bluuebunny/crossref_metadata_2025 huggingface dataset:
Biodiversity conservation and restoration of wetlands in suburban areas: challenges and prospects
Authors: Wang Shaoyi , Yu Hailan , Shentu Huabin , Gu Caiwei , Huang Senjun , Wang Libing , Zheng Heng , Ma Junchao , Wang Jianguang , Wei Jun
Published: September 2024

Context Wetland loss threatens global biodiversity. Peri-urban wetlands face acute pressures from urban expansion. Aims Investigate biodiversity and land-cover changes in two wetlands undergoing suburbanisation near Hangzhou, China. Methods Seasonal field surveys of birds, fish and amphibians, coupled with remote-sensing analysis of land-cover changes from 2009 to 2020. Key results Suburban wetlands exhibited unique degradation patterns, including reduced species diversity, simplified community structures and proliferation of invasive species, with 91 bird species being recorded, dominated by common residents, 25 still-water fish species with few carnivores and migratory species, and 5 ubiquitous amphibian species detected. Species richness was lower than in nearby conserved wetlands. From 2009 to 2020, 6–7% of the wetlands were lost to urban expansion and converted to artificial vegetation or infrastructure. Conclusions Ecological degradation is driven by rapid urbanisation, with habitats being fragmented by roads and converted to artificial land covers. Water pollution from insufficient treatment and abandoned aquaculture further impairs habitats. Implications Innovative integrated-management framework was proposed for wetlands biodiversity restoration in suburban area. Key strategies include (1) modernising traditional circular economies to sustain wise use, (2) wildlife-friendly infrastructure design, (3) targeted invasive species control, and (4) adaptive co-management informed by ongoing monitoring. This socio-ecological systems approach aims to harmonise biodiversity conservation, cultural heritage and sustainable development in threatened suburban wetlands.
High chytrid prevalence and infection intensities in tadpoles of Mixophyes fleayi
Authors: Hollanders Matthijs , Grogan Laura F. , McCallum Hamish I. , Newell David A.
Published: September 2024

Context The amphibian chytrid fungus Batrachochytrium dendrobatidis (Bd) has caused catastrophic biodiversity loss globally, but species and life stages within species respond differently to the pathogen. Although tadpoles are often reported to be less vulnerable to disease, they can constitute important infection reservoirs in ecosystems. Aims We aimed to describe Bd infection patterns of a long-lived tadpole in a species where post-metamorphic animals appear to exhibit limited mortality as a result of chytridiomycosis. We further investigated how oral dekeratinisation can be used as an indicator of infection. Methods We conducted surveys of tadpoles of Mixophyes fleayi (Fleay’s barred frog) over 2 years, at two rainforest streams on the east coast of Australia, to assess patterns in Bd infection prevalence and intensity. We developed an integrated hierarchical model propagating pathogen-detection errors and incorporating how Bd infections affect oral dekeratinisation. Key results We found that Bd infection prevalence was strongly associated with lower temperatures and a larger body size, consistent with Bd optimal thermal range and a cumulative risk of exposure for tadpoles. The individual probability of a tadpole being infected with Bd was estimated to be 0.58 [95% HPDI: 0.432, 0.713], the odds of which were approximately eight times greater than for adults at the same sites. Tadpoles infected with Bd were 113 [29, 293] times more likely to have oral dekeratinisation than were uninfected tadpoles, where uninfected individuals were estimated to have a 0.05 [95% HPDI: 0.011, 0.11] probability of having mouthpart loss. Conclusions Our results showed that M. fleayi tadpoles are more likely to be infected with Bd than are adults, suggesting that tadpoles could contribute to Bd maintenance in streams. We further showed that sites can be rapidly assessed for Bd by visually checking for oral dekeratinisation. Implications Long-lived tadpoles, in general, may contribute to Bd maintenance in ecosystems. We suggest continued exploration of Bd immunocompetence across amphibian life stages to further understand the vastly different infection patterns.
Fast, variable stiffness-induced braided coiled artificial muscles
Authors: Hu Xinghao , Wang Xiangyu , Wang Jian , Zhang Guorong , Fang Shaoli , Zhang Fengrui , Xiao Ye , Cheng Guanggui , Baughman Ray H. , Ding Jianning
Published: September 2024

Biomimetic actuation technologies with high muscle strokes, cycle rates, and work capacities are necessary for robotic systems. We present a muscle type that operates based on changes in muscle stiffness caused by volume expansion. This muscle is created by coiling a mechanically strong braid, in which an elastomer hollow tube is adhesively attached inside. We show that the muscle reversibly contracts by 47.3% when driven by an oscillating input air pressure of 120 kilopascals at 10 Hz. It generates a maximum power density of 3.0 W/g and demonstrates a mechanical contractile efficiency of 74%. The muscle’s low-pressure operation allowed for portable, thermal pneumatical actuation. Moreover, the muscle demonstrated bipolar actuation, wherein internal pressure leads to muscle length expansion if the initial muscle length is compressed and contraction if the muscle is not compressed. Modeling indicates that muscle expansion significantly alters its stiffness, which causes muscle actuation. We demonstrate the utility of BCMs for fast running and climbing robots.
Assessment of a system for gait parameter extraction and individual feature classification using artificial neural networks and a low-cost accelerometer
Authors: López-Tapia Andrea , Reyes-Barranca Mario Alfredo , Abarca-Jiménez Griselda Stephany , Sánchez-Márquez Luis , Flores-Nava Luis Martín
Published: September 2024

