bluuebunny/crossref_metadata_2025_split huggingface dataset:
The Evolution of the Finale, 1874–1888
Authors: Korstvedt Benjamin M 
Published: September 2024

Abstract
The Finale of the Fourth stands out in several ways. It seems to exist somewhat apart from the rest of the symphony, both in form and character. It also underwent marked, persistent change during the compositional evolution of this symphony; in fact, it is the single most profoundly reworked movement in Bruckner’s oeuvre. In this chapter, the movement is considered in the context of the “Finale Problem” that confronted the symphony after Beethoven. The chapter explores the musical changes the Finale underwent from its original conception in 1874 through its final version in 1888. Special consideration is given to the recapitulation of the movement, the section Bruckner revised most intensely. It describes the little-known variants of this passage he created in 1880 and 1881. The chapter concludes with a discussion of the significance of the five different versions of the concluding pages of the symphony.
External Validation of the TWIST Algorithm for Predicting Walking Independence Post-Acute Stroke: An Irish Prospective Cohort Study
Authors: Harte Mary , Horgan Frances , Galvin Rose , Newell Evelyn 
Published: September 2024

Abstract

Background
Early prediction of walking dependency post-stroke is important for clinician and patient decision-making. National stroke guidelines recommend using the ‘Time to Walking Independently after Stroke’ (TWIST) model to predict walking independence post-stroke. External validation of the TWIST model is required prior to its clinical integration. This study aimed to evaluate whether the TWIST model is a valid predictor of walking independence post-stroke in an Irish population.

Methods
This prospective cohort study recruited patients admitted to a tertiary hospital with an acute stroke from July-November 2023. The Trunk Control Test (TCT) and paretic-limb hip extensor strength (Medical Research Council (MRC) scale) were assessed within 3 days post-stroke. Walking independence (Functional Ambulatory Category) was measured at 6 or 12 weeks post-stroke based on TWIST algorithm predictions. Predictive performance was measured using the area under the curve (AUC), accuracy, sensitivity, specificity, positive and negative predictive value.

Results
Sixty-one participants (38 male, median (interquartile range) age 74 years (68-86) and National Institutes of Health Stroke Scale 7 (4-11.5)) were included. The AUC (95% CI) was 0.88 (0.81-0.96) and 0.7 (0.21-1) at 6 and 12 weeks post-stroke respectively. Predictive accuracy (95% CI) was higher at 6 weeks (88.52% (77.78-95.26)) than 12 weeks post-stroke (86.96% (66.41-97.22)). Overall, the TWIST model made accurate predictions for 83.61% (71.91-91.85) of participants.

Conclusion
The TWIST model demonstrated fair-good predictive performance when externally validated. However, it performed poorly at 12 weeks post-stroke for those with poor post-stroke trunk control (TCT &lt; 40) but moderate hip extensor strength (≥ 3 MRC scale). Further research is needed to explore its utility in this subgroup.

Implication of Findings
The TWIST model may benefit clinicians and patients by accurately predicting walking independence post-stroke. Further research is needed to explore its utility in specific subgroups, particularly those with poor post-stroke trunk control but moderate hip extensor strength.
Are There Missed Opportunities For Falls Prevention In Older People With Fractures? Data From TILDA
Authors: Daly Simon , Carroll Thomas , Kenny Rose Anne , Briggs Robert 
Published: September 2024

Abstract

Background
Fractures can represent a seminal event in later life associated with significantly higher rates of functional impairment, nursing home admission and mortality. The aim of this study therefore was to measure the cumulative incidence of hip and wrist fractures longitudinally in a population-representative sample of community-dwelling older people and examine opportunities to intervene prior to the fracture.

Methods
Participants aged ≥65 years from the Irish Longitudinal Study on Ageing were included and followed from Wave 1 to Wave 5 (8-year follow-up). Falls and Fractures (Hip and Wrist) and were elicited by self-report at each wave. Participants were also asked how steady they feel when standing / walking. Logistic regression models assessed the relationship between reported falls and unsteadiness, and subsequent fracture.

