bluuebunny/crossref_metadata_2025 huggingface dataset:
Effect of thermal exposure on the microstructure and mechanical properties of Ti60 alloy
Authors: Yu Y Y , Liu C M , Song T J , Wang J , Kang K , Yan P F
Published: January 2024

The effect of thermal exposure on the microstructure and mechanical properties of Ti60 alloy was investigated in the present study. Meanwhile, the fatigue fracture microscopic appearance characteristics at elevated temperature were analyzed compared, providing the basis to further improve the performance of the series of high temperature titanium alloy. The results show that the yield strength and tensile strength were basically stable under long-term thermal exposure below 600°C, while the elongation decreased with the increase of exposure temperature. Thermal exposure below 800°C did not change the microstructure type of Ti60 alloy, but at higher temperature local β coursing occurred at the grain boundary. When the alloy was exposed above 600°C, Si was obviously concentrated in the grain boundary region, and the maximum concentration was up to 2.5%. With the increase of thermal exposure temperature, the characteristics of high-temperature fatigue fracture of Ti60 alloy change from trans-granular toughness to intergranular brittleness.
An Application of Feedback Linearizing Controller with Disturbance Observer for DC Motor Real-Time Speed Control
Authors: Prasanthi Achikkulath , Shareef Hussain , Asna Madathodika
Published: January 2024

The main objective of this paper is the hardware implementation of robust speed and torque control of DC motors. The proposed speed controller is a feedback linearizing controller (FLC) with a disturbance observer (DO). The designed control circuit can withstand non-linearities of the system and other unpredictable disturbances. In addition, the exact mathematical modelling of the controller is used and thus the system can be easily reproduced to any higher rating. The converter used to interface the DC motor is a bi-directional H bridge converter that can supply and accept power at any voltage conditions. The developed system is experimentally tested under different case studies of motoring and regenerating conditions. From the results, it is verified that the objective is met, and the designed prototype system can work accurately to follow the speed and load torque. The designed system can be used for variety of industrial applications including electric traction, robotics, and various fixed as well as variable speed electric drives.
Investigation of the technical potential of a hydrogen powered phosphoric acid fuel cell (PAFC) for CHP
Authors: Biebl M , Roes J , Hoster H
Published: January 2024

Due to the fluctuating feed-in of renewable energies, controllable power plants such as highly efficient CHP plants (combined heat and power) will continue to be required to cover the residual load. Gas engines and turbines currently dominate the natural gas-based CHP market due to their low investment costs and acceptable electrical efficiency. In the event of a future fuel switch due to the energy transition from natural gas to hydrogen, fuel cell systems are becoming increasingly important due to their very high efficiency and improved dynamics in hydrogen operation and can therefore represent an alternative to gas engines and turbines. In addition to a possible fuel switch, good dynamic and full heat utilization represents an additional challenge for CHP systems. Therefore, this study aims to investigate the influence of a fuel switch from natural gas to hydrogen on the operation of a fuel cell (PAFC) in terms of efficiency, heat utilization and dynamics. It was shown that the electrical efficiency of the hydrogen-operated PAFC is significantly higher than in natural gas operation due to the omitted reformer and the associated reformer losses. In hydrogen operation, there is also no limitation of the dynamics by the reformer. Furthermore, in hydrogen operation there is a more favorable ratio of high-temperature to low-temperature heat, which facilitates the use of heat. Detailed and validated simulation models in Aspen Plus are used as the basis for this investigation.
Design and simulation analysis of 130 KWp grid-connected solar PV system using PVsyst: A case study in Egypt.
Authors: Moustafa M. , Mahmoud M. , Akef S. , Swillam M.
Published: January 2024

This paper presents a feasibility study using a PV system grid-connected photovoltaic design that satisfies a 130 KWp grid’s electrical needs for a local factory in Al Obour City, Egypt (Coordinates 30.19373, 31.44213). This system has been mounted on a fixed tilt mounting structure. The system comprises a photovoltaic array to capture solar energy. The modeling is accomplished by evaluating the required load and selecting and deciding the proper specifications of the components inherent in the system. Several constituents, such as the geographic area, atmospheric condition, solar irradiance, and load consumption, are analyzed and discussed for the whole work. The system produces 212.7 MWh each year. The cost of the system can be enhanced by variable system parameters such as net present one, initial capital one, energy cost, and operating expense. Further, the techno-economic analysis of the suggested system has been performed using PVsyst simulation software. The simulated results reveal that the proposed model meets the load demand, reducing the monthly bill by ~20 %. The PVsyst proves an easy, speedy, accurate, dependable, well-grounded software tool for the simulation of the solar PV system.
Failure analysis of low-pressure steam superheater in a purification device
Authors: Song Ce , Li Xiaowei , Din Zhihui , Zhu Zhengwei , Du Chenyang
Published: January 2024

