bluuebunny/crossref_metadata_2025 huggingface dataset:
Semi-analytical covariance matrices for two-point correlation function for DESI 2024 data
Authors: Rashkovetskyi M. , Forero-Sánchez D. , de Mattia A. , Eisenstein D.J. , Padmanabhan N. , Seo H. , Ross A.J. , Aguilar J. , Ahlen S. , Alves O. , Andrade U. , Brooks D. , Burtin E. , Chen X. , Claybaugh T. , Cole S. , de la Macorra A. , Ding Z. , Doel P. , Fanning K. , Ferraro S. , Font-Ribera A. , Forero-Romero J.E. , Garcia-Quintero C. , Gil-Marín H. , Gontcho A Gontcho S. , Gonzalez-Morales A.X. , Gutierrez G. , Honscheid K. , Howlett C. , Juneau S. , Kremin A. , Le Guillou L. , Manera M. , Medina-Varela L. , Mena-Fernández J. , Miquel R. , Mueller E. , Muñoz-Gutiérrez A. , Myers A.D. , Nie J. , Niz G. , Paillas E. , Percival W.J. , Poppett C. , Pérez-Fernández A. , Rezaie M. , Rosado-Marin A. , Rossi G. , Ruggeri R. , Sanchez E. , Saulder C. , Schlegel D. , Schubnell M. , Sprayberry D. , Tarlé G. , Weaver B.A. , Yu J. , Zhao C. , Zou H.
Published: January 2025

We present an optimized way of producing the fast semi-analytical covariance matrices for the Legendre moments of the two-point correlation function, taking into account survey geometry and mimicking the non-Gaussian effects.
We validate the approach on simulated (mock) catalogs for different galaxy types, representative of the Dark Energy Spectroscopic Instrument (DESI) Data Release 1, used in 2024 analyses.
We find only a few percent differences between the mock sample covariance matrix and our results, which can be expected given the approximate nature of the mocks,
although we do identify discrepancies between the shot-noise properties of the DESI fiber assignment algorithm and the faster approximation (emulator) used in the mocks.
Importantly, we find a close agreement (≤ 8% relative differences) in the projected errorbars for distance scale parameters for the baryon acoustic oscillation measurements.
This confirms our method as an attractive alternative to simulation-based covariance matrices, especially for non-standard models or galaxy sample selections, making it particularly relevant to the broad current and future analyses of DESI data.
Using SMC OB Field Stars and Field Binaries to Study the Origin and Evolution of Massive Star Populations
Authors: Vargas-Salazar Irene
Published: January 2025

Doctoral Committee:

Professor Sally Oey, Chair

Professor Fred Adams

Professor Jan J. Eldridge, University of Auckland

Professor Lee Hartmann
Low power design for Medipix readout systems
Authors: Paulino G. , Wanner L.F. , Oliveira P.H. , Tartarotti R.K. , Argentato M.C.
Published: January 2025

Photon-counting hybrid pixel detector chips, such as those based on the Medipix3RX technology, have been central to advancements in spectral and multi-dimensional imaging at synchrotron facilities. As these facilities continue to improve with ongoing upgrades, there is a growing demand for large-area cameras that not only handle increased X-ray flux performances but also integrate effectively into various scientific setups with minimal power consumption.

This work focuses on optimizing the energy efficiency of Medipix3RX readout chips used in the context of large-area X-ray photon-counting detectors. We have introduced several power optimization techniques, including dynamic frequency and voltage scaling, and the incorporation of standby/sleep modes into sensor operation. These methods have significantly reduced power consumption, thereby allowing for simplified cooling systems and enhanced durability without compromising the robustness and reliability of the system.

Experimental results demonstrate that applying dynamic voltage and frequency scaling can reduce power consumption by 5%, while the clock gating technique can reduce it by up to 23%. Furthermore, the implementation of a sleep mode during periods of inactivity reduces heat dissipation, improving sensor temperature stability, while also reducing overall energy requirements by up to 40% compared to continuous operation. A detailed characterization of the internal parameters of the Medipix3RX analog front-end has enabled us to identify optimal operating points that balance low power consumption with high performance, which is crucial for maintaining low noise levels and fast count rates in challenging experimental environments.
Design and characterization of a large-area phoswich detector for continuous measurement of gross alpha and beta activity in low-level radioactive water
Authors: Chen Meng-jia , He San-jun , Qu Guo-pu , Liu Li-yan , Yu Wan-tang , Wei Qi-an , Hou Jia-bin , Zhao Xiu-liang
Published: January 2025

