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Muheilan M, Scanlon L, Barea B, Smyth L, Thomas A, Flynn R, Manecksha R, Casey R. A Comparison of Urology Service Provision Between the First and the Third Waves of the COVID-19 Pandemic. Ir Med J 2022; 115:659. [PMID: 36327989] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Affiliation(s)
- M Muheilan
- Department of Urology, Tallaght University Hospital, Dublin, Ireland
| | - L Scanlon
- Department of Urology, Tallaght University Hospital, Dublin, Ireland
| | - B Barea
- Department of Urology, Tallaght University Hospital, Dublin, Ireland
| | - L Smyth
- Department of Urology, Tallaght University Hospital, Dublin, Ireland
| | - A Thomas
- Department of Urology, Tallaght University Hospital, Dublin, Ireland
| | - R Flynn
- Department of Urology, Tallaght University Hospital, Dublin, Ireland
- Department of Surgery, School of Medicine, Trinity College Dublin, Dublin, Ireland
| | - R Manecksha
- Department of Urology, Tallaght University Hospital, Dublin, Ireland
- Department of Surgery, School of Medicine, Trinity College Dublin, Dublin, Ireland
| | - R Casey
- Department of Urology, Tallaght University Hospital, Dublin, Ireland
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Abstract
Abstract
Background
While breastfeeding may be among the most effective ways to ensure child health and survival, breastfeeding rates in Ireland are consistently low. This study aimed to explore women's experiences of infant feeding in Ireland.
Methods
Thematic analysis of feeding-related free-text comments from the National Maternity Experience Survey 2020 was undertaken. The survey collected data on the experiences of women who were 16 years or older and gave birth in one of Ireland's 19 maternity hospitals or units or had a home birth.
Results
3,204 women participated in the survey (50% response rate). In the first few days after birth, 41.9% of women breastfed exclusively, 29.0% used formula and breast milk, and 29.1% bottle fed only. 824 comments related to feeding were received. A number of themes were identified, including support and encouragement from healthcare professionals, information and education regarding feeding, and pressure and respect for personal preferences. Women highlighted that while breastfeeding was encouraged in antenatal care, this was not always the case in the postnatal ward, where formula was readily available, with an apparent lack of resources for breastfeeding women. Some women described feeling pressured to use a feeding method that was not their first preference, with some feeling pushed to breastfeed when this may not have been their wish, while women who wished to breastfeed felt pressured to supplement with formula. Staffing shortages on postnatal wards, a lack of lactation consultants and contradictory advice from healthcare professionals exacerbated difficulties with both feeding methods.
Conclusions
Some women experience a lack of practical support with infant feeding, regardless of feeding method, and clear and concise information on feeding practices is needed. The addition of lactation consultants, home supports and further education and training could benefit mothers on their breastfeeding journey.
Key messages
Barriers to breastfeeding included a lack of support from healthcare professionals and conflicting information. It is important to support women regardless of their chosen feeding method.
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Affiliation(s)
- R Murphy
- National Care Experience Programme, Health Information and Quality Authority, Mahon Cork, Ireland
| | - D Rohde
- National Care Experience Programme, Health Information and Quality Authority, Mahon Cork, Ireland
| | - C Foley
- National Care Experience Programme, Health Information and Quality Authority, Mahon Cork, Ireland
| | - T O'Carroll
- National Care Experience Programme, Health Information and Quality Authority, Mahon Cork, Ireland
| | - R Flynn
- National Care Experience Programme, Health Information and Quality Authority, Mahon Cork, Ireland
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Madden A, Naughton A, Flynn R, Thomas A. A video case series of migrated Hem-o-lok clip retrieval post robotic assisted laparoscopic prostatectomy and a review of the literature. EUR UROL SUPPL 2021. [DOI: 10.1016/s2666-1683(21)00244-5] [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: 11/15/2022] Open
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4
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Collins P, O'Connell C, Omer SA, Inder MS, Madden A, Smyth L, Casey R, Manecksha R, Thomas A, Browne R, O'Neill A, Tierney S, Flynn R. 401 Three Birds with One Stone: Ureteric Calculus Precipitates Diagnosis and Resection of Three Primary Neoplasms. Br J Surg 2021. [DOI: 10.1093/bjs/znab134.271] [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: 11/13/2022]
Abstract
Abstract
A 67 year-old female presented to our centre with a 2 day history of right flank pain, clinically suggestive of ureteric colic. Computed tomography (CT) confirmed a 6mm right ureteric calculus. However, CT also revealed a large 13cm ipsilateral renal mass, concerning for renal cell carcinoma (RCC). At ureteroscopy for management of the obstructing calculus, a small papillary lesion was noted in the bladder, and excised. Histology confirmed pTa low-grade transitional cell carcinoma.
Following discussion at the Urology multidisciplinary tumour board, MRI venogram (MRV) was recommended to delineate the extension of tumour into the renal vein, and to characterise a pelvic mass seen on original CT. MRV showed enhancing material extending into the IVC, consistent with tumour thrombus. However, it also identified a concerning 6cm solid ovarian mass.
The patient proceeded to open right radical nephrectomy and IVC thrombectomy, hysterectomy, bilateral salpingo-oopherectomy, and omental biopsy, with combined input from Urological, Gynaecological and Vascular surgical teams. Post-operative course was uneventful. Histology showed an 11cm pT3a G2 clear cell RCC, and 7.5cm ovarian fibroma, both fully excised. This case demonstrated the serendipity of a simple ureteric calculus precipitating a cascade of investigations, that ultimately led to complete resection of three primary neoplasms.
