Technological University Dublin

Donor‐acceptor BODIPY dyads, functionalized at the 2 and 6 positions with benzyl ester (BDP‐DE) or carboxylic acid (BDP‐DA) groups, were synthesized, and their optoelectronic properties were investigated. Carbonyl groups were found to increase the reduction potential of the BODIPY core by 0.15–0.4 eV compared to regular alkyl‐substituted BODIPYs. These compounds exhibited efficient intramolecular charge separation and triplet state formation through the spin‐orbit charge transfer intersystem crossing (SOCT‐ISC) process, achieving singlet oxygen quantum yields of up to 92 %, depending on the solvent polarity. Notably, the fluorescence and singlet oxygen generation of BDP‐DAs were found to depend on the ionization state of the carboxylic groups. Time‐resolved fluorescence measurements revealed that complexation of BDP‐DAs with bovine serum albumine (BSA) significantly extended their excited state lifetimes. Fluorescence lifetime imaging microscopy (FLIM) studies of human colorectal carcinoma (HCT116) cells and pig small intestinal organoids (enteroids) provided insights into subcellular localization. The diacid with 2,4‐dimethoxyphenyl group at the meso‐position (DA1) displayed longer lifetimes in lipid‐droplet‐like structures and shorter lifetimes in cytoplasmic regions. The diacid containing a meso‐anthracenyl group (DA2) formed ′islands’ in cell monolayers, exhibiting a distinct lifetime gradient from the periphery to the center. These results highlight the potential of donor‐acceptor BODIPYs as fluorescent probes for biological imaging, particularly in revealing subtle differences in cellular environments.

Importance Additional data are required regarding atropine treatment regimens for control of myopia progression. Objective To investigate the efficacy and safety of different atropine regimens for myopia in children. Design, Setting, and Participants This was a secondary analysis of the 3-year results of the 24-Month Myopia Outcome Study of Atropine in Children (MOSAIC) trial, called the MOSAIC2 trial. The MOSAIC trial was an investigator-led, double-masked, randomized clinical trial of different atropine concentrations and regimens. The MOSAIC2 study took place at the Centre for Eye Research Ireland, in Dublin, Ireland, and included children and adolescents with myopia from the MOSAIC trial. Data analysis was conducted from November 2023 to February 2024. Interventions Participants were randomly assigned to the following cohorts: group 1, nightly placebo for 2 years then 0.05% atropine eye drops for 1 year and group 2, nightly 0.01% atropine eye drops for 2 years then rerandomization to placebo nightly, tapering placebo, or tapering of 0.01% atropine eye drops for 1 year. Main Outcomes and Measures Observed changes in cycloplegic spherical equivalent refraction and axial length from month 24, or baseline, to month 36. Results A total of 199 children with myopia (mean [SD] age, 13.9 [2.4] years; 121 female [60.8%]) of the 250 children and adolescents from the MOSAIC trial were included in the MOSAIC2 trial analysis. Of 83 participants assigned to group 1, 66 (79.5%) reconsented to year 3, and 61 (73.5%) completed the trial. Of 167 participants assigned to group 2, 133 (79.6%) continued to year 3, and 121 (72.5%) completed the trial (0.01% atropine, then nightly placebo: n = 31 and n = 29 [93.5%]; 0.01% atropine, then tapering placebo: n = 29 and n = 25 [86.2%]; 0.01% atropine then tapering 0.01% atropine: n = 73 and n = 67 [91.8%], respectively). Compared with the group taking placebo then 0.05% atropine, the combined atropine then placebo groups had more spherical equivalent progression (adjusted difference, −0.13 diopters [D]; 95% CI, −0.22 to −0.04 D; P = .01) and axial elongation (adjusted difference, 0.06 mm; 95% CI, 0.02-0.09 mm; P = .008), and the group taking 0.01% atropine then tapering 0.01% atropine had more axial elongation (adjusted difference, 0.04 mm; 95% CI, 0.009-0.07 mm; P = .04). In the group taking placebo then 0.05% atropine, 15% (n = 10) and 8% (n = 5) reported blurred near vision and photophobia, respectively, during year 3, compared with 3% (n = 2) and 0%, respectively, in the group taking 0.01% atropine then tapering 0.01% atropine, and no reports in both placebo groups. Conclusions and Relevance Despite more adverse events, participants using 0.05% atropine during year 3 had no differences in treatment completion rates and exhibited 0.13-D less myopia progression and 0.06-mm less axial elongation, compared with participants using placebo, supporting consideration of treatment as given to the group taking 0.05% atropine in this European population. Trial Registration isrctn.org Identifier: ISRCTN36732601

