bluuebunny/crossref_metadata_2025 huggingface dataset:
The Impact of the Pandemic of COVID-19 on the Head Injury Fast-Track System and Surgical Outcome
Authors: Norasethada Thunya , Limpastan Kriengsak , Vaniyapong Tanat , Watcharasaksilp Wanarak , Jetjumnong Chumpon , Srihagulang Chanon , Kanthawang Thanat , Praphanuwat Todsapon , Vuthiwong Withawat , Vongsfak Jirapong
Published: September 2024

Objective This study aims to evaluate the impact of the coronavirus disease 2019 (COVID-19) pandemic on the head injury fast-track system and surgical treatment outcomes.

Materials and Methods A retrospective review was conducted on patients who underwent emergency neurological procedures according to the head injury fast-track system. Data from April 2018 to April 2020 (pre-COVID) were compared with data from May 2020 to May 2022 (during COVID).

Results The analysis comprised 128 patients in the prepandemic group and 119 patients in the pandemic group, with 5 patients diagnosed with COVID infection during the pandemic. Acute subdural hematoma resulting from motorcycle accidents was the most common diagnosis in both groups (56.3 and 47.5%, respectively). The initial Glasgow coma scale (GCS) score was significantly lower during the pandemic compared to the prepandemic period (p = 0.025). Time metrics in the emergency department, including door to computed tomography (CT), emergency room (ER) exit, and incision times, were significantly longer in the pandemic group (p < 0.05). However, there were no statistically significant differences in in-hospital mortality rates (25.8 and 17.7%, respectively; p = 0.12) or the percentage of patients with a favorable functional outcome (Glasgow outcome scale ≥4). At 1 month, a favorable functional outcome was observed in 51.6% of prepandemic patients and 57.1% of pandemic patients (p = 0.69), while at 6 months, the percentages were 56.8 and 64.5%, respectively (p = 0.23).

Conclusions Our study revealed significant delays in hospital processes for head injuries during the COVID-19 pandemic. However, we found no significant impact on mortality rates or functional outcomes of patients.
Endovascular Treatment of Mycotic Intracranial Aneurysms: A Series of Three Cases with Institutional Treatment Algorithm
Authors: Charan Bheru Dan , Gaikwad Shailesh B. , Agarwal Sushant , Jain Savyasachi
Published: September 2024

Mycotic intracranial aneurysms (MIAs) are rare but can cause significant morbidity and mortality due to rupture. Most patients have additional systemic medical comorbidities making endovascular treatment a vital modality in the treatment of these aneurysms. We aimed to share our institutional experience with the role of endovascular therapy in the treatment of mycotic aneurysms with a literature review. We conducted a retrospective review of our patient database to identify individuals diagnosed with MIAs who underwent endovascular intervention at our institution between January 2002 and December 2021. We have found three patients with ruptured MIAs. All three patients had a heart disease with infective endocarditis. Two patients presented with subarachnoid hemorrhage (SAH) in which, one had a rebleed resulting in intracerebral hemorrhage (ICH), the third patient initially presented with ICH. Distal anterior cerebral artery (ACA) was the site of MIA in two cases and distal middle cerebral artery (MCA) in one patient. Two patients were treated with simple coiling and one patient was treated by glue (n-butyl cyanoacrylate [NBCAs]) injection within the aneurysm. There was no periprocedural complication with complete obliteration of the aneurysm and preservation of the parent artery. All the patients had good outcomes on follow-up. Two patients had a modified Rankin scale (mRS) score of 0 at 6 months and one patient had an mRS score of 3 at the end of 3 months whose preprocedure mRS score was 5. Endovascular embolization of MIAs with coils or liquid embolic agents can be performed in critically ill patients and is an excellent treatment modality with high occlusion rates and low procedural complications.
Risk Prediction in Diverticulitis
Authors: Velez-Padilla Jonathan , Pastrana Del Valle Jonathan , Cavallaro Paul
Published: September 2024

Acute diverticulitis is a common sequela of colonic diverticulosis that often poses a significant dilemma for surgeons and patients considering surgical management of the disease. Importantly, the decision to recommend surgery for patients with diverticular disease hinges on identifying those who will benefit most in terms of preventing future disease-related complications. This review focuses on identifying patient risk factors that are predictive of onset of diverticulitis, recurrence of disease, and progression to complicated disease, such as abscess, fistula, or stricture, and aims to assist clinicians with counseling patients who are considering surgery versus medical management. Specifically, a variety of modifiable and nonmodifiable risk factors have been identified across several studies that have strong associations with the development of diverticulitis, recurrence of uncomplicated disease, and progression to complicated disease. A handful of clinical scores have been described to guide surgeons and patients on their individual risk; however, none have been adopted into wider clinical practice. A novel polygenic risk score does show promise in potentially fulfilling this role. Nevertheless, there is significant room for innovation and development of new methods to risk-stratify patients presenting with the spectrum of diverticular disease.
Top 10 Clinical Pearls in Vasculitic Neuropathies
Authors: Pacut Peter , Gwathmey Kelly G.
Published: September 2024

