bluuebunny/crossref_metadata_2025 huggingface dataset:
930 SAFETY, TOLERABILITY AND IMMUNOGENICITY OF 15-VALENT PNEUMOCOCCAL CONJUGATE VACCINE + PPV23 12 MONTHS LATER IN HEALTHY ADULTS ≥ 50
Authors: Song J-Y , Chang C-J , Andrews C , Diez-Domingo J , Oh M-d , Dagan R , Musey L , Buchwald U K , Hartzel J , Pedley A , Li J , Sterling T , Tamms G , Chiarappa J A , Lutkiewicz J , Tu Y
Published: June 2022

Background

Older adults are at increased risk of pneumococcal disease (PD). V114, an investigational 15-valent Pneumococcal Conjugate Vaccine (PCV), contains all serotypes in 13-valent PCV (PCV13) plus serotypes 22F and 33F. This phase 3 trial evaluated the safety, tolerability and immunogenicity of V114 or PCV13 followed 12 months later by PPSV23 in healthy adults aged ≥50 years.

Materials/Method

652 eligible adults were randomised 1:1 to receive V114 or PCV13 followed by PPSV23 12 months later. Solicited and non-solicited adverse events (AEs) were collected after each vaccination. Serotype-specific opsonophagocytic activity (OPA) and immunoglobulin G (IgG) antibodies were measured at Day 1, Day 30, Month 12 and Month 13.

Results

The most common solicited AEs following PCV were injection-site pain, fatigue and myalgia; higher proportions of participants with solicited AEs were observed in the V114 group; however, the differences were not clinically significant, as most AEs were mild and of short duration. The most common solicited AEs following PPSV23 were injection-site pain, injection-site swelling, fatigue and myalgia; these events were comparable across both intervention groups. The proportion of participants with serious AEs were low in both groups and none reported to be vaccine related. No deaths occurred during the study. Serotype-specific OPA geometric mean titres (GMTs) and IgG geometric mean concentrations (GMCs) were comparable between the groups for all 15 serotypes 30 days post-vaccination with PPSV23. OPA GMTs and IgG GMCs were comparable between PCV groups for the 13 shared serotypes and higher in V114 than PCV13 for serotypes 22F and 33F 30 days and 12 months post-vaccination with PCV. V114 elicited an immune response that persisted for at least 12 months.

Conclusion

Sequential administration of V114 and PPSV23 is well tolerated, immunogenic and generally comparable to PCV13 followed by PPSV23 in healthy adults ≥50 years of age.
938 ‘TO DIP OR NOT TO DIP’: IMPROVING THE MANAGEMENT OF LOWER URINARY TRACT INFECTIONS IN OLDER PEOPLE
Authors: Muir G
Published: June 2022

Introduction

I completed two PDSA cycles of a Quality Improvement project, from 2019 to 2021, aimed at improving the management of lower urinary tract infections (UTIs) in older people. My interest in this subject was instilled after it was brought to my attention that Public Health England (PHE) guidelines were revised in 2018 to state that urine dipsticks tests (UDTs) should not be used as a diagnostic aid in any patient over the age of 65 years. I became concerned that geriatric patients may be misdiagnosed and mistreated with unnecessary antibiotics, given the high prevalence of asymptomatic bacteriuria in this population.

Method

I sampled patients diagnosed with a urinary tract infection in the Emergency Department of the Queen Elizabeth Hospital, Gateshead over a 7-day period. I extracted medical notes of patients prescribed one of 7 antibiotics, then excluded patients under 65-years-old and those treated for an infection outside the lower urinary tract. Next, I established whether a UDT was used as a diagnostic aid using the medical notes.

Results

Before and after intervention: my initial findings revealed that a UDT was performed in 100% patients diagnosed with a UTI (i.e. no cases were in line with best practice). My first educational intervention involved sharing the revised PHE guidelines with staff via an interactive teaching-session, following this I found that a UDT was performed in 62% patients. My next intervention was a flow-chart entitled ‘to dip or not to dip’ pasted in the ED. Following this final intervention, I found that 27% cases were in line with best practice (a UDT was used in 73% cases).

Conclusion

With this modest improvement, I concluded that my recommendations reduced the number of over 65-year-old patients undergoing unnecessary UDTs as part of their diagnostic work-up.
948 THE DEVELOPMENT OF A DYSPHAGIA CUP TO IMPROVE WATER INTAKE AND REDUCE CAREGIVER BURDEN IN CHANGI GENERAL HOSPITAL (CGH)
Authors: Lim S C , Arroyo S P , Li F , Lee Y Q , Chew X J , Sinatamby S
Published: June 2022

At any one time, >60% of the beds in the 1,000 bedded CGH is occupied by an elderly >65. Ensuring adequate water intake among the elderly patients is a challenge. Hence, 90% of our elderly inpatients in the acute wards did not consume the recommended daily allowance of fluid. Causes for poor water consumption included dysphagia requiring thickened fluids, manpower reasons, patient and environmental factors. The Geriatrician led a team to explore, designed and developed a dysphagia cup to improve fluid intake for the elderly inpatients, with input from nursing, occupational and speech therapists. The plan-do-study-act methodology was employed in this study. Training was provided to nursing staff and caregivers prior to issuing the cups.

Results

The cup improves availability of water for the patients, encourages autonomy so the patients may drink independently without aspirating, reduces caregiver burden while thickening prior to serving fluids and improves patient care.

