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Papers by Cliona M Cheallaigh

Background: The pilot Inclusion Health Service was a multi-component intervention designed to imp... more Background: The pilot Inclusion Health Service was a multi-component intervention designed to improve outcomes for adults experiencing homelessness accessing hospital care. The objectives of this report are to describe the development and evaluation of the Inclusion Health Service. Method: Observational study reporting on a multi-component intervention including comprehensive assessment and case management of homeless adult inpatients, case management advice to emergency department- and community-based health, and social care providers and education sessions for hospital and community-based staff. Results: The Inclusion Health Service assessed and developed a comprehensive discharge plan for 262 patients admitted to the hospital. 51 weekly interagency case management meetings took place during the one-year pilot. Additional interventions included education sessions for hospital and community-based health and social care providers; case management advice to ED and community-based hea...

Nature Communications

Host immunity to infection with SARS-CoV-2 is highly variable, dictating diverse clinical outcome... more Host immunity to infection with SARS-CoV-2 is highly variable, dictating diverse clinical outcomes ranging from asymptomatic to severe disease and death. We previously reported reduced type I interferon in severe COVID-19 patients preceded clinical worsening. Further studies identified genetic mutations in loci of the TLR3- or TLR7-dependent interferon-I pathways, or neutralizing interferon-I autoantibodies as risk factors for development of COVID-19 pneumonia. Here we show in patient cohorts with different severities of COVID-19, that baseline plasma interferon α measures differ according to the immunoassay used, timing of sampling, the interferon α subtype measured, and the presence of autoantibodies. We also show a consistently reduced induction of interferon-I proteins in hospitalized COVID-19 patients upon immune stimulation, that is not associated with detectable neutralizing autoantibodies against interferon α or interferon ω. Intracellular proteomic analysis shows increased ...

Irish Journal of Medical Science (1971 -)

Background The COVID-19 pandemic has put considerable strain on healthcare systems. Aim To invest... more Background The COVID-19 pandemic has put considerable strain on healthcare systems. Aim To investigate the effect of the COVID-19 pandemic on 30-day in-hospital mortality, length of stay (LOS) and resource utilization in acute medical care. Methods We compared emergency medical admissions to a single secondary care centre during 2020 to the preceding 18 years (2002–2019). We investigated 30-day in-hospital mortality with a multiple variable logistic regression model. Utilization of procedures/services was related to LOS with zero truncated Poisson regression. Results There were 132,715 admissions in 67,185 patients over the 19-year study. There was a linear reduction in 30-day in-hospital mortality over time; over the most recent 5 years (2016–2020), there was a relative risk reduction of 36%, from 7.9 to 4.3% with a number needed to treat of 27.7. Emergency medical admissions increased 18.8% to 10,452 in 2020 with COVID-19 admissions representing 3.5%. 18.6% of COVID-19 cases requi...

Objective: The objective of this study was to identify and understand the health system contexts ... more Objective: The objective of this study was to identify and understand the health system contexts and mechanisms that allow for homeless populations to access appropriate healthcare when needed.Design: A realist review.Data sources: Ovid MEDLINE, embase.com, CINAHL, ASSIA and grey literature until April 2019. Eligibility criteria for selecting studies: The purpose of the review was to identify health system patterns which enable access to healthcare for people who experience homelessness. Peer reviewed articles were first identified through a systematic search, grey literature searching, citation tracking and expert recommendations. Studies meeting the inclusion criteria were assessed for rigour and relevance and coded to identify data relating to contexts, mechanisms and/or outcomes.Analysis: Inductive coding was used to generate Context-Mechanism-Outcome configurations which were refined and then used to build several iterations of the overarching programme theory.Results: Searchin...

Journal of Thrombosis and Haemostasis, 2021

This is an open access article under the terms of the Creative Commons Attribution-NonCommercial ... more This is an open access article under the terms of the Creative Commons Attribution-NonCommercial License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited and is not used for commercial purposes.

Journal of Thrombosis and Haemostasis, 2021

This is an open access article under the terms of the Creat ive Commo ns Attri bution-NonCo mmerc... more This is an open access article under the terms of the Creat ive Commo ns Attri bution-NonCo mmercial License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited and is not used for commercial purposes.

