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Trask L, Ward NA, Tarpey R, Beatty R, Wallace E, O'Dwyer J, Ronan W, Duffy GP, Dolan EB. Exploring therapy transport from implantable medical devices using experimentally informed computational methods. Biomater Sci 2024. [PMID: 38683198 DOI: 10.1039/d4bm00107a] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/01/2024]
Abstract
Implantable medical devices that can facilitate therapy transport to localized sites are being developed for a number of diverse applications, including the treatment of diseases such as diabetes and cancer, and tissue regeneration after myocardial infraction. These implants can take the form of an encapsulation device which encases therapy in the form of drugs, proteins, cells, and bioactive agents, in semi-permeable membranes. Such implants have shown some success but the nature of these devices pose a barrier to the diffusion of vital factors, which is further exacerbated upon implantation due to the foreign body response (FBR). The FBR results in the formation of a dense hypo-permeable fibrous capsule around devices and is a leading cause of failure in many implantable technologies. One potential method for overcoming this diffusion barrier and enhancing therapy transport from the device is to incorporate local fluid flow. In this work, we used experimentally informed inputs to characterize the change in the fibrous capsule over time and quantified how this impacts therapy release from a device using computational methods. Insulin was used as a representative therapy as encapsulation devices for Type 1 diabetes are among the most-well characterised. We then explored how local fluid flow may be used to counteract these diffusion barriers, as well as how a more practical pulsatile flow regimen could be implemented to achieve similar results to continuous fluid flow. The generated model is a versatile tool toward informing future device design through its ability to capture the expected decrease in insulin release over time resulting from the FBR and investigate potential methods to overcome these effects.
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Affiliation(s)
- Lesley Trask
- Biomedical Engineering, School of Engineering, University of Galway, Galway, Ireland
- Biomechanics Research Centre (BMEC), Biomedical Engineering, School of Engineering, University of Galway, Galway, Ireland
| | - Niamh A Ward
- Biomedical Engineering, School of Engineering, University of Galway, Galway, Ireland
- Biomechanics Research Centre (BMEC), Biomedical Engineering, School of Engineering, University of Galway, Galway, Ireland
| | - Ruth Tarpey
- Biomedical Engineering, School of Engineering, University of Galway, Galway, Ireland
- Anatomy and Regenerative Medicine Institute (REMEDI), School of Medicine, University of Galway, Galway, Ireland
- CÚRAM, Centre for Research in Medical Devices, University of Galway, Galway, Ireland
| | - Rachel Beatty
- Anatomy and Regenerative Medicine Institute (REMEDI), School of Medicine, University of Galway, Galway, Ireland
- SFI Centre for Advanced Materials and BioEngineering Research Centre (AMBER), Trinity College Dublin, Dublin, Ireland
| | - Eimear Wallace
- Anatomy and Regenerative Medicine Institute (REMEDI), School of Medicine, University of Galway, Galway, Ireland
| | - Joanne O'Dwyer
- Anatomy and Regenerative Medicine Institute (REMEDI), School of Medicine, University of Galway, Galway, Ireland
| | - William Ronan
- Biomedical Engineering, School of Engineering, University of Galway, Galway, Ireland
- Biomechanics Research Centre (BMEC), Biomedical Engineering, School of Engineering, University of Galway, Galway, Ireland
| | - Garry P Duffy
- Anatomy and Regenerative Medicine Institute (REMEDI), School of Medicine, University of Galway, Galway, Ireland
- SFI Centre for Advanced Materials and BioEngineering Research Centre (AMBER), Trinity College Dublin, Dublin, Ireland
- CÚRAM, Centre for Research in Medical Devices, University of Galway, Galway, Ireland
| | - Eimear B Dolan
- Biomedical Engineering, School of Engineering, University of Galway, Galway, Ireland
- Biomechanics Research Centre (BMEC), Biomedical Engineering, School of Engineering, University of Galway, Galway, Ireland
- CÚRAM, Centre for Research in Medical Devices, University of Galway, Galway, Ireland
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Mooney S, Lavallee S, O'Dwyer J, Majury A, O'Neill E, Hynds PD. Private groundwater contamination and risk management: A comparative scoping review of similarities, drivers and challenges across two socio-economically developed regions. Sci Total Environ 2024; 922:171112. [PMID: 38387579 DOI: 10.1016/j.scitotenv.2024.171112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/10/2023] [Revised: 02/13/2024] [Accepted: 02/18/2024] [Indexed: 02/24/2024]
Abstract
Consolidation of multi-domain risk management research is essential for strategies facilitating the concerted government (educational) and population-level (behavioural) actions required to reduce microbial private groundwater contamination. However, few studies to date have synthesised this literature or sought to ascertain the causal generality and extent of supply contamination and preventive responses. In light of the Republic of Ireland (ROI) and Ontario's high reliance and research focus on private wells and consequent utility for empirical comparison, a scoping review of pertinent literature (1990-2022) from both regions was undertaken. The SPICE (Setting, Perspective, Intervention, Comparison, Evaluation) method was employed to inform literature searches, with Scopus and Web of Science selected as primary databases for article identification. The review identified 65 relevant articles (Ontario = 34, ROI = 31), with those investigating well user actions (n = 22) and groundwater quality (n = 28) the most frequent. A markedly higher pooled proportion of private supplies in the ROI exhibited microbial contamination (38.3 % vs. 4.1 %), despite interregional similarities in contamination drivers (e.g., weather, physical supply characteristics). While Ontarian well users demonstrated higher rates of historical (≥ 1) and annual well testing (90.6 % vs. 71.1 %; 39.1 % vs. 8.6 %) and higher rates of historical well treatment (42.3 % vs. 24.3 %), interregional levels of general supply knowledge were analogous (70.7 % vs. 71.0 %). Financial cost, organoleptic properties and residence on property during supply construction emerged as predictors of cognition and behaviour in both regions. Review findings suggest broad interregional similarities in drivers of supply contamination and individual-level risk mitigation, indicating that divergence in contamination rates may be attributable to policy discrepancies - particularly well testing incentivisation. The paucity of identified intervention-oriented studies further highlights the importance of renewed research and policy agendas for improved, targeted well user outreach and incentivised, convenience-based services promoting routine supply maintenance.
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Affiliation(s)
- S Mooney
- School of Architecture, Planning & Environmental Policy, University College Dublin, Ireland.
| | - S Lavallee
- Center for Tobacco and the Environment, San Diego State University, San Diego, CA, United States
| | - J O'Dwyer
- School of Biological, Earth and Environmental Sciences, University College Cork, Cork, Ireland; Environmental Research Institute, University of Cork, Cork, Ireland; Irish Centre for Research in Applied Geosciences (iCRAG), University College Dublin, Dublin, Ireland
| | - A Majury
- School of Environmental Studies, Queen's University, Kingston, Ontario, Canada; Public Health Ontario, Kingston, Ontario, Canada
| | - E O'Neill
- School of Architecture, Planning & Environmental Policy, University College Dublin, Ireland; UCD Earth Institute, University College Dublin, Belfield, Dublin 4, Ireland
| | - P D Hynds
- Irish Centre for Research in Applied Geosciences (iCRAG), University College Dublin, Dublin, Ireland; Environmental Sustainability & Health Institute, Technological University Dublin, Dublin, Ireland
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Ward NA, Hanley S, Tarpey R, Schreiber LHJ, O'Dwyer J, Roche ET, Duffy GP, Dolan EB. Intermittent actuation attenuates fibrotic behaviour of myofibroblasts. Acta Biomater 2024; 173:80-92. [PMID: 37967693 DOI: 10.1016/j.actbio.2023.11.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2023] [Revised: 10/31/2023] [Accepted: 11/09/2023] [Indexed: 11/17/2023]
Abstract
The foreign body response (FBR) to implanted materials culminates in the deposition of a hypo-permeable, collagen rich fibrotic capsule by myofibroblast cells at the implant site. The fibrotic capsule can be deleterious to the function of some medical implants as it can isolate the implant from the host environment. Modulation of fibrotic capsule formation has been achieved using intermittent actuation of drug delivery implants, however the mechanisms underlying this response are not well understood. Here, we use analytical, computational, and in vitro models to understand the response of human myofibroblasts (WPMY-1 stromal cell line) to intermittent actuation using soft robotics and investigate how actuation can alter the secretion of collagen and pro/anti-inflammatory cytokines by these cells. Our findings suggest that there is a mechanical loading threshold that can modulate the fibrotic behaviour of myofibroblasts, by reducing the secretion of soluble collagen, transforming growth factor beta-1 and interleukin 1-beta, and upregulating the anti-inflammatory interleukin-10. By improving our understanding of how cells involved in the FBR respond to mechanical actuation, we can harness this technology to improve functional outcomes for a wide range of implanted medical device applications including drug delivery and cell encapsulation platforms. STATEMENT OF SIGNIFICANCE: A major barrier to the successful clinical translation of many implantable medical devices is the foreign body response (FBR) and resultant deposition of a hypo-permeable fibrotic capsule (FC) around the implant. Perturbation of the implant site using intermittent actuation (IA) of soft-robotic implants has previously been shown to modulate the FBR and reduce FC thickness. However, the mechanisms of action underlying this response were largely unknown. Here, we investigate how IA can alter the activity of myofibroblast cells, and ultimately suggest that there is a mechanical loading threshold within which their fibrotic behaviour can be modulated. These findings can be harnessed to improve functional outcomes for a wide range of medical implants, particularly drug delivery and cell encapsulation devices.
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Affiliation(s)
- Niamh A Ward
- Biomedical Engineering, School of Engineering, College of Science and Engineering, University of Galway, Galway, Ireland
| | - Shirley Hanley
- Flow Cytometry Core Facility, University of Galway, Galway, Ireland
| | - Ruth Tarpey
- Biomedical Engineering, School of Engineering, College of Science and Engineering, University of Galway, Galway, Ireland; Anatomy and Regenerative Medicine Institute (REMEDI), School of Medicine, University of Galway, Galway, Ireland
| | - Lucien H J Schreiber
- Biomedical Engineering, School of Engineering, College of Science and Engineering, University of Galway, Galway, Ireland; Anatomy and Regenerative Medicine Institute (REMEDI), School of Medicine, University of Galway, Galway, Ireland
| | - Joanne O'Dwyer
- Anatomy and Regenerative Medicine Institute (REMEDI), School of Medicine, University of Galway, Galway, Ireland
| | - Ellen T Roche
- Institute for Medical Engineering and Science, Massachusetts Institute of Technology, Cambridge, MA, USA; Department of Mechanical Engineering, Massachusetts Institute of Technology, Cambridge, MA, USA; Harvard-MIT Program in Health Sciences and Technology, Cambridge, MA, USA
| | - Garry P Duffy
- Anatomy and Regenerative Medicine Institute (REMEDI), School of Medicine, University of Galway, Galway, Ireland; Advanced Materials and BioEngineering Research Centre (AMBER), Trinity College Dublin, Dublin, Ireland; CÚRAM, Centre for Research in Medical Devices, University of Galway, Galway, Ireland
| | - Eimear B Dolan
- Biomedical Engineering, School of Engineering, College of Science and Engineering, University of Galway, Galway, Ireland; CÚRAM, Centre for Research in Medical Devices, University of Galway, Galway, Ireland.
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Beatty R, Mendez KL, Schreiber LHJ, Tarpey R, Whyte W, Fan Y, Robinson ST, O'Dwyer J, Simpkin AJ, Tannian J, Dockery P, Dolan EB, Roche ET, Duffy GP. Soft robot-mediated autonomous adaptation to fibrotic capsule formation for improved drug delivery. Sci Robot 2023; 8:eabq4821. [PMID: 37647382 DOI: 10.1126/scirobotics.abq4821] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Accepted: 08/02/2023] [Indexed: 09/01/2023]
Abstract
The foreign body response impedes the function and longevity of implantable drug delivery devices. As a dense fibrotic capsule forms, integration of the device with the host tissue becomes compromised, ultimately resulting in device seclusion and treatment failure. We present FibroSensing Dynamic Soft Reservoir (FSDSR), an implantable drug delivery device capable of monitoring fibrotic capsule formation and overcoming its effects via soft robotic actuations. Occlusion of the FSDSR porous membrane was monitored over 7 days in a rodent model using electrochemical impedance spectroscopy. The electrical resistance of the fibrotic capsule correlated to its increase in thickness and volume. Our FibroSensing membrane showed great sensitivity in detecting changes at the abiotic/biotic interface, such as collagen deposition and myofibroblast proliferation. The potential of the FSDSR to overcome fibrotic capsule formation and maintain constant drug dosing over time was demonstrated in silico and in vitro. Controlled closed loop release of methylene blue into agarose gels (with a comparable fold change in permeability relating to 7 and 28 days in vivo) was achieved by adjusting the magnitude and frequency of pneumatic actuations after impedance measurements by the FibroSensing membrane. By sensing fibrotic capsule formation in vivo, the FSDSR will be capable of probing and adapting to the foreign body response through dynamic actuation changes. Informed by real-time sensor signals, this device offers the potential for long-term efficacy and sustained drug dosing, even in the setting of fibrotic capsule formation.