The area of eXplainable Artificial Intelligence (XAI) has shown remarkable progress in the past few years, with the aim of enhancing the transparency and interpretability of the machine learning (ML) and deep learning (DL) models. This review paper presents an in-depth review of the current state-of-the-art XAI techniques applied to the diagnosis of brain diseases. The challenges encountered by traditional ML and DL models within this domain are thoroughly examined, emphasising the pivotal role of XAI in providing the transparency and interpretability of these models. Furthermore, this paper presents a comprehensive survey of the XAI methodologies used for making diagnoses of various brain disorders. Recent studies utilising XAI for diagnosing a range of brain illnesses, including Alzheimer, brain tumours, dementia, Parkinson, multiple sclerosis, autism, epilepsy, and stroke, are critically reviewed. Finally, the limitations inherent in current XAI techniques are discussed, along with prospective avenues for future research. The key goal of this study is to provide researchers with a roadmap that shows the potential of XAI techniques in improving the interpretability and transparency of DL and ML algorithms for the diagnosis of brain diseases, while also delineating the challenges that require concerted research efforts.

Federated Learning (FL) paradigm has been very popular in the implementation of 5G and beyond communication systems as it provides necessary security for the users in terms of data. However, the FL paradigm is still vulnerable to model inversion attacks, which allow malicious attackers to reconstruct data by using the trained model gradients. Such attacks can be carried out using generative adversarial networks (GANs), generative models, or by backtracking the model gradients. A zero-trust mechanism involves securing access and interactions with model gradients under the principle of “never trust, always verify.” This proactive approach ensures that sensitive information, such as model gradients, is kept private, making it difficult for adversaries to infer the private details of the users. This paper proposes a zero-trust based Block Encryption LAyer (BELA) module that provides defense against the model inversion attacks in FL settings. The BELA module mimics the Batch normalization (BN) layer in the deep neural network architecture that considers the random sequence. The sequence and the parameters are private to each client, which helps in providing defense against the model inversion attacks. We also provide extensive theoretical analysis to show that the proposed module is integratable in a variety of deep neural network architectures. Our experimental analysis on four publicly available datasets and various network architectures show that the BELA module can increase the mean square error (MSE) up to 194% when a reconstruction attempt is performed by an adversary using existing state-of-the-art methods.

This article presents the implementation of the canonical Lemaitre and Gurson–Tvergaard–Needleman (GTN) damage models and a more recent phase‐field type model within a Lagrangian, geometrically nonlinear, cell‐centred finite volume framework. The proposed segregated solution procedure uses Picard‐type defect (deferred) outer corrections, where the primary unknowns are cell‐centre displacements and pressures. Spurious zero‐energy modes (numerical oscillations in displacement and pressure) are avoided by introducing stabilisation (smoothing) diffusion terms to the pressure and momentum equations. Appropriate scaling of the momentum “Rhie–Chow” stabilisation term is shown to be important in regions of plasticity and damage. To accurately predict damage and fracture in wire drawing where hydrostatic pressure is high, novel variants of the Lemaitre model with crack‐closure and triaxiality effects are proposed. The developed methods are validated against the notched round bar and flat notched bar experimental cases and subsequently applied to the analysis of axisymmetric wire drawing. It is shown that the proposed finite volume approach provides a robust basis for predicting damage in wire drawing, where the proposed novel Lemaitre model with crack‐closure effects was shown to be the most suitable for predicting experimentally observed fracture.

The current work outlines the preparation of a TiO2 nanotube (NT) layer electrochemically formed on the surface of a clinically-relevant titanium alloy via anodisation. This NT layer was subsequently modified via alternating current electrodeposition to incorporate copper micro- and nanoparticles on top of and within the NTs. Physical characterisation of the NT layer and the copper-incorporated NTs was carried out through analysis of the surface morphology, elemental composition, crystallinity, and stability via SEM, EDX, XRD, and ICP-OES, respectively. After immersion in Dulbecco's phosphate buffer saline solution at 37 °C for 24 hours, the electrodeposited copper particles transformed into Cu3(PO4)2·3H2O microflowers. Bacterial susceptibility tests were carried out against E. coli and S. aureus. The antibacterial activity was influenced by the physical characteristics of the electrodeposited copper, the transformation of the copper particles to microflowers, and the extent at which the copper-incorporated surface released Cu²⁺ ions.