A system designed for monitoring the footsteps of a person is presented, aimed at determining characteristic and statistical parameters of the individual’s gait. This non-invasive approach utilizes a low-cost commercial capacitive accelerometer to sense the vibrations caused by each step as an individual walks on the floor. The system captures signals from the accelerometer, which are then processed to obtain different signal parameters (such as step duration, cadence, stride duration, kurtosis, skewness, etc), providing information about each subject under study. The collected information is stored in a database, and artificial neural networks are employed in this report to classify types or styles of walking, as well as to identify the person’s gender, age, and body mass index. With the implementation of classifiers, physical characteristics can be grouped, potentially focusing on diagnoses or identifications based on specific data. Finally, the results obtained from tests performed on 30 volunteers are presented, verifying the accelerometer’s performance and the algorithm’s effectiveness, with accuracy percentages up to 99.2% for classification. The results show a high level of coincidence and are promising for the future improvement of the system.
Effect of anisotropy and length dispersity on electrical and optical properties of nanowire network based transparent electrodes: a computational study
Authors: Bharti Yugam , Malik Vikas , Bhandari Preeti , Aggarwal Shruti
Published: September 2024

We have studied the impact of nanowire alignment and measurement direction at the percolation threshold on the effective resistance (R) of two-dimensional (2D) films. This helps us to analyze the effect of anisotropy on the conductivity and transmittance of the nanowire-based network characterized by the disorder parameter (s). These optoelectronic properties are determined for systems with monodisperse and bimodal length distribution (a combination of two fixed lengths of nanowires). The 2D systems simulated using our computational approach are assumed to be transparent and conductive in which percolative transport is the primary conduction mechanism. We obtain our results numerically using a computational and geometrical approach, i.e. a Discrete (grid) method that is advantageous in algorithm speed. For a particular disorder parameter s, the conductivity and transmittance increase as the length fraction (LF) increases for the bimodal distribution of the length of nanowires in networks. We have observed the maximum conductivity when the nanowires are highly aligned along the measurement direction of percolation, in contrast to the isotropic arrangement of nanowires. Significantly, alignment introduced in nanowires leads to a higher percolation threshold which leads to a decrease in the transmittance of the network. We show that the resistivity of the monodisperse network in the direction parallel (perpendicular) to the alignment decreases (increases) with the disorder parameter and scales as s (s
2). This scaling holds true for the bimodal distribution of nanowires as well. For a particular LF, the electrical anisotropy increases with s. The anisotropy is maximum for nearly aligned nanowires in a bimodal network with the highest proportion of the longest wire considered. For the maximally aligned wires and highest LF, we obtained an approximately 50

%

enhancement in the figure of merit, denoted by φ. Hence, incorporating longer-length wires and increasing the alignment in nanowire networks can increase the conductivity, anisotropy, and figure of merit which may benefit a vast range of applications.
Near-field terahertz electro-optical imaging based on a polarization image sensor
Authors: Guiramand L , Lafrenière-Greig J , Ropagnol X , Blanchard F
Published: September 2024

This paper presents a hyperspectral microscopy system that offers two-dimensional (2D) measurement of the spectral phase and amplitude information of terahertz (THz) radiation without the need for raster scanning. To achieve this, a new THz imaging method is introduced, wherein the distribution of the THz electric field is spatially measured using the electro-optic effect with a commercial polarization image sensor. This method enables the direct measurement of polarization components, eliminating the need for the polarization optics usually required in conventional electro-optical imaging. The performance of this imaging method is compared with a conventional 2D imaging system based on a standard visible camera. Finally, the sub-wavelength resolution capabilities of this new sensor are demonstrated by imaging a sample in the near field.
Reliable Adder Design: A Review
Authors: Akbar M A , Abubakar A , Bermak A
Published: September 2024

With the increasing complexity of system-on-chip designs, the probability of having soft-errors is increasing sharply. Since, adder is one of the essential elements present in almost every digital system, therefore, by making adder fault tolerant will create a potential impact on wide variety of digital applications. In this paper, a review has been presented to demonstrate the previously proposed solutions for fault tolerant adder design. In addition to the self-checking approaches, this paper also presented self-repairing techniques. A comparative analysis in terms of complexity, fault coverage and area-overhead has also been presented to conclude the performance of each covered approach.
Research on the Application of improved AMCL Algorithm in Robot Obstacle Avoidance in Logistics Sorting Scene
Authors: Shang Gongyu , Gong Gu , Hu Xiaoting , Liu Xintong , Zhu Hua
Published: September 2024

