learning disabled is well documented. Provision of respite care is seen as an important means of alleviating individual carer stress. Yet, the apparent benefits of respite care have been called into question. The present study looks at this issue within the context of respite service provision in Ireland for young people with learning disabilities. A phenomenological approach was used to explore the views of two mothers on respite care and, in particular, its personal significance for them within the context of their caring relationship for their children. The authors found that for these two mothers, whilst some of the predicted benefits of respite care were present, for example improved social activity, their use of respite care and the experience of separation initiated feelings of guilt and appeared to engender a degree of emotional stress. It is argued that providers of respite services in Ireland need to consider how they can support parents who use respite care so that they see its use as a mark of caring for their child and thereby alleviate such feelings of guilt.

Direct comparison of two cold-atom-based optical frequency standards by using a femtosecond-laser comb.

With a fiber-broadened, femtosecond-laser frequency comb, the 76-THz interval between two laser-cooled optical frequency standards was measured with a statistical uncertainty of 2x10(-13) in 5 s , to our knowledge the best short-term instability thus far reported for an optical frequency measurement. One standard is based on the calcium intercombination line at 657 nm, and the other, on the mercury ion electric-quadrupole transition at 282 nm. By linking this measurement to the known Ca frequency, we report a new frequency value for the Hg(+) clock transition with an improvement in accuracy of ~10(5) compared with its best previous measurement.

'I don't want to be a psychiatric nurse': an exploration of factors inhibiting recruitment to psychiatric nursing in Ireland.

Ireland has experienced a decline in recruitment to preregistration psychiatric nursing programmes (An Bord Altranais 1999). Social care workers often do similar psychosocial work with similar client groups served by psychiatric nurses. In marked contrast to psychiatric nursing, Irish social care diplomate and degree programmes are generally over subscribed. Yet graduates working in social care often experience inferiority in terms of pay, conditions and career structure compared to their psychiatric nursing counterparts (McElwee 1998). The question that therefore needs to be asked is why school leavers opt for such courses in preference to psychiatric nursing. This article describes the results of a pilot study, utilizing a focus group approach, to examine reasons for course and career choice among school leavers, psychiatric nursing students and social care students. Results indicate that school students rely on stereotypical views as part of their decisionmaking process in shaping occupational decisions. School students tend to conceptualize psychiatric nursing as being a job involving menial and physical tasks. Social care students saw psychiatric nursing as lacking autonomy and to be institutional in nature. Psychiatric nursing students themselves felt exploited and 'second class' compared to general nurses. Current recruitment campaigns and careers guidance within schools need to be more targeted on differentiating psychiatric nursing from its general nursing counterpart.

The recruitment crisis in nursing: placing Irish psychiatric nursing in context--a review.

There is a decline in recruitment to pre-registration programmes in psychiatric nursing in Ireland. This article discusses factors that may relate to the Irish situation in the context of relevant international literature on nurse recruitment. It is noted that disciplines and courses in Ireland, such as social care, that engage in similar work to that of psychiatric nurses do not suffer from such a shortage of applicants. Whilst it is difficult to account for this difference, a number of factors identified from the literature are discussed. The need to highlight differences with general nursing and the importance of career guidance are seen as important in overcoming prejudices and stereotypes. From a review of the literature it appears that studies dedicated to recruitment to psychiatric nursing alone are notable by their paucity, and absent in the case of Ireland. Therefore, the available literature fails to fully explain the fall in psychiatric nurse recruitment compared to the robust recruitment position of social care. It is argued that dedicated research on recruitment to psychiatric nursing within an Irish setting is needed if a sustainable recruitment policy is to be implemented to reverse the long-term decline in recruitment.

Sub-systems for optical frequency measurements: application to the 282-nm (199)Hg(+) transition and the 657-nm Ca line.

We are developing laser frequency measurement technologies that should allow us to construct an optical frequency synthesis system capable of measuring optical frequencies with a precision limited by the atomic frequency standards. The system will be used to interconnect and compare new advanced optical-frequency references (such as Ca, Hg(+ ), and others) and eventually to connect these references to the Cs primary frequency standard. The approach we are taking is to subdivide optical frequency intervals into smaller and smaller pieces until we are able to use standard electronic-frequency-measurement technology to measure the smallest interval.

Severe mental illness, statutory supervision and mental health nursing in the United Kingdom: meeting the challenge.