In this paper a systematic examination of metadata/paradata is presented to support the creation and reuse of digital heritage data as a means of engaging in some way with the experience of past material cultural discourse. The contextual and procedural information generated throughout Historic Building Information Modelling (HBIM) workflows are presented through a series of case studies. The three phases of data capture, modelling and knowledge dissemination for HBIM workflows are reflected in the presented case studies. The first case study illustrate how metadata is recorded automatically by the terrestrial and aerial laser scanning instruments and software, whereas it is necessary to document paradata. Case study 2, shows how shape grammar libraries of architectural elements and procedural modelling both contained metadata within the HBIM software platforms. Again, there is a need to document the paradata using both graphic and text format, proving the need for standards and guidelines for HBIM. Finally, additional software platforms were reviewed to ensure survival of metadata (geometry, geolocation and other semantic attributes) when the virtual model is disseminated outside of HBIM in this case using Heritage GIS. The HBIM design framework is presented as a set of Data Cards, a standardised documentation to record key information about datasets, allowing for enhanced reuse of the data recorded in such a way as to contribute more meaningfully to the consideration of the many and various ways of living in the past.

Controlling Listeria monocytogenes and its associated biofilms in the food industry requires various disinfection techniques, including physical, chemical, and biological treatments. Biocides, owing to their ease of use, cost‐effectiveness, dissolvability in water, and efficacy against a wide range of microorganisms, are frequently selected options. Nonetheless, concerns have been raised about their efficacy in controlling L. monocytogenes biofilm, as laboratory‐based and commercial studies have reported the persistence of this bacterium after cleaning and disinfection. This review systematically examined scientific studies, sourced from the Web of Science, Scopus, and PubMed databases between January 2010 and May 2024, that investigated the effectiveness of the most commonly used biocides in the food industry against L. monocytogenes biofilms. A total of 92 articles which met the screening criteria, were included, with studies utilizing biocides containing sodium hypochlorite, quaternary ammonium compounds, and peroxyacetic acid being predominant. Studies indicated that several key factors may potentially influence biocides’ efficacy against L. monocytogenes biofilms. These factors included strain type (persistent, sporadic), serotype, strain origin (clinical, environmental, or food), surface type (biotic or abiotic), surface material (stainless steel, polystyrene, etc.), incubation time (biofilm age) and temperature, presence of organic matter, biocide's active agent, and the co‐culture of L. monocytogenes with other bacteria. The induction of the viable but nonculturable (VBNC) state following disinfection is also a critical concern. This review aims to provide a global understanding of how L. monocytogenes biofilms respond to biocides under different treatment conditions, facilitating the development of effective cleaning and disinfection strategies in the food industry.

Purpose To investigate 2‐year changes in macular choroidal thickness (ChT) in children receiving 0.01% atropine eyedrops and its relationship with spherical equivalent refraction (SER) progression and axial length (AL) elongation. Methods A total of 250 myopic children aged 6–16 years (167%–0.01% atropine, 83‐placebo) were enrolled in the MOSAIC ( ISRCTN36732601 ) clinical trial. Participants with complete 2‐year ChT (Topcon Triton Swept‐Source OCT), SER, and AL data were included in this study. Changes in macular ChT at 2 years and associations with changes in SER and AL elongation were analysed using linear mixed models. Results A total of 187 children (126%–0.01% atropine, 61‐placebo) were included in the analysis. Choroidal thickness over 2 years was stable in the 0.01% atropine compared with placebo group, which exhibited consistent thinning in subfoveal (mean ± SE: 0.49 ± 2.22 μm vs. −9.46 ± 2.69 μm; p = 0.034), parafoveal (1.40 ± 1.73 μm vs. −8.11 ± 2.08 μm; p = 0.002), and perifoveal (0.80 ± 1.25 vs. −6.17 ± 1.69; p = 0.002) macular subfields. Choroidal thickening was observed in participants with slower axial eye growth and myopia progression, regardless of their treatment group. Mediation analysis indicated that atropine 0.01% had a significant effect on ChT, with 68.3% of the effect being direct and 31.7% mediated through axial length changes. For SER, the direct effect on ChT was 80%, with the remaining 20% mediated by SER changes. Conclusions Myopic participants treated with 0.01% atropine exhibited stable ChT over 2 years, whereas the placebo group showed consistent thinning. The effect of atropine 0.01% on ChT was only partially explained by axial length and SER changes, indicating a direct effect of atropine treatment on the choroid.