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Affiliation(s)
- P Collins
- Tallaght University Hospital, Dublin, Ireland
| | - C O'Connell
- Tallaght University Hospital, Dublin, Ireland
| | - S A Omer
- Tallaght University Hospital, Dublin, Ireland
| | - M S Inder
- Tallaght University Hospital, Dublin, Ireland
| | - A Madden
- Tallaght University Hospital, Dublin, Ireland
| | - L Smyth
- Tallaght University Hospital, Dublin, Ireland
| | - R Casey
- Tallaght University Hospital, Dublin, Ireland
| | - R Manecksha
- Tallaght University Hospital, Dublin, Ireland
- Department of Surgery, School of Medicine, Trinity College Dublin, Dublin, Ireland
| | - A Thomas
- Tallaght University Hospital, Dublin, Ireland
| | - R Browne
- Tallaght University Hospital, Dublin, Ireland
| | - A O'Neill
- Tallaght University Hospital, Dublin, Ireland
| | - S Tierney
- Tallaght University Hospital, Dublin, Ireland
| | - R Flynn
- Tallaght University Hospital, Dublin, Ireland
- Department of Surgery, School of Medicine, Trinity College Dublin, Dublin, Ireland
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Stenzel L, Flynn R, Moore M. PO-1625: Deformable image registration (DIR) and radiobiological recalculation for retreat plan evaluation. Radiother Oncol 2020. [DOI: 10.1016/s0167-8140(21)01643-1] [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: 11/26/2022]
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6
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Foley C, Huss T, O’Carroll T, Flynn R. ISQUA18-1307The Development, Implementation and Outcomes of a National Patient Experience Survey and Associated Quality Improvement Infrastructure: Lessons from Ireland. Int J Qual Health Care 2018. [DOI: 10.1093/intqhc/mzy167.55] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- C Foley
- Health Information and Quality Authority, Cork, Ireland
| | - T Huss
- Health Information and Quality Authority, Cork, Ireland
| | - T O’Carroll
- Health Information and Quality Authority, Cork, Ireland
| | - R Flynn
- Health Information and Quality Authority, Cork, Ireland
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Zaidat OO, Bozorgchami H, Ribó M, Saver JL, Mattle HP, Chapot R, Narata AP, Francois O, Jadhav AP, Grossberg JA, Riedel CH, Tomasello A, Clark WM, Nordmeyer H, Lin E, Nogueira RG, Yoo AJ, Jovin TG, Siddiqui AH, Bernard T, Claffey M, Andersson T, Ribo M, Hetts S, Hacke W, Mehta B, Hacein-Bey L, Kim A, Abou-Chebl A, Shabe P, Hetts S, Hacein-Bey L, Kim A, Abou-Chebl A, Dix J, Gurian J, Zink W, Dabus G, O’Leary, N, Reilly A, Lee K, Foley J, Dolan M, Hartley E, Clark T, Nadeau K, Shama J, Hull L, Brown B, Priest R, Nesbit G, Horikawa M, Hoak D, Petersen B, Beadell N, Herrick K, White C, Stacey M, Ford S, Liu J, Ribó M, Sanjuan, E, Sanchis M, Molina C, Rodríguez-Luna, D, Boned Riera S, Pagola J, Rubiera M, Juega J, Rodríguez N, Muller N, Stauder M, Stracke P, Heddier M, Charron V, Decock A, Herbreteau D, Bibi R, De Sloovere A, Doutreloigne I, Pieters D, Dewaele T, Bourgeois P, Vanhee F, Vanderdouckt P, Vancaster E, Baxendell L, Gilchrist V, Cannon Y, Graves C, Armbruster K, Jovin T, Jankowitz B, Ducruet A, Aghaebrahim A, Kenmuir C, Shoirah H, Molyneaux B, Tadi P, Walker G, Starr M, Doppelheuer S, Schindler K, Craft L, Schultz M, Perez H, Park J, Hall A, Mitchell A, Webb L, Haussen D, Frankel M, Bianchi N, Belagaje S, Mahdi N, Lahoti S, Katema A, Winningham M, Anderson A, Tilley D, Steinhauser T, Scott D, Thacker A, Calderon V, Lin E, Becke S, Krieter S, Jansen O, Wodarg F, Larsen N, Binder A, Wiesen C, Hartney M, Bookhagan L, Ross H, Gay J, Snyder K, Levy E, Davies J, Sonig A, Rangel-Castilla L, Mowla A, Shakir H, Fennell V, Atwal G, Natarajan S, Beecher J, Thornton J, Cullen A, Brennan P, O’Hare A, Asadi H, Budzik R, Taylor M, Jennings M, Laube F, Jackson J, Gatrell R, Reebel L, Albon A, Gerniak J, Groezinger K, Lauf M, Voraco N, Pema P, Davis T, Hicks W, Mejilla J, Teleb M, Sunenshine P, Russo E, Flynn R, Twyford J, Ver Hage A, Smith E, Apolinar L, Blythe S, Maxan J, Carter J, Taschner T, Bergmann U, Meckel S, Elsheik S, Urbach H, Maurer C, Egger K, Niesen W, Baxter B, Knox, A, Hazelwood B, Quarfordt S, Calvert J, Hawk H, Malek, R, Padidar A, Tolley U, Gutierrez A, Mordasini P, Seip T, Balasubramaniam R, Gralla J, Fischer U, Zibold F, Piechowiak E, DeLeacy R, Apruzzeses R, Alfonso C, Haslett J, Fifi J, Mocco J, Starkman S, Guzy, J, Grunberg N, Szeder V, Tateshima S, Duckwiler G, Nour M, Liebeskind D, Tang X, Hinman J, Tipirneni A, Yavagal D, Guada L, Bates K, Balladeras S, Bokka S, Suir S, Caplan J, Kandewall P, Peterson E, Starke R, Puri A, Hawk M, Brooks C, L’Heurex J, Ty K, Rex D, Massari F, Wakhloo A, Lozano D, Rodrigua K, Pierot L, Fabienne M, Sebastien S, Emmoinoli M. Primary Results of the Multicenter ARISE II Study (Analysis of Revascularization in Ischemic Stroke With EmboTrap). Stroke 2018; 49:1107-1115. [DOI: 10.1161/strokeaha.117.020125] [Citation(s) in RCA: 92] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2017] [Revised: 02/05/2018] [Accepted: 02/26/2018] [Indexed: 02/04/2023]
Affiliation(s)
- Osama O. Zaidat
- From the Department of Neuroscience, Mercy St. Vincent Medical Center, Toledo, OH (O.O.Z., E.L.)
| | | | - Marc Ribó
- Department of Neuroradiology, Vall d’Hebron University Hospital, Barcelona, Spain (M.R., A.T.)
| | - Jeffrey L. Saver
- Department of Neurology, David Geffen School of Medicine, University of California, Los Angeles (J.L.S.)
| | - Heinrich P. Mattle
- Department of Neurology, Inselspital, University of Bern, Switzerland (H.P.M.)
| | - René Chapot
- Department of Radiology and Neuroradiology, Alfried Krupp Krankenhaus, Essen, Germany (R.C., H.N.)
| | - Ana Paula Narata
- Centre Hospitalier Régional Universitaire, Hôpitaux de Tours, France (A.P.N.)
| | | | - Ashutosh P. Jadhav
- Department of Neurology, University of Pittsburgh Medical Center, PA (A.P.J., T.G.J.)
| | - Jonathan A. Grossberg
- Department of Neurosurgery, Emory University School of Medicine, Atlanta, GA (J.A.G., R.G.N.)
| | | | - Alejandro Tomasello
- Department of Neuroradiology, Karolinska University Hospital, Karolinska Institute, Stockholm, Sweden (T.A.)
| | - Wayne M. Clark
- Oregon Health and Science University Hospital, Portland (H.B., W.M.C.)
| | - Hannes Nordmeyer
- Department of Radiology and Neuroradiology, Alfried Krupp Krankenhaus, Essen, Germany (R.C., H.N.)
| | - Eugene Lin
- From the Department of Neuroscience, Mercy St. Vincent Medical Center, Toledo, OH (O.O.Z., E.L.)
| | - Raul G. Nogueira
- Department of Neurosurgery, Emory University School of Medicine, Atlanta, GA (J.A.G., R.G.N.)
| | - Albert J. Yoo
- Department of Interventional Radiology, Texas Stroke Institute, Dallas–Fort Worth (A.J.Y.)
| | - Tudor G. Jovin
- Department of Neurology, University of Pittsburgh Medical Center, PA (A.P.J., T.G.J.)
| | | | | | | | - Tommy Andersson
- Department of Neuroradiology, Vall d’Hebron University Hospital, Barcelona, Spain (M.R., A.T.)
- AZ Groeninge, Kortrijk, Belgium (O.F., T.A.)
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O'Sullivan M, Gargan ML, Flynn R, Crowther S, Torreggiani W. Primary Renal Carcinoid - A Case Report. Ir Med J 2018; 111:677. [PMID: 29869858] [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] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Carcinoid tumours in the abdomen are uncommon, but typically occur in the gastrointestinal tract. Primary renal carcinoid is an extremely rare tumour, poorly described in the literature. We describe an unusual case where an atypical renal mass on imaging led to a preoperative diagnosis of renal carcinoid on imaging guiding biopsy.
