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1. A systematic review and meta-analysis of longitudinal cohort studies comparing mental health before versus during the COVID-19 pandemic in 2020

Author

Robinson, Eric, Sutin, Angelina R., Daly, Michael, Jones, Andrew, Robinson, Eric, Sutin, Angelina R., Daly, Michael, and Jones, Andrew

Abstract

Background: Increases in mental health problems have been observed during the COVID-19 pandemic. The ob- jectives were to examine the extent to which mental health symptoms changed during the pandemic in 2020, whether changes were persistent or short lived, and if changes were symptom specific. Methods: Systematic review and meta-analysis of longitudinal cohort studies examining changes in mental health among the same group of participants before vs. during the pandemic in 2020. Results: Sixty-five studies were included. Compared to pre-pandemic outbreak, there was an overall increase in mental health symptoms observed during March-April 2020 (SMC = .102 [95% CI: .026 to .192]) that signifi- cantly declined over time and became non-significant (May-July SMC = .067 [95% CI: -.022 to .157]. Compared to measures of anxiety (SMC = 0.13, p = 0.02) and general mental health (SMC = -.03, p = 0.65), increases in depression and mood disorder symptoms tended to be larger and remained significantly elevated in May-July [0.20, 95% CI: .099 to .302]. In primary analyses increases were most pronounced among samples with phys- ical health conditions and there was no evidence of any change in symptoms among samples with a pre-existing mental health condition. Limitations: There was a high degree of unexplained heterogeneity observed (I2s > 90%), indicating that change in mental health was highly variable across samples. Conclusions: There was a small increase in mental health symptoms soon after the outbreak of the COVID-19 pandemic that decreased and was comparable to pre-pandemic levels by mid-2020 among most population sub-groups and symptom types.

Published
2022

2. A micro-Raman and X-ray study of erupted submarine pyroclasts from El Hierro (Spain) and its' astrobiological implications

Author

Ministerio de Economía y Competitividad (España), Ontario Centres of Excellence, Daly, Michael [0000-0002-3733-2530], Lalla, Emmanuel, Sanz-Arranz, Aurelio, López-Reyes, G., Cote, Kristen, Daly, Michael, Konstantinidis, Menelaos, Rodríguez-Losada, José A., Groemer, G., Medina, Jesús, Martínez-Frías, J., Rull, Fernando, Ministerio de Economía y Competitividad (España), Ontario Centres of Excellence, Daly, Michael [0000-0002-3733-2530], Lalla, Emmanuel, Sanz-Arranz, Aurelio, López-Reyes, G., Cote, Kristen, Daly, Michael, Konstantinidis, Menelaos, Rodríguez-Losada, José A., Groemer, G., Medina, Jesús, Martínez-Frías, J., and Rull, Fernando

Abstract

The pumice volcanic samples could have possible connections to the evolution of life and give us insight about their bio-geochemical processes related. In this regard, the samples from the volcanic eruption from La Restinga (El Hierro, Spain) in 2011 have been mainly studied by means of Raman spectroscopy. The research also includes analysis of XRD, Scanning Electron Microscopy and Optical Microscopy to support the Raman analysis. The results show that the Raman methods and mineral analyses are in strong agreement with the results obtained from other authors and techniques. The internal white foamy core (WFC) of the studied pumice samples shows amorphous silica, Fe-oxides, Ti-oxides, quartz, certain sulfates, carbonates, zeolites and organics. On the other hand, the external part (dark crust – DC) of these samples mainly presents primary-sequence mineralogy combined with some secondary alteration minerals such as olivine, feldspar, pyroxene, amorphous silica, and Fe-oxide. Raman spectroscopy detected other minerals not yet reported on these samples like barite, celestine and lepidocrocite. Also, the different chemometric and calibration methods for Raman spectroscopy in elemental composition, mineral classification and structural characterization has been successfully applied. From the astrobiological perspective, the research was also complemented with comparisons to other similar samples from terrestrial analogs. The main consideration was taking into account the proposed hypothesis regarding the potential behavior of the pumice as a substrate for the evolution of life. Furthermore, the detailed analysis from La Restinga eruption is coherent with the mineral phases and processes discussed from previous literature. The white internal part fulfills the conditions to work as an organic reservoir, confirmed by the detection of organic matter and selected minerals that could be used as energy sources for bacterial communities. The external layers of the samples work as

Published
2019

3. Trajectories of change in internalizing symptoms during the COVID-19 pandemic: A longitudinal population-based study

Author

Hyland, Philip, Vallières, Frédérique, Daly, Michael, Butter, Sarah, Bentall, Richard P., Fox, Robert, Karatzias, Thanos, MacLachlan, Malcolm, McBride, Orla, Murphy, Jamie, Murphy, David, Spikol, Eric, Shevlin, Mark, Hyland, Philip, Vallières, Frédérique, Daly, Michael, Butter, Sarah, Bentall, Richard P., Fox, Robert, Karatzias, Thanos, MacLachlan, Malcolm, McBride, Orla, Murphy, Jamie, Murphy, David, Spikol, Eric, and Shevlin, Mark

Abstract

Four distinct patterns of change in internalizing symptoms were identified, and the modal response was resilience.•71% of people experienced no change in internalizing symptoms during the pandemic. More people experienced improving (18%) than worsening (11%) internalizing symptoms during the pandemic. The majority of Irish adults have not experienced a negative mental health effect from the COVID-19 pandemic. Longitudinal data indicates that the mental health of the general population may not have been as badly affected by the COVID-19 pandemic as some had feared. Most studies examining change in mental health during the pandemic have assumed population homogeneity which may conceal evidence of worsening mental health for some. In this study, we applied a heterogeneous perspective to determine if there were distinct groups in the population characterised by different patterns of change in internalizing symptoms during the pandemic. Self-report data were collected from a nationally representative sample of Irish adults (N = 1041) at four time-points between April and December 2020. In the entire sample, mean levels of internalizing symptoms significantly declined from March to December 2020. However, we identified four distinct groups with different patterns of change. The most common response was ‘Resilience’ (66.7%), followed by ‘Improving’ (17.9%), ‘Worsening’ (11.3%), and ‘Sustained’ (4.1%). Belonging to the ‘Worsening’ class was associated with younger age, city dwelling, current and past treatment for a mental health problem, higher levels of empathy, and higher levels of loneliness. Sample attrition was relatively high and although this was managed using robust statistical methods, bias associated with non-responses cannot be entirely ruled out. The majority of adults experienced no change, or an improvement in internalizing symptoms during the pandemic, and a relatively small proportion of adults experienced a worsening of internalizing symptoms. Limited publ