Vasculitic neuropathies are a diverse group of inflammatory polyneuropathies that result from systemic vasculitis (e.g., polyarteritis nodosa, granulomatosis with polyangiitis, eosinophilic granulomatosis with polyangiitis, microscopic polyangiitis), vasculitis resulting from rheumatological disorders (e.g., rheumatoid arthritis and Sjögren's syndrome), paraneoplastic conditions, viruses, and medications. Occasionally, vasculitis is restricted to the peripheral nerves and termed nonsystemic vasculitic neuropathy. Presenting with an acute or subacute onset of painful sensory and motor deficits, ischemia to individual peripheral nerves results in the classic “mononeuritis multiplex” pattern. Over time, overlapping mononeuropathies will result in a symmetrical or asymmetrical sensorimotor axonal polyneuropathy. The diagnosis of vasculitic neuropathies relies on extensive laboratory testing, electrodiagnostic testing, and nerve and/or other tissue biopsy. Treatment consists primarily of immunosuppressant medications such as corticosteroids, cyclophosphamide, rituximab, methotrexate, or azathioprine, in addition to neuropathic pain treatments. Frequently, other specialists such as rheumatologists, pulmonologists, and nephrologists will comanage these complex patients with systemic vasculitis. Prompt recognition of these conditions is imperative, as delays in treatment may result in permanent deficits and even death.
Anti-D Alloimmunization in Index Pregnancy after Appropriate Rho(D) Immune Globulin Injection in Two Obese Rh-Negative Patients
Authors: Rodriguez Stephanie , DeChristopher Phillip J. , Krum Kristen , Lal Ann
Published: September 2024

Background The rhesus factor D (RhD)-negative patients who give birth to an RhD-positive newborn or who are otherwise exposed to RhD-positive red blood cells are at risk of developing anti-D antibodies. These antibodies may cause hemolytic disease of the fetus and newborn (HDFN). During pregnancy, prevention of alloimmunization is completed with a Rho(D) immune globulin (RhIg).

Cases We report two cases, where obese patients developed alloimmunization, with high neonatal titers, after appropriate RhIG prophylaxis during the index pregnancy.

Conclusion Our cases demonstrate cases of anti D-alloimmunization in an index pregnancy, with high neonatal titers. Both patients are obese, with BMI > 35 mg/m2.

Key Points
Survey techniques and impact mitigation for the Endangered northern quoll (Dasyurus hallucatus) in the semi-arid landscapes of the Pilbara
Authors: Dunlop Judy , Moore Harry Amos , Cowan Mitchell Alec , Harrison Natasha
Published: September 2024

Improvements in survey techniques for threatened species gives quantifiable confidence about their presence or absence at a given location, enhancing our understanding of patterns of distribution and abundance. This is particularly important for legislatively protected threatened species that may be at risk of disturbance. Survey techniques vary in detection confidence, resource investment, and invasive impacts to individuals. We review the appropriate applications of techniques in surveying for the endangered northern quoll (Dasyurus hallucatus), including the effort required to be 95% confident of detecting presence and monitoring change in population trends in the Pilbara bioregion. The outlined protocols indicate best practice for effective and efficient northern quoll monitoring while protecting the welfare of the animals being monitored, and are relevant to Environmental Protection and Biodiversity Conservation Act requirements. We also provide suggestions to mitigate impacts on animals and habitat, and describe future directions and emerging techniques for the monitoring of northern quolls and other endangered species. This information is targeted at those interested in monitoring northern quolls in a field setting, including researchers, environmental consultants, Traditional Owners, and land managers.
How much soil do cattle ingest? A review
Authors: McConnachie Sue , Clayton Edward , Arundell Lis , Dominiak Bernie C. , Brock Pip
Published: September 2024

Beef and dairy cattle commonly ingest soil when consuming forage-based diets in paddock feeding situations. However, the extent of this soil intake is poorly understood in the Australian environment and under Australian grazing systems. Therefore, the aim of the current literature review was to examine soil ingestion in cattle and the factors that affect ingestion. We found 11 studies containing soil-ingestion data, based in England, France, New Zealand and USA but none from Australia. A wide range in soil ingestion rates was reported and intake varied considerably with season, forage-pasture type, pasture-on-offer, stocking rate and grazing conditions. Generally, soil ingestion was lower in beef cattle than in dairy cattle. We considered the differences in reported levels, variables around those differences, and reliability of methodology used, and compared results with existing international guidelines. For Australian applications, we deduced and recommended that 0.5 kg/head.day is used until field-based research is conducted in Australia which might provide a more specific value for Australian conditions. Our review will inform future livestock management, particularly on contaminated agricultural land.
TCA metabolism regulates DNA hypermethylation in LPS andMycobacterium tuberculosis–induced immune tolerance
Authors: Abhimanyu  , Longlax Santiago Carrero , Nishiguchi Tomoki , Ladki Malik , Sheikh Daanish , Martinez Amera L. , Mace Emily M. , Grimm Sandra L. , Caldwell Thaleia , Portillo Varela Alexandra , Sekhar Rajagopal V. , Mandalakas Anna M. , Mlotshwa Mandla , Ginidza Sibuse , Cirillo Jeffrey D. , Wallis Robert S. , Netea Mihai G. , van Crevel Reinout , Coarfa Cristian , DiNardo Andrew R.
Published: September 2024

