Northern Ireland Civil Service

Memory functional MRI (fMRI) has been used to explore cognitive processing in people with refractory temporal lobe epilepsy (TLE) to predict memory decline after anterior temporal lobe resection (ATLR). Traditional studies employed univariate analysis (UVA), focusing on isolated voxel activity in mesial temporal regions. By contrast, multivariate pattern analysis (MVPA), examines distributed activity patterns , offering deeper insight into neural networks supporting cognitive functions. MVPA allows precise mapping of individual memory encoding strategies that may influence surgical planning. Individual MVPA maps may be useful in the planning of surgical resection and trajectories for less-invasive procedures like laser interstitial thermotherapy (LiTT) to avoid critical brain regions. These may mitigate against the cognitive consequences of epilepsy surgery. We used MVPA to examine face and word encoding differences in healthy individuals and in people with TLE due to hippocampal sclerosis (HS). In healthy controls, medial temporal regions bilaterally supported face and word encoding. Lateral temporal regions were lateralized-right for faces and left for words. The fusiform gyri were involved in both tasks across all participants. HS patients showed altered encoding patterns, with reduced classifier accuracy (CA) in medial and lateral temporal regions. For face encoding, both left HS (LHS) and right HS (RHS) groups showed bilateral CA reductions in the parahippocampal gyrus (PHG), with additional hippocampal CA reduction in LHS. For word encoding, RHS patients showed CA reductions in right medial and bilateral lateral temporal regions, while LHS patients had reductions only in the left superior temporal gyrus (STG). These results highlight the bilateral network involved in memory encoding and the value of individualized cognitive mapping to prevent surgery-associated memory decline.

Abstract PurposeThis study investigates whether men who engage in dual harm while imprisoned are disproportionately involved in committing misconduct during a 1‐year follow‐up period. It also examines whether dual harm is significantly associated with future involvement in misconduct, when other known risk factors for misconduct are considered, and whether this relationship varies depending on the type of misconduct examined.MethodsDrawing on the administrative records of 430 men who were imprisoned during the 1‐year follow‐up period, a combination of descriptive statistics and negative binominal regressions was used to analyse the data.ResultsRoughly one‐in‐four men engaged in dual harm while imprisoned and were responsible for over half of all misconduct incidents recorded during the follow‐up period. A significant relationship between dual harm, as well as violence‐only harm compared to no harm, and future involvement in misconduct was also observed even when other known risk factors for misconduct were considered but only for violent and disorder‐related misconduct, demonstrating this relationship varied by harm history and type of misconduct examined.ConclusionThese findings address previous gaps in knowledge, advancing our understanding of the relationship between dual harm and misconduct. Possible explanations for why, compared to no‐harm history, dual harm as well as violence‐only harm was only related to violent and disorder‐related misconduct are offered, alongside possible implications of this research for policy and practice.

BackgroundParamedics in Northern Ireland are expected to treat unwell children; perform life-saving interventions, in challenging surroundings with limited resources. Surprisingly, Northern Irish paramedic baseline paediatric education is minimal, and reliant on the ‘Joint Colleges Ambulance Liaison Committee Clinical Guidelines’ and personal experience to provide a solid foundation of knowledge. Furthermore, the Northern Ireland Ambulance Service (NIAS) does not offer subsidised study leave. Approached by a paramedic crew, provoked by a number of tough, emotive paediatric call-outs, we conceived, designed and facilitated a collaborative, bespoke paramedic paediatric study day.AimsTo improve paramedic confidence in the management of unwell children.To provide an insight into hospital–based management of paediatric emergencies aimed to complement paramedic knowledge.To create a multidisciplinary forum for paramedics and paediatricians to network, improve relations and educate via a shared learning environment.MethodsDesigned as a regional study day for NIAS members.Recruitment of paediatric intensivists, emergency consultants and senior paediatric trainees to facilitate lectures on emergencies; recognition, interventions and outcomes. Rotating skills stations focused on airway, cardiovascular management and an informative question and answering session.A simulated ‘cot death’ scenario to amalgamate learning objectives. A paramedic led pre–recorded out of hospital neonatal arrest call, streamed and continued in hospital with the emergency team receiving the patient. An actress played the role of the parent for authenticity.Responses evaluated via feedback forms.ResultsThis complimentary course was fully subscribed within five hours of advertisement. Fifty-five paramedics attended, 35 provided feedback; 100% felt more comfortable dealing with the unwell child after the course. Greater than 90% rated the skills station and lectures as extremely useful; simulation, validated by the actress was highlighted as ‘innovative’ and ‘enlightening’. Further feedback read ‘extremely beneficial day’, ‘thoroughly enjoyed and learned so much’ and ‘please, more of these events’. Suggested improvements included a bigger venue and more time.ConclusionThe course will run annually to facilitate regular paramedic training and enhance pre and in-hospital working relationships. The collaborative paramedic paediatric study day is a fabulous opportunity for all to progress in a shared learning environment, mutually respectful of the reality and fear of losing a child!

