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1.
Bone Joint J ; 102-B(5): 627-631, 2020 May.
Artículo en Inglés | MEDLINE | ID: mdl-32349603

RESUMEN

AIMS: The timing of surgical fixation in spinal fractures is a contentious topic. Existing literature suggests that early stabilization leads to reduced morbidity, improved neurological outcomes, and shorter hospital stay. However, the quality of evidence is low and equivocal with regard to the safety of early fixation in the severely injured patient. This paper compares complication profiles between spinal fractures treated with early fixation and those treated with late fixation. METHODS: All patients transferred to a national tertiary spinal referral centre for primary surgical fixation of unstable spinal injuries without preoperative neurological deficit between 1 July 2016 and 20 October 2017 were eligible for inclusion. Data were collected retrospectively. Patients were divided into early and late cohorts based on timing from initial trauma to first spinal operation. Early fixation was defined as within 72 hours, and late fixation beyond 72 hours. RESULTS: In total, 86 patients underwent spinal surgery in this period. Age ranged from 16 to 88 years. Mean Injury Severity Score (ISS) was higher in the early stabilization cohort (p = 0.020). Age was the sole significant independent variable in predicting morbidity on multiple regression analysis (p < 0.003). There was no significant difference in complication rates based on timing of surgical stabilization (p = 0.398) or ISS (p = 0.482). CONCLUSION: Our results suggest that these patients are suitable for early appropriate care with spinal precautions and delayed definitive surgical stabilization. Earlier surgery conferred no morbidity benefit and had no impact on length of stay. Cite this article: Bone Joint J 2020;102-B(5):627-631.


Asunto(s)
Fijación de Fractura/métodos , Fracturas de la Columna Vertebral/cirugía , Tiempo de Tratamiento , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Femenino , Humanos , Puntaje de Gravedad del Traumatismo , Irlanda , Tiempo de Internación/estadística & datos numéricos , Masculino , Persona de Mediana Edad , Estudios Retrospectivos
2.
Br J Nurs ; 29(8): 476-480, 2020 Apr 23.
Artículo en Inglés | MEDLINE | ID: mdl-32324457

RESUMEN

BACKGROUND: Temporary epicardial pacing wires are inserted after cardiac surgery. However, there are no international guidelines on which to base best practice regarding wire insertion or removal. METHODS: Data were collected on patients following cardiopulmonary bypass and analysed in terms of use, duration of use and complications of pacing wires after surgery. RESULTS: Wires were inserted in 164 of the 167 patients. Most (74%) did not require pacing. Patients were categorised into those who had aortic valve replacement (AVR) (n=42) and those who did not (n=122). Of the AVR group, 26% (n=11) were pacemaker dependent after surgery and 10% (n=4) required permanent pacemakers. Most pacing wires were removed by day 4. The only noted complication was delayed discharge. CONCLUSION: Unused pacing wires are normally removed on day 4, but for 77 (47%) of patients they remained in place longer. Forty patients (24%) had delayed wire removal because of a policy of wire removal during business hours only. Of these 40 patients, 27 (17% of the 77 with delayed removal) had delayed discharge as a result of our wire removal policy.


Asunto(s)
Puente Cardiopulmonar , Marcapaso Artificial , Adulto , Anciano , Estudios Transversales , Remoción de Dispositivos/estadística & datos numéricos , Femenino , Unidades Hospitalarias/organización & administración , Humanos , Irlanda , Masculino , Persona de Mediana Edad , Política Organizacional , Marcapaso Artificial/efectos adversos , Guías de Práctica Clínica como Asunto , Factores de Tiempo
3.
Lancet ; 395(10234): 1444-1451, 2020 05 02.
Artículo en Inglés | MEDLINE | ID: mdl-32234534