Published
2021

4. Psychological distress and adaptation to the COVID-19 crisis in the United States

Author

Daly, Michael, Robinson, Eric, Daly, Michael, and Robinson, Eric

Abstract

There is growing concern that the COVID-19 crisis may have long-standing mental health effects across society particularly amongst those with pre-existing mental health conditions. In this observational population-based study, we examined how psychological distress changed following the emergence of the COVID-19 crisis in the United States and tested whether certain population subgroups were vulnerable to persistent distress during the crisis. We analyzed longitudinal nationally representative data from eight waves of the Understanding America Study (UAS) collected between March 10th and July 20th, 2020 (N = 7319 Observations = 46,145). Differences in distress trends were examined by age, sex, race/ethnicity, and household income and by the presence of a pre-existing mental health diagnosis. Psychological distress was assessed using the standardized total score on the Patient Health Questionnaire-4 (PHQ-4). On average psychological distress increased significantly by 0.27 standard deviations (95% CI [0.23,0.31], p < .001) from March 10–18 to April 1–14, 2020 as the COVID-19 crisis emerged and lockdown restrictions began in the US. Distress levels subsequently declined to mid-March levels by June 2020 (d = –0.31, 95% CI [–0.34, –0.27], p < .001). Across the sociodemographic groups examined and those with pre-existing mental health conditions we observed a sharp rise in distress followed by a recovery to baseline distress levels. This study identified substantial increases in distress in the US during the emergence of the COVID-19 crisis that largely diminished in the weeks that followed and suggests that population level resilience in mental health may be occurring in response to the pandemic.

Published
2021

5. Intergenerational social mobility predicts midlife well-being: Prospective evidence from two large British cohorts

Author

Bridger, Emma, Daly, Michael, Bridger, Emma, and Daly, Michael

Abstract

Rationale: It is often assumed that experiencing an upward shift in social position from one generation to the next will bring happiness, yet empirical evidence for this is limited. Objective: We provide a large-scale test of the relationship between intergenerational mobility and midlife life satisfaction using data from two prospective UK studies (N = 20,948). Method: Intergenerational mobility was modelled as a formative construct gauging the extent to which individuals moved up or down the social hierarchy compared to their parents, on a continuum ranging from high levels of downward mobility to high levels of upward mobility. Results: An intergenerational increase in social mobility, captured by greater educational attainment, social status, and home size than one’s parents was positively associated with life satisfaction at age 42 in both cohorts. Mediation analyses revealed that almost half of this relationship was explained by better self-reported health and fewer perceived financial difficulties amongst the upwardly mobile. Conclusion: This study provides evidence that enhanced satisfaction with life may be a key outcome of intergenerational increases in social status.

Published
2020

6. Perceived weight discrimination and performance in five domains of cognitive function

Author

Sutin, Angelina R., Stephan, Yannick, Gerend, Mary A., Robinson, Eric, Daly, Michael, Terracciano, Antonio, Sutin, Angelina R., Stephan, Yannick, Gerend, Mary A., Robinson, Eric, Daly, Michael, and Terracciano, Antonio

Abstract

Objective—Individuals who perceive unfair treatment because of their body weight have been found to be at increased risk of poor health outcomes, including risk of dementia. The present research examines the relation between weight discrimination and performance in five cognitive domains (episodic memory, speed-attention, visuospatial ability, language, numeric reasoning) and whether the associations extend to other common attributions for discrimination (age, gender, race). Method—Participants (N=2,593) were from the Harmonized Cognitive Assessment Protocol (HCAP) sub-study of the Health and Retirement Study (HRS). HCAP participants completed a battery of cognitive tasks that measured the five focal cognitive domains. Participants reported on their perceived experiences with discrimination at the previous regular HRS assessment. Results—In models that accounted for demographic covariates and BMI, weight discrimination (reported by 6% of participants) was associated with a two-fold increased risk of poor performance on tasks of episodic memory, speed-attention, visuospatial ability, and numeric reasoning. Body mass index was largely unrelated to performance in the five cognitive domains. The other attributions for discrimination were generally unrelated to cognition, but there were sexand race-specific associations for gender and race discrimination, respectively. Conclusions—The present study identified attribution- and domain-specific associations between discrimination and cognitive performance in older adulthood.

Published
2020

7. Body-related discrimination and dieting and substance use behaviors in adolescence

Author

Sutin, Angelina R., Stephan, Yannick, Robinson, Eric, Daly, Michael, Terracciano, Antonio, Sutin, Angelina R., Stephan, Yannick, Robinson, Eric, Daly, Michael, and Terracciano, Antonio

Abstract

Unfair treatment on the basis of a physical characteristic, such as body weight, is associated with unhealthy dieting behaviors in adolescence and adulthood and has also been implicated in substance use. Peer victimization is likewise associated with these health-risk behaviors. It is unclear, however, whether body discrimination is associated with these behaviors independent of peer victimization. The present research uses data from the Longitudinal Study of Australian Children (LSAC) to test the relation between body discrimination and dieting and substance use behaviors in adolescence and test whether the associations are independent of peer victimization, as well as depressive symptoms which are associated with both forms of victimization and health-risk behaviors. Participants (N = 2955) reported on body discrimination, dieting behaviors, and substance use at ages 14–15. Participants who experienced body discrimination were more likely to report fear of gaining weight, losing control over eating, going without eating, using medicine or vomiting to control their weight, engaging in restrained eating, and exercising to control their weight. They also had tried nicotine, alcohol, and marijuana. The associations with eating and alcohol use were independent of peer victimization, whereas the associations with smoking and marijuana were reduced when peer victimization was included in the model. All associations were also independent of depressive symptoms. Overall, the findings suggest that body discrimination is associated with harmful health behaviors at least as early as age 14.