The improved water consumption reduces adverse outcomes associated with dehydration such as delirium, constipation and long length of stay. Results showed improvement in water consumption among 75% of the patients, with 62% increase in amount of fluid consumption. 83% of patients were able to drink independently with >90% caregiver (nurses and family) satisfaction. The cups saved nursing time significantly, projected to save 14 full time nurses a year and 67% improvement in nursing productivity, for CGH.

Conclusion

Encouraging the elderly to drink is labour intensive and time consuming, especially for patients with dysphagia. Time saving was proven for thickening fluids and since patients drink independently, time was saved for assisting/supervising patients while drinking. Since the cup has measuring gauge, it was faster to thicken fluids. The cup holds enough fluids for several serving, the caregiver need not prepare to thicken fluids prior to every serving.
956 AN AUDIT CONDUCTED LOOKING INTO THE USE OF IV IRON TO TREAT IRON DEFICIENCY ANAEMIA ON THE ELDERLY CARE WARDS
Authors: Solomonsz A , Cheong J , Ali N , Jha A , Murray C , Williams M , Blundell A
Published: June 2022

Aims

To assess whether patients on the elderly care wards at NUH (Nottingham University Hospitals) were appropriately given IV (intravenous) iron for Iron deficiency anaemia (IDA). To improve our practice in the investigation and follow up of patients with IDA.

Method

Data was obtained of patients who had IV iron dispensed from June—September 2019. This totalled 146 patients. Digital medical records and Notis results. Server were reviewed and a spread sheet database compiled with patient demographics, presentation, blood results. Co-morbidities, medication, investigations and follow up.

Results

The average age of the patients receiving IV iron on the elderly care wards was 86 (range 74–106). 89 were female and 57 male. The top presenting complaints were; fall (38%), abdominal symptoms of pain, diarrhoea or vomiting (15%), SOB (12%). 30% of patient were on anti-coagulation and 27% were on an anti-platelet with 2% of patient on both. Mean female Hb was 89 (41–129) and male Hb was 91 (49–117). The data showed that 8 out of 81 female patients were given IV iron despite not being anaemic. In 7.5% of cases ferritin, TSAT, iron and transferrin had not been checked. Ferritin was not checked 16%. 82% of patients had no documentation with regards to the rationale for choosing not to proceed with invasive investigation.

Conclusion

Improvement is needed in the way we manage patients with IDA. This audit highlighted the need for continued review of medications—particularly anti-platelets and anti-coagulants. If there is a weak indication consider the risks and benefits. It is important we discuss and document the consideration or unsuitability of invasive investigations and follow up. A proforma is being written to guide clinicians with regards to the appropriate prescribing of IV iron and to guide investigation and follow up.
962 FROM DIRTY WORK TO MEANINGFUL WORK: A PHOTOVOICE STUDY OF RESIDENTIAL AGED CARE IN HONG KONG
Authors: Law S , Yau S , Li S , Lee Y , Lee L , Lai S , Huang S
Published: June 2022

Introduction

Caregiving work in ‘residential care homes for the elderly’ (RCHEs) has long been devalued as ‘dirty work’, which contributes to RCHE’s acute shortages of health care staff in Hong Kong. This study aims to unearth the voice of the RCHEs workers by delineating their insider perspectives of RCHE work.

Method

Adopting the Photovoice method, a participatory methodology, 30 RCHEs care workers (i.e. Registered Nurses, Enrolled Nurses, Health Workers, and Personal Care Workers) were invited to take photos that showcase their perspectives of doing aged care work. Two in-depth interviews were conducted with each research participant before and after the photo-taking procedure. Thematic analysis is then conducted to analyse the visual and verbal data.

Results

Findings show that RCHEs care workers perceive and revitalize the nature and meaning of their work in four ways: conducting ‘dirty tasks’ to help the elderly; valuing and engaging in long-term relationships; learning in work; and cultural meaning of working with the elderly. Contrary to public devaluation, RCHE care workers normalize the delivery of ‘dirty tasks’ (i.e. handling human excreta and wounds) as being helpful to both the elderly and the family members. Besides the routine caring tasks on paper, care workers highlight that they spend a lot of unrecognized labor to build rapport and provide emotional support to the elderly and their family members in their work. They also report that learning and self-development are an important part of residential care work, both in terms of professional knowledge and personal growth. Taking care of the elderly also conveys positive cultural meanings in Chinese society.

Conclusion

Policy, professional and educational initiatives of geriatric care primarily emphasize the delivery of clinical tasks (caring for), while undermining the emotional and relational aspects of aged care work.

The work described in this paper was fully supported by a grant from the Research Grants Council of the Hong Kong Special Administrative Region, China. (UGC/FDS16/M12/20).
963 THE IMPACT OF AGE, SEX AND MORBIDITY COUNT ON EARLY TERMINATION: A META-ANALYSIS OF INDIVIDUAL PATIENT DATA FROM CLINICAL TRIALS
Authors: Lees J S , Hanlon P , Butterly E , Wild S H , Mair F S , Taylor R S , Guthrie B , Gillies K , Dias S , Welton N , McAllister D A
Published: June 2022

Introduction

Multimorbidity is found in around half of people with any long-term condition but is substantially less common in randomised controlled trials (‘trials’). Multimorbidity may diminish a participant’s ability to complete a trial. However, empirical estimates of the association between individual patient characteristics and early termination are lacking.

