bluuebunny/crossref_metadata_2025 huggingface dataset:
Functional vulnerability of liver macrophages to capsules defines virulence of blood-borne bacteria
Authors: An Haoran , Qian Chenyun , Huang Yijia , Li Jing , Tian Xianbin , Feng Jiaying , Hu Jiao , Fang Yujie , Jiao Fangfang , Zeng Yuna , Huang Xueting , Meng Xianbin , Liu Xue , Lin Xin , Zeng Zhutian , Guilliams Martin , Beschin Alain , Chen Yongwen , Wu Yuzhang , Wang Jing , Oggioni Marco Rinaldo , Leong John , Veening Jan-Willem , Deng Haiteng , Zhang Rong , Wang Hui , Wu Jiang , Cui Yan , Zhang Jing-Ren
Published: March 2022

Many encapsulated bacteria use capsules to cause invasive diseases. However, it remains largely unknown how the capsules enhance bacterial virulence under in vivo infection conditions. Here we show that the capsules primarily target the liver to enhance bacterial survival at the onset of blood-borne infections. In a mouse sepsis model, the capsules enabled human pathogens Streptococcus pneumoniae and Escherichia coli to circumvent the recognition of liver-resident macrophage Kupffer cells (KCs) in a capsular serotype-dependent manner. In contrast to effective capture of acapsular bacteria by KCs, the encapsulated bacteria are partially (low-virulence types) or completely (high-virulence types) “untouchable” for KCs. We finally identified the asialoglycoprotein receptor (ASGR) as the first known capsule receptor on KCs to recognize the low-virulence serotype-7F and -14 pneumococcal capsules. Our data identify the molecular interplay between the capsules and KCs as a master controller of the fate and virulence of encapsulated bacteria, and suggest that the interplay is targetable for therapeutic control of septic infections.
Optimization of plotter printing for sub-terahertz metallic metasurfaces fabrication on ultra-thin substrate
Authors: Brulon Cyprien , Fix Baptiste , Salmon Arthur , Bouchon Patrick
Published: March 2022

Additive manufacturing processes have emerged as a promising way to conceive terahertz and millimetric components. In this work, we discuss a printing process for sub-terahertz metallic metasurfaces fabrication on ultra-thin substrates. We demonstrate the use of a plastic substrate with a micrometric thickness which makes this printing method a promising and low cost alternative to conventional optical lithography for the fabrication of flexible terahertz 2D metasurfaces. After detailing the key parameters and limitations, we applied the optimized process to fabricate samples composed of periodic arrays of split ring resonators on 50 µm thick fused silica and 3 µm thick PET substrates. The optical response in transmission of the metasurfaces shows expected resonances in the 100 GHz range and demonstrates the use of microplotter system for rapid prototyping of low-loss terahertz passive components on ultra-thin substrate.
Temperature measurements of long sparks in air using time-resolved moiré deflectometry
Authors: Cheng Chen , He Hengxin , Luo Bin , Liu Lipeng , Chen Weijiang , Bian Kai , Xiang Nianwen , Hu Jinyang
Published: March 2022

This paper presents an original investigation into time-resolved moiré deflectometry (MD) for gas temperature measurements of long sparks in air. In order to perform a rigorous comparative investigation with the widely used quantitative schlieren (QS) method, we set up an orthogonal optical measurement system. The impacts of spatial resolution and exposure time on the measurement accuracy are investigated by comparing the measured radial distribution of the gas temperature and its time evolution during the same spark discharge event. It is found that the time-resolved MD with an exposure time of 1.0 μs can accurately measure the gas temperature evolution during the isobaric heating and relaxation process of long sparks. The measured results of the expansion rate of cross-section

π
⋅

R

g

2

and average temperature T
g confirms that the energy loss is dominated by thermal conduction during the isobaric heating and relaxation process after the extinction of discharge current. The MD can achieve a finer spatial resolution than the QS method, which is beneficial to the reconstruction of steep radial temperature distribution and the suppression of measured temperature fluctuation. Moreover, the MD can obtain a sub-microsecond exposure time by increasing the power of continuous-wave laser source, which shows its potential to capture the rapid changes in gas temperature during the fast-heating process.
Cost-effective method for fabricating carbon nanotube network transistors by reusing a 99% semiconducting carbon nanotube solution
Authors: Jeon Ju Won , Lee Yongwoo , Park Geon-Hwi , Kim Dae Hwan , Kim Dong Myong , Kang Min-Ho , Choi Sung-Jin
Published: March 2022

Carbon nanotubes (CNTs) are one-dimensional materials that have been proposed to replace silicon semiconductors and have been actively studied due to their high carrier mobility, high current density, and high mechanical flexibility. Specifically, highly purified, pre-separated, and solution-processed semiconducting CNTs are suitable for mass production. These CNTs have advantages, such as room-temperature processing compatibility, while enabling a fast and straightforward manufacturing process. In this paper, CNT network transistors were fabricated on a total of five 8 inch wafers by reusing a highly purified and pre-separated 99% semiconductor-enriched CNT solution. The results confirmed that the density of semiconducting CNTs deposited on the five selected wafers was notably uniform, even though the CNT solution was reused up to four times after the initial CNT deposition. Moreover, there was no significant degradation in the key CNT network transistor metrics. Therefore, we believe that our findings regarding this CNT reuse method may provide additional guidance in the field of wafer-scale CNT electronics and may contribute strongly to the development of practical device applications at an ultralow cost.
Quasilinear Schrödinger equations involving singular potentials
Authors: Jing Yongtao , Liu Haidong , Liu Zhaoli
Published: March 2022

