Investigating falls in adults with intellectual disability living in community settings and their experiences of post-fall care services: Protocol for a prospective observational cohort study

Background: Falls among older adults with intellectual disability (ID) are recognised as a serious health problem potentially resulting in reduced health-related quality of life and premature placement in residential care. However there are limited studies that have investigated this problem and thus falls rates among older adults with ID remain uncertain. Furthermore, people with ID rely heavily on familial and professional care support to address health problems, such as after having a fall. No studies have explored the post-fall care that people with ID receive. Method: This research will be carried out in two phases using a convergent mixed methods design. The aim of Phase 1 is to estimate the falls rate by prospectively observing a cohort of older adults (≥ 35 years) with ID (n = 90) for six months. Phase 1 will be conducted according to STROBE guidelines. In Phase 2, participants from Phase 1 who have experienced a fall(s) will be asked to participate in a semi-structured interview to explore their post-fall experience. Discussion: This study will determine the rate of falls among older adults with ID living in community based settings, which will assist to identify the extent of this problem. Data collected from the study will also aid in understanding the circumstance of falls and related falls risk factors in this cohort. This will include exploring any barriers that older adults with ID may encounter when seeking or undertaking recommended post-fall care advice. Findings from this research will potentially inform future development of falls prevention services for older adults with ID. This study has been approved by the University Human Research Ethics Committee. Trial registration: The protocol for this study is registered with the Australian New Zealand Clinical Trial Registry (ACTRN12615000926538) on 7 September 2015. www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=368990&isReview=tru

Equipping Students for a Lifetime of Civic Engagement

Rationale: To teach Social Responsibility to young adults through Service Learning Goal:Participants will know how to engage the students and community in Service Learning.. Participants will know how to plan, implement, evaluate and plan for sustainability with Service Learning Projects. Equipping Students for a Lifetime of Civic Engagement Jackie Gillespie MN, RN, CNE Portia Botchway MSN, RN Clemson University, a land-grant institution, was founded with a mission to be a “high seminary of learning” dedicated to teaching, research and service. Service learning at Clemson is a “form of experiential education that uses community service experiences to enhance the academic classroom experience. This teaching process involves the students partnering with the community, identifying and analyzing community needs, identifying solutions to meet those needs, then implementing those solutions. The students also evaluate their work and assess their service experience and its impact” (Clemson University Service Learning Alliance Web Site, May 2006). Clemson School of Nursing Program has incorporated service learning within its curriculum. Students partner with community subpopulations, utilizing evidence-best practice guidelines to ensure the delivery of the highest quality of care. This collaborative effort with community partners builds continuing alliances and effects sustainable change for the multifaceted needs of the client in the community. This presentation will share the evidenced-based practice foundation on which this project is designed and attendees will view a power point presentation that shares students’ work nationally and internationally. To promote ease in future service learning projects, attendees will be given the plans and grading criteria for this project that will serve as a guide for incorporating service learning into the classroom and ultimately give students a working knowledge of implementing change in population care. Service Learning is a vital tool in the education of our nurses. Dr. Wanda Taylor, 2014-2015 Service Learning Alliance Faculty Fellow describes the beneficial relationship. “Core concepts of social responsibility, caring, and advocacy are crucial developments in nursing education. Social barriers can impede health care, but a culture of caring can break down these walls. Nursing, by sheer numbers, is poised to make a huge difference. Nursing students take these service learning experiences and build on them for a lifetime of giving back to the community. One student journaled, “From this project, I learned how important it is to get involved with the community in which I live. I know that I will be able to apply this to my future nursing career because in the community I live in there are always going to be needs that can be addressed. I can take what I have learned through this project and use it to make a difference in my own community. I want to be an integral part in helping my community become a healthier, better place to live.

Bacterial load comparison of the three main lineages of Mycobacterium tuberculosis complex in West Africa

