bluuebunny/crossref_metadata_2025 huggingface dataset:
A composition-tunable cold atmospheric plasma chip for multiplex-treatment of cells
Authors: Wang Fang , Li Chang , Zhang Ruotong , Liu Yuan , Lin Haisong , Nan Lang , Khan Muhammad Ajmal , Xiao Yang , Shum Ho Cheung , Deng Hui
Published: January 2023

This study proposes a composition-tunable cold atmospheric plasma chip capable of producing targeted species, delivering multiple dosages, and treating multiple cell lines in a single treatment.
The fundamentals and applications of piezoelectric materials for tumor therapy: recent advances and outlook
Authors: Wang Yan , Zang Pengyu , Yang Dan , Zhang Rui , Gai Shili , Yang Piaoping
Published: January 2023

Here, we introduce bio-piezoelectric platforms from the perspective of antitumor therapy, review their recent applications as nanomedicines and carriers in tumor diagnosis and treatment, and discuss future challenges and opportunities.
Crystallographic characterization and application of copper doped hydroxyapatite as a biomaterial
Authors: Tuntun Supanna Malek , Sahadat Hossain Md. , Uddin Md. Najem , Shaikh Md. Aftab Ali , Bahadur Newaz Mohammed , Ahmed Samina
Published: January 2023

Cu-doped hydroxyapatite is synthesized from eggshell and its suitability as a potential biomaterial is examined via cytotoxicity, haemolysis and antibacterial activity.
Rapid alcoholysis of cyclic esters using metal alkoxides: access to linear lactyllactate-grafted polyglycidol
Authors: Yimthachote Supajittra , Phomphrai Khamphee
Published: January 2023

A convenient catalytic alcoholysis was developed to decorate precisely one unit of lactyllactate per repeating unit onto a linear polyglycidol backbone.
A fully bio-based Schiff base vitrimer with self-healing ability at room temperature
Authors: Jiang Lin , Tian Yazhou , Wang Xiaomu , Zhang Junying , Cheng Jue , Gao Feng
Published: January 2023

The design of a green and renewable bio-based self-healing vitrimer has attracted extensive attention due to the increasing emphasis on an environment friendly society.
Electron donor–acceptor complex enabled cascade reaction of unprotectedo-anilide aryl chlorides for heterocycle synthesis
Authors: Yang Zhu-Sheng , Tang Wen-Xin , Zhang Bei-Bei , Sun De-Qun , Chen Kun-Quan , Chen Xiang-Yu
Published: January 2023

An electron donor–acceptor complex strategy that enabled photoactivation of aryl chlorides has been reported with the toluene anion ortBuOK as the electron donor.
Investigation of enhanced Am selectivity for Eu in solvent extraction using a BTPhen ligand substituted with halogen
Authors: Fukasawa Yuto , Nakashima Satoru
Published: January 2023

When the electronegativity of the substituted halogen atom for BTPhen ligand increases, ΔG(Eu) shifts to a more positive direction than ΔG(Am), ΔΔG becomes more negative and the Am selectivity increases.
One-pot synthesis of liquid photocrosslinkable poly(l-lactide) with terminal triacrylate
Authors: Yu Chung-Fu , Rwei Syang-Peng , Shu Yao-Chi
Published: January 2023

We synthesized a poly(l-lactide)–pentaerythritol triacrylate (PETA) polymer modified with acrylic trifunctional groups using a one-pot method based on ring-opening polymerization of l-lactide and PETA.
Microwave assisted regioselective halogenation of benzo[b][1,4]oxazin-2-onesviasp2C–H functionalization
Authors: Kumar Sandeep , Prince  , Gupta Mohit , Lalji Ram Sunil Kumar , Singh Brajendra K.
Published: January 2023

We are reporting a palladium catalyzed microwave assisted halogenation of 3-phenyl-2H-benzo[b][1,4]oxazine-2-ones.
Ni loaded SnS2 hexagonal nanosheets for photocatalytic hydrogen generation via water splitting
Authors: Jawale Niteen , Arbuj Sudhir , Umarji Govind , Shinde Manish , Kale Bharat , Rane Sunit
Published: January 2023

Schematic of photocatalytic H2 generation using Ni/SnS2 nanosheets along with the energy levels of SnS2 and Ni nanostructures.
Tribochemical nanolithography: selective mechanochemical removal of photocleavable nitrophenyl protecting groups with 23 nm resolution at speeds of up to 1 mm s−1
Authors: Ducker Robert E. , Brügge Oscar Siles , Meijer Anthony J. H. M. , Leggett Graham J.
Published: January 2023

Photolithography without optics: compression of nitrophenyl protecting groups under an atomic force microscope probe modifies their electronic structure and reduces the energy barrier to deprotection, enabling nanolithography without UV light.
Unveiling a new aspect of oxocarbons: open-shell character of 4- and 5-membered oxocarbon derivatives showing near-infrared absorption
Authors: Maeda Takeshi , Oka Taishi , Sakamaki Daisuke , Fujiwara Hideki , Suzuki Naoya , Yagi Shigeyuki , Konishi Tatsuki , Kamada Kenji
Published: January 2023

Near-infrared absorbing oxocarbon derivatives, so-called squaraine and croconaine dyes, regarded as closed-shell species so far, display the intermediate open-shell character that impacts their one- and two-photon absorption properties.
Two-dimensional ruthenium boride: a Dirac nodal loop quantum electrocatalyst for efficient hydrogen evolution reaction
Authors: Gao Zhen , Ma Fengxian , Wu Hongbo , Ge Yongheng , Zhu Ziming , Liu Ying , Jiao Yalong , Chen Zhongfang
Published: January 2023