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Affiliation(s)
- M O'Sullivan
- Trinity College Dublin
- Adelaide and Meath National Children's Hospital
| | - M L Gargan
- Trinity College Dublin
- Adelaide and Meath National Children's Hospital
| | - R Flynn
- Adelaide and Meath National Children's Hospital
| | - S Crowther
- Adelaide and Meath National Children's Hospital
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Tornio A, Flynn R, Morant S, Velten E, Palmer C, MacDonald T, Doney A. Investigating Real-World Clopidogrel Pharmacogenetics in Stroke Using a Bioresource Linked to Electronic Medical Records. Clin Ther 2017. [DOI: 10.1016/j.clinthera.2017.05.052] [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: 11/30/2022]
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10
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Chukwuanukwu RC, Onyenekwe CC, Martinez‐Pomares L, Flynn R, Singh S, Amilo GI, Agbakoba NR, Okoye JO. Modulation of the immune response to Mycobacterium tuberculosis during malaria/M. tuberculosis co-infection. Clin Exp Immunol 2017; 187:259-268. [PMID: 27577087 PMCID: PMC5217870 DOI: 10.1111/cei.12861] [Citation(s) in RCA: 12] [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: 05/06/2016] [Revised: 08/10/2016] [Accepted: 08/18/2016] [Indexed: 01/20/2023] Open
Abstract
Tuberculosis (TB) causes significant morbidity and mortality on a global scale. The African region has 24% of the world's TB cases. TB overlaps with other infectious diseases such as malaria and HIV, which are also highly prevalent in the African region. TB is a leading cause of death among HIV-positive patients and co-infection with HIV and TB has been described as a syndemic. In view of the overlapping epidemiology of these diseases, it is important to understand the dynamics of the immune response to TB in the context of co-infection. We investigated the cytokine response to purified protein derivative (PPD) in peripheral blood mononuclear cells from TB patients co-infected with HIV or malaria and compared it to that of malaria- and HIV-free TB patients. A total of 231 subjects were recruited for this study and classified into six groups; untreated TB-positive, TB positive subjects on TB drugs, TB- and HIV-positive, TB- and malaria-positive, latent TB and apparently healthy control subjects. Our results demonstrate maintenance of interferon (IFN)-γ production in HIV and malaria co-infected TB patients in spite of lower CD4 counts in the HIV-infected cohort. Malaria co-infection caused an increase in the production of the T helper type 2 (Th2)-associated cytokine interleukin (IL)-4 and the anti-inflammatory cytokine IL-10 in PPD-stimulated cultures. These results suggest that malaria co-infection diverts immune response against M. tuberculosis towards a Th-2/anti-inflammatory response which might have important consequences for disease progression.
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Affiliation(s)
- R. C. Chukwuanukwu
- Medical Laboratory Science DepartmentNnamdi Azikiwe UniversityNnewi CampusNigeria
| | - C. C. Onyenekwe
- Medical Laboratory Science DepartmentNnamdi Azikiwe UniversityNnewi CampusNigeria
| | | | - R. Flynn
- School of Veterinary Medicine and ScienceUniversity of NottinghamNottinghamUK
| | - S. Singh
- School of LifeUniversity of NottinghamNottinghamUK
| | - G. I. Amilo
- Haematology DepartmentNnamdi Azikiwe UniversityNnewi CampusNigeria
| | - N. R. Agbakoba
- Medical Laboratory Science DepartmentNnamdi Azikiwe UniversityNnewi CampusNigeria
| | - J. O. Okoye
- Medical Laboratory Science DepartmentNnamdi Azikiwe UniversityNnewi CampusNigeria
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Flynn R. TU-B-201-03: Accounting for MV Imaging Dose and the Future of MV Imaging. Med Phys 2016. [DOI: 10.1118/1.4957454] [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: 11/07/2022] Open
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12
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Wears B, Mohiuddin I, Flynn R, Waldron T, Kim Y, Allen B, Xia J. WE-DE-BRA-10: Development of a Novel Scanning Beam Low-Energy Intraoperative Radiation Therapy (SBIORT) System for Pancreatic Cancer. Med Phys 2016. [DOI: 10.1118/1.4957839] [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: 11/07/2022] Open
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13
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Prajapati S, Mo X, Bednarz B, Lawless M, Hammer C, Flynn R, Westerly D, Jeraj R, Mackie T. SU-F-T-667: Development and Validation of Dose Calculation for An Open-Source KV Treatment Planning System for Small Animal Radiotherapy. Med Phys 2016. [DOI: 10.1118/1.4956853] [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: 11/07/2022] Open
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14
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Dadkhah H, Wu X, Kim Y, Flynn R. WE-DE-201-08: Multi-Source Rotating Shield Brachytherapy Apparatus for Prostate Cancer. Med Phys 2016. [DOI: 10.1118/1.4957813] [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: 11/07/2022] Open
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15
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Dalhart A, Hyer D, Allen B, Flynn R, Johnston H. SU-F-T-646: SBRT Lung: Moving Beyond the 3D Conformal Paradigm with An Elekta VersaHD Accelerator. Med Phys 2016. [DOI: 10.1118/1.4956831] [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: 11/07/2022] Open
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16
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Bhatt NR, Davis NF, Addie D, Flynn R, McDermott TED, Manecksha RP, Thornhill JA. Evaluating the cost of iatrogenic urethral catheterisation injuries. Ir J Med Sci 2016; 186:1051-1055. [PMID: 27052967 DOI: 10.1007/s11845-016-1451-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [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: 10/06/2015] [Accepted: 03/21/2016] [Indexed: 11/27/2022]
Abstract
INTRODUCTION Technique is vital to prevent urethral trauma during urethral catheterisation (UC). Education programmes are helpful but are not compulsory and safe UC remains operator dependent. Traumatic UC is associated with increased morbidity, length of stay, resource utilisation and surgical intervention. AIM To determine the cost of iatrogenic urethral injuries managed in a tertiary referral centre over a 6-month period. METHODS A 6-month prospective study monitored iatrogenic urethral injuries secondary to traumatic UC. Included were referrals from district hospitals and inpatient consultations relating to urethral injury caused by traumatic UC. The added cost of management was estimated. RESULTS Thirteen iatrogenic urethral injuries were recorded in 6 months. Management included open surgery for a ruptured bladder (n = 1), flexible cystourethroscopy (n = 10), suprapubic catherisation (n = 4), 3-way catheterisation (n = 4) and catheter re-insertion under direct vision (n = 6). The cost of acute management of these injuries was approximately €50,000 including theatre costs, ambulance transfer, hospital stay, procedural and equipment costs and short-term follow-up care. CONCLUSION Iatrogenic injuries during UC represent a significant cost burden to the healthcare system. Training programmes should be compulsory for all healthcare professionals routinely involved in catheterisation procedures.