For a coal chemical enterprise purification unit in the low-pressure steam superheater in the use of frequent occurrence of heat exchanger tube bundle cracking, to find the cause of failure and ensure the safe and stable continuous operation of the device, the failure analysis work shall be carried out. In this paper, we have examined the cracked heat exchanger tube bundle in terms of macroscopic inspection, material chemical composition analysis, mechanical properties analysis scanning electron microscopy analysis, corrosion product analysis, metallurgical analysis, and many other tests, and also analyzed the internal and external media of the tube bundle, ultimately concluding the main reason for cracking of heat exchanger tube bundle for the alkali stress corrosion cracking. At the same time, to avoid similar problems, we hope that the failure analysis of the use and maintenance, inspection, and testing of the equipment provides a good solution to the failure of the equipment, and provides the best solution to the problem. It is hoped that this failure analysis will provide valuable experience for the use and maintenance of this type of equipment.
Failure analysis of large and complex engine blades based on experimental research
Authors: Chen Li , Feng Yanpeng , Ding Keqin
Published: January 2024

On a certain day in December 2022, a GE90 engine equipped by an airline experienced a surge during flight. Ground inspection revealed broken blades of the 9-stage high-pressure compressor. To identify the cause of its fracture failure, the macroscopic fracture surface was first analyzed. Obvious fatigue crack propagation characteristics were found at the blade cross-section. Small pits formed by the impact were observed at the crack source location, indicating that the blade was first formed into a circular arc-shaped impact wound after being impacted by an external object. In the subsequent service process, under continuous vibration, fatigue cracks are formed at the impact point as the crack source and gradually propagate, ultimately leading to blade fracture and failure. To further explore the source of foreign objects causing impact damage, the surface scanning method using energy spectrum analysis was used. An enriched region of C element was found near the impact point. However, due to the lack of conditions for the formation of C combustion products at the compressor location, it can be considered that the foreign object may have come from external sources.
Experimental study on stress relaxation of rubber O-ring for mechanical seal
Authors: Jin Liang , Che Liangda
Published: January 2024

The stress relaxation process and its variation law under multiple stresses have an important impact on the performance of rubber O-rings. An O-ring experimental device was developed, the end contact forces of the O-ring under the conditions of the single and multiple stresses were tested, and the contact force retention rate was calculated based on the test results. The change processes and laws of the end face contact force and the retention rate were obtained by the analyses of the experimental data under the different impact factors. The experimental results indicated that the compression ratio of the O-ring can increase the end contact force, but the greater compression ratio results in greater attenuation of contact force and longer attenuation time. The medium temperature hurts the contact force retention rate, and the medium pressure is conducive to stabilizing the contact force retention rate.
Research of influencing factors on tripping speed of double plungers turbine overspeed protector
Authors: Jiang Haicheng , Wang Decheng , Cheng Peng , Shao Chenxi , Zhang Jianghong , Jiao Hongchao
Published: January 2024

The over-speed protection mechanism is very important for the safe operation of the steam turbine, but in actual production, the tripping speed often fluctuates and deviates from the set value, resulting in a decrease in the reliability of the unit operation. In this paper, the factors that affect the tripping speed of double plungers turbine overspeed protection mechanism are analysed, the mechanism of mechanical vibration and friction that cause the tripping speed to fluctuate is explored through theoretical calculation and simulation analysis, and the change of spring dynamic stiffness by using the dynamic stiffness matrix method and finite element simulation is analysed. The change of friction force under different contact modes is calculated by using the L-N contact force model and the modified Coulomb friction model, and the change of tripping speed under non-ideal friction conditions is explored through dynamic simulation.
Trajectory prediction-based guidance law
Authors: Li Mengxuan , Guo Jianguo , Jiang Ruimin
Published: January 2024

This paper proposes a guidance law based on trajectory prediction, aiming to address the difficulty of traditional guidance laws in meeting high-speed and highly maneuverable vehicles. The unscented Kalman filtering (UKF) technique is employed to estimate the target’s motion and predict the virtual impact point using the Singer model and measuring model. The midcourse guidance law is applied to the virtual target, taking into account the constraint of the intersection angle, while the terminal guidance utilizes modified proportional guidance. To mitigate the overload chattering in the transition sections of both midcourse and terminal guidance, the distance is used to modify the transition section of the terminal guidance. Simulation results demonstrate that the proposed guidance law effectively reduces both the encounter angle and the required maneuvering. Furthermore, to minimize midcourse guidance errors, the prediction results of the virtual target are continually updated during the trace process. This method can also be applied to trail other highly maneuverable targets.
Design and realization of a small launch system with autonomous regulation and recognition guidance
Authors: Wang Huanzhen , Sun Haozhe , Wang Shengsong , Liang Keshan
Published: January 2024