Annals of the American Thoracic Society, 2021

Rationale: Much is known about the acute infective process of severe acute respiratory syndrome c... more Rationale: Much is known about the acute infective process of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the causative virus of the coronavirus disease (COVID-19) pandemic. The marked inflammatory response and coagulopathic state in acute SARS-CoV-2 infection may promote pulmonary fibrosis. However, little is known about the incidence and seriousness of post-COVID-19 pulmonary pathology. Objectives: To describe the respiratory recovery and self-reported health after infection at the time of outpatient attendance. Methods: Infection severity was graded into three groups: 1) not requiring admission, 2) requiring hospital admission, and 3) requiring intensive care unit care. Participants underwent chest radiography and a 6-minute walk test (6MWT). Fatigue and subjective return to health were assessed, and concentrations of CRP (C-reactive protein), IL-6 (interleukin-6), sCD25 (soluble CD25), and D-dimer were measured. The associations between initial illness and abnormal chest X-ray findings, 6MWT distance, and perception of maximal exertion were investigated. Results: A total of 487 patients were offered an outpatient appointment, of whom 153 (31%) attended for assessment at a median of 75 days after diagnosis. A total of 74 (48%) had required hospital admission during acute infection. Persistently abnormal chest X-ray findings were seen in 4%. The median 6MWT distance covered was 460 m. A reduced distance covered was associated with frailty and length of inpatient stay. A total of 95 (62%) patients believed that they had not returned to full health, whereas 47% met the case definition for fatigue. Ongoing ill health and fatigue were associated with an increased perception of exertion. None of the measures of persistent respiratory disease were associated with initial disease severity. Conclusions: This study highlights the rates of objective respiratory disease and subjective respiratory symptoms after COVID-19 and the complex multifactorial nature of post-COVID-19 ill health.

BMJ Open Quality, 2021

Homelessness is associated with significant psychosocial and health disparities. The rate of epil... more Homelessness is associated with significant psychosocial and health disparities. The rate of epilepsy among this cohort is eight times greater than that in the settled population, and the associated morbidity is higher due to lack of integrated care, difficulties with treatment adherence, substance abuse and poor social circumstances. There is a high rate of seizure-related death in homeless patients. Seizures are one of the most common neurological cause for emergency department presentation among this population. The aim of this quality improvement project was to use a multistakeholder co-production approach to design a new pathway of care for homeless patients with epilepsy to improve access to specialist epilepsy care and to strengthen the links between hospital and community teams who manage this population. After several years of observation, stakeholder engagement and numerous tests of change, we have created a new care pathway and developed bespoke tools for primary care pro...

SummarySARS-CoV-2 infection causes a wide spectrum of disease severity. Immune changes associated... more SummarySARS-CoV-2 infection causes a wide spectrum of disease severity. Immune changes associated with severe disease include pro-inflammatory cytokine production and expansion of immature myeloid populations. The relative importance of the immunological changes in driving progression to severe disease remain poorly understood.We aimed to identify and rank clinical and immunological features associated with progression to severe COVID-19. We sought to use tests available in an on-site diagnostic hospital laboratory to identify an immunological signature for severe disease development which could be detected prior to peak severity thereby allowing initiation of therapeutic interventions. We used univariate and multivariate analysis, including unbiased machine learning, to investigate the relationships between clinical and demographic characteristics, inflammatory markers, and leukocyte immunophenotypes with progression to severe disease in 108 patients and to rank these in importance...

International Journal of Environmental Research and Public Health, 2021

Background: People who are homeless experience poor health. Reflective of overall health and fact... more Background: People who are homeless experience poor health. Reflective of overall health and factors such as acquired injuries, physical ability or functioning is often low among people who are homeless, but there is a lack of consistency of measures used to evaluate this construct. The aim of this study was to evaluate the feasibility of a broad test battery to evaluate limitations in physical functioning among people who are homeless. Methods: This cross-sectional, observational study occurred in a hospital in Dublin, Ireland. We evaluated lower extremity physical function (Short Physical Performance Battery), falls risk (timed up and go), functional capacity (six-minute walk test), stair-climbing ability (stair climb test), frailty (Clinical Frailty Scale), grip strength (handgrip dynamometer) and muscular mass (calf circumference measurement) in a population of people experiencing homelessness admitted for acute medical care. The test completion rate was evaluated for feasibilit...