For the quasilinear Schrödinger equation

−
Δ
u
+
V

(

x

)

u
+

κ

2

Δ

(

u

2

)

u
=
h

(

u

)

,

u
∈

H

1

(

R

N

)

,

where N ⩾ 3, κ is a real parameter, V(x) = V(|x|) is a potential allowed to be singular at the origin and

h
:
R
→
R

is a nonlinearity satisfying conditions similar to those in the paper (1983 Arch. Ration. Mech. Anal.
82 347–375) by Berestycki and Lions, we establish the existence of infinitely many radial solutions for κ < 0 and the existence of more and more radial solutions as κ ↓ 0. In the case κ < 0, we allow h(u) = |u|
p−2
u for p in the whole range (2, 4N/(N − 2)) and this is in sharp contrast to most of the existing results which are only for p ∈ [4, 4N/(N − 2)). Moreover, our result in this case extends the result of Berestycki and Lions in the paper mentioned above to quasilinear equations with singular potentials. In the case κ ⩾ 0, our result extends and covers several related results in the literature, including the result of Berestycki and Lions.
Effects of linear and nonlinear dashpots forces on the dynamics of plants vibrating in a vegetation cover situation
Authors: Dozounhékpon H F , Koukpémèdji A A , Monwanou A V , Miwadinou C H , Hinvi L A , Chabi Orou J B
Published: March 2022

This paper considers the nonlinear dynamics of the oscillations of an individual plant forced by the fluctuating aerodynamic drag and significantly influenced by collisions with its close neighbors. In this study, a row of identical and flexible oscillators is considered. The flexible beams theory is used to model the equation of motion of an individual plant and then plant collisions were modelled as a simple spring, linear dashpot and nonlinear dashpot interactions between adjacent plants. The multiple scales method is used to obtain the amplitude of the plant relative to wind forcing in the resonant and nonresonant oscillations cases. Numerically, chaotic oscillations, hysteresis and coexistence of attractors have been found using the bifurcation diagram, the Lyapunov exponents and the phase portraits. The influences of both type of dashpot collisions on the dynamics behaviors of the plant have been analyzed.
Energy saving optimization scheduling of intelligent energy station based on beetle antennae searching-particle swarm optimization algorithm
Authors: Xu Yong , Zhang Lingqiao , Yang Huiwen , Lin Zhi , Yu Qian
Published: March 2022

New energy and distributed power generation system of smart energy station need to cooperate with energy storage device to carry out peak cutting and valley filling, so as to meet the requirements of grid connection. Rational distribution of power suppression tasks of batteries and other energy storage components will reduce the generation cost of smart energy stations, protect energy storage devices and prolong their life. In this paper, variational modal decomposition algorithm is used to decompose the difference between the original power and the target power and distribute it to each energy storage unit. In addition to considering the decomposition mode number of VMD algorithm, the size of the secondary penalty factor and the power boundary frequency of the energy storage system, the grid-connected target power is also taken as the quantity to be optimized, which further reduces the requirements on the maximum instantaneous power and capacity of the energy storage system. Simulation results show that the proposed method is effective.
Research on capacity configuration optimization of energy storage system participating in peak shaving
Authors: Zhang Fan , Mao Cui , Zhou Shan , Chen Yuping , Wang Yongli , Tian Hankui , Yuan Bo
Published: March 2022

The “carbon double” goal calls for a further increase in the proportion of installed renewable energy capacity in China. The need to further expand the share of installed renewable energy capacity in China is increasing the need for ancillary peaking of the grid. There is also an ever-increasing need for peaking. The configuration of the energy storage system is one of the effective ways to reduce the peak load of each unit and increase the receiving space for renewable energy. Taking wind power generation as an example, the optimization model of thermal energy storage system is studied, the charging and discharging control strategy of energy storage system is designed, the integrated load impact on the grid due to wind power generation variation is considered, and the optimal economics and wind power generation are sought to maximize the comprehensive benefits.
Operational optimization of integrated energy systems considering demand-side flexibility
Authors: Wang Yongli , Zhou Minhan , Wang Yanan , Cai Chengcong , Han Xu , Chen Xin , Zhao Kunpeng
Published: March 2022

In order to solve the operation optimization problem of integrated energy system considering the demand side, this paper takes the integrated energy system of industrial park as the research object and proposes an optimal scheduling model considering the comprehensive demand response. Algorithm analysis shows that RIES containing multiple energy storage devices fully consider the comprehensive demand side response.
Integrated Energy System Operation Optimization Based on Reinforcement Learning
Authors: Wang Yongli , Dong Huanran , Xu Miaomiao , Cai Chengcong , Yao Suhang , Ma Yang , Li Shuquan
Published: March 2022