A large number of nuclear power plants are approaching
decommissioning, and the low-level radioactive waste discharged
during the decommissioning process may increase environmental
radioactive background. There have been no reports on the accurate
differentiation of alpha, beta and gamma signals from low-level
radioactive water and their corresponding activityvalues. We have
developed a prototype of a large area phoswich detector with the
intention of establishing a detection system for real-time
monitoring of gross alpha and gross beta radioactivity levels in
water, enabling prompt response in case of elevated radioactivity
concentrations. The phoswich detector features two layers of
scintillators, and the size of the scintillator and light guide was
determined by using Geant4 simulation. The first layer is a
200 mm× 200 mm× 10 mm-plastic
scintillator coated with 7 mg/cm2 thick ZnS(Ag)that measures
alpha and beta particles, the second layer is a
200 mm× 200 mm× 10 mm-plastic
scintillator that measures gammarays, which reduces the background
interference in the main detector, and the two layers ofscintillator
are coupled to a photomultiplier(PMT) through a 6 mm thick light
guide. The alpha and beta signals detected were analyzed by usinga
digitizer. Due to the significant difference in the decay times of
the alpha and beta pulses, pulse shape discrimination (PSD) is very
effective. We obtained a 2D PSD scatter plot with a particle
discrimination line position of PSD = 0.562 and a figure of
merit (FOM) = 1.4134. We measured the alpha and beta detection
efficiencies and the background count rate under lead shielding. The
detection efficiency when the source is placed at different
positions was measured by combining simulation and experiment. We
also verified the ability of the prototype to detect alpha/beta
particles in low-level radioactive water, which can detect and
distinguish alpha and beta particles at different radioactive
activity levels in water from 1 Bq/L to 50 Bq/L within 1 hour of
counting time. After setting up the water tank and detection system,
it can be applied for continuous monitoring of low-level radioactive
water around decommissioned nuclear facilities.
Nutritional content of gluten-free cookies as an alternative snack for undernourished children
Authors: Elisanti A D , Rindiani  , Purnasari G , Amareta D I , Permadi M R
Published: January 2025

Undernourishment is one of the nutritional problems that often occurs in developing countries. In Indonesia, the undernourished is defined as underweight (17.1%), stunting (21.6%), and wasting (7.7%). The rising number of children's food allergies is one of the factors. One symptom of the body's immunological system is allergies. Food sources can act as triggers, with gluten being the most prevalent. The purpose of this study was to determine the amount of gluten, protein, vitamin C, sodium, and calcium in cookies. Through laboratory analytical research, an analysis of the nutritional content of cookies will be carried out based on SNI 01-2891;1992, Iodimetry, AAS, while the best organoleptic test results are analyzed descriptively. The results showed that 100 g of cookies contain 7.48 g of protein, 988.15 mg/kg of calcium, 90.03 mg/100g of vitamin C, 67.81 mg of sodium, and no quantitative gluten was detected. Nutritional content of gluten-free cookies are source of protein, high in calcium, high in vitamin C, low in sodium, and gluten-free, so it is safe for consumption by children, in 100 grams of cookies can fulfill the daily needs of vitamin C and calcium for children.
Parental Morality
Authors: Clayton Matthew
Published: January 2025

This chapter introduces some central questions in the philosophy of upbringing, particularly the permissibility of parents’ shaping children’s values and enrolling them into controversial conceptions of religion or human flourishing. It draws attention to the distinction between moral principles that apply directly to parents and those that inform how governments ought to regulate upbringing. It proceeds to draw two further distinctions that clarify different positions within the debate: first, the distinction between directive and non-directive approaches to parenting and education; second, the distinction between morality and ethics. Finally, the chapter provides a brief overview of three prominent positions within the philosophy of upbringing that independence for children challenges: parentalism, perfectionism, and what is termed ‘the liberal consensus’.
The Argument from Self-Rule
Authors: Clayton Matthew
Published: January 2025

This chapter presents the central argument for independence for children, particularly anti-perfectionist parenting. After a summary of the central features of an anti-perfectionist liberal political morality, which is informed by John Rawls’s influential conception, it proceeds to set out an argument for parental anti-perfectionism animated by the same ideal of individual self-rule. That argument rests on the idea that, from the point of view of parental morality, we ought to exclude from consideration principles that individuals might retrospectively reject as adults. In religiously and ethically plural societies, the avoidance of retrospective rejection requires parental anti-perfectionism. Various objections to the individual self-rule argument for parental anti-perfectionism are raised and rebutted, and the chapter ends with a discussion of some possible misinterpretations of independence for children.
The Attitudinal Requirement
Authors: Clayton Matthew
Published: January 2025

This chapter asks whether, from a moral point of view, it matters whether parents exclude religious and ethical ideals when deliberating how to raise their children. Answering affirmatively, it presents an argument for the view that parents ought to display an anti-perfectionist attitude towards their children, which deploys the argument developed by Quinn and Tadros that individuals are wronged if they are incorporated into others’ plans without their consent, at least when they have no duty to pursue the end they are made to serve. After a brief discussion of the debate in moral philosophy concerning whether intentions or motives are relevant in identifying the permissibility of people’s conduct, the chapter concludes by responding to the objection that parents’ intentional shaping of children’s values is not morally impermissible because children’s values will inevitably by shaped by external factors.
Conclusion
Authors: Clayton Matthew
Published: January 2025