Published
2020

8. Adolescent mental health and unemployment over the lifespan: population evidence from Sweden

Author

Mousteri, Victoria, Daly, Michael, Delaney, Liam, Tynelius, Per, Rasmussen, Finn, Mousteri, Victoria, Daly, Michael, Delaney, Liam, Tynelius, Per, and Rasmussen, Finn

Abstract

Rationale: Symptoms of mental health problems have been shown to predict adverse labour market outcomes including unemployment, but no studies have used sibling models to examine the relationship between clinically diagnosed psychiatric conditions in adolescence and subsequent unemployment. Objective: This study used extensive Swedish registry data to investigate the link between psychiatric conditions diagnosed during military conscription and unemployment over two decades. Further, we identified whether this relation was amplified during an economic downturn and tested whether it was affected by adjustment for unobserved family characteristics using sibling fixed-effects models. Method: Psychiatric conditions were diagnosed by psychologists and psychiatrists at military conscription in sample of 929,191 Swedish men (mean age = 18.4 years) between 1969 and 1989. The average number of days unemployed per year was observed from 1992 to 2012, using the records of the Swedish Public Employment Services. Results: After adjustment for physical health and childhood socioeconomic status those diagnosed with any psychiatric condition experienced approximately an additional 10 days per year unemployment compared to others. Alcohol (16 days unemployment) and other substance use disorders (17 days) were the strongest predictors of exposure to future unemployment, followed by personality disorders (10 days), neurotic and adjustment conditions (nine days), and depressive disorders (six days). Family background factors accounted for approximately half of the observed relationship between mental health conditions and unemployment. Psychiatric conditions interacted with macroeconomic conditions such that those with pre-existing alcohol-related, and neurotic and adjustment disorders were disproportionately more likely to become unemployed following the 1990s crisis in Sweden. Conclusions: Adolescent mental health conditions forecast an elevated risk of unemployment, which endures ov

Published
2019

9. The intra-day dynamics of affect, self-esteem, tiredness, and suicidality in Major Depression

Author

Crowe, Eimear, Daly, Michael, Delaney, Liam, Carroll, Susan, Malone, Kevin M., Crowe, Eimear, Daly, Michael, Delaney, Liam, Carroll, Susan, and Malone, Kevin M.

Abstract

Despite growing interest in the temporal dynamics of Major Depressive Disorder (MDD), we know little about the intra-day fluctuations of key symptom constructs. In a study of momentary experience, the Experience Sampling Method captured the within-day dynamics of negative affect, positive affect, self-esteem, passive suicidality, and tiredness across clinical MDD (N= 31) and healthy control groups (N= 33). Ten symptom measures were taken per day over 6 days (N= 2231 observations). Daily dynamics were modeled via intra-day time-trends, variability, and instability in symptoms. MDD participants showed significantly increased variability and instability in negative affect, positive affect, self-esteem, and suicidality. Significantly different time-trends were found in positive affect (increased diurnal variation and an inverted U-shaped pattern in MDD, compared to a positive linear trend in controls) and tiredness (decreased diurnal variation in MDD). In the MDD group only, passive suicidality displayed a negative linear trend and self-esteem displayed a quadratic inverted U trend. MDD and control participants thus showed distinct dynamic profiles in all symptoms measured. As well as the overall severity of symptoms, intra-day dynamics appear to define the experience of MDD symptoms.

Published
2019

10. Does perceived overweight increase risk of depressive symptoms and suicidality beyond objective weight status? A systematic review and meta-analysis.

Author

Haynes, Ashleigh, Kersbergen, Inge, Sutin, Angelina R., Daly, Michael, Robinson, Eric, Haynes, Ashleigh, Kersbergen, Inge, Sutin, Angelina R., Daly, Michael, and Robinson, Eric

Abstract

Obesity is associated with a significant disease burden, but whether recognising as opposed to failing to recognise personal overweight is beneficial or detrimental to mental health is unclear. Here we examine the associations between perceived overweight and depressive symptoms and suicidality. A systematic search of three electronic databases yielded 10,398 unique records, from which 32 studies (110 observations) were eligible for inclusion. Pooled odds ratios (OR) and 95% confidence intervals (CI) were calculated for each outcome using random effects meta-analyses and potential publication bias was examined. Perceived overweight was associated with an increased risk of depressive symptoms (OR: 1.42, CI: 1.31, 1.54 p <.0001, N >128,585) and suicidality (OR: 1.41, CI: 1.28, 1.56, p <.0001, N = 133,576) in both cross-sectional and longitudinal studies. The association between perceived overweight and poorer mental health was observed irrespective of study origin, participant age (children vs. adults), gender, and whether or not a person was objectively overweight. The pooled statistical relationship between objective weight status and poorer mental health was attenuated to non-significance when perceived overweight was accounted for, suggesting that the detrimental effect of overweight on mental health is largely dependent on whether or not a person identifies as overweight.

Published
2019

11. Childhood self-control and adult pension participation

Author

Egan, Mark, Delaney, Liam, and Daly, Michael

Subjects
Retirement, Self-control, Pension, Cohort studies
Abstract

Self-control problems have been proposed as a key reason for low pension saving rates, yet evidence of this link remains scarce. We test the association between childhood self-control and adult pension participation using data from 14,223 individuals from two nationally-representative British cohorts. We find that a 1 standard deviation increase in self-control predicts a 4–5 percentage point higher probability of having a pension. Mediation analysis shows that about 50–60 percent of this association is explained by the contribution of self-control to a range of factors (e.g. education, economic status, home-ownership) which are associated with pension uptake throughout adulthood.

Published
2017

12. The scarring effect of unemployment on psychological well-being across Europe

Author

Mousteri, Victoria, Daly, Michael, Delaney, Liam, Mousteri, Victoria, Daly, Michael, and Delaney, Liam

Abstract

Past unemployment may have a pervasive psychological impact that occurs across nations. We investigate the association between unemployment events across working life and subsequent psychological well-being across 14 European countries. Additionally, we consider the influence of between-country differences in labour market institutions and conditions on the cross-country well-being effects of unemployment. Data detailing life-long employment trajectories and contemporary life conditions are drawn from the Survey of Health, Ageing and Retirement in Europe. The well-being impact of unemployment is modeled using linear, multi-level specifications. Each six-month spell of past unemployment is found to predict reduced quality of life and life satisfaction after the age of 50, having adjusted for a broad range of individual and country-specific covariates. In contrast, the impact of past unemployment on depression is explained by individual demographic factors. We identify the first comparative long-term evidence that unemployment welfare scarring may be a broad, international phenomenon.

Published
2018

13. Synthesis and characterization of high density polyethylene / peat ash composites

Author

Cao, Zhi, Daly, Michael, Geever, Luke M., Higginbotham, Clement L., and Devine, Declan M.

