Waterford Institute

Pandemic influenza remains a persistent global threat with the potential to cause widespread morbidity, mortality, and economic disruption. Despite decades of preparedness efforts, current influenza vaccine systems remain constrained by long production timelines, early strain-selection requirements, and limited flexibility once a pandemic is underway. The COVID-19 pandemic fundamentally reshaped expectations for vaccine development and deployment, demonstrating that platform-based technologies, particularly messenger RNA (mRNA) vaccines, can deliver safe and effective vaccines at unprecedented speed when supported by regulatory readiness, manufacturing capacity, and coordinated public-private investment. Drawing on lessons from COVID-19, recent Phase III clinical trial data for seasonal influenza mRNA vaccines, and global preparedness initiatives such as the 100 Days Mission, this expert perspective examines how mRNA and other next-generation vaccine technologies could strengthen preparedness for a future influenza pandemic. It reviews evidence related to platform speed, clinical performance, manufacturing adaptability, regulatory pathways, and global access, while also highlighting emerging scientific frontiers, including artificial intelligence-augmented immunogen design and innovations in vaccine delivery. It argues that sustained investment in adaptable vaccine platforms, coupled with advances in delivery, manufacturing, and data-driven design, will be critical to improving global readiness and reducing the impact of the next influenza pandemic.

Abstract Opportunistic pathogens (OPs) within the Legionella and Mycobacterium can persist and sometimes proliferate in drinking water systems and pose a risk to public health. Most prior research has focused on isolated system components of the drinking water treatment and distribution system and has rarely examined spatiotemporal dynamics across the entire source water, treatment process, and distribution system continuum. This study addresses this critical knowledge gap by quantitative profiling of microbial communities with full length 16S rRNA gene sequencing and flow cytometry, and associated water chemistry parameters, including disinfection byproducts (DBPs), across five full-scale utilities. These utilities reflect varying source water types, geographic locations, treatment regimes, and climate zones. Microbial communities, including Legionella and Mycobacterium populations, in distribution system were shaped by source water type and exhibited significant community divergence across utilities. Within the same genus, strain-level analyses revealed highly distinct Legionella and Mycobacterium sequence variants unique to each utility. Interestingly, a substantial proportion of Legionella and Mycobacterium amplicon sequence variants were both utility specific and often specific to locations within the distribution system, indicating strong geographic structuring both across and within drinking water systems. Understanding the mechanistic underpinnings of this geographic structuring is critical to develop robust strategies for managing and monitoring Legionella and Mycobacterium populations in drinking water systems.

Purpose This study aims to examine how the French biopharmaceutical company IPSEN adapted the Shingo model to address the challenges of Industry 4.0 (I4.0) and the rise of Industry 5.0 (I5.0), focusing on sustaining cultural principles such as respect for people, continuous improvement and sustainable value creation in the digital age. Design/methodology/approach The research is based on an in-depth qualitative case study, including semi-structured interviews and document analysis, conducted at IPSEN’s Signes facility in France. This approach allows for a detailed examination of how the organization has embedded Shingo principles into its transformation journey, while simultaneously deploying digital tools and developing a custom adaptation of the model known internally as “Shingo 2.0.” Findings IPSEN’s Shingo 4.0 and 5.0 Framework combines human-centric values with digital transformation, ensuring a balance between cultural and technological advancements. Key elements include cultural reinforcement first, data-driven thinking, ecosystem-based improvement, real-time feedback and digital leadership enablement. This framework integrates traditional Shingo principles with modern digital practices, fostering continuous improvement, emotional engagement and leadership evolution. It provides a flexible, holistic model for organizations to align human values with digital innovation, ensuring sustainable operational excellence. Originality/value To the best of the authors’ knowledge, this case study is among the first to document the real-world integration of the Shingo Model with digital transformation initiatives in a European manufacturing context. It offers both theoretical insight and practical guidance for organizations seeking to align excellence models with I4.0 and I5.0 principles. By proposing a human-centered, digitally enabled vision of Shingo, this research advances the debate on the future of operational excellence.

