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  • 1
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    Human Opsonins Induced during Meningococcal Disease Recognize Transferrin Binding Protein Complexes
    American Society for Microbiology ; 1999
    In:  Infection and Immunity Vol. 67, No. 12 ( 1999-12), p. 6526-6532
    Details
    In: Infection and Immunity, American Society for Microbiology, Vol. 67, No. 12 ( 1999-12), p. 6526-6532
    Abstract: Patient serum opsonins against transferrin binding protein A+B (TbpA+B) complexes from two Neisseria meningitidis strains (K454 and B16B6, with 85- and 68-kDa TbpB, respectively) were quantified by a functional phagocytosis and oxidative burst assay. TbpA+B complexes adsorbed to fluorescent beads were opsonized with individual acute and convalescent sera from 40 patients infected by a variety of meningococcal strains. Flow cytometric quantitation of leukocyte phagocytosis products (PP) demonstrated that disease-induced serum opsonins recognized TbpA+B, and the highest anti-TbpA+B serum opsonic activities were found between admission to hospital and 6 weeks later. The PP values obtained with TbpA+B from strain B16B6 (PP B16B6 ) were higher than those obtained with TbpA+B from strain K454 (PP K454 ), with both acute and convalescent sera ( P 〈 0.0001), and correlated positively with higher immunoglobulin G enzyme-linked immunosorbent assay titers against TbpA+B from strain B16B6 than from strain K454 ( P 〈 0.001). In spite of considerable variations between individuals, significant correlations were found between the PP B16B6 and PP K454 values, and the PP values did not depend on the variability of the TbpB proteins of the disease-causing strains. Simultaneously measured oxidative burst activity correlated closely with the PP values. We conclude that highly cross-reactive anti-TbpA+B serum opsonins are produced during meningococcal disease. The anti-TbpA+B opsonic activities were not affected by the variability of the TbpB proteins of the disease-causing strains, which further adds to the evidence for the vaccine potential of meningococcal TbpA+B complexes.
    Type of Medium: Online Resource
    ISSN: 0019-9567 , 1098-5522
    URL: Article
    DOI: 10.1128/IAI.67.12.6526-6532.1999
    RVK:
    XA 10000
    Language: English
    Publisher: American Society for Microbiology
    Publication Date: 1999
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  • 2
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    92 ‘Greenprint’ for integrated care clinics—the hub and spoke model
    Oxford University Press (OUP) ; 2023
    In:  Age and Ageing Vol. 52, No. Supplement_3 ( 2023-09-14)
    Details
    In: Age and Ageing, Oxford University Press (OUP), Vol. 52, No. Supplement_3 ( 2023-09-14)
    Abstract: Climate change is a major public health crisis requiring attention at an individual, local and national policy level. Transport is the largest source of energy related carbon emissions in Ireland. The development of integrated care occurs alongside climate emergency. Care previously delivered in hospital outpatients, or a central ‘hub’ is now being delivered in integrated care clinics, ‘spokes’. We aimed to assess the environmental impact of transport to integrated care clinics compared to travel to hospital clinic. Methods Geriatric Medicine Integrated Care attendances from January 2023 to March 2023 were included. Distance from the patient’s home address to the location of Integrated Care Clinic (spoke), and to the affiliated hospital (hub) were recorded in kilometres. For the primary analysis we have not considered staff travel as there was heterogeneity in number of staff per clinic and distance travelled per staff member. Where more than one route was available, the shortest distance was recorded. Carbon emissions were estimated based on kilometres travelled by a standard new passenger car. Results Among 206 clinic attendances, the mean distance to ‘spoke’ clinic was 16.06 km (15.98). The mean distance to the ‘hub’ clinic was 39.29 km (17.82). The estimated total distance travelled by patients to integrated care clinics was 3293.45 km, whereas the distance which would have been travelled to ‘hub’ clinics was 8055.85 km. Total carbon emissions for 3 month travel to ‘spoke’ clinics were estimated at 371 kg, compared to 907 kg to the ‘hub’. Conclusion The development of integrated care services, which provides necessary care to older adults, may also have an environmental advantage. Healthcare’s contribution to climate change action is another incentive to invest in integrated care services.