Each subject in the integrated energy system has different interests and demands, and it is necessary to optimize the energy dispatching with the help of multi-subject game theory. In order to solve the above problems, this paper proposes a reinforcement learning-based multi-object operation optimization method for integrated energy systems. Firstly, a multi-subject integrated energy system model including energy suppliers, park service providers and users is constructed; secondly, a game search method based on reinforcement signals is proposed to improve the speed of multi-subject game solution; finally, a simulation is conducted with an integrated energy system as an example to verify the effectiveness and rapidity of the proposed method.
Small-signal Stability Analysis of Paralleled Converter System under Power Quality Control Strategy for Microgrid
Authors: Yan Heming , Lin Junjie , Lin Chang , Wang Yang
Published: March 2022

In order to enhance the output voltage stability of converter system under non-linear and unbalanced load conditions, the power quality control strategy based on fault-tolerant control architecture is adopted. By analyzing the principle of power quality control strategy, a mathematical model of parallel converter system is established. The mathematical model of the paralleled converter system is linearized at the steady-state operating point, and the corresponding small-signal mathematical model is established. The small-signal stability of the paralleled converter system under the power quality control strategy is analyzed. The results show that under the power quality control strategy, the output voltage stability of the converter system is improved, and the small interference stability of the parallel converter system is guaranteed.
Comparative investigation of nanoparticles effect for enhanced oil recovery - experimental and mechanistic study
Authors: Li Yuan , Zhou Fujian , Xu Hang , Yu Guolin , Yao Erdong , Zhang Liang , Li Bojun
Published: March 2022

Nanofluid flooding has become one of the advantageous enhanced oil recovery (EOR) techniques due to the transcendental property of nanoparticle. Nanoparticles with various morphology presents different effects and mechanisms of EOR. To provide some guidance on the selection of nanomaterials for flooding, 4 kinds of nanomaterials, including silicon dioxide (SiO2), magnesium oxide (MgO), graphene oxide (GO) and molybdenum disulfide (MoS2), are chosen to serve as research objects in the study. In lab, the morphology of four nanomaterials were systematically characterized by scanning electron microscope (SEM) tests. Moreover, nanofluid flooding experiments were further conducted to explore the relationship between the morphology of nanomaterials and EOR. Results show that the SiO2 was spherical structure, and the MgO was blocky structure, while the GO and MoS2 were both sheet structure. All the four nanomaterials have similar spatial dimensions. Flooding experiments revealed that MoS2 enable improves the oil recovery by approximately 11.53 %, and GO was followed with 10 %, twice as much as both SiO2 and MgO. From the results, it can be inferred that spherical materials only realize “point-to-surface” contact at multiphase interfaces, while sheet materials can achieve “surface-to-surface” contact with a higher interfacial activity. This paper is the first to focus morphology of nanomaterials on flooding, which contributes to the optimization of nanomaterials for high-efficiency oil displacement.
Information system of remote sensing data analysis
Authors: Bakhtina A V , Yuronen Y P , Yuronen E A
Published: March 2022

The information system is designed to solve the problems of analyzing remote sensing data and making decisions using non-parametric pattern recognition algorithms, the synthesis of which is based on kernel estimates of probability density. Initial information is compiled by training samples on the states of the investigated natural objects and their corresponding spectral data, which are presented in Microsoft Excel files. The application of the software provides the following functions: primary processing of remote sensing data to evaluate the main quantitative characteristics of the laws of distribution of random variables; testing of the hypothesis on distributions of multivariate random variables based on non-parametric pattern recognition algorithms; estimating the state of natural objects by spectral data; mapping of territories by state of natural objects based on spectral data of earth surface elements and their corresponding spatial coordinates. Results of the presented functional tasks are saved in the form of reports in graphic files and spreadsheets of Microsoft Excel. Software tools can be used in the study of various nature objects from remote sensing data.
Evaluating the mechanical properties using high beam energy electron energy loss spectroscopy
Authors: Yu Igumenov A , Dudarev A V
Published: March 2022

The electron energy loss spectra of Ge, Si, Cu, MgO, Al, Ni, C (Diamond) were analyzed. The possibility of mechanical parameters of various materials evaluating using bulk plasmon energy in electron energy loss spectra is shown. The bulk modulus of Ge, Si, Cu, MgO, Al, Ni, C (Diamond) is calculated. It is shown that bulk modulus logarithm has a linear correlation with the bulk plasmon energy.
Different approaches for SiO2 inelastic electron scattering cross section spectra dissolving
Authors: Yu Igumenov A , Andryushchenko T A
Published: March 2022

Inelastic electron scattering cross section spectra (Kλ-spectra) of SiO2 were dissolved into bulk-loss and surface-loss components using factor analysis and Tougaard functions approximation. Primary electron energy dependences of various components intensities were received. It was shown that joint using of factor analysis and Tougaard functions approximation allows receiving more reliable results in inelastic electron scattering cross section spectra studies.
Investigation of the stress-strain state for the fuel tank separator
Authors: Klimovskiy D A , Yu Zhuravlev V
Published: March 2022

The work carried out finite element modeling for the thin-walled shell of revolution loaded uniform pressure with using MSC NASTRAN software. The simulations results allow us to study the stress-strain state of the torus rolling zone for refine the boundaries of plastic deformation. It is determined that the region of plastic deformation does not arise in the entire torus zone. This region is limited by the outer part of the torus along the generatrix edges.
Engineering of GIS for environmental monitoring of mining landscapes
Authors: Yuronen Y P , Bakhtina A V , Yuronen E A
Published: March 2022

