bluuebunny/crossref_metadata_2025 huggingface dataset:
Radial X-ray profiles of simulated galaxies
Authors: Vladutescu-Zopp S. , Biffi V. , Dolag K.
Published: January 2025

Context. Theoretical models of structure formation predict the presence of a hot gaseous atmosphere around galaxies. While this hot circumgalactic medium (CGM) has been observationally confirmed through UV absorption lines, the detection of its direct X-ray emission remains scarce. Recent results from the eROSITA collaboration have claimed the detection of the CGM out to the virial radius for a stacked sample of Milky Way-mass galaxies.

Aims. We investigate theoretical predictions of the intrinsic CGM X-ray surface brightness (SB) using simulated galaxies and connect them to their global properties, such as the gas temperature, hot gas fraction, and stellar mass.

Methods. We selected a sample of central galaxies from the ultra-high-resolution cosmological volume (48 cMpc h−1) of the Magneticum Pathfinder set of hydrodynamical cosmological simulations. We classified them as star-forming (SF) or quiescent (QU) based on their specific star formation rate (SFR). For each galaxy, we generated X-ray mock data using the X-ray photon simulator PHOX, from which we obtained SB profiles out to the virial radius for different X-ray emitting components; namely, gas, active galactic nuclei (AGNs), and X-ray binaries (XRBs). We fit a β-profile to the gas component of each galaxy and observed trends between its slope and global quantities of the simulated galaxy.

Results. We found marginal differences among the average total SB profile in SF and QU galaxies beyond r > 0.05 Rvir. The relative contribution from hot gas exceeds 70% and is non-zero (≲10%) for XRBs in both galaxy types. At small radii (r < 0.05 Rvir), XRBs dominate the SB profile over the hot gas for QU galaxies. We found positive correlations between the galaxies’ global properties and the normalization of their SB profiles. The fitted β-profile slope is correlated with the total gas luminosity, which, in turn, shows strong connections to the current accretion rate of the central supermassive black hole (SMBH). We found the halo scaling relations to be consistent with the literature.
COmoving Computer Acceleration (COCA): N-body simulations in an emulated frame of reference
Authors: Bartlett Deaglan J. , Chiarenza Marco , Doeser Ludvig , Leclercq Florent
Published: January 2025

Context.N-body simulations are computationally expensive and machine learning (ML) based emulation techniques have thus emerged as a way to increase their speed. Surrogate models are indeed fast, however, they are limited in terms of their trustworthiness due to potentially substantial emulation errors that current approaches are not equipped to correct.

Aims. To alleviate this problem, we have introduced COmoving Computer Acceleration (COCA), a hybrid framework interfacing ML algorithm with an N-body simulator. The correct physical equations of motion are solved in an emulated frame of reference, so that any emulation error is corrected by design. Thus, we are able to find a solution for the perturbation of particle trajectories around the ML solution. This approach is computationally cheaper than obtaining the full solution and it is guaranteed to converge to the truth as the number of force evaluations is increased.

Methods. Even though it is applicable to any ML algorithm and N-body simulator, we assessed this approach in the particular case of particle-mesh (PM) cosmological simulations in a frame of reference predicted by a convolutional neural network. In such cases, the time dependence is encoded as an additional input parameter to the network.

Results. We find that COCA efficiently reduces emulation errors in particle trajectories, requiring far fewer force evaluations than running the corresponding simulation without ML. As a consequence, we were able to obtain accurate final density and velocity fields for a reduced computational budget. We demonstrate that this method exhibits robustness when applied to examples outside the range of the training data. When compared to the direct emulation of the Lagrangian displacement field using the same training resources, COCA’s ability to correct emulation errors results in more accurate predictions.