Severe and chronic infections, including pneumonia, sepsis, and tuberculosis (TB), induce long-lasting epigenetic changes that are associated with an increase in all-cause postinfectious morbidity and mortality. Oncology studies identified metabolic drivers of the epigenetic landscape, with the tricarboxylic acid (TCA) cycle acting as a central hub. It is unknown if the TCA cycle also regulates epigenetics, specifically DNA methylation, after infection-induced immune tolerance. The following studies demonstrate that lipopolysaccharide andMycobacterium tuberculosisinduce changes in DNA methylation that are mediated by the TCA cycle. Infection-induced DNA hypermethylation is mitigated by inhibitors of cellular metabolism (rapamycin, everolimus, metformin) and the TCA cycle (isocitrate dehydrogenase inhibitors). Conversely, exogenous supplementation with TCA metabolites (succinate and itaconate) induces DNA hypermethylation and immune tolerance. Finally, TB patients who received everolimus have less DNA hypermethylation demonstrating proof of concept that metabolic manipulation can mitigate epigenetic scars.
Evidence for a survival-driven traveling wave in a keystone boreal predator population
Authors: Arnold Derek A. , Breed Greg A. , Laufenberg Jared S. , Berg Nathan D. , Bertram Mark R. , Scotton Bradley D. , Kielland Knut
Published: September 2024

Cyclical population dynamics are a common phenomenon in populations worldwide, yet the spatial organization of these cycles remains poorly understood. In this study, we investigated the spatial form and timing of a population collapse from 2018 to 2022 in Canada lynx (Lynx canadensis) across the northwest boreal forest. We analyzed survival, reproduction, and dispersal data from 143 individual global positioning system (GPS) collared lynx from populations across five study sites spanning interior Alaska to determine whether lynx displayed characteristics of a population wave following a concurrent wave in snowshoe hare (Lepus americanus) abundance. Reproductive rates declined across the study sites; however, site-level reproduction declined first in our easternmost study sites, supporting the idea of a population wave. Despite a clear increase in percent of dispersing lynx, there was no evidence of directional bias in dispersal following a hare population wave. Analysis did show increasingly poor survival for lynx dispersing to the east compared to combined resident and westward dispersal. This pattern is consistent with a survival-mediated population wave in lynx as the driver of the theorized population wave. The combination of these factors supports the idea of a hierarchical response to snowshoe hare population declines with a drop in lynx reproduction followed by increased dispersal, and finally reduced survival. All of this evidence is consistent with the expected characteristics of a population undergoing a traveling wave and supports the hypothesis that lynx presence may facilitate and mirror the underlying wave patterns in snowshoe hare.
First Thomson scattering results from AWAKE’s helicon plasma source
Authors: Stollberg C , Guittienne Ph , Karimov R , Sublet A , Furno I , Vincent B , Andrebe Y , Buttenschön B
Published: September 2024

We present the first results of electron density and temperature measurements obtained from Thomson scattering at the helicon plasma source (HPS) for the AWAKE project. These measurements are compared to simulation results from a 1D power and particle balance model (PPM), confirming that the plasma can be fully sustained by collisional power dissipation. The variations in plasma parameters under different experimental conditions are evaluated in the PPM framework. We discuss current limitations of the model and propose possible improvements. Additionally, we suggest modifications to the existing HPS setup to enhance axial plasma homogeneity.
Schottky–Kronecker forms and hyperelliptic polylogarithms
Authors: Baune Konstantin , Broedel Johannes , Im Egor , Lisitsyn Artyom , Zerbini Federico
Published: September 2024

Elliptic polylogarithms can be defined as iterated integrals on a genus-one Riemann surface of a set of integration kernels whose generating series was already considered by Kronecker in the 19th century. In this article, we employ the Schottky parametrization of a Riemann surface to construct higher-genus analogues of Kronecker’s generating series, which we refer to as Schottky–Kronecker forms. Our explicit construction generalizes ideas from Bernard’s higher-genus construction of the Knizhnik-Zamolodchikov connection. Integration kernels generated from the Schottky–Kronecker forms are defined as Poincaré series. Under technical assumptions, related to the convergence of these Poincaré series on the underlying Riemann surface, we argue that these integration kernels coincide with a set of differentials defined by Enriquez, whose iterated integrals constitute higher-genus analogues of polylogarithms. Enriquez’ original definition is not well-suited for numerical evaluation of higher-genus polylogarithms. In contrast, the Poincaré series defining our integration kernels can be evaluated numerically for real hyperelliptic curves, for which the above-mentioned convergence assumptions can be verified. We numerically evaluate several examples of genus-two polylogarithms, thereby paving the way for numerical evaluation of hyperelliptic analogues of polylogarithms.
Constrained Hamiltonian dynamics for electrons in magnetic field and additional forces besides the Lorentz force acting on electrons
Authors: Koizumi Hiroyasu
Published: September 2024

We consider the forces acting on electrons in magnetic field including the constraints and a condition arising from quantum mechanics. The force is calculated as the electron mass,

m

e

, multiplied by the total time-derivative of the velocity field evaluated using the quantum mechanical many-electron wave function. The velocity field includes a term of the Berry connection from the many-body wave function; thereby, quantum mechanical effects are included. It is shown that additional important forces besides the Lorentz force exist; they include the gradient of the electron velocity field kinetic energy, the gradient of the chemical potential, and the ‘force’ for producing topologically protected loop currents. These additional forces are shown to be important in superconductivity, electric current in metallic wires, and charging of capacitors.
Characterisation of surface morphology of high voltage DC relay contacts under arc erosion
Authors: Wang Haitao , Yang Tao , Wu Kai , Li Wei , Lin Zhen , Liu Qinneng , Jiang Wenli
Published: September 2024

