Anne Marie Henihan

Advances in poultry litter disposal technology--a review.

The land disposal of waste from the poultry industry and subsequent environmental implications has stimulated interest into cleaner and more useful disposal options. The review presented here details advances in the three main alternative disposal routes for poultry litter, specifically in the last decade. Results of experimental investigations into the optimisation of composting, anaerobic digestion and direct combustion are summarised. These technologies open up increased opportunities to market the energy and nutrients in poultry litter to agricultural and non-agricultural uses. Common problems experienced by the current technologies are the existence and fate of nitrogen as ammonia, pH and temperature levels, moisture content and the economics of alternative disposal methods. Further advancement of these technologies is currently receiving increased interest, both academically and commercially. However, significant financial incentives are required to attract the agricultural industry.

Emissions modeling of fluidised bed co-combustion of poultry litter and peat

Gaseous emissions from the fluidised bed co-combustion of 50% w/w chicken litter and peat were monitored and recorded. Emission data were used to create a dispersion model for a proposed site on a poultry farm in Ireland. Variables within the combustion unit influenced both combustion and emission levels of pollutants such as SO(2) and NO(x), CO. Concentrations of atmospheric pollutants decreased with use of the correct ratio between fluidising and secondary air. Dispersion modelling of combustion at a proposed poultry unit predicted that ground level concentrations for the set of emissions data would be below the limits and guidelines set by air quality standards.

Psychosocial Interventions for Problem Alcohol Use in Primary Care Settings (PINTA): Baseline Feasibility Data

Objective: Many individuals receiving methadone maintenance receive their treatment through their primary care provider. As many also drink alcohol excessively, there is a need to address alcohol use to improve health outcomes for these individuals. We examined problem alcohol use and its treatment among people attending primary care for methadone maintenance treatment, using baseline data from a feasibility study of an evidence-based complex intervention to improve care. Methods: Data on addiction care processes were collected by (1) reviewing clinical records (n = 129) of people who attended 16 general practices for methadone maintenance treatment and (2) administering structured questionnaires to both patients (n = 106) and general practitioners (GPs) (n = 15). Results: Clinical records indicated that 24 patients (19%) were screened for problem alcohol use in the 12 months prior to data collection, with problem alcohol use identified in 14 (58% of those screened, 11% of the full sample). Of those who had positive screening results for problem alcohol use, five received a brief intervention by a GP and none were referred to specialist treatment. Scores on the Alcohol Use Disorders Identification Test (AUDIT) revealed the prevalence of hazardous, harmful, and dependent drinking to be 25% (n = 26), 6% (n = 6), and 16% (n = 17), respectively. The intraclass correlation coefficient (ICC) for the proportion of patients with negative AUDITs was 0.038 (SE = 0.01). The ICCs for screening, brief intervention, and/or referral to treatment (SBIRT) were 0.16 (SE = 0.014), −0.06 (SE = 0.017), and 0.22 (SE = 0.026), respectively. Only 12 (11.3%) AUDIT questionnaires concurred with corresponding clinical records that a patient had any/no problem alcohol use. Regular use of primary care was evident, as 25% had visited their GP more than 12 times during the past 3 months. Conclusions: Comparing clinical records with patients’ experience of SBIRT can shed light on the process of care. Alcohol screening in people who attend primary care for substance use treatment is not routinely conducted. Interventions that enhance the care of problem alcohol use among this high-risk group are a priority.

Monitoring and dispersion modelling of emissions from the fluidised bed combustion of poultry litter.

Gaseous emissions from the fluidised bed combustion of chickenlitter were monitored and recorded. Emission data was used tocreate a dispersion model for a proposed site on a poultry farmin Limerick, Ireland. Variables within the combustion unit notonly influenced combustion but also emission levels ofpollutants such as SO2 and NOx. CO emissions decreased withuse of the correct ratio between fluidising and secondary air,the staging of secondary air and the degree of turbulence withwhich the secondary air is introduced. Dispersion modelling ofactual combustion at a proposed poultry unit predicted thatground level concentrations for the set of emissions data wouldbe below the limits and guidelines set by air quality standards.This was true for both and line source. Line sourceconcentration levels were less than those for point source.