Conclusions. Therefore, COCA makes N-body simulations cheaper by skipping unnecessary force evaluations, while still solving the correct equations of motion and correcting for emulation errors made by ML.
Towards a Greener Tomorrow: Sustainable synthesis of well-defined polymers in ionic liquids via recyclable nano catalyst mediated photopolymerization
Authors: Jain Amul , Sahu Bhanendra , Ingale Nikhil , BANERJEE Sanjib
Published: January 2025

A new path has been opened by the widespread use of ionic liquids (ILs) in reversible-deactivation radical polymerization (RDRP) procedures to address the problems caused by hazardous solvent. Additionally, a photoinduced RDRP (photoRDRP) of methacrylate monomer in recyclable IL has been developed, which is catalyzed by magnetic nano zero valent iron (nZVI), enabling incredible control over Mn and Đs during the polymerization of methacrylate by simply turning the UVA radiation (λmax = 352 nm) "ON" and "OFF". This allows for good temporal control. Furthermore, the chain end fidelity was determined through the synthesis of many distinct diblock copolymers with permissible Đs values (≤1.20).
Impact of standard enhancement settings of endoscopy systems on performance of endoscopic artificial intelligence systems
Authors: Jong Martijn R. , Kusters Carolus H. J. , van Bokhorst Querijn N. E. , Jukema Jelmer B. , van Eijck van Heslinga Rixta A. H. , Fockens Kiki N. , Houwen Britt B. S. L. , Jaspers Tim J. M. , Boers Tim G. W. , van der Vlugt Manon , Dekker Evelien , van der Sommen Fons , de With Peter H. N. , de Groof Albert J. , Bergman Jacques J. G. H. M ,   on behalf of the BONS-AI Consortium
Published: January 2025

Background Artificial intelligence (AI) systems in endoscopy are predominantly developed and tested using high-quality imagery from expert centers. However, their performance may be different when applied in clinical practice, partly due to the diversity in post-processing enhancement settings used in endoscopy units. We evaluated the impact of post-processing enhancement settings on AI performance and tested specific data augmentation strategies to mitigate performance loss.

Methods We used a computer-aided detection (CADe) system for Barrett’s neoplasia (6223 images, 906 patients) and a computer-aided diagnosis (CADx) system for colorectal polyps (3288 images, 969 patients), both trained on datasets acquired with Olympus equipment and with limited variability in enhancement settings. The CAD systems were then tested across a wide range of test sets, which comprised the same images, but displayed with different enhancement settings. Both CAD systems were then retrained using image enhancement-based data augmentation. The performance of the adjusted CAD systems was evaluated on the same test sets.

Results Both systems displayed substantial performance variability over a range of enhancement settings (CADe: 83 %–92 % sensitivity, 84 %–91 % specificity; CADx: 78 %–85 % sensitivity, 45 %–63 % specificity). After retraining, variability in sensitivity and specificity was reduced to 2 % (P < 0.001) and 1 %, respectively (P = 0.003) for CADe, and 2 % (P = 0.03) and 8 %, respectively (P = 0.19) for CADx.

Conclusion The performance of endoscopic AI systems can vary substantially depending on post-processing enhancement settings of the endoscopy unit. Specific data augmentation can mitigate this performance loss.
Multidimensional Analysis of Preoperative Patient-Reported Outcomes Identifies Distinct Phenotypes in Total Knee Arthroplasty: Secondary Analysis of the SHARKS Registry in a Public Hospital Department
Authors: McGill Raquel , Scholes Corey , Torbey Stephen , Calabro Lorenzo
Published: January 2025

Traditional research on total knee arthroplasty (TKA) relies on preoperative patient-reported outcome measures (PROMs) to predict postoperative satisfaction. We aim to identify distinct patient phenotypes among TKA candidates, and investigate their correlations with patient characteristics. Between 2017 and 2021, patients with primary knee cases at a metropolitan public hospital were enrolled in a clinical quality registry. Demographics, clinical data, and the Veterans Rand 12 and Oxford Knee Score were collected. Imputed data were utilized for the primary analysis, employing k-means clustering to identify four phenotypes. Analysis of variance assessed differences in scores between clusters, and nominal logistic regression determined relationships between phenotypes and patient age, sex, body mass index (BMI), and laterality. The sample comprised 389 patients with 450 primary knees. Phenotype 4 (mild symptoms with good mental health) exhibited superior physical function and overall health. In contrast, patients in phenotype 2 (severe symptoms with poor mental health) experienced the most knee pain and health issues. Phenotype 1 (moderate symptoms with good mental health) reported high mental health scores despite knee pain and physical impairment. Patient characteristics significantly correlated with phenotypes; those in the severe symptoms with poor mental health phenotype were more likely to be younger, female, have a higher BMI, and bilateral osteoarthritis (p < 0.05). This multidimensional analysis identified TKA patient phenotypes based on common PROMs, revealing associations with patient demographics. This approach has the potential to inform prognostic models, enhancing clinical decision-making and patient outcomes in joint replacement.
Academic freedom: Challenges to cultivating a revolutionary unconscious in a neoliberal world
Authors: O’Loughlin Michael
Published: January 2025