High voltage DC relays are a crucial component in new energy vehicles. Due to the high failure rate caused by contact sticking (fusion welding), existing technologies can only analyze contact morphology after failure. There is an urgent need to determine the quantitative characterization value of contact surface morphology and the correlation between morphology, failure mechanisms, and working conditions. In this study, an Olympus DSX1000 microscope is used to extract surface topography data, and a quantitative topography characterization method based on a machine vision system is proposed to quantitatively analyze contact surface changes after arc erosion. Grey correlation analysis was applied to explore the relationship between electrical parameters such as voltage, current, and capacitance, and the contact morphology features. The results show that current and capacitance have the greatest influence on contact surface features after arc erosion, while voltage has a relatively smaller influence. This conclusion is consistent with the experimentally observed arc erosion features. Finally, an arc ion sputtering deposition model was developed to analyze the material transfer mode and its influence on the contact failure mechanism. The results provide a scientific basis for the analysis and design improvement of high voltage DC relays.
Thermal stability of electron beam welded AlCoCrFeNi2.1 alloy
Authors: Roncak Jan , Jozefovic Patrik , Müller Peter , Adam Ondrej , Judas Jakub , Dupak Libor , Zavdoveev Anatoliy , Jan Vit , Zobac Martin
Published: September 2024

AlCoCrFeNi2.1 alloy, which belongs to the group of eutectic high-entropy alloys (EHEAs), possesses a combination of increased strength and ductility. It should retain these properties over a wide temperature range due to the high entropy effect of the system. At the same time, eutectic alloys are generally considered to have good castability, which increases the possibility of casting the alloy in larger volumes. One of the processes, that the alloy does not avoid when applied in industry, are the various joining techniques including electron beam welding. The weld area is often in a non-equilibrium state, which increases the risk of failure during operation. The paper therefore discusses the stability of the microstructure and mechanical properties of AlCoCrFeNi2.1 alloy when exposed to short-term elevated temperatures. The material heated at 900 °C for 1 h in a vacuum furnace was observed using light and electron microscopy, analyzed for chemical and phase composition and finally subjected to HV0.1 hardness measurement and tensile strength test. The resulting condition was compared with the welded joint before exposure to elevated temperature. The microstructure of the weld was formed by a fine lamellar eutectic over the entire observed area. EBSD analysis confirmed the presence of a combination of FCC and BCC phases. The material hardness reached an average value of 370 HV0.1. Maximum tensile strength of the weld joint was measured at 944 MPa with the corresponding displacement of the crosshead 6.1 mm. The welded joint demonstrated sufficient stability and the ability to withstand short-term severe elevated temperature conditions.
A 3D wideband electromagnetic horn antenna applicator for biomedical applications
Authors: Abdulkawi Wazie M , Elshafiey Ibrahim , Sheta Abdel-Fattah A , Al-Bawri Samir Salem
Published: September 2024

This paper proposes a new, compact, wideband 3D horn antenna for biomedical wireless applications such as cancer and tumor detection. In order to achieve the best penetration level, the antenna has been built and tuned to work in the low frequency range of 0.48–1.24 GHz, which can exhibit a high-resolution detection result. The proposed applicator is a double ridge horn antenna (DRHA). The layout and operation of the key needed components to assemble a wideband hyperthermia system are provided in this study. We assume a cylindrical human tissue phantom with wideband dispersive tissue properties, and simulation results are given. The resulting field maps are displayed in several planes to illustrate the energy localization process. The findings indicate that, in contrast to traditional narrowband systems, wideband operation may improve energy localization in deep tumor locations while eliminating hot spots. The suggested antenna was built and measured to verify the result.
Performance evaluation of the static thrust and efficiency of an actuated biomimetic jellyfish model
Authors: Jaya Arie Sukma , Farhan Muhammad , Caesarendra Wahyu
Published: September 2024

This study offers an in-depth analysis of a jellyfish-inspired robotic model designed to simulate the expansion and contraction mechanisms found in natural jellyfish. By employing variable Duty Cycles to replicate the cyclic motions of the jellyfish, the thrust generation of the model is measured through static thrust assessments using a load cell, while its efficiency is evaluated using the Thrust-to-Power Ratio, TPR. The findings indicate that increasing the amplitude of the motion leads to more complex wave patterns, which in turn reduce the peak-to-peak force generated. Specifically, a 25% increase in the A/D ratio results in a significant 30% decrease in static thrust. It was observed that higher actuation frequencies do not notably influence thrust generation when the A/D ratio remains constant. Importantly, the TPR was found to be highest at an A/D ratio of 0.10, with an increase of up to 6% observed at higher Duty Cycles, suggesting that smaller actuation amplitudes are more efficient in enhancing thrust performance. These results highlight the critical role of amplitude in the efficiency of static thrust generation within a given Duty Cycle, emphasizing that lower amplitudes generally lead to higher efficiency. The study underscores the importance of optimizing both geometric and kinematic parameters for improved propulsion performance. It suggests that future research should focus on fine-tuning A/D ratios and Duty Cycles, as well as exploring alternative geometric configurations and materials to further enhance the hydrodynamic performance of jellyfish-inspired robots. The insights gained from this study provide a valuable foundation for developing more efficient and effective bio-inspired underwater vehicles.
Exploring artificial neural networks for the forward kinematics of a SCARA robotic manipulator using varied datasets and training optimizers
Authors: Bouzid Rania , Narayan Jyotindra , Gritli Hassène
Published: September 2024

