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Background Globally, in excess of one billion children experience violence and abuse every year, leading to upwards of 40,000 deaths. Child safeguarding education typically occurs in professional silos across healthcare, often focusing on specific undergraduate competencies. In practice, however, child safeguarding requires a multi-professional approach, necessitating effective communication in emotionally charged contexts. To address these needs, we designed an interprofessional course using simulation-based education for experienced healthcare professionals working in the emergency department. Methods On three occasions, we delivered an in-person, two-day course with 32 healthcare professionals from medicine, nursing, and social work. We collected data using multiple methods including participant demographics and child safeguarding experience ( n  = 32), observational field notes, individual semi-structured interviews ( n  = 14) and focus groups ( n  = 4). We analyzed the data using landscapes of practice theory as a sensitizing concept. Results Using landscapes of practice theory, we deductively generated three key themes from our data: (1) collaborative learning, (2) the medium of language, and (3) creating a safe space. These themes encapsulate our participants’ experiences in navigating interprofessional learning within newly established teams, during simulated child safety scenarios in the emergency department. Findings also detail participants’ knowledge gains and confidence in reporting child safeguarding concerns. Conclusions This co-designed interprofessional simulation-based child safeguarding course created space for learners to renegotiate safeguarding as a shared, interdependent responsibility. Authentic, emotionally charged scenarios in a psychologically safe environment helped participants tolerate uncertainty, rehearse reporting decisions, and develop a shared safeguarding lexicon. The resulting design principles may assist educators seeking to foreground psychological safety, authentic collaboration and the child’s voice in interprofessional safeguarding education.

ObjectiveThis study examines the forensic medical examination (FME) service provided to children in a regional centre in Dublin, Ireland, over 5 years. It reports on patient characteristics, alleged perpetrators and service provision. The goal is to inform future service provision and prevention strategies.DesignThe retrospective cohort study included all children and adolescents who underwent FME from January 2018 to December 2022. Data was collected from encrypted child protection reports and analysed with descriptive statisticsSettingThe study was undertaken in the Laurels Clinic, one of the three regional Irish centres for FME.ResultsOf 448 patients, 79% were female, with 37.3% aged 5–11 years. Vaginal penetration occurred in 46% of cases, with digital penetration (vaginal or anal) being the most common method. Anal penetration was reported in 26%, and 6.3% had anogenital findings suggestive of child sexual abuse (CSA). CSA was most often perpetrated in the home, with nearly half of patients showing behavioural changes. About 18% had developmental concerns, and 30% lived in blended families. Alleged perpetrators were mainly male (90.1%), with over 20% being teenagers and 12.8% under 13. Over half of cases involved repeated abuse. Disclosure rates were higher with age, with 69% of disclosures made to a parent.ConclusionThis study highlights CSA risk factors, including blended families and developmental concerns. A worrying finding was that many perpetrators were adolescents or children. Prevention programmes must address risks related to smartphone use and exposure to pornography. These findings can guide clinicians, policymakers and institutions in strengthening CSA prevention and response efforts.

Introduction/BackgroundSt Louise’s Unit provides assessment and therapy services for children/young people where CSA is a concern. The multidisciplinary, multiagency professionals’ consultation model was introduced in 2016, and adapted in 2018. Some children/young people referred to the unit for assessment and/or therapy regarding CSA, have other complexities in their lives such as concerns of other types of abuse, living in care and other health concerns (including mental health concerns). Therefore introducing additional specialist CSA services to the child’s life, may in fact add to these complexities.Aims and objectivesWhen a referral is received in St Louise’s Unit, the Consultation service aims to bring together the professionals already involved in the child/young person’s life by offering additional support for those professionals.MethodologyThe interdisciplinary team came together as part of the Children’s Health Ireland Quality Improvement and Patient Safety Programme in 2018. A retrospective review of the referrals to St Louise’s Unit was carried out and data from referrals from June 2018 to March 2019 was collected.ResultsFor that 9 month timeframe, there were 89 referrals to St Louise’s Unit, with 20 directly to the Consultation Service. Consultation appointments were offered on Wednesday afternoons. Interdisciplinary representation from St Louise’s Unit, Laurels Clinic, Tusla, An Garda Síochána other agencies involved in the child/young person’s life all met in St Louise’s Unit for a 2 hour meeting. The outcomes were 50% of referrals were discharged, 43% were forwarded for assessment and 7% were referred to therapy services in St Louise’s Unit.DiscussionThe consultation service is a collaborative and reflective process that allows for shared thinking in complex cases and supports case progression or resolution. Some of the outcomes included working through assessment versus therapy dilemmas with the system around the child; successfully resolving CSA concerns in custody and access cases in a way that was least intrusive for a child; identifying mental health concerns; and preserving foster placement and stability for a child.ConclusionsThis structured consultation service in St Louise’s Unit has led to collaborative working within the unit and with other professionals involved in the child/young person’s life where CSA is a concern. In the 20 cases reviewed, this service supported the professionals already involved in the complexities of the child’s life with least intrusion for the child.

The work in this thesis was carried out to examine currently acknowledged sources of endothelial cells for use in prosthetic graft seeding with the aim of assessing their practicality and applicability in a human clinical situation. Chapter 1 reviews the theories of the aetiology of peripheral vascular disease and discusses the clinical presentation and natural history of lower limb ischaemia. Chapter 2 reviews the therapeutic modalities currently available and Chapter 3 the current status of knowledge regarding why one such modality - bypass grafting - fails. Chapter 4 reviews our knowledge of endothelial cell function with emphasis on relevance to graft seeding and experience with seeding since its introduction in 1976. The experimental work is based on three cell types from four sources. In Chapter 5 the isolation of human umbilical vein endothelial cells is described, with assessment of cell yield and coagulation functions. Data on the antigenicity of such cells is presented using quantification of MHC Class II antigens and lymphoproliferative ability. Chapter 6 details the application of a similar isolation method to human saphenous vein segments. Chapter 7 details a new isolation method for obtaining microvascular endothelial cells from human omentum with assessment of cell yield, purity, function and ability to adhere to polytetrafluoroethylene. My experience with the application of the technique to human superficial fat is described in Chapter 8. Chapter 9 describes the modifications necessary to apply this technique to canine omentum and Chapter 10 recounts the results of a series of in vivo experiments in a canine model - assessing autologously seeded graft thrombogenicity and patency. In the last Chapter the results of my experiments are reviewed and an overall assessment of the potential of the various cell sources in a human clinical situation made. Possible avenues of research uncovered by my work are presented.