Subjects
Polymer composites, Polyethylene, Materials Research Institute AIT, Compantibilizer, Peat ash
Abstract

A new type of polymer composite was synthesized from one industrial waste, peat ash, at varying mixing ratios of high density polyethylene (HDPE) and the resulting products were characterized using different experiments included fourier transform infrared spectroscopy (FTIR), scanning electron microscopy (SEM), melt flow index (MFI), density, wettability, tensile test, flexural test and cost analysis. The effects of various ash loads and the use of the maleic anhydride grafted high density polyethylene (HDPE-g-MA) compatibilizer on the physical and mechanical properties of composites were investigated. It was observed that the utilization of peat ash significantly increases the tensile strengths and the flexural modulus, also reduces the cost. Higher peat ash ratios generally lead to higher tensile, flexural strengths and lower cost. Incorporating (HDPE-g-MA) in the composites formulation led to a significant increase in tensile and flexural properties. Conversely, there was a significant decrease of impact strength found for all composites in comparison to the virgin HDPE. And the impact strengths generally decrease as peat ash content increases. Microstructural analysis showed that surface treated peat ash particles appeared to be incorporated into the HDPE matrix as less debonding and voids were observed. In addition, the melt flow ability of the composites decreased remarkably with an increase in peat ash content. No significant water uptake effect was detected on peat ash composites indicating that these materials could be used as a direct replacement for HDPE in applications where impact strength is no a critical factor. Furthermore, due to the heavier components of peat ash and lack of the voids between filler and matrix, the use of peat ash increased the composite density in comparison to HDPE. Nevertheless, as peat ash reinforcement does offer increased tensile and flexural properties, this may make the end product lighter as lower wall thickness parts can be used to fulfil the same function. From this study, it was concluded that the utilization of the peat ash from peat fired power stations has proved to have significant value-added potential as a filler material in polymer composites. yes

Published
2016

14. Characteristics of the treated calcium carbonate particles with stearic acid using different treating methods

Author

Cao, Zhi, Daly, Michael, Clémence, Lopez, Major, Ian, Higginbotham, Clement L., and Devine, Declan M.

Subjects
Treatment method, Void content, Materials Research Institute AIT, Calcium carbonate, Stearic acid
Abstract

Calcium carbonate (CaCO3) is often treated with stearic acid (SA) to decrease its polarity. However, the method of application of the SA treatments has a strong influence on their interface structure and distribution. Several of papers describe the promising effects of SA surface treatment, but few compare the treatment process and its effect on the properties of the final composite. In the current study, we assessed a new SA treatment method, namely, combination treatment for polymer composite fabrication with HDPE. Subsequently, a comparative study was performed between the “combination” process and the other existing methods. The composites were assessed using different experiments included scanning electron microscopy (SEM), void content, density, wettability, differential scanning calorimetry (DSC), and tensile tests. It was observed that the “combination” surface treatment yielded composites with a significantly lower voids content and higher density compared to other surface treatments. This indicates that the “combination” treatment process can bring the CaCO3 particles and HDPE matrix much closer together than other methods. DSC and wettability results suggest that the “wet” and “combination” treated CaCO3 composites had a significantly higher heat of fusion and moisture resistance compared to the “dry” treated CaCO3 composites. Furthermore, “wet” and “combination” treated CaCO3 composites have a significantly higher tensile strength than the composites containing untreated and “dry” treated CaCO3. This is mainly because the “wet” and “combination” treatment processes have increased adsorption density of stearate, which enhances the interfacial interaction between matrix and filler. These results confirm that the chemical adsorption of the surfactant ions at solid-liquid interface is higher than at other interface. From this study it was concluded that the utilization of the “combination” method minimised the negative effects of void coalescence should provide key information for the improvement of existing processes.

Published
2016

15. Childhood General Cognitive Ability Predicts Leadership Role Occupancy: Evidence from Two British Cohort Studies

Author

Daly, Michael, Egan, Mark, and O'Reilly, Fionnuala

Subjects
Leadership role occupancy, Intelligence, Individual differences, General cognitive ability, Longitudinal research
Abstract

Research in the leadership literature has not yet identified links between childhood general cognitive ability and leadership potential in adulthood. We tested whether early cognitive ability contributed to leadership role occupancy across four decades in a sample of 17,000 working individuals from two representative British cohorts. On average a 1 standard deviation increase in cognitive ability predicted a 6.2 percentage point higher probability of leadership role occupancy. In Study 1, adjusted models showed that 37.3% of high cognitive ability children (+1SD) occupied leadership positions compared to 25.4% of low cognitive ability (-1SD) children and this gap was even more pronounced in Study 2 (27.8% vs. 15.1%). Cognitive ability showed a graded association with the number of employees supervised in both studies and educational attainment partially explained the cognitive ability-leadership association. The results suggest that early individual differences in childhood general cognitive ability may profoundly shape trajectories of leadership across working life.

Published
2015

16. Childhood self-control and adult pension participation

Author

Lades, Leonhard K., Egan, Mark, Delaney, Liam, Daly, Michael, Lades, Leonhard K., Egan, Mark, Delaney, Liam, and Daly, Michael

Abstract

Self-control problems have been proposed as a key reason for low pension saving rates, yet evidence of this link remains scarce. We test the association between childhood self-control and adult pension participation using data from 14,223 individuals from two nationally-representative British cohorts. We find that a 1 standard deviation increase in self-control predicts a 4–5 percentage point higher probability of having a pension. Mediation analysis shows that about 50–60 percent of this association is explained by the contribution of self-control to a range of factors (e.g. education, economic status, home-ownership) which are associated with pension uptake throughout adulthood.

Published
2017

17. Influencing green behaviour through environmental goal-priming: The mediating role of automatic evaluation

Author

Tate, Kelly, Stewart, Andrew, and Daly, Michael

Subjects
environmental behaviours, goal priming, implicit attitudes, automatic evaluation, consumer behaviour, Environment
Abstract

Understanding how pro-environmental messages may influence behaviour is key to promoting sustainable consumer choice. Research suggests that people automatically evaluate objects as a function of their instrumentality to satisfying active goals. We hypothesized that priming an environmental-protection goal through exposure to a pro-environmental message would produce more positive automatic evaluations and lead people to make the pro-environmental choice of selecting loose rather than packaged products in a hypothetical choice task. As predicted, those primed with an environmental-protection goal automatically evaluated loose products more positively and selected more loose consumer products than a control group. Increased implicit positivity towards loose products mediated the observed behaviour change. Crucially, the effect of environmental goal priming on choices or implicit attitudes towards packaging was not contingent on existing environmental attitudes. Our findings suggest that pro-environmental messages could induce more environmentally friendly consumer choice by leading people to evaluate readily available goal-relevant stimuli positively.