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Affiliation(s)
- Rachel Beatty
- Anatomy and Regenerative Medicine Institute (REMEDI), School of Medicine, University of Galway, Galway, Ireland
- SFI Centre for Advanced Materials and BioEngineering Research (AMBER), Trinity College Dublin, Dublin, Ireland
| | - Keegan L Mendez
- Harvard-MIT Program in Health Sciences and Technology, Cambridge, MA, USA
- Institute for Medical Engineering and Science, Massachusetts Institute of Technology, Cambridge, MA, USA
| | - Lucien H J Schreiber
- Anatomy and Regenerative Medicine Institute (REMEDI), School of Medicine, University of Galway, Galway, Ireland
| | - Ruth Tarpey
- Anatomy and Regenerative Medicine Institute (REMEDI), School of Medicine, University of Galway, Galway, Ireland
- CÚRAM, Centre for Research in Medical Devices, University of Galway, Galway, Ireland
- Biomedical Engineering, School of Engineering, University of Galway, Galway, Ireland
| | - William Whyte
- Institute for Medical Engineering and Science, Massachusetts Institute of Technology, Cambridge, MA, USA
| | - Yiling Fan
- Department of Mechanical Engineering, Massachusetts Institute of Technology, Cambridge, MA, USA
| | - Scott T Robinson
- Anatomy and Regenerative Medicine Institute (REMEDI), School of Medicine, University of Galway, Galway, Ireland
- SFI Centre for Advanced Materials and BioEngineering Research (AMBER), Trinity College Dublin, Dublin, Ireland
| | - Joanne O'Dwyer
- Anatomy and Regenerative Medicine Institute (REMEDI), School of Medicine, University of Galway, Galway, Ireland
| | - Andrew J Simpkin
- School of Mathematical and Statistical Sciences, University of Galway, Galway, Ireland
| | - Joseph Tannian
- Anatomy and Regenerative Medicine Institute (REMEDI), School of Medicine, University of Galway, Galway, Ireland
| | - Peter Dockery
- Anatomy and Regenerative Medicine Institute (REMEDI), School of Medicine, University of Galway, Galway, Ireland
| | - Eimear B Dolan
- Anatomy and Regenerative Medicine Institute (REMEDI), School of Medicine, University of Galway, Galway, Ireland
- CÚRAM, Centre for Research in Medical Devices, University of Galway, Galway, Ireland
- Biomedical Engineering, School of Engineering, University of Galway, Galway, Ireland
| | - Ellen T Roche
- Harvard-MIT Program in Health Sciences and Technology, Cambridge, MA, USA
- Institute for Medical Engineering and Science, Massachusetts Institute of Technology, Cambridge, MA, USA
- Department of Mechanical Engineering, Massachusetts Institute of Technology, Cambridge, MA, USA
| | - Garry P Duffy
- Anatomy and Regenerative Medicine Institute (REMEDI), School of Medicine, University of Galway, Galway, Ireland
- SFI Centre for Advanced Materials and BioEngineering Research (AMBER), Trinity College Dublin, Dublin, Ireland
- CÚRAM, Centre for Research in Medical Devices, University of Galway, Galway, Ireland
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5
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Daly E, Collins G, Hall E, O'Dwyer J, Gallagher D, Kelly J. Telehealth Rehabilitation for the Management of Long Covid Symptoms. Ir Med J 2023; 115:677. [PMID: 36920416] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Subscribe] [Scholar Register] [Indexed: 03/16/2023]
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Whyte W, Goswami D, Wang SX, Fan Y, Ward NA, Levey RE, Beatty R, Robinson ST, Sheppard D, O'Connor R, Monahan DS, Trask L, Mendez KL, Varela CE, Horvath MA, Wylie R, O'Dwyer J, Domingo-Lopez DA, Rothman AS, Duffy GP, Dolan EB, Roche ET. Dynamic actuation enhances transport and extends therapeutic lifespan in an implantable drug delivery platform. Nat Commun 2022; 13:4496. [PMID: 35922421 PMCID: PMC9349266 DOI: 10.1038/s41467-022-32147-w] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2021] [Accepted: 07/18/2022] [Indexed: 12/03/2022] Open
Abstract
Fibrous capsule (FC) formation, secondary to the foreign body response (FBR), impedes molecular transport and is detrimental to the long-term efficacy of implantable drug delivery devices, especially when tunable, temporal control is necessary. We report the development of an implantable mechanotherapeutic drug delivery platform to mitigate and overcome this host immune response using two distinct, yet synergistic soft robotic strategies. Firstly, daily intermittent actuation (cycling at 1 Hz for 5 minutes every 12 hours) preserves long-term, rapid delivery of a model drug (insulin) over 8 weeks of implantation, by mediating local immunomodulation of the cellular FBR and inducing multiphasic temporal FC changes. Secondly, actuation-mediated rapid release of therapy can enhance mass transport and therapeutic effect with tunable, temporal control. In a step towards clinical translation, we utilise a minimally invasive percutaneous approach to implant a scaled-up device in a human cadaveric model. Our soft actuatable platform has potential clinical utility for a variety of indications where transport is affected by fibrosis, such as the management of type 1 diabetes. Drug delivery implants suffer from diminished release profiles due to fibrous capsule formation over time. Here, the authors use soft robotic actuation to modulate the immune response of the host to maintain drug delivery over the longer-term and to perform controlled release in vivo.
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Affiliation(s)
- William Whyte
- Institute for Medical Engineering and Science, Massachusetts Institute of Technology, Cambridge, MA, USA
| | - Debkalpa Goswami
- Institute for Medical Engineering and Science, Massachusetts Institute of Technology, Cambridge, MA, USA
| | - Sophie X Wang
- Institute for Medical Engineering and Science, Massachusetts Institute of Technology, Cambridge, MA, USA.,Department of Surgery, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Yiling Fan
- Department of Mechanical Engineering, Massachusetts Institute of Technology, Cambridge, MA, USA
| | - Niamh A Ward
- Institute for Medical Engineering and Science, Massachusetts Institute of Technology, Cambridge, MA, USA.,Department of Biomedical Engineering, National University of Ireland Galway, Galway, Ireland
| | - Ruth E Levey
- Anatomy and Regenerative Medicine Institute (REMEDI), National University of Ireland Galway, Galway, Ireland
| | - Rachel Beatty
- Anatomy and Regenerative Medicine Institute (REMEDI), National University of Ireland Galway, Galway, Ireland
| | - Scott T Robinson
- Anatomy and Regenerative Medicine Institute (REMEDI), National University of Ireland Galway, Galway, Ireland.,Advanced Materials and BioEngineering Research Centre (AMBER), Trinity College Dublin, Dublin, Ireland
| | - Declan Sheppard
- Department of Radiology, University Hospital, Galway, Ireland
| | - Raymond O'Connor
- Anatomy and Regenerative Medicine Institute (REMEDI), National University of Ireland Galway, Galway, Ireland
| | - David S Monahan
- Institute for Medical Engineering and Science, Massachusetts Institute of Technology, Cambridge, MA, USA.,Anatomy and Regenerative Medicine Institute (REMEDI), National University of Ireland Galway, Galway, Ireland
| | - Lesley Trask
- Department of Biomedical Engineering, National University of Ireland Galway, Galway, Ireland
| | - Keegan L Mendez
- Harvard-MIT Program in Health Sciences and Technology, Cambridge, MA, USA
| | - Claudia E Varela
- Harvard-MIT Program in Health Sciences and Technology, Cambridge, MA, USA
| | - Markus A Horvath
- Harvard-MIT Program in Health Sciences and Technology, Cambridge, MA, USA
| | - Robert Wylie
- Anatomy and Regenerative Medicine Institute (REMEDI), National University of Ireland Galway, Galway, Ireland
| | - Joanne O'Dwyer
- Institute for Medical Engineering and Science, Massachusetts Institute of Technology, Cambridge, MA, USA.,Department of Biomedical Engineering, National University of Ireland Galway, Galway, Ireland
| | - Daniel A Domingo-Lopez
- Anatomy and Regenerative Medicine Institute (REMEDI), National University of Ireland Galway, Galway, Ireland
| | - Arielle S Rothman
- Institute for Medical Engineering and Science, Massachusetts Institute of Technology, Cambridge, MA, USA
| | - Garry P Duffy
- Anatomy and Regenerative Medicine Institute (REMEDI), National University of Ireland Galway, Galway, Ireland.,Advanced Materials and BioEngineering Research Centre (AMBER), Trinity College Dublin, Dublin, Ireland
| | - Eimear B Dolan
- Department of Biomedical Engineering, National University of Ireland Galway, Galway, Ireland.
| | - Ellen T Roche
- Institute for Medical Engineering and Science, Massachusetts Institute of Technology, Cambridge, MA, USA. .,Department of Mechanical Engineering, Massachusetts Institute of Technology, Cambridge, MA, USA. .,Harvard-MIT Program in Health Sciences and Technology, Cambridge, MA, USA.
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7
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Mooney S, O'Dwyer J, Hynds PD. Private groundwater management and risk awareness: A cross-sectional analysis of two age-related subsets in the Republic of Ireland. Sci Total Environ 2021; 796:148844. [PMID: 34328897 DOI: 10.1016/j.scitotenv.2021.148844] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Revised: 06/29/2021] [Accepted: 06/30/2021] [Indexed: 06/13/2023]
Abstract
Risk communication represents the optimal instrument for decreasing the incidence of private groundwater contamination and associated waterborne illnesses. However, despite attempts to promote voluntary well maintenance in high groundwater-reliant regions such as the Republic of Ireland, awareness levels of supply status (e.g. structural integrity) have remained low. As investigations of supply awareness are often thematically narrow and homogeneous with respect to sub-population, revised analyses of awareness among both current and future supply owners (i.e. adults of typical well owner and student age) are necessary. Accordingly, the current study utilised a national survey of well users and an age-based comparison of supply awareness. Awareness was measured among 560 Irish private well users using a multi-domain scoring framework and analysed in conjunction with experiential variables including experience of extreme weather events and previous household infections, and perceived self-efficacy in maintaining supply. Respondents displayed a median overall awareness score of 66.7%, with supply owners (n = 399) and students (n = 161) exhibiting median scores of 75% and 58.3%. Awareness among both combined respondent subsets and well owners was significantly related to gender, well use factors and self-perceived behavioural efficacy while awareness among students was not correlated with any independent variable. Cluster analysis identified three distinct respondent groups characterised by awareness score and gender in both current and future well owner subsets. Male well owners and students displayed higher perceived self-efficacy irrespective of awareness score while female well owners that demonstrated high awareness were significantly more likely to report postgraduate educational (p < 0.001). Findings suggest that recent experience of extreme weather events does not significantly influence supply awareness and mirror previously identified knowledge differences between well owners and young adults. Age, gender, supply use and perceived self-efficacy emerge as recurring focal points and accordingly merit consideration from groundwater and health communication practitioners for future risk interventions.
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Affiliation(s)
- S Mooney
- Environmental Sustainability & Health Institute, Technological University Dublin, Dublin, Ireland
| | - J O'Dwyer
- Irish Centre for Research in Applied Geosciences (iCRAG), University College Dublin, Dublin, Ireland; School of Biological, Earth and Environmental Sciences, University College Cork, Cork, Ireland; Environmental Research Institute, University of Cork, Cork, Ireland
| | - P D Hynds
- Environmental Sustainability & Health Institute, Technological University Dublin, Dublin, Ireland; Irish Centre for Research in Applied Geosciences (iCRAG), University College Dublin, Dublin, Ireland.
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8
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Chique C, Hynds P, Nyhan MM, Lambert S, Boudou M, O'Dwyer J. Psychological impairment and extreme weather event (EWE) exposure, 1980-2020: A global pooled analysis integrating mental health and well-being metrics. Int J Hyg Environ Health 2021; 238:113840. [PMID: 34543982 DOI: 10.1016/j.ijheh.2021.113840] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Revised: 08/19/2021] [Accepted: 09/10/2021] [Indexed: 01/04/2023]
Abstract
Extreme Weather Events (EWEs) impose a substantial health and socio-economic burden on exposed populations. Projected impacts on public health, based on increasing EWE frequencies since the 1950s, alongside evidence of human-mediated climatic change represents a growing concern. To date, the impacts of EWEs on mental health remain ambiguous, largely due to the inherent complexities in linking extreme weather phenomena with psychological status. This exploratory investigation provides a new empirical and global perspective on the psychological toll of EWEs by exclusively focusing on psychological morbidity among individuals exposed to such events. Morbidity data collated from a range of existing psychological and well-being measures have been integrated to develop a single ("holistic") metric, namely, psychological impairment. Morbidity, and impairment, were subsequently pooled for key disorders-, specifically PTSD, anxiety and depression. A "composite" (any impairment) post-exposure pooled-prevalence rate of 23% was estimated, with values of 24% calculated for depression and ⁓17% for both PTSD and anxiety. Notably, calculated pooled odds ratios (pOR = 1.9) indicate a high likelihood of any negative psychological outcome (+90%) following EWE exposure. Pooled analyses of reported risk factors (p < 0.05) highlight the pronounced impacts of EWEs among individuals with higher levels of event exposure or experienced stressors (14.5%) and socio-demographic traits traditionally linked to vulnerable sub-populations, including female gender (10%), previous history (i.e., pre-event) of psychological impairment (5.5%), lower socio-economic status (5.5%), and a lower education level (5.2%). Inherent limitations associated with collating mental health data from populations exposed to EWEs, and key knowledge gaps in the field are highlighted. Study findings provide a robust evidence base for developing and implementing public health intervention strategies aimed at ameliorating the psychological impacts of extreme weather among exposed populations.