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Affiliation(s)
- N R Bhatt
- Department of Urology, Tallaght Hospital, Dublin 24, Ireland.
| | - N F Davis
- Department of Urology, Tallaght Hospital, Dublin 24, Ireland
| | - D Addie
- Finance Department, Tallaght Hospital, Dublin 24, Ireland
| | - R Flynn
- Department of Urology, Tallaght Hospital, Dublin 24, Ireland
| | - T E D McDermott
- Department of Urology, Tallaght Hospital, Dublin 24, Ireland
| | - R P Manecksha
- Department of Urology, Tallaght Hospital, Dublin 24, Ireland
| | - J A Thornhill
- Department of Urology, Tallaght Hospital, Dublin 24, Ireland
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Zeiser R, Burchert A, Lengerke C, Verbeek M, Maas-Bauer K, Metzelder SK, Spoerl S, Ditschkowski M, Ecsedi M, Sockel K, Ayuk F, Ajib S, de Fontbrune FS, Na IK, Penter L, Holtick U, Wolf D, Schuler E, Meyer E, Apostolova P, Bertz H, Marks R, Lübbert M, Wäsch R, Scheid C, Stölzel F, Ordemann R, Bug G, Kobbe G, Negrin R, Brune M, Spyridonidis A, Schmitt-Gräff A, van der Velden W, Huls G, Mielke S, Grigoleit GU, Kuball J, Flynn R, Ihorst G, Du J, Blazar BR, Arnold R, Kröger N, Passweg J, Halter J, Socié G, Beelen D, Peschel C, Neubauer A, Finke J, Duyster J, von Bubnoff N. Ruxolitinib in corticosteroid-refractory graft-versus-host disease after allogeneic stem cell transplantation: a multicenter survey. Leukemia 2015; 29:2062-8. [PMID: 26228813 DOI: 10.1038/leu.2015.212] [Citation(s) in RCA: 384] [Impact Index Per Article: 42.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2015] [Revised: 07/23/2015] [Accepted: 07/24/2015] [Indexed: 12/15/2022]
Abstract
Despite major improvements in allogeneic hematopoietic cell transplantation over the past decades, corticosteroid-refractory (SR) acute (a) and chronic (c) graft-versus-host disease (GVHD) cause high mortality. Preclinical evidence indicates the potent anti-inflammatory properties of the JAK1/2 inhibitor ruxolitinib. In this retrospective survey, 19 stem cell transplant centers in Europe and the United States reported outcome data from 95 patients who had received ruxolitinib as salvage therapy for SR-GVHD. Patients were classified as having SR-aGVHD (n=54, all grades III or IV) or SR-cGVHD (n=41, all moderate or severe). The median number of previous GVHD-therapies was 3 for both SR-aGVHD (1-7) and SR-cGVHD (1-10). The overall response rate was 81.5% (44/54) in SR-aGVHD including 25 complete responses (46.3%), while for SR-cGVHD the ORR was 85.4% (35/41). Of those patients responding to ruxolitinib, the rate of GVHD-relapse was 6.8% (3/44) and 5.7% (2/35) for SR-aGVHD and SR-cGVHD, respectively. The 6-month-survival was 79% (67.3-90.7%, 95% confidence interval (CI)) and 97.4% (92.3-100%, 95% CI) for SR-aGVHD and SR-cGVHD, respectively. Cytopenia and cytomegalovirus-reactivation were observed during ruxolitinib treatment in both SR-aGVHD (30/54, 55.6% and 18/54, 33.3%) and SR-cGVHD (7/41, 17.1% and 6/41, 14.6%) patients. Ruxolitinib may constitute a promising new treatment option for SR-aGVHD and SR-cGVHD that should be validated in a prospective trial.
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Affiliation(s)
- R Zeiser
- Department of Hematology, Oncology and Stem Cell Transplantation, Freiburg University Medical Center, Freiburg, Germany
| | - A Burchert
- Department of Hematology, Oncology and Immunology, Philipps University Marburg, and University Medical Center Giessen and Marburg, Marburg, Germany
| | - C Lengerke
- Division of Hematology, University Hospital of Basel, Basel, Switzerland
| | - M Verbeek
- III Department of Internal Medicine, Technical University of Munich, Munich, Germany
| | - K Maas-Bauer
- Department of Hematology, Oncology and Stem Cell Transplantation, Freiburg University Medical Center, Freiburg, Germany
| | - S K Metzelder
- Department of Hematology, Oncology and Immunology, Philipps University Marburg, and University Medical Center Giessen and Marburg, Marburg, Germany
| | - S Spoerl
- III Department of Internal Medicine, Technical University of Munich, Munich, Germany
| | - M Ditschkowski
- Department of Bone Marrow Transplantation, West German Cancer Center, University Hospital Essen, Essen, Germany
| | - M Ecsedi
- Division of Hematology, University Hospital of Basel, Basel, Switzerland
| | - K Sockel
- Department of Hematology and Oncology, Universitätsklinikum Carl Gustav Carus an der Technischen Universität Dresden, Dresden, Germany
| | - F Ayuk
- Department of Stem Cell Transplantation, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - S Ajib
- Department of Internal Medicine II, University Hospital, Frankfurt/Main, Germany
| | - F S de Fontbrune
- Hematology Stem cell transplant Unit, Saint Louis Hospital, APHP, Paris, France
| | - I-K Na
- Department of Stem Cell Transplantation, Charité University Medicine Berlin, Berlin, Germany
| | - L Penter
- Department of Stem Cell Transplantation, Charité University Medicine Berlin, Berlin, Germany
| | - U Holtick
- Department of Internal Medicine I, University Hospital Cologne, Cologne, Germany
| | - D Wolf
- Medical Clinic III, Oncology, Hematology and Rheumatology, University Hospital Bonn (UKB), Bonn, Germany
| | - E Schuler
- Department of Hematology, Oncology and Clinical Immunology, Universitätsklinikum Düsseldorf, Düsseldorf, Germany
| | - E Meyer
- Department of Bone Marrow Transplantation, Stanford University Medical School, Stanford, CA, USA
| | - P Apostolova
- Department of Hematology, Oncology and Stem Cell Transplantation, Freiburg University Medical Center, Freiburg, Germany
| | - H Bertz
- Department of Hematology, Oncology and Stem Cell Transplantation, Freiburg University Medical Center, Freiburg, Germany
| | - R Marks
- Department of Hematology, Oncology and Stem Cell Transplantation, Freiburg University Medical Center, Freiburg, Germany
| | - M Lübbert
- Department of Hematology, Oncology and Stem Cell Transplantation, Freiburg University Medical Center, Freiburg, Germany
| | - R Wäsch
- Department of Hematology, Oncology and Stem Cell Transplantation, Freiburg University Medical Center, Freiburg, Germany
| | - C Scheid
- Department of Internal Medicine I, University Hospital Cologne, Cologne, Germany
| | - F Stölzel
- Department of Hematology and Oncology, Universitätsklinikum Carl Gustav Carus an der Technischen Universität Dresden, Dresden, Germany
| | - R Ordemann
- Department of Hematology and Oncology, Universitätsklinikum Carl Gustav Carus an der Technischen Universität Dresden, Dresden, Germany
| | - G Bug
- Department of Internal Medicine II, University Hospital, Frankfurt/Main, Germany
| | - G Kobbe
- Department of Hematology, Oncology and Clinical Immunology, Universitätsklinikum Düsseldorf, Düsseldorf, Germany
| | - R Negrin
- Department of Bone Marrow Transplantation, Stanford University Medical School, Stanford, CA, USA
| | - M Brune
- Department of Internal Medicine, Sahlgrenska University Hospital, University of Gothenburg, Gothenburg, Sweden
| | - A Spyridonidis
- Department of Bone Marrow Transplantation, Patras University Medical School, Patras, Greece
| | - A Schmitt-Gräff
- Department of Pathology, Freiburg University Medical Center, Freiburg, Germany
| | | | - G Huls
- Radboud University Medical Centre, Nijmegen, The Netherlands