Seeking to frame the debate around academic freedom in terms of freedom of thought, this article begins with an exploration of the hazards of fascist ideology and the psychodynamics of persuadability. Attention is paid to the perverse lure of certainty and the apparent willingness of many people to accede to an instrumentalized unconscious. Through the writings of Butler and Athanasiou, an antithesis to the dispossession of an instrumentalized unconscious is explored in terms of radical performativity and critical relationality, modalities which have the potential to undo what Elizabeth Povinelli termed “the cunning of recognition.” The limitations of psychoanalysis due to its historical antecedents in colonialism and racialized capitalism are explored, and an argument for a genealogically and sociohistorically constituted psychoanalysis is entertained. Following Derrida’s imagining of the university as truth-seeker, aspects of the history of U.S. higher education are explored to illustrate the continuous struggle between sovereign power and capitalist logic and the possibility of education as the practice of freedom. The essay concludes with an exploration of the intersection between psychoanalysis and critical pedagogy, posing the question of whether analytic institutes and universities might become vehicles for an encounter with alterity that could potentially sow the seeds for a revolutionary unconscious.
Robust and consistent bonding of polydimethylsiloxane to polystyrene cell culture plates
Authors: Orlowska Marta K. , Lor Mary , Fitzsimmons Rebecca L. , Robinson Harley , Delcheva Iliana , Williams Daniel , Priest Craig , Hudson James E.
Published: January 2025

Polydimethylsiloxane (PDMS) is a commonly used material for the design of new cell culture devices. Typically, molded PDMS is bonded to glass or another PDMS layer; however, it is challenging to form high-strength bonds with polymers commonly used for cell culture-ware, such as polystyrene (PS). Therefore, a robust PDMS–PS bonding method would facilitate a wider use of PDMS in tissue culture applications. Herein, we develop an irreversible, stable, and consistent PDMS–PS bonding protocol. We show that this method is superior to other currently available methods because of its bonding strength, reusability, and reliability. Furthermore, we demonstrate the utility of this bonding process in fabricating our Heart-Dyno device, a 96-well-based platform for culturing cardiac organoids. This bonding process has been successfully used over the past 2 years, with hundreds of plates manufactured for drug screening applications. Others may also have similar applications where this method may facilitate the fabrication of more robust PDMS–PS devices.
Monolithic on-chip integration of micro-thin film thermocouples on multifinger gallium oxide MOSFETs
Authors: Bhatti Hassan Irshad , Mainali Ganesh , Li Xiaohang
Published: January 2025

