bluuebunny/crossref_metadata_2025 huggingface dataset:
Visualizing extended defects at the atomic level in a Bi2Sr2CaCu2O8+δ superconducting wire
Authors: Hu 胡 Kejun 柯钧 , Wang 王 Shuai 帅 , Li 李 Boyu 泊玉 , Liu 刘 Ying 影 , Ge 葛 Binghui 炳辉 , Song 宋 Dongsheng 东升
Published: August 2024

The microstructure significantly influences the superconducting properties. Herein, the defect structures and atomic arrangements in high-temperature Bi2Sr2CaCu2O8+δ
(Bi-2212) superconducting wire are directly characterized via state-of-the-art scanning transmission electron microscopy. Interstitial oxygen atoms are observed in both the charge reservoir layers and grain boundaries in the doped superconductor. Inclusion phases with varied numbers of CuO2 layers are found, and twist interfaces with different angles are identified. This study provides insights into the structures of Bi-2212 wire and lays the groundwork for guiding the design of microstructures and optimizing the production methods to enhance superconducting performance.
SAFE-OPT: a Bayesian optimization algorithm for learning optimal deep brain stimulation parameters with safety constraints
Authors: Cole Eric R , Connolly Mark J , Ghetiya Mihir , Sendi Mohammad E S , Kashlan Adam , Eggers Thomas E , Gross Robert E
Published: August 2024

Objective. To treat neurological and psychiatric diseases with deep brain stimulation (DBS), a trained clinician must select parameters for each patient by monitoring their symptoms and side-effects in a months-long trial-and-error process, delaying optimal clinical outcomes. Bayesian optimization has been proposed as an efficient method to quickly and automatically search for optimal parameters. However, conventional Bayesian optimization does not account for patient safety and could trigger unwanted or dangerous side-effects. Approach. In this study we develop SAFE-OPT, a Bayesian optimization algorithm designed to learn subject-specific safety constraints to avoid potentially harmful stimulation settings during optimization. We prototype and validate SAFE-OPT using a rodent multielectrode stimulation paradigm which causes subject-specific performance deficits in a spatial memory task. We first use data from an initial cohort of subjects to build a simulation where we design the best SAFE-OPT configuration for safe and accurate searching in silico. Main results. We then deploy both SAFE-OPT and conventional Bayesian optimization without safety constraints in new subjects in vivo, showing that SAFE-OPT can find an optimally high stimulation amplitude that does not harm task performance with comparable sample efficiency to Bayesian optimization and without selecting amplitude values that exceed the subject’s safety threshold. Significance. The incorporation of safety constraints will provide a key step for adopting Bayesian optimization in real-world applications of DBS.
Wasserstein generative adversarial network with gradient penalty and convolutional neural network based motor imagery EEG classification
Authors: Xiong Hui , Li Jiahe , Liu Jinzhen , Song Jinlong , Han Yuqing
Published: August 2024

Objective. Due to the difficulty in acquiring motor imagery electroencephalography (MI-EEG) data and ensuring its quality, insufficient training data often leads to overfitting and inadequate generalization capabilities of deep learning-based classification networks. Therefore, we propose a novel data augmentation method and deep learning classification model to enhance the decoding performance of MI-EEG further. Approach. The raw EEG signals were transformed into the time-frequency maps as the input to the model by continuous wavelet transform. An improved Wasserstein generative adversarial network with gradient penalty data augmentation method was proposed, effectively expanding the dataset used for model training. Additionally, a concise and efficient deep learning model was designed to improve decoding performance further. Main results. It has been demonstrated through validation by multiple data evaluation methods that the proposed generative network can generate more realistic data. Experimental results on the BCI Competition IV 2a and 2b datasets and the actual collected dataset show that classification accuracies are 83.4%, 89.1% and 73.3%, and Kappa values are 0.779, 0.782 and 0.644, respectively. The results indicate that the proposed model outperforms state-of-the-art methods. Significance. Experimental results demonstrate that this method effectively enhances MI-EEG data, mitigates overfitting in classification networks, improves MI classification accuracy, and holds positive implications for MI tasks.
A UWB indoor positioning method based on triple filtering fingerprint matching algorithm
Authors: Yang Jiaqi , Gao Junbo , Sun Wei , Jing Xin
Published: August 2024

In recent years, ultra-wideband (UWB) has gradually become a research hot spot in the field of indoor positioning because of its various advantages. Although UWB has such excellent performance in normal environments, the non-line-of-sight propagation of signals in complex indoor environments and the multi-path effect caused by obstacles will affect its positioning accuracy. To solve this problem, we use the fingerprint positioning method and optimize the previously commonly used k-nearest neighbor algorithm in the online matching phase. In this paper, we proposed a triple-filtered k-nearest neighbor algorithm based on sample distance weighting (TFWKNN). Experimental results show that the mean calculation error of TFWKNN is 63.4% less than the k-nearest algorithm, and the proposed algorithm has better prediction stability than other commonly used machine learning regression algorithms.
Causal V: A five-phase causal mining methodology for real-world accident data
Authors: Zhao Jiangnan
Published: August 2024