Features of GIS design, designed to monitor the state of disturbed lands at open mining facilities, natural and climatic conditions in the mining area, are considered in order to inform the adoption of administrative and management decisions. The introduction of such systems will make it possible to carry out operational environmental monitoring of lands subject to technological violations, reduce the time for preparing reporting and technical documentation when designing and conducting measures aimed at land reclamation, make decisions on the technology and timing of reclamation of subsoil use facilities, and also reduce the time for making such decisions.
Model predictive and fuzzy logic controllers for reactor power control at Reaktor TRIGA PUSPATI
Authors: Sabri Minhat Mohd , Adilla Mohd Subha Nurul , Hassan Fazilah , Rashid Husain Abdul , Ahmad Anita
Published: March 2022

The Reaktor TRIGA PUSPATI (RTP) rely extensively on a core power control system for control reactivity to fulfilment the fundamental safety function for a nuclear reactor. It is technically challenging to operate within tight multiple parameter constraints and keep the core power output stable. At present, the power tracking performance of the system could be considered unsatisfactory which produces a relatively long settling time and high control effort. Hence, a study of a model predictive control (MPC) strategy by integrating the current Power Change Rate Constraint (PCRC) using fuzzy logic which is part of the core power control design is conducted. In this paper, the MPC design based on mathematical models of the reactor core included point kinetics model, thermal-hydraulic model, reactivity model and dynamic rod position model help to enhance core power control. The power tracking performance of the proposed control method and previous Feedback Control Algorithm-Fuzzy PCRC is compared via computer simulation with different power range operations. Overall, the results show the MPC-Fuzzy PCRC strategy provides a greater level of operational safety and optimum operation of the TRIGA reactor.
A comparative photon shielding properties of protective Window materials by using EGS5 code
Authors: Mamat Nurhakimah , Mohamad Tajudin Suffian , Hanim Aminordin Sabri Adila , Faddilah Mohd Noor Arif , Norizan Nursyafika , Zahri Abdul Aziz Mohd
Published: March 2022

For an X-ray room, there is a special window for radiation workers to monitor the patient during an irradiation procedure. Lead glass commonly used as protective window materials for diagnostic X-rays even it is known for its toxicity due to the lead oxide in the air which could be inhaled either during manufacturing or recycled process. Monte Carlo simulation (EGS5 code) was used to study several other types of available protective windows for its radiation shielding efficiency. In this study, the practicability of acrylic glass, plate glass and Pyrex glass systems with respect to lead glass were studied for protective window materials. The photon attenuation coefficients (μ), the percentage of transmitted and reflected photon energy spectra and half-value layer (HVL) were investigated by using simulation. Three photon source energies of 59.5 keV, 150 keV, and X-ray 150 kVp were calculated via EGS5 code to study the capability of these four glass systems as low energy photons radiation shielding materials. A thickness of 7 cm plate glass, 8 cm pyrex glass and more than 10 cm acrylic glass are adequate as a non-lead shielding material for 150 kVp X-ray to have a similar lead-glass equivalency. The use of plate glass as radiation protecting material to replace lead glass can reduce expenses as plate is way cheaper than lead but the increase thickness of plate will need special framing and concerns of its increased weight needs to be considered. However, given that the X-ray primary beam will not be directed towards the protective windows, therefore the findings are appropriate, with less thickness of plate glass could be used.
Physical properties of polyvinyl alcohol (PVAL) gel materials as phantoms for mammography
Authors: Oyiwoja Okoh Franca , Fahmi Mohd Yusof Mohd , Ahmad Kabir Norlaili , Nor Azizah Abdullah Siti
Published: March 2022

This study evaluates the possibility of using polyvinyl alcohol (PVAL) composites as phantom material to simulate different densities of breast tissue for mammography based on their elastic properties. Three categories of PVAL gels were prepared by freezing and thawing 10 % water based PVAL (PVAL), ethanol and water based PVAL (PVAL/E) and a blend of PVAL with graphite powder (PVAL/G) solutions to mimic various breast densities. Young’s modulus (YM) of all samples was evaluated by puncture test using the texture analyser. The results recorded ranged from 0.93 to 4.79 kPa for all samples. The results indicate that the PVAL based phantoms examined could be used to simulate fatty and dense breast tissues based on the values of their densities and YM.
On the role of surface carbonate species in determining the cycling performance of all-solid-state batteries
Authors: Strauss Florian , Payandeh Seyedhosein , Kondrakov Aleksandr , Brezesinski Torsten
Published: March 2022

This short perspective summarizes recent findings on the role of residual lithium present on the surface of layered Ni-rich oxide cathode materials in liquid- and solid-electrolyte based batteries, with emphasis placed on the carbonate species. Challenges and future research opportunities in the development of carbonate-containing protective nanocoatings for inorganic solid-state battery applications are also discussed.
675 IMPROVING RECOGNITION OF DELIRIUM IN CRITICAL CARE PATIENTS
Authors: Meakin O , Young N , Woods S , Sherwin T
Published: March 2022

Introduction

Delirium is more prevalent in patients admitted to the critical care environment, those over 65 years old and living with frailty. By increasing the recognition of delirium we can improve management of patients and therefore reduce associated morbidity. Initial audit of this patient group highlighted that we are missing opportunities to screen for, diagnose and document the presence of delirium. This Quality Improvement project aimed to improve delirium screening, and therefore recognition, on the critical care unit at The Royal Bolton Hospital.