Method

Individual patient-level data were obtained from Phase 3/4 trials contained within two clinical trial repositories. Eligible trials for inclusion were identified according to pre-specified criteria (PROSPERO CRD42018048202). Within each trial, the association between morbidity count and early termination (failure for any reason to complete the final trial visit) was estimated in logistic regression models, adjusting for age and sex. These estimates were meta-analysed in Bayesian linear models, with partial pooling across index conditions and drug classes. Using these estimates, the impact of morbidity count on early termination was modelled for a set of notional trials.

Results

In 92 trials across 20 index conditions and 17 drug classes, the mean morbidity count ranged from 0.3–2.7. Neither age nor sex was associated with early termination (OR 1.04, 95% CI 0.98–1.11; OR 1.00, 95% PI 0.95–1.07 respectively). Morbidity count was associated with early termination (OR per additional morbidity: 1.11, 95% CI: 1.07 to 1.14). There was no evidence of non-linearity in the association between morbidity count and early termination, and there was minimal variation across drug classes and index conditions. For a notional trial with high level of early termination in individuals without multimorbidity, doubling the mean morbidity count from 1 to 2 increases risk of early termination from 29% to 31%.

Conclusion

Multimorbidity, irrespective of age and sex, is associated with a relatively modest increased odds of early termination of trial participation. The benefit of increased generalisability of trials by including patients with multimorbidity appears likely to outweigh the disadvantages of lower retention.
977 IMPLEMENTATION OF THE FIRST FRAILTY UNIT IN WESTERN AUSTRALIA
Authors: Lee S , Horrocks A , Mandal B
Published: June 2022

Background

Implementation of the first Frailty Unit in Western Australia within the tertiary Hospital—Fiona Stanley. The Frailty Unit was based within the Acute Medical Unit and included a Geriatrician, Medical team, Multidisciplinary Allied Health (AH) Team and Acute Medical Nursing Staff to manage a 12 bed Frailty Unit.

Introduction

Evidence shows that a prolonged hospital stay can be a risk factor for hospital acquired complications, deconditioning, loss of independence and early entry into residential care. This is especially evident amongst the frail population. This leads to poor outcomes of patients, high costs from complications and prolonged hospital admissions. The primary goal of this unit was to provide comprehensive Geriatric assessment from a multidisciplinary team at the front door of the hospital which will improve patient centered care and allow earlier discharges with a multitude of issues being addressed on day 1.

Method

included the allocation of staffing as documented above which provided earlier Geriatric assessment as well as comprehensive AH input. The intent was to redirect patients out of the hospital and back into the community to utilise nursing, medical and AH staff who can further assess and support patients in their own home environment and out of the busy hospital system.

Results

The impact of this change comparing 2018 (calendar year) with 2020/21 (financial year) has included: Readmission rates (0–7 day readmission) reduced from 8.5% to 6% Increase of 7% (182 patients) returning to their usual residence For those returning home, significant reduction in length of stay on this ward by 30%.

Conclusion

The effect on length of stay and higher quality assessments of elderly patients on day 1 has been clear not only from the data but also from staff experience who have seen a difference in the impact of this model.
982 ARE POST FALL CT HEAD SCANS DONE ACCORDING TO TRUST GUIDELINES
Authors: Rahman M M , Ezeigwe O
Published: June 2022

Introduction

Falls are a major public health concern, which poses a high risk of injury and even death. Due to fears regarding increased morbidity and mortality post fall, we have noticed that there is a tendency for junior doctors to request computerized tomography (CT) head scans beyond clinical reasoning and indications that are not found in the trusts post falls protocol. In addition, we discovered significant delays in completion of inpatient CT head scans resulting in delayed management. We therefore embarked on an audit with the aim of improving post falls assessment. We assessed compliance with trust post fall protocol regarding suspected head injury and requesting of urgent CT head scans, if urgent CT had scan are done within 1 hour and carrying out neurological observations post fall. The initial audit outcomes demonstrated poor compliance with the audited standards. As a result we introduced a new comprehensive post falls assessment proforma.

Results

We re-audited after the introduction of the new falls proforma, assessing inpatient falls from 20th January to 27th February 2021 at the William Harvey Hospital. 69% of falls cases have CT head scans requested as per trust policy, an improvement of 77% from the initial audit. 50% of patients who met the criteria for urgent CT head scans had it done within one hour of the request being made, an improvement of 150%. 84% of patient’s had neurological observations recorded as part of post fall assessment, an improvement of 12% from the initial audit.

Conclusion

The improvements seen in the audited standards are indicative that the new post falls proforma improves compliance with the trusts post falls protocol. We recommend that the new post falls proforma be a part of the trusts post fall protocol and for it to be included in the trust induction to new doctors.
984 ADVANCE CARE PLANNING ON THE COMPLEX CARE WARDS AT ROYAL BOLTON HOSPITAL
Authors: Green S , Oates R , Lim V-H , Lennon R , Woods S
Published: June 2022

Introduction

Advance care planning (ACP) is an important aspect of geriatric medicine, giving patients the opportunity to express their wishes and identify their preferred place of care and death whilst reducing unwanted hospital admissions. At Royal Bolton Hospital we reviewed the Complex Care department’s performance in engaging with ACP discussions with appropriate patients and considered how this could be improved.