Amid rapid advancements in autonomous vehicle technology, traffic accidents due to Autonomous Driving Systems (ADS) flaws persist. The critical task of attributing causality to accidents and forecasting potential incidents based on situational data stands at the forefront of enhancing vehicular safety. Addressing these challenges, this study introduces Casual V, a systematic five-phase V-shape approach to constructing a causal Bayesian network (CBN) from massive real-work crash data. To evaluate the proposed approach, a CBN was constructed from more than 300,000 Maryland accident records. Experiments demonstrate that our method is capable of effectively constructing a CBN that provides deep insights into the causal relationships within vehicular accident data.
Bone-on-a-chip simulating bone metastasis in osteoporosis
Authors: Lee Sunghan , Kim Young Gyun , Jung Hyo-Il , Lim Ji Seok , Nam Ki Chang , Choi Han Seok , Kwak Bong Seop
Published: August 2024

Osteoporosis is the most common bone disorder, which is a highly dangerous condition that can promote bone metastases. As the current treatment for osteoporosis involves long-term medication therapy and a cure for bone metastasis is not known, ongoing efforts are required for drug development for osteoporosis. Animal experiments, traditionally used for drug development, raise ethical concerns and are expensive and time-consuming. Organ-on-a-chip technology is being developed as a tool to supplement such animal models. In this study, we developed a bone-on-a-chip by co-culturing osteoblasts, osteocytes, and osteoclasts in an extracellular matrix environment that can represent normal bone, osteopenia, and osteoporotic conditions. We then simulated bone metastases using breast cancer cells in three different bone conditions and observed that bone metastases were most active in osteoporotic conditions. Furthermore, it was revealed that the promotion of bone metastasis in osteoporotic conditions is due to increased vascular permeability. The bone-on-a-chip developed in this study can serve as a platform to complement animal models for drug development for osteoporosis and bone metastasis.
Enhancing mechanical properties of lanthanide zirconates through the cold sintering assisted sintering process
Authors: Cruz-Sánchez Brianda , Díaz-Guillén Juan C , Hdz-García Hector M , Perez-Cortes Pedro , Fuentes Antonio F
Published: August 2024

This study evaluates the impact of incorporating varying contents (10–40 wt%) and molar concentrations (0.001–1 M) of citric acid solutions, as transient liquid phases in the Cold Sintering Assisted Sintering (CSAS) process of dysprosium zirconate (Dy2Zr2O7). CSAS processed samples achieved relative densities up to 98% of the theoretical maximum and significantly increased Vickers microhardness by over 2.5 times, compared to the traditional ‘press and fired’ sintering method. The Dy2Zr2O7 crystal structure remained consistent with the fluorite-type, with no secondary phases detected. Our findings underscore the benefits of using CSAS to enhance the mechanical strength of Dy2Zr2O7, while reducing the lengthy processing times at very high temperatures typically required for sintering refractory materials such as lanthanide zirconates.
An integrated expert recommender system approach to environmental service priorities in renewable energy
Authors: Yüksel Serhat , Dinçer Hasan , Hacıoğlu Ümit , An Jaehyung , Mikhaylov Alexey , Karpyn Zuleima
Published: August 2024

The purpose of this study is to analyze the investment success of renewable energy generation projects design. A novel model has been constructed for this purpose. At the first stage, collaborative filtering methodology is taken into consideration to complete missing evaluations. After that, M-SWARA based on QUSFSs with golden cut is used to compute the weights of these factors. Finally, the components of the service design are ranked by TOPSIS approach. The main contribution of the paper is that a new methodology (M-SWARA) has been created in this study by making improvements to SWARA. With the help of this new model, causal directions between the indicators can also be examined. Similarly, collaborative filtering methodology is taken into consideration to complete missing evaluations. In this process, the decision makers are allowed to leave the questions they wanted blank. This situation is considered as the superiority of the proposed model compared to many previous models in the literature. The findings indicate that cost is the most significant factor for the success of renewable energy investments because it gets the highest weight (.261). The ranking results also demonstrate that product is the most essential component of the service design of renewable energy investments. Therefore, solving the high-cost problem is of vital importance to increase these investments. First, renewable energy companies can reduce costs with more effective financial management. To carry out this process effectively, a finance department consisting of qualified personnel is needed. Thanks to this team, current situations in the financial markets will be better followed and this will play an important role in reducing costs.
Household air pollution disparities between socioeconomic groups in Chicago
Authors: Krakowka William Isaac , Luo Jiajun , Craver Andrew , Pinto Jayant M , Ahsan Habibul , Olopade Christopher S , Aschebrook-Kilfoy Briseis
Published: August 2024