Method

A retrospective analysis of patients aged ≥65 years or with a CFS ≥5 admitted to critical care at The Royal Bolton Hospital over a 2-week period for each PDSA cycle. Three cycles were undertaken. The initial intervention was a local teaching session for medical and nursing staff on critical care. The second intervention was to display delirium information posters throughout critical care which encouraged recognition and screening of delirium.

Results

Prior to intervention 9% of this patient group were assessed for delirium on admission to critical care and 55% were re-assessed at some point during their admission. After the initial intervention these numbers significantly improved to 33% and 80% respectively. After the second intervention 8% were screened on admission and 69% were re-assessed. Missed opportunities to document delirium as a diagnosis remained similar throughout all cycles.

Conclusion

We can improve delirium screening via regular educational sessions for medical and nursing staff on critical care. Information posters do not appear to have as much impact. There is scope to improve documentation of delirium as a diagnosis which would further aid in management and outcomes. We suggest a further PDSA cycle with an intervention to address this.
685 HOSPITAL @HOME: TREATING SEVERE COVID-19 IN THE COMMUNITY
Authors: Quinn M , Walters S , McEnhill P , Oyston M , Schiff R
Published: March 2022

Introduction

Patient numbers during the second wave of COVID-19 threatened to overwhelm hospital capacity. Hospital @home services bring the ward to the patient; providing acute care in the home, delivered by a specialised multi-disciplinary team. Our Hospital @home was ideally placed to adapt to support the care of COVID patients in the community who would otherwise have required hospitalisation yet were unlikely to benefit from level 2/3 care. Here we report on the process and 30 day outcomes.

Methods

An evidence-based guideline for the treatment of severe COVID by Hospital @home was developed. A severe bundle pack including dexamethasone, oxygen, IV fluids and thromboprophylaxis was used at first patient contact. Patients were referred from the community or from hospital and streamed into severe or non-severe pathways. Outcome data was retrospectively extracted from the notes of all COVID positive patients admitted to hospital @home between 16/12/2020 and 14/02/2021.

Results

125 COVID patients were treated by hospital @home. Patients were triaged by infection severity: severe (n = 42, 34%) and non-severe (n = 83, 66%). Average length of stay with hospital @home was 6.8 days (IQR 4–8); equivalent to 855 occupied bed days—i.e. one 28 bed ward for 30.5 days. 33 patients were treated with the severe COVID bundle with an average Clinical Frailty Score 6.9 (IQR 6–8). 30 day outcomes for patients treated with the severe bundle were: 13 (39%) alive in the community (average CFS 6.2), 1 (3%) in hospital and 19 (57%) deceased (average CFS 7.4).

Conclusion

Rapid redesign of an existing hospital @home service during the COVID pandemic offered appropriate patients the choice to have Level 1 hospital care in their home. Hospital @home has an essential role in offering alternative pathways of care to patients and optimising local healthcare capacity.
695 QUALITY IMPROVEMENT PROJECT ON TRANSFER TIMES OF ACUTE HIP FRACTURE PATIENTS FROM ED TO INPATIENT BED POST SIMULATION TRAINING
Authors: Clancy C , Mahony R , Donegan M , Meighan V
Published: March 2022

Introduction

The care of patients with hip fractures is a surrogate marker of trauma care. Irish hip Fracture Standard (IHFS) 1 involves patients with a hip fracture being admitted to an orthopaedic ward bed within 4 hours of attending the ED. We wanted to audit our current practice and introduce a quality improvement project to improve the timeliness and efficiency of care of our hip fracture patients compared with the gold standard IHFS 1. We introduced a 90 minute multidisciplinary simulation training programme on the hip fracture pathway to our ED in February 2021. All key stakeholders were represented; from Emergency Medicine, Orthopaedics, Nursing (EM and Orthopaedic), Radiology, Radiography, Porters (32 people overall). Because of covid-19, the training was available in person and online via zoom.

Methods

We performed a retrospective audit of patients presenting to TUH ED with a proximal third of femur fracture between 4th February and 31st March inclusive in 2020 and 2021, pre and post introduction of multidisciplinary simulation based medical education on the hip fracture pathway. Data was collected from the electronic record database (symphony). We recorded the following data;

Results

2020 n = 31 Average time to ward—8 hrs 29 mins. 26% patients reached ward <4 hours. (8/31) 2021 n = 25 Average time to ward—5 hrs 58 mins (32% reduction vs 2020) 72% patients reached ward <4 hours. (18/25) (46% increase vs 2020).

Conclusion

Simulation based medical education is a successful intervention to improve compliance with our hip fracture pathway, time from presentation to transfer to an orthopaedic ward bed and achieve IHFS 1.
715 REDUCING OVERTREATMENT OF TYPE 2 DIABETES IN OLDER PEOPLE LIVING IN CARE HOMES
Authors: Samarasekara N , Dinsdale E , Taylor S , Sulaiman M , Gittens A , Ahmed E , Jain A , Tang M , Ninan S
Published: March 2022

Introduction

Older people in care homes living with frailty are less likely to benefit from tight glycaemic control in the management of type 2 diabetes with increased risk of adverse effects for example hypoglycaemia, falls and hospital admission. We wished to ascertain the scale of the problem and reduce overtreatment. We defined overtreatment based on American Diabetes Association guidelines as being on an agent that can cause hypoglycaemia and having an HBA1C of ≤53 mmol/mol or, an HbA1c 53–64 mmol/mol with either three or more co-morbidities.