| | - S Mielke
- Department of Hematology and Oncology, University Medical Centre Würzburg, Würzburg, Germany
| | - G U Grigoleit
- Department of Hematology and Oncology, University Medical Centre Würzburg, Würzburg, Germany
| | - J Kuball
- Department of Hematology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - R Flynn
- Department of Pediatrics, Division of Blood and Marrow Transplantation, University of Minnesota, Minneapolis, MN, USA
| | - G Ihorst
- Clinical Trials Unit, Department of Hematology, Freiburg University Medical Center, Freiburg, Germany
| | - J Du
- Department of Pediatrics, Division of Blood and Marrow Transplantation, University of Minnesota, Minneapolis, MN, USA
| | - B R Blazar
- Department of Pediatrics, Division of Blood and Marrow Transplantation, University of Minnesota, Minneapolis, MN, USA
| | - R Arnold
- Department of Stem Cell Transplantation, Charité University Medicine Berlin, Berlin, Germany
| | - N Kröger
- Department of Stem Cell Transplantation, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - J Passweg
- Division of Hematology, University Hospital of Basel, Basel, Switzerland
| | - J Halter
- Division of Hematology, University Hospital of Basel, Basel, Switzerland
| | - G Socié
- Hematology Stem cell transplant Unit, Saint Louis Hospital, APHP, Paris, France
| | - D Beelen
- Department of Bone Marrow Transplantation, West German Cancer Center, University Hospital Essen, Essen, Germany
| | - C Peschel
- III Department of Internal Medicine, Technical University of Munich, Munich, Germany
| | - A Neubauer
- Department of Hematology, Oncology and Immunology, Philipps University Marburg, and University Medical Center Giessen and Marburg, Marburg, Germany
| | - J Finke
- Department of Hematology, Oncology and Stem Cell Transplantation, Freiburg University Medical Center, Freiburg, Germany
| | - J Duyster
- Department of Hematology, Oncology and Stem Cell Transplantation, Freiburg University Medical Center, Freiburg, Germany
| | - N von Bubnoff
- Department of Hematology, Oncology and Stem Cell Transplantation, Freiburg University Medical Center, Freiburg, Germany
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Dadkhah H, Flynn R, Wu X, Kim Y. SU-E-T-564: Multi-Helix Rotating Shield Brachytherapy for Cervical Cancer. Med Phys 2015. [DOI: 10.1118/1.4924926] [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: 11/07/2022] Open
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19
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Smith B, Gelover E, Wang D, Moignier A, Flynn R, Lin L, Kirk M, Solberg T, Hyer D. SU-E-T-187: Collimation Methods in Spot Scanning Proton Therapy: A Treatment Plan Comparison Between a Fixed Aperture and a Dynamic Collimation System. Med Phys 2015. [DOI: 10.1118/1.4924548] [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: 11/07/2022] Open
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20
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Moignier A, Gelover E, Wang D, Flynn R, Kirk M, Lin L, Solberg T, Lin A, Hyer D. TU-EF-304-11: Therapeutic Benefits of Collimation in Spot Scanning Proton Therapy in the Treatment of Brain Cancer. Med Phys 2015. [DOI: 10.1118/1.4925666] [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: 11/07/2022] Open
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21
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Renaud M, Flynn R, Seuntjens J, Enger S. TU-AB-201-08: Rotating Shield High Dose Rate Brachytherapy with 153Gd and 75Se Isotopes. Med Phys 2015. [DOI: 10.1118/1.4925546] [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: 11/07/2022] Open
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22
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Dowling C, Moran D, Walsh A, Alsinnawi M, Flynn R, McDermott TED, Grainger R, Thornhill JA. Transurethral resection of the prostate--"now and then". Ir Med J 2015; 108:144-146. [PMID: 26062241] [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: 06/04/2023]
Abstract
The number of transurethral resections of the prostate (TURP) performed each year is decreasing. The aim of this study was to assess a cohort of patients undergoing TURP and compare this to one twenty years earlier in terms of procedure, complications and outcomes. A retrospective comparative analysis of one hundred consecutive TURPs performed in 2010 was compared to one hundred cases performed in 1990. Fifty-five (55%) had a urinary catheter (UC) in situ pre-operatively in 2010 compared to 22 (22%) in 1990. The length of catheterisation time was significantly longer in 2010 compared with 1990 (average 65 days vs 20 days). Infective complications occurred in six (6%) patients in 2010 and three (3%) in the 1990 cohort. Patients who had UCs in situ preoperatively for longer periods had a higher rate of infective complications and more serious complications. This highlights the importance of early specialist referral for patients diaqnosed with urinary retention.
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Brown C, Williams S, McNutt L, Beilick S, Flynn R, Litvack D, Huss H, Nair A, Del Priore G. Cytoreductive surgery (CRS) and HIPEC in recurrent platinum-resistant ovarian cancer. Gynecol Oncol 2015. [DOI: 10.1016/j.ygyno.2015.01.282] [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: 11/30/2022]
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Blazar BR, Flynn R, Lee R, Marcucci G, Caliguiri MA, Heeger PS. Strategies to inhibit alloantibody production in alloprimed murine recipients of hematopoietic stem cell grafts. Am J Transplant 2015; 15:931-41. [PMID: 25762193 DOI: 10.1111/ajt.13125] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [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: 07/21/2014] [Revised: 10/06/2014] [Accepted: 10/08/2014] [Indexed: 01/25/2023]
Abstract
Alloantibody, not primed T cells, is the major barrier to bone marrow (BM) engraftment in allosensitized mice. We have shown that a single intravenous injection of donor splenocytes, to mimic a blood transfusion, results in high, sustained levels of serum alloantibody sufficient to eliminate donor BM within 3 h, resulting in uniform mortality in lethally irradiated allogeneic recipients. Current studies focused preventing and treating allopriming. Blockade of B cell survival signals with mTACI-Ig pre- and postpriming was ineffective, as was the B cell but not plasma cell depleting anti-CD20 mAb. Germinal center formation inhibition by lymphotoxin-beta receptor-Ig (LβR-Ig) diminished allosensitization, although conditional Prmd1 (Blimp-1) deletion in CD19+ cells was highly effective. By combining anti-CD20 mAb to reduce B cells and LTβR-Ig to diminish the frequency of B cells that could form germinal centers pre- and postpriming, allosensitization was precluded, permitting long-term survival in T- and NK-depleted, irradiated allogeneic recipients, whereas combined therapy postpriming alone was ineffective. As evidence of the critical role of B cells, the proteosomal inhibitor, bortezomib, given unencapsulated or encapsulated, proved ineffective in influencing allosensitization. These data extend our understanding of allopriming and provide a potential therapy for patients at risk for allosensitization and BM graft rejection.