Within the United Kingdom a combination of limited resources and public fears about the behaviour of mentally ill people living in the community has led the government to prioritize those with severe mental illness. In support of this legislation has been passed which provides for those mentally ill deemed 'at risk' to be supervized in the community against their will. This supervisory role will be mainly undertaken by mental health nurses. Through examination of relevant British and American literature, this paper argues that mental health nursing at a national level lacks a defined role which the new legislation may provide, thereby enhancing the profession's voice in overall mental health policy formulation. Such a role, however, also poses important questions for mental health nurses' practice, their relationships with users, colleagues and the wider society. Such issues may have unforeseen negative consequences for users. It is argued that the legislation will pose important dilemmas for mental health nurses in these domains. It is argued that a proactive research agenda needs to be established which is relevant and of use to practitioners when confronted with issues in their supervision role. Areas for future research are suggested.

Continuous-wave frequency tripling and quadrupling by simultaneous three-wave mixings in periodically poled crystals: application to a two-step 1.19-10.71-microm frequency bridge.

We observed cw third-harmonic generation in a periodically poled LiNbO(3) crystal by cascading optimally phase-matched second-harmonic and sum-frequency generation. Other processes, such as fourth-harmonic generation, are allowed by the flexibility of quasi-phase matching. We demonstrate a divide-by-nine (1.19- 10.71-microm) frequency chain that uses only two lasers.

Division by 3 of optical frequencies by use of difference-frequency generation in noncritically phase-matched RbTiOAsO(4).

A new scheme for coherently connecting optical frequencies in a 3:1 ratio has been demonstrated. To phase lock a Nd:YAG laser at 1064 nm with a CO overtone laser at 3192 nm, we generated their difference frequency in RbTiOAsO(4) (RTA) and beat it against the second harmonic of 3192 nm that was generated in AgGaSe(2).

Health care rationing: nursing perspectives.

Ideas currently postulated around the way health care should be delivered and costs controlled, often referred to as health care rationing, are increasingly coming to dominate the agenda of health care in the 1990s. British nursing has yet to take a noticeably visible role in this debate, despite the fact that it poses a serious dilemma for a profession whose cultural ethos has been shaped by the concepts of universal access and comprehensiveness of care and is wedded to the idea of holism. In the USA debate amongst nurses is further advanced and whilst this discourse may be of limited value to British nursing, owing to a differing historical and cultural attitude to health care, recent changes to the organizational values in the NHS are leading to similar issues arising already faced by American nurses. This paper considers the broad parameters of the debate on health care rationing and examines how these parameters have been reflected within relevant North American and British nursing literature, pointing both to similar and differentiating factors between the two countries.

Discontent without focus? An analysis of nurse management and activity on a psychiatric in-patient facility using a 'soft systems' approach.

Psychiatric nursing in the United Kingdom is undergoing major change as a consequence of the policy of community care. Whilst much has been written about the role of the community psychiatric nurse (CPN), less has been said about the preparedness of nurses in in-patient facilities to adapt to the changes. Checkland's (1981) 'soft systems' methodology was used to analyse the situational environment on an acute admission unit. It was found that an increased sense of accountability, combined with the demands of the Mental Health Act 1983, led the ward manager to develop a system, particularly in relation to discharge planning, in which his role was central. This left the ward staff feeling unrecognized and insufficiently experienced in a vital aspect of patient care. Lack of support from the college of nursing and inadequate staff development programmes were also found to have played a part in the situation. The use of reflection in action is recommended as a way of initiating changes in structure, processes and attitudes. Wider inferences are drawn concerning the competence of registered mental nurses (RMNs) practising in in-patient facilities, and the role of the colleges of nursing in operating effectively in the new care and market paradigms.

Manumycins E, F and G, new members of manumycin class antibiotics, from Streptomyces sp.

Three new manumycin class antibiotics, namely manumycins E, F and G, were isolated from the culture broth of Streptomyces sp. strain WB-8376. Their structures were established by spectroscopic methods, and the S configuration of C-4 in the epoxycyclohexenone moiety was determined by CD exciton chirality method for each of the three compounds. Manumycins E, F and G are active against Gram-positive bacteria, and have moderate inhibitory effects on the farnesylation of p21 ras protein. They demonstrated weak cytotoxic activity against human colon tumor cell HCT-116.

Analysis of health rationing policies in the NHS.

Explicit rationing policies are beginning to appear in the NHS in response to the increasing demand for health care and rising treatment costs. Such policies challenge the traditional values upon which nursing in the UK is founded. This article examines the case for rationing and its implications for nursing.