In previous chapters, religion is treated as the primary case for elaborating the nature and appeal of independence for children. This concluding chapter explores how independence for children extends beyond the case of religion, by considering the implications of anti-perfectionist parenting for other conceptions of the good such as those concerning consumption, work, gender, and diet. The central thought is that we need to identify the public reasons in play when addressing these issues, but within the limits of public reason, and giving due attention to the moral claims of non-human animals, independence for children supports the view that parents should adopt an anti-perfectionist stance: as parents, they should not take a stand on whether a Protestant work ethic, or materialist attitude towards consumption, is helpful or harmful; and their gendering their children is morally problematic.
Introduction
Authors: Cureton Adam
Published: January 2025

An exceedingly large and complicated task that philosophers and others over generations can cooperatively pursue is this: First, explore and reflect on the many ordinary ways we think and speak about ideas of reason. Second, develop and study philosophical theories of reason, reasons, rationality, reasoning, reasonableness, and the like. Third, evaluate theories of reason by how well they fit with the ways we think and speak about reason and related concepts in reflective common sense and ordinary language. This introductory chapter highlights the many ways we think and speak about reason and related ideas, explores some gaps between standard philosophical theories of reason and reflective common sense, and explains the general aim of the book, which is to work back and forth between commonsense judgments about reason and key assumptions of the philosophical tradition that is associated with Kant to propose a partial theory of the mental power of reason that accords with some features of common sense and ordinary language. After explaining this approach and its limits, the chapter introduces the Sovereignty Conception of Reason and highlights its distinctive and unorthodox features, especially its emphasis on substantive interests of reason and the fundamental role they play in justifying many rational standards through a principle of justifiability to persons. The chapter also outlines the structure of the book and explains its unorthodox engagement with Kant’s ideas and texts.
Scope of Rational Self-Governance
Authors: Cureton Adam
Published: January 2025

The aim of this chapter is to consider our first main question, namely: What features of ourselves does our power of reason allow us to govern? Autonomy or rational self-governance, according to traditional Kantian views, concerns the ways our reason governs just one aspect of ourselves, namely our power to make choices. There is, in common sense and ordinary language, a broader idea of an autonomous or rationally self-governing person who governs herself by reason in many respects. Such a person is governed by her reason not only in the choices she makes but also in what she believes, notices, imagines, wants, and perhaps even feels. This chapter explores the first feature of the Sovereignty Conception of Reason, namely that our power of reason allows us to govern many of our powers of mind, including our powers of imagination, understanding, desire, and choice, through laws of reason. The chapter examines the general idea of a mental power, specifies some of the mental powers that humans typically possess as well as some of their connections to one another, and explains why it is initially plausible that our reason allows us to govern many powers of our minds besides our power of choice. This partial model of the human mind also serves as needed background for later chapters, especially those in Part II, where how the Sovereignty Conception of Reason can generate and explain many particular requirements of reason on our various mental powers will be illustrated.
Governing Abilities of Reason
Authors: Cureton Adam
Published: January 2025

The book’s second main question is: In what ways does our power of reason allow us to govern ourselves? The aim of this chapter is to specify some of the basic governing abilities that are part of our reason. Traditional Kantian conceptions of autonomy emphasize two governing abilities of reason, namely to legislate moral requirements about what we choose and to enforce in ourselves these moral laws. There is, in common sense and ordinary language, a much broader idea of a rationally self-governing person who governs herself as a whole in specific ways by standards of theoretical, prudential, and moral reason. The second feature of the Sovereignty Conception of Reason is that our power of reason includes many legislative, executive, and judicial abilities to govern our various mental powers through rational requirements of all kinds. This feature expands traditional Kantian conceptions of autonomy by incorporating additional governing abilities besides legislation and enforcement, by extending the set of mental powers that we can rationally govern in ourselves beyond the power of choice, and by expanding the set of rational requirements that we impose on ourselves to include moral, prudential, theoretical rational requirements. The chapter explains how our reason allows us to formulate, issue, and connect incentives with laws of reason, to interpret, apply, enforce, and police them, and to establish internal courts in which we attribute and impute mental acts to ourselves, render verdicts, and assign punishments to ourselves in the form of painful feelings of regret and self-reproach.
Laws of Reason
Authors: Cureton Adam
Published: January 2025