An innovative route to design 2D catalysts by using the concept of Dirac nodal loop semimetals was reported to boost the hydrogen evolution reaction.
Water bridge solar evaporator with salt-resistance and heat localization for efficient desalination
Authors: Luo Yu-Qiong , Song Fei , Wang Xiu-Li , Wang Yu-Zhong
Published: January 2023

Bridge-shaped thin water layer is evaluated by capillary force, which endows the evaporator with salt-resistance and heat localization.
Highly resolved and refreshable X-ray imaging from Tb3+doped aluminosilicate oxyfluoride glass scintillators
Authors: Chen SunYueZi , Li LianJie , Chen JunYu , Xu ShuJun , Huang WenJun , Wen ZhuoXing , Jiang TingMing , Guo Hai
Published: January 2023

A glass scintillator with high spatial resolution of 20 lp mm−1and refreshable X-ray imaging is designed. The practical tests also reveal the great potential for applications in X-ray imaging.
Graphene memristors based on humidity-mediated reduction of graphene oxide
Authors: Haghshenas Gorgabi Fatemeh , Morant-Miñana Maria C. , Zafarkish Haniyeh , Abbaszadeh Davood , Asadi Kamal
Published: January 2023

Humidity-mediated electrochemical reduction of graphene oxide yields memristors with controllable and highly stable resistance states that can be used in multibit memory applications. The obtained kinetic, enables a predictive resistance setting.
Phase behaviour of liquid crystalline dendronized fullerene binary mixtures
Authors: Lu Huanjun , Zou Hui , Chen Xingwei , Zhang Wenhao , Wang Bingbing , Cao Zhaoliang , Tu Yingfeng
Published: January 2023

The phase behaviour of three groups of binary mixtures of dendronized fullerene liquid crystals was studied. In the LT phase formed by blends, a preference for the long-chain component to occupy the outermost of the three fullerene layers was shown.
Close, but not too close: a mesoscopic description of (a)symmetry and membrane shaping mechanisms
Authors: Ruhoff Victoria Thusgaard , Bendix Poul Martin , Pezeshkian Weria
Published: January 2023

Biomembranes are fundamental to our understanding of the cell, the basic building block of all life. An intriguing aspect of membranes is their ability to assume a variety of shapes, which is crucial for cell function. Here, we review various membrane shaping mechanisms with special focus on the current understanding of how local curvature and local rigidity induced by membrane proteins leads to emerging forces and consequently large-scale membrane deformations. We also argue that describing the interaction of rigid proteins with membranes purely in terms of local membrane curvature is incomplete and that changes in the membrane rigidity moduli must also be considered.
An Efficient Route to Access Spirooxindole–Pyrazolone-Fused Cyclopentenes by a Diastereoselective [3+2] Annulation
Authors: Bhat Ramakrishna G. , Sabale Abhijeet S. , Warghude Prakash K.
Published: January 2023

A DMAP-catalyzed, highly diastereoselective, [3+2] cycloaddition of pyrazolone-derived Morita–Baylis–Hillman carbonates to 3-methyleneoxindoles has been developed. A variety of structurally diverse and complex spiropyrazolone-fused oxindoles bearing three contiguous chiral centers have been synthesized in high yields (up to 98%) and with excellent diastereoselectivities (up to 99:1). Moreover, the synthetic potential of this protocol has been demonstrated by performing a Suzuki coupling reaction.
Severity of Illness Scores and Biomarkers for Prognosis of Patients with Coronavirus Disease 2019
Authors: Cavallazzi Rodrigo , Bradley James , Chandler Thomas , Furmanek Stephen , Ramirez Julio A.
Published: January 2023

The spectrum of disease severity and the insidiousness of clinical presentation make it difficult to recognize patients with coronavirus disease 2019 (COVID-19) at higher risk of worse outcomes or death when they are seen in the early phases of the disease. There are now well-established risk factors for worse outcomes in patients with COVID-19. These should be factored in when assessing the prognosis of these patients. However, a more precise prognostic assessment in an individual patient may warrant the use of predictive tools. In this manuscript, we conduct a literature review on the severity of illness scores and biomarkers for the prognosis of patients with COVID-19. Several COVID-19-specific scores have been developed since the onset of the pandemic. Some of them are promising and can be integrated into the assessment of these patients. We also found that the well-known pneumonia severity index (PSI) and CURB-65 (confusion, uremia, respiratory rate, BP, age ≥ 65 years) are good predictors of mortality in hospitalized patients with COVID-19. While neither the PSI nor the CURB-65 should be used for the triage of outpatient versus inpatient treatment, they can be integrated by a clinician into the assessment of disease severity and can be used in epidemiological studies to determine the severity of illness in patient populations. Biomarkers also provide valuable prognostic information and, importantly, may depict the main physiological derangements in severe disease. We, however, do not advocate the isolated use of severity of illness scores or biomarkers for decision-making in an individual patient. Instead, we suggest the use of these tools on a case-by-case basis with the goal of enhancing clinician judgment.
Evolution of Antiphospholipid Syndrome
Authors: Arachchillage Deepa R.J. , Pericleous Charis
Published: January 2023