RESUMEN

BACKGROUND: Catheter-based renal denervation has significantly reduced blood pressure in previous studies. Following a positive pilot trial, the SPYRAL HTN-OFF MED (SPYRAL Pivotal) trial was designed to assess the efficacy of renal denervation in the absence of antihypertensive medications. METHODS: In this international, prospective, single-blinded, sham-controlled trial, done at 44 study sites in Australia, Austria, Canada, Germany, Greece, Ireland, Japan, the UK, and the USA, hypertensive patients with office systolic blood pressure of 150 mm Hg to less than 180 mm Hg were randomly assigned 1:1 to either a renal denervation or sham procedure. The primary efficacy endpoint was baseline-adjusted change in 24-h systolic blood pressure and the secondary efficacy endpoint was baseline-adjusted change in office systolic blood pressure from baseline to 3 months after the procedure. We used a Bayesian design with an informative prior, so the primary analysis combines evidence from the pilot and Pivotal trials. The primary efficacy and safety analyses were done in the intention-to-treat population. This trial is registered at ClinicalTrials.gov, NCT02439749. FINDINGS: From June 25, 2015, to Oct 15, 2019, 331 patients were randomly assigned to either renal denervation (n=166) or a sham procedure (n=165). The primary and secondary efficacy endpoints were met, with posterior probability of superiority more than 0·999 for both. The treatment difference between the two groups for 24-h systolic blood pressure was -3·9 mm Hg (Bayesian 95% credible interval -6·2 to -1·6) and for office systolic blood pressure the difference was -6·5 mm Hg (-9·6 to -3·5). No major device-related or procedural-related safety events occurred up to 3 months. INTERPRETATION: SPYRAL Pivotal showed the superiority of catheter-based renal denervation compared with a sham procedure to safely lower blood pressure in the absence of antihypertensive medications. FUNDING: Medtronic.


Asunto(s)
Hipertensión/cirugía , Riñón/inervación , Riñón/cirugía , Adulto , Antihipertensivos/normas , Australia/epidemiología , Austria/epidemiología , Teorema de Bayes , Presión Sanguínea/fisiología , Canadá/epidemiología , Femenino , Alemania/epidemiología , Grecia/epidemiología , Humanos , Hipertensión/diagnóstico , Hipertensión/etnología , Irlanda/epidemiología , Japón/epidemiología , Riñón/fisiopatología , Masculino , Persona de Mediana Edad , Placebos/efectos adversos , Estudios Prospectivos , Simpatectomía/métodos , Resultado del Tratamiento , Reino Unido/epidemiología , Estados Unidos/epidemiología
4.
Med Hist ; 64(2): 195-218, 2020 04.
Artículo en Inglés | MEDLINE | ID: mdl-32284634

RESUMEN

The twentieth-century history of men and women's attempts to gain access to reproductive health services in the Republic of Ireland has been significantly shaped by Ireland's social and religious context. Although contraception was illegal in Ireland from 1935 to 1979, declining family sizes in this period suggest that many Irish men and women were practising fertility control measures. From the mid-1960s, the contraceptive pill was marketed in Ireland as a 'cycle regulator'. In order to obtain a prescription for the pill, Irish women would therefore complain to their doctors that they had heavy periods or irregular cycles. However, doing so could mean going against one's faith, and also depended on finding a sympathetic doctor. The contraceptive pill was heavily prescribed in Ireland during the 1960s and 1970s as it was the only contraceptive available legally, albeit prescribed through 'coded language'. The pill was critiqued by men and women on both sides of the debate over the legalisation of contraception. Anti-contraception activists argued that the contraceptive pill was an abortifacient, while both anti-contraception activists and feminist campaigners alike drew attention to its perceived health risks. As well as outlining these discussions, the paper also illustrates the importance of medical authority in the era prior to legalisation, and the significance of doctors' voices in relation to debates around the contraceptive pill. However, in spite of medical authority, it is clear that Irish women exercised significant agency in gaining access to the pill.


Asunto(s)
Catolicismo/historia , Anticoncepción/historia , Anticonceptivos Orales/historia , Relaciones Médico-Paciente , Religión y Medicina , Anticoncepción/ética , Servicios de Planificación Familiar/historia , Servicios de Planificación Familiar/legislación & jurisprudencia , Femenino , Feminismo/historia , Historia del Siglo XX , Humanos , Irlanda , Masculino , Rol del Médico/historia , Derechos de la Mujer/historia
5.
J Environ Manage ; 264: 110523, 2020 Jun 15.
Artículo en Inglés | MEDLINE | ID: mdl-32250923