    Type of Medium: Online Resource
    ISSN: 0002-0729 , 1468-2834
    URL: Article
    DOI: 10.1093/ageing/afad156.278
    Language: English
    Publisher: Oxford University Press (OUP)
    Publication Date: 2023
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  • 3
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    102 PROMOTING BRAIN HEALTH IN AN INTEGRATED CARE OUTREACH PROGRAMME
    Oxford University Press (OUP) ; 2021
    In:  Age and Ageing Vol. 50, No. Supplement_3 ( 2021-11-18), p. ii9-ii41
    Details
    In: Age and Ageing, Oxford University Press (OUP), Vol. 50, No. Supplement_3 ( 2021-11-18), p. ii9-ii41
    Abstract: Lifestyle modifications, in older at risk populations, may prevent or slow the rate of cognitive decline. Promotion of brain health has been recommended by the WHO and other governing bodies. Supporting patients in making these lifestyle changes, however, can be complex. Generic guidance may not apply to all in a heterogenous and frail patient cohort, when physical mobility may be limited and weight loss/nutrition a concern. We sought to review current practices and barriers to brain health guidance in a regional integrated care outreach programme (ICOP). Methods From March–June’21 the comprehensive geriatric assessment (CGA) of consecutive patients were reviewed. Those presenting with cognitive complaints, for their first assessment, were included. Demographic data and data on screening for hearing impairment and sleep disturbance were collected, in addition to information on physical activity and nutritional risk. Whether information and guidance on aspects of brain health was given was also assessed. Results 30 patients met the inclusion criteria. The mean age was 80.3 and the mean clinical frailty scale (CFS) was 4.4. Hearing impairment was present in 20% (n = 6), with no information available in 10% (n = 3). All patients were screened for sleep disturbance, with 13% (n = 4) not fully satisfied with their sleep. Mobility aids, assistance or supervision were required in 40% (n = 12), and 23% (n = 7) were at medium or high malnutrition risk. Only 30% (n = 9) cooked their own meals. Generic brain health advice, or advice about sleep was documented in 30 (n = 9), without hearing impairment advice documented in any patient. Conclusion There are several barriers to brain health advice in the ICOP setting, with only 30% of patients having brain health advice documented. We are currently developing patient information leaflets on brain health, that will take potential barriers into account. Dedicated and specific information on local hearing services is also in development, as part of an ongoing quality improvement project.
    Type of Medium: Online Resource
    ISSN: 0002-0729 , 1468-2834
    URL: Article
    DOI: 10.1093/ageing/afab219.102
    Language: English
    Publisher: Oxford University Press (OUP)
    Publication Date: 2021
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  • 4
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    Using geological history of the Laurentian Great Lakes to better understand their future
    Michigan State University Press ; 2010
    In:  Aquatic Ecosystem Health & Management Vol. 13, No. 2 ( 2010-05-28), p. 118-126
    Details
    In: Aquatic Ecosystem Health & Management, Michigan State University Press, Vol. 13, No. 2 ( 2010-05-28), p. 118-126
    Abstract: With growing use of numerical models to forecast lake conditions under future climates and other stressors, paleo-events in the history of the Great Lakes have greater potential for relevance. Past events and history may extend records of observations, provide estimates of the sensitivity of the lake system to stressing conditions, and contribute scenarios for model validation. Here we describe four examples that hold promise for improving understanding of the present and future Great Lakes: 1) using an event of lake closure to derive climate-hydrology sensitivity, 2) extending the record of lake-level history by examining beach ridge sequences, 3) investigating sedimentary black bands to indicate past anoxia at the lakebed in deep basins, and 4) deriving evidence of lake process teleconnections with atmospheric circulation.