Gallium oxide (Ga2O3), with its ultra-wide bandgap (>4.5 eV), is a key material for the next-generation power electronics due to its high breakdown voltage and efficient power-switching capabilities. Multifinger (MF) Ga2O3 MOSFETS, designed to enhance current handling and thermal management, experience significant self-heating effects that can lead to localized hotspots, thermal runaway, and reduced device reliability. Accurate thermal characterization is therefore critical to ensure the reliable operation and longevity of such devices. Conventional methods, such as thermoreflectance imaging, Raman thermometry, and infrared thermography, are limited by complex setups, slow response times, resolution constraints, and cost, making them less practical for real-time, on-chip applications. On-chip thermal characterization directly at the active regions of the device provides an unparalleled opportunity to overcome these limitations by capturing localized temperature variations during operation. In this study, we demonstrate the integration of micro-thin film thermocouples (micro-TFTCs) onto multifinger Ga2O3 MOSFETs for precise, real-time, and localized thermal monitoring. The sensors captured temperature variations across different gate fingers, with the measured maximum channel temperature reaching 40.5 °C under peak power dissipation. Predicted thermal behavior under high power densities shows temperatures rising to approximately 80 °C at 5 W/mm2, illustrating the thermal challenges faced by Ga2O3 devices. This work demonstrates that micro-TFTCs are not only compatible with complex device architectures but also highly effective for localized thermal characterization, making them a promising tool for improving the thermal management and reliability of Ga2O3-based power electronics.
An illustrative guide to a Policy Lab model: contributing to evidence-informed policies for digital technology in youth mental health care
Authors: Baker David G. , Kenny Bridget , Prober Sophie C. , Sabo Amanda , Hamilton Matthew P. , Gao Caroline X. , Cross Shane
Published: January 2025

Objective This article provides researchers with an illustrative guide for a workshop model that facilitates evidence-informed policy. The Policy Lab model supports collaboration between experts and policymakers; in the example provided, participants considered digital technologies with near-term potential to improve youth mental health care. Method The Policy Lab model uses structured workshop activities to explore a policy question, before narrowing the focus on potential answers. The barriers, enablers, and implementation mechanisms of potential policies are then considered. From this data policy proposal(s) are drafted, reviewed, and reported. Results Through the Policy Lab activities, participants identified two priority technologies and generated data to inform the formulation of two policies. The policies were focused on (1) using artificial intelligence to improve the personalisation and precision of youth mental health care and (2) the expanded use of integrated data to improve youth mental health service quality. Conclusions Evidence-informed policy is a collaborative process. To potentially influence policy requires timely engagement with policymakers and an understanding of the policy context. Researchers considering using the model are encouraged to include a range of expertise.
Rational design and modular synthesis of biodegradable ionizable lipids via the Passerini reaction for mRNA delivery
Authors: Xu Yue , Gong Fanglin , Golubovic Alex , Strilchuk Amy , Chen Jingan , Zhou Muye , Dong Songtao , Seto Breanna , Li Bowen
Published: January 2025

The ionizable lipid component of lipid nanoparticle (LNP) formulations is essential for mRNA delivery by facilitating endosomal escape. Conventionally, these lipids are synthesized through complex, multistep chemical processes that are both time-consuming and require significant engineering. Furthermore, the development of new ionizable lipids is hindered by a limited understanding of the structure-activity relationships essential for effective mRNA delivery. In this work, we have developed a modular platform utilizing the Passerini reaction to rapidly generate large, chemically diverse libraries of biodegradable ionizable lipids. This high-throughput approach enables the systematic exploration of various lipid components–head groups, tails, and spacers–and their impacts on mRNA delivery efficiency. By investigating the hydrogen bonding potential between the lipid’s head groups and the mRNA’s ribose phosphate complex, we found that optimizing the methylene units between the lipid’s head groups and linkages could enhance endosomal escape and, consequently, mRNA delivery efficiencies. Leveraging this insight, our platform has led to the identification of the biodegradable ionizable lipid A4B4-S3, which outperforms the current clinical benchmark, SM-102, in gene editing efficacy in mouse liver following systemic administration and demonstrates the promise for repeat-dose protein replacement treatments. This work not only offers a rapid, scalable method for ionizable lipid synthesis but also deepens our understanding of their structure-activity relationships, paving the way for more effective mRNA therapeutics.
Exploring L1/L2 and time impact on linguistic complexity of
Laozi translations
Authors: Cheung Joyce Oiwun
Published: January 2025