Antiphospholipid syndrome (APS) is an autoimmune prothrombotic disease characterized by thrombosis and/or pregnancy complications caused by antiphospholipid antibodies (aPL). The history of APS can be traced back to observations made during screening programs for syphilis conducted in the mid-20th century, with identification of patients with the so-called biological false-positive serological reactions for syphilis. Initial observation linking aPL with recurrent miscarriages was first reported more than 40 years ago. Since then, our understanding of the pathogenesis and management of APS has evolved markedly. Although APS is an autoimmune disease, anticoagulation mainly with vitamin K antagonists (VKAs) rather than immunomodulation, is the treatment of choice for thrombotic APS. Direct acting oral anticoagulants are inferior to VKAs, especially those with triple-positive APS and arterial thrombosis. Inflammation, complement activation, and thrombosis in the placenta may contribute to pathogenesis of obstetric APS. Heparin, mainly low-molecular-weight heparin, and low-dose aspirin represent the treatments of choice for women with obstetric complications. Increasingly, immunomodulatory agents such as hydroxychloroquine for thrombotic and obstetric APS are being used, especially in patients who are refractory to present standard treatment.
Epidemiology of Respiratory Syncytial Virus-Associated Acute Lower Respiratory Tract Infection among Hospitalized Under-5s in Northwestern Nigeria
Authors: Garba Maria Ahuoiza , Giwa Fatima Jummai , Adelaiye Hamdala , Olorukooba Abiola Aira , Abdullahi Fatima , Makarfi Hauwa , Löwensteyn Yvette , Bont Louis , Abdurraheem Fadlullah , Uudu Ehi , Mudasir Halima , Mazur Natalie I
Published: January 2023

Objective Globally, 33 million cases of respiratory syncytial virus (RSV) infections occur annually among under-fives (5s). Ninety-nine percent of deaths from RSV occur in low- and middle-income countries. Under-five pneumonia mortality in Nigeria was estimated at 140,520 in 2017, but RSV epidemiological data are scant due to poor awareness and limited testing. Vaccines for RSV are currently under development and RSV mortality data from this high mortality, low resource setting are essential to maximizing the potential benefit of vaccination as well as promoting vaccine uptake. This study aimed to describe the epidemiology of RSV-associated acute lower respiratory tract infection (ALRTI) in children younger than 5 years in Zaria, Northwestern Nigeria.

Methods A prospective cohort study was conducted among children aged 1 month to 5 years who were hospitalized with ALRTI in the Emergency Pediatric Unit of a tertiary hospital in Zaria from November 2018 to October 2019. Naso-pharyngeal swabs were obtained for RSV testing using a point-of-care immunoassay technique.

Results Thirty-three percent (35/106) of the children had RSV-related ALRTI. The median age of RSV-positive cases was 8 months (IQR 3–14). Two-thirds of children (68.6%, 24/35) were below 12 months. The RSV mortality rate was 5.7% (2/35). RSV occurred in 10 months of the year with peaks in March and July.

Conclusion A third of admitted children with ALRTI were positive for RSV. Therefore RSV significantly contributes to childhood pneumonia and the dual seasonal peak observed in our study may have implications for vaccine implementation.
Spin-crossover complexes: Self-interaction correction vs density correction
Authors: Ruan Shiqi , Jackson Koblar A. , Ruzsinszky Adrienn
Published: January 2023

Complexes containing a transition metal atom with a 3d4–3d7 electron configuration typically have two low-lying, high-spin (HS) and low-spin (LS) states. The adiabatic energy difference between these states, known as the spin-crossover energy, is small enough to pose a challenge even for electronic structure methods that are well known for their accuracy and reliability. In this work, we analyze the quality of electronic structure approximations for spin-crossover energies of iron complexes with four different ligands by comparing energies from self-consistent and post-self-consistent calculations for methods based on the random phase approximation and the Fermi–Löwdin self-interaction correction. Considering that Hartree–Fock densities were found by Song et al., J. Chem. Theory Comput. 14, 2304 (2018), to eliminate the density error to a large extent, and that the Hartree–Fock method and the Perdew–Zunger-type self-interaction correction share some physics, we compare the densities obtained with these methods to learn their resemblance. We find that evaluating non-empirical exchange-correlation energy functionals on the corresponding self-interaction-corrected densities can mitigate the strong density errors and improves the accuracy of the adiabatic energy differences between HS and LS states.
A perspective on the microscopic pressure (stress) tensor: History, current understanding, and future challenges
Authors: Shi Kaihang , Smith Edward R. , Santiso Erik E. , Gubbins Keith E.
Published: January 2023

The pressure tensor (equivalent to the negative stress tensor) at both microscopic and macroscopic levels is fundamental to many aspects of engineering and science, including fluid dynamics, solid mechanics, biophysics, and thermodynamics. In this Perspective, we review methods to calculate the microscopic pressure tensor. Connections between different pressure forms for equilibrium and nonequilibrium systems are established. We also point out several challenges in the field, including the historical controversies over the definition of the microscopic pressure tensor; the difficulties with many-body and long-range potentials; the insufficiency of software and computational tools; and the lack of experimental routes to probe the pressure tensor at the nanoscale. Possible future directions are suggested.
Generation of a net flow due to fixed oblique beam structures in the nucleate boiling region
Authors: Sugioka Hideyuki , Miyauchi Atsushi
Published: January 2023