Methods

In 2016, we audited the management of type 2 diabetes in older people discharged from LTHT to care homes. We discussed our concerns with diabetes and geriatric medicine colleagues across medical, nursing and pharmacy disciplines. We engaged the support of the citywide diabetes network which comprises secondary care colleagues, general practitioners and pharmacists. We presented the findings of our initial audit to colleagues within primary and secondary care through departmental meetings and citywide network meetings. We wrote a new guideline, specifically for frail older people that was disseminated citywide through these networks. We re-audited in 2020.

Results

In total, 113 cases were reviewed in 2016 and 105 cases in 2020. In 2020, only 6% (6 patients) were overtreated compared to 38% (43 patients) in 2016.

Conclusions

There has been a marked reduction in overtreatment which should result in less adverse events. We believe the reasons for success lie in wide engagement of relevant stakeholder groups around an issue that is important, large in scale and meaningful to both patient and clinician. There are potential cost savings from reducing medications and reducing harm.
729 INCORPORATING PATIENTS’ VIEWS IN THE DESIGN OF AN EDUCATIONAL LEAFLET FOR FRAIL, OLDER PATIENTS WITH KIDNEY DISEASE
Authors: Ryan L , McNicholas J , Beckwith H ,   Kidney Care UK, Brown E A
Published: March 2022

Introduction

There are an increasing number of older people live with advanced kidney disease. These individuals tend to have a higher number of co-morbidities, including frailty. This group experience multiple challenges in understanding and managing their co-existing conditions. This quality improvement project aimed to incorporate patient and carers views and experiences to improve their understanding and support self-management.

Method

Semi-structured interviews were conducted with older patients with advanced kidney disease and their carers. Interviews explored their views on ageing and frailty, how it affects them, coping strategies, resource awareness and opinions on structure and content for an educational leaflet for older people with kidney disease. The interviews were transcribed verbatim then coded into themes to inform key topics for the leaflet. These were used to generate reader-friendly questions and answers. The leaflet was reviewed and approved by the Clinical Committee and Patient Information Board in Kidney Care UK.

Results

10 individuals (8 patients and 2 carers) were interviewed. Patients were aged 62–88 years. Three were receiving haemodialysis, two peritoneal dialysis, two had a kidney transplant and three attended the advanced kidney care clinic. The five most common codes identified were ‘physical exercise’, ‘losing abilities’, ‘mobility’, ‘prevention and safety’ and ‘medical problems’. Themes identified were 1. Mood and memory, 2. Mobility and medical problems, 3. Self-help and supports, 4. Determination, 5. Impact on self and other. The leaflet title was chosen by patients and carers. Figure 1 shows the completed, published leaflet.

Conclusion

This quality improvement project used semi-structured interviews with older patients and carers affected by advanced kidney disease. The main issues they identified in relation to getting older with kidney disease were included in an educational leaflet. Partnership with Kidney Care UK has made the leaflet available across the UK. We hope it will directly address their everyday concerns.
740 ASSESSING THE IMPACT OF A DEDICATED FRAILTY MULTIDISCIPLINARY TEAM TO DELIVER A PROACTIVE VIRTUAL COMPREHENSIVE GERIATRIC ASSESSMENT
Authors: Conlon K , Harris E , Spiers E , Coleman H , Gallifent R , Farnsworth M , Chan C S
Published: March 2022

Introduction

Surrey Downs Health and Care (SDHC) is an innovative partnership between acute and community providers, local general practitioner (GP) federations and adult social care. The NHS Long Term Plan emphasises the importance of ageing well and supporting people living with frailty by improving integrated proactive services in the community. To achieve this, SDHC collaborated with local Primary Care Networks (PCNs) to develop a frailty multidisciplinary team (MDT) to deliver proactive virtual Comprehensive Geriatric Assessments (CGA).

Method

A monthly frailty MDT meeting was introduced across two PCNs. MDT members included a geriatrician, GP, frailty nurse, community matron, district nurse, therapists, social prescriber, paramedic practitioner and social worker. A reactive-proactive model was utilised; patients over 65-years-old already referred to the community teams were proactively screened for frailty and scored using the Clinical Frailty Scale (CFS). Patients that scored 6 and above were discussed at the MDT and a virtual CGA completed.

Results

151 patients were referred for MDT discussion over eight months. Patients had a mean age of 86 years and a modal CFS score of 6. In the 8-weeks following MDT discussion compared with the 8-weeks prior, patients attended 11% fewer GP consultations, a 9% decrease in community visits and 30% fewer emergency department (ED) attendances.