The book’s fourth main question is: What are the laws of reason through which we govern ourselves? Common sense and ordinary language suggest that requirements of reason are quite extensive and varied, but capturing and explaining them is notoriously difficult for Kantian theories of reason. The fourth feature of the Sovereignty Conception of Reason (SCR), which unifies the other three, is that our power of reason constitutively includes a set of formal and substantive principles of reason and that one of the substantive laws is a fundamental principle of justifiability that says mental acts of competent rational persons are required by reason if and because those mental acts or things suitably related to them could or would be rationally endorsed by a set of rational people on the basis of their interests of reason. This chapter considers the idea of a constitutive principle of reason by examining a special restriction that Kantian theories place on the kinds of things that can ground or explain such principles. It discusses the nature of formal and substantive principles of reason. Finally, it explores the idea that one of the fundamental substantive principles of reason has to do with ensuring that mental acts of all kinds are justifiable to persons. The chapter develops a schema for interpreting principles of justifiability and uses that schema to describe the novel but partial principle of justifiability that is part of the SCR. This principle assigns a fundamental role to our substantive interests of reason.
Knowledge, Error, and Enlightenment
Authors: Cureton Adam
Published: January 2025

Our power of reason includes substantive final interests in all people representing the truth, avoiding errors of judgment, and thinking for themselves. Our rational nature itself drives us to expand our knowledge and understanding, to discover and correct our mistaken beliefs, and to employ our own cognitive powers of reflection and investigation. Our rational nature also leads us to want all other people to do the same. Ascribing these substantive final interests in theoretical cognition to our power of reason allows for novel and promising ways of justifying some plausible requirements that concern not only how our cognitive capacities should operate but also how we should regard and treat one another. Rational and reasonable people who care about truth in everyone could or would rationally oppose lying and deception because of their concern for promoting knowledge as such. Our interests of reason in diminishing errors could or would also rationally lead us to support openness in scientific inquiry, educating children, taking the views of others seriously, and helping them to correct their mistakes. Rational and reasonable people could or would rationally support freedom of thought and speech out of our concern for ensuring that everyone thinks for themselves. These mental acts are presumptively required or prohibited by reason, according to the Sovereignty Conception of Reason’s Qualified Justifiability Argument, because rational and reasonable people could or would rationally endorse or reject them on the basis of their interests that all people acquire true representations, avoid errors in judgment, and achieve enlightenment.
Happiness
Authors: Cureton Adam
Published: January 2025

Our power of reason includes substantive final interests in the happiness or well-being of all people. Rational and reasonable people, simply as such, care about the happiness of everyone. Our interests of reason in the happiness of all could or would lead rational and reasonable people to endorse a variety of laws that concern the happiness of persons. There are several surprising features of these interests and the presumptive laws that they favor, including that rational and reasonable people as such are concerned to determine our own conception of happiness for ourselves, that our reason leads us to care about the happiness of all, and that our reason moves us to legislate presumptive laws that concern the kinds of feelings and desires that we have toward the happiness of others. The aim of this chapter is to explore this interest of reason in happiness and some presumptive laws of reason that it grounds. Rational and reasonable people could or would, on the basis of this interest, endorse presumptive laws to set the happiness of everyone as an end, to promote the happiness of all, to respect everyone’s right to promote their own happiness, to adjust our own conception of happiness to match our circumstances, to harmonize our own happiness with that of others, to take due care in applying these laws, to encourage and not discourage others from following them, and to have and avoid certain natural feelings and natural desires toward the happiness, unhappiness, and misery of everyone.
Solidarity
Authors: Cureton Adam
Published: January 2025

Personal relationships of various kinds are, from the perspective of reflective common sense, part of a fully reason-governed life. The aim of this chapter is to illustrate how the Sovereignty Conception of Reason can be interpreted and applied in ways that capture and explain a wide variety of judgments in reflective common sense about loving relationships. The chapter sketches several normative dimensions that loving relationships seem to have. It considers the charge that central features of Kantian theories of reason prevent them from adequately capturing and explaining these ordinary judgments. It draws on Kant’s discussions of various relationships to characterize a kind of solidarity and suggests that our power of reason includes final interests in each of us establishing relationships of solidarity, maintaining and perfecting ones we are in, promoting such relationships among others, and respecting relationships of solidarity themselves. The chapter then examines some presumptive laws of reason that are favored by our interests of reason in solidarity when they are combined with a principle of justifiability. Particular people in specific relationships presumptively should favor their friends over others, maintain their spouse’s trust, participate in joint projects, improve their relationships with their parents, promote the aims of their communities, avoid betrayal and duplicity, and otherwise maintain and perfect the social ties they have with others. The chapter ends by describing a fully general and universal social ideal that arises out of the Sovereignty Conception of Reason and reveals the deeply social nature of our power of reason itself.
Postscript
Authors: Cureton Adam
Published: January 2025