Results
3,072 participants were included (Mean age 73 years, 53% female) and followed for a median of 6.3 years, with over 7% (228/3,072) reporting a fracture. Over one quarter (69/267) of fractures were preceded by an injurious fall requiring medical attention in the prior 24 months, 45% were preceded by a fall of any type (121/267). One third of participants who subsequently had a fracture (89/267), reported that they were unsteady on their feet when interviewed prior to the fracture. One fifth (19/89) of these participants accessed physiotherapy services prior to the fracture. The combination of either a fall or unsteadiness reported during the preceding 24 months significantly increased the likelihood of future fracture (Odds Ratio 2.62 (95% CI 2.05 – 3.35)).

Conclusion
Most fractures are predictable with almost two thirds heralded by falls or unsteadiness in the preceding 24 months. Falls prevention strategies, which can reduce further falls by 20-40%, targeted at those with unsteadiness and falls would likely prevent an important proportion of future fractures, and have a positive impact on health outcomes in this cohort.
Detection of Prescribing Cascades in Multimorbid Older Patients Hospitalized with Acute Unselected Illness
Authors: Daunt Ruth , McGettigan Siobhan , Kelly Lorna , Curtin Denis , O'Mahony Denis 
Published: September 2024

Abstract

Background
Prescribing cascades (PCs) occur when a new medication is prescribed to treat an unrecognized side-effect of another medication. PCs represent an important but often underrecognized aspect of inappropriate prescribing in older people with multimorbidity and associated polypharmacy and can result in avoidable morbidity and mortality. Numerous PCs are described in the literature, however, there are no prospective studies describing PC prevalence in older people. Therefore, we aimed to investigate the prevalence of PCs in acutely hospitalized older adults.

Methods
We undertook a prospective observational study, including adults ≥65years with polypharmacy (≥5 daily drugs) and multimorbidity (≥3 chronic disorders). Prescription medication lists were examined for the co-prescription of 31 drug pairs according to two pre-defined PC lists– ThinkCasades1 and of the explicit cascades published by Doherty et al2. PCs were defined as ‘definite’, ‘probable’, ‘possible’, ‘uncertain’ or ‘indeterminate’ according to specific criteria.

Results
We obtained prospective data on 300 patients (56% female, mean age 80.4yrs SD 7.2). 233 drug pairs were prescribed in the sequence of drug A → drug B, these occurred in 43% (n=130) of patients. Of the 233 pairs, 38% (n=88) were probable or possible PCs and 62% (n=145) were uncertain. 45 patients (15%) had ≥1 possible or probable PCs. The most commonly identified probable/possible PCs were diuretic → overactive bladder medication and calcium channel blocker → diuretic. Patients with an identified PC experienced higher mean levels of polypharmacy than patients with no PCs (11.7, SD 4.0 vs 9.6, SD 3.1, T= -4.97, p &lt;0.001).

Conclusion
In this first-ever study to report prospective prevalence of PCs, possible or probable PCs were significantly prevalent among acutely hospitalized multimorbid older patients and were associated with higher levels of polypharmacy.McCarthy LM, et al. Drgs & aging. 2022 Oct;39(10):829-40.Doherty AS, et al. Pharmacology research & perspectives. 2022 Oct;10(5): e01008.
Circulating IL-17A and Executive Function in Middle-Aged Adults with and without Type 2 Diabetes
Authors: Morrison Laura , Dyer Adam , Bourke Nollaig , Kennelly Sean 
Published: September 2024

Abstract

Background
Midlife cardiovascular risk factors, such as Type 2 Diabetes Mellitus (T2DM) and obesity, are associated with a greater risk of cognitive impairment and dementia in later life, with altered peripheral inflammation postulated as a crucial mechanistic link. Yet there is a significant gap in knowledge regarding when pathogenic alterations to these systemic inflammatory responses change during the early stages of cognitive dysfunction prior to overt disease development. To assess the earliest possible signs of this link, we recruited a cohort of middle-aged cognitively-unimpaired individuals with and without uncomplicated T2DM.

Methods
A comprehensive neuropsychological assessment was performed at baseline and at 4-year follow-up. A panel of ten serum chemokines and cytokines were measured at both time-points using high-sensitivity assays (Eotaxin, MCP-1, MIP-1β, CXCL-10, IL-6, IL-10, IL12p70, IL-17A, IFN-γ and TNF-α).