Published
2014

18. Adolescent psychological distress, unemployment, and the Great Recession: Evidence from the National Longitudinal Study of Youth 1997

Author

Egan, Mark, Daly, Michael, Delaney, Liam, Egan, Mark, Daly, Michael, and Delaney, Liam

Abstract

Rationale: Several studies have shown a link between psychological distress in early life and subsequent higher unemployment, but none have used sibling models to account for the unobserved family back- ground characteristics which may explain the relationship. Objective: This paper uses the National Longitudinal Study of Youth 1997 data to examine whether adolescent psychological distress in 2000 predicts higher unemployment over 2000e11, whether this relationship changed in the period following the Great Recession, and whether it is robust to adjustment for family effects. Methods: 7125 cohort members (2986 siblings) self-reported their mental health in 2000 and employ- ment activities over 2000e11. This association was examined using Probit and ordinary least squares regressions controlling for intelligence, physical health, other sociodemographic characteristics and family background. Results: After adjustment for covariates and compared to those with low distress, highly distressed adolescents were 2.7 percentage points (32%) more likely to be unemployed, 5.1 points (26%) more likely to be unemployed or out of the labor force and experienced 11 weeks (28%) more unemployment. The impact of high distress was similar to a one standard deviation decrease in intelligence, and double the magnitude of having a serious physical health problem, and these estimates were robust to adjustment for family fixed-effects. The highly distressed were also disproportionately more likely to become un- employed or exit the labor force in the years following the Great Recession. Conclusion: These findings provide strong evidence of the unemployment penalty of early-life psycho- logical distress and suggest that this relationship may be intensified during economic recessions. Investing in mental health in early life may be an effective way to reduce unemployment.

Published
2016

19. Intraoperative surgical navigation improves margin status in advanced malignancies of the anterior craniofacial area: A prospective observational study with systematic review of the literature and meta-analysis.

Author

Ferrari M, Gaudioso P, Taboni S, Contro G, Roccuzzo G, Costantino P, Daly MJ, Chan HHL, Fieux M, Ruaro A, Maroldi R, Signoroni A, Deganello A, Irish JC, Carsuzaa F, and Nicolai P

Abstract

The current scientific evidence suggests that surgical navigation (SN) can contribute to improve oncologic outcomes in sinonasal and craniofacial surgery. The present study investigated the feasibility of intraoperative SN and its role in improving the outcomes of surgically treated sinonasal and craniofacial tumors. This prospective study compared navigation-guided surgery for sinonasal or craniofacial malignancies with a pair-matched cohort (1:2 matching) of patients operated without SN. A systematic review of the literature was performed. Thirty-five patients who underwent navigation-guided surgery were included. The pair-matched control cohort included 70 patients operated without SN. The margin status analysis demonstrated a lower rate of positive margins (p = 0.013) in the SN group, especially in pT4 (p = 0.034), recurrent (p = 0.024), high-grade tumors (p = 0.043), and endoscopic-assisted open surgery (p = 0.035). The mean preoperative time did not show a significant difference between surgeries performed with or without SN (1.26 vs. 1.23 h, p = 0.445). However, surgeries utilizing SN had a significantly longer median duration compared to those without (8.10 vs. 6.00 h, p = 0.029). A total of 209 patients were included in the meta-analysis; 91 patients (43.5 %) underwent surgery with SN. The results of the meta-analysis showed an improvement in terms of negative margins rate with the use of SN (OR = 2.62; 95%-confidence interval: 1.33-5.17). In conclusion, intraoperative SN can contribute to achieve a clear margin resection, especially in locally advanced tumors, recurrences, highly aggressive histologies, and when endoscopic-assisted open surgery is employed., Competing Interests: Declaration of conflicting interests As of April 2024, Dr. Marco Ferrari and Prof. Piero Nicolai are members of an advisory board on the use of steroid-eluting resorbable stents (Propel®) distributed by the same vendor of the navigation system used in the present study (Medtronic®). Other author(s) declared no potential conflicts of interest concerning the research, authorship, and/or publication of this article., (Copyright © 2024 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Published
2024
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20. Development of a cadaveric head and neck cancer model and three-dimensional analysis of margins in surgical navigation-aided ablations.

Author

Ferrari M, Taboni S, Carobbio ALC, Buffoli B, Rampinelli V, Mattavelli D, Schreiber A, Verzeletti V, Ravanelli M, Daly MJ, Chan HHL, Sahovaler A, Franz L, Gualtieri T, Rezzani R, Maroldi R, Signoroni A, Deganello A, Irish JC, and Nicolai P

Subjects
Cadaver, Humans, Margins of Excision, Reproducibility of Results, Head and Neck Neoplasms surgery, Surgery, Computer-Assisted methods
Abstract

Introduction: The adequacy of the surgical resection is the main controllable variable that is in the hands of the surgical team. There exists an unmet need to increase the rate of negative margins, particularly in cancers invading the craniofacial area. The study aimed 1) at developing a gross tumor model to be utilized for research, educational, and training purposes and 2) establishing the 3-dimensional relationship between the outer surface of the surgical specimen and tumor surface and test the effect of guiding ablations on cadavers with surgical navigation (SN)., Material and Methods: Seven cadaver heads were employed to create 24 craniofacial tumor models. Simulation of tumor resections was performed by 8 surgeons. Fourteen and 10 resections were performed with and without SN-guidance, respectively. Gross specimens underwent computed tomography and 3-dimensional analysis through dedicated software. Task load was assessed through a validated questionnaire. Tumor model reliability was studied based on visual analogue scale rate by surgeons and radiologists., Results: SN reduced the rate of margin involvement, particularly by decreasing the percentage of the gross specimen outer surface involvement in areas uncovered by normal bony structures. The workload of SN-aided ablations was found to be medium-to-somewhat-high. Tumor model reliability was deemed satisfactory except for the extension to bony structures., Conclusions: A gross tumor model for head and neck cancers involving the craniofacial area was developed and resulted satisfactorily reliable from both a surgical and radiologic standpoint. SN reduced the rate of margin involvement, particularly by improving delineation of bone-uncovered areas., (Copyright © 2021 Elsevier Ltd, BASO ~ The Association for Cancer Surgery, and the European Society of Surgical Oncology. All rights reserved.)

Published
2022
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21. Projected cutting guides using an augmented reality system to improve surgical margins in maxillectomies: A preclinical study.