The trajectory of immunological and inflammatory changes following acute COVID-19 infection are u... more The trajectory of immunological and inflammatory changes following acute COVID-19 infection are unclear. We investigate immunological changes in convalescent COVID-19 and interrogate their potential relationships with persistent symptoms, termed long COVID.We performed paired immunophenotyping at initial SARS-CoV-2 infection and convalescence (n=40, median 68 days) and validated findings in 71 further patients at median 101 days convalescence. Results were compared to 40 pre-pandemic controls. Fatigue and exercise tolerance were assessed and investigated their relationship with convalescent results.We demonstrate persistent expansion of intermediate monocytes, effector CD8+, activated CD4+ and CD8+ T cells, and reduced naïve CD4+ and CD8+ T cells at 68 days, with activated CD8+ T cells remaining increased at 101 days. Patients >60 years also demonstrate reduced naïve CD4+ and CD8+ T cells and expanded activated CD4+ T cells at 101 days. Ill-health, fatigue, and reduced exercise t...

HRB Open Research, 2021

Background:Over the last several years, homelessness has increased in Ireland and across Europe. ... more Background:Over the last several years, homelessness has increased in Ireland and across Europe. Rates have recently declined since the coronavirus disease 2019 (COVID-19) pandemic, but it is unclear whether emergency housing measures will remain in place permanently. Populations experiencing long-term homelessness face a higher burden of multi-morbidity at an earlier age than housed populations and have poorer health outcomes. However, this population also has more difficulty accessing appropriate health services. A realist review by the authors found that important health system contexts which impact access are resourcing, training, funding cycles, health system fragmentation, health system goals, how care is organised, culture, leadership and flexibility of care delivery. Using a realist evaluation approach, this research will explore and refine key system-level factors, highlighted in our realist review, in a local health care system.Aim:The aim of this study is to understand ho...

HRB Open Research, 2020

Background: Over the last several years, homelessness has increased in Ireland and across Europe.... more Background: Over the last several years, homelessness has increased in Ireland and across Europe. Rates have recently declined since the coronavirus disease 2019 (COVID-19) pandemic, but it is unclear whether emergency housing measures will remain in place permanently. Populations experiencing long-term homelessness face a higher burden of multi-morbidity at an earlier age than housed populations and have poorer health outcomes. However, this population also has more difficulty accessing appropriate health services. A realist review by the authors found that important health system contexts which impact access are resourcing, training, funding cycles, health system fragmentation, health system goals, how care is organised, culture, leadership and flexibility of care delivery. Using a realist evaluation approach, this research will explore and refine key system-level factors, highlighted in our realist review, in a local health care system. Aim: The aim of this study is to understand...

Poster presentations, 2021

(treatment/prognosis discussions, advance care planning, treatment withdrawal, memory-making, ber... more (treatment/prognosis discussions, advance care planning, treatment withdrawal, memory-making, bereavement care) and felt it improved care by providing privacy, removing distractions and facilitating the humanisation of care. However, issues were highlighted that influenced how MH was understood and used by staff, and have subsequently shaped the routine use of MH. These included issues relating to the practical management of MH, sense of ownership and shared understanding of purpose. Conclusion The findings reveal important information about how palliative care can be improved in acute settings. They show how initial implementation strategies can influence staff engagement with innovations like MH and suggest factors that affect uptake and the quality of care. This work is informing the development of MH and has wider implications for how other acute settings can transform their care environments for the benefit of patients and families.