Abstract Background Antipsychotic drugs (APDs) are frequently used in combination with other drugs, leading to potential pharmacokinetic and pharmacodynamic drug interactions. Many of these interactions have not been adequately studied in clinical research. This study presents a simple, cost-effective and robust LC-MS method which is based on protein precipitation for the simultaneous analysis of 35 APDs in human plasma. Methods In brief, 50 µL of plasma and 100 µL of protein precipitation solvent, a 70:30 (v:v) mixture of MeOH:0.1M ZnSO4(aq) containing stable isotope labeled internal standards was added to a microfuge tube. The samples were vortex mixed briefly and centrifuged at 18,000 g for five minutes at room temperature. Subsequently, 100 µL of the supernatant was diluted with 100 µL distilled water and the samples were mixed on a shaker for three minutes at 850 rpm prior to analysis. Samples were injected onto a Waters XSelect™ HSS C18 SB XP Column using an ACQUITY™ UPLC™ I-Class PLUS FL System and eluted using a water/methanol/formic acid/ ammonium acetate gradient. The 35 APDs were quantified using a Xevo™ TQ-S micro Mass Spectrometer operated in electrospray positive mode with multiple reaction monitoring. Results For each analyte, the method was demonstrated to be linear across calibration range, with analytical sensitivity investigations showing precise quantification (<20% CV, =15% bias). Non-linearity at all levels for all compounds was less than 10% across the targeted linearity interval. Coefficients of variation (CV) for total precision and repeatability for low, mid and high QCs were =8.7% CV and =7.4%, respectively (n = 25). Recoveries for the low and high QC across all analytes ranged from 91.5-108.7% and 85.7-112.7%, respectively. Mean extraction efficiencies for the 35 APDs ranged from 52.2%-96.9%. Conclusion A fast (less than 5 minutes per injection) and inexpensive LC-MS/MS clinical research method was developed for 35 APDs, based on protein precipitation and requiring only 50µL of plasma. The method demonstrated good recovery and extraction efficiency for each analyte, with minimal matrix effects, and total precision =8.7% CV. For Research Use Only. Not for Use in Diagnostic Procedures. ACQUITY, UPLC, XSelect and Xevo are trademarks of Waters Technologies Corporation.

PURPOSE: Frailty is not inevitable with age, with research identifying transitions between states. Evidence indicates exercise and protein supplementation as the most effective and easily implemented intervention. Although widely recognised, such interventions are rarely fully integrated into geriatric medicine, combined with an inconsistency in implementation regarding design, prescription and delivery. Engaging experts in intervention design enables interdisciplinary interpretation of evidence, highlights contextual factors, and informs implementation. The aim of this research was to ascertain multi-professional perspectives on the design and delivery of an exercise and protein intervention for frail older adults and gain expert consensus on intervention components. METHODS: A two-round online Delphi study was conducted. Academics, health care professionals and implementers (exercise and nutrition professionals) (n = 36) were identified and invited to participate via email. Round one used a combination of open and closed questions to gather opinion on setting, delivery model, exercise prescription, protein supplementation and recruitment. The results informed round two, which used Likert scale and rank questions to ascertain level of agreement for the delivery model, exercise prescription, and behaviour change techniques. RESULTS: Response rates in rounds one and two were 69% (25/36) and 76% (19/25). Supervised delivery was the preferred option (74%), with hybrid (9%) and home-based (4%) less popular, but if implemented, 47% favoured in person delivery. Multicomponent interventions were favoured with equal weighting (33%) given to strength, aerobic and balance. A frequency of 2 sessions emerged for both supervised (42%) and home-based delivery (52%), but session duration differed with 45mins (47%), 30 mins (57%), respectively. Education was superior (73.75%) regarding behaviour change strategies CONCLUSIONS: Integrating multi-profession perspectives to the design of exercise and nutrition interventions for frailty provides valuable insights into appropriate options and considerations. Although expert consensus was limited, recommendations can be embedded into multi-component interventions in the co-design of feasible, effective and sustainable interventions. Supported by: This study is funded by the Irish Research Council Ireland enterprise partnerscholarship with industry partner Tirlan.