    Type of Medium: Online Resource
    ISSN: 1463-4988 , 1539-4077
    URL: Article
    DOI: 10.1080/14634981003799950
    Language: English
    Publisher: Michigan State University Press
    Publication Date: 2010
    detail.hit.zdb_id: 2014970-0
    SSG: 12
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  • 5
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    The development of a meningococcal disease vaccine based on outer membrane vesicles
    Elsevier BV ; 2005
    In:  Vaccine Vol. 23, No. 17-18 ( 2005-03-18), p. 2210-2213
    Details
    In: Vaccine, Elsevier BV, Vol. 23, No. 17-18 ( 2005-03-18), p. 2210-2213
    Type of Medium: Online Resource
    ISSN: 0264-410X
    URL: Article
    DOI: 10.1016/j.vaccine.2005.01.055
    Language: English
    Publisher: Elsevier BV
    Publication Date: 2005
    detail.hit.zdb_id: 1468474-3
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  • 6
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    100 SCREENING FOR SLEEP DISTURBANCE AS PART OF THE COMPREHENSIVE GERIATRIC ASSESSMENT
    Oxford University Press (OUP) ; 2021
    In:  Age and Ageing Vol. 50, No. Supplement_3 ( 2021-11-18), p. ii9-ii41
    Details
    In: Age and Ageing, Oxford University Press (OUP), Vol. 50, No. Supplement_3 ( 2021-11-18), p. ii9-ii41
    Abstract: Sleep disturbance is common in the older patient, and has been associated with many common comorbidities, falls, impaired quality of life, and mortality. Sleep disturbance screening and management are important elements of the comprehensive geriatric assessment (CGA). There are few sleep disturbance assessment tools, however, that have been validated for use in older patients, or in those with cognitive impairment. We sought to review the assessment and management of sleep disturbance within a regional integrated care outreach programme (ICOP), where the RU-SATED tool had been used. Methods From March–June’21 the notes of 30 consecutive patients, presenting to ICOP with cognitive complaints, were reviewed. Demographic and sleep disturbance data were collected, in addition to whether advice, treatment or further assessment for sleep disturbance was documented. Feedback from staff on the utility of the RU-SATED tool was also sought. Results Of those reviewed, the mean age was 80.3 (SD = 7.8), and the mean Montreal Cognitive Assessment score (MOCA) was 17.7 (SD = 5.9). Where data was available, the mean RU-SATED score was 7.6 (SD = 1.9), and 42% were frail (n = 11). The most commonly endorsed sleep symptom was sleep onset latency/sleep maintenance issues (n = 16). RU-SATED score did not significantly predict age, MOCA or frailty (p  & gt; 0.1 for all). Advice, treatment or further assessment of sleep disturbance was offered to 23% of patients (n = 7), and this was not predicted by overall RU-SATED score or by individual question responses (p  & gt; 0.1 for all). Staff also stated that they found elements of the tool difficult to explain and interpret. Conclusion Although the numbers are small, we have not found the RU-SATED tool to be helpful in guiding the management of sleep disturbance in our cohort. A more practical CGA tool is currently in development by the ICOP service.
    Type of Medium: Online Resource
    ISSN: 0002-0729 , 1468-2834
    URL: Article
    DOI: 10.1093/ageing/afab219.100
    Language: English
    Publisher: Oxford University Press (OUP)
    Publication Date: 2021
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  • 7
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    317 Analysing the social history aspects of an integrated care comprehensive geriatric assessment incorporating patients views and wishes
    Oxford University Press (OUP) ; 2023
    In:  Age and Ageing Vol. 52, No. Supplement_3 ( 2023-09-14)
    Details
    In: Age and Ageing, Oxford University Press (OUP), Vol. 52, No. Supplement_3 ( 2023-09-14)
    Abstract: An evaluation of social well-being is an important component of a Comprehensive Geriatric Assessment (CGA). There is no clear guidance about how best to structure and examine these factors as part of a CGA. We sought to examine current practice with respect to the collection of information from a social care perspective across different integrated care CGA proformas. Methods We completed a cross sectional study of the social care domain of integrated care based CGA proformas. All operational leads for each integrated care hub in the country were contacted and invited to share their local CGA. We completed a thematic analysis of the social care section including social, financial and wellbeing assessments. Results We included 16 different CGAs that are in use across different integrated care hubs. All CGAs had a dedicated section for assessing social history with variability in what was included in different CGAs. Patient’s wishes and expectations were commonly included but the manner in which they were collected and emphasis varied. 7 (43%) specifically captured whether the patient has an enduring power of attorney in place, 5 (31%) collected information about formal advanced care directives, and 2 (12%) enquired about nominated assisted decision makers. Ability to manage finances was captured through the Lawton Brody IADL scale in two CGAs. Half of CGAs included a section to capture carer strain and the term ‘next of kin’ was used in 6 of 16 CGAs. Conclusion There is significant heterogeneity in the structure of the social care section of a CGAs across different integrated care hubs, particularly with respect to capturing information surrounding advanced care planning. Signposting of patients’ wishes and expectations was useful for focusing on patient-centred care.