A small launching system with autonomous regulation and recognition guidance is designed. Firstly, it ensures a solid and reliable transmission on the mechanical structure of the launcher and the small vehicle. Further, stepper motors and sensors are used to ensure precise control and effective feedback of the angle of the launcher. The small vehicle is equipped with the functions of guidance signal recognition and attitude adjustment, which have the advantages of strong real-time and high versatility. Finally, the practicality and accuracy of the designed launching system to a certain extent are verified through tests.
A study on flow distribution characteristics of heat exchanger module integration scheme for aircraft environmental control system based on CFD
Authors: Zhong Yifei , Wu Chang , Luo Haining , Zeng Yu
Published: January 2024

With the rapid development of the civil aviation industry, the performance requirements of the environmental control system for domestic commercial large aircraft are gradually improved, and the ram air inlet heat exchanger system is its main component. Generally speaking, a ram air heat exchanger system mainly includes an air conditioning system heat exchanger, air preparation system heat exchanger, and auxiliary cooling system heat exchanger. The integration mode of the heat exchanger will directly affect the flow and flow distribution characteristics of the ram air heat exchanger system. This paper develops three integration schemes referring to the integration mode of heat exchangers in Boeing 787 and Airbus 350 aircraft. Based on Fluent software, the calculation and simulation of three integrated scheme models under the seven working conditions of taking off, climbing, cruising, descent, hovering, emergency, and landing during flight were carried out, and the flow distribution and flow resistance values of different schemes were obtained, which were compared to meet the heat transfer requirements.
Thermal field simulation and material parameter optimization for spaceborne annular truss antennas
Authors: Fu Xiaoyi , Hua Yuntao , Ma Wenlai , Cui Hutao , Zhao Yang
Published: January 2024

The operational efficacy of large spaceborne annular truss antennas in orbit is significantly influenced by solar irradiation and alternating Earth shadow. This antenna system periodically encounters diverse extreme environments that impact the precision of the antenna surface performance. Consequently, this study presents an optimized thermal control design and conducts temperature field simulation calculations for such antennas. Initial efforts are directed toward analyzing the variables influencing the antenna structure’s temperature, with specific attention paid to the distinctive compositional characteristics of high-precision antennas. As a subsequent step, orthogonal tests are implemented, facilitating the development of an antenna thermal analysis model. This model assists in the identification of principal variables influencing the antenna’s temperature field. Finally, the antenna’s optimal thermal design is drawn upon the biogeography-based optimization (BBO) algorithm, enabling the derivation of ideal material parameters for the thermal design of the antenna. This methodology offers theoretical guidance for future thermal control design of large spaceborne annular truss antennas.
Study on effect of injection temperature on shear strength of the direct bond between polyphenylene sulfide and anodized aluminum alloy
Authors: Zhao Wei , Qiu Jianhui , Sakai Eiichi , Wu Haonan , Feng Huixia
Published: January 2024

A simple and environmentally friendly technique has been proposed to form a composite structure of high interfacial bonding strength between polyphenylene sulfide (PPS) and aluminum alloy (Al). The Al substrate is modified through anodization and enlarging treatments. The influences of injection temperature on the anodic aluminum oxide film surface on the interfacial bond strength of the formed PPS-Al is discussed. The results revealed that when the injection temperature of PPS was set at 310°C, the bonding strength increased to 18.0 MPa. The adhesive strength exhibits a clear dependency on the injection temperature. At higher injection temperatures, PPS exhibits higher flowability and better penetration into nanoscale pores, resulting in a strong interlocking between PPS and anodized aluminum alloy.
High -temperature duct thermal insulation debonding analysis for civil aircraft
Authors: Du Nannan
Published: January 2024

The paper focuses on the problem of the composite thermal insulation of High-temperature Pneumatic ducts for civil aircraft debonding phenomenon. The performance of thermal insulation material is tested to explain the reason why debonding. A model based on the test and thermal kinetic analysis is proposed to quantify the life of the insulation. Based on the model, a certain duration of thermal insulation is calculated. This methodology can predict the life of thermal insulation.
Experimental study on the combustion characteristics of carbon fiber composite materials coated in different coatings
Authors: Yao Shuai , Dong Lihui , Zheng Qiuyu , Liu Fangbo , Zhao Yingwen , Yuan Ruijie , Tang Mingjun
Published: January 2024

The special environment in which the aircraft operates in terms of flight and safety assurance has special requirements for coating performance. Based on the combustion characteristics of four kinds of high-performance aviation coatings coated with carbon fiber composites, for parameters such as average ignition time and heat release rate of the composite, the results show that the carbon fiber composite has the longest average ignition time, Minimum heat release rate, while the 2-ethyl-4-Mylimidazole cured epoxy coated fiber composite had the shortest average ignition time. The maximum heat release rate was observed.
Study on microstructure and corrosion resistance of CoCrFeNiTi0.2Mox high entropy alloy
Authors: Chen Shujun , Zhao Hui , Yang Jingmei , Li Mei
Published: January 2024