Effective utilization of unused heat below 200 °C is essential for a sustainable society. In this study, we propose a thermally driven water pump using fixed oblique beam structures with bubbles in the nucleate boiling region (approximately, 100–130 °C). Here, the oblique beam structure breaks the symmetry of the bubble force, and thus, they provide a net flow. Specifically, by using six fixed oblique beams along a circular fluidic channel, we observed a net flow of an average flow velocity of ∼40 mm/s and an average volume flow rate of ∼10 000 mm3/s (∼0.01 l/s) at the superheat of ∼22 K. Our findings should contribute to the effective use of unused heat such as factory waste heat and environmental energy.
Benchmarking fundamental gap of Sc2C(OH)2 MXene by many-body methods
Authors: Dubecký Matúš , Minárik Stanislav , Karlický František
Published: January 2023

Sc2C(OH)2 is a prototypical non-magnetic member of MXenes, a promising transition-metal-based 2D material family, with a direct bandgap. We provide here a benchmark of its fundamental gap Δ obtained from many-body GW and fixed-node diffusion Monte Carlo methods. Both approaches independently arrive at a similar value of Δ ∼ 1.3 eV, suggesting the validity of both methods. Such a bandgap makes Sc2C(OH)2 a 2D semiconductor suitable for optoelectronic applications. The absorbance spectra and the first exciton binding energy (0.63 eV), based on the Bethe–Salpeter equation, are presented as well. The reported results may serve to delineate experimental uncertainties and enable selection of reasonable approximations such as density functional theory functionals, for use in modeling of related MXenes.
Enhanced growth and lipid productivity by living Chlorella sorokiniana immobilized in Ca-alginate beads
Authors: Alfaro-Sayes Daniel A , Amoah Jerome , Rachmadona Nova , Hama Shinji , Hasunuma Tomohisa , Kondo Akihiko , Ogino Chiaki
Published: January 2023

The bottleneck for the production of biofuels from microalgae consists on costly harvesting processes and low lipid production, immobilization technology could play a part on making the production of biofuels more feasible. The aim of this study was to evaluate the effect of alginate immobilization on the growth and lipid productivity of the microalgae Chlorella sorokiniana, so far, the main focus of immobilization technology has been its use for wastewater treatment and nutrient removal from effluents. The microalgae Chlorella sorokiniana was cultured in both free and immobilized forms under optimal autotrophic growth conditions. Microalgae were immobilized in calcium alginate beads generated by mixing algal cells with a sodium alginate solution, followed by extrusion into a CaCl2 solution. The results obtained in this study showed that the growth of the microalgae immobilized in alginate beads, was enhanced and achieved a dry cell weight 1.4-fold higher than that of a free cell culture, a higher light transmittance was also achieved in the alginate immobilized culture, and the lipid productivity was increased from 54.21 ± 2.48 mg l−1 d in the free cell culture to 82.22 ± 8.48 mg l−1 d in the immobilized culture. These results demonstrate the effectiveness of immobilization technology for promoting growth and lipid productivity in the microalgae Chlorella sorokiniana.
1223 IDENTIFYING SCOTLAND'S CARE HOME POPULATION LIVING WITH DEMENTIA - IS DATA LINKAGE USEFUL?
Authors: Drelciuc M , Quinn T J , Burton J K
Published: January 2023

Background

People living with dementia are more likely to move into care homes. The true prevalence of dementia among care home residents in Scotland is not known. People living with dementia often interact with multiple social and healthcare services, thus routine data may offer a way to enhance understanding.

Aim

To compare national health and social care data sources recording dementia status for Scottish care home residents.

Methods

A retrospective cohort study of adult (≥ 18 years) care home residents in Scotland during financial years 2012/13 and 2013/14. An indexing process linked data from the Scottish Care Home Census (SCHC) to Community Health Index numbers to allow linkage to healthcare datasets. Anonymised individual data was accessed in a secure environment, within the National Safe Haven. A linked dataset with acute/general and psychiatric hospitalisations (SMR01, SMR04), prescriptions (Prescribing Information System), Scottish Patients at Risk of Admission and Readmission (SPARRA) data, and National Records of Scotland (NRS) mortality records was analysed. Dementia recording was studied across these datasets.

Results

In 2012/13 and 2013/14, 31,589 and 31,504 care home residents were included for analysis. In 2012/13, 17,548 (55.5%) had dementia according to SCHC. PIS and SMR01 confirm 4,701 (26.8%) and 4,254 (24.3%) SCHC dementia records, respectively. SMR04 and SPARRA confirm 1,830 (10.4%) and 964 (5.5%). Among 2012/13 residents, 19,593 (62.0%) have at least one dementia record across datasets. Of these, 10,445 (53.3%) have one record – 83.9% SCHC records, 7.3% SMR01 records, and 5.0% PIS records. Of 15,781 residents who die within 5 years from 2012/13, 6,984 (44.3%) have death records confirming dementia. Results for 2013/14 are similar.

Conclusion

Routine data enhances dementia ascertainment amongst care home residents, with most confirmation from general hospitalisations and prescriptions. Primary care data and analysis of more financial years would enable further exploration of dementia recording patterns.
1208 FEASIBILITY OF A PHARMACIST-LED INTERVENTION FOR ATRIAL FIBRILLATION IN LONG-TERM CARE: THE PIVOTALL STUDY
Authors: Ritchie L A , Penson P E , Akpan A , Lip G Y H , Lane D A
Published: January 2023

Introduction

Older people in care homes with atrial fibrillation (AF) have complex health needs and would benefit from taking part in research. This study assessed the feasibility of pharmacist implementation of the Atrial Fibrillation Better Care (ABC: Anticoagulation; Better symptoms; Cardiovascular comorbidity management) pathway, and collection of an AF-specific, resident-centred outcome.