Results
Overall, 136 individuals were recruited including 90 with uncomplicated midlife T2DM (age 52.6 ± 8.3; 47% female) and 46 without (age 52.9 ± 8.03; 61% female). Cognitive trajectories were stable over time and did not differ by T2DM status. Yet on cross-sectional analyses, we observed consistent evidence across timepoints between greater circulating IL-17A and poorer performance on tests of executive function/attention (β: -0.21; -0.40, -0.02, p = 0.03 at baseline; β: -0.26; -0.46, -0.05, p = 0.02 at follow-up) as well as poorer reaction time (β: 0.34; 0.12, 0.56, p = 0.003 at follow-up). These persisted on covariate adjustment and did not differ by T2DM status.

Conclusion
We provide exploratory evidence that greater serum IL-17A levels are associated with poorer executive function in midlife. Long-term follow-up of this and other cohorts will further elucidate this relationship to provide further mechanistic insights and potentially identify individuals at greatest risk for later cognitive decline.
Losing the Postcode Lottery: An Observational Study Examining the Association Between Patient Address and Delayed Discharge in a Rehabilitation Centre
Authors: Murphy Robert Allan , Ward Andrea , Larkin Joanne , McKeag Avril , O'Connor Marie 
Published: September 2024

Abstract

Background
Quality and Fairness: A Health System for You published by the HSE in 2001 stated, as one of its core principles “Access to healthcare should be fair. The system must respond to people’s needs rather than have access dependent on geographic location or ability to pay.”1 Twenty years on, experience at our rehab unit suggests that inequality exists in accessing care in the community for older persons based on their residential address. The aim of our study was to examine and quantify this inequity of access.

Methods
A retrospective study was designed. Using the local patient information management system, all discharges in 2023 were identified. Baseline demographics, admission and discharge date and residential address were recorded. Delayed discharges were defined as patients for whom their rehabilitation programme is complete as agreed at the multi-disciplinary team meeting. Delayed discharge data was obtained from medical social work department who input this data to the HSE weekly. Patients were assigned a community healthcare organisation (CHO) based on address. CHO ‘A’ included two CHOs with predominantly rural areas whilst CHO ‘B’ comprised of one predominantly urban CHO.

Results
167 patients were included. 24 discharges were delayed (14.4%). Median age was 84. Total bed days lost: 935 (mean 40.6, range 3 – 232). All nine CHOs were represented. Patients living in CHO A had increased likelihood of having discharge delayed (OR: 4.82, CI 2.86 – 8.13). Conversely, those living in CHO B were less likely to have had a discharge delayed (OR: 0.39, CI 0.15 – 0.96)

Conclusion
Our study demonstrates that health inequity does exist. Patients residing in rural communities are 4 times more likely to have their discharge delayed awaiting community supports compared to urban dwellers. Ending of the discrimination of patients based on their postcode and ensuring access based on need is the very essence of Sláintecare.
What Benefits Does Local Sports Club Membership Confer On Community-Dwelling Older People In Ireland?
Authors: Flanagan Clodagh , Kenny Regius Rose Anne , Ward Mark , Briggs Robert 
Published: September 2024

Abstract

Background
There is a strong culture of sports club membership amongst older people in Ireland. It has been suggested that this confers health benefits due to increased physical activity and social connection, but studies examining this are currently lacking. The aim of this study therefore was to assess the relationship of sports club membership with markers of health and well-being in a large population-representative cohort of older people.

Methods
Over 3,500 participants ≥65 years at Wave 5 (mean 74 years, 54% female) of the Irish Longitudinal Study on Ageing were included. Sports club membership (GAA, soccer, rugby, tennis, golf) was elicited by self-report. Depressive symptoms (Centre for Epidemiological Studies Depression Scale), loneliness (UCLA Scale), and quality of life (Control Autonomy Self-Realization Please Scale) were assessed with internationally validated scales. Physical Activity was by self-report and mobility impairment was defined as Timed-Up-and-Go≥14s. The associations between sports club membership and these outcomes were assessed with regression models adjusted for age, sex, education, polypharmacy, chronic disease burden and heart disease.

Results
One fifth (708/3,510) of participants were a member of a local sports club. Sports club membership was associated with lower rates of depressive symptoms (Odds ratio 0.51 (95% CI 0.34,0.75)), lower levels of loneliness (Beta = -0.28 (95% CI -0.46, -0.10)) and better quality of life (Beta= 0.93 (95% CI 0.49,1.38)) in fully-adjusted models. Sports club members spent more days doing moderate physical activity per week (2.0 (95% CI 1.85,2.21) vs 1.64 (95% CI 1.54,1.73); p&lt;0.001) and had lower likelihood of mobility impairment (Adjusted Odds Ratio 0.49 (95% CI 0.36,0.68)).