Although analytical methods are traditionally employed, the solution to the Forward Kinematics (FK) problem for Selective Compliance Assembly Robot Arm (SCARA) manipulator robots can prove intricate and computationally demanding. Recognizing this challenge, this study endeavors to introduce an intelligent approach by leveraging Artificial Neural Networks (ANNs) to address the FK problem specifically tailored for a four-degree-of-freedom (4-DoF) SCARA robot. To train the ANNs, we employ three distinct datasets, one with a fixed step size, one with a random step size, and one based on a sinusoidal signal. Moreover, the objective is to scrutinize the ANNs performance under the influence of three distinct training algorithms: Levenberg-Marquardt (LM), Bayesian Regularization (BR), and Scaled Conjugate Gradient (SCG). Through a systematic comparison of various ANN models, diverse training algorithms, and the three chosen datasets, the investigation reveals that optimal Mean Squared Error (MSE) results are achieved with random step size datasets for models with two hidden layers using the LM algorithm (MSE = 8.6099e-05). For the BR algorithm, the best MSE (8.0535e-05) was obtained with sinusoidal datasets and three hidden layers. For the SCG algorithm, the optimal MSE (1.1144e-04) was achieved with fixed step size datasets and one hidden layer. The accuracy of the ANN model is significantly influenced by the dataset, the choice of training optimizer, and the configuration of hidden layers. Consequently, further research could explore hybrid approaches that integrate evolutionary algorithms to leverage their respective strengths and improve overall ANN model performance.
Introduction
Authors: Korstvedt Benjamin M
Published: September 2024

A most remarkable aspect of Bruckner’s compositional approach was his commitment to revision. The indefatigability of Bruckner’s pursuit of his musical vision was extraordinary. To grasp the sheer time, energy, and devotion he brought to this task, over a decade and a half, is humbling. Several of his symphonies exist in multiple versions. The Fourth represents the most extreme case; Bruckner’s revisions produced three complete versions of this symphony along with a fourth version of the Finale. The “orthodox” view of the work’s history excludes the latter stages of Bruckner’s compositional process as inauthentic. But this chapter argues that when seen as a whole, the history of the work presents an extraordinary picture of a composer pursuing a compositional vision with extraordinary persistence and perspicacity.
Reinventing the Fourth, 1878–1881
Authors: Korstvedt Benjamin M
Published: September 2024

In late 1877, at the time he was completing the Fifth Symphony, Bruckner come to the decision that his Fourth was, as he wrote, “urgently in need of a thorough revision.” During the following year he fundamentally recomposed the symphony. This chapter reveals the process by which he created a new version. He began by sketching new ideas in his score of the first version. He then created an entirely new score, which contained a new Scherzo along with revised versions of the other movements. Shortly after he completed this score, Bruckner abruptly withdrew the Finale he had just finished and composed a radically new version.
Applying the 2023 ESH Hypertension Guidelines to the Irish Population- findings from the Irish Longitudinal Study on Ageing (TILDA)
Authors: McGarvey Caoimhe , Briggs Robert , McCrory Cathal , Kenny Regius Rose Anne , Sexton Donal
Published: September 2024

Background

Hypertension (HTN) is an important risk factor for cardiovascular disease (CVD), the leading cause of mortality worldwide. The aim of this study was to apply the latest European Society of Hypertension (ESH) Guidelines 2023 to the Irish general population.

Methods

This study used data from Wave 1 (2009-2010) and Wave 3 (2014-2015) of the Irish Longitudinal Study on Ageing (TILDA). TILDA is a prospective cohort study based on stratified random sampling, which is representative of the community living older population in Ireland (Aged 50 years and over). Using this data, the prevalence of HTN in the general population by grade and stage, as set out in the ESH 2023 guidelines, was calculated. Population awareness of diagnosis, treatment status, control on treatment and adherence to recommended anti-hypertensive medication classes were assessed. Subgroup analyses were explored in alignment with specified groups highlighted in the Guidelines including those over 80 years old with and without frailty, those with chronic kidney disease and those with home blood pressure (BP) measurements. Inverse probability weighting was applied to account for the complex survey design used in TILDA and data analysis was conducted using Stata 15.1.

Results

Results from Wave 3 (N=5,329): The prevalence of hypertension was 64.0% (95% confidence interval (CI) 62.4-65.6%). Of those with HTN, 55.5% (95% CI 53.3-57.7) were aware of their HTN diagnosis and 70.4% (95% CI 68.3-72.2%) were on antihypertensive treatment. Of those on treatment, 53.2% were controlled (BP < 140/90), and only 20.0% (95% CI 18.3-21.8) were on a recommended dual therapy. 55.2% were on at least one agent recommended by the ESH guidelines.