BACKGROUND: The global burden of vision impairment has been acknowledged by the World Health Organisation as a public health challenge. In order to scale up the production of eye health personnel in developing countries, a tiered model of optometry training was explored in Mozambique. OBJECTIVES: The Mozambique case study was evaluated to assess the feasibility of a tiered model of optometry training as a developmental eye health strategy. METHODS: A qualitative, case study approach was used. Semi-structured key informant interviews were conducted and project documents were reviewed in the data collection phase. Data underwent a process of content analysis, using a constant comparative approach across sources, and was analysed thematically using inductive reasoning. RESULTS: Three key themes which emerged were Rationale for a training model, Implementation considerations and Development practice considerations. Results demonstrated that while tiered models of training may have developmental rationale, awareness of the profession and its place in addressing health needs, intensive consultation with local stakeholders and a thorough situational analysis are required for this strategy to be feasible. CONCLUSIONS: A tiered model of training appears to have theoretical basis as a developmental eye health strategy. However, local applicability and legislative alignment is required in order for these training initiatives to be sustainably implemented.

Rapid and accurate determination of target proteins in cells provide essential diagnostic information for early detection of diseases, evaluation of drug responses, and the study of pathophysiological mechanisms. Traditional Western blotting method has been used for the determination, but it is complex, time-consuming, and semi-quantitative. Here, a tapered seven-core fiber (TSCF) biosensor was designed and fabricated. By immobilizing protein kinase B (PKB), also known as AKT, antibody onto TSCF surface, the microfiber biosensor can be used for quantitatively detecting the AKT level in solution concentrations as low as 0.26 ng/mL. To test the reliability of the TSCF sensing method in a medical application, the TSCF biosensor was used to study the relationship between chrysin’s anticancer effect and the concentration of AKT in a human colorectal cancer cell line (LoVo cells). The results reveal that the inhibitory effect of chrysin on LoVo cells is positively correlated with the dose, agreeing well with the equivalent results using the traditional Western blotting method.

Beyond 5G/6G communication systems promise to significantly impact the development of a New Generation of CCAM. Reconfigurable Intelligent Metasurfaces (RIM) are by now established as a key enabling technology for 6G Systems. They have been extensively investigated the last few years, as they possess exotic properties allowing for precise control over any aspect of an impinging wave. As such, they can be harnessed for the realization of Programmable Wireless Environments (PWE). Despite their investigation for deployment in a number of applications, their integration in Connected Autonomous Driving Applications has not been considered in literature with respect to cooperative driving performance. In this chapter, we consider the HyperSurface (HSF) as the enabling technology for RIM and present recent results demonstrating the feasibility and the associated performance gains achieved from the integration of RIM in Connected Automated Driving Applications. We discuss HSF design considerations which can affect CCAM performance with respect to the system architecture, the controller network and the associated routing protocols, the workload characterization and the closed loop beam steering design. We envision the chapter to serve as a synopsis of tools and methodologies that can be used for RIM-enabled CCAM system design.

Much has been said around the dynamics/process of competition and gaining business advantage within the construction sector, however, much less investigation has gone into the practice-based elements of firms in the construction sector, particularly high knowledge intensive professional service firms(PSFs). The strategy-as-practice viewpoint is one of the most recent approaches to strategic management, which focuses on the people, practices and praxis elements of organisations. There is a lack of research on people within the construction industry who are the link between strategy practice (social, symbolic, and material tools and processes) and praxis (how strategic activity is accomplished). These people form the critical link between organizational and extra-organizational levels, making them a critical element in strategic analysis. The realization of strategic goals depends on these people, and for the strategy to be effective within construction organizations, it needs to be properly interpreted in the organizational context by these people. This study presents a unique strategy-as-practice lens of construction professional service firms (architectural, engineering, and surveying consultancies) using a sample of 27 Irish firms. The findings advance knowledge on the who (people) is involved in strategy within PSFs, what they engage in for strategizing (practices) and how they achieve the same (praxis).