This book draws from Kant and common sense some features of a new way of thinking about what it is to govern oneself by reason and to lay some needed groundwork for a broadly Kantian normative ethical framework. This Postscript discusses the book’s main findings, why anyone should care about them, and the author’s future research directions. The Sovereignty Conception of Reason gives us a way of thinking about ourselves as autonomous or rationally self-governing people. Investigating the abilities, interests, and principles that make up our rational nature enhances our understanding of ourselves as rationally self-governing people who can establish in our own minds a rational and reasonable order that incorporates the fundamental interests of all people and forms the foundation for an ideal world of mutual love and respect. The picture of autonomy in this book is far more expansive and rich than traditional ideas of rational self-governance. It incorporates sociality and emotional attachment, encourages partiality toward our friends and family, extends to our attitudes as well as our actions, and reflects our ambivalence when we are pulled in different moral directions. The Sovereignty Conception of Reason also provides a foundation for developing a new kind of broadly Kantian normative ethical theory that reflects Kant’s idea of an ideal Kingdom of Ends. In such a world, our reason binds us with others through mutually agreeable standards that reflect the love, respect, and sense of fellowship we necessarily have for one another as rational and reasonable people.
Musical Phases
Authors: Glass Philip , Reich Steve
Published: January 2025

This chapter focuses on Freeman’s support of American forms of minimalism. The musical figures featured here include Philip Glass and Steve Reich. Contemporary opera becomes a major theme in these salons, as does the development of minimalism as style and movement, thanks in part to Freeman’s salons hosting conversations such as these. Some highlights from this chapter include Glass’s introduction of his impending opera Satyagraha, Reich’s telling of Jewish ideals in Tehillim, and an open conversation between Reich and audience about the role of emotion in his work. The chapter also revolves around a reading of Lichtenstein’s painting Frolic, which Freeman displayed in the music room.
Setting the Scene
Authors: Loporcaro Laura
Published: January 2025

Chapter 1 examines the start and overall construction of the Institutio, arguing for the artfulness of both. First, it analyses how Quintilian, introducing his project and his persona, closely follows his own advice for the orator’s self-staging at the start of a speech. He presents himself as well-connected, competent, modest, and practically minded. This is a prime example of how Quintilian performs the rhetorical theory he teaches. He also sets his work into a literary context beyond rhetorical handbooks, and subtly engages in polemic against predecessors. Second, this chapter demonstrates how Quintilian, who at the start of the Institutio advertises it as proposing a coherent educational programme gradually increasing in difficulty, throughout the work indeed creates the sense that it unfolds in parallel with the pupil’s training and with his own life. Finally, this chapter suggests that Vergilian allusions may indicate the orator’s educational trajectory to have an epic quality.
In the Shadow of Cicero
Authors: Loporcaro Laura
Published: January 2025

Chapter 2 considers Quintilian’s reception of Cicero, showing how he promotes his model’s excellence while also striving to assert his own authority. First, it shows how Quintilian ‘canonizes’ Cicero as an orator by constantly quoting him, praising him as the best Latin orator who ever lived, and giving him a central place in early education, but also sometimes criticizes Cicero and denies that he was the ideal orator. This balancing act is key for the didactic framework of the Institutio, which would be undermined if the ideal orator had already existed. Second, the chapter examines how in his reception of Cicero as a theorist, Quintilian similarly acknowledges a strong debt to his model while striving to assert his own independence as a writer, advertising his treatment of single topics as more ‘didactic’ in a strict sense and setting the Institutio as a coherent whole against Cicero’s beautiful but contradictory writings.
Conclusion
Authors: Loporcaro Laura
Published: January 2025

This chapter concludes Reading Quintilian, showing how the separate thematic chapters of the book together contributed to the study of didactic authority in the Institutio oratoria. Overall, it concludes, the book argued that the Institutio is an intrinsically persuasive work with high literary ambitions and aimed for a holistic reading of this important cultural artefact, proposing a new, ‘linear’ way to reengage with it.
2822 Improving bone health assessments in Parkinson’s clinic
Authors: Chisanga B , Walters R , Adhi S , Pugh L
Published: January 2025

Introduction

People with Parkinson’s disease are more likely to have osteoporosis and falls. They also have a higher risk of fractures, and their outcomes are poorer than in the general population. Despite this, only half of the patients seen in Parkinson’s clinic have a bone health assessment. The aim of this project was to improve bone health assessments in the Parkinson’s clinic at Mansfield Community Hospital.

Method

One plan-do-study-act cycle was completed with the implementation of a Parkinson’s fracture risk assessment tool in the clinic. 19 clinic notes were evaluated over an 8-week period. The notes were scored on whether bone health was addressed using the assessment tool. Feedback was collected from the clinicians about utilising the assessment tool in clinic. The FRAX (Fracture risk assessment) tool was also used to calculate the risk of fractures in the patients selected.

Results

16/19 (84%) notes had used the risk assessment tool in clinic. There was an improvement in the bone health assessments in clinic from 5% (1/19) at baseline to 29% (5/17). The Parkinson’s risk assessment tool’s identification of individuals who were high risk of fractures, correlated with those identified as high risk using FRAX. The clinicians had positive reviews of the tool, but they highlighted the time constraints.