Purpose: To assess household air pollution levels in urban Chicago households and examine how socioeconomic factors influence these levels. Methods: We deployed wireless air monitoring devices to 244 households in a diverse population in Chicago to continuously record household fine particulate matter (PM2.5) concentration. We calculated hourly average PM2.5 concentration in a 24-hour cycle. Four factors—race, household income, area deprivation, and exposure to smoking—were considered in this study. Results: A total of 93085 h of exposure data were recorded. The average household PM2.5 concentration was 43.8 μg m−3. We observed a significant difference in the average household PM2.5 concentrations between Black/African American and non-Black/African American households (46.3 versus 31.6 μg m−3), between high-income and low-income households (18.2 versus 52.5 μg m−3), and between smoking and non-smoking households (69.7 versus 29.0 μg m−3). However, no significant difference was observed between households in less and more deprived areas (43.7 versus 43.0 μg m−3). Implications: Household air pollution levels in Chicago households are much higher than the recommended level, challenging the hypothesis that household air quality is adequate for populations in high income nations. Our results indicate that it is the personal characteristics of participants, rather than the macro environments, that lead to observed differences in household air pollution.
Robust Left-Right Hashing Scheme for Ubiquitous Computing
Authors: Tripathi Rajeev Ranjan Kumar , Singh Pradeep Kumar , Singh Sarvpal
Published: August 2024

Ubiquitous computing systems possess the capability to collect and process data, which is subsequently shared with other devices. These systems encounter resource challenges such as memory constraints, processor speed limitations, power consumption considerations, and the availability of data storage. Therefore, maintaining data access and query processing speed in ubiquitous computing is challenging. Hashing is crucial to search operations and has caught the interest of many researchers. Several hashing techniques have been proposed and Cuckoo Hashing is found efficient to use in several applications. There are two variants of Cuckoo Hashing: Parallel Cuckoo Hashing and Sequential Cuckoo Hashing. Cuckoo Hashing suffers from challenges like high insertion latency, inefficient memory usage, and data migration. This paper proposes two hashing schemes: Left-Right Hashing and Robust Left-Right Hashing that successfully address and solve the major challenges of Sequential Cuckoo Hashing. The proposed schemes adopt the Combinatorial Hashing technique after modification and use this with a new collision resolution technique called Left-Right Random Probing. Left-Right Random Probing is a variant of random probing and uses prime numbers and Fibonacci numbers. In addition, this paper proposes a new performance indicator, degree of dexterity to estimate the performance of hashing techniques. Sequential Cuckoo Hashing suffers from hidden switching costs which are identified and its estimation is given by a new performance indicator called, T.R.C./Key. Performance of Sequential Cuckoo Hashing is order dependent.
Die design optimization for connecting rod using simulation modeling and taguchi methodology
Authors: Yadav Siddharth , Gautam Sujeet Kumar , Upadhyaya Rajat , Singh Niranjan Kumar , Singh Kamlesh Kumar , Namdev Anurag
Published: August 2024

This paper presents a novel approach to optimizing the die design for forging used in connecting rods. The combination of Taguchi (orthogonal L9) and the finite element method (FEM) was employed to achieve this optimization. The main objective of this study was to analyze the impact of design parameters on die-filling and yield improvement. The orthogonal L9 design was generated with three input parameters and one response variable. These input parameters were derived from the design dimensions of the forging tool, specifically flash land, draft, and flash thickness. The response variable was the maximum yield percentage, which was obtained through finite element simulations of the forging processes. By conducting an orthogonal analysis, the relationships between the response variable and the input parameters were established. The simulation results were then used to compare the outcomes of two different designs. It was found that preform one outperformed the other design, achieving an impressive yield of 88% at a forging load of 1.37 × 104 N, with complete die filling observed.
Preparation and performance of hydrotalcite and montmorillonite composite as flame retardant in asphalt pavement
Authors: Tang Ning , Jiang Yi-Yu , Wu Limei , Sun Yi-han
Published: August 2024

The increasing use of tunnel bitumen pavements has led to a corresponding rise in fire hazards. To improve the fire safety of these pavements, a novel flame retardant material has been developed, which incorporates carbonate intercalated magnesium aluminum hydrotalcite (MALC) and calcium-based montmorillonite (MMT) to form intercalation composites. The resulting MALC/MMT composite, along with 4,4’-methylenebis(isocyanate) (4,4’-MDI), was added in specific proportions to the bitumen, producing a flame retardant modified bitumen. The flame retardant performance was assessed through aging and combustion tests. The results indicate that the most effective flame retardant performance was achieved with a MALC:MMT ratio of 2:1 and a composite dosage of 5%. This study presents a straightforward and effective method for developing a novel inorganic flame retardant.
Development of fishbone powder and carbon-jute fiber reinforced unsaturated polyester based novel green composites: investigation of tensile, impact strength, and morphology microstructure
Authors: Dikshit Iti , Singh Ravinder Pal , Singh Gurminder , Sharma Neeraj
Published: August 2024

In the last decade, hybrid composites have been the subject of significant advancements and study. This fast expansion necessitated the development of lightweight composite material with enhanced mechanical strength. In the past few years, the utilization of organic wastes from the food industry, like powder from cow bone, pig bone, and fishbone, has substantially improved the mechanical characteristics of composite materials. Owing to the increasing growth of the meat-based fisheries industry, fish bones are readily available. These bones are often thrown, causing environmental damage. Hence, a sustainable and unique hybrid composite was created employing fish bone powder (FBP) as filler in carbon/jute fibers reinforced polyester matrix. The hybrid composite was compression-molded. FTIR, SEM, and EDS studies were used to characterize the composite. The ASTM standard was used as a reference to explore the mechanical strength (tensile and impact). Additionally explored are the effects of alkali treatment of jute fiber on the above-mentioned processes. It was revealed that the inclusion of FBP and alkali treatment enhanced the mechanical characteristics of the composite. Fishbone powder with a particle size range of 200–250 μm and a weight percentage of 10 to 15% had significant fiber attachment which resulted in improved strength. The produced green composites have proven to be a viable choice for bio-waste treatment in the food sector.
Navigating Cultural Differences
Authors: Jamison Nicole , Kirova Anna
Published: August 2024