Research shows that language complexity is a crucial measure of
proficiency and that academic and scientific writing has evolved over time.
However, linguistic complexity may differ between first (L1) and second (L2)
language translations, and its development over time remains unexplored. This
study examines how the translator’s native language and the time of translation
affect the complexity of Laozi translations. Using a corpus of
79 translations, we analyzed syntactic and lexical complexity to compare L1 and
L2 English speakers’ translations across three distinct periods. Contrary to
expectations, our results reveal no significant complexity differences between
L1 and L2 translators, suggesting that native language proficiency does not
necessarily influence translation complexity. However, significant variations
were found across different historical periods, indicating changes in
translation styles over time. These findings show that time influences
translation complexity more than the translator’s native language.
Green materials in semiconductors: perspective from the IRDS beyond-CMOS roadmap
Authors: Ueda Akiko , Akinaga Hiroyuki , Agarwal Sapan , Hagmann Joseph A , Das Shamik , Marinella Matthew J , Chen An
Published: January 2025

Environmental, safety, health, and sustainability (ESHS) have become an indispensable issue in the semiconductor industry. The ‘Beyond CMOS’ chapter of the International Roadmap for Devices and Systems roadmap introduces the concept of ‘Green materials’, emphasizing their importance for maintaining sustainability in semiconductor manufacturing. We discuss the current trends of emerging architectures and devices in the perspective of ‘Green materials’. Additionally, we highlight the significance of benchmarking and standardization in advancing sustainable practices within the semiconductor industries.
Studying decoherence in hyperfine ground states of 133Cs atoms using two photon lineshape spectroscopy
Authors: Yadav Poonam , Ghosh Arnab , Yadav Hemant , Santra Bodhaditya
Published: January 2025

Hyperfine ground states in alkali atoms are among the most promising candidates for realizing high fidelity scalable quantum information processing architecture. Fast manipulation of ground states can be realized via two-photon transitions driven by lasers. The light-atom interaction can cause decoherence in the system. Here, we study the decoherence rate using accurate lineshape spectroscopy involving hyperfine ground states of D2 transition in

133

Cs

atoms in room-temperature-atomic-vapor. The measured decoherence rate varies very slowly as a function of the Rabi frequency of the probe field. Furthermore, we have investigated the slow light group velocity resulting from the narrow spectral width of the electromagnetically induced transparency lineshape. Our study paves the way to implement quantum information processing protocols using coherent photonic polarization qubits in an atomic medium across a large parameter range.
Climatology of waterspouts in Mexico and numerical modeling of a particular case
Authors: Monterde Daniela , Carbajal Noel , León-Cruz José Francisco , Pineda-Martínez Luis Felipe
Published: January 2025

Numerous waterspout events occur practically in all Mexican waters. The principal aim was to carry out a climatology of these events. A data compilation allowed the identification of 103 cases from 2010–2022. A Szilagyi waterspout nomogram was constructed to explain the formation mechanism using the ERA5 reanalysis data. The nomogram classified waterspout events according to their origin using thermodynamic parameters. The results revealed that the thermodynamics of some waterspouts in Mexico do not fit the current definition of the Szilagyi nomogram. Most waterspouts are thunderstorm-related and fit the nomogram. A minority that arises from land breezes and upper-low conditions also fit. A relevant case, which occurred in an area with a recurrent incidence of waterspouts, allowed observation of relevant dynamic properties, such as its strength, occurred on August 8, 2019, in Coatzacoalcos, Veracruz. The documented waterspout trajectory revealed that it moved through the sea and city. The Weather Research and Forecasting (WRF) model was used for modeling this event at a resolution of 250 m. The results showed the instability, a cyclonic disturbance (misocyclone) that caused the waterspout. The analysis showed the behavior of meteorological variables, such as temperature, humidity, wind, vorticity, and unstable atmospheric variables during the storm.
Transparency in United States healthcare sustainability: a scoping review
Authors: Locke Sara , Hadley Courtney , Sherman Jodi D , Hantel Andrew , Senay Emily
Published: January 2025