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Affiliation(s)
- C Chique
- School of Biological, Earth and Environmental Science (BEES), University College Cork, Cork, Ireland; Environmental Research Institute, University College Cork, Cork, Ireland
| | - P Hynds
- Irish Centre for Research in Applied Geoscience, University College Dublin, Dublin, Ireland; Environmental Sustainability and Health Institute (ESIH), Technological University Dublin, Dublin, Ireland
| | - M M Nyhan
- School of Engineering & Architecture, MaREI Centre for Energy, Climate & Marine & Environmental Research Institute, University College Cork, Ireland; Harvard TH Chan School of Public Health, Harvard University, Boston, United States
| | - S Lambert
- School of Applied Psychology Research, University College Cork, Cork, Ireland
| | - M Boudou
- Environmental Sustainability and Health Institute (ESIH), Technological University Dublin, Dublin, Ireland
| | - J O'Dwyer
- School of Biological, Earth and Environmental Science (BEES), University College Cork, Cork, Ireland; Environmental Research Institute, University College Cork, Cork, Ireland; Irish Centre for Research in Applied Geoscience, University College Dublin, Dublin, Ireland.
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9
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Boudou M, ÓhAiseadha C, Garvey P, O'Dwyer J, Hynds P. Modelling COVID-19 severity in the Republic of Ireland using patient co-morbidities, socioeconomic profile and geographic location, February to November 2020. Sci Rep 2021; 11:18474. [PMID: 34531478 PMCID: PMC8446039 DOI: 10.1038/s41598-021-98008-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Accepted: 09/01/2021] [Indexed: 12/23/2022] Open
Abstract
Understanding patient progression from symptomatic COVID-19 infection to a severe outcome represents an important tool for improved diagnoses, surveillance, and triage. A series of models have been developed and validated to elucidate hospitalization, admission to an intensive care unit (ICU) and mortality in patients from the Republic of Ireland. This retrospective cohort study of patients with laboratory-confirmed symptomatic COVID-19 infection included data extracted from national COVID-19 surveillance forms (i.e., age, gender, underlying health conditions, occupation) and geographically-referenced potential predictors (i.e., urban/rural classification, socio-economic profile). Generalised linear models and recursive partitioning and regression trees were used to elucidate COVID-19 progression. The incidence of symptomatic infection over the study-period was 0.96% (n = 47,265), of whom 3781 (8%) required hospitalisation, 615 (1.3%) were admitted to ICU and 1326 (2.8%) died. Models demonstrated an increasingly efficacious fit for predicting hospitalization [AUC 0.816 (95% CI 0.809, 0.822)], admission to ICU [AUC 0.885 (95% CI 0.88 0.89)] and death [AUC of 0.955 (95% CI 0.951 0.959)]. Severe obesity (BMI ≥ 40) was identified as a risk factor across all prognostic models; severely obese patients were substantially more likely to receive ICU treatment [OR 19.630] or die [OR 10.802]. Rural living was associated with an increased risk of hospitalization (OR 1.200 (95% CI 1.143-1.261)]. Urban living was associated with ICU admission [OR 1.533 (95% CI 1.606-1.682)]. Models provide approaches for predicting COVID-19 prognoses, allowing for evidence-based decision-making pertaining to targeted non-pharmaceutical interventions, risk-based vaccination priorities and improved patient triage.
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Affiliation(s)
- M Boudou
- Spatiotemporal Environmental Epidemiology Research (STEER) Group, Environmental Sustainability and Health Institute, Technological University Dublin, Dublin, Ireland
| | - C ÓhAiseadha
- Spatiotemporal Environmental Epidemiology Research (STEER) Group, Environmental Sustainability and Health Institute, Technological University Dublin, Dublin, Ireland
- Department of Public Health, Health Service Executive, (HSE), Dublin, Ireland
| | - P Garvey
- Spatiotemporal Environmental Epidemiology Research (STEER) Group, Environmental Sustainability and Health Institute, Technological University Dublin, Dublin, Ireland
- Health Protection Surveillance Centre (HPSC), Dublin, Ireland
| | - J O'Dwyer
- Spatiotemporal Environmental Epidemiology Research (STEER) Group, Environmental Sustainability and Health Institute, Technological University Dublin, Dublin, Ireland
- Environmental Research Institute, University College Cork, Cork, Ireland
- Irish Centre for Research in Applied Geoscience, University College Dublin, Dublin, Ireland
| | - P Hynds
- Spatiotemporal Environmental Epidemiology Research (STEER) Group, Environmental Sustainability and Health Institute, Technological University Dublin, Dublin, Ireland.
- Irish Centre for Research in Applied Geoscience, University College Dublin, Dublin, Ireland.
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10
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Jayaram A, Reid A, Wheeler G, Alifrangis C, O'Dwyer J, Jones R, Pezaro C, Pintus E, Staffurth J, Crabb S, Sidhu H, Smith K, Brock S, Rodwell S, Wingate A, Zakka L, Chiwewe M, Cartwright H, White L, Attard G. 650TiP PARADIGM: Plasma analysis for response assessment and to direct the management of metastatic prostate cancer (mPCa). Ann Oncol 2021. [DOI: 10.1016/j.annonc.2021.08.1163] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
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11
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Boudou M, Cleary E, ÓhAiseadha C, Garvey P, McKeown P, O'Dwyer J, Hynds P. Spatiotemporal epidemiology of cryptosporidiosis in the Republic of Ireland, 2008-2017: development of a space-time "cluster recurrence" index. BMC Infect Dis 2021; 21:880. [PMID: 34454462 PMCID: PMC8401175 DOI: 10.1186/s12879-021-06598-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Accepted: 08/22/2021] [Indexed: 11/24/2022] Open
Abstract
Background Ireland frequently reports the highest annual Crude Incidence Rates (CIRs) of cryptosporidiosis in the EU, with national CIRs up to ten times the EU average. Accordingly, the current study sought to examine the spatiotemporal trends associated with this potentially severe protozoan infection. Methods Overall, 4509 cases of infection from January 2008 to December 2017 were geo-referenced to a Census Small Area (SA), with an ensemble of geo-statistical approaches including seasonal decomposition, Local Moran’s I, and space–time scanning used to elucidate spatiotemporal patterns of infection. Results One or more confirmed cases were notified in 3413 of 18,641 Census SAs (18.3%), with highest case numbers occurring in the 0–5-year range (n = 2672, 59.3%). Sporadic cases were more likely male (OR 1.4) and rural (OR 2.4), with outbreak-related cases more likely female (OR 1.4) and urban (OR 1.5). Altogether, 55 space–time clusters (≥ 10 confirmed cases) of sporadic infection were detected, with three “high recurrence” regions identified; no large urban conurbations were present within recurrent clusters. Conclusions Spatiotemporal analysis represents an important indicator of infection patterns, enabling targeted epidemiological intervention and surveillance. Presented results may also be used to further understand the sources, pathways, receptors, and thus mechanisms of cryptosporidiosis in Ireland. Supplementary Information The online version contains supplementary material available at 10.1186/s12879-021-06598-3.
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Affiliation(s)
- M Boudou
- Environmental Sustainability and Health Institute (ESHI), Technological University Dublin, Greenway Hub, Grangegorman, Dublin 7, D07 H6K8, Republic of Ireland.
| | - E Cleary
- Environmental Sustainability and Health Institute (ESHI), Technological University Dublin, Greenway Hub, Grangegorman, Dublin 7, D07 H6K8, Republic of Ireland
| | - C ÓhAiseadha
- Department of Public Health, Health Service Executive (HSE), Dr. Steevens' Hospital, Dublin 8, Republic of Ireland
| | - P Garvey
- Health Protection Surveillance Centre, 25 Middle Gardiner Street, Dublin 1, Republic of Ireland
| | - P McKeown
- Health Protection Surveillance Centre, 25 Middle Gardiner Street, Dublin 1, Republic of Ireland
| | - J O'Dwyer
- School of Biological, Earth and Environmental Sciences, Environmental Research Institute (ERI), University College Cork, Cork, Republic of Ireland.,Irish Centre for Research in Applied Geosciences (iCRAG), University College Dublin, Dublin 4, Republic of Ireland
| | - Paul Hynds
- Environmental Sustainability and Health Institute (ESHI), Technological University Dublin, Greenway Hub, Grangegorman, Dublin 7, D07 H6K8, Republic of Ireland. .,Irish Centre for Research in Applied Geosciences (iCRAG), University College Dublin, Dublin 4, Republic of Ireland.
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12
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Mooney S, O'Dwyer J, Lavallee S, Hynds PD. Private groundwater contamination and extreme weather events: The role of demographics, experience and cognitive factors on risk perceptions of Irish private well users. Sci Total Environ 2021; 784:147118. [PMID: 33901952 DOI: 10.1016/j.scitotenv.2021.147118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Revised: 04/06/2021] [Accepted: 04/09/2021] [Indexed: 06/12/2023]
Abstract
Extreme weather events (EWEs) may significantly increase pathogenic contamination of private (unregulated) groundwater supplies. However, due to the paucity of protective guidance, private well users may be ill-equipped to undertake adaptive actions. With rising instances of waterborne illness documented in groundwater-dependent, developed regions such as the Republic of Ireland, a better understanding of well user risk perceptions pertaining to EWEs is required to establish appropriate educational interventions. To this end, the current study employed an online and physical questionnaire to identify current risk perceptions and correspondent predictors among Irish private well users concerning extreme weather. Respondents were elicited via purposive sampling, with 515 private well users elucidating perceived supply contamination risk in the wake of five EWEs between the years 2013-2018 including drought and pluvial flooding. A novel scoring protocol was devised to quantify overall risk perception (i.e. perceived likelihood, severity and consequences) of extreme weather impacts. Overall risk perception of EWEs was found to demonstrate a significant relationship with gender (p = 0.017) and event experience (p < 0.001), with female respondents and those reporting prior event experience exhibiting higher median risk perception scores. Risk perception was additionally mediated by perceived self-efficacy in undertaking supply maintenance (p = 0.001), as well users citing confidence in ability scored significantly lower than those citing no confidence. Two-step cluster analysis identified three distinct respondent subsets based on risk perception of EWEs (high, moderate and low perception), with female respondents and those with a third-level education significantly more likely to fall within the high perception cluster. Study findings affirm that certain demographic, experiential and cognitive factors exert a significant influence on private well user risk perceptions of EWE impacts and highlight potential focal points for future educational interventions seeking to reduce the risk of human infection associated with groundwater and extreme weather.
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Affiliation(s)
- S Mooney
- Environmental Sustainability & Health Institute, Technological University Dublin, Dublin, Ireland
| | - J O'Dwyer
- Irish Centre for Research in Applied Geosciences (iCRAG), University College Dublin, Dublin, Ireland; School of Biological, Earth and Environmental Sciences, University College Cork, Cork, Ireland; Environmental Research Institute, University of Cork, Cork, Ireland
| | - S Lavallee
- School of Environmental Studies, Queen's University, Kingston, Ontario, Canada
| | - P D Hynds
- Environmental Sustainability & Health Institute, Technological University Dublin, Dublin, Ireland; Irish Centre for Research in Applied Geosciences (iCRAG), University College Dublin, Dublin, Ireland.
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13
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Kimmins SD, Hanay SB, Murphy R, O'Dwyer J, Ramalho J, Ryan EJ, Kearney CJ, O'Brien FJ, Cryan SA, Fitzgerald-Hughes D, Heise A. Antimicrobial and degradable triazolinedione (TAD) crosslinked polypeptide hydrogels. J Mater Chem B 2021; 9:5456-5464. [PMID: 34048521 DOI: 10.1039/d1tb00776a] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Hydrogels are perfectly suited to support cell and tissue growth in advanced tissue engineering applications as well as classical wound treatment scenarios. Ideal hydrogel materials for these applications should be easy to produce, biocompatible, resorbable and antimicrobial. Here we report the fabrication of degradable covalent antimicrobial lysine and tryptophan containing copolypeptide hydrogels, whereby the hydrogel properties can be independently modulated by the copolypeptide monomer ratio and chiral composition. Well-defined statistical copolypeptides comprising different overall molecular weights as well as ratios of l- and d-lysine and tryptophan at ratios of 35 : 15, 70 : 30 and 80 : 20 were obtained by N-carboxyanhydride (NCA) polymerisation and subsequently crosslinked by the selective reaction of bifunctional triazolinedione (TAD) with tryptophan. Real-time rheology was used to monitor the crosslinking reaction recording the fastest increase and overall modulus for copolypeptides with the higher tryptophan ratio. Water uptake of cylindrical hydrogel samples was dependent on crosslinking ratio but found independent of chiral composition, while enzymatic degradation proceeded significantly faster for samples containing more l-amino acids. Antimicrobial activity on a range of hydrogels containing different polypeptide chain lengths, lysine/tryptophan composition and l/d enantiomers was tested against reference laboratory strains of Gram-negative Escherichia coli (E. coli; ATCC25922) and Gram-positive, Staphylococcus aureus (S. aureus; ATCC25923). log reductions of 2.8-3.4 were recorded for the most potent hydrogels. In vitro leachable cytotoxicity tests confirmed non-cytotoxicity as per ISO guidelines.