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Affiliation(s)
- B R Blazar
- Division of Blood and Marrow Transplantation, University of MN, Masonic Cancer, Center and Department of Pediatrics, Minneapolis, MN
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25
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Rorie D, Flynn R, McConnachie L, Mackenzie IS, Macdonald TM. Poster advertisements in practice waiting rooms to recruit patients to the Treatment In Morning vs. Evening (TIME) online study. Br J Clin Pharmacol 2015; 80:325-6. [PMID: 25690880 DOI: 10.1111/bcp.12609] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2015] [Accepted: 02/09/2015] [Indexed: 11/26/2022] Open
Affiliation(s)
- D Rorie
- Medicines Monitoring Unit, University of Dundee, Dundee, UK
| | - R Flynn
- Medicines Monitoring Unit, University of Dundee, Dundee, UK
| | - L McConnachie
- Medicines Monitoring Unit, University of Dundee, Dundee, UK
| | - I S Mackenzie
- Medicines Monitoring Unit, University of Dundee, Dundee, UK
| | - T M Macdonald
- Medicines Monitoring Unit, University of Dundee, Dundee, UK
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26
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Alsinnawi M, Dowling CM, McKeown S, Flynn R, McDermott TED, Grainger R, Thornhill JA. A patient reported outcome measure (PROM) assessing quality of care in the urology hospital outpatient setting. Ir Med J 2014; 107:255-256. [PMID: 25282974] [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: 06/03/2023]
Abstract
A prospective blind PROM (patient reported outcome measure) study performed in our urology department examined the outpatient-clinic experience. 104 questionnaires were completed. 23 patients (22%) felt the waiting times for appointments was excessive. 13 patients (13%) experienced difficulty in contacting administrative staff. 98 patients (94%) considered the waiting areas good but 31 patients (31%) considered lack of privacy an issue. Consultants saw 65 patients (63%). 62 patients (60%) expected to be seen by a consultant. 32 patients (31%) felt consultation with a different doctor on return visits was unsatisfactory. 76 patients (73%) "fully trusted" their doctors. 78 patients (75%) rated their visit excellent, 10 patients (10%) added comments. Despite frustration with waiting times, the experience of patients reflects a positive rapport and trust between patient and doctor.
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27
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Wang D, Smith B, Hill P, Gelover E, Flynn R, Hyer D. TH-C-BRD-03: Determining the Optimal Collimator Position for Collimated Pencil Beam Scanning Proton Therapy. Med Phys 2014. [DOI: 10.1118/1.4889601] [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: 11/07/2022] Open
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28
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Ma M, Rouabhi O, Bayouth J, Flynn R, Xia J. SU-E-J-200: A Dosimetric Analysis of 3D Versus 4D Image-Based Dose Calculation for Stereotactic Body Radiation Therapy in Lung Tumors. Med Phys 2014. [DOI: 10.1118/1.4888253] [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: 11/07/2022] Open
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29
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Hill P, Wang D, Flynn R, Hyer D. SU-E-T-321: The Effects of a Dynamic Collimation System On Proton Pencil Beams to Improve Lateral Tissue Sparing in Spot Scanned Proton Therapy. Med Phys 2014. [DOI: 10.1118/1.4888654] [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: 11/07/2022] Open
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30
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Hyer D, Hill P, Wang D, Smith B, Flynn R. WE-D-17A-01: A Dynamic Collimation System for Spot Scanned Proton Therapy: Conceptual Overview. Med Phys 2014. [DOI: 10.1118/1.4889404] [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: 11/07/2022] Open
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31
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Li X, Adams Q, Flynn R. SU-C-16A-04: Dosimetric Validation of a Partially-Shielded Gd-153 Brachytherapy Concept. Med Phys 2014. [DOI: 10.1118/1.4889696] [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: 11/07/2022] Open
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32
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Gelover E, Wang D, Hill P, Flynn R, Hyer D. TH-C-BRD-02: Analytical Modeling and Dose Calculation Method for Asymmetric Proton Pencil Beams. Med Phys 2014. [DOI: 10.1118/1.4889600] [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: 11/07/2022] Open
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33
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Ma M, Bayouth J, Flynn R, Xia J. SU-E-J-260: Dose Recomputation Versus Dose Deformation for Stereotactic Body Radiation Therapy in Lung Tumors: A Dosimetric Study. Med Phys 2014. [DOI: 10.1118/1.4888314] [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: 11/07/2022] Open
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34
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Kydd JH, Cobb K, Davis R, Dean R, Drinkwater J, Dunham S, Flynn R, Gray C, Grogono-Thomas R, Hagan P, Jefferies A, Jones M, Ogden C, Pearson G, Robinson N, Rutland C, Tarlinton R, Tötemeyer S, Wason J, Whittington R, Williams L, Mossop L. Report of the first veterinary student support workshop. Vet Rec 2013; 173:346. [PMID: 24043705 DOI: 10.1136/vr.101782] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Affiliation(s)
- J H Kydd
- School of Veterinary Medicine and Science, University of Nottingham, Sutton Bonington, Loughborough, Leicestershire LE12 5RD, UK
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35
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Schmitt A, Hung T, Flynn R, Payumo A, Peres-da-Silva A, Kenzelmann Broz D, Attardi L, Chen J, Chang H. Regulation of the DNA Damage Response by an Inducible Long Noncoding RNA. Int J Radiat Oncol Biol Phys 2013. [DOI: 10.1016/j.ijrobp.2013.06.055] [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: 11/28/2022]
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36
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Bolan RK, Beymer M, Klausner JD, Flynn R, Leibowitz A. P3.430* Doxycycline prophylaxis for syphilis in a persistently high risk HIV infected population. Sex Transm Infect 2013. [DOI: 10.1136/sextrans-2013-051184.0881] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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37
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Dirksen B, Wang D, Hyer D, Buatti J, Sheybani A, TenNapel M, Bayouth J, Flynn R. SU-E-T-690: Radiosurgery of Peripheral Brain Lesions by Spot Scanning Proton Therapy. Med Phys 2013. [DOI: 10.1118/1.4815117] [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: 11/07/2022] Open
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38
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Flynn R, Li X, Kim Y, Wu X, Townsend K, Zhang W, Woodin B, Rockey W, Enger S, Breitbach E, Adams Q. WE-A-108-09: Interstitial Rotating Shield Brachytherapy for Prostate Cancer. Med Phys 2013. [DOI: 10.1118/1.4815502] [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: 11/07/2022] Open
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39
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Li X, Flynn R, Pike T. SU-D-108-07: Experimental Verification of a Compensator-Based Brachytherapy System. Med Phys 2013. [DOI: 10.1118/1.4814017] [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: 11/07/2022] Open
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40
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Liu Y, Flynn R, Kim Y, Wu X. SU-E-T-585: Inverse Optimization Using Smoothness Control for Rotating Shield Brachytherapy. Med Phys 2013. [DOI: 10.1118/1.4815013] [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: 11/07/2022] Open
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41
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Alsinnawi M, Torreggiani WC, Flynn R, McDermott TED, Grainger R, Thornhill JA. Percutaneous nephrolithotomy in adult patients with spina bifida, severe spinal deformity and large renal stones. Ir J Med Sci 2012; 182:357-61. [PMID: 23224858 DOI: 10.1007/s11845-012-0888-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2012] [Accepted: 11/27/2012] [Indexed: 11/29/2022]
Abstract
AIMS To present our experience in patients with spina bifida with severe spinal abnormality undergoing percutaneous nephrolithotomy (PCNL) for large stone burden. PATIENTS AND METHODS A retrospective review identified five spina bifida patients with abnormal spinal curvature who had a PCNL for large kidney stones. The mean age was 28 years. In two patients, stones were on the concave side of the scoliotic spine further limiting percutaneous access. Mean stone burden was 940 mm2. All patients were paraplegic, three patients had symptomatic stone disease. We performed initial percutaneous renal access in radiology department and staged nephrolithotomy in operating room. Tract dilatation was accomplished using Amplatz dilators and a 24 Ch or 26 Ch nephroscope was used. Fragmentation and stone removal were accomplished in all patients using pneumatic and or ultrasound lithotripter and a retrieval grasper. RESULTS No anaesthetic complications were recorded. One patient required multiple percutaneous tracts, four had single tract to access stones. Three patients were stone free after PCNL. One required second PCNL through the same tract and another patient had multiple adjunctive ESWL. All five patients were stone clear after the final procedure. Two patients required blood transfusion. No patient had major complication or admission to intensive care unit. CONCLUSIONS Percutaneous nephrolithotomy in patients with spina bifida is challenging but safe. Detailed pre-operative anaesthetic assessment and precise uroradiological evaluation of renal anatomy is essential. Second-look PCNL and additional ESWL/URS treatment may be required to completely clear stones.