Abstract Background Simulation-based training is an increasingly accepted way for multidisciplinary teams to learn together. Its use in geriatric departments around Ireland is increasingly visible. The application of simulation to pathway and process development however is less common. We decided therefore to deploy a simulation lab to test a new virtual ward platform for local nursing homes. Methods We developed, in partnership with a digital provider, a piece of software that could enable the efficient and safe operation of a virtual ward. Our simulation was conducted in two phases. Phase 1 involved bench simulation of the platform in order to identify any obvious software issues. Phase 2 involved the development of two simulated patient scenarios that would specifically test the operation of the pathway. Nursing staff from our local nursing homes and specialist MDT members from our own department were invited to the Sim lab in order to work through the developed scenarios. Results Bench simulation of the software during phase 1 identified three significant limitations to the software developed. These were resolved before progressing to phase II testing. The simulated scenarios at our lab worked well and participants shared positive feedback regarding the pathway and technology. They found the software easy to navigate, practical and agreed unanimously to its future use. There were further minor technical issues identified that have been fed back to the software company for resolution. The simulation facilitated training using the “live” system for both the staff at our nursing homes and our own team members. Conclusion The simulation lab proved to be an ideal environment for testing both our new virtual ward pathway and the digital technology developed for its enablement. It facilitated the creation of a comprehensive process map and ensures that all stakeholders had a clear understanding of the new pathway.

Abstract Background The risk of hospital-associated deconditioning for frail older adults (i.e. reduced functional performance after acute hospitalisation, due to low activity levels during an admission) is well recognised, yet continues to occur commonly. This quality improvement project aimed to promote a cultural change within two acute medical wards, in line with the principles of “End PJ Paralysis”, which aims to “get patients out of bed, dressed in their own clothes and when possible, moving rather than lying in bed”. Methods A multidisciplinary committee was formed to oversee this project. An initial audit on observed levels of patient activity was performed, along with a root cause analysis to identify points of action. A multicomponent intervention was designed and implemented over an 8-week period (Oct to Nov 2023), with weekly re-audit of activity levels. Data on the monthly incidence of falls & pressure areas, as well as average length-of-stay, was also collected, with the results for the intervention period (Q4) compared with the monthly averages for the nine months prior (Q1-3). Results A total of 570 Patients were included. Improvements were observed in all outcomes. The proportion of patients dressed in their own clothes increased from 28.5% (18/63) to 51.8% (263/507), those sitting out in a chair increased from 50% (32/63) to 64% (326/507), and those mobilising at the time of audit increased from 60% (38/63) to 71% (360/507). Average falls (Q1-3 vs Q4) fell from 14.8 to 12.6 per month, average pressure sores from 5.5 to 5 per month, and average length of stay from 11.20 to 10 days. Conclusion This project demonstrates that a ward-based multidisciplinary initiative can lead to an increase in the proportion of patients on an acute medical ward being dressed in their own clothes, sitting out, and mobilising, without an increase in the incidence of falls.

Schools frequently adopt new interventions for each new public health issue, but this is both time- and resource-intensive. Adversity exposure is an example of a pervasive public health issue that emerged during Coronavirus Disease 2019 (COVID-19) with notable consequences, including an elevated risk of developing substance use disorders and mental illnesses. Adapting existing, universal, evidence-based interventions, such as the Michigan Model for HealthTM (MMH), by incorporating trauma-sensitive content is a promising approach to meet this need. We examined critical steps in promoting MMH adaptability as part of the Enhanced REP (Replicating Effective Programs) implementation strategy during the COVID-19 pandemic. We share usability testing from the 2020 to 2021 school year and describe how we apply the results to inform the group randomized trial pilot study. We applied key steps from implementation adaptation frameworks to integrate trauma-sensitive content as COVID-19 unfolded, documenting the process through field notes. We conducted initial usability testing with two teachers via interviews and used a rapid qualitative analysis approach. We conducted member checking by sharing the information with two health coordinators to validate results and inform additional curriculum refinement. We developed an adapted MMH curriculum to include trauma-sensitive content, with adaptations primarily centered on adding content, tailoring content, substituting content, and repeating/reinforcing elements across units. We designed adaptations to retain the core functional elements of MMH. Building foundational relationships and infrastructure supports opportunities to user-test intervention materials for Enhanced REP that enhance utility and relevance for populations that would most benefit. Enhanced REP is a promising strategy to use an existing evidence-based intervention to meet better the needs of youth exposed to adversity. Building on the foundations of existing evidence-based interventions, is vital to implementation success and achieving desired public health outcomes.