Conclusion
Sports Club Membership is prevalent amongst community-dwelling older people in Ireland and is associated with lower rates of loneliness, depressive symptoms and mobility impairment, and better quality of life. Older sports club members should be encouraged to maintain this activity where feasible.
Overcoming a Treatment Barrier – Setting Up a Home-Based Osteoporosis Treatment with Zoledronate (HOTZ) Service
Authors: Butler Elaine , Hogan Eleanor , Sheridan Noeleen , Carroll Joanna , Dockery Frances 
Published: September 2024

Abstract

Background
Intravenous Zoledronic acid is an effective, once-annual treatment for osteoporosis and is indicated following hip fracture in particular, in addition to other osteoporotic fracture types. One of the barriers to its administration (as described in a survey of Geriatricians attending the FFN, BGS and IGS meetings in 2023), is a lack of facility to arrange subsequent doses because intravenous infusions are traditionally, exclusively hospital-based.

Methods
The Beaumont Hospital Fracture Liaison Service (FLS) collaborated with our local Community Intervention Team (CIT) to establish a protocol for home-based Zoledronic acid infusions. Following an initial Zoledronate dose being given in the inpatient or outpatient setting, a virtual clinic is conducted 11 months later to plan subsequent doses, as is standard practice in our unit. At these clinics, we identified those who are housebound with no means of travelling to hospital clinics as potentially eligible for the HOTZ service. Following home-based blood tests, a customised Zoledronic acid checklist addresses patient information, biochemical parameters, required infusion duration and includes a safety checklist for any rare adverse events since previous infusion. Education and training was provided by the FLS and the CIT lead to the CIT nursing staff responsible for administering the infusions.

Results
We have had four patients to date receive the HOTZ service with several further planned. No adverse events reported. The feedback from all was extremely positive, some stating that they felt everyone should have this service, and they were glad of the cost savings on taxis and avoiding the strain on family members or carers of escorting them to hospital appointments for blood tests and again for treatment.

Conclusion
Setting up a Home-based Osteoporosis Treatment Service is feasible and preliminary results show very high user-satisfaction with the service. We recommend that FLS & CIT nationally consider roll out of such services.
Psychological Health Outcomes of Older Adult Volunteers: Findings from The Irish Longitudinal Study on Ageing
Authors: Lehane Grace , Scarlett Siobhan 
Published: September 2024

Abstract

Background
Volunteering has been shown to alleviate the feeling of loneliness and have indirect positive effects on the subjective quality of life of older adults. Volunteering post-retirement has been shown to have a positive effect on loneliness, quality of life, and depression. This research aimed to examine the relationship between volunteering and depression, loneliness, and quality of life among a nationally representative sample of older adults in the Republic of Ireland. These measures were also examined in the context of volunteering and retirement.

Methods
Through secondary analysis of five waves of data from the Irish Longitudinal Study on Ageing (TILDA), this research explored the relationships between volunteering, retirement, loneliness, depression and quality of life. To achieve this, both cross-sectional analyses using regression models and longitudinal analysis using mixed-effects modelling were utilised.

Results
Volunteering had a significant negative association with loneliness [Incident Rate Ratio (IRR)=0.87, 95% CI=0.80,0.95, p&lt;0.01] and depression [IRR=0.88, 95% CI=0.81, 0.96, p&lt;0.01], and a positive association with quality of life [Beta (B)=0.69, 95% CI=0.39, 1.00, p&lt;0.05] at baseline. These associations were not significant over time. Volunteering in retirement was associated with increased quality of life [B=0.7, 95% CI=0.2, 1.1, p&lt;0.05], while associations between depression and loneliness and retirement were not significant. Those who volunteered in retirement experienced less depression over time [IRR=0.90, 95% CI=0.83, 0.99].