Compared with the normal scenes, the positions of obstacles, delivery boxes and sorting stations in the logistics sorting scene are relatively fixed, what’s more, the number of static obstacles in the logistics sorting scene is large. It requires higher navigation accuracy and pose adjustment of the robot. The author proposes an Adaptive Monte Carlo Localization (AMCL) algorithm that integrates the Dynamic Window Approach (DWA) algorithm to improve the accuracy and efficiency of robots in real-time positioning, navigation in static indoor environments, and obstacle avoidance efficiency. Using this method, the data collection of lidar sensor are optimized, reducing positioning calculation. By adjusting the parameters’ value, the adaptive positioning accuracy and real-time positioning rate of the logistics robot are improved. The experimental results show that the Adaptive Monte Carlo Localization integrated with Dynamic Window Approach algorithm is about 13.682 % higher than the normal Adaptive Monte Carlo Localization algorithm in the obstacle avoidance rate, which effectively makes the number of particles collected by lidar more standardized and rational.
Ghost imaging Lidar: principle, progress and prospect
Authors: Gong Wenlin , Han Shensheng
Published: September 2024

Ghost imaging (GI), as a computational imaging technology, can staringly obtain the target’s image by computing the second-order correlation function between the intensity of modulation field and the target’s echo signal recorded by a single-pixel detector. Since GI with classical light source was experimentally demonstrated, GI Lidar has been considered to be one of the best application prospects in GI direction and become a research hotspot. With in-depth study and development of GI Lidar in recent years, GI Lidar has achieved significant progress and is expected to be applied in the near future. In this paper, we try to sketch the basic principles and superiorities of two kinds of GI Lidar. Next, with respect to the application of long-range, high-resolution, and high-speed moving target detection and recognition, we introduce the development progress of narrow-pulsed GI Lidar and long-pulsed GI Lidar via heterodyne detection. Finally, the key problems and prospect of GI Lidar are also discussed.
Rejecting, Sifting, Reshaping, and Ordering, 1875–1876
Authors: Korstvedt Benjamin M
Published: September 2024

Bruckner began to revise the Fourth Symphony almost immediately after he completed the score in 1874. First, he added additional layers of imitative counterpoint to certain passages. Then, in anticipation of a possible performance in 1876, he made two additional sets of revisions. These have never before been brought to light. One was a series of revisions to phrase structures based on his systematic analysis of the work, which made use of his so-called metrical numbers. The other was a series of adjustments to orchestration and dynamic markings in passages that he came to feel he had “harmed” with an excess of contrapuntal imitation.
The Music of the Third Version
Authors: Korstvedt Benjamin M
Published: September 2024

The musical differences between the second version and the third version of the Fourth may be less fundamental than those between the first and the second versions; nevertheless they are significant and demand careful consideration. By and large, the fundamental musical content is not substantially altered, but throughout the score, changes exist in the orchestration, including dynamic balances, and in tempo and other performance markings. This chapter explores these attributes of the third version, as well as Bruckner’s role in their creation. The pertinence of these changes to successful performance of the work is emphasized. Finally, the chapter surveys differing opinions about the musical value of this version offered by scholars, critics, composers, and conductors.
The Fourth in Performance, a Historical Sketch
Authors: Korstvedt Benjamin M
Published: September 2024

In the early twentieth century, Bruckner’s Fourth Symphony gained a secure place in the orchestral repertoire. This chapter considers how it has been performed over the ensuing decades. It begins by discussing Bruckner’s statements about the performance of his symphonies. Tempos and tempo modifications emerge as a point of central concern for Bruckner—and for later generations of performers as well. Wagner’s ideas about the need for tempos that respond fluidly to the Melos of the music influenced the first generation of Bruckner conductors, starting with Ferdinand Löwe and Franz and Josef Schalk. In the 1920s and 1930s, reactions against this style arose. The chapter reviews how these changing approaches developed, in part by surveying how tempo is handled in recordings from the 1930s onward. Finally, the chapter examines how musical meaning may be colored by performance styles.
Systematic Review and Meta-Analysis of Diagnostic and Predictive Accuracy of the Clinical Frailty Scale in Older Adults in Emergency Department
Authors: Koay Wen Jie , Leahy Aoife , Barry Louise , Condon Jennifer , Egan Aisling , Prendiville Tadhg , O'Loughlin Monica , Gabr Ahmed , Mohamed Abdirahman Sheikh , Peters Catherine , Quinn Colin , Conroy Simon , O'Connor Margaret , Galvin Rose
Published: September 2024

Background

Older adults attending the Emergency Department (ED) should be assessed using a frailty screening tool as older adults living with frailty are more likely to experience adverse outcomes. The Clinical Frailty Scale (CFS) is commonly used for this. This systematic review and meta-analysis synthesise the literature studying predictive accuracy of the CFS for identifying older adults at risk of adverse outcomes following ED visit, and the diagnostic accuracy of the CFS for identifying older adults living with frailty attending the ED.

Methods

A systematic literature search was conducted to identify studies that attempted to validate the diagnostic and predictive accuracy of the CFS for older adults in the ED setting. The population included were older adults over 65 years of age who presented to the ED with undifferentiated medical complaints. All included studies assessed the diagnostic accuracy of the CFS in comparison to a reference standard: Frailty Index, Comprehensive Geriatric Assessment or Frailty Phenotype. The adverse outcomes included were mortality, falls, functional decline, ED re-attendance, hospital admission, length of stay and institutionalisation.