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Affiliation(s)
- M Alsinnawi
- Department of Urology, The Adelaide and Meath Hospital Dublin, Incorporating The National Children's Hospital, Tallaght, Dublin 24, Ireland.
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Yang X, Flynn R, von der Kammer F, Hofmann T. Modeling colloid deposition on a protein layer adsorbed to iron-oxide-coated sand. J Contam Hydrol 2012; 142-143:50-62. [PMID: 23108339 DOI: 10.1016/j.jconhyd.2012.09.006] [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] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/30/2012] [Revised: 07/14/2012] [Accepted: 09/04/2012] [Indexed: 06/01/2023]
Abstract
Our recent study reported that conformation change of granule-associated Bovine Serum Albumin (BSA) may influence the role of the protein controlling colloid deposition in porous media (Flynn et al., 2012). The present study conceptualized the observed phenomena with an ellipsoid morphology model, describing BSA as an ellipsoid taking a side-on or end-on conformation on granular surface, and identified the following processes: (1) at low adsorbed concentrations, BSA exhibited a side-on conformation blocking colloid deposition; (2) at high adsorbed concentrations, BSA adapted to an end-on conformation promoted colloid deposition; and (3) colloid deposition on the BSA layer may progressively generate end-on molecules (sites) by conformation change of side-on BSA, resulting in sustained increasing deposition rates. Generally, the protein layer lowered colloid attenuation by the porous medium, suggesting the overall effect of BSA was inhibitory at the experimental time scale. A mathematical model was developed to interpret the ripening curves. Modeling analysis identified the site generation efficiency of colloid as a control on the ripening rate (declining rate in colloid concentrations), and this efficiency was higher for BSA adsorbed from a more dilute BSA solution.
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Affiliation(s)
- X Yang
- Provincial Key Laboratory of Agricultural Environmental Engineering, College of Resources and Environment, Sichuan Agricultural University, Huimin Road 211, Chengdu, 611130 Sichuan Province, China.
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Thompson JJD, Doody DG, Flynn R, Watson CJ. Dynamics of critical source areas: does connectivity explain chemistry? Sci Total Environ 2012; 435-436:499-508. [PMID: 22889750 DOI: 10.1016/j.scitotenv.2012.06.104] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/28/2012] [Revised: 06/27/2012] [Accepted: 06/28/2012] [Indexed: 06/01/2023]
Abstract
Critical source area approaches to catchment management are increasingly being recognised as effective tools to mitigate sediment and nutrient transfers. These approaches often assume hydrological connectivity as a driver for environmental risk, however this assumption has rarely been tested. Using high resolution monitoring, 14 rainfall events of contrasting intensity were examined in detail for spatial and temporal dynamics of overland flow generation at a hydrologically isolated grassland hillslope in Co. Down, Northern Ireland. Interactions between overland flow connectivity and nutrient transfers were studied to test the critical source area hypothesis. While total and soluble phosphorus loads were found to be representative of the size of the overland flow contributing area (P=<0.05), the dynamics of concentrations throughout storm hydrographs were found to be complex and storm dependant. Near linear relationships were observed between the contributing area and total overland flow volumes (R(2)=0.86). Export coefficients (kg ha(-1)) calculated using plot size were found to under estimate annual losses of total phosphorus by a factor of 17, when compared to those calculated using the contributing area. This study shows that current critical source area definitions for implementing mitigation measures may be overlooking the importance of storm characteristics in determining nutrient transfers and hence may be insufficient in determining catchment scale risk.
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Affiliation(s)
- J J D Thompson
- Agri-Environment Division, The Agri-Food and Biosciences Institute, 18a Newforge Lane, Malone Upper, Belfast BT9 5PX, Northern Ireland.
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Bayouth J, Huang Y, Flynn R, Siochi R. MO-A-BRB-03: A Clinical Review of the Dosimetric and Temporal Impact of Unflattened X- Ray Beams. Med Phys 2012; 39:3862. [DOI: 10.1118/1.4735766] [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: 11/07/2022] Open
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Abstract
PURPOSE To assess rotating shield brachytherapy (RSBT) delivered with the electronic brachytherapy (eBT) source comparing to intracavitary (IC) and intracavitary plus supplemental interstitial brachytherapy (IC+IS BT) delivered with conventional isotope radiation source. METHOD AND MATERIALS IC, IC+IS and RSBT plan was simulated for 5 patients with advanced cervical cancer (>40cc). One BT plan for each patient (fraction 1) guided by magnetic resonance imaging (MRI) was used in our treatment planning system (TPS). A bio- and MRI-compatible polycarbonate (Makrolon Rx3158) intrauterine applicator was simulated for IC and RSBT, and the vienna applicator was simulated for IC+IS BT. 192Ir was used as the radiation source of IC and IC+IS BT; Xoft AxxentTM eBT source was used for RSBT. A 0.5 mm thick tungsten shield was used for RS-BT with different azimuthal and zenith angles. The total dose for each plan was escalated as the external beam radiation therapy (EBRT) plus BT times fraction number (5 in our case). RESULTS RSBT and IC+IS BT had higher dose conformity in terms of D90 than IC BT for all the patients. The advantage of RSBT over IC+IS BT was dependent on the shield emission angle, tumor shape and tandem applicator location. The delivery time of RSBT was increased as finer emission angle was selected. CONCLUSIONS RSBT is a less-invasive potential alternative to conventional IC and IC+IS BT for treating bulky (>40cc) cervical cancer. RSBT can provide better treatment outcome with clinically acceptable increased delivery time if proper emission angle is selected based on the tumor shape and tandem applicator location. supported in part by NSF grants CCF-0830402 and CCF-0844765; and the NIH grant K25-CA123112, and American Cancer Society seed grant (IRG-77-004-31).