Fatigue is a common symptom in those presenting with symptomatic COVID-19 infection. However, it ... more Fatigue is a common symptom in those presenting with symptomatic COVID-19 infection. However, it is unknown if COVID-19 results in persistent fatigue in those recovered from acute infection. We examined the prevalence of fatigue in individuals recovered from the acute phase of COVID-19 illness using the Chalder Fatigue Score (CFQ-11). We further examined potential predictors of fatigue following COVID-19 infection, evaluating indicators of COVID-19 severity, markers of peripheral immune activation and circulating pro-inflammatory cytokines. Of 128 participants (49.5 ± 15 years; 54% female), more than half reported persistent fatigue (52.3%; 45/128) at 10 weeks (median) after initial COVID-19 symptoms. There was no association between COVID-19 severity (need for inpatient admission, supplemental oxygen or critical care) and fatigue following COVID-19. Additionally, there was no association between routine laboratory markers of inflammation and cell turnover (leukocyte, neutrophil or ...

ABSTRACTThe aging process is characterized by the presence of high interindividual variation betw... more ABSTRACTThe aging process is characterized by the presence of high interindividual variation between individuals of the same chronical age prompting a search for biomarkers that capture this heterogeneity. The present study examines the associations of four epigenetic clocks - Horvath, Hannum, PhenoAge, GrimAge - with a wide range of clinical phenotypes, and with all-cause mortality at up to 10-year follow-up in a sample of 490 participants in the Irish Longitudinal Study on Ageing. Results indicate that the GrimAge clock represents a step-improvement in the predictive utility of the epigenetic clocks for identifying age-related decline in an array of clinical phenotypes.

Open Forum Infectious Diseases, 2020

Background High-cost, high-need users are defined as patients who accumulate large numbers of eme... more Background High-cost, high-need users are defined as patients who accumulate large numbers of emergency department visits and hospital admissions that might have been prevented by relatively inexpensive early interventions and primary care. This phenomenon has not been previously described in HIV-infected individuals. Methods We analyzed the health records of HIV-infected individuals using scheduled or unscheduled inpatient or outpatient health care in St James’s Hospital, Dublin, Ireland, from October 2014 to October 2015. Results Twenty-two of 2063 HIV-infected individuals had a cumulative length of stay >30 days in the study period. These individuals accrued 99 emergency department attendances and 1581 inpatient bed days, with a direct cost to the hospital of >€1 million during the study period. Eighteen of 22 had potentially preventable requirements for unscheduled care. Two of 18 had a late diagnosis of HIV. Sixteen of 18 had not been successfully engaged in outpatient HI...

The Journals of Gerontology: Series A, 2019

Allostatic load (AL) and epigenetic clocks both attempt to characterize the accelerated aging of ... more Allostatic load (AL) and epigenetic clocks both attempt to characterize the accelerated aging of biological systems, but at present it is unclear whether these measures are complementary or distinct. This study examines the cross-sectional association of AL with epigenetic age acceleration (EAA) in a subsample of 490 community-dwelling older adults participating in The Irish Longitudinal study on Aging (TILDA). A battery of 14 biomarkers representing the activity of four different physiological systems: immunological, cardiovascular, metabolic, renal, was used to construct the AL score. DNA methylation age was computed according to the algorithms described by Horvath, Hannum, and Levine allowing for estimation of whether an individual is experiencing accelerated or decelerated aging. Horvath, Hannum, and Levine EAA correlated 0.05, 0.03, and 0.21 with AL, respectively. Disaggregation by sex revealed that AL was more strongly associated with EAA in men compared with women as assessed...

HRB Open Research, 2019

Socially marginalised groups suffer vastly poorer health outcomes compared to the general populat... more Socially marginalised groups suffer vastly poorer health outcomes compared to the general population. Inclusion health seeks to directly address the health inequities experienced by groups such as homeless people and refugees. Despite the unique healthcare needs experienced by these vulnerable groups, inclusion health features very little in health education curricula. This letter has been written by a group of clinicians, academics, clinical education specialists and students with a common interest in inclusion health. In the absence of established guidance on how best to incorporate the broad topic of inclusion health in undergraduate education, we have developed a two-pronged approach within physiotherapy. We are writing to highlight the following initiatives; firstly, the provision of a dedicated undergraduate clinical placement devoted to the area of inclusion health. Secondly, we have also initiated a step-wise process of introducing the topic of inclusion health into the form...

International Journal of Integrated Care, 2019

Suggestions for future research: Development of innovative ways to assess and provide appropriate... more Suggestions for future research: Development of innovative ways to assess and provide appropriate services to these individuals.