Conclusion

Whilst the use of the assessment tool has shown some improvement in the number of bone health assessments happening in clinic; it hasn’t resulted in all patients having an assessment. This is likely due to the time constraints in clinic. This project was successful in highlighting the current problem to the clinicians and has led the development of a further separate clinic, where bone heath can be addressed. The risk assessment tool plays an important role in identifying high risk patients who would be referred into this service.
2825 Embedding the anticholinergic burden score and deprescribing into a collaborative community and secondary care frailty clinic
Authors: Wright C , McNamarra F , Kidd L , Heseltine D
Published: January 2025

Background

This clinical improvement project took place at a community frailty clinic. The primary and secondary care collaboration clinic comprised of an MDT including a physiotherapist, HCA, social prescriber, consultant geriatrician and GPwER in older people’s medicine. Older adults with a Rockwood score of 5 or more were assessed using the CGA domains.

Introduction

Anticholinergic burden (ACB) is defined as the cumulative effect of taking one or more medications with anticholinergic effects (e.g. opioids, antimuscarinics and trycyclics). ACB score is a method of quantifying this. Higher ACB scores (3+) are associated with cognitive decline, risk of admissions with falls/fractures and increased mortality. The aim of the study was to quantify reduction in ACB score following structured medication review. The goal was to determine whether the frailty clinic was an appropriate setting for this.

Methods

Over a 5-month period the consultant geriatrician and GPwER calculated each patient’s ACB score. A medication reconciliation within their appointment facilitated deprescribing of high-risk medications. The HCA recorded ACB scores for all patients before and after medication review.

Results

54 patients attended the clinic. 18 patients had an initial ACB score of 0. The remaining 36 patients had an ACB score of at least 1. Their mean reduction in ACB score was 1.2 points. Most pertinently, of the 19 patients with ACB scores of 3 or more, 12 left the clinic with a lower score and the mean reduction was 2.1 points. One patient achieved a drop in score from 9 to 0. Only 2 patients left with increased anticholinergic burden (in both cases, only increasing by 1 point).

Conclusions

Embedding the ACB score into patient medication reviews at the frailty clinic was easily achieved. This process was documented in clinic proformas, letters and the MDT discussion. This would be simple to transfer to similar settings.
2764 Optimising blood sugar monitoring in frail diabetic inpatients
Authors: Mark H , Thackeray K , DeSilva R , Cheung J
Published: January 2025

Introduction

1 in 6 hospital beds in the UK is occupied by someone with diabetes1. Keeping diabetic patients safe during hospital stays is a priority, and in 2023 the Joint British Diabetes Societies (JBDS-IP) published guidance on managing Diabetes in Frail inpatients2. An audit at our hospital later that year found that 70% of Capillary Blood Glucose (CBG) testing was non-compliant with guidelines resulting in unnecessary patient intervention, use of staff time and consumption of non-recyclable resources. The main aim of our project was to improve compliance with these guidelines and establish potential time and cost saving resulting from this.

Method

Focus on medical education with teaching sessions, information cards for lanyards and prompt posters around the inpatient ward areas. Worked with electronic prescribing team to establish use of an order-set for CBG testing to allow medical team to accurately communicate with nursing colleagues. In addition, engaged nursing staff via ward bulletins and observed CBG testing on ward.

Results

There was a reduction in CBG frequency for all diabetic patients of 27.9%. We identified that those patients with diet-controlled diabetes were commonly over tested, and in this sub-group the number of CBG tests performed was reduced by 51.9%. Average time for CBG testing was 147 seconds with anticipated cost savings from staff time and equipment use.

Conclusions

The use of default four times a day CBG testing results in unnecessary intervention in our frail inpatients. Through education and use of electronic systems we can reduce these interventions based on national guidelines, but more work needs to be done. Reducing CBG testing reduces use of healthcare assistant time, costly non-recyclable materials and overall reduces unnecessary patient intervention.
2841 Moving CGA closer to the front door in St Georges emergency department. ‘Impact on length of stay and other outcomes.’
Authors: Smith S , Alg G , Howes E
Published: January 2025

Introduction

Emergency departments are increasingly seeing more older adults living with frailty. Between 5% and 10% of all those attending EDs and 30% of acute medical units are older adults living with frailty. The consequences of this on the system manifests as increased patient length of stay, poorer patient experience and clinical outcomes such as mortality and morbidity are measurably worse.

The Acute Frailty team aimed to move and expand its resource to provide a service to frail, older adults in both the Acute Medical Unit and the Emergency Department. This aligns with a key National objective that recommends all type 1 EDs have 70 hours access to a Acute Frailty Service. The team are a liaison service and therefore work alongside the ED and medical teams.

Method

Quality improvement methodology was applied utilising multiple PDSA cycles. An incremental increase in provision of an Acute Frailty service within the ED. A stakeholder group was set up, KPIs were set. The team worked alongside the ED team to improve early CFS scoring for over 65 s and embedded the Nationally agreed same day frailty criteria of CFS/4AT, EWS and the presence of a frailty syndrome to identify appropriate patients for the service with the ED. The CGA was initiated in parallel with the ED assessment.