    Type of Medium: Online Resource
    ISSN: 0002-0729 , 1468-2834
    URL: Article
    DOI: 10.1093/ageing/afad156.249
    Language: English
    Publisher: Oxford University Press (OUP)
    Publication Date: 2023
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  • 8
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    105 Antiplatelet therapy and incident cognitive impairment or dementia—a systematic review and Meta-analysis of randomised clinical trials.
    Oxford University Press (OUP) ; 2023
    In:  Age and Ageing Vol. 52, No. Supplement_3 ( 2023-09-14)
    Details
    In: Age and Ageing, Oxford University Press (OUP), Vol. 52, No. Supplement_3 ( 2023-09-14)
    Abstract: The benefit of antiplatelet therapy in the prevention of cognitive impairment or dementia is uncertain. We investigated the association between antiplatelet therapy with incident cognitive impairment or dementia in randomised clinical trials. Methods We searched PubMed, EMBASE, and CENTRAL for randomised clinical trials published from database inception through Feb 1st, 2023. Trials that evaluated the association of antiplatelet therapy with incident cognitive impairment or dementia were included. For single agent antiplatelet, the control group was placebo and for dual agent antiplatelet therapy, the control group was single agent monotherapy. Two authors screened and independently extracted all data, and a random-effects meta-analysis model was used to report pooled treatment effects and 95% Confidence Intervals. The primary outcome was incident cognitive impairment or dementia. Secondary outcomes included change in cognitive test scores. Results Eleven randomised clinical trials were eligible for inclusion (109,860 participants), all of which reported the incidence of cognitive impairment or dementia on follow-up. The mean (SD) age of trial participants was 66.2 (7.9) years and 46,150 (42%) were women. The mean duration of follow-up was 70 months. Antiplatelet therapy, compared to control, was not significantly associated with a reduced risk of cognitive impairment or dementia (11 trials; 109,860 participants) (3.49% vs 4.18% of patients over a mean trial follow-up of 5.8 years; odds ratio [OR], 0.94 [95% CI, 0.88–1.00] ; absolute risk reduction, 0.2% [95% CI, −0.4% to 0.009%]; I2 = 0.0%). Antiplatelet therapy was not significantly associated with mean change in cognitive test scores. Conclusion In this meta-analysis of randomised clinical trials, antiplatelet therapy was not significantly associated with a lower risk of incident cognitive impairment or dementia. The confidence intervals around this outcome do not exclude a modest preventative effect, and at a population level this could have a substantial benefit. Further large trials with longer term follow up are needed.
    Type of Medium: Online Resource
    ISSN: 0002-0729 , 1468-2834
    URL: Article
    DOI: 10.1093/ageing/afad156.009
    Language: English
    Publisher: Oxford University Press (OUP)
    Publication Date: 2023
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  • 9
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    198 How comprehensive is our Comprehensive Geriatric Assessment in clinical practice?