Although the disconnect between young newcomer children’s experiences at home and in early childhood settings is commonly attributed to different cultural values and practices, there is little research on how young children perceive, experience, and navigate it. This chapter draws on Vygotsky’s concept of perezhivanie to interpret a case study of a young child’s dialectical becoming in the process of creating herself as a unique subject interacting within a social and cultural environment of both home and school, as a source of her development. Through creative and imaginative activities of play and art-making, the child was engaged in creating and recreating social situations to navigate and negotiate complexities and differences between these social and cultural institutions, experiences, and influences. The chapter offers a deeper pedagogical understanding of the dynamic relationship between the social and the individual aspects of the young newcomer child’s complex subjective configurations of different social instances and systems of relationships within more complex systems of society.
Play and Early Schooling Across Cultural Communities
Authors: Roopnarine Jaipaul L , Ong’ayi Dickson M M , Parella Morgan A
Published: August 2024

Playful learning and its implications for social and cognitive development in children have received considerable attention from scholars in diverse disciplines. The focus in this chapter is on play and early schooling across diverse cultural communities. Topics covered include parents’ and teachers’ beliefs about play and early education, play as a part of parental engagement activities in the development of early social and cognitive skills, implementation of play-based learning in early childhood education, and connections between playful learning and developmental outcomes in children across cultural communities. Within benchmarks of establishing global early childhood education, it is recommended that playful learning should reflect developmentally appropriate objects/materials and experiences of children in their cultural communities, and that more attention should be allocated to health and social justice issues; environmental/climate change; play activities that incorporate science, technology, engineering, and mathematics; play and learning other languages; and play therapy in attending to the mental health needs of young children in school settings.
Teacher Experiences of Curriculum Implementation in South Africa
Authors: Mahadew Ashnie
Published: August 2024

In South Africa, early childhood care and education (ECCE) refers to the learning and development opportunities for children aged from birth to 4 years before formal schooling begins. In South Africa, this sector is primarily characterized by poor government funding, unqualified or underqualified teachers, career instability, and disparities in opportunities for the wealthy and poor. In the government’s National Development Plan, ECCE is a possible avenue to level the playing fields between the “haves and the have-nots” in the country. In response to the challenges experienced by this sector and attempting to achieve the goals of the National Development Plan, the National Curriculum Framework (NCF) for children from birth to 4 years was published. The NCF was envisioned to be used in various settings to improve the early learning experiences of young children. This chapter aims to establish teacher experiences of curriculum implementation in ECCE, and ways to improve teachers’ curriculum implementation in ECCE, using data on teachers’ perceptions of the NCF.
The Engines of National Shame and Indignation
Authors: Pham Kevin D
Published: August 2024

This chapter explains how the Vietnamese figures profiled in this study challenged assumptions in mainstream scholarship on national identity by showing that national identity can come from shame (rather than pride), that national shame can come from perceived inadequacies (rather than bad actions toward others), and that national responsibility means the duty to create national identity anew by harnessing shame and indignation (rather than righting the wrongs of bad actions against others). Furthermore, postcolonial and decolonial literature has tended to attribute any perception of inferiority on the part of the colonized to “internalized inferiority” and to assume the existence of an indigenous “original” culture that colonizers destroy, overlooking the fact that natives themselves sometimes questioned the existence of “original” culture. These Vietnamese figures show that colonized people can be ashamed of themselves on their own terms and be anticolonial at the same time.
Hồ Chí Minh’s Rehumanizing Blueprint
Authors: Pham Kevin D
Published: August 2024

This chapter interprets Hồ Chí Minh (1890–1969) as a theorist of humanization, namely, as a critic of dehumanization and an architect of rehumanization. Whereas his mentor Phan Chu Trinh saw the source of Vietnamese national shame as coming from within Vietnam, Hồ saw it as coming from Europe: capitalism. As a critic of dehumanization, he explains that the racial dehumanization faced by the Vietnamese is a consequence of capitalism and colonialism. As an architect of rehumanization, Hồ has a vision for how the Vietnamese can restore their dignity: “paternalistic democracy.” Namely, Party cadres must cultivate their revolutionary moral virtue, which will make them trustworthy in the eyes of “the people” whom they are to serve and enable them to effectively guide “the people” toward the goals of independence and communist revolution.
Women’s Relationships With Healthcare and Providers: The Role of Weight Stigma in Healthcare and Weight Bias Internalization
Authors: Wetzel Karen E , Himmelstein Mary S
Published: August 2024

Background

Weight stigma (devaluation due to body weight) in healthcare is common and influences one’s engagement in healthcare, health behaviors, and relationship with providers. Positive patient–provider relationships (PPR) are important for one’s healthcare engagement and long-term health.