Vacuum arc melting was employed by produting the high entropy alloys CoCrFeNiTi0.2Mox (x=0, 0.1, 0.3). We investigated the influence of Mo on the phase, microstructure, and corrosion resistance of CoCrFeNiTi0.2Mox (x=0, 0.1, 0.3). The introduction of Mo led the high entropy alloy to shift to a double-phase structure, with a rise in the volume percentage of σ phase. The corrosion resistance of high-entropy alloys decreases first and subsequently increases with increasing Mo content in 3.5 weight percent NaCl solution.
Methods of machine learning for the analysis of cosmic rays mass composition with the KASCADE experiment data
Authors: Kuznetsov M.Y. , Petrov N.A. , Plokhikh I.A. , Sotnikov V.V.
Published: January 2024

We study the problem of reconstruction of high-energy cosmic rays mass composition from the experimental data of extensive air showers. We develop several machine learning methods for the reconstruction of energy spectra of separate primary nuclei at energies 1–100 PeV, using the public data and Monte-Carlo simulations of the KASCADE experiment from the KCDC platform. We estimate the uncertainties of our methods, including the unfolding procedure, and show that the overall accuracy exceeds that of the method used in the original studies of the KASCADE experiment.
Optimal geometry of the powered roof support’s operation
Authors: Trzop K , Szurgacz D
Published: January 2024

Monitoring the working parameters of powered roof support is an area for improvement in hard coal mining. The phenomena occurring during the operation generate many risks from difficult geological and mining conditions, leading to undesirable events. In addition, improper use of machinery and equipment results in a high accident rate in mining. Thus, monitoring the operation of machines in mining reduces accidents and losses resulting from stops and prevents unforeseen failures caused by operational and external factors. The paper presents the research results on the optimal geometry of the powered roof support operation in the mining wall. The research included the powered roof support’s essential elements’ operation. Sensors constituting the measuring system were installed on these elements. The measurements made by the sensors made it possible to determine the working height at a given stage of the section’s operation. The research was carried out in three sections, which were part of the powered roof support. The measurements were taken during actual changes occurring in the coal mining process.
Preliminary Assessment of Badajo Cave (Segovia, Spain) Stability Using Empirical, Numerical and Remote Techniques
Authors: Benrabah A , Domínguez S Senent , Bordehore L Jorda , Alonzo D Alvares , Herrero A Diez , Herrero M de Andrés
Published: January 2024

Badajo cave is a shallow cavity (hemispherical rock shelter) located in the valley of Clamores River (Segovia city, Central Spain). This small canyon carved in Cretaceous dolostones has numerous geosites, as well as a rich archaeological and historical heritage. There are dozens of rock outcrops in the valley’s cliffs and slopes, on both banks, where various types of sedimentary rocks can be easily recognized and differentiated, especially carbonates (dolostones and limestones), and mixed carbonate-detrital (dolomitic sandstones, calcareous silts, marls). The cave was formed by karstic and gravitational processes within a mixed dolomitic sandstones and limestones, and it has an important archaeological interest. This study proposes a preliminary stability analyses of the cave applying: (i) empirical approaches based on geomechanical classifications using Barton’s Q Index, Rock Mass Rating (RMR) and the recently created Cave Geomechanical Index (CGI); (ii) three-dimensional model generated with the remote photogrammetric technique Structure from Motion (SfM) to allow acquisition of data to complete values collected in the geomechanical station, and to create the numerical model of the critical sections of the cave; and (iii) numerical simulations using a 2D model based on the generalized Hoek and Brown failure criterion and a 3D wedge analysis. The results of the analysis show that the cave is stable, although it presents some places with small problems (falls of slabs and blocks) that deserve monitoring. Furthermore, the evaluation by the geomechanical classification Q and the corresponding abacus of cave stability indicates that it is located in the “transition” zone where attention is required. In addition, SfM photogrammetric technique makes possible to generate a geometric 3D model that allowed the acquisition of data that were difficult to take in situ. The geotechnical parameters obtained from the different methods complement each other, resulting in a more realistic engineering representation of the subsurface environment. As a conclusion, a graph showing the two empirical methodologies (Barton’s Q Index and CGI), and some recommendation for a future analysis are given.
On a free Schrödinger solution studied by Barceló–Bennett–Carbery–Ruiz–Vilela
Authors: Du Xiumin , Ou Yumeng , Wang Hong , Zhang Ruixiang
Published: January 2024

We present a free Schrödinger solution studied by Barceló–Bennett–Carbery–Ruiz–Vilela and show why it can be viewed as a sharp example for the recently discovered refined decoupling theorem.
An extremal problem and inequalities for entire functions of exponential type
Authors: Chirre Andrés , Dimitrov Dimitar , Quesada-Herrera Emily , Sousa Mateus
Published: January 2024