Conclusion

This study indicates a high prevalence of HTN in the general population in Ireland aged 50+ years with low levels of awareness, control, and poor adherence to the most recent ESH HTN guidelines.
Unscheduled Returns of Older Patients to the Emergency Department of an Irish Teaching Hospital in the Final Quarter of 2023
Authors: Broin Ruairi O
Published: September 2024

Background

Rapid unscheduled returns to emergency departments (ED) are considered to be an indication of a potential lack of quality of care of an ED as outlined in the academic literature. Our ED multidisciplinary team (MDT) dedicated to the assessment and treatment of older persons is a relatively new one. In order to evaluate our efficacy, we sought to compare our rate of unscheduled returns with international norms.

Methods

Retrospective audit of 883 patients from October 2023 to January 2024. Our ED software programme which holds the patient histories was reviewed to establish whether the patients came back to the ED, if so, how quickly, and for what reason. The results were collated and reviewed.

Results

Average age: 81. Average Clinical Frailty Scale Score (CFS): 5. 69% of older patients assessed by the MDT did not return to our ED. 3% returned within 72hrs. 2% returned within one week. 9% returned within one month. 13% returned within 3 months. 2% returned within 6 months.

Conclusion

In numerous academic articles, the 72hr unscheduled return should not exceed 3-5%. While we would always seek to reduce the rate of unscheduled returns to our ED, the results show that our 72hr return percentage is within international norms. This is despite the age profile and frailty of the patients assessed, treated and reviewed.
Results From A Snapshot Survey Of Delirium Prevalence, Detection And Care In Hospitals In Ireland On World Delirium Awareness Day
Authors: Azizi Zahra , Bohane Teresa , Dukelow Tim , O'Regan Niamh , Harkin Eithne , Donnellan Christina , Carroll Ida , Costello Maria , O'Reilly Susan , Noonan Claire , Timmons Suzanne
Published: September 2024

Background

Delirium, an acute encephalopathy characterized by acute onset, fluctuation, and attention deficits, is associated with increased mortality and morbidity, and with precipitation or worsening of dementia. Thus, delirium prevention, timely detection, and appropriate management are crucial.

Methods

On World Delirium Awareness Day (15th March 2023), a global survey was assessed delirium prevalence and care. A senior clinical staff member on each participating ward reported on delirium prevalence at 8AM and 8PM, and on usual ward practice; data was entered into an online survey by a data collector (typically an on-site clinician, visiting several wards to record data). This study reports data from Irish hospitals.

Results

In total, 132 wards from 15 hospitals across Ireland participated. Delirium prevalence, using a formal assessment tool, was 15.9% across all wards, highest in geriatric wards (20.5%). However, on wards where 'personal judgment' to detect delirium was utilized, the prevalence rate was 11.5%, implying that delirium may be missed on these wards. Intensive care units (76.2%), geriatric wards (70%), and Emergency Departments/Acute Medical Units (ED/AMUA; 66.7%) had the highest rate of written delirium protocols. Similarly, staff training (51.5% overall), was highest in ED/AMAU (88.9%), followed by general surgical (66.7%), and geriatrics wards (60%). In contrast, only 30.8% (4/13) of non-acute wards had provided staff with delirium training in the preceding year. Having at least one training session in the preceding year was associated with higher use of formal delirium tools (18.8% versus 60.3%). Wards reported staff training/educating as the main care improvement priority; 72.7% of wards identified lack of time to train staff as a key barrier.

Conclusion

Delirium is prevalent in Irish hospitals and appears under-detected without formal screening. Training staff in delirium-related skills, including the use of simple screening tools for delirium detection and causation, could be paramount to improving patient outcomes.
An Evaluation of In-Hospital Stroke in Irish Acute Hospitals
Authors: Chapman Lucy , Harbison Joseph , McCormack Joan , Brych Olga
Published: September 2024

Background

Between 1 and 17% of strokes occur in-hospital in patients hospitalised for another reason. In-hospital strokes are associated with worse outcomes and poor performance on quality-of-care measures of stroke care.

Methods

A retrospective multi-centre cohort study comparing in-hospital and community-onset strokes was conducted using stroke data collected for the purposes of the Irish National Audit of Stroke from the 1st of January 2020 to the 31st of December 2021.

Results

Of 10,781 stroke cases, 618 occurred in-hospital stroke equating to 5.7%. In-hospital stroke patients were older (Median age 76 years versus 74 years in community-onset stroke). Patients with an in-hospital stroke were more likely to have an ischaemic stroke (90.0% versus 85.4%; p=0.002, pre-stroke disability (defined as modified Rankin score of 3 to 5) (30.6% versus 14.3%; p<.001), atrial fibrillation (40.6% versus 29.8%; p<.001). The median [IQR] length-of-stay was longer for in-hospital stroke (14 [6-30] versus 8 [4-16] days) and admission to the stroke unit was less frequent (44.2% versus 70.2% of community-onset strokes; adjusted odds ratio 0.46 95% CI 0.38-0.56; p<.001). Longer median [IQR] times to medical assessment (20 [5-84] versus 12 [0-100] minutes; p<.001) and thrombolysis (90 [63-135] versus 54 [37-80] minutes; p<.001) were observed for patients with in-hospital stroke onset. One in four (27.2%) in-hospital onset stroke cases die in-hospital compared with one in ten (10.4%) community-onset strokes (adjusted odds ratio 2.98 [2.37-3.75]; p<.001). Favourable functional ability was less likely at discharge for in-hospital onset stroke cases (28.9% versus 52.3% of community-onset strokes; adjusted odds ratio 0.38 [0.30-0.48]; p<.001).