Background: The pilot Inclusion Health Service was a multi-component intervention designed to imp... more Background: The pilot Inclusion Health Service was a multi-component intervention designed to improve outcomes for adults experiencing homelessness accessing hospital care. The objectives of this report are to describe the development and evaluation of the Inclusion Health Service. Method: Observational study reporting on a multi-component intervention including comprehensive assessment and case management of homeless adult inpatients, case management advice to emergency department- and community-based health, and social care providers and education sessions for hospital and community-based staff. Results: The Inclusion Health Service assessed and developed a comprehensive discharge plan for 262 patients admitted to the hospital. 51 weekly interagency case management meetings took place during the one-year pilot. Additional interventions included education sessions for hospital and community-based health and social care providers; case management advice to ED and community-based hea...

Nature Communications

Host immunity to infection with SARS-CoV-2 is highly variable, dictating diverse clinical outcome... more Host immunity to infection with SARS-CoV-2 is highly variable, dictating diverse clinical outcomes ranging from asymptomatic to severe disease and death. We previously reported reduced type I interferon in severe COVID-19 patients preceded clinical worsening. Further studies identified genetic mutations in loci of the TLR3- or TLR7-dependent interferon-I pathways, or neutralizing interferon-I autoantibodies as risk factors for development of COVID-19 pneumonia. Here we show in patient cohorts with different severities of COVID-19, that baseline plasma interferon α measures differ according to the immunoassay used, timing of sampling, the interferon α subtype measured, and the presence of autoantibodies. We also show a consistently reduced induction of interferon-I proteins in hospitalized COVID-19 patients upon immune stimulation, that is not associated with detectable neutralizing autoantibodies against interferon α or interferon ω. Intracellular proteomic analysis shows increased ...

Irish Journal of Medical Science (1971 -)

Background The COVID-19 pandemic has put considerable strain on healthcare systems. Aim To invest... more Background The COVID-19 pandemic has put considerable strain on healthcare systems. Aim To investigate the effect of the COVID-19 pandemic on 30-day in-hospital mortality, length of stay (LOS) and resource utilization in acute medical care. Methods We compared emergency medical admissions to a single secondary care centre during 2020 to the preceding 18 years (2002–2019). We investigated 30-day in-hospital mortality with a multiple variable logistic regression model. Utilization of procedures/services was related to LOS with zero truncated Poisson regression. Results There were 132,715 admissions in 67,185 patients over the 19-year study. There was a linear reduction in 30-day in-hospital mortality over time; over the most recent 5 years (2016–2020), there was a relative risk reduction of 36%, from 7.9 to 4.3% with a number needed to treat of 27.7. Emergency medical admissions increased 18.8% to 10,452 in 2020 with COVID-19 admissions representing 3.5%. 18.6% of COVID-19 cases requi...

Objective: The objective of this study was to identify and understand the health system contexts ... more Objective: The objective of this study was to identify and understand the health system contexts and mechanisms that allow for homeless populations to access appropriate healthcare when needed.Design: A realist review.Data sources: Ovid MEDLINE, embase.com, CINAHL, ASSIA and grey literature until April 2019. Eligibility criteria for selecting studies: The purpose of the review was to identify health system patterns which enable access to healthcare for people who experience homelessness. Peer reviewed articles were first identified through a systematic search, grey literature searching, citation tracking and expert recommendations. Studies meeting the inclusion criteria were assessed for rigour and relevance and coded to identify data relating to contexts, mechanisms and/or outcomes.Analysis: Inductive coding was used to generate Context-Mechanism-Outcome configurations which were refined and then used to build several iterations of the overarching programme theory.Results: Searchin...

Journal of Thrombosis and Haemostasis, 2021

This is an open access article under the terms of the Creative Commons Attribution-NonCommercial ... more This is an open access article under the terms of the Creative Commons Attribution-NonCommercial License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited and is not used for commercial purposes.

Journal of Thrombosis and Haemostasis, 2021

This is an open access article under the terms of the Creat ive Commo ns Attri bution-NonCo mmerc... more This is an open access article under the terms of the Creat ive Commo ns Attri bution-NonCo mmercial License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited and is not used for commercial purposes.