Methods

Older residents (aged ≥65 years) with AF were recruited from care homes within Liverpool and Sefton and randomised to receive the pharmacist intervention, or continue their existing treatment. Resident quality of life was assessed using the Atrial Fibrillation Effect on Quality of Life Questionnaire (AFEQT).

Results

Twenty-two care homes were approached about the study, and seven signed up to take part between 28 September 2020 and 29 April 2021. Time taken to recruit care homes ranged from 0 to 122 days. There were 83 residents identified as potentially eligible to take part, but after screening only 28 residents (34%) were invited. Overall, 21 residents were recruited. Eleven residents received the pharmacist intervention and three had ABC recommendations made to their GPs. Two out of four recommendations were implemented. The pharmacist administered the AFEQT questionnaire to 17 residents with capacity and completion rates were 94% and 93% at baseline and six-months, respectively. Residents found the questionnaire difficult; most were unable to distinguish if symptoms were AF-related (n=3), or did not know they had AF (n=8), and questions related to physical activity were not applicable to any of the residents who were bed bound (n=5) or had severely limited mobility (n=12).

Conclusion

There were procedural (encountered before research starts), system (encountered during research) and resident-specific barriers that impacted this study. Barriers need addressing before wider implementation, and AF-specific quality of life measures need to be developed and validated for care home residents. A detailed commentary has been submitted for publication.
1175 WAS ICU RIGHT FOR YOU? AN EXPLORATORY QUALITATIVE STUDY OF PATIENTS >=65 YRS AND NEXT OF KIN IN COVID-19: THE ESCALATE STUDY
Authors: Warner B E , Harry A , Wells M , Brett S J , Antcliffe D B
Published: January 2023

Introduction

The decision to admit an older patient to the intensive care unit (ICU) should reflect shared goals of care. Resource limitations during the Covid-19 pandemic highlighted challenges in selecting candidates for escalation. Patients and next of kin (NoK) who have experienced ICU are well-placed to reflect on whether the admission was right for them.

Objective

To explore older patients’ (>65 years) and their loved ones’ views on escalation decision making.

Methods

Qualitative study involving semi-structured interviews with patients, NoK of survivors and NoK of deceased who experienced UK ICU admission with Covid-19 respiratory failure between March 2020 and February 2021. A preliminary questionnaire was used to maximise sample diversity of age, sex, ethnicity, survival, decision regret and impact of event scores. Interview data were collected via video conferencing or telephone. Transcripts were analysed using framework analysis. Results 30 participants were interviewed.

Results

Five themes were identified: ‘Inevitability’ - a sense that the illness and its management are out of the control of the patient or their loved one; ‘Disconnect’ - differences between hospital and lay person narratives; challenges to bridging that gap included effective communication aided by technology; ‘Acceptance’ - of the consequences, good or bad, of an intensive care admission as unalterable; ‘Beyond comprehension’ - participants had not contemplated ill health or ICU prior to admission and even with the benefit of hindsight struggled to describe which potential outcomes would be acceptable or unacceptable if they needed to be involved in similar decision-making around escalation in the future; ‘Covid-19’ - unique impact of a pandemic.

Conclusion

This study, which includes bereaved NoK as well as patients and NoK of survivors, adds perspective to inform decision making regarding treatment escalation of older people.
1264 AN ANALYSIS OF CONSULTANT JOB ADVERTS IN GERIATRIC MEDICINE IN ENGLAND AND WALES
Authors: Monnier-Hovell Z , Jundi A , Sims H , Sheikh A
Published: January 2023

Introduction

The British Geriatrics Society (BGS) Flexible Workforce Statement supports national policy such as the NHS People Plan in promoting less than full time (LTFT) working.1,2 As LTFT trainee representatives on the BGS Trainees' Council we were interested to know how consultant work patterns are advertised. We analysed job adverts for Consultants in Geriatric Medicine over a two-year period to identify how many were LTFT posts.

Method

A freedom of information (FOI) request was submitted to online recruitment website ‘NHS Jobs’. The request identified jobs in ‘Elderly Care Medicine’ OR those containing ‘Geriatric’ in their title between 01/04/2019 and 31/03/2021. The FOI data were filtered to only include Consultant posts, grouped by training deanery and analysed using Excel. Regional numbers of LTFT trainees were identified by emailing Training Programme Directors and a FOI request to deaneries for non-responders. The number of LTFT consultants was identified using the online Royal College of Physicians census.3

Results

The FOI request returned 7589 jobs; of these 1083 were consultant posts. These ranged from 42 in Thames Valley to 171 in East of England. Twenty-one jobs (1.9%) were advertised as LTFT, the highest proportion was 10.5% in Yorkshire and Humber. Twenty-eight (2.6%) were negotiable, the highest proportion was 15.9% in the South West. On average, 33% of LTFT jobs were advertised as permanent posts. Currently, 37.7% of trainees, and 25% of consultants, work LTFT.

Conclusion

Number of LTFT job adverts was low compared to the number of LTFT consultants and trainees, although there is regional variation. A limitation was that details of adverts were not seen, which made it unclear whether each job was a fresh advert or readvertising an unfilled post. The latter is likely given there are 1747 consultants working in the UK.3 Further avenues of work include identifying LTFT opportunities for SAS grade doctors and allied health professionals.