Conclusion

The Irish cohort of in-hospital stroke patients reflect a distinct stroke subgroup. Longer delays to medical assessment and thrombolysis, poorer functional outcomes and increased in-hospital mortality were observed highlighting opportunities to improve care.
Consequences of Delayed Access to Community Social Care for Older Hospital Inpatients with Frailty
Authors: Ahmed Razan , Cloonan Joy , May Ella , Chambers Hugh , Madden Rachel , Doyle Joyce , Briggs Robert
Published: September 2024

Background

The social care system is currently under enormous pressure leading to delays in home care provision and often unnecessarily prolonged hospital stays for frail, older people. The risks of prolonged hospital admissions for frail older people are well-recognised. The aim of this study therefore was to examine the rate of hospital-associated complications (HAC) amongst older inpatients who are otherwise medically optimised for discharge but are awaiting home care to facilitate discharge home.

Methods

Electronic medical records of patients ≥65 years with delayed transfer of care (DTOC) while awaiting provision of home care provision were examined for incidence of delirium, falls and infection. A smaller cohort of current inpatients (n=14) awaiting home care were interviewed with focus on quality-of-life (CASP-19), loneliness (UCLA Scale) and depressive symptoms (CES-D).

Results

59% (57/97) of patients (median 82 years, 60% female, median Clinical Frailty Scale 6) developed a HAC (delirium, fall or infection) while considered medically optimised for discharge. Logistic regression models demonstrated that for every additional day spent awaiting home care, the likelihood of a HAC increased by 4% (Adjusted Odds Ratio 1.04 (95% CI 1.00 – 1.08; p=0.027; z=2.21). Almost half of interview respondents reported that quality-of-life had declined while discharge home was delayed, while over 1/3 (5/14) met criteria for clinically significant depressive symptoms (CES-D-10 ≥10).

Conclusion

Almost 60% of frail, older inpatients who are medically optimised have a HAC while awaiting home care provision, with the likelihood increasing significantly for every additional day in hospital awaiting care. Long delays to home care package provision are having a hugely detrimental impact on the health of frail, older people in hospital. While addressing the crisis in social care is challenging, interventions to tackle this deficit in home care provision are required urgently.
Using Cerebrospinal Fluid Biomarkers To Enhance Diagnostic Testing For Alzheimer's Disease In A Tertiary Memory Service
Authors: Crowe Andrew , Garcia-Gallardo Angela , Ferguson Damien , Dunne Jean , Hutchinson Siobhan
Published: September 2024

Background

Cerebrospinal Fluid (CSF) biomarkers are useful in the definitive diagnosis of Alzheimer’s disease (AD) when basic investigations and neuroimaging are inconclusive. In our tertiary memory clinic, the standard CSF biomarker panel consists of Amyloid Beta (AB) 42, Total tau, and Phosphorylated tau. AB42/40 is an additional CSF biomarker which has been shown to improve diagnostic accuracy for AD but is not part of our standard CSF biomarker panel (1). We examined the use of AB42/40 in patients attending our service.

Methods

In our service, diagnosis of dementia is based on a multidisciplinary consensus meeting (including Geriatricians, Neurologists, Psychiatrists) who review clinical presentation and neuroimaging. In a minority of cases, CSF analysis is performed. We retrospectively evaluated how the addition of AB40/42 to our standard CSF panel impacted diagnostic accuracy for AD, taking a ratio of <0.067 to indicate AD (2).

Results

Of 1853 patients attending the Memory service between September 2022 and December 2023, CSF was available for 107 patients. Of these 107, average age was 68. 56 were female (52%) and 51 were male (48%). At the multidisciplinary consensus meeting, 81 of these 107 patients were diagnosed with AD (75%), with the remaining 26 (24%) patients being diagnosed with a non-AD process (Vascular disease, Lewy Body etc) or an inconclusive diagnosis. After the addition of AB42/40 to CSF, 8 of the 26 patients (31%) with non-AD or an inconclusive diagnosis were identified as potential AD. Of the 81 with a diagnosis of AD, none were reclassified after addition of AB42/40. Receiver Operating Characteristic (ROC) curve analysis was performed to determine relevant cut off values.

Conclusion

This study suggests the addition of AB42/40 ratio to our standard CSF biomarker panel improves identification of potential AD cases in our sample. This biomarker is being added to the standard CSF panel for our Memory service.
Retracted: A Pre-Hospital Prediction Tool for Stroke Type Utilising Machine Learning Techniques
Authors: McDermott Clodagh , Krewer Finn , O'Donnell Martin
Published: September 2024

Background

Stroke is a leading cause of death worldwide and leaves most survivors with permanent disability. 12.2 million people suffer strokes annually, of which 70% occur in low- and middle-income countries (LMIC). Stroke presents diagnostic challenges which limits access to effective, but time-sensitive, reperfusion therapies. Currently, stroke is diagnosed by the combination of clinical symptoms and signs and brain imaging. The aim of this study was to develop clinical prediction tools, for differentiating acute ischemic stroke (AIS) and intracerebral haemorrhage (ICH) in the pre-hospital setting without neuroimaging, utilising machine learning (ML).