Annals of the American Thoracic Society, 2021

Rationale: Much is known about the acute infective process of severe acute respiratory syndrome c... more Rationale: Much is known about the acute infective process of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the causative virus of the coronavirus disease (COVID-19) pandemic. The marked inflammatory response and coagulopathic state in acute SARS-CoV-2 infection may promote pulmonary fibrosis. However, little is known about the incidence and seriousness of post-COVID-19 pulmonary pathology. Objectives: To describe the respiratory recovery and self-reported health after infection at the time of outpatient attendance. Methods: Infection severity was graded into three groups: 1) not requiring admission, 2) requiring hospital admission, and 3) requiring intensive care unit care. Participants underwent chest radiography and a 6-minute walk test (6MWT). Fatigue and subjective return to health were assessed, and concentrations of CRP (C-reactive protein), IL-6 (interleukin-6), sCD25 (soluble CD25), and D-dimer were measured. The associations between initial illness and abnormal chest X-ray findings, 6MWT distance, and perception of maximal exertion were investigated. Results: A total of 487 patients were offered an outpatient appointment, of whom 153 (31%) attended for assessment at a median of 75 days after diagnosis. A total of 74 (48%) had required hospital admission during acute infection. Persistently abnormal chest X-ray findings were seen in 4%. The median 6MWT distance covered was 460 m. A reduced distance covered was associated with frailty and length of inpatient stay. A total of 95 (62%) patients believed that they had not returned to full health, whereas 47% met the case definition for fatigue. Ongoing ill health and fatigue were associated with an increased perception of exertion. None of the measures of persistent respiratory disease were associated with initial disease severity. Conclusions: This study highlights the rates of objective respiratory disease and subjective respiratory symptoms after COVID-19 and the complex multifactorial nature of post-COVID-19 ill health.

BMJ Open Quality, 2021

Homelessness is associated with significant psychosocial and health disparities. The rate of epil... more Homelessness is associated with significant psychosocial and health disparities. The rate of epilepsy among this cohort is eight times greater than that in the settled population, and the associated morbidity is higher due to lack of integrated care, difficulties with treatment adherence, substance abuse and poor social circumstances. There is a high rate of seizure-related death in homeless patients. Seizures are one of the most common neurological cause for emergency department presentation among this population. The aim of this quality improvement project was to use a multistakeholder co-production approach to design a new pathway of care for homeless patients with epilepsy to improve access to specialist epilepsy care and to strengthen the links between hospital and community teams who manage this population. After several years of observation, stakeholder engagement and numerous tests of change, we have created a new care pathway and developed bespoke tools for primary care pro...

SummarySARS-CoV-2 infection causes a wide spectrum of disease severity. Immune changes associated... more SummarySARS-CoV-2 infection causes a wide spectrum of disease severity. Immune changes associated with severe disease include pro-inflammatory cytokine production and expansion of immature myeloid populations. The relative importance of the immunological changes in driving progression to severe disease remain poorly understood.We aimed to identify and rank clinical and immunological features associated with progression to severe COVID-19. We sought to use tests available in an on-site diagnostic hospital laboratory to identify an immunological signature for severe disease development which could be detected prior to peak severity thereby allowing initiation of therapeutic interventions. We used univariate and multivariate analysis, including unbiased machine learning, to investigate the relationships between clinical and demographic characteristics, inflammatory markers, and leukocyte immunophenotypes with progression to severe disease in 108 patients and to rank these in importance...

International Journal of Environmental Research and Public Health, 2021

Background: People who are homeless experience poor health. Reflective of overall health and fact... more Background: People who are homeless experience poor health. Reflective of overall health and factors such as acquired injuries, physical ability or functioning is often low among people who are homeless, but there is a lack of consistency of measures used to evaluate this construct. The aim of this study was to evaluate the feasibility of a broad test battery to evaluate limitations in physical functioning among people who are homeless. Methods: This cross-sectional, observational study occurred in a hospital in Dublin, Ireland. We evaluated lower extremity physical function (Short Physical Performance Battery), falls risk (timed up and go), functional capacity (six-minute walk test), stair-climbing ability (stair climb test), frailty (Clinical Frailty Scale), grip strength (handgrip dynamometer) and muscular mass (calf circumference measurement) in a population of people experiencing homelessness admitted for acute medical care. The test completion rate was evaluated for feasibilit...