Results

Time between admission and CGA decreased by ave. 30 hours. Time between CGA and dc from hospital decreased by ave. 1.6 days. Acute Frailty team activity increased in the ED and decreased in the AMU. No increase in re-admission rate was seen.

Conclusion

A CGA initiated in the ED had a positive impact on length of stay and the earlier dc did not increase readmission rates.
2722 Improving advance care planning within residential homes
Authors: Evans S , Cassius N
Published: January 2025

Introduction

As care home residents are living with advancing frailty and multi-morbidity, it is important to initiate advance care planning as part of the comprehensive geriatric assessment and create universal care plans (UCPs). There is evidence that it can reduce inappropriate escalations of care, reduce hospital admissions, increase the proportion of residents dying in their preferred place and improve both resident and relative satisfaction.

Method

Retrospective audit in June 2024 of residents within the five residential homes covered by the newly formed enhanced health in care home (EHCH) team who had an initial comprehensive geriatric assessment (CGA) between March 2022–May 2024 to review if they had a universal care plan in place (UCP).

Further sub-analysis to review whether they had an existing UCP prior to EHCH review or this was created/edited by the EHCH team. Both the CGA and UCP would have either been completed by the EHCH matron or consultant geriatrician.

Results

There was an average increase from 26% to 89% in the number of residents with a UCP following an EHCH CGA. We have created/edited a total of 117 UCPs across the care homes in addition to those already in place across the 177 CGAs completed over this time period.

Conclusions

Advance care planning is a vital part of a comprehensive geriatric assessment and it is often not completed for many reasons including its time-consuming nature, lack of awareness and apprehension in having these discussions both among residents, relatives and staff and a lack of training and education. As an EHCH team, we have managed to improve the number of residents with UCPs to 89%. We hope this will mean a greater proportion of residents receive appropriate personalised care according to their wishes in their chosen place as well as dying in their place of preference.
2759 Cardiogeriatrics—what is the impact on end of life Care for Older Cardiology Patients?
Authors: Miller A , Patel N
Published: January 2025

Background

Royal Bolton Hospital is a district general hospital in Greater Manchester. In 2023, a Cardiogeriatrics service was introduced to deliver comprehensive geriatric assessment for older cardiology inpatients with frailty.

Introduction

Our aim was to evaluate the Cardiogeriatrics service with respect to the impact on end-of-life care for older cardiology inpatients.

Methods

Audit standards were defined using metrics for quality in end-of-life e care. All patients between the year 2021 and 2024 aged 75 and over who died as an inpatient or within 30 days of discharge were included. Patients who died following procedural interventions were excluded. Patient’s casenotes were audited and compared before and after the initiation of the service.

Results

Casenotes for 88 inpatient deaths were audited (66 prior to introduction of the Cardiogeriatric service, 22 following). The Cardiogeriatrician initiated end of life care in 31.6% of inpatient deaths. This corresponded with a reduction in unexpected deaths from 25.8% to 13.6%, and a reduction in patients initiated on end-of-life care by the on-call team, from 28.6% to 10.5%. Junior doctors on Cardiology began to initiate resuscitation conversations with patients. Casenotes for 44 deaths within 30 days of discharge were audited. The majority (72.1%) of discharges were via standard discharge pathways rather than palliative pathways.

Conclusion

After introduction of the Cardiogeriatrics service, there was improved recognition of patients who were approaching end of life, and more proactive management of this. As many patients audited were not seen directly by the Cardiogeriatrician, we believe the service has contributed to a cultural change in the Cardiology team more widely towards more proactive recognition and management of end-of-life issues in older Cardiology patients. There remains a need for better utilisation of palliative discharge pathways and we plan to address this through further quality improvement work.
2669 Diagnosing delirium on the Care of the Elderly Ward: a quality improvement project
Authors: Haber A , Batra A , Naqvi D , Sivanesan S , Arastu AH , Singh S
Published: January 2025

Introduction

Delirium has a significant impact on morbidity and mortality. It is also associated with an increased level of institutionalisation at discharge and increased length of stay. Therefore, a diagnosis of delirium should always be considered with an assessment of risk factors. The aim of this project was to ensure 100% of patients on Geriatric wards have a diagnosis of delirium considered via the 4AT as per NICE guidelines.

Methods

A Plan-Do-Study-Act methodology was utilised with an initial audit exploring identification and documentation of delirium diagnosis. A Lanyard Prompt Card was then distributed to all physicians with the 4AT score illustrated. A departmental teaching session about Delirium was delivered to all juniors. A re-audit was conducted to assess impact.

Results

Of the 41 patients evaluated initially, 50.7% (21) were suspected to be delirious. Of these, 9.5% (2) had been assessed for delirium on the same day delirium was suspected. Of 38 patients, post-intervention audit revealed 36% (14) were suspected to be delirious and of these patients, 43% (6) had a 4AT score on the same day.