Results

Nineteen studies were included with sixteen individual cohorts. All studies investigated predictive accuracy and four studies assessed diagnostic accuracy for the CFS. The CFS showed predictive accuracy for the outcomes of mortality at all timepoints (RR 3.05 (CI 2.22, 4.21)), ED re-attendance at 30 days (RR 1.47 (CI 1.12, 1.94)), hospital admission at index visit (RR 1.72 (CI 1.26, 2.34) and institutionalisation (RR 3.63 (CI 1.41, 9.36). The studies included had an overall low risk of bias.

Conclusion

The CFS successfully identifies those at risk of adverse outcomes of death, ED revisit, hospitalisation and institutionalisation. However, there is a paucity of studies which assess its diagnostic accuracy. Overall, it is a useful screening tool to identify those who may benefit from comprehensive multidisciplinary assessment in the ED setting.
The Contexts and Resources that Support Effective Interprofessional Collaboration in Community Care for Older People: A Realist Synthesis
Authors: O'Donnell Deirdre , Davies Carmel , Devaney Catherine , Radomska Apolonia , O'Shea Marie , O'Donoghue Gráinne , De Brún Aoife , Donnelly Sarah , Whitty Helen , Harnett Patrick John , Lang Deirdre , Ahern Emer , Shé Éidín Ní
Published: September 2024

Background

Interprofessional collaboration (IPC) is widely accepted as important to enable quality, safe care integration for older people. There is limited understanding of how IPC can be fostered, enhanced, or sustained within the various contexts of team-based care integration for older people. This review describes the contextual factors and resources that support IPC in interdisciplinary community care teams for older people.

Methods

A five-step process guided the realist synthesis. This involved exploratory scoping (steps 1-2) including a cross-sectional descriptive survey of members of the 30 specialist community teams for older people in Ireland (n=65). Four stakeholder workshops with operational leads, healthcare professionals, policymakers, older people and caregivers (n=25); a systematic evidence retrieval and synthesis phase (40 academic and 5 grey literatures included) (steps 3-4) and finally the development of programme theories via expert advisory panel (n=10) (steps 5).

Results

We generated 14 initial programme theories from the exploratory scoping phase, and these were refined into 7 programme theories following realist evidence synthesis. The programme theories describe the contexts and resources required to enable IPC within community care teams for older people under the following headings: 1. Professional identity and role awareness; 2. Information sharing and communication across boundaries of care; 3. Enabling Effective Operational and Clinical Governance; 4. Developing team competence in IPC; 5. Meaningful inclusion of older people and caregivers; 6. Monitoring and reviewing team performance for quality improvement and system development. 7. Capacity development and workforce planning.

Conclusion

The exploratory stakeholder process with local experts, including older people and caregivers, added a rich contextual depth to this realist review. The seven areas of programme theory convey the complex multifaceted contexts and resources that enable IPC in care integration for older people. Work has commenced to test these theories across four interdisciplinary community specialist teams for older people in Ireland.
A Systemic Review & Meta-Analysis of the Impact of Vascular-Geriatric Service Models on Short-Term Outcomes in Vascular Surgery Inpatients
Authors: Foley Megan Power , Walsh Stewart
Published: September 2024

Background

Vascular surgeons are treating progressively older, frailer and more medically complex patients. Care models including both surgeons and geriatricians have improved peri-operative outcomes in orthopaedics and surgical oncology. This meta-analysis investigates the impact of “vascular-geriatric” services on short-term inpatient outcomes.

Methods

Search strategy included PubMed, Scopus and Embase databases, conference abstracts and clinical trial registries. All study methodologies comparing outcomes before and after the introduction of a dedicated vascular-geriatrics service were eligible. Meta-analyses compared the relative risk (RR) of mortality, complications and 30-day readmission using a random-effects model. Risk of bias was assessed with the MINORS tool.

Results

Eight studies were identified, including one randomised trial and seven ‘before & after’ observational studies. 2074 patients were included, 1065 in the “Vascular-Geriatrics” cohort and 1009 in standard care. Care models included comprehensive geriatric assessment as part of the pre-operative review process before elective aortic surgery, inpatient geriatric liaison services and formal vascular-geriatric co-management arrangements. Source studies were of moderate to high risk of bias. A meta-analysis of five studies demonstrated vascular-geriatrics models were significantly associated with lower mortality rates than standard care (pooled 2.4% vs 4.9%) (RR 0.51, 95% CI 0.28-0.94, p=.03) (I2=0%). Vascular-Geriatrics models were also significantly associated with lower risk of infective complications (RR 0.49, 95% CI 0.36–0.66, p<.001) (I2=0%) and delirium (RR 0.58, 95% CI 0.35–0.97, p=.04) (I2=48%). There was no difference in mean length of stay (SMD -2.20, 95% CI -4.6-0.19, p=.07) (I2=86%). or 30-day readmission rates between Vascular-Geriatrics models and standard care (RR 1.10, 95% CI 0.81-1.51, p=.54) (I2=38%).