The trajectory of immunological and inflammatory changes following acute COVID-19 infection are u... more The trajectory of immunological and inflammatory changes following acute COVID-19 infection are unclear. We investigate immunological changes in convalescent COVID-19 and interrogate their potential relationships with persistent symptoms, termed long COVID.We performed paired immunophenotyping at initial SARS-CoV-2 infection and convalescence (n=40, median 68 days) and validated findings in 71 further patients at median 101 days convalescence. Results were compared to 40 pre-pandemic controls. Fatigue and exercise tolerance were assessed and investigated their relationship with convalescent results.We demonstrate persistent expansion of intermediate monocytes, effector CD8+, activated CD4+ and CD8+ T cells, and reduced naïve CD4+ and CD8+ T cells at 68 days, with activated CD8+ T cells remaining increased at 101 days. Patients >60 years also demonstrate reduced naïve CD4+ and CD8+ T cells and expanded activated CD4+ T cells at 101 days. Ill-health, fatigue, and reduced exercise t...

HRB Open Research, 2021

Background:Over the last several years, homelessness has increased in Ireland and across Europe. ... more Background:Over the last several years, homelessness has increased in Ireland and across Europe. Rates have recently declined since the coronavirus disease 2019 (COVID-19) pandemic, but it is unclear whether emergency housing measures will remain in place permanently. Populations experiencing long-term homelessness face a higher burden of multi-morbidity at an earlier age than housed populations and have poorer health outcomes. However, this population also has more difficulty accessing appropriate health services. A realist review by the authors found that important health system contexts which impact access are resourcing, training, funding cycles, health system fragmentation, health system goals, how care is organised, culture, leadership and flexibility of care delivery. Using a realist evaluation approach, this research will explore and refine key system-level factors, highlighted in our realist review, in a local health care system.Aim:The aim of this study is to understand ho...

HRB Open Research, 2020

Background: Over the last several years, homelessness has increased in Ireland and across Europe.... more Background: Over the last several years, homelessness has increased in Ireland and across Europe. Rates have recently declined since the coronavirus disease 2019 (COVID-19) pandemic, but it is unclear whether emergency housing measures will remain in place permanently. Populations experiencing long-term homelessness face a higher burden of multi-morbidity at an earlier age than housed populations and have poorer health outcomes. However, this population also has more difficulty accessing appropriate health services. A realist review by the authors found that important health system contexts which impact access are resourcing, training, funding cycles, health system fragmentation, health system goals, how care is organised, culture, leadership and flexibility of care delivery. Using a realist evaluation approach, this research will explore and refine key system-level factors, highlighted in our realist review, in a local health care system. Aim: The aim of this study is to understand...

Poster presentations, 2021

(treatment/prognosis discussions, advance care planning, treatment withdrawal, memory-making, ber... more (treatment/prognosis discussions, advance care planning, treatment withdrawal, memory-making, bereavement care) and felt it improved care by providing privacy, removing distractions and facilitating the humanisation of care. However, issues were highlighted that influenced how MH was understood and used by staff, and have subsequently shaped the routine use of MH. These included issues relating to the practical management of MH, sense of ownership and shared understanding of purpose. Conclusion The findings reveal important information about how palliative care can be improved in acute settings. They show how initial implementation strategies can influence staff engagement with innovations like MH and suggest factors that affect uptake and the quality of care. This work is informing the development of MH and has wider implications for how other acute settings can transform their care environments for the benefit of patients and families.