References

1. https://www.england.nhs.uk/ournhspeople/online-version/lfaop/

2. https://www.bgs.org.uk/resources/flexible-working-in-geriatric-medicine

3. https://www.rcplondon.ac.uk/projects/outputs/working-differently-shadow-covid-19-uk-2021-census-consultant-higher-specialty
1286 IS VIRTUAL ADVANCE CARE PLANNING SIMULATION AS EFFECTIVE AS FACE-TO-FACE LEARNING?
Authors: Barnard A , Petra H , Owen L , Goffe K , Bergbaum C , Wickham H , Fox O , Pleming J , Steel A
Published: January 2023

Introduction

Advance care planning (ACP) is about what matters to patients, enabling their wishes to be respected, even when they become unable to engage in decision-making. Evidence shows ACP improves end of life care for patients and reduces relatives’ bereavement reactions (Detering KM et al. BMJ. 2010; 340:1345). A simulation course for multidisciplinary healthcare professionals, using actors, was developed to improve understanding of ACP, and confidence in having these conversations. In response to the COVID-19 pandemic, the course was adapted to an online format.

Method

Participants were asked about their ACP confidence and understanding pre- and post-course, using a Likert scale (1-Not at all to 5-Very confident). Data between 2018-2022 was analysed to compare face-to-face and online course responses. Free-text responses to ‘How do you feel about attending the course online?’ were analysed qualitatively. Ethics approval was not required.

Results

Five face-to-face and five virtual sessions trained 128 and 133 attendees respectively. Confidence in having ACP discussions improved significantly following the course in both cohorts; from a mean Likert rating of 2.77 (95% CI 2.60-2.94, n=132) to 4.11 following face-to-face training (95% CI 3.97-4.25, n=128), and from 2.79 (95% CI 2.66-2.91, n=149) to 4.11 following the online course (95% CI 4.01-4.21, n=133). Additionally, 97% (n=132) of face-to-face attendees and 99.2% (n=133) of virtual attendees said their practice would change because of the course. Following the training, 100% of participants across both cohorts reported that they ‘fully understood’ what was meant by ACP, from a baseline of 77.3% (n=132) in the face-to-face cohort and 81.9% (n=149) of virtual participants. Free-text analysis highlighted the convenience of attending online (n=22, 21%), and only a minority reported technical difficulties (n=8,8%).

Conclusion

This course was successfully adapted to a virtual format, improving participants’ ACP confidence and understanding as effectively as in-person training, whilst being more accessible.
1342 DO NOT ATTEMPT CONVERSATIONS PRE-REHEARSAL: TEACHING MEDICAL STUDENTS TO HAVE DNACPR CONVERSATIONS
Authors: Mistry Z
Published: January 2023

Introduction

The Recommended Summary Plan for Emergency Care and Treatment (ReSPECT) form is widely adopted to document advanced care plans, including Do Not Attempt Resuscitation (DNACPR) decisions. Communication between clinicians and patients, or next of kin is required for completion. It is widely documented UK medical students have little exposure to these experiences, including being asked to leave whilst they are occurring. During the COVID19 pandemic, Foundation Year 1 (FY1) doctors led discussions with increased frequency and autonomy, with no documented concurrent training. We present a novel learning experience designed to aid these discussions. Students were timetabled to a 1.5 hour workshop, facilitated by a clinical teaching fellow. They were invited to complete ReSPECT form for a celebrity to familiarise themselves with the layout. They then considered a patient admission scenario in 3 different groups from the perspective of the patient, family and medical team, and used this to contemplate potential, future, emergency treatments. Subsequently a discussion surrounding CPR effectiveness, ways of communicating this, and legal advanced decision documents occurred. The session concludes with scrutinising example ReSPECT forms provided by the Resuscitation Council UK.

Method

Students' confidence levels were measured pre and post session using a Likhert scale questionnaire.

Results

90 students attended workshops across 6 rotations. 80% students completed post - session questionnaires, of which 100% reported an increase in confidence with having a DNACPR/advanced care planning discussion compared to before the session.

Conclusion

DNACPR conversations can incite anxiety in any seniority of health care professionals. Medical educators need to adequately prepare medical students during their training in advanced care planning and DNACPR discussions. This can be done with simulated workshop experiences, reinforced with opportunistic or organised observational experience. Adequate preparation will lead to increased confidence in discussions, ultimately leading to better experiences for patients and their families.
1321 THE ASSOCIATION OF PAINFUL AND NON-PAINFUL COMORBIDITIES WITH FRAILTY
Authors: Chaplin W J , Lewis H R , Shahtaheri S , Millar B S , McWilliams D F , Gladman J R F , Walsh D A
Published: January 2023

Introduction

Chronic pain is associated with frailty. We hypothesised that painful comorbidities would be more strongly associated with frailty than non-painful comorbidities.

Method

Data were from Investigating Musculoskeletal Health and Wellbeing, a UK-based cohort of people with or at risk of musculoskeletal problems or frailty. Average pain over the previous month was assessed using an 11-point numerical rating scale (NRS). The original FRAIL questionnaire comprises five self-report items: Fatigue, Resistance, Ambulation, Illnesses and Loss of weight. In this study risk of frailty was operationalised using a modified FRAIL questionnaire, omitting the “illnesses” item which related to comorbidities. Comorbidities were classified as either ‘painful’ or ‘non-painful’ based on the International Association for the Study of Pain chronic pain classification criteria. Ordinal logistic regression models explored associations of comorbidity counts with frailty.