Author

H L Chan H, Sahovaler A, Daly MJ, Ferrari M, Franz L, Gualtieri T, Tzelnick S, Eu D, Manojlovic-Kolarski M, Berania I, Orzell S, de Almeida JR, Goldstein DP, Nicolai P, Gilbert RW, and Irish JC

Subjects
Humans, Imaging, Three-Dimensional, Margins of Excision, Osteotomy methods, Augmented Reality, Paranasal Sinuses, Surgery, Computer-Assisted methods
Abstract

Background: Positive margins have been reported up to 80% in advanced maxillary cancers. Intraoperative navigation (IN) aims to improve margins, but provides a two-dimensional view of a registered instrument without anticipating any cutting directions, and the information is displayed in monitors outside surgical field. Augmented Reality (AR) can delineate margins while addressing the gaze-toggling drawback of IN. In a preclinical setting, we implemented preoperative-planned osteotomies needed for maxillectomies and projected this information on the surgical field using AR. We aimed to improve negative margin rates while retaining the benefits of AR., Methods: Five maxillary tumor models were built. Five fellowship-trained surgeons completed virtual unguided and AR-guided maxillectomies. Comparisons in terms of intratumoral cuts, close, adequate, and excessive distances from the tumor were performed. Differences between "ideal" cutting-plan and the AR-guided virtual osteotomies was obtained. Workload questionnaires to evaluate the technology were completed., Results: 115 virtual osteotomies were analyzed. Intra-tumoral and "close" margins were lower for the AR-assisted osteotomies (0.0% vs 1.9% p < 0.0001 and 0.8% vs 7.9% p < 0.0001). Proportion of "adequate" margins were higher in the AR simulations (25.3% vs 18.6%, p = 0.018). The AR osteotomies had high similarity with the pre-planned with interclass correlation index close to 1 in "adequate" margins 0.893 (95% CI: 0.804-0.949). Workload scores were better for AR-guided simulations for the domains of mental demand, performance, effort and frustration., Conclusion: The projector-based AR method improved margin delineation, and preoperative planning was accurately translated to the simulations. Clinical translation will aim to consolidate our preclinical findings to improve outcomes., (Copyright © 2022 Elsevier Ltd. All rights reserved.)

Published
2022
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22. Cross-national and longitudinal evidence for a rapid decline in life satisfaction in adolescence.

Author

Daly M

Subjects
Adolescent, Child, Female, Humans, Longitudinal Studies, Male, Surveys and Questionnaires, Personal Satisfaction, Schools
Abstract

Introduction: While several studies have documented a declining-with-age trend in life satisfaction in adolescence, cross-national and nationally representative longitudinal evidence is needed to establish the normative trajectory of life satisfaction during this critical developmental period., Methods: The Health Behaviour in School-Aged Children (HBSC) study of 10-16-year-olds included the Cantril Ladder life satisfaction measure in surveys of 43 countries between 2001 and 2014 (N = 752,620, 51% females). The UK Household Longitudinal Study (UKHLS) was used to assess within-person changes in life satisfaction from age 10 to 15 years among young people sampled between 2009 and 2018 (N = 8952, Obs. = 30,278)., Results: Life satisfaction decreased by 0.61 SDs on average from ages 10 to 16 in the HBSC sample. A statistically significant decreasing-with-age trend was observed in each of the 43 countries examined. Females experienced a more pronounced decline in life satisfaction than males (0.75 SD vs. 0.46) on average, and a significantly larger decrease in life satisfaction among females was identified in 38 of 43 countries examined. Longitudinal analysis of adolescents from the UKHLS sample replicated this pattern: life satisfaction declined significantly by 0.5 SD between the ages of 10 and 15 and this decline was found to be steeper for females (0.76 SD) than for males (0.23SD)., Conclusions: The study findings enhance our understanding of the lifespan dynamics of life satisfaction and point to a potential universal decline in life satisfaction in adolescence. Understanding the developmental processes underlying this phenomenon will now be crucial., (© 2022 The Authors. Journal of Adolescence published by Wiley Periodicals LLC on behalf of Foundation for Professionals in Services to Adolescents.)

Published
2022
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23. Prevalence of Depression Among Adolescents in the U.S. From 2009 to 2019: Analysis of Trends by Sex, Race/Ethnicity, and Income.

Author

Daly M

Subjects
Adolescent, Child, Depression epidemiology, Female, Humans, Income, Prevalence, Depressive Disorder, Major epidemiology, Ethnicity
Abstract

Purpose: Major depression is a leading cause of disability and represents a significant health concern for adolescents. Evidence of temporal trends in adolescent depression stratified by sociodemographic characteristics is needed., Methods: This study drew on 11 years of the National Survey on Drug Use and Health (N = 167,783), a nationally representative survey of adolescents aged 12-17 years conducted between 2009 and 2019., Results: The prevalence of past-year major depressive episode (MDE) increased by 7.7 percentage points from 8.1% to 15.8% between 2009 and 2019. MDE increased by 12 percentage points from 11.4% to 23.4% among girls. The gender difference in the prevalence of MDE increased from 6.4% to 14.8% between 2009 and 2019. Black participants experienced a comparatively small increase in depression (4.1%)., Conclusions: Since 2009 there has been a sharp and sustained increase in depression among adolescent girls in the U.S. This concerning trend highlights the critical importance of directing prevention and intervention efforts toward this group., (Copyright © 2021 Society for Adolescent Health and Medicine. Published by Elsevier Inc. All rights reserved.)

Published
2022
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24. Depression and anxiety during COVID-19.

Author

Daly M and Robinson E

Subjects
Anxiety etiology, Anxiety Disorders etiology, Humans, SARS-CoV-2, COVID-19, Depression etiology
Abstract

Competing Interests: We declare no competing interests.

Published
2022
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25. Assessment of a liposomal CT/optical contrast agent for image-guided head and neck surgery.

Author

Muhanna N, Eu D, Chan HH, Daly M, Fricke IB, Douglas CM, Townson JL, Zheng J, Allen C, Jaffray DA, and Irish JC

Subjects
Animals, Biomarkers, Tumor metabolism, Cone-Beam Computed Tomography, Fluorescence, Head and Neck Neoplasms pathology, Injections, Liposomes administration & dosage, Liposomes pharmacokinetics, Lymph Nodes diagnostic imaging, Lymph Nodes pathology, Rabbits, X-Ray Microtomography, Contrast Media chemistry, Head and Neck Neoplasms surgery, Optical Imaging, Surgery, Computer-Assisted, Tomography, X-Ray Computed
Abstract

This study evaluates a long-acting liposomal fluorescence / CT dual-modality contrast agent (CF800) in head and neck cancer to enhance intraoperative tumor demarcation with fluorescence imaging and cone-beam computed tomography (CBCT). CF800 was administered to 12 buccal cancer-bearing rabbits. Imaging was acquired at regular time points to quantify time-dependent contrast enhancement. Surgery was performed 5-7 days after, with intraoperative near-infrared fluorescence endoscopy and CBCT, followed by histological and ex-vivo fluorescence assessment. Tumor enhancement on CT was significant at 24, 96 and 120 hours. Volumetric analysis of tumor segmentation showed high correlation between CBCT and micro-CT. Fluorescence signal was apparent in both ex-vivo and in-vivo imaging. Histological correlation showed [100%] specificity for primary tumor. Sensitivity and specificity of CF800 in detecting nodal involvement require further investigation.CF800 is long acting and has dual function for CT and fluorescence contrast, making it an excellent candidate for image-guided surgery., (Copyright © 2020 Elsevier Inc. All rights reserved.)