Method

In October 2020, patients were identified from the current inpatients on the Complex Care wards using the following criteria: nursing home resident, clinical frailty score (CFS) 7 or above, or CFS 6 with 3 or more hospital admissions in the last 6 months. We reviewed the patient notes to ascertain whether any ACP had occurred and then followed the patients up at 6 and 12 months. At 6 and 12 months we identified the mortality and readmission rates to quantify whether the patients had been appropriate for ACP.

Results

35 patients identified as appropriate for ACP. ACP had been conducted in 10 patients. At 6 months, 13 patients had died and 17 had had hospital readmissions, totalling 196 readmission days. At 12 months, 8 patients had died, and 8 patients had been readmitted to hospital, totalling 85 readmission days. Combining the data for the 6- and 12-month results revealed 21 patients had died and 25 had been readmitted to hospital, totalling 281 readmission days. Only 4 of the 35 patients had neither died nor been readmitted to hospital.

Conclusion

Appropriate patients were accurately identified for ACP as confirmed by their subsequent mortality and readmission rates. However, there is scope for improving the quantity of ACP discussions by the Complex Care department in these patients. Further education for the medical staff, a patient leaflet and poster aimed at the ward juniors will be introduced with the aim of doing this.
986 IMMUNOSENESCENCE PROFILES AND MULTIPLE LONG-TERM CONDITIONS IN VERY OLD ADULTS: THE NEWCASTLE 85+ STUDY
Authors: Granic A , Martin-Ruiz C , Rimmer L , Dodds R M , Robinson L , Spyridopoulos I , Kirkwood T B L , Zglinicki T , Sayer A A
Published: June 2022

Introduction

Immunosenescence, a decline in immune system function, has been linked to several age-related diseases and geriatric syndromes, including cardiovascular diseases and frailty. Very old adults (aged ≥85 years) live with multiple long-term conditions (MLTC) or multimorbidity—a complex phenomenon of poor health defined by either counts (≥2 diseases), indices, or patterns. However, little is known about the relationship between immunosenescence and MLTC in this age group. We utilised baseline data from the Newcastle 85+ Study to investigate the association between previously defined immunosenescence profilesa and MLTC.

Method

We used data from 703 participants who had multimorbidity and complete data for 16 chronic diseases and geriatric syndromes (i.e. analytic sample). MLTC counts were derived from the number of conditions and categorised into <median and ≥ median MLTC groups. We used the SPSS Two Step clustering with all 16 conditions to define MLTC patterns. Two immunosenescence profiles (‘Senescent-like phenotype’ and ‘Less senescent-like phenotype’) were defined previously from 13 lymphocyte compartments. We used multivariable regression analyses to investigate the association between immunosenescence profiles and MLTC counts, groups, and patterns.

Results

In the analytic sample only 6.8% participants had 2 conditions, whilst 79.1% had 3–7, and 14.1% had ≥8 conditions, a median of 5, and 62.2% were in ≥median MLTC group. Three distinct MLTC patterns emerged by clustering: ‘Low cardio-cerebro-metabolic diseases’ (n = 209), ‘High geriatric syndromes-arthritis’ (n = 240), and ‘Hypertensive-renal impairment’ pattern, (n = 254). Having ‘Senescent-like phenotype’ characterised by higher frequency of CD4 and CD8 senescence-like effector memory cells and lower CD4/CD8 ratio was not significantly associated with either MLTC counts, ≥median MLTC group, or patterns compared with ‘Less senescent phenotype’.

Conclusion

No cross-sectional associations between immunosenescence and MLTC were found in the very old. Further studies are needed to determine whether immunosenescence drives change in MLTC counts and patterns and influences MLTC burden in late adulthood.
993 IMPROVING ADVANCE CARE PLANNING ON A GERIATRICS WARD: A QUALITY IMPROVEMENT PROJECT
Authors: Miles H , Athavale N , Olaniyan M , Al-Alzubaidi F
Published: June 2022

Introduction

Despite ongoing improvement work in our hospital regarding Advance Care Planning (ACP) in the community and specialist palliative care settings, our team was concerned that ACP was underutilized for inpatients. We aimed to increase the number of ACPs (specifically focusing on re-admission avoidance) made on our geriatrics ward, and to communicate these effectively with community colleagues.

Method

We retrospectively reviewed 26 deaths on our ward during a three-month period, and found significant missed opportunities to discuss ACP, e.g. 54% of patients had more than one admission in the six months prior to death. We developed a novel co-morbidity score to help support our decision-making, and used aspects of the Gold Standards Framework’s Proactive Identification Guidance. Our working group, led by a consultant geriatrician, focused on increasing the team’s engagement with ACP, including use of an ‘ACP Champion’, and we worked to align our documentation with that used elsewhere in the Trust. We used a paper form, resembling a DNACPR, to prompt community teams to re-consider whether admission was necessary. We made ACPs for six patients during this four-month pilot phase, and followed them up over the next five months.

Results

Following our interventions, follow-up of our patients showed 83% had ACP described in their discharge letter; 33% had ACP mentioned on their Summary Care Record (SCR); 0% of patients who had died re-presented to hospital prior to death.