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Affiliation(s)
- W Yang
- Department of Biomedical Engineering, the University of Iowa, Iowa City, IA.,Department of Radiation Oncology, the University of Iowa, Iowa City, IA.,Department of Electrical and Computer Engineering, the University of Iowa, Iowa City, IA
| | - Y Kim
- Department of Biomedical Engineering, the University of Iowa, Iowa City, IA.,Department of Radiation Oncology, the University of Iowa, Iowa City, IA.,Department of Electrical and Computer Engineering, the University of Iowa, Iowa City, IA
| | - Y Liu
- Department of Biomedical Engineering, the University of Iowa, Iowa City, IA.,Department of Radiation Oncology, the University of Iowa, Iowa City, IA.,Department of Electrical and Computer Engineering, the University of Iowa, Iowa City, IA
| | - X Wu
- Department of Biomedical Engineering, the University of Iowa, Iowa City, IA.,Department of Radiation Oncology, the University of Iowa, Iowa City, IA.,Department of Electrical and Computer Engineering, the University of Iowa, Iowa City, IA
| | - R Flynn
- Department of Biomedical Engineering, the University of Iowa, Iowa City, IA.,Department of Radiation Oncology, the University of Iowa, Iowa City, IA.,Department of Electrical and Computer Engineering, the University of Iowa, Iowa City, IA
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Flynn R. WE-C-213AB-03: Preparing for Part II of the ABR Radiotherapy Physics Exam. Med Phys 2012. [DOI: 10.1118/1.4736093] [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: 11/07/2022] Open
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Liu Y, Flynn R, Yang W, Kim Y, Wu X. SU-E-T-606: Optimal Emission Angle Selection in Rotating Shield Brachytherapy. Med Phys 2012; 39:3845. [PMID: 28517084 DOI: 10.1118/1.4735695] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
PURPOSE In this work a general method is presented that enables clinicians to rapidly select Rotating shield brachytherapy (RSBT) emission angles based on the patient-specific tradeoff between delivery time and tumor dose conformity. Cervical cancer cases are used as examples. METHODS Anchor plans with high dose conformity but infeasible delivery times are generated with a fine emission angle, with simulated annealing. The RSBT emission angle selector determines the optimal emission angle for each case by efficiently solving a globally-optimal quadratic programming problem that closely reproduces the angular distribution of beam intensities from the anchor plan. Pareto plots of the dosimetric plan quality metrics, such as D90 versus the delivery time, are generated for clinicians. In this work two cervical cancer cases were considered for verification. The RSBT system was assumed to be a Xoft AxxentTM electronic BT(eBT) source with a 0.2mm tungsten shield. The intent for each treatment plans was to maximize tumor D90 while respective the GEC-ESTRO recommended constraints on the D2cc values to OARs. RESULTS Generating anchor plans with simulated annealing takes 10-20min while emission angle selection can finish within seconds. The shield sequencing algorithm also ensures the balance between D90 and delivery time. One case shows that the D90 can achieve 98.3Gy10 with emission angle 202.5 degree with 8.64min delivery, while the conventional intracavitary plan has D90 65Gy10 with 2.86min delivery. Another case shows RSBT with emission angle 67.5 degree can produce D90 108.7Gy10 with 44min, and the conventional plan uses 2.2min for D90 48.9Gy10. CONCLUSIONS The RSBT emission angle selection algorithm enables the users to rapidly determine the best emission angle for a given cervical cancer case by selecting the most appropriate D90 and delivery time. RSBT may be a less invasive alternative to intracavitary and supplementary interstitial BT for the treatment of cervical cancer tumors, supported in part by NSF grants CCF-0830402 and CCF-0844765, the NIH grant K25-CA123112.
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Affiliation(s)
- Y Liu
- Department of Electrical and Computer Engineering, the University of Iowa, Iowa City, IA.,Department of Radiation Oncology, the University of Iowa, Iowa City, IA.,Department of Biomedical Engineering, the University of Iowa, Iowa City, IA
| | - R Flynn
- Department of Electrical and Computer Engineering, the University of Iowa, Iowa City, IA.,Department of Radiation Oncology, the University of Iowa, Iowa City, IA.,Department of Biomedical Engineering, the University of Iowa, Iowa City, IA
| | - W Yang
- Department of Electrical and Computer Engineering, the University of Iowa, Iowa City, IA.,Department of Radiation Oncology, the University of Iowa, Iowa City, IA.,Department of Biomedical Engineering, the University of Iowa, Iowa City, IA
| | - Y Kim
- Department of Electrical and Computer Engineering, the University of Iowa, Iowa City, IA.,Department of Radiation Oncology, the University of Iowa, Iowa City, IA.,Department of Biomedical Engineering, the University of Iowa, Iowa City, IA
| | - X Wu
- Department of Electrical and Computer Engineering, the University of Iowa, Iowa City, IA.,Department of Radiation Oncology, the University of Iowa, Iowa City, IA.,Department of Biomedical Engineering, the University of Iowa, Iowa City, IA
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Doody DG, Archbold M, Foy RH, Flynn R. Approaches to the implementation of the Water Framework Directive: targeting mitigation measures at critical source areas of diffuse phosphorus in Irish catchments. J Environ Manage 2012; 93:225-34. [PMID: 22054589 DOI: 10.1016/j.jenvman.2011.09.002] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/23/2011] [Revised: 08/15/2011] [Accepted: 09/01/2011] [Indexed: 05/23/2023]
Abstract
The Water Framework Directive (WFD) has initiated a shift towards a targeted approach to implementation through its focus on river basin districts as management units and the natural ecological characteristics of waterbodies. Due to its role in eutrophication, phosphorus (P) has received considerable attention, resulting in a significant body of research, which now forms the evidence base for the programme of measures (POMs) adopted in WFD River Basin Management Plans (RBMP). Targeting POMs at critical sources areas (CSAs) of P could significantly improve environmental efficiency and cost effectiveness of proposed mitigation strategies. This paper summarises the progress made towards targeting mitigation measures at CSAs in Irish catchments. A review of current research highlights that knowledge related to P export at field scale is relatively comprehensive however; the availability of site-specific data and tools limits widespread identification of CSA at this scale. Increasing complexity of hydrological processes at larger scales limits accurate identification of CSA at catchment scale. Implementation of a tiered approach, using catchment scale tools in conjunction with field-by-field surveys could decrease uncertainty and provide a more practical and cost effective method of delineating CSA in a range of catchments. Despite scientific and practical uncertainties, development of a tiered CSA-based approach to assist in the development of supplementary measures would provide a means of developing catchment-specific and cost-effective programmes of measures for diffuse P. The paper presents a conceptual framework for such an approach, which would have particular relevance for the development of supplementary measures in High Status Waterbodies (HSW). The cost and resources necessary for implementation are justified based on HSWs' value as undisturbed reference condition ecosystems.
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Affiliation(s)
- D G Doody
- Agri-Environment Division, Agri-Food and Biosciences Institute, 18a Newforge Lane, BT9 5PX, UK.
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Yang X, Flynn R, von der Kammer F, Hofmann T. Influence of ionic strength and pH on the limitation of latex microsphere deposition sites on iron-oxide coated sand by humic acid. Environ Pollut 2011; 159:1896-1904. [PMID: 21514021 DOI: 10.1016/j.envpol.2011.03.026] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/16/2010] [Revised: 03/17/2011] [Accepted: 03/18/2011] [Indexed: 05/30/2023]
Abstract
This study, for the first time, investigates and quantifies the influence of slight changes in solution pH and ionic strength (IS) on colloidal microsphere deposition site coverage by Suwannee River Humic Acid (SRHA) in a column matrix packed with saturated iron-oxide coated sand. Triple pulse experimental (TPE) results show adsorbed SRHA enhances microsphere mobility more at higher pH and lower IS and covers more sites than at higher IS and lower pH. Random sequential adsorption (RSA) modelling of experimental data suggests 1 μg of adsorbed SRHA occupied 9.28 ± 0.03 × 10(9) sites at pH7.6 and IS of 1.6 mMol but covered 2.75 ± 0.2 × 10(9) sites at pH6.3 and IS of 20 mMol. Experimental responses are suspected to arise from molecular conformation changes whereby SRHA extends more at higher pH and lower ionic strength but is more compact at lower pH and higher IS. Results suggest effects of pH and IS on regulating SRHA conformation were additive.
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Affiliation(s)
- X Yang
- School of Planning, Architecture & Civil Engineering, Queen's University Belfast, David Keir Building, Stranmillis Road, Belfast BT9 5AG, N. Ireland, UK
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