Results

Cross-sectional data were from 2473 participants, 57% female, median age 72 (range 40 to 96) years. 518 (21%) participants were classified as frail. Mean (SD) pain score was 5.5 (2.5). Median (IQR) painful comorbidities was 2 (1 to 3) and non-painful 1 (0 to 2). Highest comorbidity frequency: arthritis (66%) and hypertension (38%). Pain was associated with frailty (OR 1.58 (1.52 to 1.64)). Painful comorbidities (aOR 1.64 (1.54 to 1.75) and non-painful comorbidities (aOR 1.31 (1.21 to 1.41)) were both associated with frailty when included in the same multivariable model adjusted for age, sex and BMI.

Conclusions

Painful comorbidities were most strongly associated with frailty, although non-painful comorbidities also contributed. Pain and frailty are interconnected, and this might in part be due to comorbidities or their treatments. These findings provide justification for further research to identify the mechanisms through which pain is involved in frailty and to include pain management in interventions to ameliorate frailty.
1142 ASSOCIATION OF SOCIAL PARTICIPATION AND MORTALITY IN WIDOWED PERSONS - RESULTS OF THE TAIWAN LONGITUDINAL STUDY ON AGING (TLSA)
Authors: Hsiao Y-H , Lee M-C , Lee S-S
Published: January 2023

Introduction

It has been suggested that the widowed have a higher risk of death. This study intended to explore whether social participation could improve this trend.

Method

A longitudinal study database was constructed to explore the trend of survival and its change with social participation in widowed persons. The Taiwan Longitudinal Study on Aging (TLSA), based on four consecutive waves of longitudinal follow-up data in 1999, 2003, 2007, and 2011 was linked with the National Death Registry from 1999 through 2012. In total, there were 1417 widowed persons and 4500 nonwidowed persons included in this study, excluding divorced and never-married people. The survival trend analysis was carried out with social participation as the main predictive factor stratified for comparative analysis.

Results

Our results showed that the widowed were older than the nonwidowed, were female-dominant, had a lower education level, were more economically stressed, and were less likely to engage in regular exercise, and thus showed generally poorer health; for example, being more vulnerable to having chronic diseases, disability with the Activities of Daily Living (ADL), cognitive impairment with the Short Portable Mental State Questionnaire (SPMSQ), and depression with The Center for Epidemiological Studies-Depression (CES-D). The death risk of the widowed was significantly higher than that of the nonwidowed, but the death trend for those with social participation was significantly lower than that of their counterparts in both the widowed and nonwidowed. After matching with gender and age for widowed persons, the widowed with social participation had a significantly lower risk of death.

Conclusion

It was concluded that social participation can improve the death risk for the widowed, and social participation is worthily included in health promotion plans and social welfare services for widowed persons.
1179 4.5 TONNES OF FOOD WASTED ACROSS A HOSPITAL WARD: A SERVICE EVALUATION OF DIETARY INTAKE AND FOOD WASTE
Authors: Marsh K , Avery A , Sahota O
Published: January 2023

Introduction

Malnutrition is a debilitating condition in hospitalised older people. There has been limited studies exploring dietary intake and oral nutritional supplement (ONS) compliance in these people. The purpose of this service evaluation was to observe daily energy and protein intake, plate waste and ONS compliance and to report food waste at ward level.

Methods

Three-day dietary (food-only) intake and plate waste of 19 older (≥ 65 years) people on a hospital trauma and orthopaedic (T&O) ward were assessed. Patients were categorised as ‘nutritionally well’ or ‘nutritionally vulnerable’ as per British Dietetics Association’s (BDA) Nutrition and Hydration Digest criteria. Dietary intake was calculated by a Dietitian and compared with adjusted BDA standards to exclude energy and protein from drinks. Ward plate and food trolley waste were weighed after lunch and supper for five days. Thirty-three ONS from 11 patients were collected before disposal and weighed.

Results

Mean age of the patients were 84 ± 9 years (9 female, and 10 male) with the most common injury hip fracture (68.4%). Mean (standard deviation, SD) intake for ‘nutritionally well’ was 1592 (257) kcal/day and 65.7(8.5) g/day protein and ‘nutritionally vulnerable’ (n= 15) 643 (354) kcal/day and 24.8 (14.0) g/day protein. Plate waste for ‘nutritionally well’ was 4.1 (5.8)% at main meals and 1.7 (3.4)% at pudding and for ‘nutritionally vulnerable’ 53.1 (26.6)% at main meals and 38.6 (32.2)% at pudding. Compliance to ONS was 28.3 (38.8)%. The combined mealtime plate waste weighed 6.2 (1.2) kg/day and food-trolley waste 6.2 (0.9) kg/day. This equates to approximately 4526kg/year (4.5T).

Conclusions

Energy and protein intake and compliance to ONS in older T&O patients is sub-optimal. Food waste is high and urgently needs addressing. Further, interventions are warranted to improve dietary intake in hospital and to explore the acceptability of alternative ONS food/drink styles.
1239 AGEING WELL IN FRAILTY: DEVELOPING A PRACTICAL MODEL FOR USE IN COMMUNITY PRACTICE TO IMPROVE PATIENT REPORTED WELLNESS
Authors: Thomas D
Published: January 2023

Introduction

Empowering patients to ‘age well’ (NHS England Long Term Plan, 2019) has become a key driver to meet the rising demand for healthcare. Despite a growing body of evidence regarding ageing well and the benefits of patient empowerment (Selman et al, 2017) and reducing demand on resources (Age UK, 2020), there remains confusion regarding applied meaning for the spectrum of older persons health. This research will consider expert view on the topic of ‘ageing well’ related to the predictable patterns of ageing. The aims of this study will be to develop a new interventional frailty stratification model to best meet the needs in advancing frailty.