Conclusion

Our project showed that diligent attention to making ACPs for suitable patients was successful in preventing re-admission. Despite this, communication about ACPs in the discharge letters and transfer of this information to the SCR was suboptimal. This demonstrates that even with a focused team, mistakes can happen. I’m now working on a subsequent project focusing on improving understanding of ACP amongst junior doctors.
1075 THE EFFECTIVENESS OF INTERVENTIONS TO REDUCE ADVERSE OUTCOMES AMONG OLDER ADULTS FOLLOWING EMERGENCY DEPARTMENT DISCHARGE
Authors: Conneely M , Leahy S , Dore L , Trépel D , Robinson K , Jordan F , Galvin R
Published: June 2022

Background

Population ageing is increasing rapidly worldwide. Older adults are frequent users of health care services including the Emergency Department (ED) and experience a number of adverse outcomes following an ED visit. Adverse outcomes include functional decline, unplanned hospital admission and an ED revisit. Given these adverse outcomes a number of interventions have been examined to improve the outcomes of older adults. The aim of this umbrella review was to evaluate the effectiveness of ED interventions in reducing adverse outcomes in older adults discharged from the ED.

Method

Systematic reviews of randomised controlled trials investigating ED interventions for older adults presenting to the ED exploring clinical, patient experience and healthcare utilisation outcomes were included. A comprehensive search strategy was employed in eleven databases and grey literature was searched. Quality was assessed using the A MeaSurement Tool to Assess Systematic Reviews 2 tool. Overlap between systematic reviews was assessed and an algorithm to assign the Grading of Recommendations Assessment, Development and Evaluation to assess the strength of evidence was applied to outcomes.

Results

Nine systematic reviews including 29 randomised controlled trials were included. Interventions comprised of solely ED-based or transitional interventions. The specific interventions delivered were highly variable. There was high overlap and low methodological quality of the trials informing the systematic reviews. There is low quality evidence to support ED interventions in reducing functional decline, improving patient experience and improving quality of life. The quality of evidence of the effectiveness of ED interventions to reduce mortality and ED revisits varied from very low to moderate.

Conclusion

Older adults are the most important emerging group in healthcare for several economic, social and political reasons. The evidence for the effectiveness of ED interventions for older adults is limited. Higher quality intervention studies in line with current geriatric medicine research guidelines are recommended.
1081 A COMPARISON OF THE ISAR TOOL AND THE CLINICAL FRAILTY SCALE TO PREDICT MORTALITY AND ED REATTENDANCE IN A COHORT OF ED ATTENDER
Authors: Leahy A , Corey G , O’Neill A , Higginbotham O , Devlin C , Barry L , Cummins N , Shanahan E , Shchetkovsky D , Ryan D , O'Connor M , Galvin R
Published: June 2022

Background

Frailty Screening is one method by which we can risk stratify older adults to urgent assessment in the Emergency Department. The ISAR (Identification of Seniors at Risk) and Rockwood Clinical Frailty Scale are two frailty screening tools. We assessed the validity of these tools at predicting adverse outcomes for older adults presenting to the Emergency Department.

Method

This was a prospective cohort study. Patients over 65 were recruited, baseline.

demographics were obtained and a research nurse assessed them using both the Clinical Frailty Scale and ISAR. Patients were assessed by telephone interviews at one month and six months. The outcome measures assessed were mortality, ED re-attendance, hospital readmission, functional decline and institutionalisation.

Results

419 patients were recruited. 53.3% (223) were male with a median age of 76 (IQR = 10). The median ISAR and CFS score was 2,5 respectively at baseline. The mortality rate was 5.4% and rate of ED re-attendance was 16.9% at one month. The relative risk of ED re-admission with an ISAR score >/= 2 more was 1.84 (1.12, 3.02) and CFS > 4 was 1.85 (1.08, 3.16). The ISAR tool >/= 2, had a sensitivity of 74.29 (95% CI = 62.44, 83.99) and specificity of 41.18 (95% CI = 35.90, 46.61) when used as a diagnostic tool for ED re-admission at one month. The CFS > 4 had a sensitivity of 71.43 (95% CI = 57.79, 82.70) and specificity of 45.23 (95% CI = 39.33, 51.23) for the same outcome.

Conclusion

The ISAR tool >/= 2 was the more sensitive at predicting ED reattendance at one month in comparison to the Clinical Frailty Scale. We would advocate using this tool in the ED setting to highlight those at greatest risk of adverse outcomes and those most likely to benefit from Comprehensive Geriatric Assessment.
1083 A REVIEW OF FAST DATA IN TALLAGHT UNIVERSITY HOSPITAL, AND THE IMPACT OF COVID ON TREATMENT
Authors: O’Connor A , Hobson H , Collins R
Published: June 2022

Introduction

Stroke is a leading cause of morbidity. Current guidelines advise maximum of 4.5 hours post symptom onset for thrombolysis, and 24 hours for thrombectomy. (1) Delay between symptom onset and treatment is associated with an inferior outcome. Thrombolysis is available in 27 Irish centers. Average rate of thrombolysis is 11%. (3) Fewer than half of stroke patients arrived in hospital within three hours of symptom onset in 2019. (4) Median door-to-needle time is 48 minutes.

Method

FAST calls in Tallaght University Hospital, from 2/7/19–1/7/21, were included in this analysis (n = 594).

Results

160 FAST calls took place pre-Covid (20/month), and 434 post-Covid (27.12/month). Time of symptom onset was recorded in 390 cases. Time patients last seen well was known in 185 cases, unknown time of onset in 19. After review by the stroke clinician, FAST imaging was obtained in 78% of cases (n = 464). Of these, 34 cases of FAST imaging were performed for inpatients. Average time from registration to CT was 35:24 minutes pre covid, and 45:52 minutes post. 9.7% of patients were thrombolysed. The median door-to-needle time was 41 minutes pre-Covid(n = 21, 2.625/month), and 54 minutes after (n = 37, 2.3/month). Thrombectomy was performed in 46 cases. 222 patients were diagnosed with an ischaemic stroke, 50 had TIA and 48 had haemorrhagic strokes. Other diagnoses included migraine (6.7%, n = 40), seizures (6.7%, n = 40) and Bells Palsy (3.7%, n = 22). 55% (n = 330) of cases were registered to ED with FAST call between the hours of 9 am-5 pm. 27% (n = 161) of cases occurred during the night shift.