Conclusion

The implementation of a dedicated PCN frailty MDT who conducted proactive CGAs reduced patient attendance to ED and resulted in fewer consultations with community services. This success has led to a system wide implementation of the model to the other local PCNs.
763 QUALITY IMPROVEMENT PROJECT (QIP) ON IMPROVING THE USE OF THE CLINICAL FRAILTY SCALE (CFS) DURING THE COVID-19 PANDEMIC
Authors: Wijayaratne P , Vijay A , Shah A , Ene M
Published: March 2022

Introduction

Older people were disproportionally affected by the COVID-19 pandemic resulting in a surge in the demand for healthcare resources. The aim of this QIP was to assess and improve the compliance of using the CFS in patients over the age of 65 with COVID-19 to aid in establishing appropriate Treatment Escalation Plans (TEPs) during admission.

Method

Prospectively, clinical notes of 80 patients were reviewed to calculate the compliance of documenting the CFS on admission. Multiple Plan-Do-Study-Act (PDSA) cycles were implemented. As the first intervention, a trust-wide email message was sent to all medical doctors highlighting the importance of assessing CFS in all patients during admission. Also, reminder emails and text messages were sent to all medical doctors’ WhatsApp groups. As the second intervention, we designed an e-poster and displayed it as a screensaver on all trust computers for 2 weeks. Data was collected and analysed after each intervention.

Results

The baseline audit showed that only 42% of patients had a CFS documented during admission. The majority (55%) had a CFS above 5 and 93% of the patients had a ‘Do Not Attempt Cardiopulmonary Resuscitation (DNACPR) order in place. Compliance in assessing CFS after the two interventions was 65% and 68% respectively. In both cycles, all patients who had a CFS of 5 and above had DNACPR decisions in place. Moreover, significant variability in escalation plans was noted when the CFS was 4.

Conclusion

The compliance in assessing CFS progressively improved with each intervention. Although the CFS is a valuable tool in assisting TEPs, it should be treated as a spectrum that is independent of age, rather than a binary phenomenon. We hope to further improve compliance by arranging teaching sessions for doctors in our hospital and thereby ensure appropriate TEPs are in place.
812 GERIATRIC PERIOPERATIVE CARE IS ASSOCIATED WITH REDUCED LENGTH OF STAY IN UROLOGY PATIENTS
Authors: Parry F , Rideway A , Ibitoye S , Nitharsan R , Grange R , Braude P , Warren K , Shipway D
Published: March 2022

Introduction

Comprehensive Geriatric Assessment (CGA) is associated with reduced length of stay and perioperative complications in older orthopaedic, gastrointestinal and vascular surgical patients [1,2,3]. Limited published data from a single UK centre [4] reports reproducing these outcomes in a urological setting. It is unclear whether these outcomes can be repeated in other urological centres.

Method

We piloted a Geriatric Perioperative Care service delivering CGA to older emergency urology patients admitted to within a tertiary centre. The aim of the service was to reduce length of hospital stay (LOS). We evaluated it using quality improvement methodology. Patients for review were identified using age ≥ 65 and the Clinical Frailty Scale. Patients that were transferred to another hospital team prior to discharge were excluded.

Results

101 patients were included: 35 in the pre-intervention group and 66 in the post-intervention group. Mean LOS in the pre-intervention group was 7 days. In the post-intervention group, mean LOS was reduced to 3.5 days, 6 days and 5.5 days in the first, second and third months respectively.

Conclusion

We found that perioperative geriatric care was associated with reduced length of stay in older urology patients. These data would support the need for larger and/or multicentre studies to evaluate the relationship between geriatric intervention in urological inpatients and length of hospital stay. References: on request due to word count.
817 AVOIDING THAT SINKING FEELING: A QIP TO IMPROVE THE IDENTIFICATION OF POSTURAL HYPOTENSION ON A MEDICINE FOR THE ELDERLY WARD
Authors: Gilmartin C G S , Peacock M , Coultas J , Alavi N , Long S
Published: March 2022

Background

Postural hypotension contributes significantly to falls in frail older people. The RCP recommend that all inpatients >65 years have a lying and standing blood pressure (L&SBP) performed early. We recognised that there was a need to improve the understanding, measurement and consistency of documentation for L&SBP on our ward, a 20-bedded acute MFE ward with many patients at risk of falls.

Methods

This project incorporates two PDSA cycles with three data collection points. We began with baseline measurements of the proportion of patients with: 1) L&SBP recorded within two working days of arrival 2) BP recorded at 1 and 3 minutes, and 3) documentation of associated symptoms. Patients were excluded where it was not possible or appropriate to perform L&SBP. We then carried out a qualitative questionnaire to understand the barriers for staff performing L&SBPs and potential solutions. Our first intervention was to design and deliver a teaching session to all nurses and health care assistants. After re-audit, we created a poster highlighting guidelines for measuring and documenting L&SBPs, and reinforced the learning at MDMs We reviewed the notes of all eligible patients on the ward before and after each intervention.

Results

Our questionnaire revealed useful insights including time constraints and uncertainty of where to document results—these findings allowed us to develop bespoke training for our team.

Discussion

This project demonstrates that junior doctor-led teaching and working with MDT colleagues improves the identification of postural hypotension on a ward. Reinforcement of learning is important.
776 INTRODUCING TREATMENT ESCALATION PLANS (TEP) FOR OLDER PERSONS: RESPONSE TO THE COVID-19 PANDEMIC
Authors: Woolford S J , Patel H P
Published: March 2022

Introduction

TEP detail appropriate ceilings of care and guide treatment of patients based on shared decision making. TEP documentation was not standard within our trust up to 2018. We aimed to design and introduce a standardised TEP proforma and evaluate its use in older persons aged ≥80.