Published
2021
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26. Leech Therapy Following Digital Replantation and Revascularization.

Author

Pickrell BB, Daly MC, Freniere B, Higgins JP, Safa B, and Eberlin KR

Subjects
Animals, Fingers surgery, Humans, Replantation, Amputation, Traumatic surgery, Leeches, Leeching
Abstract

Venous congestion after digital replantation or revascularization threatens digit survival in the immediate postoperative period. External bloodletting, including leech therapy, provides a central role in salvage of the congested finger. Although there have been previous studies describing the initiation of leech therapy for digits experiencing venous insufficiency, few published articles and no consensus guidelines have discussed the weaning of leeches in the postoperative period. We review the current evidence behind leech therapy and offer a treatment algorithm based on available data and existing leech weaning protocols., (Copyright © 2020 American Society for Surgery of the Hand. Published by Elsevier Inc. All rights reserved.)

Published
2020
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27. Outcomes of Late Microsurgical Nerve Reconstruction for Brachial Plexus Birth Injury.

Author

Daly MC, Bauer AS, Lynch H, Bae DS, and Waters PM

Subjects
Female, Humans, Infant, Male, Range of Motion, Articular, Treatment Outcome, Birth Injuries surgery, Brachial Plexus injuries, Brachial Plexus surgery, Brachial Plexus Neuropathies surgery, Nerve Transfer
Abstract

Purpose: Microsurgical nerve reconstruction has been advocated between 3 and 9 months of life in select patients with brachial plexus birth injury (BPBI), yet some patients undergo indicated surgery after this time frame. Outcomes in these older patients remain poorly characterized. We analyzed outcomes of nerve reconstruction performed after 9 months of age and hypothesized that (1) Active Movement Scale (AMS) scores improve after surgery, and (2) there are no differences in AMS scores between patients undergoing nerve transfers versus those undergoing nerve grafting., Methods: From 2000 to 2014, 750 patients at 6 U.S. centers were prospectively enrolled in a multicenter database. We included patients treated with nerve reconstruction after 9 months of age with minimum 12 months' follow-up. Patients were evaluated using AMS scores. To focus on the results of microsurgery, only outcomes prior to secondary surgery were analyzed. We analyzed baseline variables using bivariate statistics and change in AMS scores over time and across treatment groups using linear mixed models., Results: We identified 32 patients (63% female) with median follow-up of 29.8 months. Median age at microsurgery was 11.2 months. Twenty-five (78%) had an upper trunk injury. Compared with before surgery, total AMS scores improved modestly at 1 year and 2 or more years follow-up. At 1 year follow-up, AMS scores improved for shoulder function (abduction, external rotation) and elbow flexion. Between-group comparisons found no differences in total AMS scores or AMS subscales between graft and transfer groups at 1 year or 2 or more years after surgery, so we cannot recommend one strategy over the other based on our findings., Conclusions: Overall, nerve reconstruction in patients with BPBI after 9 months of age resulted in improved function over time. There was no difference in outcomes between nerve transfer and nerve graft groups and 1 or 2 or more years follow-up., Type of Study/level of Evidence: Therapeutic IV., (Copyright © 2020 American Society for Surgery of the Hand. Published by Elsevier Inc. All rights reserved.)

Published
2020
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28. Navigation-guided osteotomies improve margin delineation in tumors involving the sinonasal area: A preclinical study.

Author

Ferrari M, Daly MJ, Douglas CM, Chan HHL, Qiu J, Deganello A, Taboni S, Thomas CM, Sahovaler A, Jethwa AR, Hasan W, Nicolai P, Gilbert RW, and Irish JC

Subjects
Female, Humans, Male, Margins of Excision, Osteotomy methods, Paranasal Sinuses surgery
Abstract

Objectives: To demonstrate and quantify, in a preclinical setting, the benefit of three-dimensional (3D) navigation guidance for margin delineation during ablative open surgery for advanced sinonasal cancer., Materials and Methods: Seven tumor models were created. 3D images were acquired with cone beam computed tomography, and 3D tumor segmentations were contoured. Eight surgeons with variable experience were recruited for the simulation of osteotomies. Three simulations were performed: 1) Unguided, 2) Guided using real-time tool tracking with 3D tumor segmentation (tumor-guided), and 3) Guided by 3D visualization of both the tumor and 1-cm margin segmentations (margin-guided). Analysis of cutting planes was performed and distance from the tumor surface was classified as follows: "intratumoral" when 0 mm or negative, "close" when greater than 0 mm and less than or equal to 5 mm, "adequate" when greater than 5 mm and less than or equal to 15 mm, and "excessive" over 15 mm. The three techniques (unguided, tumor-guided, margin-guided) were statistically compared., Results: The use of 3D navigation for margin delineation significantly improved control of margins: unguided cuts had 18.1% intratumoral cuts compared to 0% intratumoral cuts with 3D navigation (p < 0.0001)., Conclusion: This preclinical study has demonstrated the significant benefit of navigation-guided osteotomies for sinonasal tumors. Translation into the clinical setting - with rigorous assessment of oncological outcomes - would be the proposed next step., (Copyright © 2019 Elsevier Ltd. All rights reserved.)

Published
2019
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29. Localization of pulmonary nodules using navigation bronchoscope and a near-infrared fluorescence thoracoscope.