Fatigue is a common symptom in those presenting with symptomatic COVID-19 infection. However, it ... more Fatigue is a common symptom in those presenting with symptomatic COVID-19 infection. However, it is unknown if COVID-19 results in persistent fatigue in those recovered from acute infection. We examined the prevalence of fatigue in individuals recovered from the acute phase of COVID-19 illness using the Chalder Fatigue Score (CFQ-11). We further examined potential predictors of fatigue following COVID-19 infection, evaluating indicators of COVID-19 severity, markers of peripheral immune activation and circulating pro-inflammatory cytokines. Of 128 participants (49.5 ± 15 years; 54% female), more than half reported persistent fatigue (52.3%; 45/128) at 10 weeks (median) after initial COVID-19 symptoms. There was no association between COVID-19 severity (need for inpatient admission, supplemental oxygen or critical care) and fatigue following COVID-19. Additionally, there was no association between routine laboratory markers of inflammation and cell turnover (leukocyte, neutrophil or ...

ABSTRACTThe aging process is characterized by the presence of high interindividual variation betw... more ABSTRACTThe aging process is characterized by the presence of high interindividual variation between individuals of the same chronical age prompting a search for biomarkers that capture this heterogeneity. The present study examines the associations of four epigenetic clocks - Horvath, Hannum, PhenoAge, GrimAge - with a wide range of clinical phenotypes, and with all-cause mortality at up to 10-year follow-up in a sample of 490 participants in the Irish Longitudinal Study on Ageing. Results indicate that the GrimAge clock represents a step-improvement in the predictive utility of the epigenetic clocks for identifying age-related decline in an array of clinical phenotypes.

Open Forum Infectious Diseases, 2020

Background High-cost, high-need users are defined as patients who accumulate large numbers of eme... more Background High-cost, high-need users are defined as patients who accumulate large numbers of emergency department visits and hospital admissions that might have been prevented by relatively inexpensive early interventions and primary care. This phenomenon has not been previously described in HIV-infected individuals. Methods We analyzed the health records of HIV-infected individuals using scheduled or unscheduled inpatient or outpatient health care in St James’s Hospital, Dublin, Ireland, from October 2014 to October 2015. Results Twenty-two of 2063 HIV-infected individuals had a cumulative length of stay >30 days in the study period. These individuals accrued 99 emergency department attendances and 1581 inpatient bed days, with a direct cost to the hospital of >€1 million during the study period. Eighteen of 22 had potentially preventable requirements for unscheduled care. Two of 18 had a late diagnosis of HIV. Sixteen of 18 had not been successfully engaged in outpatient HI...

The Journals of Gerontology: Series A, 2019

Allostatic load (AL) and epigenetic clocks both attempt to characterize the accelerated aging of ... more Allostatic load (AL) and epigenetic clocks both attempt to characterize the accelerated aging of biological systems, but at present it is unclear whether these measures are complementary or distinct. This study examines the cross-sectional association of AL with epigenetic age acceleration (EAA) in a subsample of 490 community-dwelling older adults participating in The Irish Longitudinal study on Aging (TILDA). A battery of 14 biomarkers representing the activity of four different physiological systems: immunological, cardiovascular, metabolic, renal, was used to construct the AL score. DNA methylation age was computed according to the algorithms described by Horvath, Hannum, and Levine allowing for estimation of whether an individual is experiencing accelerated or decelerated aging. Horvath, Hannum, and Levine EAA correlated 0.05, 0.03, and 0.21 with AL, respectively. Disaggregation by sex revealed that AL was more strongly associated with EAA in men compared with women as assessed...

HRB Open Research, 2019

Socially marginalised groups suffer vastly poorer health outcomes compared to the general populat... more Socially marginalised groups suffer vastly poorer health outcomes compared to the general population. Inclusion health seeks to directly address the health inequities experienced by groups such as homeless people and refugees. Despite the unique healthcare needs experienced by these vulnerable groups, inclusion health features very little in health education curricula. This letter has been written by a group of clinicians, academics, clinical education specialists and students with a common interest in inclusion health. In the absence of established guidance on how best to incorporate the broad topic of inclusion health in undergraduate education, we have developed a two-pronged approach within physiotherapy. We are writing to highlight the following initiatives; firstly, the provision of a dedicated undergraduate clinical placement devoted to the area of inclusion health. Secondly, we have also initiated a step-wise process of introducing the topic of inclusion health into the form...

International Journal of Integrated Care, 2019

Suggestions for future research: Development of innovative ways to assess and provide appropriate... more Suggestions for future research: Development of innovative ways to assess and provide appropriate services to these individuals.