Purpose

To date, no research has yet investigated whether weight bias internalization (self-stigma due to weight; WBI) moderates the effect of weight stigma on the PPR. We predict that weight stigma in healthcare is negatively associated with (i) trust in physicians, (ii) physician empathy, (iii) autonomy and competence when interacting with physicians, and (iv) perceived physician expertise. We also predict that those with high levels of WBI would have the strongest relationship between experiences of weight stigma and PPR outcomes.

Methods

We recruited women (N = 1,114) to complete a survey about weight stigma in healthcare, WBI and the previously cited PPR outcomes.

Results

Weight stigma in healthcare and WBI were associated with each of the PPR outcomes when controlling for age, BMI, education, income, race, and ethnicity. The only exception was that WBI was not associated with trust in physicians. The hypothesis that WBI would moderate the effect of weight stigma in healthcare on PPR outcomes was generally not supported.

Conclusions

Overall, this research highlights how weight stigma in healthcare as well as one’s own internalization negatively impact PPRs, especially how autonomous and competent one feels with their provider which are essential for one to take an active role in their health and healthcare.
2229 A review of CT head scans in elderly patients admitted to hospital with falls and adherence to the NICE guidelines.
Authors: Savarimuthu S , Ahmad S , Roka A , Kar S
Published: August 2024

Introduction

Falls remain the leading reason for elderly people to attend emergency department (ED), which in 2023 led to 250,000 hospital admissions in the UK. A seemingly large number of geriatric patients undergo CT head as an initial workup in ED which might not be necessary, especially in minor head trauma. NICE (National Institute for Health and Care Excellence), recommended risk stratification to reduce unnecessary head scanning which may potentially reduce ED length of stay, hospitalisation and medical expense. Our study evaluated the current practice of adherence to NICE guidance on Head Injury: assessment and early management for performing CT head scans in elderly admitted to Basildon hospital.

Methods

Two cycles of retrospective data collection were undertaken across three elderly care wards. Elderly patients admitted with falls who had CT head scans were identified. Indication for scanning were evaluated to determine adherence with NICE guidelines for head injury. Between cycles, formal educational sessions were provided to Junior Doctors by departmental teaching and distributing leaflets/posters explaining NICE guidance for indication of CT head scans in head injury.

Results

Following the interventions implemented, patient compliance to the NICE guidance for undergoing CT head with a history of falls, rose from 77.33% to 93.99%. No significant difference in abnormal CT head findings were demonstrated between cycles. In addition, mortality observed between cycles was near equivalent, 12% and 11.67% respectively. The mean time for CT head scans performed also improved, from 13 hours to 4 hours.

Conclusion

We demonstrated education regarding the indication for CT head scans in elderly with falls improved the appropriateness of scans performed in accordance with NICE guidance. CT head scans performed which more robustly met NICE guidance demonstrated no difference in adverse findings or patient mortality and may have contributed to reduced mean scan time, thus improving resource allocation.
2303 Improving the assessment and management of osteoporosis in a district general hospital
Authors: Darcy B , Rose S , Zonza S , Bloom I
Published: August 2024

Introduction

Over 500,000 fragility fractures occur in the UK each year (1). NICE guidelines state that all women aged ≥65 and all men aged ≥75 should be considered for a fracture risk assessment. It was recognised that locally these guidelines were not being met. The aim of this quality improvement project was to improve the number of patients being assessed for osteoporosis across two medical wards.

Method

This quality improvement project followed two ‘Plan Do Study Act’ (PDSA) cycles. The first cycle involved teaching sessions for junior doctors on using the FRAX tool—a tool recommended by NICE guidelines to estimate 10-year predicted absolute fracture risk. Posters and visual reminders were placed around the wards. The second cycle involved creating a sticker which was placed in patients’ medical records prompting doctors to calculate FRAX scores and document the results. Patients deemed inappropriate for bone protection and patients already receiving bone protection prior to admission were excluded.

Results

A baseline set of data showed that 0% of patients had undergone fracture risk assessment, therefore resulting in no patients being prescribed bone protection or being referred to osteoporosis clinic. Repeat assessment after the first intervention showed 29.7% of patients had undergone fracture risk assessment, 13.5% were prescribed bone protection and 16.2% referred to osteoporosis clinic. After the second intervention, 80% of patients had undergone fracture risk assessment, 10% were prescribed bone protection and 55% referred to osteoporosis clinic.

Conclusion

Use of the FRAX tool was moderately increased by the targeted training of junior doctors and markedly increased by using a visual memorandum in the patient records. This led to an increase in treatment for osteoporosis, reducing patients’ future risk of fragility fractures.