    Oxford University Press (OUP) ; 2023
    In:  Age and Ageing Vol. 52, No. Supplement_3 ( 2023-09-14)
    Details
    In: Age and Ageing, Oxford University Press (OUP), Vol. 52, No. Supplement_3 ( 2023-09-14)
    Abstract: No gold standard exists for what should be included within a Comprehensive Geriatric Assessment (CGA). Consensus is that a CGA assessment should assess physical, functional, psychological and social well-being. We sought to examine the specific content of CGA that are being delivered across integrated care teams in Ireland. Methods We completed a cross sectional study of what domains are included in different integrated care CGA proformas. All operational leads for each integrated care hub were contacted and invited to share their local CGA. We examined what components across the domains of physical, psychological, functional and social assessment were included. Results We examined 16 different CGAs. The median length of a CGA was 14 pages (range: 4–28 pages). Common areas in all CGAs included assessments of frailty, cognition, mobility, falls, continence and social assessment, but there was variability in how these assessments were carried out. The Rockwood Clinical frailty scale the most common diagnostic tool for frailty (15/16 CGAs) with sarcopenia assessed in 75% of CGAs. The 4AT tool was used in 56% of CGAs, with a more detailed tool (e.g MMSE or MOCA) used in 56% of CGAs. Mood was assessed in 15 CGAs, sleep assessed in 10 CGAs and pain assessed in 7 CGAs. The widest variability was in the social assessment section with inconsistent assessments of caregiver strain (completed in 50%) and assessments of formal advanced care supports such as enduring power of attorney included in 44% of CGAs. Sexual health was not explicitly addressed in any CGA. Conclusion While there is considerable overlap with the core components of a CGA across integrated care sites there is significant variability across individual sites. Our results highlight the opportunity for consensus building across different integrated care teams to harmonise the delivery of CGA.
    Type of Medium: Online Resource
    ISSN: 0002-0729 , 1468-2834
    URL: Article
    DOI: 10.1093/ageing/afad156.286
    Language: English
    Publisher: Oxford University Press (OUP)
    Publication Date: 2023
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  • 10
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    Role of Proxy Respondents in International Stroke Research: Experience of the INTERSTROKE Study
    S. Karger AG ; 2022
    In:  Neuroepidemiology Vol. 56, No. 5 ( 2022), p. 355-364
    Details
    In: Neuroepidemiology, S. Karger AG, Vol. 56, No. 5 ( 2022), p. 355-364
    Abstract: 〈 b 〉 〈 i 〉 Introduction: 〈 /i 〉 〈 /b 〉 Measuring patient-reported information in stroke research is challenging. To overcome this, use of proxy respondents is often a necessary strategy. In this study, we report on use and effect of proxy respondents on patient case-mix in a large international epidemiologic stroke study (INTERSTROKE). 〈 b 〉 〈 i 〉 Methods: 〈 /i 〉 〈 /b 〉 This was a cross-sectional study of 13,458 cases of acute first stroke in 32 countries. A standardized study questionnaire recording behavioural cardiovascular risk factors was administered to the patient, and if unable to communicate adequately, a valid proxy, or both. We used logistic regression to evaluate the association of age, sex, education, occupation, stroke severity, and region with need for proxy respondent, and report odds ratio (OR) with 95% confidence interval (CI). 〈 b 〉 〈 i 〉 Results: 〈 /i 〉 〈 /b 〉 Among 13,458 participants with acute stroke, questionnaires were completed by patients alone in 41.4% ( 〈 i 〉 n 〈 /i 〉 = 5,573), combination of patient and proxy together in 21.7% ( 〈 i 〉 n 〈 /i 〉 = 2,918), and proxy alone in 36.9% ( 〈 i 〉 n 〈 /i 〉 = 4,967). Use of proxy alone was greater in participants with severe stroke (4.7% with modified-Rankin score of 0 vs. 80.5% in those with score 5; OR 187.13; 95% CI: 119.61–308.22), older persons (43.8% of those aged 80 years and over vs. 33.2% of those aged less than 40 years; age per decade OR 1.09; 95% CI: 1.06–1.12), women (40.7% vs. 34.3% of men; OR 1.32 95% CI: 1.22–1.43), and those less educated (58.9% of those never educated vs. 25.7% of those who attended third level education; OR 7.84; 95% CI: 6.78–9.08). 〈 b 〉 〈 i 〉 Conclusion: 〈 /i 〉 〈 /b 〉 Use of proxy respondents enhances the generalizability of international research studies of stroke, by increasing representation of women, patients with severe stroke, older age, and lower education.
    Type of Medium: Online Resource
    ISSN: 0251-5350 , 1423-0208
    URL: Article
    DOI: 10.1159/000525510
    Language: English
    Publisher: S. Karger AG
    Publication Date: 2022
    detail.hit.zdb_id: 1483032-2
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