We study two variations of the classical one-delta problem for entire functions of exponential type, known also as the Carathéodory–Fejér–Turán problem. The first variation imposes the additional requirement that the function is radially decreasing while the second one is a generalization which involves derivatives of the entire function. Various interesting inequalities, inspired by results due to Duffin and Schaeffer, Landau, and Hardy and Littlewood, are also established.
A rigidity theorem for asymptotically flat static manifolds and its applications
Authors: Harvie Brian , Wang Ye-Kai
Published: January 2024

In this paper, we study the Minkowski-type inequality for asymptotically flat static manifolds

(

M

n

,
g
)

(M^{n},g)

with boundary and with dimension

n
>
8

n>8

that was established by McCormick [Proc. Amer. Math. Soc. 146 (2018), pp. 4039–4046]. First, we show that any asymptotically flat static

(

M

n

,
g
)

(M^{n},g)

which achieves the equality and has CMC or equipotential boundary is isometric to a rotationally symmetric region of the Schwarzschild manifold. Then, we apply conformal techniques to derive a new Minkowski-type inequality for the level sets of bounded static potentials. Taken together, these provide a robust approach to detecting rotational symmetry of asymptotically flat static systems.

As an application, we prove global uniqueness of static metric extensions for the Bartnik data induced by both Schwarzschild coordinate spheres and Euclidean coordinate spheres in dimension

n
>
8

n > 8

under the natural condition of Schwarzschild stability. This generalizes an earlier result of Miao [Classical Quantum Gravity 22 (2005), pp. L53–L59]. We also establish uniqueness for equipotential photon surfaces with small Einstein-Hilbert energy. This is interesting to compare with other recent uniqueness results for static photon surfaces and black holes, e.g. see V. Agostiniani and L. Mazzieri [Comm. Math. Phys. 355 (2017), pp. 261–301], C. Cederbaum and G. J. Galloway [J. Math. Phys. 62 (2021), p. 22], and S. Raulot [Classical Quantum Gravity 38 (2021), p. 22].
1945 Hospital at Home - developing a novel simulation induction programme through quality improvement
Authors: Watson G , Paveley A , Chin K , Lindsay-Perez A , Schiff R
Published: January 2024

Introduction

The UK is expanding provision of acute medical care in people’s own homes through Hospital at Home (H@H) and virtual wards. Our H@H service is training junior doctors to meet the growing clinical need in this environment. We describe the use of simulation training to improve the H@H induction process.

Methods

From their experiences in H@H, junior doctors identified specific training needs to build relevant competencies. From this feedback, PDSA cycle one involved junior doctors designing a dedicated simulation training (H@H-SIM). Stations addressed clinical, practical and advanced communication skills required in H@H using high- and low-fidelity simulation. PDSA cycle two used post-course evaluation to refine H@H-SIM through introduction of FP10 prescribing stations, point-of-care testing (POCT) and greater emphasis on practical skills. Revisions were evaluated via participant questionnaire before and after the H@H-SIM.

Results

Cycle two of H@H-SIM involved twenty doctors. The clinical scenarios, prescribing and practical skills stations, including POCT and IV administration, were perceived as the most useful parts of training. Overall self-rated confidence in knowledge and skills to work in H@H improved from a mean of 6.9 to 7.7/10. Before H@H-SIM, 60% were ‘not confident’ with recognising end of life (EOL), IV administration or decision-making around remaining at home; 10% with advance care planning (ACP). After H@H-SIM, 10% felt ‘not confident’ with recognising EOL or ACP and 5% with IV administration. Concerns persisted with using equipment, prescribing and availability of senior support. An additional station on recording ECGs was suggested.

Conclusions

Working in a H@H context and seeing patients in their homes can be daunting for junior doctors. H@H-SIM embedded into induction is one way to prepare doctors for this role, improve their confidence and has potential for wider replication.
1805 The importance of ongoing awareness and education for Lying and Standing blood pressure (LSBP) during hospital admissions
Authors: Bendahan D H , Mitchell C , Chauduri S , Wing J , Bird B , Safeer S , Hota S
Published: January 2024

Introduction

Inpatient falls remain a huge problem in hospital, causing significant injuries to patients and are an avoidable cost to the NHS. Therefore, the National Audit of Inpatient Falls (2015-2017) set out key recommendations for management of falls, including the measurement of LSBP within 3 days of hospital admission.

Method

Our project was conducted in a major acute teaching hospital in North West London across three geriatric wards. Our aim was to improve the measurement of LSBP and correct documentation across the wards in line with the NAIF guidelines. We excluded patients unable to mobilise to standing with support, patients too unwell or unable to follow instructions and actively dying patients. Prior to any intervention, we found that only 24% of patients had LSBP performed within three days of admission. We focused our intervention in raising education and awareness across our staff. We arranged weekly reminders during MDT meetings, created posters and organised twice monthly teaching sessions, including one to one, on how to document correctly electronically.