Enhancing alcohol screening and brief intervention among people receiving opioid agonist treatment: qualitative study in primary care

Purpose Problem alcohol use (PAU) is common and associated with considerable adverse outcomes among patients receiving opioid agonist treatment (OAT). The purpose of this paper is to describe a qualitative feasibility assessment of a primary care-based complex intervention to promote screening and brief intervention for PAU, which also aims to examine acceptability and potential effectiveness. Design/methodology/approach Semi-structured interviews were conducted with 14 patients and eight general practitioners (GPs) who had been purposively sampled from practices that had participated in the feasibility study. The interviews were transcribed verbatim and analysed thematically. Findings Six key themes were identified. While all GPs found the intervention informative and feasible, most considered it challenging to incorporate into practice. Barriers included time constraints, and overlooking and underestimating PAU among this cohort of patients. However, the intervention was considered potentially deliverable and acceptable in practice. Patients reported that (in the absence of the intervention) their use of alcohol was rarely discussed with their GP, and were reticent to initiate conversations on their alcohol use for fear of having their methadone dose reduced. Research limitations/impelications Although a complex intervention to enhance alcohol screening and brief intervention among primary care patients attending for OAT is likely to be feasible and acceptable, time constraints and patients’ reticence to discuss alcohol as well as GPs underestimating patients’ alcohol problems is a barrier to consistent, regular and accurate screening by GPs. Future research by way of a definitive efficacy trial informed by the findings of this study and the Psychosocial INTerventions for Alcohol quantitative data is a priority. Originality/value To the best of the knowledge, this is the first qualitative study to examine the capability of primary care to address PAU among patients receiving OAT.

Digital network of writers helps to foster spirit of collaboration.

1. School of Medicine and Medical Science, University College Dublin, Dublin, Ireland. 2. Inst. of Psychiatry, Kings College London, Addiction Sciences Building, Denmark Hill, London, United Kingdom 3. British Columbia Centre for Excellence in HIV/AIDS, St. Paul’s Hospital, 608 -1081 Burrard Street, Vancouver, BC, CANADA, V6Z 1Y6 4. Graduate Entry Medical School, University of Limerick, Limerick, Ireland.

Methodological challenges and issues of recruiting for mental health and substance use disorders trials in primary care

Background Poor recruitment to controlled trials is a frequently reported problem. Challenges related to study design, communication, participants, interventions, outcomes, and clinician workload hinder recruitment, and the effectiveness of interventions used by trialists to increase recruitment rates is unknown. Objectives To explore the methodological challenges and issues in recruiting for mental health and substance use disorder trials in primary care, and to consider how these methodological challenges can be addressed. Method The presentation will recount the authors’ experience of recruiting for cluster randomized trials in primary care. Methodological challenges, such as clarity of instruction, patient characteristics, patient-doctor relationship, effects of intervention on patients and clinic, and personal benefits for clinicians will be described. The authors will consider how these might relate to and be used for peer learning and peer support in primary care research. Conclusion The presentation will conclude with an overview of how lessons learned from past studies may be used to improve recruitment for trials of mental health and substance use disorders in primary care. Acknowledgements

Commentary on Zeremski et al. (2016): Improvements in Hcv-related Knowledge Among Substance Users on Opioid Agonist Therapy After an Educational Intervention

Letter to editor: Zeremski et al., (2016) highlight how improving patients’ knowledge about hepatitis C virus (HCV) care can enhance adherence to treatment plans and improved treatment outcomes. In this regard we believe that patients’ knowledge of HCV care can best be optimized through community-based approaches to HCV treatment as supported by recent findings from (Wade et al., 2015; Grebely et al., 2016). The advent of such models of care provide an opportunity to embed HCV treatment within a holistic approach that also addresses related issues, especially alcohol use disorders. This is especially the case in Ireland, where alcohol use disorders are common among people who inject drugs (Ryder et al., 2009). This increases the risk of complications related to chronic HCV infection as alcohol can exacerbate HCV infection and the associated liver damage by causing oxidative stress and promoting fibrosis, thereby accelerating disease progression to cirrhosis (Batchelder et al., 2015).......