Correlates of Social Isolation Among Community-Dwelling Older Adults During the COVID-19 Pandemic

The past year has severely curtailed social interactions among older adults given their high rates of COVID-19 morbidity and mortality. This study examined social, behavioral, and medical correlates of social isolation among community-dwelling older adults during the COVID-19 pandemic and stratified findings to explore unique differences in two typically neglected populations, African American and Hispanic older adults

Leveraging Public-Private Partnerships During COVID-19: Providing Virtual Field Opportunities for Student Learners and Addressing Social Isolation in Older Adults

While preventive and management measures are important to mitigate the spread of COVID-19, strategies like social distancing can have devastating effects on older adults who are already at risk for social isolation and loneliness. In response, two Colleges of Health Professions (Social Work and Nursing) at a large public University leveraged a partnership with a national health and wellbeing company to address social isolation and loneliness in Houston area older adults during the COVID-19 pandemic. This intergenerational linkage initiative involved 707 older adults and 177 graduate social work and nursing students. This study describes the process of developing a virtual educational opportunity for students while also meeting the needs of vulnerable older adults in Houston, the third largest, and one of the most diverse cities in the U.S. Findings include student/learner outcomes, as well as self-reported improvements in loneliness scores, and unhealthy physical and mental health days among enrolled older adults

The development and validation of a scoring tool to predict the operative duration of elective laparoscopic cholecystectomy

Background: The ability to accurately predict operative duration has the potential to optimise theatre efficiency and utilisation, thus reducing costs and increasing staff and patient satisfaction. With laparoscopic cholecystectomy being one of the most commonly performed procedures worldwide, a tool to predict operative duration could be extremely beneficial to healthcare organisations. Methods: Data collected from the CholeS study on patients undergoing cholecystectomy in UK and Irish hospitals between 04/2014 and 05/2014 were used to study operative duration. A multivariable binary logistic regression model was produced in order to identify significant independent predictors of long (> 90 min) operations. The resulting model was converted to a risk score, which was subsequently validated on second cohort of patients using ROC curves. Results: After exclusions, data were available for 7227 patients in the derivation (CholeS) cohort. The median operative duration was 60 min (interquartile range 45–85), with 17.7% of operations lasting longer than 90 min. Ten factors were found to be significant independent predictors of operative durations > 90 min, including ASA, age, previous surgical admissions, BMI, gallbladder wall thickness and CBD diameter. A risk score was then produced from these factors, and applied to a cohort of 2405 patients from a tertiary centre for external validation. This returned an area under the ROC curve of 0.708 (SE = 0.013, p  90 min increasing more than eightfold from 5.1 to 41.8% in the extremes of the score. Conclusion: The scoring tool produced in this study was found to be significantly predictive of long operative durations on validation in an external cohort. As such, the tool may have the potential to enable organisations to better organise theatre lists and deliver greater efficiencies in care

Signaling of the T Cell Costimulatory Receptor CD28: Regulation and Initiation

T cells provide antigen-specific immunity to pathogens, but are also capable of inducing destructive autoimmunity when responding to self antigens. In order to achieve full activation, T cells must receive two signals: one from the T cell antigen receptor, and a second from a costimulatory receptor, such as CD28. Expression of the ligands for CD28 activation is strongly induced on professional antigen presenting cells under conditions of inflammation or danger-sensing. Hence, CD28 costimulatory receptor acts as a gatekeeper to T cell activation and is essential in maintaining the balance between immunity and self-tolerance. CD28 function has been implicated in many animal models of T cell-dependent infection control and autoimmune disorders. Intensive study of CD28 signaling biology over more than two decades has elucidated key signaling pathways and transcriptional targets that help to explain the unique CD28-dependent functions in T cells. Some signaling pathways downstream of CD28 activation have been mapped to particular motifs within the CD28 cytoplasmic domain, although no consensus has emerged on the importance of these signaling motifs to CD28 function in vivo. This thesis describes the discovery of a novel motif within CD28 cytoplasmic domain that regulates receptor signal initiation through membrane binding and kinase recruitment, and discusses the new findings in light of existing literature.Medical Science

Correlates of Social Isolation Among Community-Dwelling Older Adults During the COVID-19 Pandemic

The past year has severely curtailed social interactions among older adults given their high rates of COVID-19 morbidity and mortality. This study examined social, behavioral, and medical correlates of social isolation among community-dwelling older adults during the COVID-19 pandemic and stratified findings to explore unique differences in two typically neglected populations, African American and Hispanic older adults