References

1. National Osteoporosis Society. Susan’s story: Osteoporosis 2017. https://www.england.nhs.uk/rightcare/wp-content/uploads/sites/40/2017/02/rightcare-susans-story-full-narrative.pdf
2264 A novel frailty specific same day emergency care (SDEC) score—an initial retrospective validation cohort
Authors: Burgess AJ , James KH , Maddock TB , Burberry DJ , Davies EA
Published: August 2024

Aim

Several scores have been developed to identify SDEC patients from Emergency Department (ED) triage and acute medical intakes. Scores are designed to improve system efficiency, overcrowding and patient experience but none have been developed for older adults. Previous work has shown that existing scores e.g. Glasgow Admission Prediction Score, Sydney Triage to Admission Risk Tool and the Ambulatory Score were not able to predict admission in our population (1). We have developed a novel, frailty-focused score.

Methods

The Older Person’s Assessment service (OPAS) is ED based, accepting patients with frailty syndromes aged >70 years to provide a comprehensive geriatric assessment (CGA) and is extended into medical SDEC. The databases were retrospectively analysed and interactions with age, Charlson Co-morbidity index (CCI) and Clinical Frailty Score (CFS) were evaluated alongside NEWS, 4AT, including who with and where the patient resides.

Results

1011 attendances, 414 (40.9%) Male, mean age 82.3(±8.4) years, CFS 5.3(±1.2) and CCI 8.0(±1.8), 701 (69.3%) discharged same-day and 629 (62.2%) fallers. OPAS: 776 attendances, 306 (39.4%) Male, age 82.4(±8.7) years, CFS 5.3(±1.1) and CCI 7.9(±1.9), 540 (69.5%) discharged same-day, 557 (71.8%) fallers. SDEC: 234 attendances, 108 (46.2%) Male, age 81.8(±8.0) years, CFS 5.2(±1.3) and CCI 8.2(±1.7),162 (69.2%) discharged same-day, 72 (30.1%) fallers. There was significant difference between groups with NEWS (p < 0.02), mortality (P < 0.001) and presenting complaint (p < 0.001). We used a cut-off Score > 6.5 indicating admission (p < 0.0001). Each variable’s weighing was determined using T-tests and Chi-squared analysis. Overall score Sensitivity 0.75, Specificity 0.63, Positive Predictive Value 0.65, Negative Predictive value 0.57, Area under Curve 0.65.

Conclusion

Frailty is an important determinant in identifying whether ambulatory care is appropriate. The efficacy of the score is comparable to the results derived in validation cohorts of existing and recommended scores. We are currently prospectively testing the score but clinical judgement, alongside a MDT providing a CGA is gold standard care.
2330 Community frailty hotline service: an innovative hospital avoidance model for frailer older people in mid and South Essex health
Authors: Aggarwal D , Sweeting M , Kar S , Orpin J , Qureshi A
Published: August 2024

Introduction

Frailty Hotline Service (FHS) was set up initially in January 2021 to provide 24/7 advice and guidance to care home medical staff within the Mid & South Essex Health and Care Partnership footprint as a part of covid response. This was expanded to support GPs, Urgent Care Response Team (UCRT), community hospitals, hospices etc and later established as Community Frailty Hotline Service (FHS) with an aim for hospital avoidance and provide support to frailer older patients in their own places. Later, a Frailty Virtual Ward (FVW) was established to complement FHS within the MSE HCP.

Methods

FHS was led by 5 secondary care consultant geriatricians with direct access to telephone, 7 days service operating from 9 am till 10 pm weekdays and 9 am till 10 pm weekends in 1:5 rota. Unified online portal ‘Netcalls’ was used to directly call consultants. Documentation completed on dedicated Frailty Consultant Hotline Tab on SystmOne to be visible to all care providers. Data-collection automated via Netcall and SystmOne from March 2023 till January 2024.

Results

Average number of call was 487/month, 2098 advices given over 11 months. Referral mostly done by UCRT 1511 (72%) followed by GP 193 (9.19%). Hospital admission avoided in 7 days and 30 days where the advice given in 82.9% and 73.6% cases, respectively. Total bed days saved was 13,920 Cost saving was over six million. Frailty score completed in 2982 cases. FVW referral done in 853 cases (40.6%). Feedback from FVW and UCRT, 95% found FHS was useful.

Conclusion

Our innovative model of FHS with direct access to geriatrician showed a safe and efficient model to support frailer older patients in the community with appropriate signposting to FVW and other community services as an alternative to acute hospital emergency admission and treat the right patient in the right place.
2354 Clinical assessment and documentation of delirium in older patients undergoing vascular surgery: a quality improvement project
Authors: Chand C , McCarthy T , Anthony R
Published: August 2024

Introduction

The Centre for Perioperative Care recommends the assessment and documentation of delirium using a validated tool such as the 4-AT in older people undergoing surgery.

Aim

This quality improvement project (QIP) aimed to improve the assessment and documentation of delirium in patients aged 65 and above following vascular surgery in a tertiary centre.

Methods

Patients aged ≥65 years who had undergone vascular surgery were identified and data was collected with access to the electronic patient record system. Analysis was carried out using Microsoft Excel and SPSS. Following baseline measurements taken in August 2023, 1 plan-do-study-act (PDSA) cycle was completed between September 2023–January 2024.