Method

This research study will incorporate a systematic literature review alongside patient and carer focus groups to inform initial questionnaire design for a modified Delphi panel of mixed professional experts. The overall aim of undertaking rounds of questionnaire and subsequent survey will be to arrive at consensus expert view to fulfil the research aims of identifying a conceptual approach to be further tested in community clinical practice.

Results

The results of the study will inform a defined model of intervention to guide community practitioners in preventative care for frailty. Testing of the intervention will consider impact upon individuals, clinicians, and ongoing frailty trajectory.

Conclusion

At the time of the Autumn conference, the research study will be at recruitment stage for the modified Delphi panel. This abstract application is requesting support to share the background and progress to date with conference delegates to actively support a modified Delphi research process. The opportunity to showcase the study and network with participants to gauge interest in the ageing well research area would be a valued way to recruit an expert panel with the aim of improving care in this emerging and exciting aspect of older person’s care.
1353 “I’M MY OWN BOSS” - A QUALITATIVE STUDY WITH PEOPLE RECEIVING ADULT DAY SERVICES IN GERMANY ABOUT THEIR UNDERSTANDING OF LEISURE
Authors: Rommerskirch-Manietta M , Purwins D , Van Haitsma K , Abbott K , Roes M
Published: January 2023

Introduction

Community-based care such as adult day services (ADS) are preferred by people with dementia. ADS offers the opportunity to support the health and social needs of their clients and provide respite to family members, contributing to a stable care situation at home. The psychological needs of humans according to the self-determination-theory (SDT) (autonomy, competence, and relatedness) can be fulfilled by leisure activities and thus improve well-being and quality of life. The implementation of leisure activities that reflect individual preferences support active participation, preserve autonomy, improve satisfaction with care and consequently can be understood as a core aspect of person-centred care. However, it is currently unknown how people receiving ADS understand leisure and which leisure activities they prefer.

Method

To gain insight, a qualitative design was chosen. We conducted semi-structure interviews with 13 people receiving ADS in Germany. Participants were recruited from two different ADS in one state in Germany. Interviews were recorded, transcribed verbatim and analysed using thematic analysis and categories of the SDT.

Results

The results show that over 90 % of participants were diagnosed with dementia and that the ADS was considered a place to participate in leisure activities. However, this consideration depends primarily on the degree of autonomy they experienced and thus the freedom to choose activities in the ADS according to their individual preferences. The participants mentioned a variety of preferred meaningful leisure activities related to competence and relatedness (e.g., mentoring, socializing, reminiscence).

Conclusion

The results indicate the importance of preference-based service design in ADS to meet clients’ psychological needs and thus provide person-centred care to improve well-being and quality of life. These results can be used to develop an item-based assessment tool to assess the preferences of people with care needs regarding leisure activities in ADS.
1218 GREY MATTER VOLUME AND NEUROTRANSMITTER RECEPTORS ABNORMALITIES IN PARKINSON’S DISEASE PSYCHOSIS: A META-ANALYSIS
Authors: Pisani S , Gunasekera B , Velayudhan L , Bhattacharyya S
Published: January 2023

Introduction

Recent evidence suggests extensive grey matter abnormalities in Parkinson’s Disease Psychosis (PDP), as well as dysfunction of dopaminergic and serotonergic receptors. However, findings remain unclear. This meta-analysis aimed to identify neuroanatomical correlates of PDP and to examine the relationship between grey matter and key candidate receptors.

Method

Peak coordinates were extracted from structural magnetic resonance imaging (MRI) studies (identified through systematic searches on PubMed, Web of Science, and Embase) for PDP patients and Parkinson's Disease patients without psychosis (PDnP) and were analysed using Seed-based d mapping with permutation of subject images (SDM-PSI). Gene expression data for dopaminergic (D1/D2) and serotonergic (5-HT2a/5-HT1a) receptors were extracted from the Allen Human Brain Atlas, probe-to-gene re-annotation data were downloaded from Arnatkevic̆iūtė et al. (Neuroimage, 2019;189:353-67) and parcellated on 78 regions of the Desikan-Killiany brain atlas. Effect-size estimates, extracted from the SDM-PSI analysis for these 78 regions as a measure of grey matter in PDP patients, were entered in multiple regression models.

Results

10 studies were included in the meta-analysis (PDP, n= 211; mean age = 69.01 years, 52.1% males; PDnP, n = 298, mean age = 67.34 years, 41.9 % males). Reduction in grey matter was observed in parieto-temporo-occipital regions in PDP patients (uncorrected, p < 0.05). When controlling for PD medications, expressed in Levodopa equivalent daily dose (LEDD), results remained significant (uncorrected, p < 0.05). 5-HT2a and 5-HT1a gene receptor expressions were associated with estimates of grey matter volume (5-HT2a, b=-0.20, p=0.01, adjusted for LEDD, b=-0.18, p=0.03; 5-HT1a, b=0.11, p=0.02, adjusted for LEDD, b=0.12, p=0.01).

Conclusion

We observed lower cortical volume in parieto-temporo-occipital areas, which are involved in information processing, integration, and attention in PDP compared to PDnP patients. We also reported an association between regional brain expression of serotonergic receptors and grey matter volume suggesting a role of serotonin in PDP.