The United States (U.S.) healthcare sector—a significant contributor to climate change through emissions, pollution, and waste—is beginning to integrate sustainability into operations. Sustainability science and accounting have been widely adopted across other industries to measure and communicate mitigation progress. Transparency, defined as ensuring accurate reporting and open disclosure of sustainability data, is critical. Without it, organizations risk ‘greenwashing,’ where misleading claims can erode public trust and undermine sustainability efforts. This scoping review evaluates the extent to which U.S. healthcare literature addresses transparency as a critical component of sustainability initiatives. This review identified peer-reviewed and non-peer-reviewed literature on environmental sustainability within U.S. healthcare from 1994 to 2024, with a focus on transparency and related concepts. Articles were excluded if they were not in English, corporate reports, advertisements, or irrelevant to U.S. healthcare sustainability. The following databases were searched: Ovid MEDLINE, Nexis Uni, Business Source Complete, Scopus, and Health Care Administration. Two independent reviewers screened and extracted the data, with a third resolving disagreements. Qualitative and thematic analyses were employed to assess if and how transparency was defined and operationalized in the context of healthcare sustainability. Of the 835 articles screened, 33 met inclusion criteria. Only 10 of the 33 articles both defined and operationalized transparency. Key focus areas included environmental sustainability practices in healthcare (n = 18, 55%); ESG or CSR and public health impact (n = 18, 55%); the business of healthcare (n = 8, 24%); and policy-driven sustainability initiatives (n = 7, 21%). Barriers included absence of mandates, standardization, and leadership. Despite a growing body of research on healthcare sustainability, studies addressing transparency are sparse. Limitations included a narrow keyword focus and limited databases searched. Transparent reporting could be considered the sixth ‘R’ in the 5 Rs of sustainability–refuse, reduce, reuse, recycle, repurpose, and report.
2633 Reducing delays in Administration of First Dose Denosumab through introduction of ACP led consent process during inpatient stay
Authors: Atkinson A , Alićehajić-Bečić Đ , Adejumo S
Published: January 2025

Introduction

At Wrightington, Wigan and Leigh we admitted over 400 patients with hip fracture diagnosis in 2023. As part of orthogeriatric review, denosumab treatment would be utilised in a cohort of patients where this is appropriate, in line with NOGG guidelines. Traditional model of delivering first dose after outpatient appointment led to delays in treatment initiation and did not address the significant risk of ‘imminent fracture’ which was recognised in the latest NOGG guidelines. The aim of this project was to reduce delays in denosumab treatment initiation by introducing consenting process during hospital stay led by orthogeriatric Advanced Clinical Practitioner.

Method

Utilising hospital electronic records, a sample of patients was selected from patients admitted in 2022 (19 patients), 2023 (19 patients) and 2024 (6 patients). Time of decision to treat with denosumab to time of first dose administered was used as the outcome measure. Alongside this, analysis of time to outpatient appointment was completed which was where the pre-intervention consent was taken. Intervention of inpatient consent being taken was implemented in September 2023.

Results

The average length of time from clinical decision being made to first dose of denosumab being administered was 187 days in 2022 sample, 76 days in 2023 sample and 27 days in 2024 sample. The governance around consent process was established and adopted by the whole orthogeriatric team. Waiting times for outpatient bone health clinic were on average 240 days in 2022, 164 days in 2023 and unknown in 2024 cohort.

Conclusion(s)

Introduction of ward-based consent process for patients who are suitable for denosumab led to significant decrease in delays in time to first dose. This ensures that patients benefit from bone protection in a timely manner, as their risk of refracture is greatest in the first 6 months post index fracture.
2829 Improving door to needle times in stroke thrombolysis through simulation-based training in a district general hospital
Authors: Koushik S , Nagsayi S , Coombe L , Aguirre C , Elfeky M
Published: January 2025

Introduction/Background

Teamwork is very important in hospitals where the medical on-call team manage the stroke and thrombolysis alert calls. In addition to technical skills, human factors play a very significant role in meeting a target door-to-needle time.

Aim

To improve door-to-needle time by improving human factors (leadership, understanding and delegation of roles and confidence in participation) and technical factors (quick NIHSS and efficient documentation of vital information on radiology request forms for urgent CT head).

Method

We conducted 6 simulation-based training sessions and de-briefing sessions (role-playing and education around technical and non-technical skills) starting from November 2022. We measured the participants’ responses before and after the sessions, with the help of Kirkpatrick’s four level training evaluation model. We measured and compared the thrombolysis breakdown data (total of 38 consecutive patients from May 2022 to February 2023) throughout the process. We used statistical process control (SPC) charts to calculate and visually represent median values to demonstrate the changes.