Baseline measures

Baseline data collected between August 1-31st 2023 identified 51 patients, of which delirium was screened using the 4-AT tool in 39.2% (n = 20), on average 90 hours post-operatively. The 4-AT was never documented in a consultant-led surgical post-operative review (100%, n = 51). There were clinical concerns of post-operative delirium documented in 7 patients, with the 4-AT documented in 5 of those cases.

Intervention

Interventions included stakeholder discussions to identify key barriers in the assessment and documentation of delirium, multidisciplinary team education and poster reminders across the ward. These were introduced between November–December 2023.

Results

Post-intervention results reviewed between 10th-31st January 2024 showed that the 4-AT was used to screen for delirium in 61.9% of patients (n = 13), on average 45 hours post-operatively. The 4-AT was never documented in a consultant-led surgical post-operative review. In addition, 2 patients developed delirium post-operatively with the 4-AT reported in both cases.

Conclusions

This QIP has demonstrated a marked improvement in compliance with national guidelines on the assessment of delirium, highlighting the impact of multidisciplinary education in improving the perioperative clinical pathway for older people undergoing surgery. Future PDSA cycles will focus on improving the documentation of 4AT in the post-operative surgical review.
2341 Qualitative assessment of introducing bone health assessment for Parkinson’s disease patients in a university hospital setting
Authors: Challoner F , Cox C , Richards G , Amar K , Tiwari D
Published: August 2024

Introduction

Parkinson’s disease (PD) patients with or without psychosis are at higher risk of recurrent falls and fracture and, as a consequence, higher mortality and morbidity NICE (13) Henderson et al. (2019). We conducted a qualitative study to understand barriers and facilitators of introducing ‘bone health assessment’ for PD patients.

Method

We conducted a pilot study to identify and implement a bone health assessment tool to communicate falls and fracture risks to GPs. • SWOT and Stakeholder analysis was conducted to identify an appropriate bone health assessment tool. • PDSA cycles were completed to assess barriers and facilitators of bone health assessment in all PD clinical areas. • 4 Participants were identified from all possible PD clinical settings and trained on how to use the FRAX assessment tool. • Semi structured interviews were conducted to explore themes from 6-week pilot study.

Results

Bone health assessments were not conducted routinely in PD clinical settings in our Trust Literature review/SWOT and Stake holder analysis identified ‘FRAX’ score as an appropriate bone health assessment tool for PD patients. Interviews with participants identified time constraints during the clinical consultation as a major barrier to conducting bone health assessment using the FRAX assessment tool. All participants agreed that this improved communication with patients and GPs in understanding bone health and risk of falls and fractures. Face to face PD Nurse Clinics were deemed the most appropriate clinical settings for these assessments.

Conclusion

As a result of this service improvement project bone health is now assessed in all PD Nurse clinics. This has enabled GPs to start the most appropriate bone protection treatment for PD patients.
2317 Geriatrician-led perioperative services: an example of value-based care
Authors: Thorburn M , Liu L , Taylor N , Hodgson L , Redburn C , Thorburn P , Venn R
Published: August 2024

Background

Perioperative services must adapt to the needs of an increasingly older surgical population. Perioperative medicine for Older People undergoing Surgery (POPS) services integrate geriatric medicine teams into surgical pathways to provide quality and cost-effective medical care. This project aims to examine value-based outcomes (clinical and financial impact) of embedding a POPS service at a district general hospital.

Methods

Following a period of implementation on an acute Trauma and Orthopaedic (T&O) ward, a two-week pilot was undertaken. All emergency fragility fracture admissions aged over 65 years with Clinical Frailty Scores (CFS) of ≥5 were included. Patients with hip fractures were excluded. The POPS service provided medical consultation, medicine rationalisation, proactive treatment escalation planning and shared decision making, as well as leading multidisciplinary team meetings. Outcome metrics: geriatric medicine consults, medical emergency team (MET)/cardiac arrest calls, staff/patient satisfaction and clinical coding. The REDUCE trial cost calculator was used to estimate savings.

Results

35 patients were included, mean age 84 years, mean CFS score 7. Ward MET calls and cardiac arrest calls were reduced from a weekly average of 2.5 to 0, and weekly referrals to geriatric medicine reduced from 3 to 0. Experience-based design surveys identified thematic improvements relating to leadership, communication, dignity and respect. Improved quality of documentation resulted in the comorbidity score tariff increasing from £3325 to £6096 per patient. For services introduced by POPS including Comprehensive Geriatric Assessment and delirium assessments, the REDUCE trial cost calculator estimated an additional saving of £2926 per patient totalling hospital savings of £2 million per year (for an estimated 700 patients per year).

Conclusion

Implementation of a POPS service at a district general hospital can lead to cost savings, improved patient and staff experience, and improved clinical outcomes within a sustainable workforce model.
2203 Avoiding therapeutic nihilism in critically ill older adults: a single Centre approach to enhanced care in patients with frailty
Authors: Gavartin M , Jennings C , He F , Pleming J , Steel A , Carr E
Published: August 2024

Introduction

Enhanced care units (ECU) are a novel concept, targeting the gap between ward-level and critical care. They care for patients requiring intensive medical or nursing care, who may not require, desire, or be suitable for, escalation above ward care (Society of Acute Medicine and Intensive Care Society, 2022). The ECU at Barnet Hospital opened in March 2022, and, because of the local population demographic, admits a high number of older patients living with frailty. We aimed to assess the performance of the ECU for this subset of patients.