Methods

We included 5349 patients with confirmed acute stroke who presented within 6 hours of symptom onset, from the INTERSTROKE case-control study. We compared predictions using six commonly used ML algorithms for classification i.e. multivariate logistic regression (MLR), k-nearest neighbour (KNN), support vector machine (SVM), neural networks (NN), random forests (RF), XGBoost. Algorithm inputs included medical history, symptoms and signs, and point-of-care blood tests, with an output of final diagnosis.

Results

The training cohort included 4280 patients with 3084 ischemic stroke and 1196 ICH cases, and the test cohort included 1069 patients with 771 ischemic stroke and 298 ICH cases. From 174 potential variables, we used univariate analyses to select 52 candidate variables for inclusion in the ML algorithms. These were selected based on their ability to predict (p < 0.20) stroke subtype. The AUCs in the test cohort for each of the ML classification models were: MLR 0.819, KNN 0.795, SVM 0.802, NN 0.814, RF 0.814, and XGBoost 0.807.

Conclusion

ML models showed great potential to predict stroke type at the prehospital stage and have comparable predictive abilities to previously developed ML prediction tools. This may facilitate point-of-care decisions and management of stroke in the pre-hospital setting in the future.
Right Care, Right Time, Right Place: Real-life Challenges in Delivering Sláintecare – A Multi-Centre Survey of Multidisciplinary Team Members
Authors: Murphy Robert Allan , Ward Andrea , Moran Fionnula , Walsh Mary , O'Connor Marie
Published: September 2024

Background

Sláintecare launched in 2018 seeks to reform the delivery of healthcare services in Ireland towards equity of access based on patient need1. However, delivering the right care, in the right place at the right time is, as yet an aspirational goal. We sought to identify the on-the ground challenges that exist in delivering Sláintecare in the day-to-day practice of multidisciplinary team members.

Methods

An online survey questionnaire was distributed to medical social workers, occupational therapists, and physiotherapists. Respondents were asked about their experience in applying for community-based care in their practice including home care packages, community occupational therapy and home equipment. Descriptive statistics were applied to numerical data and a thematic analysis was performed on free text responses.

Results

There were 31 respondents from 10 clinical sites including acute and rehabilitation settings. All nine community healthcare organisations (CHOs) were represented. 29/31 (94%) felt that access to community-based care differed based on the patient’s residential address. 23/31 (74%) stated the referral documentation and process for home care packages varied depending on the patients’ CHO. Qualitative analysis identified three core themes; Unfulfilled care hours due to dearth of carer availability differed across CHOs; inconsistencies in the application process that exists between CHO’s and incongruities in the availability of and accessibility to publicly funded services on hospital discharge.

Conclusion

Our survey highlights the practical challenges of delivering Sláintecare currently. It reinforces the health inequities that limits patients’ ability to access quality healthcare because of their geographical location.
A Biomarker Signature Associated With Future Functional Decline And Outcomes On The Frailty-Disability Cascade
Authors: Hernandez Belinda , McCrory Cathal , Kenny Rose Anne , O'Halloran Aisling
Published: September 2024

Background

Biological ageing is a dynamic and heterogeneous process that occurs due to dysregulation at the molecular, cellular, physiological and functional level, manifesting in functional decline. We investigated whether biomarker data across a range of biological systems predicted incident functional decline and frailty-disability cascade outcomes.

Methods

Secondary data analyses were performed on n=4,961 participants aged 50+ years from waves 1-5 of The Irish Longitudinal Study on Ageing (TILDA). We examined 18 blood biomarkers representing key systems that become dysregulated with ageing (inflammatory, cardiovascular, metabolic, renal, cognitive, musculoskeletal and senescence). Model-based clustering classified participants as belonging to one of three biomarker signatures - low, medium and high risk. These biomarker signatures were utilized to predict 4-year functional decline (grip strength, timed up and go test (TUG) and gait speed) using mixed effect models; 8-year frailty and disability using logistic regression models; and 12-year mortality using Cox-Proportional Hazard models. All models were adjusted for age, sex, education, smoking history, lipid lowering and anti-hypertensive medications.

Results

The prevalence of the low, medium and high-risk groups was 58.5%, 9.2% and 32.3%. Medium and high-risk biomarker signatures had progressively increased hazard of 12-year mortality (HR:1.54, 95%CI:1.13-2.10) and (HR:1.89, 95%CI:1.53-2.34) respectively. Participants with the high-risk signature also had significantly higher odds of 8-year incident frailty (OR:2.1, 95%CI:1.60-2.74) and disability (OR:1.72, 95%CI:1.30-2.29), with the medium-risk group showing attenuated associations. The biomarker signatures had a dose response relationship with functional decline; with the high-risk group having lower grip strength, slower walking speed and higher time to complete the TUG over 4-year follow-up (p<0.01). Findings were replicated in a US cohort.

Conclusion

We report a unique biomarker signature that was consistently associated with mortality, incident frailty and disability, and functional decline. This signature may be a useful early indicator and risk stratification tool to predict future functional decline and frailty-disability cascade outcomes.