Respiratory physicians are likely to encounter occupational lung disease (OLD) in their daily practice. To assess the profile of cases being encountered by general respiratory physicians in Northern Ireland (NI) and determine satisfaction with training, confidence in diagnosis and management of OLD. An online survey of all consultant respiratory physicians currently practising in NI. Questions assessed the numbers of new cases seen over the preceding year, case type, satisfaction with specialist registrar training in OLD and degree of confidence in the diagnosis and management of these conditions. Of the 40 consultants identified, the response rate was 80% (n = 32) with 94% of respondents (n = 30) indicating they had dealt with patients suspected of having occupation-related respiratory symptoms. The most commonly encountered OLDs were pleural plaques (91% of respondents), occupational asthma (88%), asbestosis (84%), non-asbestosis pulmonary fibrosis (76%), hypersensitivity pneumonitis (67%) and mesothelioma (66%). Just over one third of consultants (36%, n = 10) indicated a lack of confidence in diagnosis and management of OLD with almost half (48%) dissatisfied with OLD training as a registrar and a further 78% (n = 25) indicating they would value additional training in OLD as a consultant. The majority of respiratory consultants in NI encountered OLD in their day to day practice and half were dissatisfied with their specialist registrar training in OLD and express a lack of confidence in the diagnosis and management of these conditions. This highlights the need for additional training at both registrar and consultant level.

Tissue transglutaminase is now recognized as the autoantigen for antiendomysial antibodies. Antibodies to tissue transglutaminase have been proposed as a valuable test for coeliac disease. To determine the value of antibodies to tissue transglutaminase in the diagnosis of coeliac disease in our outpatient population. Patients who underwent serological tests for coeliac disease during the first 18 months of the tissue transglutaminase antibody assay were retrospectively identified from the regional serology laboratory database. Patients' symptoms were noted, along with serological results and duodenal histology in those patients who underwent duodenal biopsy. RESULTS In total, 586 patients were identified as having been serologically tested for coeliac disease, of whom 92 patients (33 men; mean age 51.7 years) had been followed up with duodenal biopsies. Of these 92 patients, 29 (31%; 14 men; mean age 52.5 years) had histological features of coeliac disease. The 63 patients with normal histology (19 men; mean age 51.8 years) acted as controls. Weight loss was more frequent in coeliac disease patients compared to controls (7 vs 5; P = 0.04) whereas the frequency of anaemia (P = 0.85) and diarrhoea (P = 0.74) did not differ significantly between the two groups. The sensitivity and specificity of tissue transglutaminase antibodies (86%; 84%) were compared to those for antiendomysial antibodies (90%; 98%) and antigliadin antibodies (76%; 79%). The diagnostic value of tissue transglutaminase antibodies was intermediate between that of antiendomysial antibodies and antigliadin antibodies. However, duodenal biopsy remains the gold standard diagnostic test for coeliac disease.

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