Conclusion
The findings of this study demonstrate the positive effects of volunteering on the psychological outcomes of older adults. This study also found evidence of the long-term effects of volunteering in retirement on depression, suggesting that continued participation in volunteer activities positively impacts depression. This research demonstrates the importance of increasing opportunities and promoting volunteer participation to contribute to the positive ageing of older adults.
A Novel Primary Care-Based, Practice Nurse-Led Bone Health Service for People in Long Term Care
Authors: Warlow Geraint , Toland Sarah 
Published: September 2024

Abstract

Background
11% of all Irish hip fractures originate in the long-term care (LTC) setting and LTC residents are at the highest risk of reduced bone density. Risk is poorly managed as no primary care framework exists. A novel practice nurse-prescriber-led service is described in which risk estimation directs stratification, investigation, and treatment of fragility fracture risk.

Methods
Baseline assessment uses FRAX (fracture risk assessment tool) to risk-stratify using NOGG (National Osteoporosis Guideline Group) risk charts and inform the need for bone mineral density (BMD) measurement. A bone health drug optimisation process ensured patients were offered treatment at appropriate intensity.

Results
107 residents of mean age 86.2 were newly admitted to long-term care in 2023. 92 were included and 15 were excluded due to poor prognosis. 10 of the 92 residents included died in 2023. 91 patients were risk-stratified into NOGG categories as follows: Low 22%, n=20; intermediate, below intervention threshold 23%, n=21; intermediate, above intervention threshold 16%, n=15; high 19%, n=17; very high 20% n=18. 84% (n=77) of those in risk categories indicating anti-resorptive treatment were not prescribed a bisphosphonate at baseline and none were prescribed Denosumab. 84% (n=42) were prescribed Vitamin D either with or without supplemental calcium and 16% were prescribed nothing to improve bone health. Post-intervention, 100% (n=43) of patients at a risk level of NOGG ‘intervention threshold’ or above were prescribed either Vitamin D with or without supplemental calcium and 58% (n=25) were prescribed anti-resorptive therapy (denosumab =47%, n=20 or bisphosphonate = 9%, n=5). Discussion of treatment with the primary care and LTC team is periodic. At the time of data capture, 88% of residents were discussed and 12% were planned for discussion.

Conclusion
A practice nurse-prescriber led service targeting LTC residents is effective in optimising screening and prescribing. Future work could include replication in the national LTC community.
A Process Evaluation Exploring the Delivery of a CGA-Based Intervention in the ED: The SOLAR RCT
Authors: Barry Louise , Leahy Aoife , O'Connor Margaret , Corey Gillian , O'Shaughnessy Ide , Smalle Eimear , Synnott Aoife , Moran Brian , McCarthy Aoife , Carroll Ida , Meskell Pauline , Tighe Sylvia Murphy , Galvin Rose 
Published: September 2024

Abstract

Background
Evidence to support the delivery of CGA, to improve the care of older adults in ED, is encouraging but limited. The SOLAR trial is the first of its kind to explore this ED intervention. The trial process and delivery were underpinned by the development of a complex trial protocol, facilitation of stakeholder involvement and Multidisciplinary team (MDT)-based collaboration. The aim of this study was to utilise a mixed methods approach to explore the delivery of this trial.

Methods
Using the Medical Research Council (MRC) Framework, we investigated the trial design, implementation and delivery. Mechanisms of impact and contextual influences were explored by analysing participant recruitment logs, team activity logs and by interviewing SOLAR MDT members and trial participants. Qualitative insights were mapped to the theoretical domains framework (TDF) to inform implementation strategies.

Results
Clinical knowledge and experience is vital when delivering CGA to a complex heterogenous group in the ED. This approach is time consuming and needs to be delivered by skilled and highly motivated professionals who build positive relationships and foster a multidisciplinary and patient-centred ethos. To facilitate implementation, establishing preconditions to screening processes and involving relevant stakeholders in pre-implementation processes can facilitate acceptance of intervention operations.

Conclusion
This is the first evaluation to provide in-depth insights from both trial participants and the MDT trial team. Findings provide practical insights into the value of consistent stakeholder involvement when delivering a complex intervention. The importance of establishing a knowledgeable and highly skilled MDT team to successfully deliver CGA was emphasised. Experience in delivering complex care to a heterogenous group of older adults in the ED is vital to underpin this care and ensure CGA integration into current ED processes, this was recognised by both older adults and the trial team. A collaborative approach to CGA delivery ensured that participants had positive experiences throughout the trial.