Results

Thrombolysis breakdown data revealed substantial improvement post intervention (November 2022) compared to data from May–October 2022. SPC charts demonstrated significant reduction and step change in median door-to-needle time (83.7 to 52.2 minutes) and CT imaging to reporting time (36.2 min to 19.5 min).

Conclusion

A series of simulation-based training sessions and debriefing sessions for stroke thrombolysis was able to demonstrate statistically significant improvement in door-to-needle time. We will continue the simulation sessions and will assess sustainability of the interventions.

Declaration of Funding

None.

References

1. Ajmi SC, Advani R, Fjetland L. et al. Reducing door-to-needle times in stroke thrombolysis to 13 min through protocol revision and simulation training: a quality improvement project in a Norwegian stroke Centre. BMJ Quality & Safety. 2019;28:939–48.

2. Chalwin RP, Flabouris A. Non-technical skills training for MET. Intern Med J. 2013;43:962–9. https://doi.org/10.1111/imj.12172.
2893 Telemedicine Unreadiness in an older frail population attending the geriatric day hospital
Authors: Lynch A , Ensar D , Clancy C , Ryan D
Published: January 2025

Introduction

Telemedicine uses communications technology for remote healthcare. Unreadiness includes difficulties with hearing, speaking, cognitive issues, vision problems, lack of internet-enabled devices, or no recent use of digital communication. Telehealth can enhance access and convenience, especially for rural patients, but faces challenges such as technology issues and impacts on patient-provider relationships, examination quality, care quality, and patient satisfaction. The COVID-19 pandemic has accelerated telemedicine adoption to protect medical personnel and patients, with significant promotion of video visits for home-based care.

Objective

This study aims to evaluate telemedicine unreadiness in an older, frail population at a geriatric clinic. Patients were contacted from February 1st to March 14th, 2021, during Ireland’s COVID-19 ‘third wave,’ with up to three contact attempts made.

Method

Statistical analysis was conducted using STATA 14. 84 patients attended the Geriatric clinic, with 33 excluded for various reasons, leaving 51 participants (67%) who completed the survey. The mean age was 81.7 years, with 49% female. Most referrals were for cognitive issues (59%), followed by BPSD (13%), weight loss (9%), and falls (7%). The median Clinical Frailty Score was 4, indicating moderate to severe frailty. Regarding mobility, 77% were independent, 21% used an aid, and 2% were immobile. Cognitive assessments revealed 25% had normal cognition, 18% had mild impairment, and 57% had dementia.

Results

Only 10% of patients were ideal for teleconsultations, while 90% faced significant barriers, such as environmental impairments (26), sensory impairments (2), and both (18). Additionally, 25% lacked computer, and only 10% used the internet regularly. Despite 59% having family assistance, overall, 82% had some form of environmental impairment. Sensory impairments were common, with 29% using hearing aids but 37% still experiencing issues. Visual impairments were better managed, with 76% wearing glasses.

Conclusion

Telemedicine adoption has accelerated due to COVID-19, but significant barriers for geriatric patients highlight the need for better support.
2771 Improving collateral history taking in the geriatric population
Authors: Swain E , Ramsay K
Published: January 2025

Introduction

The geriatric population has a high incidence of dementia, delirium and frailty meaning often these patients cannot give comprehensive histories themselves. We are left with missing pieces of the puzzle; we might not know their ‘normal’ and frequently ask: ‘Are they always like this?’ A collateral history becomes a valuable tool, contributing to a Comprehensive Geriatric Assessment and assisting the whole MDT to make informed decisions for patient-centred care. The primary aim of this project was to improve the quality of collateral histories taken for patients admitted to the geriatric wards, with content measured against 8 domains. A secondary aim was to encourage timely collateral histories within 48 hours of admission to the ward.

Method

Using PDSA methodology, collateral histories were analysed before and after implementation of a poster and teaching session.