Background Social prescribing link workers support patients to connect with community resources to improve their health and well-being. These roles are prominent in policy, but there is limited evidence on what support is provided by link workers and what factors influence implementation of link worker interventions. Methods A convergent, mixed methods process evaluation of an exploratory randomised trial of a one-month general practice-based link worker intervention targeting adults with multimorbidity in deprived areas. Qualitative data from interviews with 25 patients, 10 general practitioners, 10 link workers and eight community resource providers were thematically analysed and integrated with quantitative data to explore implementation, adaptations, context and mediators. Results GPs reported recruitment challenges related to complicated research documentation and COVID-19 related workload and restrictions. Despite most components of the intervention being delivered, the intervention was considered too short to support people with complex needs to connect with resources, particularly in the context of COVID-19 restrictions. Timing of the referral, location within general practice and link workers’ person-centred approach facilitated the intervention. Conclusions For future evaluations, recruitment procedures need to be simplified and integrated into everyday practice. For patients with multimorbidity, a longer intervention is indicated to achieve connection with community resources.

Satellite high aerial platform terrestrial integrated networks have become the hot topic these years, which have been regarded as the major part of the intelligence of things for future networks. During this work, we investigate the secrecy performance for rate-splitting multiple access-assisted satellite high aerial platform terrestrial integrated networks. Besides, imperfect hardware and channel estimation errors are considered in the secrecy networks. Moreover, to enhance the energy utilization efficiency, rate-splitting multiple access scheme is utilized into the considered network, which is prior to that of the non-orthogonal multiple access scheme. What's more, to enhance the satellite transmission, multiple high aerial platforms are used to forward the transmission along with multiple eavesdroppers. In addition, the direct transmission link is not considered in the secrecy networks due to the heavy fading and obstacles. Relied on the former considerations, the exact and asymptotic analysis for the secrecy performance is further obtained to confirm the rightness of the analysis. Finally, some representative Monte Carlo simulations are carried out to validate the obtained results.

The aim of this study was to use blue whiting fish protein hydrolysate (BWFPH) as a novel dietary amino acid supplement in whey protein isolate (WPI) and pea protein isolate (PPI)‐based protein bars. The findings indicate that incorporating BWFPH significantly influenced the nutritional profile of the protein bars, leading to a ~93% reduction in hardness compared to bars without the hydrolysate. Additionally, BWFPH effectively delayed the hardening process during storage. However, sensory evaluation revealed that the inclusion of BWFPH adversely affected the sensory characteristics, indicating a need for optimization. Using a simplex centroid mixture design, we identified an optimized protein blend compromising 76.02% WPI, 6.72% PPI, and 17.26% BWPFH, which achieved a balance of improved texture and sensory appeal. These results suggest that high‐protein bars can be enhanced by integrating novel protein sources through careful formulation and optimization.

Background The models that historically have been used to model infectious disease outbreaks are equation-based and statistical models. However, these models do not capture the impact of individual and social factors that affect the spread of common blood-borne viruses (BBVs) such as human immunodeficiency virus (HIV), hepatitis C virus (HCV), and hepatitis B virus (HBV). Agent-based modelling (ABM) is an alternative modelling approach that is gaining popularity in public health and epidemiology. As the field expands, it is important to understand how ABMs have been applied. In this context, we completed a scoping review of research that has been done on the ABM of BBVs. Method The inclusion/exclusion criteria were drafted using the idea of Population, Concept, and Context (PCC). The Preferred Reporting Item for Systematic Reviews and Meta-Analysis, an extension to scoping review (PRISMA-ScR), was employed in retrieving ABM literature that studied BBVs. Three databases (Scopus, Pubmed, and Embase) were systematically searched for article retrieval. 200 articles were retrieved from all the databases, with 10 duplicates. After removing the duplicates, 190 papers were screened for inclusion. After analysing the remaining articles, 70 were excluded during the abstract screening phase, and 32 were excluded during the full-text decision. Eighty-eight were retained for the scoping review analysis. To analyse this corpus of 88 papers, we developed a five-level taxonomy that categorised each paper based first on disease type, then transmission mechanism, then modelled population, then geographic location and finally, model outcome. Results The result of this analysis show significant gaps in the ABM of BBV literature, particularly in the modeling of social and individual factors influencing BBV transmission. Conclusion There is a need for more comprehensive models that address various outcomes across different populations, transmission and intervention mechanisms. Although ABMs are a valuable tool for studying BBVs, further research is needed to address existing gaps and improve our understanding of individual and social factors that influence the spread and control of BBVs. This research can inform researchers, modellers, epidemiologists, and public health practitioners of the ABM research areas that need to be explored to reduce the burden of BBVs globally.