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Affiliation(s)
- Scott D Kimmins
- Department of Chemistry, RCSI University of Medicine and Health Sciences, Dublin 2, Ireland. and Instituto de Química, Pontificia Universidad Católica de Valparaíso, Avda. Universidad 330, Curauma, Placilla, Valparaíso, Chile
| | - Saltuk B Hanay
- Department of Chemistry, RCSI University of Medicine and Health Sciences, Dublin 2, Ireland.
| | - Robert Murphy
- Department of Chemistry, RCSI University of Medicine and Health Sciences, Dublin 2, Ireland.
| | - Joanne O'Dwyer
- Drug Delivery and Advanced Materials Team, School of Pharmacy, RCSI University of Medicine and Health Sciences, Dublin 2, Ireland and Tissue Engineering Research Group, Department of Anatomy & Regenerative Medicines, RCSI University of Medicine and Health Sciences, Dublin 2, Ireland
| | - Jessica Ramalho
- Department of Chemistry, RCSI University of Medicine and Health Sciences, Dublin 2, Ireland.
| | - Emily J Ryan
- Tissue Engineering Research Group, Department of Anatomy & Regenerative Medicines, RCSI University of Medicine and Health Sciences, Dublin 2, Ireland and Department of Biomedical Engineering, University of Massachusetts Amherst, MA, USA and Trinity Centre for Biomedical Engineering, Trinity College Dublin (TCD), Dublin 2, Ireland
| | - Cathal J Kearney
- Tissue Engineering Research Group, Department of Anatomy & Regenerative Medicines, RCSI University of Medicine and Health Sciences, Dublin 2, Ireland and Department of Biomedical Engineering, University of Massachusetts Amherst, MA, USA and Trinity Centre for Biomedical Engineering, Trinity College Dublin (TCD), Dublin 2, Ireland and Advanced Materials and Bioengineering Research Centre (AMBER), RCSI University of Medicine and Health Sciences, and Trinity College Dublin, Dublin 2, Ireland
| | - Fergal J O'Brien
- Tissue Engineering Research Group, Department of Anatomy & Regenerative Medicines, RCSI University of Medicine and Health Sciences, Dublin 2, Ireland and Trinity Centre for Biomedical Engineering, Trinity College Dublin (TCD), Dublin 2, Ireland and Advanced Materials and Bioengineering Research Centre (AMBER), RCSI University of Medicine and Health Sciences, and Trinity College Dublin, Dublin 2, Ireland and Centre for Research in Medical Devices (CURAM), RCSI University of Medicine and Health Sciences, Dublin 2, and National University or Ireland, Galway, Ireland
| | - Sally-Ann Cryan
- Drug Delivery and Advanced Materials Team, School of Pharmacy, RCSI University of Medicine and Health Sciences, Dublin 2, Ireland and Tissue Engineering Research Group, Department of Anatomy & Regenerative Medicines, RCSI University of Medicine and Health Sciences, Dublin 2, Ireland and Trinity Centre for Biomedical Engineering, Trinity College Dublin (TCD), Dublin 2, Ireland and Advanced Materials and Bioengineering Research Centre (AMBER), RCSI University of Medicine and Health Sciences, and Trinity College Dublin, Dublin 2, Ireland and Centre for Research in Medical Devices (CURAM), RCSI University of Medicine and Health Sciences, Dublin 2, and National University or Ireland, Galway, Ireland
| | - Deirdre Fitzgerald-Hughes
- Department of Clinical Microbiology, RCSI University of Medicine and Health Sciences, Education and Research Centre, Beaumont Hospital, Dublin 9, Dublin, Ireland
| | - Andreas Heise
- Department of Chemistry, RCSI University of Medicine and Health Sciences, Dublin 2, Ireland. and Advanced Materials and Bioengineering Research Centre (AMBER), RCSI University of Medicine and Health Sciences, and Trinity College Dublin, Dublin 2, Ireland and Centre for Research in Medical Devices (CURAM), RCSI University of Medicine and Health Sciences, Dublin 2, and National University or Ireland, Galway, Ireland
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14
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Chique C, Hynds P, Burke LP, Morris D, Ryan MP, O'Dwyer J. Contamination of domestic groundwater systems by verotoxigenic escherichia coli (VTEC), 2003-2019: A global scoping review. Water Res 2021; 188:116496. [PMID: 33059158 DOI: 10.1016/j.watres.2020.116496] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Revised: 09/10/2020] [Accepted: 10/03/2020] [Indexed: 06/11/2023]
Abstract
Verocytotoxin-producing E. coli (VTEC) are important agents of diarrhoeal disease in humans globally. As a noted waterborne disease, emphasis has been given to the study VTEC in surface waters, readily susceptible to microbial contamination. Conversely, the status of VTEC in potable groundwater sources, generally regarded as a "safe" drinking-water supply remains largely understudied. As such, this investigation presents the first scoping review seeking to determine the global prevalence of VTEC in groundwater supply sources intended for human consumption. Twenty-three peer-reviewed studies were identified and included for data extraction. Groundwater sample and supply detection rates (estimated 0.6 and 1.3%, respectively) indicate VTEC is infrequently present in domestic groundwater sources. However, where generic (fecal indicator) E. coli are present, the VTEC to E. coli ratio was found to be 9.9%, representing a latent health concern for groundwater consumers. Geographically, extracted data indicates higher VTEC detection rates in urban (5.4%) and peri‑urban (4.9%) environments than in rural areas (0.9%); however, this finding is confounded by the predominance of research studies in lower income regions. Climate trends indicate local environments classified as 'temperate' (14/554; 2.5%) and 'cold' (8/392; 2%) accounted for a majority of supply sources with VTEC present, with similar detection rates encountered among supplies sampled during periods typically characterized by 'high' precipitation (15/649; 2.3%). Proposed prevalence figures may find application in preventive risk-based catchment and groundwater quality management including development of Quantitative Microbial Risk Assessments (QMRA). Notwithstanding, to an extent, a large geographical disparity in available investigations, lack of standardized reporting, and bias in source selection, restrict the transferability of research findings. Overall, the mechanisms responsible for VTEC transport and ingress into groundwater supplies remain ambiguous, representing a critical knowledge gap, and denoting a distinctive lack of integration between hydrogeological and public health research. Key recommendations and guidelines are provided for prospective studies directed at increasingly integrative and multi-disciplinary research.
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Affiliation(s)
- C Chique
- School of Biological, Earth and Environmental Science (BEES), University College Cork, Cork, Ireland; Environmental Research Institute, University College Cork, Cork, Ireland
| | - P Hynds
- Irish Centre for Research in Applied Geosciences, University College Dublin, Dublin, Ireland; Environmental Sustainability and Health Institute (ESHI), Technological University Dublin.
| | - L P Burke
- Antimicrobial Resistance and Microbial Ecology Group, School of Medicine, National University of Ireland Galway, Galway, Ireland; Centre for One Health, Ryan Institute, National University of Ireland Galway, Galway, Ireland
| | - D Morris
- Antimicrobial Resistance and Microbial Ecology Group, School of Medicine, National University of Ireland Galway, Galway, Ireland; Centre for One Health, Ryan Institute, National University of Ireland Galway, Galway, Ireland
| | - M P Ryan
- Department of Chemical Sciences, University of Limerick, Limerick, Ireland
| | - J O'Dwyer
- School of Biological, Earth and Environmental Science (BEES), University College Cork, Cork, Ireland; Environmental Research Institute, University College Cork, Cork, Ireland; Irish Centre for Research in Applied Geosciences, University College Dublin, Dublin, Ireland.
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15
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O'Brien S, Brannigan RP, Ibanez R, Wu B, O'Dwyer J, O'Brien FJ, Cryan SA, Heise A. Biocompatible polypeptide-based interpenetrating network (IPN) hydrogels with enhanced mechanical properties. J Mater Chem B 2020; 8:7785-7791. [PMID: 32744280 DOI: 10.1039/d0tb01422b] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Hydrogels are widely used for biomedical applications such as drug delivery, tissue engineering, or wound healing owing to their mimetic properties in relation to biological tissues. The generation of peptide-based hydrogels is a topic of interest due to their potential to increase biocompatibility. However, their usages can be limited when compared to other synthetic hydrogels because of their inferior mechanical properties. Herein, we present the synthesis of novel synthetic polypeptide-based interpenetrating network (IPN) hydrogels with enhanced mechanical properties. The polypeptide single network is obtained from alkyne functional polypeptides crosslinked with di, tri and tetra azide functional PEG by copper-catalysed alkyne-azide cycloaddition (CuAAC). Interpenetrating networks were subsequently obtained by loading of the polypeptide single network with PEG-dithiol and orthogonally UV-crosslinking with varying molar ratios of pentaerythritol tetraacrylate. The characteristics, including the mechanical strength (i.e. compressive strength (UCS), fracture strain (εbreak), and Young's modulus (E)) and cell compatibility (i.e. metabolic activity and Live/Dead of human Mesenchymal Stem Cells), of each synthetic polypeptide-based IPN hydrogel were studied and evaluated in order to demonstrate their potential as mechanically robust hydrogels for use as artificial tissues. Moreover, 1H NMR diffusometry was carried out to examine the water mobility (DH2O) within the polypeptide-based hydrogels and IPNs. It was found that both the mechanical and morphological properties could be tailored concurrently with the hydrophilicity, rate of water diffusion and 'swellability'. Finally it was shown that the polypeptide-based IPN hydrogels exhibited good biocompatibility, highlighting their potential as soft tissue scaffolds.
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Affiliation(s)
- Shona O'Brien
- Department of Chemistry, Royal College of Surgeons in Ireland, 123 St. Stephens Green, Dublin 2, Ireland.
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16
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Chique C, Hynds PD, Andrade L, Burke L, Morris D, Ryan MP, O'Dwyer J. Cryptosporidium spp. in groundwater supplies intended for human consumption - A descriptive review of global prevalence, risk factors and knowledge gaps. Water Res 2020; 176:115726. [PMID: 32247994 DOI: 10.1016/j.watres.2020.115726] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/05/2019] [Revised: 03/05/2020] [Accepted: 03/15/2020] [Indexed: 06/11/2023]
Abstract
Cryptosporidiosis is one of the leading causes of diarrhoeal illness and mortality induced by protozoan pathogens worldwide. As a largely waterborne disease, emphasis has been given to the study of Cryptosporidium spp. in surface waters, readily susceptible to pathogenic contamination. Conversely, the status of Cryptosporidium in potable groundwater sources, generally regarded as a pristine and "safe" drinking-water supply owing to (sub)-soil protection, remains largely unknown. As such, this investigation presents the first literature review aimed to ascertain the global prevalence of Cryptosporidium in groundwater supply sources intended for human consumption. Thirty-seven peer-reviewed studies were identified and included in the review. Groundwater sample and supply detection rates (estimated 10-20%) indicate Cryptosporidium is frequently present in domestic groundwater sources, representing a latent health concern for groundwater consumers. Specifically, sample (10.4%) and source (19.1%) detection rates deriving from comprehensive "temporal" investigations are put forward as representative of a contamination 'baseline' for Cryptosporidium in 'domestic' groundwater supplies. Proposed 'baseline' prevalence figures are largely applicable in preventive risk-based catchment and groundwater quality management including the formulation of Quantitative Microbial Risk Assessment (QMRA). Notwithstanding, a large geographical disparity in available investigations and lack of standardized reporting restrict the transferability of research findings. Overall, the mechanisms responsible for Cryptosporidium transport and ingress into groundwater supplies remain ambiguous, representing a critical knowledge gap, and denoting a distinctive lack of integration between groundwater and public-health sub-disciplines among investigations. Key recommendations and guidelines are provided for prospective studies directed at more integrative and multi-disciplinary research.