Key conclusions

This project revealed 4AT assessments were approximately tripled in patients suspected to be delirious post-interventions. There remains scope for improvement in confidence and skill of documenting assessments to meet the NICE recommendations and potential to explore barriers. Ultimately, we aim to expand across all medical and surgical wards to upskill all MDT members on identification and management of delirium.
2845 Prevalence and outcomes of recorded dementia: a population-based study of 133,407 older adults using linked routine data sources
Authors: Penfold R , Wilkinson T , Russ T , Stirland L , MacRae C , Shenkin S , Anand A , Guthrie B , Sampson E , MacLullich A
Published: January 2025

Introduction

Recording dementia diagnoses is essential to ensure appropriate post-diagnostic support and care. We examined the prevalence of recorded dementia in different routine datasets and associations with emergency hospitalisation and mortality.

Methods

This retrospective longitudinal cohort study included all adults ≥65 years registered with a Southeast Scotland GP on 1st April 2016. Dementia diagnoses were identified in primary care, hospital discharge and community prescribing records. New diagnoses were considered from 1st April 2016 to 1st April 2020. All individuals were followed up to 23rd October 2023. Cox proportional hazards and Fine-Grey models were used to estimate associations between recorded dementia and death and emergency hospitalisation, respectively. Diagnosis capture in other datasets was examined, accounting for mortality.

Results

On 1st April 2016, 7544/133407 (5.7%) individuals had a recorded dementia diagnosis: 1254 (16.6%) in a single dataset, including 940 (12.5%) only in primary care and 279 (3.7%) in hospital data. Between 1st April 2016 to 1st April 2020, 7359/133,407 (5.8%) had a new diagnosis: 5165 (70.2%) first recorded in primary care, 1634 (22.2%) in hospital and 560 (7.6%) in community prescribing data. People with dementia had higher risks of death [adjusted hazard ratio (HR) 2.46 (95% Confidence Interval (CI) 2.39–2.54)] and emergency hospitalisation [adjusted subdistribution HR 1.58 (95%CI 1.56–1.60)] then those without dementia. People with diagnoses first recorded in hospital had higher mortality rates than those with community diagnoses [<30 days: aHR 8.96 (95%CI 6.94–13.52); >365 days: aHR 1.29 (95%CI 1.19–1.41)]. Only 562 (35.9%) of those with hospital diagnoses had recorded primary care diagnoses within a year.

Conclusions

Dementia is often recorded in single datasets, sometimes only in hospital data. Dementia is associated with adverse prognosis, with highest mortality in those with first diagnoses recorded in hospital. Findings highlight the need for better recording, dataset integration and scrutiny of hospital-based diagnostic pathways to ensure appropriate post-diagnostic support and care.
2800 25-hydroxyvitamin D and inflammation in older acute hip fracture patients
Authors: Ezeobika C , Ahmed M , Punekar A , Jose J , Bamisaye J , Jouni H , Wray A , Thummin J , Michael A , Mukherjee B , Nandi A , Obiechina N
Published: January 2025

Introduction

Preoperative systemic inflammation has been shown to worsen postoperative outcome in emergency surgical patients. C-reactive protein (mg/L)/Albumin (g/L) ratio is a well validated inflammation marker. Studies have shown an inverse relationship between 25-hydroxyvitaminD level and markers of inflammation. Vitamin D deficiency has been previously shown to be associated with inflammation.

Aims and Objectives

Methods

A retrospective review of electronic notes from the hip fracture database was carried out on hip fracture patients attending a single trauma centre from January to December 2022. Anonymized data were extracted from the database. Patients aged 60 years and older who sustained an acute hip fracture were included. Patients with incomplete data were excluded. The IBM SPSS 29 software was used for statistical analysis. Descriptive statistics was used for baseline characteristics. Linear regression was used to determine correlation.

Results

A total of 293 patients were analysed: 82 males and 211 females with a mean age of 81.6(SD 8.28) and 83.2(SD 7.85) years respectively. Mean 25-hydroxyvitamin D levels were 39.1 (SD 25.0) and 49.7 (SD 29.01) nmols/L respectively. Mean CRP/Albumin ratio was 0.94 (SD 1.51) and 0.71 (SD 1.34). There was a negative, statistically significant correlation between 25-hydroxyvitaminD and CRP/Albumin ratio in male patients but not in the females (r = −.274; p = 0.013 & r = − 0.035; p = 0.61) respectively.

Conclusion

In this study, 25-hydroxyvitamin D levels are inversely correlated with markers of inflammation (CRP/Albumin ratio) in older male hip fracture patients but not older female hip fracture patients. More studies are needed to clarify whether vit D lowers inflammation or inflammation lowers 25-hydroxyvitamin D concentrations and to investigate the gender difference.