Funding: This work was funded by The Royal Society Africa Prize 2018 awarded to Dorothy Yeboah-Manu and supported by funding from Scottish Funding Council (SCF)-Global Challenges Research Fund (GCRF) to Prof Stephen Gillespie and Dr Wilber Sabiiti.Studies have shown an association between bacterial load and virulence; however, not much is known about the diversity in this phenotypic characteristic of Mycobacterium tuberculosis complex (MTBC). This study was therefore aimed to determine the differences in bacterial load of the three most prevalent MTBC genotypes (L4, L5 and L6) in West Africa at the time of diagnosis. A total of 170 paired fresh sputum samples were collected; one part in guanidinium thiocyanate (GTC) was used for RNA extraction and tuberculosis Molecular Bacterial Load Assay (TB-MBLA) and the other part without GTC was confirmed for TB positivity using Gene Xpert MTB/RIF, smear microscopy grading and culture on Löwenstein-Jensen media slants. The 170 sputum samples comprised of 155 new cases, 3 follow-up cases and 12 TB negative sputum samples. The time-to-culture-positivity (TTP) and degree of culture positivity (DCP) were recorded. All 122 isolates obtained were Spoligotyped for lineage (L) classification but spoligotypes were obtained from 120 isolates. Of the typed isolates, 70.0%, 10.8%, 10.8%, 4.2%, 2.5%, 0.8% and 0.8% were Lineage- 4, 5, 6, 2, 3, 1, and M. bovis respectively. Further analysis of the three most prevalent lineages showed significantly shorter TTP and higher DCP by L4 compared to L5 and L6 respectively: TTP 20.8, versus 26.5, and 28.2 days; p-value=0.005 and DCP 1.27, versus 0.81 and 0.29, p<0.001. Average TB-MBLA measured bacterial load of L4 was 3.82 Log10eCFU/mL which was not significantly different from 3.81 and 3.80 Log10eCFU/mL of L5 and L6 respectively, p=0.84. Degree of smear microscopy: L4=1.20, L5=1.20, L6=0.92 and Gene Xpert Cq values: L4=17.08, L5=18.37, L6=17.59; showed no significant difference between the lineages, p=0.72 and p=0.48 respectively. Retrospective analysis of a larger sample confirmed the difference in TTP, p<0.001. In conclusion, the observed shorter TTP and high DCP of L4 could signify high growth rate in culture that is independent of total bacterial load at diagnosis.Publisher PDFPeer reviewe

Production of recombinant TSA-1 and evaluation of its potential for the immuno-therapeutic control of Trypanosoma cruzi

A therapeutic vaccine for human Chagas disease (American trypanosomiasis caused by Trypanosoma cruzi) is under development based on the success of vaccinating mice with DNA constructs expressing the antigens Tc24 and Tc-TSA-1. However, because DNA and nucleic acid vaccines produce less than optimal responses in humans, our strategy relies on administering a recombinant protein-based vaccine, together with adjuvants that promote Th1-type immunity. Here we describe a process for the purification and refolding of recombinant TSA-1 expressed in Escherichia coli. The overall yield (20–25%) and endotoxin level of the purified recombinant TSA-1 (rTSA-1) is suitable for pilot scale production of the antigen for use in phase 1 clinical trials. Mice infected with T. cruzi were treated with rTSA-1, either alone or with Toll-like receptor 4 (TLR-4) agonist adjuvants including monophosphoryl lipid A (MPLA), glucopyranosyl lipid A (GLA, IDRI), and E6020 (EISEI, Inc). TSA-1 with the TLR-4 agonists was effective at reducing parasitemia relative to rTSA-1 alone, although it was difficult to discern a therapeutic effect compared to treatment with TLR-4 agonists alone. However, rTSA-1 with a 10 ug dose of MPLA optimized reductions in cardiac tissue inflammation, which were significantly reduced compared to MPLA alone. It also elicited the lowest parasite burden and the highest levels of TSA-1-specific IFN-gamma levels and IFN-gamma/IL-4 ratios. These results warrant the further evaluation of rTSA-1 in combination with rTc24 in order to maximize the therapeutic effect of vaccine-linked chemotherapy in both mice and non-human primates before advancing to clinical development

Molecular Cloning, Biochemical Characterization, and Partial Protective Immunity of the Heme-Binding Glutathione S-Transferases from the Human Hookworm Necator americanus

Hookworm glutathione S-transferases (GSTs) are critical for parasite blood feeding and survival and represent potential targets for vaccination. Three cDNAs, each encoding a full-length GST protein from the human hookworm Necator americanus (and designated Na-GST-1, Na-GST-2, and Na-GST-3, respectively) were isolated from cDNA based on their sequence similarity to Ac-GST-1, a GST from the dog hookworm Ancylostoma caninum. The open reading frames of the three N. americanus GSTs each contain 206 amino acids with 51% to 69% sequence identity between each other and Ac-GST-1. Sequence alignment with GSTs from other organisms shows that the three Na-GSTs belong to a nematode-specific nu-class GST family. All three Na-GSTs, when expressed in Pichia pastoris, exhibited low lipid peroxidase and glutathione-conjugating enzymatic activities but high heme-binding capacities, and they may be involved in the detoxification and/or transport of heme. In two separate vaccine trials, recombinant Na-GST-1 formulated with Alhydrogel elicited 32 and 39% reductions in adult hookworm burdens (P < 0.05) following N. americanus larval challenge relative to the results for a group immunized with Alhydrogel alone. In contrast, no protection was observed in vaccine trials with Na-GST-2 or Na-GST-3. On the basis of these and other preclinical data, Na-GST-1 is under possible consideration for further vaccine development