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Affiliation(s)
- C Chique
- School of Biological, Earth and Environmental Science (BEES), University College Cork, Cork, Ireland; Environmental Research Institute, University College Cork, Cork, Ireland
| | - P D Hynds
- Irish Centre for Research in Applied Geosciences, University College Dublin, Dublin, Ireland; Environmental Sustainability and Health Institute (ESIH), Technological University Dublin, Ireland.
| | - L Andrade
- School of Biological, Earth and Environmental Science (BEES), University College Cork, Cork, Ireland; Environmental Research Institute, University College Cork, Cork, Ireland; Irish Centre for Research in Applied Geosciences, University College Dublin, Dublin, Ireland
| | - L Burke
- Antimicrobial Resistance and Microbial Ecology Group, School of Medicine and Centre for Health from Environment, Ryan Institute, National University of Ireland, Galway, Ireland
| | - D Morris
- Antimicrobial Resistance and Microbial Ecology Group, School of Medicine and Centre for Health from Environment, Ryan Institute, National University of Ireland, Galway, Ireland
| | - M P Ryan
- Department of Chemical Sciences, University of Limerick, Limerick, Ireland
| | - J O'Dwyer
- School of Biological, Earth and Environmental Science (BEES), University College Cork, Cork, Ireland; Environmental Research Institute, University College Cork, Cork, Ireland; Irish Centre for Research in Applied Geosciences, University College Dublin, Dublin, Ireland.
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17
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Mooney S, McDowell CP, O'Dwyer J, Hynds PD. Knowledge and behavioural interventions to reduce human health risk from private groundwater systems: A global review and pooled analysis based on development status. Sci Total Environ 2020; 716:135338. [PMID: 31839297 DOI: 10.1016/j.scitotenv.2019.135338] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/29/2019] [Revised: 10/31/2019] [Accepted: 10/31/2019] [Indexed: 06/10/2023]
Abstract
Groundwater contamination constitutes a significant health risk for private well users residing in rural areas. As the responsibility to safeguard rural private domestic groundwater typically rests with non-expert homeowners, interventions promoting risk mitigation and awareness represent the most viable means of preventing supply contamination. However, no global review or pooled analyses of these interventions has been undertaken to date. The current study sought to identify and quantify the performance of private well interventions from 1990 to 2018 via a global systematised review and pooled analysis. The PICO (Population-Intervention-Comparison-Outcome) approach was employed for literature identification. Relevant studies were statistically analysed across two quantitative outcome (performance) types, namely knowledge and behaviour, controlling for intervention characteristics and country development status. Mean behavioural and knowledge attainment across interventions was 53% and 48%, respectively, with interventions in economically developed regions exhibiting higher behavioural outcomes (56% vs. 45%) than those in developing regions. Geographically, interventions were located in southern or southeast Asia (n = 23), North America (n = 15), Central America (n = 1) and Africa (n = 1), with none identified in Australia/Oceania, Europe, or South America. Behavioural outcomes were significantly associated with presence of educational/research coordinator (p = 0.023), with these interventions attaining higher levels of efficacy (+74%) than those implemented by other coordinator types. Findings indicate that instructor-led, practical interventions allied with both large- and local-scale awareness-raising campaigns represent an optimum approach for future private well risk interventions. Subsequent adoption of such interventions may lead to increased levels of private well maintenance and provide a point of reference for myriad water and health communication contexts.
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Affiliation(s)
- S Mooney
- Environmental Sustainability & Health Institute, Technological University Dublin, Dublin, Ireland
| | - C P McDowell
- School of Architecture, Planning and Environmental Policy, University College Dublin, Dublin, Ireland
| | - J O'Dwyer
- School of Biological, Earth and Environmental Sciences, University College Cork, Cork, Ireland; Environmental Research Institute, University of Cork, Cork, Ireland; Irish Centre for Research in Applied Geosciences (iCRAG), University College Dublin, Dublin, Ireland
| | - P D Hynds
- Environmental Sustainability & Health Institute, Technological University Dublin, Dublin, Ireland; Irish Centre for Research in Applied Geosciences (iCRAG), University College Dublin, Dublin, Ireland.
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18
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Eufrásio-da-Silva T, Ruiz-Hernandez E, O'Dwyer J, Picazo-Frutos D, Duffy GP, Murphy BP. Enhancing medial layer recellularization of tissue-engineered blood vessels using radial microchannels. Regen Med 2019; 14:1013-1028. [PMID: 31746270 DOI: 10.2217/rme-2019-0011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Aim: Cell repopulation of tissue-engineered vascular grafts (TEVGs) from decellularized arterial scaffolds is limited by dense concentric tunica media layers which impede cells migrating radially between the layers. We aimed to develop and validate a new microneedle device to modify decellularized carotid arteries with radial microchannels to enhance medial layer repopulation. Material & methods: Modified decellularized porcine arteries were seeded with rat mesenchymal stem cells using either standard longitudinal injection, or a dual vacuum-perfusion bioreactor. Mechanical tests were used to assess the arterial integrity following modification. Results & conclusion: The method herein achieved radial recellularization of arteries in vitro without significant loss of mechanical integrity, Thus, we report a novel method for successful radial repopulation of decellularized carotid artery-based tissue-engineered vascular grafts.
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Affiliation(s)
- Tatiane Eufrásio-da-Silva
- Department of Anatomy, Tissue Engineering Research Group (TERG), Royal College of Surgeons in Ireland (RCSI), Dublin, Ireland.,Trinity Centre for Biomedical Engineering (TCBE), Trinity Biomedical Sciences Institute, TCD, Dublin, Ireland.,Advanced Materials & BioEngineering Research Centre (AMBER), RCSI & TCD, Dublin, Ireland
| | - Eduardo Ruiz-Hernandez
- Advanced Materials & BioEngineering Research Centre (AMBER), RCSI & TCD, Dublin, Ireland.,School of Pharmacy & Pharmaceutical Sciences, Trinity College Dublin (TCD), Dublin, Ireland
| | - Joanne O'Dwyer
- Department of Anatomy, Tissue Engineering Research Group (TERG), Royal College of Surgeons in Ireland (RCSI), Dublin, Ireland.,School of Pharmacy, RCSI, Dublin, Ireland.,Anatomy, School of Medicine, College of Medicine Nursing & Health Sciences, National University of Ireland Galway, Galway, Ireland
| | - Dolores Picazo-Frutos
- Department of Anatomy, Tissue Engineering Research Group (TERG), Royal College of Surgeons in Ireland (RCSI), Dublin, Ireland.,School of Pharmacy, RCSI, Dublin, Ireland
| | - Garry P Duffy
- Department of Anatomy, Tissue Engineering Research Group (TERG), Royal College of Surgeons in Ireland (RCSI), Dublin, Ireland.,Trinity Centre for Biomedical Engineering (TCBE), Trinity Biomedical Sciences Institute, TCD, Dublin, Ireland.,Advanced Materials & BioEngineering Research Centre (AMBER), RCSI & TCD, Dublin, Ireland.,Anatomy, School of Medicine, College of Medicine Nursing & Health Sciences, National University of Ireland Galway, Galway, Ireland
| | - Bruce P Murphy
- Trinity Centre for Biomedical Engineering (TCBE), Trinity Biomedical Sciences Institute, TCD, Dublin, Ireland.,Advanced Materials & BioEngineering Research Centre (AMBER), RCSI & TCD, Dublin, Ireland.,Department of Mechanical & Manufacturing Engineering, TCD, Dublin, Ireland
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19
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Andrade L, O'Malley K, Hynds P, O'Neill E, O'Dwyer J. Assessment of two behavioural models (HBM and RANAS) for predicting health behaviours in response to environmental threats: Surface water flooding as a source of groundwater contamination and subsequent waterborne infection in the Republic of Ireland. Sci Total Environ 2019; 685:1019-1029. [PMID: 31390693 DOI: 10.1016/j.scitotenv.2019.06.249] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/19/2018] [Revised: 06/15/2019] [Accepted: 06/16/2019] [Indexed: 06/10/2023]
Abstract
Extreme weather events (EWEs) are increasing in frequency, posing a greater risk of adverse human health effects. As such, developing sociological and psychological based interventions is paramount to empowering individuals and communities to actively protect their own health. Accordingly, this study compared the efficacy of two established social-cognitive models, namely the Health Beliefs Model (HBM) and Risks-Attitudes-Norms-Abilities-Self-regulation (RANAS) framework, in predicting health behaviours following EWEs. Surface water flooding was used as the exemplar EWE in the current study, due to the increasing incidence of these events in the Republic of Ireland over the past decade. Levels of prior experience with flooding were considered for analyses and comparative tools included a number of variables predicting health behaviours and intervention potential scores (i.e. measure of impact of targeting each model element). Results suggest that the RANAS model provides a robust foundation for designing interventions for any level of experience with an extreme weather event, however, use of the simpler HBM may be more cost-effective among participants unacquainted with an EWE and in relatively infrequent health threat scenarios. Results provide an evidence base for researchers and policymakers to appropriately engage with populations about such threats and successfully promote spatiotemporally appropriate health behaviours in a changing climate.
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Affiliation(s)
- L Andrade
- School of Biological, Earth and Environmental Sciences, Distillery Fields, University College Cork, Cork, Ireland; Irish Centre for Research in Applied Geosciences (iCRAG), University College Cork, Ireland
| | - K O'Malley
- Department of Psychology, University of Limerick, Limerick, Ireland
| | - P Hynds
- Irish Centre for Research in Applied Geosciences (iCRAG), University College Cork, Ireland; Environmental Sustainability & Health Institute, Technological University Dublin, Ireland.
| | - E O'Neill
- School of Architecture, Planning & Environmental Policy, University College Dublin, Ireland
| | - J O'Dwyer
- School of Biological, Earth and Environmental Sciences, Distillery Fields, University College Cork, Cork, Ireland; Irish Centre for Research in Applied Geosciences (iCRAG), University College Cork, Ireland; Environmental Research Institute, University College Cork, Cork, Ireland
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20
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Dolan EB, Varela CE, Mendez K, Whyte W, Levey RE, Robinson ST, Maye E, O'Dwyer J, Beatty R, Rothman A, Fan Y, Hochstein J, Rothenbucher SE, Wylie R, Starr JR, Monaghan M, Dockery P, Duffy GP, Roche ET. An actuatable soft reservoir modulates host foreign body response. Sci Robot 2019; 4:4/33/eaax7043. [PMID: 33137787 DOI: 10.1126/scirobotics.aax7043] [Citation(s) in RCA: 38] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2019] [Accepted: 08/01/2019] [Indexed: 12/18/2022]
Abstract
The performance of indwelling medical devices that depend on an interface with soft tissue is plagued by complex, unpredictable foreign body responses. Such devices-including breast implants, biosensors, and drug delivery devices-are often subject to a collection of biological host responses, including fibrosis, which can impair device functionality. This work describes a milliscale dynamic soft reservoir (DSR) that actively modulates the biomechanics of the biotic-abiotic interface by altering strain, fluid flow, and cellular activity in the peri-implant tissue. We performed cyclical actuation of the DSR in a preclinical rodent model. Evaluation of the resulting host response showed a significant reduction in fibrous capsule thickness (P = 0.0005) in the actuated DSR compared with non-actuated controls, whereas the collagen density and orientation were not changed. We also show a significant reduction in myofibroblasts (P = 0.0036) in the actuated group and propose that actuation-mediated strain reduces differentiation and proliferation of myofibroblasts and therefore extracellular matrix production. Computational models quantified the effect of actuation on the reservoir and surrounding fluid. By adding a porous membrane and a therapy reservoir to the DSR, we demonstrate that, with actuation, we could (i) increase transport of a therapy analog and (ii) enhance pharmacokinetics and time to functional effect of an inotropic agent. The dynamic reservoirs presented here may act as a versatile tool to further understand, and ultimately to ameliorate, the host response to implantable biomaterials.