Methods

A retrospective audit of electronic records of 75 randomly selected patients admitted to ECU between March and August 2023. Data were gathered on Clinical Frailty Score (CFS) at baseline, comorbidity, escalation status, APACHE II illness severity score, and outcome measures.

Results

The majority of patients in the sample, 52 of 75 (69.3%), were over 65 years of age with an average of 69.1 years. Baseline frailty score was high, with a modal CFS of 6. Of these patients, 32 (61.5%) had a DNACPR, and 17 (32.7%) had treatment ceiling at ECU level. Illness severity was similar across CFS groups, with a mean APACHE II score of 15.2 (representing a 25% mortality risk). Overall mortality in the over 65 s was 23.1% (12/52), without significant change when stratified by CFS. Mortality in the under 65 s was 8.7% (2/23).

Conclusions

Acutely unwell patients with frailty may benefit from ECU level care. In our centre, we found no significant increase in mortality linked to a higher frailty score. We suggest that this may represent good case selection by clinicians experienced in working with frailty: admitting patients with more reversibility and targeting therapies towards reversible causes. Limitations remain, especially in assessing illness severity, as the assessment tools are not targeted to this cohort.
2216 Geriatric overactive bladder and botulinum toxin a: feasibility and tolerability in the outpatient setting under local anaesthetic
Authors: Lavigne A , Foley S , Evans K , Yang B
Published: August 2024

Introduction

Urinary incontinence significantly impacts the lives of older adults increasing their susceptibility to falls, social isolation and long term care Intravesical Botulinum Toxin A (Botox) offers a well-established treatment for overactive bladders in women. In select centres, it can be administered under local anaesthetic, allowing access for frailer patients at higher risk from general anaesthetic and in whom anti-muscarinic therapies are best avoided. This project performed an analysis of geriatric patients who underwent intravesical Botox under local anaesthetic in an outpatient setting and assessed the tolerability and feasibility.

Method

50 women (mean age 66, range 34–88) with overactive bladders underwent Botox administration in 2023. The procedure utilised local anaesthesia (Instillagel) while patients held a supine position with abducted hips on an outpatient couch. A LiNA OperaScope and injeTAK® needle facilitated administration. A sub-analysis focused on patients aged 75+. Pain levels were compared to past cervical smear experiences for reference.

Results

All 50 patients successfully completed the procedure. 15 were aged 75+ (mean 80.8, range 76–88), with 8 classified as ‘frail’ based on the Prisma 7 score (mean 2.3, range 0–5). The geriatric cohort reported lower average pain levels (1.8/10, range 1–3) compared to the non-geriatric group (2.2/10, range 1–5). Both groups pain perception was also lower than for past smears (2.9/10, range 1–4 vs. 3.4/10, range 1–7). Total ‘operative’ time was <3 minutes for all patients. Two non-geriatric participants experienced post-procedure UTIs, successfully treated with oral antibiotics (Clavien-Dindo II).

Conclusion

Intravesical Botox under local anaesthesia demonstrated promise as a safe and well-tolerated treatment for geriatric patients with overactive bladder, where lower levels of pain were reported compared to their younger counterparts. Tolerability was also better than previous smear tests and notably offers a relatable and novel comparison point to facilitate clearer counselling for patients and their families regarding this procedure.
2285 Medicines and falls—what does the audience participation indicate about future learning needs?
Authors: Alićehajić-Bečić Ð , Smith H
Published: August 2024

Introduction

On behalf of National Falls Prevention Coordination Group, we were tasked with creating a user-friendly guide on Medicines and Falls. We delivered two sessions on this topic one at British Geriatric Society Conference in November 2022 and another to Specialist Pharmacy Service audience in January 2024.

Method

Audience participation was used in both sessions as part of the discussion on ‘What do you consider important when completing a medication review in a person who is at risk of falls?’ and ‘Which group of medicines do you prioritise for deprescribing discussion in patients at risk of falls?’. The results from slido contribution were analysed for trends and future learning needs.

Results

In the SPS audience, greater level of importance was imparted on individual drug classes when considering question of ‘what is important when reviewing a person at risk of falls’ with anticholinergic burden being quoted most frequently and patient goals being second. Reducing risk and patient goals were the two items which the BGS audience prioritised. In terms of groups of medication to prioritise for deprescribing discussion, SPS audience once again chose anticholinergic medication followed by sedatives while BGS categorised antihypertensives and diuretics most commonly.

Conclusion(s)

When completing falls medication reviews, medication groups were generally thought to be important by pharmacy-focused audience, with patient goals the second most important aspect whilst the BGS audience prioritised reducing risk and patient goals. There should be greater emphasis on managing risk as part of teaching offerings to teams where therapeutics is the core focus. In terms of groups of medications to deprescribe, better guidance around reviewing antihypertensives and diuretics would facilitate more effective falls medication reviews. The difference observed between prioritising anticholinergic burden reduction indicates that general geriatric audience would benefit from further awareness raising of their contribution to falls risk.