Conclusion

While the source data is heterogenous and of limited quality, this meta-analysis suggests that dedicated geriatric intervention may reduce adverse peri-operative outcomes in vascular patients compared to traditional care models. Further studies are needed to investigate the most effective design of geriatrician-surgeon partnership.
An Early Supported Discharge Model of Care for Older Adults Admitted to Hospital: A Descriptive Cohort Study
Authors: Williams Susan , Whiston Aoife , Morrissey Ann-Marie , O'Riordan Clíona , O'Connor Margaret , Hartigan Deirdre , Devlin Collette , Galvin Rose
Published: September 2024

Background

Early supported discharge (ESD) facilitates an early discharge from hospital with continued rehabilitation in the home environment from a multi-disciplinary team at the same intensity as would be received in the inpatient setting. Evidence suggests it can have a positive impact on older adults discharging from the acute setting to home. This study aims to characterise an inreach model of ESD for older adults discharged from four hospitals in the Mid-West of Ireland and describe its impact on clinical and process outcomes at 30 days and 180 days.

Methods

Consecutive older adults referred for ESD from four hospitals in the Mid-West of Ireland were recruited over a six-month period. Baseline assessments were carried out on initial review and patients were followed up at 30 days and 180 days by an independent outcome assessor. Outcomes measured include functional status, frailty, health related quality of life, mortality, and healthcare utilisation.

Results

130 older adults (mean age 76.623 years, SD 9.812 years) were recruited over six months, 44 due to surgical and 86 for medical complaints. The ESD service was provided over a median of 31 (medical) - 44 (surgical) days. The incidence of functional decline was 16.406% at 30 days and 27.5% at 180 days. There was a significant improvement in self-reported function from index visit 72.939 (19.502) mean (SD) to 30 days 84.046 (21.078) mean (SD) which was maintained at 180 days 80.534 (30.930) mean (SD). Frailty was independently associated with incidence of functional decline at 30 days (OR 2.061, 95%CI 1.386 to 3.062) and 180 days (OR 1.7, 95%CI 1.292 to 2.236).

Conclusion

An ESD model of care can have significant effects on patient outcomes for older adults admitted to hospital at 30 and 180 days. Future research should explore the impact of an ESD model of care on specific cohorts, using RCT methodology.
Can Avatar Robots Assist Older People and Care Professionals? Evaluation of an Intervention Study in Eight Nursing Homes in Tokyo
Authors: Obayashi Kazuko , Kodate Naonori , Ishii Yoko , Okamoto Yoshimi , Kondo Hiromasa , Kurishima Sae , Masuyama Shigeru
Published: September 2024

Background

Securing human resources to meet increasing demand for older people's care is challenging, particularly in Japan, where the pace of ageing is accelerating. Central and local government have been seeking partial solutions in assistive technologies such as robotics. Against such a background, the study was conducted in 8 nursing care homes in Tokyo, where avatar robots were tested to examine whether and how these robot interventions can affect the daily life of older people and care professionals.

Methods

Four different types of avatar robot (ORIHIME, NEWME, Piyokame and BOCCO) were introduced to and used in eight nursing care facilities, in order to create conversational opportunities over 12 weeks. Before–after studies were conducted, and a variety of data was collected (interpersonal communication, self-care and depressive tendencies using the International Classification of Functioning, Disability and Health (ICF) and InterRAI assessments). System usability scores (SUS) were collected from care professionals, who also performed a time-on-task analysis.

Results

Study participants who consented to taking part were 136 older adults (88.4±6.6 years old, 18 men and 118 women) and 63 care professionals. Participants with a high degree of dependency accounted for 31 percent. In total, 136 avatar robots were used. There was an overall, yet marginal, improvement for older people. While the SUS scores were poor, the majority (90 percent) responded that such devices would prove useful in the future. The time-on-task analysis indicates that more time can be secured for ‘person-to-person’ care.

Conclusion

Positive impacts of avatar robots (to increase the level of social interaction and communication) were observed. However, the results are inconclusive, and more needs to be done with regard to technology skills, competence enhancement and data collection methods for this type of research. The study was funded in part by the Tokyo Metropolitan Government.
Community Initiatives and the Use of Welfare Technologies in Super-Aged Areas: A Case Study from Japan
Authors: Maeda Yurie , Kodate Naonori
Published: September 2024

Background

Community initiatives are seen as a solution to issues such as social isolation of older people and the lack of formal care. The study examines the use of welfare technologies in two municipalities in southern Japan to enhance their community-based care systems amidst challenges like underfunding and coordination. One case, an agriculture-led town with a handful of administrators, and the other, a manufacturing-led 'Tokku' (national strategic special zone) with active central and local government involvement, provide contrasting approaches.

Methods

Using a case study approach, the initiatives taken by the two municipalities were identified from ’grey’ literature and examined to see what types of welfare technologies have been introduced and how, and what impacts the overall projects had on older people’s lives, well-being and care delivery.