Author

Anayama T, Qiu J, Chan H, Nakajima T, Weersink R, Daly M, McConnell J, Waddell T, Keshavjee S, Jaffray D, Irish JC, Hirohashi K, Wada H, Orihashi K, and Yasufuku K

Subjects
Animals, Bronchoscopes, Coloring Agents, Fluorescence, Indocyanine Green, Swine, Thoracoscopes, Bronchoscopy methods, Multiple Pulmonary Nodules pathology, Thoracoscopy methods
Abstract

Background: Video-assisted thoracoscopic wedge resection of multiple small, non-visible, and nonpalpable pulmonary nodules is a clinical challenge. We propose an ultra-minimally invasive technique for localization of pulmonary nodules using the electromagnetic navigation bronchoscope (ENB)-guided transbronchial indocyanine green (ICG) injection and intraoperative fluorescence detection with a near-infrared (NIR) fluorescence thoracoscope., Methods: Fluorescence properties of ICG topically injected into the lung parenchyma were determined using a resected porcine lung. The combination of ENB-guided ICG injection and NIR fluorescence detection was tested using a live porcine model. An electromagnetic sensor integrated flexible bronchoscope was geometrically registered to the three-dimensional chest computed tomographic image data by way of a real-time electromagnetic tracking system. The ICG mixed with iopamidol was injected into the pulmonary nodules by ENB guidance; ICG fluorescence was visualized by a near-infrared (NIR) thoracoscope., Results: The ICG existing under 24-mm depth of inflated lung was detectable by the NIR fluorescence thoracoscope. The size of the fluorescence spot made by 0.1 mL of ICG was 10.4 ± 2.2 mm. An ICG or iopamidol spot remained at the injected point of the lung for more than 6 hours in vivo. The ICG fluorescence spot injected into the pulmonary nodule with ENB guidance was identified at the pulmonary nodule with the NIR thoracoscope., Conclusions: The ENB-guided transbronchial ICG injection and intraoperative NIR thoracoscopic detection is a feasible method to localize multiple pulmonary nodules., (Copyright © 2015 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.)

Published
2015
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31. Death by protein damage in irradiated cells.

Author

Daly MJ

Subjects
Cell Death radiation effects, Cells metabolism, Deinococcus genetics, Deinococcus radiation effects, Oxidation-Reduction radiation effects, Cells cytology, Cells radiation effects, Proteins metabolism, Proteins radiation effects, Radiation, Ionizing
Abstract

A founding concept of radiobiology that deals with X-rays, γ-rays and ultraviolet light is that radiation indiscriminately damages cellular macromolecules. Mounting experimental evidence does not fit into this theoretical framework. Whereas DNA lesion-yields in cells exposed to a given dose and type of radiation appear to be fixed, protein lesion-yields are highly variable. Extremely radiation resistant bacteria such as Deinococcus radiodurans have evolved extraordinarily efficient antioxidant chemical defenses which specifically protect proteins and the functions they catalyze. In diverse prokaryotes, the lethal effects of radiation appear to be governed by oxidative protein damage, which inactivates enzymes including those needed to repair and replicate DNA. These findings offer fresh insight into the molecular mechanisms of radiation resistance and present themselves as new opportunities to study and control oxidative stress in eukaryotes, including mammalian cells and their cancer cell counterparts., (Published by Elsevier B.V.)

Published
2012
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32. Multiple uracil-DNA glycosylase activities in Deinococcus radiodurans.

Author

Sandigursky M, Sandigursky S, Sonati P, Daly MJ, and Franklin WA

Subjects
Cloning, Molecular, DNA, Bacterial metabolism, Hot Temperature, Uracil-DNA Glycosidase, DNA Glycosylases metabolism, Deinococcus enzymology, Uracil metabolism
Abstract

The extremely radiation resistant bacterium, Deinococcus radiodurans, contains a spectrum of genes that encode for multiple activities that repair DNA damage. We have cloned and expressed the product of three predicted uracil-DNA glycosylases to determine their biochemical function. DR0689 is a homologue of the Escherichia coli uracil-DNA glycosylase, the product of the ung gene; this activity is able to remove uracil from a U : G and U : A base pair in double-stranded DNA and uracil from single-stranded DNA and is inhibited by the Ugi peptide. DR1751 is a member of the class 4 family of uracil-DNA glycosylases such as those found in the thermophiles Thermotoga maritima and Archaeoglobus fulgidus. DR1751 is also able to remove uracil from a U : G and U : A base pair; however, it is considerably more active on single-stranded DNA. Unlike its thermophilic relatives, the enzyme is not heat stable. Another putative enzyme, DR0022, did not demonstrate any appreciable uracil-DNA glycosylase activity. DR0689 appears to be the major activity in the organism based on inhibition studies with D. radiodurans crude cell extracts utilizing the Ugi peptide. The implications for D. radiodurans having multiple uracil-DNA glycosylase activities and other possible roles for these enzymes are discussed.

Published
2004
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33. Spinal cord stimulator adjustment to maximize implanted battery longevity: a randomized, controlled trial using a computerized, patient-interactive programmer.

Author

North RB, Brigham DD, Khalessi A, Calkins SK, Piantadosi S, Campbell DS, Daly MJ, Dey PB, Barolat G, and Taylor R

Abstract

Internally powered, implanted pulse generators (IPGs) have been an important advance in spinal cord stimulation for the management of pain, but they require surgical replacement, with attendant cost and risk, when the implanted battery is depleted. Battery life is determined by the programmed settings of the implant, but until now the technical means to optimize settings for maximal battery life, delaying surgical replacement as long as possible, Materials and Methods.  We have developed a patient-interactive, computerized programmer for use with IPGs. It has been designed for easy operation and comprehensive data management, which have not been features of the standard programmers available until now. It automatically and rapidly presents to the patient a sequence of settings (contact combinations and pulse parameters) specified by the practitioner. Test results are analyzed and sorted to determine the optimal settings by multiple criteria, including battery life. In the present study we used new, improved algorithms to estimate battery life.  We have compared the computerized, patient-interactive system with standard practitioner-operated, manual programming methods in a randomized, controlled trial in 44 patients at two study centers.  In 95% of patients (41/43), the computerized, patient-interactive system identified new settings with improved estimated battery life (and corresponding anticipated cost savings) which had not been recognized as such using manual methods. The estimated battery life for the setting chosen by each patient using manual methods averaged 25.4 ± 49.5 (mean ± standard deviation) months; the longest battery life identified by computerized methods averaged 55.0 ± 71.7, a 2.2-fold or 29.6 month improvement. Seventy-two percent of patients (31/43) achieved better battery life at settings with technical results (visual analog scale rating of overlap or coverage of pain by stimulation paresthesias) equal or superior to those achieved by manual methods. The overall improvement over the setting chosen by manual methods was 1.41-fold or 10.5 months; averaged by patient, the improvement was 1.63-fold. Estimated cost savings averaged just over one-third. As reported previously, the new system also yields significantly (p < 0.0001) better technical results than traditional, manual methods in achieving coverage of pain by stimulation paresthesias; the very best technical results were achieved at some expense in estimated battery life (assuming the same frequency of use). We conclude that significant potential savings in longevity of the implanted battery are possible in the majority of patients with implanted spinal cord stimulators, but have not been realized until now for lack of appropriate methods. Computerized, patient-interactive programming addresses this problem and allows optimization of estimated battery life along with other treatment goals. Long-term clinical followup will be required to establish the full magnitude of the resulting savings.

Published
2004
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