Methods

Data was obtained from patient notes and questionnaires within the Medicine for Older Persons department (MOP) from four PDSA cycles between 2018–2020. Cycle 1 was a service evaluation. Based on this data, a TEP form was created and approved for use in all adult patients. Cycles 2, 3 and 4 evaluated TEP after introduction of the proforma.

Results

There was a 239% increase in TEP after introduction of the proforma, compared to baseline (cycle 1: n = 14/47 [29.8%], cycle 2: n = 17/112 [15.2%], cycle 3: n = 30/97 [30.9%], cycle 4: n = 42/59 [71.2%]). The increase in TEP between cycles 3 and 4 coincided with the COVID-19 epidemic. Clinicians were more confident in actioning TEP based on the proforma, compared to those written in the notes (cycle 2: 83% confidence vs 54%, cycle 3: 100% vs 35%, Cycle 4: 98% vs none written in the notes). An improvement in understanding the purpose, comprehensiveness and location of TEP forms was observed. Feedback suggested TEP provided clear guidance for 1. ceilings of care; especially useful out of hours 2. discussions with critical care and 3. patient handover between staff and successive shifts.

Conclusion

TEP forms offer clear guidance on ceilings of care. Introduction of the TEP proforma has led to more frequent and proactive discussions with patients on ceilings of care and have facilitated a culture change in the management of older persons. Use of the forms increased during the COVID-19 pandemic but are now viewed as an essential component of patient safety and have been successfully implemented trustwide.
759 RELATIONSHIP BETWEEN G8 AND CFS IN A COHORT OF LUNG CANCER PATIENTS REFERRED TO A SPECIALISED ONCO-GERIATRIC CLINIC
Authors: Dunnett-Kane V , Ayrton L , Ng C
Published: March 2022

Introduction

The International Society of Geriatric Oncology recommends using screening tools to identify cancer patients who would benefit from a comprehensive geriatric assessment. G8, a tool specifically designed for oncology, has been well validated in this setting (1). Rockwood Clinical frailty score (CFS) is a widely used tool to assess frailty, and has been adopted into standard assessments at many sites (2). However, this tool is less well validated in patients with cancer.

Methods

In this single site observational study we recorded CFS and G8 in 89 patients with lung cancer referred to a local onco-geriatrics clinic between 21/10/20 and 5/2/21. Both scores were available for 82 patients. We aimed to measure the correlation between G8 and CFS in this cohort.

Results

G8 score ≤ 14 is a referral criteria for the clinic, therefore 100% (82/82) of patients were classified as ‘frail’ using G8. Of these, only 23.2% (19/82) were classified as ‘mildly frail’ or worse using CFS (scores ≥5). Using Spearman’s rank correlation we found a very weak/negligible negative correlation between CFS and G8 (−0.2519, p = 0.0224).

Conclusion

The small proportion of patients (23.2%) classified as frail by CFS suggests that a G8 cut off of 14 may overestimate frailty. Previous work by our group has found that using a cut off of 13 is better able to predict chemotherapy outcomes(3). However, considering the lack of evidence for CFS in oncology, this poor correlation between G8 and CFS may question the usefulness of CFS in this context. (1) Decoster L, Puyvelde K, Mohile S, et al. Ann Oncol. 2015 Feb; 26(2): 288–300 (2) NHS Elect. [Online].; 2018 [cited 16/2/21] (3) A. Tivey, M. Ullah, A. Beech, et al. J Geriatr Oncol. 2020 Mar; 11(7).
801 EFFECTIVENESS OF HEARING REHABILITATION FOR CARE HOME RESIDENTS WITH DEMENTIA: A SYSTEMATIC REVIEW
Authors: Cross H , Dawes P , Hooper E , Armitage C J , Leroi I , Millman R E
Published: March 2022

Introduction

Hearing loss is common among people with dementia living in long-term care homes, leading to poorer quality of life, communication difficulties and exacerbated dementia-related symptoms. Hearing rehabilitation may improve outcomes; however, evidence suggests hearing is poorly managed in care homes.

Methods

A systematic review reporting on the effectiveness of, and barriers and facilitators to, hearing rehabilitation for residents with dementia was conducted. No restrictions on publication date or language were set and grey literature was considered. Eligible studies were critically appraised and presented via a narrative review.

Results

Sixteen studies, most of low-to-moderate quality, were identified. Hearing rehabilitation, including hearing devices, communication techniques and visual aids (e.g. flashcards), were reported to improve residents’ communication, quality of life and reduce agitation, with improvements in staff knowledge of hearing loss and job satisfaction. Residents’ symptoms of dementia presented barriers, e.g. losing or not tolerating hearing aids. Low staff prioritization of hearing loss due to time-pressures and lack of hearing-related training for staff were further barriers, particularly for residents who required assistance with hearing devices. Adopting a person-centered approach based on residents’ capabilities and preferences and involving family members facilitated hearing device use.

Conclusions

Residents with dementia can benefit from hearing rehabilitation. Identifying and implementing efficient, individualized hearing rehabilitation is necessary for those with complex cognitive needs. Increased funding and support for the social care sector is required to address systemic issues that pose barriers to hearing rehabilitation, including time-pressures, lack of training for staff and access to audiology services for residents.