Conclusion

The median door-to-needle times were below national median pre-Covid, and longer post-pandemic, with an increase in the rate of presentation in the same time-frame. This report highlights the effect of the pandemic on time-critical patient interventions in stroke and the need to stratify services to respond to structural challenges.
Deriving homing sequences for Finite State Machines with timeouts
Authors: Tvardovskii Aleksandr , Yevtushenko Nina
Published: June 2022

State identification is the well-known problem in the automata theory that is aimed to determining the current or initial state of a system under test and this fact is widely used in the model-based testing of software and hardware systems. When modern systems are modeled, it is necessary to take into account the timed aspects and for this reason classical Finite State Machines (FSM) are extended by clock variables. In this work, we study the homing problem for FSMs with timeouts (TFSM). For this purpose, we introduce the notion of a timed homing sequence (HS) that is different from that for classical FSMs and propose a method for checking the existence and deriving a timed HS if it exists. A proposed method is based on the FSM abstraction of a TFSM, i.e. on a classical FSM that partially describes the behavior of a corresponding TFSM and inherits many of its properties. Since timeouts allow the system to move from state to state without input impact, we define a timed HS as a sequence that sets a TFSM to a stable state where the system can stay infinitely long waiting for an input.
Robotic-assisted minimally invasive esophagectomy (RAMIE) for esophageal cancer training curriculum—a worldwide Delphi consensus study
Authors: Fuchs Hans F , Collins Justin W , Babic Benjamin , DuCoin Christopher , Meireles Ozanan R , Grimminger Peter P , Read Matthew , Abbas Abbas , Sallum Rubens , Müller-Stich Beat P , Perez Daniel , Biebl Matthias , Egberts Jan-Hendrik , van Hillegersberg Richard , Bruns Christiane J
Published: June 2022

Background

Structured training protocols can safely improve skills prior initiating complex surgical procedures such as robotic-assisted minimally invasive esophagectomy (RAMIE). As no consensus on a training curriculum for RAMIE has been established so far it is our aim to define a protocol for RAMIE with the Delphi consensus methodology.

Methods

Fourteen worldwide RAMIE experts were defined and were enrolled in this Delphi consensus project. An expert panel was created and three Delphi rounds were performed starting December 2019. Items required for RAMIE included, but were not limited to, virtual reality simulation, wet-lab training, proctoring, and continued monitoring and education. After rating performed by the experts, consensus was defined when a Cronbach alpha of ≥0.80 was reached. If ≥80% of the committee reached a consensus an item was seen as fundamental.

Results

All Delphi rounds were completed by 12–14 (86–100%) participants. After three rounds analyzing our 49-item questionnaire, 40 items reached consensus for a training curriculum of RAMIE.

Conclusion

The core principles for RAMIE training were defined. This curriculum may lead to a wider adoption of RAMIE and a reduction in time to reach proficiency.
The effect of magnitude uncertainty on the Gutenberg–Richter b-value estimation and the magnitude–frequency distribution: ‘what hump?’
Authors: Taroni Matteo
Published: June 2022

The uncertainties on magnitudes of the earthquakes have a negligible effect on the estimation of the Gutenberg–Richter b-value if these uncertainties have a homogeneous distribution, that is, the magnitude error is the same for all the earthquakes. Here, we show that a non-uniform error distribution can have a significant impact on the b-value estimation, and it generates a hump in the magnitude–frequency distribution. Through a simulation approach, we show when the bias in the estimation is large, when it can be neglected, and how it is possible to avoid it.
Strong Subconvexity for Self-Dual GL(3) L-Functions
Authors: Lin Yongxiao , Nunes Ramon , Qi Zhi
Published: June 2022

In this paper, we prove strong subconvexity bounds for self-dual $\textrm {GL}(3)\ L$-functions in the $t$-aspect and for $\textrm {GL}(3)\times \textrm {GL}(2)$$L$-functions in the $\textrm {GL}(2)$-spectral aspect. The bounds are strong in the sense that they are the natural limit of the moment method pioneered by Xiaoqing Li, modulo current knowledge on estimate for the second moment of $\textrm {GL}(3)$$L$-functions on the critical line.
#11 Development of a Kinetic ELISA (kELISA) and Reactive B Cell Frequency (RBF) Assay to Detect Respiratory Syncytial Virus (RSV) Pre-Fusion F Protein-Specific Immune Responses in Infants
Authors: Rolsma Stephanie
Published: June 2022

Background

RSV is a major cause of pediatric respiratory disease. Antibodies to the prefusion conformation of the RSV fusion (pre-F) protein are needed for virus neutralization.

Method

We measured RSV-specific responses in two groups of children <3 years of age; subjects with laboratory-confirmed RSV (RSV-infected) or infants born in the period May to September and enrolled prior to their first RSV season (RSV-uninfected). RSV-infected infants had blood samples obtained at 1, 6, 9, and 12 months after infection. RSV-uninfected infants had blood samples obtained at enrollment, at the end of their first RSV season, and 6 months later. A kELISA to measure RSV pre-F-specific antibodies and an RBF assay to identify RSV F-specific B cells were developed.