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Affiliation(s)
- E B Dolan
- Institute for Medical Engineering and Science, Massachusetts Institute of Technology, Cambridge, MA, USA.,Biomedical Engineering, College of Engineering and Informatics, National University of Ireland Galway, Galway, Ireland.,Anatomy and Regenerative Medicine Institute (REMEDI), School of Medicine, College of Medicine Nursing and Health Sciences, National University of Ireland Galway, Galway, Ireland
| | - C E Varela
- Institute for Medical Engineering and Science, Massachusetts Institute of Technology, Cambridge, MA, USA.,Harvard-MIT Program in Health Sciences and Technology, Cambridge, MA, USA
| | - K Mendez
- Institute for Medical Engineering and Science, Massachusetts Institute of Technology, Cambridge, MA, USA.,Harvard-MIT Program in Health Sciences and Technology, Cambridge, MA, USA
| | - W Whyte
- Institute for Medical Engineering and Science, Massachusetts Institute of Technology, Cambridge, MA, USA.,Trinity Centre for Bioengineering, Trinity Biomedical Sciences Institute, Trinity College Dublin, Dublin 2, Ireland.,Advanced Materials and BioEngineering Research Centre (AMBER), Trinity College Dublin, Dublin, Ireland.,Royal College of Surgeons in Ireland, Dublin, Ireland
| | - R E Levey
- Anatomy and Regenerative Medicine Institute (REMEDI), School of Medicine, College of Medicine Nursing and Health Sciences, National University of Ireland Galway, Galway, Ireland
| | - S T Robinson
- Anatomy and Regenerative Medicine Institute (REMEDI), School of Medicine, College of Medicine Nursing and Health Sciences, National University of Ireland Galway, Galway, Ireland.,Advanced Materials and BioEngineering Research Centre (AMBER), Trinity College Dublin, Dublin, Ireland.,Royal College of Surgeons in Ireland, Dublin, Ireland
| | - E Maye
- Anatomy and Regenerative Medicine Institute (REMEDI), School of Medicine, College of Medicine Nursing and Health Sciences, National University of Ireland Galway, Galway, Ireland
| | - J O'Dwyer
- Biomedical Engineering, College of Engineering and Informatics, National University of Ireland Galway, Galway, Ireland.,Anatomy and Regenerative Medicine Institute (REMEDI), School of Medicine, College of Medicine Nursing and Health Sciences, National University of Ireland Galway, Galway, Ireland
| | - R Beatty
- Anatomy and Regenerative Medicine Institute (REMEDI), School of Medicine, College of Medicine Nursing and Health Sciences, National University of Ireland Galway, Galway, Ireland
| | - A Rothman
- Department of Mechanical Engineering, Massachusetts Institute of Technology, Cambridge, MA, USA
| | - Y Fan
- Department of Mechanical Engineering, Massachusetts Institute of Technology, Cambridge, MA, USA
| | - J Hochstein
- Harvard-MIT Program in Health Sciences and Technology, Cambridge, MA, USA
| | - S E Rothenbucher
- Institute for Medical Engineering and Science, Massachusetts Institute of Technology, Cambridge, MA, USA
| | - R Wylie
- Anatomy and Regenerative Medicine Institute (REMEDI), School of Medicine, College of Medicine Nursing and Health Sciences, National University of Ireland Galway, Galway, Ireland
| | - J R Starr
- Epidemiology and Biostatistics Core, The Forsyth Institute, 245 First Street, Cambridge, MA, USA
| | - M Monaghan
- Trinity Centre for Bioengineering, Trinity Biomedical Sciences Institute, Trinity College Dublin, Dublin 2, Ireland.,CÚRAM, Centre for Research in Medical Devices, National University of Ireland Galway, Galway, Ireland
| | - P Dockery
- Anatomy and Regenerative Medicine Institute (REMEDI), School of Medicine, College of Medicine Nursing and Health Sciences, National University of Ireland Galway, Galway, Ireland.,CÚRAM, Centre for Research in Medical Devices, National University of Ireland Galway, Galway, Ireland
| | - G P Duffy
- Anatomy and Regenerative Medicine Institute (REMEDI), School of Medicine, College of Medicine Nursing and Health Sciences, National University of Ireland Galway, Galway, Ireland. .,Trinity Centre for Bioengineering, Trinity Biomedical Sciences Institute, Trinity College Dublin, Dublin 2, Ireland.,Advanced Materials and BioEngineering Research Centre (AMBER), Trinity College Dublin, Dublin, Ireland.,Royal College of Surgeons in Ireland, Dublin, Ireland.,CÚRAM, Centre for Research in Medical Devices, National University of Ireland Galway, Galway, Ireland
| | - E T Roche
- Institute for Medical Engineering and Science, Massachusetts Institute of Technology, Cambridge, MA, USA. .,Department of Mechanical Engineering, Massachusetts Institute of Technology, Cambridge, MA, USA
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21
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Andrade L, O'Dwyer J, O'Neill E, Hynds P. Surface water flooding, groundwater contamination, and enteric disease in developed countries: A scoping review of connections and consequences. Environ Pollut 2018; 236:540-549. [PMID: 29428708 DOI: 10.1016/j.envpol.2018.01.104] [Citation(s) in RCA: 70] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/28/2017] [Revised: 01/23/2018] [Accepted: 01/30/2018] [Indexed: 05/27/2023]
Abstract
Significant volumes of research over the past four decades has sought to elucidate the social, infrastructural, economic, and human health effects of climate change induced surface flooding. To date, epidemiological and public health studies of flooding events have focused on mental health effects, vector-borne diseases, and infectious enteric disease due to floodwater contact (i.e. typically low consumption rates). The inherent nature of groundwater (i.e. out of sight, out of mind) and the widely held belief that aquifers represent a pristine source of drinking water due to natural attenuation may represent the "perfect storm" causing direct consumption of relatively large volumes of surface flood-contaminated groundwater. Accordingly, the current study sought to systematically identify and synthesize all available peer-reviewed literature pertaining to the nexus between surface flooding, groundwater contamination and human gastroenteric outcomes. Just 14 relevant studies were found to have been published during the period 1980-2017, thus highlighting the fact that this potentially significant source of climate-related exposure to environmental infection has remained understudied to date. Studies differed significantly in terms of type and data reporting procedures, making it difficult to discern clear trends and patterns. Approximately 945 confirmed cases of flood-related enteric disease were examined across studies; these concurred with almost 10,000 suspected cases, equating to approximately 20 suspected cases per confirmed case. As such, no regional, national or global estimates are available for the human gastrointestinal health burden of flood-related groundwater contamination. In light of the demonstrable public health significance of the concurrent impacts of groundwater susceptibility and climate change exacerbation, strategies to increase awareness about potential sources of contamination and motivate precautionary behaviour (e.g. drinking water testing and treatment, supply interruptions) are necessary. Mainstreaming climate adaptation concerns into planning policies will also be necessary to reduce human exposure to waterborne sources of enteric infection.
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Affiliation(s)
- L Andrade
- School of Architecture, Planning & Environmental Policy, University College Dublin, Ireland
| | - J O'Dwyer
- School of Biological, Earth and Environmental Sciences, University College Cork, Cork, Ireland
| | - E O'Neill
- School of Architecture, Planning & Environmental Policy, University College Dublin, Ireland
| | - P Hynds
- Environmental Sustainability & Health Institute, Dublin Institute of Technology, Ireland.
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23
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Varnfield M, Jayasena R, O'Dwyer J, Celler B. ISQUA16-2955HOME TELEMONITORING FOR AGED CARE – DO THE ELDERLY COMPLY AND COMPLETE? Int J Qual Health Care 2016. [DOI: 10.1093/intqhc/mzw104.105] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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24
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O'Neill HS, Gallagher LB, O'Sullivan J, Whyte W, Curley C, Dolan E, Hameed A, O'Dwyer J, Payne C, O'Reilly D, Ruiz-Hernandez E, Roche ET, O'Brien FJ, Cryan SA, Kelly H, Murphy B, Duffy GP. Biomaterial-Enhanced Cell and Drug Delivery: Lessons Learned in the Cardiac Field and Future Perspectives. Adv Mater 2016; 28:5648-5661. [PMID: 26840955 DOI: 10.1002/adma.201505349] [Citation(s) in RCA: 50] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/30/2015] [Revised: 12/04/2015] [Indexed: 06/05/2023]
Abstract
Heart failure is a significant clinical issue. It is the cause of enormous healthcare costs worldwide and results in significant morbidity and mortality. Cardiac regenerative therapy has progressed considerably from clinical and preclinical studies delivering simple suspensions of cells, macromolecule, and small molecules to more advanced delivery methods utilizing biomaterial scaffolds as depots for localized targeted delivery to the damaged and ischemic myocardium. Here, regenerative strategies for cardiac tissue engineering with a focus on advanced delivery strategies and the use of multimodal therapeutic strategies are reviewed.
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Affiliation(s)
- Hugh S O'Neill
- Tissue Engineering Research Group (TERG), Department of Anatomy, Royal College of Surgeons in Ireland (RSCI), 123, St. Stephens Green, Dublin 2, Dublin, D02 YN77, Ireland
- Trinity Center for Bioengineering (TCBE), Trinity College Dublin, Dublin 2, Dublin, Ireland
| | - Laura B Gallagher
- Tissue Engineering Research Group (TERG), Department of Anatomy, Royal College of Surgeons in Ireland (RSCI), 123, St. Stephens Green, Dublin 2, Dublin, D02 YN77, Ireland
- Trinity Center for Bioengineering (TCBE), Trinity College Dublin, Dublin 2, Dublin, Ireland
| | - Janice O'Sullivan
- Tissue Engineering Research Group (TERG), Department of Anatomy, Royal College of Surgeons in Ireland (RSCI), 123, St. Stephens Green, Dublin 2, Dublin, D02 YN77, Ireland
- Trinity Center for Bioengineering (TCBE), Trinity College Dublin, Dublin 2, Dublin, Ireland
| | - William Whyte
- Tissue Engineering Research Group (TERG), Department of Anatomy, Royal College of Surgeons in Ireland (RSCI), 123, St. Stephens Green, Dublin 2, Dublin, D02 YN77, Ireland
- Advanced Materials and Bioengineering Research Center (AMBER), RCSI and TCD, Dublin, Ireland
| | - Clive Curley
- Tissue Engineering Research Group (TERG), Department of Anatomy, Royal College of Surgeons in Ireland (RSCI), 123, St. Stephens Green, Dublin 2, Dublin, D02 YN77, Ireland
- Trinity Center for Bioengineering (TCBE), Trinity College Dublin, Dublin 2, Dublin, Ireland
| | - Eimear Dolan
- Tissue Engineering Research Group (TERG), Department of Anatomy, Royal College of Surgeons in Ireland (RSCI), 123, St. Stephens Green, Dublin 2, Dublin, D02 YN77, Ireland
- Trinity Center for Bioengineering (TCBE), Trinity College Dublin, Dublin 2, Dublin, Ireland
| | - Aamir Hameed
- Tissue Engineering Research Group (TERG), Department of Anatomy, Royal College of Surgeons in Ireland (RSCI), 123, St. Stephens Green, Dublin 2, Dublin, D02 YN77, Ireland
- Trinity Center for Bioengineering (TCBE), Trinity College Dublin, Dublin 2, Dublin, Ireland
| | - Joanne O'Dwyer
- Tissue Engineering Research Group (TERG), Department of Anatomy, Royal College of Surgeons in Ireland (RSCI), 123, St. Stephens Green, Dublin 2, Dublin, D02 YN77, Ireland
- Trinity Center for Bioengineering (TCBE), Trinity College Dublin, Dublin 2, Dublin, Ireland
- School of Pharmacy, Royal College of Surgeons in Ireland, 123, St. Stephens Green, Dublin 2, Dublin, Ireland
| | - Christina Payne
- Tissue Engineering Research Group (TERG), Department of Anatomy, Royal College of Surgeons in Ireland (RSCI), 123, St. Stephens Green, Dublin 2, Dublin, D02 YN77, Ireland
- School of Pharmacy, Royal College of Surgeons in Ireland, 123, St. Stephens Green, Dublin 2, Dublin, Ireland
| | - Daniel O'Reilly
- Tissue Engineering Research Group (TERG), Department of Anatomy, Royal College of Surgeons in Ireland (RSCI), 123, St. Stephens Green, Dublin 2, Dublin, D02 YN77, Ireland
| | - Eduardo Ruiz-Hernandez
- Tissue Engineering Research Group (TERG), Department of Anatomy, Royal College of Surgeons in Ireland (RSCI), 123, St. Stephens Green, Dublin 2, Dublin, D02 YN77, Ireland
- Trinity Center for Bioengineering (TCBE), Trinity College Dublin, Dublin 2, Dublin, Ireland
- Advanced Materials and Bioengineering Research Center (AMBER), RCSI and TCD, Dublin, Ireland
| | - Ellen T Roche
- Department of Biomedical Engineering, Eng-2053, Engineering Building, National University of Ireland, Galway, Ireland
| | - Fergal J O'Brien
- Tissue Engineering Research Group (TERG), Department of Anatomy, Royal College of Surgeons in Ireland (RSCI), 123, St. Stephens Green, Dublin 2, Dublin, D02 YN77, Ireland
- Advanced Materials and Bioengineering Research Center (AMBER), RCSI and TCD, Dublin, Ireland
| | - Sally Ann Cryan
- Tissue Engineering Research Group (TERG), Department of Anatomy, Royal College of Surgeons in Ireland (RSCI), 123, St. Stephens Green, Dublin 2, Dublin, D02 YN77, Ireland
- Trinity Center for Bioengineering (TCBE), Trinity College Dublin, Dublin 2, Dublin, Ireland
- School of Pharmacy, Royal College of Surgeons in Ireland, 123, St. Stephens Green, Dublin 2, Dublin, Ireland
| | - Helena Kelly
- Tissue Engineering Research Group (TERG), Department of Anatomy, Royal College of Surgeons in Ireland (RSCI), 123, St. Stephens Green, Dublin 2, Dublin, D02 YN77, Ireland
- School of Pharmacy, Royal College of Surgeons in Ireland, 123, St. Stephens Green, Dublin 2, Dublin, Ireland
| | - Bruce Murphy
- Trinity Center for Bioengineering (TCBE), Trinity College Dublin, Dublin 2, Dublin, Ireland
- Advanced Materials and Bioengineering Research Center (AMBER), RCSI and TCD, Dublin, Ireland
| | - Garry P Duffy
- Tissue Engineering Research Group (TERG), Department of Anatomy, Royal College of Surgeons in Ireland (RSCI), 123, St. Stephens Green, Dublin 2, Dublin, D02 YN77, Ireland
- Trinity Center for Bioengineering (TCBE), Trinity College Dublin, Dublin 2, Dublin, Ireland
- Advanced Materials and Bioengineering Research Center (AMBER), RCSI and TCD, Dublin, Ireland
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25
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Abstract
Star-shaped amphiphilic block copolymers form hydrogels as opposed to their linear counterparts.