Results

The current average ageing rate in Japan is 29.2%. Town A, with a population of 13,878 and a significant ageing population of 43.3%, has initiated various ICT projects since 2011. For example, recognising the difficulties older people have in accessing information, adopting a familiar ICT solution and taking time to explore new applications together contributed to the overall wellbeing during the initiation process. In contrast, ‘Tokku’ B, with a population of 916,003 and an ageing rate of 31.5%, the highest among 25 ‘Tokku’, prioritises Digital Transformation from cradle to grave. They are committed to sustainable development and improving the well-being of their residents (all ages) through collaborative strategies and a forward-looking perspective. The overall impact remains uncertain, however.

Conclusion

These findings shed light on Japan's technology-driven strategies to address age-related challenges, which resonate with age-friendly city initiatives worldwide. However, challenges remain, particularly in depopulated areas with limited resources and skilled care professionals. Further research, including comparative studies between Japan, Ireland and beyond, is essential to understand the impact of welfare technology integration in supporting ageing in place.
Unmet Needs Post Stroke: Level of Unmet Need According to Discharge Destination
Authors: Harte Gillian , Lawson Susan , Walsh Rachel , Ryan Dan
Published: September 2024

Background

Stroke survivors often face unmet needs after leaving acute and rehabilitation services (McKevitt et al., 2011). UK and Ireland stroke guidelines (2023) advise a 6-month health and social care review for all patients, yet resource access in hospital and community settings hinder this. Targeting those with the most unmet needs could improve service delivery. Consequently, we examined unmet needs of stroke patients post-rehabilitation, comparing those who were discharged to rehabilitation (RG) to the non-rehabilitation group (NRG).

Methods

Participants: All patients attending a post-stroke review clinic between March 2023 and April 2024. Groups: RG included patients discharged to Early Supported Discharge or inpatient rehabilitation; NRG included patients not discharged to these services. Data: Collected demographic information and assessed unmet needs using a modified Greater Manchester Stroke Assessment Tool. Analysis: Using Microsoft Excel, group comparisons were made using chi-squared tests and t-tests, with log transformation applied to non-normally distributed data.

Results

251 patients attended during the data collection period (69 patients (27%) in RG, 182 patients (73%) in NRG). The average age was 68 in both groups. The RG had a longer mean length of stay (23 days) compared to the NRG (19 days) (p=0.0007). The RG also had a higher mean score on the clinical frailty scale (RG 4, NRG 3, p=0.05). In the RG, 97% reported no follow-up after discharge, compared to 78% in the NRG. A greater proportion of RG patients reported swallow difficulties (12% vs. 3%, p=0.03), mobility difficulties (46% vs. 30%, p=0.02), and falls (41% vs. 30%, p=0.008) compared to NRG patients.

Conclusion

Data from this exploratory study suggests substantial unmet needs among post-stroke patients with a significantly higher level of unmet needs among patients who were discharged to post-acute rehabilitation. Despite this, the majority of these patients were not seen by community services at the time of 6-month review.
End of Life Care, It’s a Journey
Authors: Healy Sarah , Monahan Cathy , Donlon Josephine
Published: September 2024

Background

The Hospice Friendly Hospital (HFH) approach was adopted by an urban academic hospital in 2010 which involved the roll out of the Final Journeys Workshops. in 2019 a review of nursing and healthcare attendant’s (HCA) education and training within geriatric department, alongside patient feedback, identified the need for greater focus to be made on End-of-Life Care. In 2022, it was then decided by the department’s Assistant Director of Nursing that the Final Journeys Workshops was a mandatory requirement for the nursing and HCA staff working in the geriatric inpatient areas.

Methods

Results

Workshops are ongoing with nine having been completed so far. As of April 2024, 34 HCA’s and 70 nurses have now completed the workshop within the directorate. Oral feedback received from the 2023’s attendees highlighted the need for a more interprofessional approach so it was decided that the workshop would be offered to all staff who are working in older person’s services from 2024. Since then, 8 members of staff outside nursing and HCA roles attended the workshop. This had a positive impact on the learning experience but also solidifies that much needed multi-disciplinary approach to EOLC.

Conclusion

At the end of each session, attendees were asked to complete an evaluation. Post reviewing these evaluations the following themes emerged:

By having our geriatric directorate facilitators, we can create more awareness surrounding the culture and practices of EOLC for the older person thus improve the quality of EOLC within the directorate in line with HFH approach.
Is there a Solution to Lengthy Hospital Stays for Nursing Home Residents? Our Nursing Home Liaison Team Are Virtually There
Authors: Coen Neville , Power Leslee , Mahoney Niamh O , Buckley Emily , Mello Sarah
Published: September 2024

Background

Research indicates that Nursing Home residents frequently undergo transfers to acute care, leading to adverse events and functional decline (Brucksch et al., 2018). Local data from highlights the significance of this issue, with 447 admissions averaging 11.1 days in 2022 (HIPE, 2023). Hospital at Home is recognised as a cost-effective alternative for older patients (Singh et al., 2022). The proposed solution involves implementing Virtual Wards, remote telemetry, and a Nursing Home Liaison team led by a Consultant Geriatrician. This initiative targets Early Supported Discharge to reduce the hospital length of stay for Nursing Home patients. The study aimed to investigate the feasibility of using the Virtual Ward platform in this service.