Results

After one month of intervention, 73% of patients had LSBP as part of the ward round plan and almost half of patients had it correctly recorded on our system. After 4 months, we reaudited our project and found that only 32% of patients had LSBP appropriately recorded. This significant decrease can be explained by the changeover of junior doctors and emphasises the need of a more sustainable change.

Conclusion

Our goal is making LSBP part of a routine preadmission checklist when appropriate. We are currently working on making changes to our electronic patient record (EPR) to facilitate documentation to members of staff. This includes a new falls assessment tool and the newly incorporation of Smartzone feature on EPR. This will allow staff to put non-critical jobs in the workflow showing a less intrusive alert until completed.
1733 An itemised discharge letter format improves clarity of information - a quality improvement project
Authors: Macaulay J , Wear H
Published: January 2024

Introduction

Commonly, discharge letters employ a chronological “narrative” style (NS). These unstructured letters often do not clearly communicate rationale for diagnoses and management – a problem exacerbated in letters compiled by multiple staff. This project trialled an alternative format.

Methods

An itemised letter (IL) was designed, each diagnosis a separate numbered point; guidance was provided for relevant investigations and management to include for core geriatric conditions. Four “Plan Do Study Act” (PDSA) cycles were completed. Mixed-methods feedback informed subsequent cycles. PDSA cycle 1 piloted the IL. Responding to concerns ILs took longer, cycle 2 measured writing times on a second ward. Cycle 3 monitored spontaneous IL uptake and feedback throughout geriatric medicine, continued in Cycle 4 after 12 months when the department formally adopted ILs.

Results

We collected 17 email responses, 9 semi-structured interviews, 1 tweet, writing times, and uptake statistics. Framework analysis synthesised qualitative and quantitative results. The key finding was that ILs improved information clarity. The standardised structure made it easier to update letters, and teach letter writing to new staff. Some staff reported challenges changing letter format, and noted electronic templates were not optimised for ILs. Mean completion times were 23 minutes for IL (range 6.5–38, N=15) and 20 minutes for NS (15–26, N=5). Sample size imbalance reflected exclusion of letters, predominantly NS, started on other wards. Uptake data evidenced continued IL use despite staff rotations. When cycle 4 commenced a mean of 35% (range 0–91%) of letters were in IL, increasing after seven months to 64% (40.6–90%). Qualitative feedback mirrored on-going usage, with many doctors continuing IL use after rotation. PDSA cycle 5 has begun, discussing using ILs in other specialties.

Conclusions

The IL format was well received by hospital staff, and will be improved by feedback from GPs, relatives, and patients.
1959 De-prescribing within the East Kent Community Frailty Team: assessment of medication review processes and potential cost-savings
Authors: Jones A J D , Bristow-Smith M
Published: January 2024

Introduction

Older people living with frailty are often prescribed many medications exposing them to potential medicine-related harm. Pharmacists are a new addition to the East Kent Community Frailty Team, which otherwise consists of doctors and advanced clinical practitioners at various levels of training. Pharmacists are ideally placed to develop medication review processes and support fellow clinicians with deprescribing efforts in frailty. This audit set out to determine current levels of medication review and associated cost-savings through deprescribing.

Method

All patients admitted to the frailty team caseloads in the month of May 2023 had their notes manually reviewed for evidence of medication reconciliation, review, and deprescribing. Medicines were assigned a cost price based on the NHSBSA Drg Tariff (May 2023).

Results

192 patients were seen in total, 170 of whom were acutely unwell. 62% of patients had their medication documented, taking an average of 8.2 medicines. The majority of omissions were patients with a zero length-of-stay, which include advice calls. 29% of patients had at least one medication stopped, representing an average 0.7 medicines stopped per patient seen. The monthly cost of medications stopped was £690. There were greater levels of deprescribing in the caseloads with MDT board rounds.

Conclusion

Rates of deprescribing are low compared to published studies (Ibrahim et al, BMC Geriatr 21, 258 (2021)), although still represent a rolling saving of approximately £8,000 per month on cost of medicines alone, assuming a twelve-month average life expectancy. Lack of standardisation of clinical notes and documentation made data collection difficult and has the potential to lead to transfer-of-care errors. Further work needs to be undertaken to optimise the medication review process and address inappropriate polypharmacy and will be the focus of efforts over the coming year.
1899 Early intervention by physiotherapy and occupational therapy in older inpatient population
Authors: Kotak S
Published: January 2024

Background

Currently, on inpatient medical wards at University Hospitals of Leicester NHS Trust, first contact by physiotherapy and occupational therapy is made when patients become medically optimised for discharge. This is due to a number of reasons such as staffing and resource shortages.

Aim

Analyse the effects of early intervention by therapy on patients on a geriatric medicine inpatient ward. It is hypothesised that earlier intervention can improve patient and service outcomes.

Method

A data sheet was created to capture baseline information including mobility/care needs prior to admission, date of initial contact by therapy, mobility/care on discharge, length of stay and discharge destination. Data was collected over two phases; initial therapy contact at point of patient being medically optimised, and then with the planned intervention of proactive therapy input early in a patient’s admission.