RESUMEN

In Ireland, agriculture accounts for 33% of national greenhouse gas (GHG) emissions. Ireland faces significant challenges in terms of emissions reduction and is well off course in terms of meeting binding European Union targets. Flexibility mechanisms will allow Ireland to offset 5.6% of its commitment via sequestration in biomass and soils and land use change. Agricultural emissions in Ireland are largely driven by livestock production. As such, the purpose of this research is to estimate the net GHG emission benefit resulting from a land use change with forest replacing livestock systems (dairy, beef cattle and sheep). We estimate the total carbon sequestration in biomass and harvested wood products, along with the total emissions avoided from each livestock system on a per hectare basis. In addition, the paper compares the social cost of carbon to the average income per hectare of each livestock system. Finally, a hypothetical national planting scenario is modelled using plausible planting rates. Results indicate that the greatest carbon benefit is achieved when forest replaces dairy production. This is due to high emissions per hectare from dairy systems, and greater sequestration potential in higher-yielding forests planted on better quality soils associated with dairy production. The inclusion of harvested wood products in subsequent rotations has the potential to enhance GHG mitigation and offset terrestrial carbon loss. A hypothetical national planting scenario, afforesting 100,000 ha substituting dairy, beef cattle and sheep livestock systems could abate 13.91 Mt CO2e after 10 years, and 150.14 Mt CO2e (unthinned plantations) or 125.89 Mt CO2e (thinned plantations) over the course of the rotation. These results highlight the critical role for forest land use change in meeting the urgent need to tackle rising agricultural emissions.


Asunto(s)
Secuestro de Carbono , Gases de Efecto Invernadero , Animales , Carbono , Bovinos , Efecto Invernadero , Irlanda , Ganado , Ovinos
10.
J Environ Manage ; 262: 110243, 2020 May 15.
Artículo en Inglés | MEDLINE | ID: mdl-32250775

RESUMEN

Agri-environment schemes (AES) are an important part of agricultural policy within Europe. They seek to achieve important goals with regards to biodiversity and the protection of natural resources while also helping to maintain culturally important landscapes and agricultural practices. Participation rates have been an important area of research into assessing the success of AES. Within Ireland and more broadly across Europe, systematic non-participation in AES has been observed. Certain farm and farmer types have been found more likely to participate. In this paper a contingent valuation exercise is conducted that assesses how AES payment levels impact on the participation decision of farmers. A bivariate probit with sample selection is utilised to account for farmers who are unwilling to participate regardless of payment levels. This allows for a more accurate estimation of farmer willingness-to-accept to participate in the hypothetical AES presented. It also offers insight into the characteristics of farmers who are unlikely to ever participate in these schemes. From the results it appears a significant proportion (30%) of farmers are unlikely to ever participate in AES, with the remaining open to participation depending on the compensation offered. It is argued that increased compensation levels may increase participation rates among some farmers who to date have been unlikely to participate.


Asunto(s)
Agricultura , Agricultores , Biodiversidad , Conservación de los Recursos Naturales , Europa (Continente) , Humanos , Irlanda
11.
Sci Total Environ ; 719: 137215, 2020 Jun 01.
Artículo en Inglés | MEDLINE | ID: mdl-32126403

RESUMEN

Knowledge of the location, physical attributes and impacts of obstacles on river connectivity is a requirement for any mitigating action aimed at restoring the connectivity of a river system. Here, we present a study that recorded the numbers and physical diversity of obstacles in 10 river catchments in Ireland, together with the impact these structures had on overall river connectivity. A total of 372 obstacles were recorded, 3 of these were dams, and the remainder were low-head weirs/sluices, obstacles associated with road or rail crossings of rivers and natural structures. The degree of fragmentation was estimated in each catchment by calculating obstacle density and the Dendritic Connectivity Index (DCI). DCI scores were calculated for 4 native Irish fish species with different life-histories, namely diadromous (Atlantic salmon, sea trout, European eel, sea lamprey) and potamodromous (brown trout). Obstacle density ranged between 1.2 and 0.02 obstacles/km of river. Six of the 10 catchments had at least one obstacle located on the mainstem river at least 5 km from its mouth/confluence. These 6 catchments typically had the lowest connectivity scores for diadromous species and ranged between 0.6 and 44.1 (a fully connected river would receive a maximum score of 100). While there was no significant correlation between obstacle density and the DCI score for diadromous fish, a significant negative correlation was detected between obstacle density and the DCI score for potamodromous brown trout. Here, we highlight the merit of these obstacle assessments and associated challenges for decision-making relating to prioritisation of obstacles for removal or modification.