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Affiliation(s)
- R. Murphy
- Polymer Chemistry and Biopolymers Laboratory
- Department of Pharmaceutical and Medicinal Chemistry
- Royal College of Surgeons in Ireland
- Dublin 2
- Ireland
| | - T. Borase
- Polymer Chemistry and Biopolymers Laboratory
- Department of Pharmaceutical and Medicinal Chemistry
- Royal College of Surgeons in Ireland
- Dublin 2
- Ireland
| | - C. Payne
- School of Pharmacy
- Royal College of Surgeons in Ireland
- Dublin 2
- Ireland
| | - J. O'Dwyer
- School of Pharmacy
- Royal College of Surgeons in Ireland
- Dublin 2
- Ireland
| | - S.-A. Cryan
- School of Pharmacy
- Royal College of Surgeons in Ireland
- Dublin 2
- Ireland
- Tissue Engineering Research Group
| | - A. Heise
- Polymer Chemistry and Biopolymers Laboratory
- Department of Pharmaceutical and Medicinal Chemistry
- Royal College of Surgeons in Ireland
- Dublin 2
- Ireland
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Crilly J, O'Dwyer J, Lind J, Tippett V, Thalib L, O'Dwyer M, Keijzers G, Wallis M, Bost N, Shiels S. Impact of opening a new emergency department on healthcare service and patient outcomes: analyses based on linking ambulance, emergency and hospital databases. Intern Med J 2014; 43:1293-303. [PMID: 23734944 DOI: 10.1111/imj.12202] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2012] [Accepted: 05/22/2013] [Indexed: 11/30/2022]
Abstract
BACKGROUND Emergency department (ED) crowding caused by access block is an increasing public health issue and has been associated with impaired healthcare delivery, negative patient outcomes and increased staff workload. AIM To investigate the impact of opening a new ED on patient and healthcare service outcomes. METHODS A 24-month time series analysis was employed using deterministically linked data from the ambulance service and three ED and hospital admission databases in Queensland, Australia. RESULTS Total volume of ED presentations increased 18%, while local population growth increased by 3%. Healthcare service and patient outcomes at the two pre-existing hospitals did not improve. These outcomes included ambulance offload time: (Hospital A PRE: 10 min, POST: 10 min, P < 0.001; Hospital B PRE: 10 min, POST: 15 min, P < 0.001); ED length of stay: (Hospital A PRE: 242 min, POST: 246 min, P < 0.001; Hospital B PRE: 182 min, POST: 210 min, P < 0.001); and access block: (Hospital A PRE: 41%, POST: 46%, P < 0.001; Hospital B PRE: 23%, POST: 40%, P < 0.001). Time series modelling indicated that the effect was worst at the hospital furthest away from the new ED. CONCLUSIONS An additional ED within the region saw an increase in the total volume of presentations at a rate far greater than local population growth, suggesting it either provided an unmet need or a shifting of activity from one sector to another. Future studies should examine patient decision making regarding reasons for presenting to a new or pre-existing ED. There is an inherent need to take a 'whole of health service area' approach to solve crowding issues.
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Affiliation(s)
- J Crilly
- Gold Coast Hospital and Health Service, Southport, Australia; Griffith Health Institute, Griffith University, Gold Coast, Australia; State Wide Emergency Department Network, Brisbane, Australia
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Moran AP, Stock K, Jenkins C, Uncles D, Panayiotou S, Spring C, O'Dwyer J, Kelley K, Venn R. Co-induction of anaesthesia with 0.75 mg kg propofol followed by sevoflurane: a randomized trial in the elderly with cardiovascular risk factors. Eur J Anaesthesiol 2007; 25:183-7. [PMID: 17888191 DOI: 10.1017/s026502150700138x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND The induction of general anaesthesia is associated with the greatest cardiovascular changes in elderly patients. Induction can be performed either intravenously or with gaseous induction. Sevoflurane has advantages over propofol for induction of anaesthesia in the elderly, since the lower reduction in mean arterial pressure with sevoflurane is both statistically and clinically significant. This prospective randomized controlled trial investigated the cardiovascular benefits of co-induction of anaesthesia with 0.75 mg kg(-1) propofol and 8% sevoflurane, when compared with 8% sevoflurane alone in patients requiring surgery for fractured neck of femur. METHOD In total, 38 patients aged 75 or over were allocated into the two groups, receiving either 0.75 mg kg(-1) of propofol followed by 8% sevoflurane or 8% sevoflurane alone. Vital signs were recorded until successful insertion of a laryngeal mask. Induction times, induction events and patient satisfaction scores were also recorded. RESULTS Results showed that there were no differences in the cardiovascular parameters between the two groups. Induction times were faster in the propofol and sevoflurane group (62 vs. 81 s; P = 0.028). The postoperative questionnaire showed that the majority of patients in both groups were satisfied with the induction process. CONCLUSIONS We concluded that 0.75 mg kg(-1) of propofol followed by sevoflurane induction is an acceptable alternative to sevoflurane induction. It is associated with similar haemodynamic variables, faster induction times and is very well tolerated.
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MESH Headings
- Aged
- Aged, 80 and over
- Anesthesia, General/adverse effects
- Anesthesia, General/methods
- Anesthetics, Combined/adverse effects
- Anesthetics, Combined/therapeutic use
- Anesthetics, Inhalation/adverse effects
- Anesthetics, Inhalation/therapeutic use
- Anesthetics, Intravenous/adverse effects
- Anesthetics, Intravenous/therapeutic use
- Blood Pressure/drug effects
- Drug Therapy, Combination
- Female
- Femoral Neck Fractures/surgery
- Heart Rate/drug effects
- Humans
- Male
- Methyl Ethers/adverse effects
- Methyl Ethers/therapeutic use
- Oximetry
- Patient Satisfaction
- Propofol/adverse effects
- Propofol/therapeutic use
- Prospective Studies
- Risk Factors
- Sevoflurane
- Time Factors
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Affiliation(s)
- A P Moran
- Worthing Hospital, Department of Anaesthesia, West Sussex, UK
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Hussey J, Bell C, Bennett K, O'Dwyer J, Gormley J. Relationship between the intensity of physical activity, inactivity, cardiorespiratory fitness and body composition in 7-10-year-old Dublin children. Br J Sports Med 2007; 41:311-6. [PMID: 17395610 PMCID: PMC2659066 DOI: 10.1136/bjsm.2006.032045] [Citation(s) in RCA: 85] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
OBJECTIVE To investigate the relationships between the time spent in specific intensities of activity and inactivity, cardiorespiratory fitness and body composition in children. METHODS A cross-sectional study was conducted in a random sample of schools. Height, weight and waist circumference were measured in 224 children aged 7-10 years. Cardiorespiratory fitness was estimated by the 20 m multistage running test, and physical activity was measured over 4 days by the RT3 (a triaxial accelerometer). Time each day spent in moderate and vigorous intensities of activity was calculated. RESULTS Twelve schools agreed to participate in the study. Body composition and fitness data were obtained for 224 children and activity data for 152 children. Boys were found to take part in about twice as much vigorous and hard activity as girls (mean (95% confidence interval) 64.3 (53.2 to 75.4) min in boys compared with 37 (33.1 to 40.9) min in girls; p<0.001). In boys there was significant difference between those defined as normal, overweight and obese in the time spent in vigorous activity (p<0.05), but no such difference was found in girls. A significant negative correlation between waist circumference and time spent in vigorous activity (r = -0.31, p<0.05) was found in boys but not in girls. Time spent sedentary was positively correlated with waist circumference in boys (r = 0.33, p<0.01) but not in girls. In both boys and girls there were significant negative correlations between fitness and both body mass index (r = -0.274, p<0.001) and waist circumference (boys: r = -0.503, p<0.01; girls: r = -0.286, p<0.01). CONCLUSION In boys, body composition was inversely related to fitness and to vigorous activity and was positively related to inactivity. In girls, body composition was related to fitness but not to specific components of physical activity.
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Affiliation(s)
- J Hussey
- Trinity College, Dublin, Ireland.
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29
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Abstract
BACKGROUND the practical issues confronting older people who suffer chronic pain may not be tackled in a pain clinic setting and little is known of their strategies for coping. They seem to have little or no information on how to improve the quality of their lives or on resources available to them. AIM the aim of this study was to ascertain from older people the practical, physical and psychosocial limitations they faced because of chronic pain, and the strategies they used to deal with them. METHOD a qualitative approach to generating data was chosen using a Grounded Theory approach and unstructured interviews. Sixty-three people ranging from 60 to 87 years of age participated in the study. Audio-tapes were transcribed verbatim. The material was coded and collapsed into themes. RESULTS two main themes emerged: (i) the desire for independence and control; and (ii) adaptation to a life with chronic pain. The valuing of independence is in line with previous findings. With only three exceptions none of the participants were certain how or where to get help with practical issues and so they lived in fear of loss of their independence. Several sub-categories formed the theme of adaptation. These were acceptance and non-acceptance, pacing oneself, helping other people, the use of prayer and 'looking good and feeling good'. When independence and control is effective, older people may adapt better to chronic pain. CONCLUSION understanding chronic pain sufferers from their own perspective may have important clinical implications. The interview data informed the development of a booklet designed to meet the needs of older patients with chronic pain.
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Affiliation(s)
- B Sofaer
- Clinical Research Centre for Health Professions, University of Brighton, Eastbourne, UK.
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30
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Majumdar A, Tinsley D, O'Dwyer J, Doyle PT, Sandler J, Benson P, Davies SJ. The ‘Chesterfield stent’: an aid to the placement of midpalatal implants. Br J Oral Maxillofac Surg 2005; 43:36-9. [PMID: 15620772 DOI: 10.1016/j.bjoms.2004.08.013] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/09/2004] [Indexed: 10/26/2022]
Abstract
A palatal endosseous implant is a valuable adjunct to orthodontic treatment. Its insertion is considerably simplified by the use of a stent that was designed in our department and that we describe here.
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Affiliation(s)
- A Majumdar
- Department of Maxillofacial Surgery & Orthodontics, Chesterfield and North Derbyshire Royal Hospital, Calow Road, Chesterfield S44 5BL, UK.
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Molyneux M, Venn R, O'Dwyer J. Localized abdominal pain following sympathetic blockade with bretylium for the management of complex regional pain syndrome. Eur J Anaesthesiol 2002; 19:147-8. [PMID: 11999600 DOI: 10.1017/s0265021502220268] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Abstract
PURPOSE Little is known concerning the efficacy and adverse effects of the ketogenic diet in adults with refractory epilepsy. This review reports preliminary results in 11 adults prospectively treated with the diet who had previously failed to gain seizure control with two or more medications and/or surgery. METHODS Eleven patients nine women, two men), median age, 32.2 years (range, 19-45 years) were treated with the ketogenic diet with a 4:1 ratio with fluid restriction. Six patients had symptomatic partial epilepsy, and five had symptomatic generalized epilepsy. The diet was administered in addition to antiepileptic medication by a multidisciplinary team geared exclusively to adult patients. Medications were not changed while on the diet. Seizure frequency at 8-month follow-up was compared with frequency during a baseline period. RESULTS At 8 months of follow-up, three patients had a 90% seizure decrease, three patients had a 50-89% decrease in seizure frequency, one patient had <50% seizure decrease, and four patients discontinued the diet. Of the four patients who discontinued the diet, two had no appreciable change in their seizures despite high ketone levels. Two patients were unable to maintain persistent ketosis at home, despite having done so in the hospital. All seizure types responded to the diet. Common adverse effects included constipation and menstrual irregularities in women. Most patients reported a subjective improvement in concentration. Serum cholesterol and triglycerides increased while on the diet as well as cholesterol high-density lipoprotein (HDL) ratios. CONCLUSIONS The ketogenic diet shows promise in both adult generalized and partial epilepsy. Persistent ketosis was possible in adults, and the diet was tolerable for most patients. Further study assessing the efficacy of the ketogenic diet, and the cognitive and long-term effects is ongoing.
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Affiliation(s)
- J Sirven
- Jefferson Comprehensive Epilepsy Center, Department of Neurology, Jefferson Medical College, Philadelphia, Pennsylvania, USA.
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Abstract
The prevalence of Fragile-X syndrome in those with learning disability has been reported. There is little agreement regarding the prevalence rate which varies between 0% and 16%. We report a study investigating the prevalence of Fragile-X syndrome in two institutions for those with learning disability, using DNA testing. We found a rate of 0.7%, which is one of the lowest record rates. We also found that physical signs could be used as a reliable discriminator to determine those likely to have the disorder. We conclude that indiscriminate mass screening of those with learning disability for the Fragile-X syndrome is probably not useful because, in adults, physical signs and a family history of learning disability can predict those likely to have the disorder.
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Affiliation(s)
- J O'Dwyer
- University Department of Psychiatry, Northern General Hospital, Sheffield, UK.