Results

The data shows an improvement in all measured patient outcomes in the intervention group. The average time from admission to therapy first contact reduced from 7 days to 2 days. The average length of stay reduced from 14.5 days to 7 days in the intervention group. 70% of patients left the hospital with a reduction in their mobility status in the control group, whereas only 32% of patients left with worse mobility in the intervention group. 41% of patients in the control group left with new or increased care provision compared to 36% in the intervention group. The data also showed that a higher proportion of patients were mobilised by ward staff and less patients were discharged to 24-hour care settings in the intervention group.

Conclusion

Therapy (with the help of the multi-disciplinary team) should proactively identify patients in need of therapy input as soon as safely possible. This research shows that adopting this approach leads to improvements for our patients and our service.
1849 Implementing a comprehensive geriatric assessment (CGA) in older adults presenting to a district general emergency department
Authors: Niranjan D , Findlay A , Joomye S , Carolan C , De Bhaldraithe S , Rabia M Abu
Published: January 2024

Introduction

Frailty is the concept of increasing vulnerability to minor stressors in the context of a reduction in physiological reserves (Clegg et Al. The Lancet 2013, Volume 381, pages 752-762). It affects 10% of people presenting to Emergency departments (ED) and around 30% of inpatients in acute medical units (NHS England and NHS Improvements. 2019). Implementing a CGA is known to result in a significant increase in your likelihood of being alive and in your own home at 6 months (Ellis et Al. BMJ 2013).

Aims

To implement an ED in reach frailty service with the goal of performing a CGA at the earliest opportunity.

Methods

We undertook a 3-week pilot with a small team comprising a consultant, frailty ACP, SHO and geriatric registrar. The team were based in ED and worked alongside the existing ED navigator team and in conjunction with various community teams. Data was collected assessing completion of the usual domains within the CGA and discharge data.

Results

62 patients were seen in total. Mean age was 82.4 years with a mean CFS of 5. Each patient received a CGA. 9/62 (15%) of patients were discharged on the same day. 15/53 (28%) were discharged within 72 hours of admission. Other notable results include: 100% completion of 4AT and 70 medications de-prescribed. Feedback from patient and relatives in addition to ED and AMU doctors was extremely positive.

Conclusion

We demonstrated that performing a CGA in ED resulted in higher numbers of patients being discharged on the same day or within 72 hours of admission. We were able to demonstrate a significant increase in assessment of delirium allowing earlier detection and a much higher rate of deprescribing with significant benefits for both patient and the trust.
1949 Improving the utilisation rate of ‘hot slots’ in an outpatient frailty service
Authors: Shekarchi-Khanghahi E , Morelli F , Smith N
Published: January 2024

Background

North Middlesex University Hospital runs an outpatient frailty service where patients are referred for a Comprehensive Geriatric Assessment. There is a daily ‘hot slot’ for patients who otherwise would have required hospital admission if not seen within seven days. We aimed to improve utilisation of hot slots from 50% to 100%. Empty hot slots result in the under-utilisation of pre-allocated resources and increase the workload of healthcare professionals in other departments.

Methods

Author ESK audited hot slot usage in November and December 2022, marking slots as ‘filled’ or ‘unfilled’. In January 2023 we established a clear referral process for the hot slots and implemented an education program targeted at referrers to increase awareness of the availability of hot slots and referral criteria. Authors ESK, NS and FM re-audited the hot slot usage from February to April 2023. Author FM analysed the data and conducted statistical testing of the results. Authors NS and FM produced visual representation of the data collected.

Results

After exclusion of periods where the hot slots were closed (n=13) including strike days, bank holidays and times with below minimum staffing; 82 hot slots were audited, pre-intervention (n=39) and post-intervention (n=43). The utilisation of hot slots increased from 51% pre-intervention to 86% post-intervention. Fisher's exact test shows this is statistically significant (p<0.0007).

Conclusions

The education program increased utilisation of hot slots but fell short of the targeted 100% utilisation rate. We made the hot slot available exclusively to the Geriatric Emergency Medicine (GEM) team for one week in August 2023 to assess whether this increases GEM utilisation of the hot slot. We intend to further analyse the data to review the appropriateness of referrals and try to improve this. A larger project could assess impact of hot slot usage on patient outcomes.
1689 Establishing an oncogeriatric multi-disciplinary team (MDT) and accompanying clinic at a DGH in Somerset
Authors: Parker H , Birchenough S , Cattell E , Barthakur U , Woodhill S , Foster M
Published: January 2024

Introduction

Recent studies show the use of comprehensive geriatric assessment (CGA) in older patients with cancer can result in better quality of life, improved treatment tolerance and reduced hospital admissions, leading to international consensus that CGA should be routinely included in care. We have piloted an onco-geriatric MDT, consisting of oncologists, geriatricians and therapy input, alongside a rapid-access geriatrician-led onco-geriatric clinic

Method

Referrals were invited from oncologists for older patients (>70) with a new diagnosis of cancer, with expected prognosis of more than 1 year, about whom they had concerns regarding their ability to undergo radical treatment due to co-morbidities, falls, cognitive impairment or social isolation. A CGA was completed prior to starting radical treatment in most cases. Performance status, Rockwood frailty score (RFS) and G8 score were calculated for all patients.