Methods

The study aimed to investigate the feasibility of using the Virtual Ward platform, primarily utilising the Telehealth Usability Questionnaire (TUQ) (Parmanto et al., 2016). A Simulation Lab was also used to test the digital solution before its clinical implementation. Additionally, debriefing sessions were conducted to assess clinicians' perceptions of the technology and identify any potential issues.

Results

The TUQ scores for clinicians using a Virtual Ward for Nursing Home patients show a notably positive outcome. With an average score of 120.5 out of 147, the system received significant approval. The range of scores, from 111 to 139, demonstrates a consistent positive perception among respondents. After simulation-based training in the Simulation Lab, participants reflected on their experiences with Virtual Ward technology. They found it useful, easy to navigate and committed to future use. However, they also identified areas, such as information retrieval, needing refinement. Increased training was suggested to address these concerns.

Conclusion

The Virtual Ward system demonstrates significant approval. In light of these promising results, we are proceeding with the plan to launch the Virtual Wards in May 2024 to complement the existing team.
“Understanding Dementia Together”: The Design, Delivery and Evaluation of a Collaborative Inter-professional Dementia Workshop for Healthcare Students
Authors: O'Sullivan Trish , Moore Niamh , McVeigh Joseph G , Timmons Suzanne , Foley Tony
Published: September 2024

Background

A collaborative, multi-disciplinary team input is crucial for the optimal management of a person with dementia. Interprofessional learning (IPL) has benefits at undergraduate level. Allowing students to engage in IPL pre-qualification enables them to understand the value of a collaborative approach in improving patient care, and this insight may cultivate future collaboration. The aim of this study was to develop, deliver and evaluate an IPL dementia workshop for healthcare students across a broad range of relevant disciplines. A secondary aim was to determine the extent of perceived clinical application of learned knowledge in students who completed the workshop and subsequently underwent clinical placement.

Methods

This study adopted a social constructivist pedagogical approach. A steering group was formed which included faculty members from 11 healthcare disciplines. Disciplines represented included medicine, nursing, dentistry, physiotherapy, radiography, radiation therapy, audiology, speech and language therapy, pharmacy, occupational therapy and paramedicine. Kern's map for the development of a curriculum in medical education informed the development of the intervention. The Alzheimer's Disease Knowledge Scale questionnaire was used to assess students’ knowledge.

Results

102 students completed the pre and post workshop surveys. There was a statistically significant increase in student's knowledge (t (11) = -5.251, p≤0.001) and communication scores (Z=-7.792, p≤0.001) post workshop. The follow up of students on clinical placement showed a perceived behavioural change in communication modification, with 79% of students stating that they have changed the way they communicate with a person with dementia.

Conclusion

The findings of this study provide insight into the optimum modes of design and delivery of an IPL dementia workshop, state of knowledge, confidence, and role recognition across a broad spectrum of healthcare students. The longitudinal follow up of students on clinical placement established perceived behavioural change due to the training.
The Effectiveness of a Community Specialist Team for Older Persons in Preventing Emergency Department Attendances 30 and 90 Days Post-Intervention
Authors: Dunne Aoife , Quinn Laura , Digan Eimear , Campbell Claire , Reilly Amy , John Shalini , Murphy Carole , Everdeen Tara , Martin Ruth
Published: September 2024

Background

Population ageing is prevalent throughout Ireland and its impact is evident particularly in acute hospitals with long Patient Experience Times (PETs) in the emergency department. A Community Specialist Team for Older Persons (CSTOP) was established in our area in 2018 with expansion under Sláintecare in 2022. The main goal is to improve access in the community to age attuned services, and thus prevent Emergency Department (ED) presentations and admissions and improving health outcomes for older people. The team provides a comprehensive geriatric assessment and resultant interventions required for each patient. The cohort of patients includes (Frail Intervention Team) FIT referrals from the ED, Geriatrician referrals from Outpatient clinics and GP referrals. Many of these patients have either presented to the Emergency Department or are at risk of same.

Methods

Data for all CSTOP patients is recorded including medical record numbers. All medical records for patient admitted in 2023 were analysed using the integrated patient management system (IPIMS) in our local hospital. ED presentations and admissions were reviewed at 30 and 90 days post intervention.

Results

232 referrals were received in 2023. 42 (18%) had an ED presentation 30 days post discharge and 48 (21%) had a presentation 90 days post discharge. 11 RIPs.

Conclusion

This study shows the effectiveness of the CSTOP team at preventing ED presentations and resultant admissions. The number of bed days is estimated at 2000. One limitation to our study is data could only be analysed from our hospital system, patients could attend other public or private hospitals during the follow up period. Our results are found to be in keeping with reviews by similar services. Our team provide a rapid access interdisciplinary assessment and intervention to people who may otherwise experience fragmented care within primary care services.
Location, Location, Location- Impact Of Introducing A Local Clinic On Clients’ Waiting Time, Travel Time And Cost
Authors: Keeffe Orla O , Sadeghi Fatemeh
Published: September 2024

Background

Comprehensive Geriatric Assessment (CGA) is the first, essential step to develop and implement a coordinated and integrated plan for older persons’ care. The National Clinical Programme for Older People recommends that older adults identified as being frail or at risk of frailty should have a timely CGA performed (HSE 2012). This pilot quality improvement project relates to a recently established (June 2023) Integrated Care Programme for Older Persons (ICPOP) team. As our current office lies in a different county to our clients’ homes, all CGAs have been domiciliary to date. This project aims to investigate if running a clinic closer to clients’ homes could result in earlier CGA and reduce travel time and cost.