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Abstract
OBJECTIVES In trauma and in surgical patients, respiratory mechanics may change because of many factors, including the hypotension induced by hemorrhage. The effects of acute hemorrhage on elastic and resistive characteristics of the respiratory system were studied. DESIGN Prospective study. SETTING Anesthesia research laboratory. INTERVENTIONS Acute hemorrhagic shock was induced in 24 supine anesthetized/paralyzed, mechanically ventilated dogs by blood withdrawal over a 12-minute period to decrease systolic arterial pressure to 50 mmHg; additional blood was subsequently withdrawn to maintain this pressure for 2 hours. Total respiratory system dynamic compliance and resistance and lung and chest wall compliances and resistances were measured. MEASUREMENTS AND MAIN RESULTS Total respiratory system dynamic compliance decreased from control (0.03 +/- 0.002 L/cmH2O) by the first 10 minutes of shock (p < 0.05) and was 9.8 +/- 2% lower than control 2 hours after the induction of shock because of decreases in both lung (9.6 +/- 3%) and chest wall (7.7 +/- 3%) compliances. Total respiratory resistance increased 12.8 +/- 3% from control (3.08 +/- 0.19 cmH2O/L/s) after 2 hours of shock (p < 0.05) because of an increase in chest wall resistance (21.6 +/- 8%, p < 0.05). Pulmonary resistance was not significantly increased (p > 0.05). In six control dogs, prepared similarly but not hemorrhaged, chest wall compliance and resistance did not change, but lung compliance gradually decreased by 17.8% during 150 minutes of anesthesia/paralysis. Lung resistance increased only after 100 minutes (p < 0.05). CONCLUSIONS (1) Hemorrhagic shock caused slight changes in the chest wall, but effects on lung mechanics were a consequence of prolonged mechanical ventilation during anesthesia/paralysis, and (2) changes in respiratory mechanics caused by hemorrhagic shock are small and, unless other deleterious factors are present, would probably have little clinical significance.
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Affiliation(s)
- J Sprung
- Department of Anesthesiology, Cleveland Clinic Foundation, OH 44195-9247, USA
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O'Dwyer J, McCartan B. Poultry cooking method to reduce weight loss. Trends Food Sci Technol 1995. [DOI: 10.1016/s0924-2244(00)89162-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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O'Dwyer J, Whitton I. Why do so few patients appeal against detention under section 2 of the Mental Health Act? Intellectually elite are more likely to appeal. BMJ 1995; 310:1196. [PMID: 7632237 PMCID: PMC2549575 DOI: 10.1136/bmj.310.6988.1196a] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
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Affiliation(s)
- J O'Dwyer
- Department of Psychiatry, Halifax General Hospital, N. Yorks, United Kingdom
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Weiner LM, O'Dwyer J, Kitson J, Comis RL, Frankel AE, Bauer RJ, Konrad MS, Groves ES. Phase I evaluation of an anti-breast carcinoma monoclonal antibody 260F9-recombinant ricin A chain immunoconjugate. Cancer Res 1989; 49:4062-7. [PMID: 2786751] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Four women with metastatic breast cancer were treated with monoclonal antibody 260F9-recombinant ricin A chain, a ricin A chain immunoconjugate (IC) which targets a Mr 55,000 antigen expressed by human mammary carcinomas. Patients were treated by daily, 1-h i.v. injections for 6 to 8 consecutive days. Two patients were treated with 10 micrograms/kg daily and the two others were treated with 50 micrograms/kg daily. The trial was suspended after four patients had been treated because patients treated with a continuous infusion schedule with this IC had developed significant neurological toxicity at doses similar to those used in this study. The half-life of the IC showed a t 1/2 alpha of approximately 1.8 h, a t 1/2 beta of approximately 8.3 h, and a peak concentration of about 200 ng/ml, at the lower dose level, and showed a t 1/2 alpha of approximately 2.5 h, t 1/2 beta of about 10.4 h, and a peak concentration of 500 and 850 ng/ml for the two patients at the higher dose level. All four patients developed evidence of a human anticonjugate antibody response within 16 days of the onset of therapy. The treatment was associated with significant toxicity, manifested by a syndrome consisting of weight gain, edema, hypoalbuminemia, and dyspnea. Similar symptoms were observed in patients treated by continuous infusions of the IC. This clinical syndrome, seen at doses of IC which were insufficient to saturate antigen-expressing malignant tumor deposits in this trial, has been seen in other IC therapy trials and in clinical trials using the cytokine interleukin 2. To investigate a possible mechanism responsible for this toxicity, human monocytes were incubated with varying concentrations of IC. There was detectable binding of IC to human monocytes at IC concentrations which were achieved clinically in this trial. Furthermore, the binding appeared to be abrogated by preincubation of the monocytes with pooled human immunoglobulin, thus suggesting that binding occurs via Fc gamma receptor-mediated mechanisms. Binding was not affected if different linkers between recombinant ricin A chain and the antibody were used or if a different antibody moiety was used in the IC preparation. Chemically linked dimers of MOPC-21 bound to human monocytes at least as well as the ICs; this binding was not abrogated by preincubation with pooled human immunoglobulin. Since the IC preparations used in this clinical trial contained small percentages of dimers and/or multimers, the clinical toxicity syndromes which we observed may be related to this series of observations.(ABSTRACT TRUNCATED AT 400 WORDS)
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Affiliation(s)
- L M Weiner
- Department of Medical Oncology, Fox Chase Cancer Center, Philadelphia, Pennsylvania 19111
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Weiner LM, Moldofsky PJ, Gatenby RA, O'Dwyer J, O'Brien J, Litwin S, Comis RL. Antibody delivery and effector cell activation in a phase II trial of recombinant gamma-interferon and the murine monoclonal antibody CO17-1A in advanced colorectal carcinoma. Cancer Res 1988; 48:2568-73. [PMID: 3128400] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Murine monoclonal antibodies of the immunoglobulin G2a isotype interact with human effector cells to mediate antibody-dependent cellular cytotoxicity (ADCC) directed against malignant cells which express antigens recognized by these antibodies. gamma-Interferon enhances these effects in vitro. In a Phase I trial of murine monoclonal antibody CO17-1A and recombinant gamma-interferon (rIFN-gamma), we demonstrated that low doses of rIFN-gamma were superior to high doses in augmenting ADCC mediated by treated patients' monocytes. These results formed the basis for a Phase II trial of CO17-1A combined with low dose rIFN-gamma. Nineteen patients with metastatic colorectal carcinoma were treated with four consecutive daily infusions of 1.0 X 10(6) IU/m2 rIFN-gamma, with 150 mg of CO17-1A administered on days 2, 3, and 4. Therapy was tolerated well. Peripheral blood mononuclear cells were purified from patient samples obtained at baseline and at 1, 4, or 24 h following the start of the first rIFN-gamma infusion and were tested for their ability to lyse 111In-labeled cells of the SW1116 colorectal line. Enhancement of monocyte ADCC was seen by 24 h, while lymphocyte ADCC and natural killer activity directed against K562 cells were enhanced to a lesser extent. Nonspecific lysis of SW1116 cells by effectors was not seen at the time points examined. While CO17-1A antigen expression was observed in most biopsies, 131I-labeled CO17-1A imaged positively in less than one-half of the organs known to harbor metastases, and therapeutic antibody delivery was not always demonstrated by immunoperoxidase staining techniques of tissue obtained following therapy. In antigen-positive lesions, tissue pO2 levels appear to identify lesions which would image positively. No objective responses were seen. Our findings suggest that prolonged therapy with low doses of rIFN-gamma potentiates ADCC but that physiological obstacles to therapeutic antibody delivery are significant. In order to evaluate the validity of this therapeutic approach, measures to enhance antibody delivery are needed, starting with systematic evaluations of therapy with escalating doses of CO17-1A combined with low dose rIFN-gamma therapy.
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Affiliation(s)
- L M Weiner
- Department of Medical Oncology, Fox Chase Cancer Center, Philadelphia, Pennsylvania 19111
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O'Dwyer J. Current policy issues in the Irish Health Services. Acta Hosp 1987; 28:59-68. [PMID: 10313009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/12/2023]
Abstract
The article provides a general outline of current policy issues in the Irish health services. Referring to a demographic and epidemiological background and taking into account the recent trends in health expenditure, the author deals with six main issues: selection and clarification of objectives, funding, resource allocation, organisation, managing for change, the public/private mix. Comparing Ireland to other European countries, the author concludes that, because of limited resources, Ireland must be clearer and cleverer. The meeting of the expectations of the population will continue to provide a stirring challenge.
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Lorigan G, Doorly T, O'Dwyer J, Toland J. Acoustic neuroma: a benign condition? Ir Med J 1987; 80:263-4. [PMID: 3499418] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
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Vandongen R, O'Dwyer J, Barden A. Role of prostaglandins during reversal of one-kidney, one-clip hypertension in the rat. Clin Exp Pharmacol Physiol 1984; 11:391-4. [PMID: 6518668 DOI: 10.1111/j.1440-1681.1984.tb00285.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
Unclipping the one-kidney, one-clip rat returned blood pressure to normotensive levels within 24 h and was associated with a substantial increase in urinary PGE2 and 6-keto PGF1 alpha excretion. Prior treatment with indomethacin (6.0 mg/kg) markedly reduced urinary prostaglandins after clip removal and attenuated the fall in blood pressure. Aspirin (100 mg/kg) treatment, which reduced 6-keto PGF1 alpha to a lesser degree without altering PGE2 excretion, had no significant effect on the blood pressure fall. It is suggested that in the one-kidney, one-clip rat prostaglandins are released as the result of exposing the unclipped kidney to elevated arterial pressure, and that these contribute to the subsequent fall in blood pressure.
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Abstract
The 24 hour urinary excretion of 6-keto PGF1 alpha and PGE2 was compared in 2 kidney-1 clip rats developing hypertension within 12 weeks of renal artery clipping with rats remaining normotensive over this period. Although systolic blood pressure was markedly elevated in the hypertensive (210 +/- 5.1 mm Hg), in contrast with the normotensive (141 +/- 1.9 mm Hg) group, urinary levels of 6-keto PGF1 alpha (26.1 +/- 3.4 and 22.1 +/- 2.7 ng/24 h, respectively) and PGE2 (52.8 +/- 28 and 53.3 +/- 10.8 ng/24 h) were not significantly different. Treating the 2 kidney-1 clip normotensive group with indomethacin (3.0 mg/kg, by intraperitoneal injection) twice-weekly for 3 weeks reduced 6-keto PGF1 alpha excretion from 22.1 +/- 2.7 to 8.4 +/- 2.2 ng/24 h (P less than 0.002) and PGE2 from 53.3 +/- 10.8 to 8.7 +/- 1.8 ng/24 h (P less than 0.002) but did not change blood pressure when compared with a similar group given buffer vehicle only. These findings do not support a role for renal prostaglandins in 2 kidney-1 clip hypertension in the rat.
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Abstract
Changes in systolic blood pressure and urinary excretion of PGE2 and 6-keto PGF1 alpha 24 h after removing the renal artery clip were compared in one-kidney and two-kidney, one clip Goldblatt hypertension in the rat. Unclipping the one-kidney rat returned blood pressure to normotensive levels within 24 h and was associated with a substantial increase in urinary PGE2 and 6-keto PGF1 alpha. Although hypertension was also completely reversed in the two-kidney model there was no significant change in urinary prostaglandin excretion. Prior treatment with indomethacin (6.0 mg/kg) markedly reduced urinary prostaglandins after clip removal in both forms of hypertension but attenuated the fall in blood pressure in the one-kidney model only. There were no significant changes in urinary kallikrein activity following unclipping. It is suggested that in the one-kidney, one clip rat prostaglandins are released as the result of exposing the unclipped kidney to elevated arterial pressure and that these contribute to the subsequent fall in blood pressure.
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Vandongen R, O'Dwyer J, Barden A. Effect of alpha-adrenergic stimulation on prostacyclin and renin release in the rat kidney. Prostaglandins 1982; 24:815-25. [PMID: 6762615 DOI: 10.1016/0090-6980(82)90061-2] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
The relationship between renin secretion and PGI2 production, in response to intrarenal infusion of norepinephrine, was examined in the isolated perfused rat kidney. Infusion of norepinephrine in a dose which caused substantial vasoconstriction (100 ng/min), markedly increased urinary excretion of 6-keto PGF1 alpha, the stable derivative of PGI2, without significantly altering renin secretion measured in the effluent perfusate. No change in urinary 6-keto PGF1 alpha occurred when vasoconstriction was prevented by infusing the alpha-adrenoceptor blocking drug phenoxybenzamine (2 x 10(3) ng/min) alongside norepinephrine (100 ng/min). However, under these conditions there was marked stimulation of renin secretion which, as has been demonstrated previously, is mediated by a beta-adrenoceptor. There were significant increases in urine flow rates during both vasoconstrictor and non-vasoconstrictor infusions. These findings clearly indicate that in the rat kidney prostacyclin production and renin release in response to norepinephrine are dissociated.
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