Results

During the 24-week trial period, an MDT and clinic has run every week. A total of 32 patients have been discussed at MDT, with 22 seen in clinic, from cancer sites including colorectal, breast, urological and ovarian. Patient seen in clinic had an average RFS of 4.5 and G8 score of 13. All patients have seen a geriatrician, with most also seeing our physiotherapist. Interventions included medication review and rationalisation, anaemia review and treatment, referral to specialist memory and continence services, blood pressure optimisation and completion of a treatment escalation plan.

Conclusions

Feedback from patients attending the clinic has been resoundingly positive, with 100% of patients rating their service experience as “good” or “very good” and praising the time to talk about their health as a whole. Follow up of clinic patients is in progress, identifying emergency admissions alongside treatment toxicities and complications within this group, as well as whether G8 is an appropriate screening tool for clinic review, to secure the long-term future of the service.
1896 Community geriatrician led memory service improving access to dementia diagnosis with focus on admission avoidance
Authors: McCarthy M , O'Donnell C
Published: January 2024

Introduction

The Community Geriatrician team based at the Countess of Chester Hospital is a multidisciplinary team offering comprehensive assessments at home to older patients with frailty. The team review frail patients identified as being at risk of hospital admission. Cognitive impairment and dementia are increasingly common concerns in our patient group and significant risk factors for admission. Frail patients often struggle to access traditional memory clinics for a variety of reasons and can therefore remain undiagnosed. They often require a more holistic approach in their home environment. We therefore identified a need to offer a dedicated frailty memory pathway within our community geriatrician team enabling better access to dementia assessment and diagnosis in complex frail patients.

Method

A frailty memory assessment pathway was proposed and commenced in 2022. Following identification of a cognitive concern during the initial comprehensive geriatric assessment a further home visit is arranged to assess memory in more depth. Patients are then discussed, and a diagnosis reached via a monthly Frailty memory MDT attended by a consultant psychiatrist, consultant geriatrician, and specialist occupational therapist. Following delivery of a diagnosis our AGE UK well-being coordinator within the team provides post diagnostic support and sign posting to patient and family. A retrospective audit was undertaken reviewing the 44 patients diagnosed since pathway commenced. The number of hospital admissions and number of inpatient bed days was compared in the 3 months pre and post initial assessment.

Results

In the 3 months following assessment, 82% of patients had a reduction or unchanged number of admissions, there was a total reduction of 71 inpatient bed days.

Conclusion

We believe our pathway offers a unique multidisciplinary approach to dementia diagnosis in the frail population, improving frail patients access to dementia assessment with a reduction in hospital admissions.
2026 Development of a novel 2-week wait oncogeriatric service: A GI Frailty Clinic
Authors: Dinsdale E , Whitehead K , Gould D , Miller C , Nair S
Published: January 2024

Introduction

Over the last 12 months, a novel oncogeriatric clinic was successfully established to assess frail 2-week wait (2WW) patients referred with gastrointestinal (GI) symptoms. The clinic was initially funded by the West Yorkshire Cancer Alliance, enabling a weekly clinic, run by a geriatrician, clinical specialist nurse and an advance clinical practitioner.

Methods

A total of 350 patients were assessed (those with a clinical frailty score of ≥ 6 were eligible for referral); due to demand exceeding capacity, remaining patients were referred on through the default surgical or GI pathways. Patients were triaged by endoscopy nurses from ‘straight to test’ referrals after training provided to assess frailty scores using routinely available data.

Results

Only a third of patients referred remained on the 2WW pathway compared to surgical patients; this was due to patients being too frail or an alternative diagnosis being made through comprehensive geriatric assessment, and a shared decision-making process. The patient level information and costing system (PLICS) demonstrated that the oncogeriatric clinic was cost effective, costing approximately £190 less per patient than the default pathways of care. Feedback from patients demonstrated extremely high satisfaction rates with the service provided. One of the most significant interventions was medicines management, which has led to a pharmacist supporting the clinic through further innovation funding.

Conclusion

Lessons learned included developing a better understanding of cancer diagnosis and frailty, providing a ‘one stop centre’ for cancer care, and managing complex comorbid conditions in frail older people suspected of having cancer. As a result of this QI service development project, a Frailty Cancer Strategy for the Trust is currently being developed and will be presented to the executive team with the aim of developing a comprehensive oncogeriatric service for frail patients in Leeds, providing the right care, the right treatment, first time.