Results

102 subjects were enrolled; 11 were excluded due to missed visits or withdrawal. Of the 65 subjects in the RSV-uninfected group, all were kELISA positive at enrollment, consistent with maternal antibody transfer. 53 subjects had sufficient samples for analysis at multiple time points; 29 became seronegative and 24 remained seropositive. In the seronegative group, the kELISA value decreased rapidly to <0.25 by 6 months after the RSV season in 27/29 (93%), (Figure 1a). In the persistently seropositive group, all 24 subjects maintained a positive kELISA value, with some developing higher values over time, consistent with asymptomatic infection (Figure 1b). An RBF assay was used to determine whether antibodies were due to persistent maternal antibodies or endogenous production (Figure 1c). In the seronegative group, 24/29 (80%) had a negative RBF; in the seropositive group, 23/24 (96%) had a positive RBF during follow-up. There were 26 subjects in the RSV-infected group; 22 had sufficient samples for analysis at multiple time points. All were seropositive by kELISA at one month post-infection with variable kELISA values during follow-up (Figure 1d). 17/22 (77%) had a positive RBF, although 4 of the subjects without a positive RBF had indeterminate results at ≥ 1 visit.

Conclusion

Assays measuring F-specific immune responses in infants will be critical for RSV vaccine development. A kELISA targeting RSV pre-F epitopes, with an RBF assay targeting RSV F-specific B cells, may allow discrimination for maternal and infant-derived antibodies.
#63 Allowing Access to Parents into COVID-19 Hospitalization Areas Does Not Increase Infections among Hospital Workers in a Pediatric Hospital.
Authors: Guerrero-Díaz Ana Carmen
Published: June 2022

Background

At the beginning of the current COVID-19 pandemic, it became critical to isolate all infected patients, regardless of their age. In the case of hospitalized children, isolation imposes a significant, negative impact on the well-being of isolated infants and their parents, in addition to the deleterious effect that the clinical condition and hospitalization by itself inflicts on patients and their families; this negative effect must be weighed against the potential risk that visitation might have on COVID-19 dissemination, mostly among hospital workers.

Method

Parents were gradually allowed during supervised, restricted visit time, progressively increasing the visitation time, and carefully monitoring for the presence of COVID-19 symptoms among healthcare workers (HCW) in the COVID-19 area, who were also tested for the infection when clinically justified. Family members were interrogated about symptoms and signs suggestive of COVID-19 infection, or positive PCR testing within 14 days of hospital stay.

Results

We found that, when safely implemented, allowing parents to spend time with their hospitalized COVID-19 children does not increase the contagion risk for hospital workers. The percentage of COVID-19 cases among HCW decreased after parents were allowed to visit their children in the COVID-19 areas. The percentage dropped from 27.78% to 12.77% (p=0.022). The rate of workers with COVID-19 for every 1000 shifts per worker was reduced after the parents were allowed to visit, although no statistically significant differences were found. Only 6 out of 129 parents (4.65%), that visited their children, were infected and there is no guarantee that they got infected within the hospital.

Conclusion

With proper training, parents do not increase the risk of infection among healthcare workers or among themselves. To develop and implement policies to permit the children to be accompanied during their suffering should be a standard in the context of an epidemic and out of it.
#65 Respiratory Syncytial Virus Surveillance Among Hospitalized Children in Amman, Jordan
Authors: Yanis Ahmad
Published: June 2022

Background

Respiratory syncytial virus (RSV) is a leading cause of acute respiratory infection (ARI) in young children worldwide. In Jordan, RSV has previously been reported as the most frequently detected virus among hospitalized children less than two years. We aimed to compare the demographic and clinical characteristics of RSV-positive and RSV-negative hospitalized children during the peak season in Amman, Jordan.

Method

Children under two years who presented with fever and/or respiratory symptoms within 72 hours of hospitalization at a government-run hospital were enrolled. We systematically collected demographic and clinical characteristics via parental interviews and medical chart abstractions. Anterior nasal and/or throat swabs were collected and tested for RSV by PCR. Differences in clinical characteristics were evaluated by RSV status using two-sample t- tests allowing for unequal variances for continuous variables and Pearson's Chi-squared test for categorical variables, alpha=0.05.

Results

From January 8 to March 17, 2020, 531 children were enrolled and tested, of which 57% were male and had a mean age of 5 months. Of those who were tested, 401 (76%) were RSV-positive. Children with RSV were younger and less likely to have an underlying medical condition compared to children without RSV (Table 1). RSV-positive children were more likely to present with cough, shortness of breath, runny nose, nasal congestion, decreased appetite, vomiting, wheezing, and had a higher respiratory rate at admission than RSV-negative children. Compared to RSV-negative children, RSV-positive children were more likely to have an admission diagnosis of pneumonia and bronchiolitis and less likely have the diagnosis of rule out sepsis.