Asunto(s)
Migración Animal , Animales , Anguilas , Irlanda , Lampreas , Ríos , Salmón , Trucha
12.
14.
PLoS One ; 15(2): e0228629, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-32053601

RESUMEN

This study examined the capsular phenotype and genotype of invasive meningococcal disease (IMD)-associated Neisseria meningitidis recovered in the Republic of Ireland (RoI) between 1996 and 2015. This time period encompasses both pre- (when IMD was hyperendemic in the RoI) and post- meningococcal serogroup C conjugate (MCC) vaccine introduction. In total, 1327 isolates representing over one-third of all laboratory-confirmed cases of IMD diagnosed each epidemiological year (EY), were characterised. Serogroups B (menB) and C (menC) predominated throughout, although their relative abundance changed; with an initial increase in the proportion of menC in the late 1990s followed by their dramatic reduction post-MCC vaccine implementation and a concomitant dominance of menB, despite an overall decline in IMD incidence. While the increase in menC was associated with expansion of specific clonal-complexes (cc), cc11 and cc8; the dominance of menB was not. There was considerable variation in menB-associated cc with declines in cc41/44 and cc32, and increases in cc269 and cc461, contributing to a significant increase in the clonal diversity of menB isolates over the study. This increase in diversity was also displayed among the serosubtyping data, with significant declines in proportions of menB isolates expressing p1.4 and p1.15 antigens. These data highlight the changing diversity of IMD-associated meningococci since 1996 in the RoI and emphasise the need for on-going surveillance particularly in view of the recent introduction of a menB vaccine.


Asunto(s)
Antígenos Bacterianos/genética , Infecciones Meningocócicas/microbiología , Neisseria meningitidis/genética , Variación Genética , Genotipo , Humanos , Incidencia , Irlanda/epidemiología , Infecciones Meningocócicas/epidemiología , Vacunas Meningococicas/administración & dosificación , Tipificación de Secuencias Multilocus , Fenotipo , Serogrupo
15.
Mar Pollut Bull ; 151: 110802, 2020 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-32056597

RESUMEN

In assessing the overall status of individual water bodies the EU Water Framework Directive (WFD) requires member states to assess both ecological and chemical status. The ecological status of transitional and coastal (TraC) waters is based on the assessment of specific biological elements as well as supporting chemical, physico-chemical and hydromorphological elements. Hydromorphology of TraC waters is one of the basic features of marine and coastal ecosystems controlling the presence of biota. Human induced hydromorphological alterations and pressures can damage the ecology and functioning of aquatic ecosystems. Thirteen metrics were developed and combined to form a hydromorphological index, the Hydromorphological Quality Index (HQI). The index categorises a water body into 5 classes. Semi-qualitative and quantitative criteria were used to assign a morphological classification directly related to that of the WFD, i.e., high, good, moderate, poor and bad. Thirty-three transitional and coastal water bodies were assessed using HQI.


Asunto(s)
Ecosistema , Monitoreo del Ambiente , Biota , Ecología , Irlanda
16.
Sci Total Environ ; 710: 136297, 2020 Mar 25.
Artículo en Inglés | MEDLINE | ID: mdl-32050363