Methods

Three CGA-pilot clinics occurred over six weeks (29thFebruary-11thApril 2024 inclusive). Clients’ addresses, Clinical frailty Scale (CFS), average waiting time six weeks prior to and during the CGA-clinic period was recorded. Staffing was unchanged during data collection. Distance between office and clients’ homes was calculated using Google Maps. Travel time was calculated on the same weekday at the same time as CGA-clinics ran. As clinicians tend to conduct consecutive visits, unidirectional distances only were populated. National Integrated Staff Records and Pay Programme system was used to calculate mileage cost.

Results

Of twelve clients that confirmed their appointment, eleven clients attended clinic (92% attendance rate). All were frail or at risk of frailty (CFS ≥4). Average waiting time reduced from 28 days to 23 days post introduction of CGA-clinic. Clinicians saved a total of 3 hours 38 minutes, and 44.31 euro was saved on mileage.

Conclusion

Pilot shows the benefits of offering in-clinic CGA closer to home in terms of reducing waiting time, optimising clinician time and reducing cost. Client satisfaction and numbers of clinicians seen will be included in the next steps of this ongoing project.
The Impact Of Assessment And Intervention By The Frailty Intervention Team On Emergency Department Re-attendance Rates Of Older Adults
Authors: Munnelly Orlaith , Desai Dhwani , Jefferies George , McGettigan Michelle , Martin Ruth
Published: September 2024

Background

The mean age of patients presenting to the Emergency Department (ED) is rising significantly each year in line with the ageing population. Older adults with frailty often present with complex medical issues on a background of multiple comorbidities. This poses challenges in the provision of timely assessment, diagnosis and treatment in the emergency environment. Previous research in this area has suggested that older adults attending the ED who receive specialist input from multidisciplinary geriatric teams experience improved outcomes, lower hospital admission and re-attendance rates. Frailty Intervention Team (FIT) services are supported by the Integrated Care Programmes for Older People at local and national levels.

Methods

Our FIT team in ED, composed of 3.5 Whole Time Equivalents (WTE), captured data on all reviewed patients over 75, from January – December 2023. Data was extracted on the cohort who were discharged home from the integrated patient management system (IPIMS). ED re-attendance rates within 30 days were then calculated.

Results

384 patients >75 were seen by FIT and discharged home from January – December 2023. 22 (6%) of these re-attended ED within 30 days.

Conclusion

The results of this review indicate that FIT teams working in the ED contribute towards improving older adults care by reducing rates of admission and re-attendance. Factors contributing to this include improved time to comprehensive geriatric assessment and enhanced pathways with community services supporting discharge. The average length of stay of patients seen by FIT and admitted is 10 days, therefore over 3500 bed days were saved by this small team in 2023. These results provide strong evidence that even frail, older patients can be safely and effectively discharged from ED with minimal risk for re-attendance.
Modelling the Non-linear Associations between Age and Health: Implications for Care
Authors: Monaghan Cormac , de Andrade Moral Rafael , Power Joanna McHugh
Published: September 2024

Background

Ageing is a complex biological process that weakens the body's defences against various health problems and diseases. This decline is not uniform or linear; rather, it varies significantly among individuals. Understanding the non-linear progression of ageing is crucial for identifying critical periods where intervention might be most beneficial. This study aimed to explore nonlinearities in the association between age and health outcomes.

Methods

Using generalised additive models, we analysed data from the 2020 wave of the United States Health and Retirement Study. This modelling approach allows for the detailed examination of nonlinearities in health outcomes across different ages. Our sample consisted of adults aged over 50 (n = 1338; mean = 68; range = 50 – 95). We assessed seven health outcomes (heart conditions, diabetes, cholesterol, blood pressure, fatigue, back pain, and headaches) and seven protective behaviours (prostate exams, mammograms, cholesterol screenings, pap smears, flu vaccinations, dental check-ups, and smoking patterns) reflecting various aspects of health status and behaviour.

Results

The analysis indicated a significant and pronounced non-linear relationship between age and certain health outcomes, namely headaches, blood pressure, diabetes, and heart conditions. Additionally, ageing was non-linearly associated with specific health behaviours, including the uptake of prostate exams, mammograms, flu vaccinations, and smoking prevalence. Notably, distinct patterns emerged concerning health behaviours in relation to age-specific screening policies.

Conclusion

The findings of this study reveal that the probability of developing health problems or engaging in health protective behaviours do not increase/decrease linearly in direct proportion to age. Rather, the probability curve exhibits fluctuations, presenting periods of heightened odds interspersed with phases of relative stability. Such non-linearity may be partially attributed to policy decisions but could also reflect a complex interplay of factors such as weakened immune systems, access to healthcare, personal health beliefs, and the evolving perception of risk as one grows older.