Conclusion

In our study, more than three-quarters of children hospitalized with ARI had RSV. Additional prevention measures, such as vaccines or antivirals, are needed to effectively reduce the RSV burden among young children in Jordan.
Non-linear reconstruction of features in the primordial power spectrum from large-scale structure
Authors: Li Yuhao , Zhu Hong-Ming , Li Baojiu
Published: June 2022

Potential features in the primordial power spectrum have been searched for in galaxy surveys in recent years since these features can assist in understanding the nature of inflation. The null detection to date suggests that any such features should be fairly weak, and next-generation galaxy surveys, with their unprecedented sizes and precisions, are in a position to place stronger constraints than before. However, even if such primordial features once existed in the early Universe, they would have been significantly damped in the non-linear regime at low redshift due to structure formation, which makes them difficult to be directly detected in real observations. A potential way to tackle this challenge for probing the features is to undo the cosmological evolution, i.e. using reconstruction to obtain an approximate linear density field. By employing a set of N-body simulations, here we show that a recently proposed non-linear reconstruction algorithm can effectively retrieve damped oscillatory features from halo catalogues and improve the accuracy of the measurement of feature parameters (assuming that such primordial features do exist). We do a Fisher analysis to forecast how non-linear reconstruction affects the constraining power, and find that it can lead to significantly more robust constraints on the feature amplitude for a DESI-like survey. Comparing non-linear reconstruction with other ways of improving constraints, such as increasing the survey volume and range of scales, this shows that it is possible to achieve what the latter do, but at a lower cost.
Characterizing the aerosol atmosphere above the Observatorio del Roque de los Muchachos by analysing seven years of data taken with an GaAsP HPD-readout, absolutely calibrated elastic LIDAR
Authors: Fruck Christian , Gaug Markus , Hahn Alexander , Acciari Victor , Besenrieder Jürgen , Dominis Prester Dijana , Dorner Daniela , Fink David , Font Lluís , Mićanović Saša , Mirzoyan Razmik , Müller Dominik , Pavletić Lovro , Schmuckermaier Felix , Will Martin
Published: June 2022

We present a new elastic LIDAR concept, based on a bi-axially mounted Nd:YAG laser and a telescope with HPD readout, combined with fast FADC signal digitization and offline pulse analysis. The LIDAR return signals have been extensively quality checked and absolutely calibrated. We analyse seven years of quasi-continuous LIDAR data taken during those nights when the MAGIC telescopes were operating. Characterization of the nocturnal ground layer yields zenith and azimuth angle dependent aerosol extinction scaleheights for clear nights. We derive aerosol transmission statistics for light emitted from various altitudes throughout the year and separated by seasons. We find further seasonal dependencies of cloud base and top altitudes, but none for the LIDAR ratios of clouds. Finally, the night sky background light is characterized using the LIDAR photon backgrounds.
Exploring the effect of baryons on the radial distribution of satellite galaxies with GAMA and IllustrisTNG
Authors: Riggs Stephen D , Loveday Jon , Thomas Peter A , Pillepich Annalisa , Nelson Dylan , Holwerda Benne W
Published: June 2022

We explore the radial distribution of satellite galaxies in groups in the Galaxy and Mass Assembly (GAMA) survey and the IllustrisTNG simulations. Considering groups with masses $12.0 \le \log _{10} (\mathcal {M}_h / h^{-1} \, \mathrm{M}_{\odot }) \lt 14.8$ at z < 0.267, we find a good agreement between GAMA and a sample of TNG300 groups and galaxies designed to match the GAMA selection. Both display a flat profile in the centre of groups, followed by a decline that becomes steeper towards the group edge, and normalized profiles show no dependence on group mass. Using matched satellites from TNG and dark matter-only TNG-Dark runs we investigate the effect of baryons on satellite radial location. At z = 0, we find that the matched subhaloes from the TNG-Dark runs display a much flatter radial profile: namely, satellites selected above a minimum stellar mass exhibit both smaller halocentric distances and longer survival times in the full-physics simulations compared to their dark-matter only analogues. We then divide the TNG satellites into those which possess TNG-Dark counterparts and those which do not, and develop models for the radial positions of each. We find the satellites with TNG-Dark counterparts are displaced towards the halo centre in the full-physics simulations, and this difference has a power-law behaviour with radius. For the ‘orphan’ galaxies without TNG-Dark counterparts, we consider the shape of their radial distribution and provide a model for their motion over time, which can be used to improve the treatment of satellite galaxies in semi-analytic and semi-empirical models of galaxy formation.
A faster growth of perturbations in an early matter dominated epoch: primordial black holes and gravitational waves
Authors: Das Subinoy , Maharana Anshuman , Muia Francesco
Published: June 2022

We present a scenario for fast growth of cosmological perturbations; δ(t) ∼ a(t)s, a(t) being the scale factor, with s > 10 for the numerical examples reported in this article. The basic ingredients of the scenario are an early matter dominated era and the dark fermion, which experiences a scalar mediated force during the epoch. Both of these arise in string/supergravity models. The fast growth occurs for sub-horizon density perturbations of the dark fermion. The fast growth has a rich set of phenomenological implications. We outline implications for the formation of primordial black holes and the production of gravitational waves. Primordial black holes in the sublunar mass range (which are ideal dark matter candidates) can be produced. Gravitational waves can be produced in a wide range of frequencies due to second-order scalar perturbations and due to evaporation and merger of primordial black holes.
Natural products are the treasure pool for antimalarial agents
Authors: Zhou Bin , Yue Jian-Min
Published: June 2022

Despite the success in malaria control, it remains a life-threatening infectious disease due mainly to the persistent emergence of drug resistance. Sharpened insight into the historical achievements and current trends in antimalarial drug discovery provides more hopes and advantages on natural products for the development of the next antimalarial treatment.