Food safety culture (FSC) has transitioned from a narrow compliance-based concept to a comprehensive organisational value that is essential for ensuring food safety. This review explores the pivotal roles of leadership, organisational commitment, and cultural diversity in shaping an effective FSC. It highlights how leadership style, particularly transformational leadership, can enhance employee engagement and foster a proactive safety culture. Additionally, the impact of national and organisational cultures on FSC is analysed, emphasising the challenges posed by a multicultural workforce in standardising food safety practices. This article also provides a comparative analysis of FSC across various sectors, such as meat and dairy processing, identifying sector-specific challenges and best practices. In particular, high-risk sectors tend to exhibit a stronger FSC due to regulatory pressure, while other sectors struggle with issues like communication and employee ownership. The importance of integrating behavioural training with cultural considerations is underscored as a key strategy for sustaining a positive FSC. For maintaining a strong FSC, tailored approaches, which account for cultural and operational differences, are necessary for improving food safety outcomes. This comprehensive analysis provides valuable insights for industry professionals and policymakers, offering a foundation for future research and the development of more effective food safety management practices.

Cow’s Milk Allergy (CMA) is estimated to affect 2-3% of infants, typically developing in the first year of life ⁽¹⁾ . The risks of misdiagnosing CMA include acute reactions, micronutrient deficiencies, growth faltering, increased burden on healthcare systems, and reduced quality of life for infants and caregivers ⁽²⁾ . The guidelines for diagnosis and management are not always followed due to lack of awareness, or difficulties with implementation (1,3) . The aim of this study was to obtain parent-reported data on the diagnosis and management of CMA in Ireland. A 23-item questionnaire was developed and distributed through an online parenting club, targeting parents of infants aged 0-12 months with CMA. The quantitative and qualitative data was analysed on SPSS (V29) using descriptive statistics and cross-tabulation tests. A total of 62 parents with an infant under 12 months responded that their infant currently has (n = 56) or previously had CMA (n = 6). Five cases were self-diagnosed and were partially excluded from analysis. General practitioners (42%) and paediatricians (39%) were the most common healthcare professionals (HCPs) to diagnose CMA. The number of visits it took before receiving a CMA diagnosis ranged from 1-15 visits, with a median of 2 visits. Some infants were diagnosed on their first appointment (n = 11) while others took 4-5 months before being diagnosed (n = 2). Only 23% of infants underwent a skin-prick/blood test, suggesting most HCPs were using symptom resolution to decipher a diagnosis. An extensively hydrolysed formula (EHF) was recommended as first-line management to most formula-fed infants (82%, n = 40), while 14% (n = 7) were initially recommended an amino acid formula (AAF). Of the 17 suspected non-IgE infants who did not exclusively breastfeed, only 41% were given advice to reintroduce standard infant formula after 2-4 weeks of being on a hypoallergenic formula, to assess if symptoms reappeared. Of this 41%, only 57% followed this advice. Of breastfeeding mothers (n = 30), 87% were advised to eliminate cow’s milk from the maternal diet, however 57% were not advised on reintroduction upon symptom resolution ⁽¹⁾ . Faltering growth was reported in 11% (n = 5) of formula-fed infants and all were prescribed an EHF, despite guidelines recommending an AAF if faltering growth is evident ⁽¹⁾ . After diagnosis, 26 infants (46%) had no follow-up with their HCP. Of the 22 infants diagnosed by a paediatrician, 77% received a follow-up appointment which was significantly greater compared to follow-up rates from other HCPs ( P = 0.006). Limitations include the use of a small convenience cohort and selfreporting of data. These results indicate a clear gap between CMA diagnosis and management guidelines, and their practical implementation within the Irish healthcare setting. Any strategy to further educate and support HCPs in this specialist area of healthcare could mitigate risk of misdiagnosis, delayed diagnosis, and inappropriate management.