RESUMEN

Anaerobic digestion (AD) has been identified as one of the cleanest producers of green energy. AD typically uses organic materials as feedstock and, through a series of biological processes, produces methane. Farmyard manure and slurry (FYM&S) are important AD feedstock and are typically mixed with agricultural waste, grass and/or food wastes. The feedstock may contain many different pathogens which can survive the AD process and hence also possibly be present in the final digestate. In this study, a semi-quantitative screening tool was developed to rank pathogens of potential health concern emerging from AD digestate. A scoring system was used to categorise likely inactivation during AD, hazard pathways and finally, severity as determined from reported human mortality rates, number of global human-deaths and infections per 100,000 populations. Five different conditions including mesophilic and thermophilic AD and three different pasteurisation conditions were assessed in terms of specific pathogen inactivation. In addition, a number of scenarios were assessed to consider foodborne incidence data from Ireland and Europe and to investigate the impact of raw FYM&S application (without AD and pasteurisation). A sensitivity analysis revealed that the score for the mortality rate (S3) was the most sensitive parameter (rank coefficient 0.49) to influence the final score S; followed by thermal inactivation score (S1, 0.25) and potential contamination pathways (S2, 0.16). Across all the scenarios considered, the screening tool prioritised Cryptosporidium parvum, Salmonella spp., norovirus, Streptococcus pyogenes, enteropathogenic E. coli (EPEC), Mycobacterium spp., Salmonella typhi (followed by S. paratyphi), Clostridium spp., Listeria monocytogenes and Campylobacter coli as the highest-ranking pathogens of human health concern resulting from AD digestate in Ireland. This tool prioritises potentially harmful pathogens which can emerge from AD digestate and highlights where regulation and intervention may be required.


Asunto(s)
Anaerobiosis , Reactores Biológicos , Cryptosporidium , Escherichia coli , Europa (Continente) , Humanos , Irlanda , Metano
17.
18.
Sci Total Environ ; 712: 136248, 2020 Apr 10.
Artículo en Inglés | MEDLINE | ID: mdl-31945525

RESUMEN

Strontium isotopes are used in archaeology, ecology, forensics, and other disciplines to study the origin of artefacts, humans, animals and food items. Strontium in animal and human tissues such as bone and teeth originates from food and drink consumed during life, leaving an isotopic signal corresponding to their geographical origin (i.e. where the plants grew, the animals grazed and the drinking water passed through). To contextualise the measurements obtained directly on animal and human remains, it is necessary to have a sound baseline of the isotopic variation of biologically available strontium in the landscape. In general, plants represent the main source of strontium for humans and animals as they usually contain much higher strontium concentrations than animal products (meat and milk) or drinking water. The observed difference between the strontium isotope composition of geological bedrock, soils and plants from the same locality warrants direct measurement of plants to create a reliable baseline. Here we present the first baseline of the biologically available strontium isotope composition for the island of Ireland based on 228 measurements on plants from 140 distinct locations. The isoscape shows significant variation in strontium isotope composition between different areas of Ireland with values as low as 0.7067 for the basalt outcrops in County Antrim and values of up to 0.7164 in the Mourne Mountains. This variability confirms the potential for studying mobility and landscape use of past human and animal populations in Ireland. Furthermore, in some cases, large differences were observed between different types of plants from the same location, highlighting the need to measure more than one plant sample per location for the creation of BASr baselines.


Asunto(s)
Isótopos de Estroncio/análisis , Animales , Arqueología , Humanos , Irlanda , Estroncio , Diente
20.
Br Dent J ; 228(1): 39-43, 2020 01.
Artículo en Inglés | MEDLINE | ID: mdl-31925372

RESUMEN

Objectives To establish current implant practice among university and hospital restorative dental specialists in the United Kingdom (UK) and Ireland and their opinions relating to criteria for implant treatment.Materials and methods An online questionnaire was distributed to 150 university and hospital restorative dental specialists in the UK and Ireland.Results The response rate was 27%. Twenty-nine (70%) respondents provided implant treatment, of which 76% and 100% placed and restored implants respectively. In addition, 79% worked with oral surgeons or oral and maxillofacial surgeons as part of the implant team. Hypodontia and malignancy were cited as the main groups that qualified for NHS dental implant treatment. Irradiation, smoking and bisphosphonates were considered the most important medical factors in patient selection for implant placement, while untreated periodontitis, poor oral hygiene and uncontrolled caries were the most important dental factors.Conclusions The majority of responding university and hospital restorative dental specialists within the UK and Ireland provide dental implant treatment and undertake a multidisciplinary approach where necessary. There is variation in the number of patients treated with implants by each respondent annually. The main patient groups that receive priority for NHS dental implant treatment are malignancy and hypodontia. Otherwise, there is general agreement about the factors considered important when selecting patients for implant treatment on the NHS and this aligns to the Royal College of Surgeons guidelines on selecting patients for the provision of dental implants.


Asunto(s)
Implantes Dentales , Humanos , Irlanda , Especialización , Reino Unido , Universidades
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