Results

At baseline each domain was covered a mean of 40.5% of the time (range 9%—81%). Following intervention this increased by 22% to 62.5% (range 18%—89%), demonstrating a significant improvement (paired t-test, P < 0.05). It was already common practice to take collateral histories within 48 hours of admission to the ward (91%) which was sustained post-intervention (88%).

Conclusion

Use of a poster as a prompt, and delivering teaching, led to more thorough collateral histories. This suggests two barriers are knowing what to ask and perceived importance, elements which could be integrated into early postgraduate education. The impact on patient care has the potential to be significant and multidimensional but further work would be needed to understand this.
2838 Evaluation of the use of the National Early Warning Score (NEWS2) for delirium identification in welsh hospitals
Authors: Gravell E , Williams G , Smith B , Willimont C , Beynon-Howells C , Quinn P , Green T , Burberry DJ , Fernandez S , Davies EA
Published: January 2025

Introduction

The National Early Warning Score (NEWS) (2017) incorporated new confusion as a category for consciousness. NEWS2 is evidenced to have high specificity but low sensitivity in detecting delirium.

Methods

Morriston Hospital. 261 patients assessed. Consciousness, overall NEWS2 score and AMT4 recorded. 227 NEWS2 charts available. 208 patients recorded as alert. 44% (n = 87) scored less than 4 on AMT4, 55% (n = 48) didn’t have documented past medical history (PMH) of cognitive impairment. Data missing for 14 patients. Ysbyty Gwynedd. 178 patients assessed.161 recorded as alert. 58.4% patients scored less than 4 on AMT4, 77% had no PMH of cognitive impairment. Data missing for 15 patients. University Hospital Llandough. 40 patients; 38 patients were marked as Alert, 2 were excluded from observations.32.5% (n = 13) had a diagnosis of possible or definite delirium. An electronic survey coupled with training delivery of 103 Health Care Workers (HCW) and 112 Registered Nurses (RN) was undertaken at Morriston. 39 HCWs (37.8%) and 31 RNs (27.6%) weren’t confident in the use of NEWS2 in regards to acute confusion. Training was offered on a 1 to 1 basis for these 215 staff members.

Results

Post intervention, 221 patients were assessed at Morriston, 209 marked as alert. 2 patients had been identified as having a new confusion and 10 patients did not have their consciousness recorded. Of the 209 marked alert 42% (88 patients) scored less than 4 on AMT4; 53 had no PMH of cognitive impairment. Training yielded little benefit.

Conclusion

The accuracy of recording consciousness has wider implications on the use of the NEWS2. NEWS2 uses routine observations and delirium assessment is variably implemented meaning routine information is not always available. The NEWS2 should be used in conjuction with other tools developed for delirium e.g 4AT and SQiD.
2834 Frailty in randomised controlled trials of glucose-lowering therapies for type 2 diabetes
Authors: Wightman H , Butterly E , Wei L , McChrystal R , Sattar N , Adler A , Phillipo D , Dias S , Welton N , Clegg A , Witham M , Rockwood K , McAllister D , Hanlon P
Published: January 2025

Background

The representation of frailty in type 2 diabetes trials is unclear. This study used individual patient data (IPD) from trials of newer glucose-lowering therapies to quantify frailty and assess the association between frailty and efficacy and adverse events.

Method

We analysed IPD from 34 trials of SGLT2 inhibitors, GLP1 receptor agonists and DDP4 inhibitors. Frailty was quantified using a cumulative deficit frailty index (FI). For each trial, we quantified the distribution of frailty; assessed interactions between frailty and treatment efficacy (HbA1c and major adverse cardiovascular events [MACE], pooled using random-effects network meta-analysis); and associations between frailty and withdrawal, adverse events, and hypoglycaemic episodes.

Findings

Trial participants numbered 25,208. Mean age 53·8 to 74·2 years. Using FI > 0·24 to indicate frailty, median prevalence was 1·9% (IQR 0·8% to 6·1%). Prevalence was higher in trials of older people and people with renal impairment. For SGLT2i and GLP1ra, there was a small attenuation in efficacy on HbA1c with increasing frailty (0·07%-point and 0·14%-point smaller reduction, respectively, per 0·1-point increase in FI). Findings for MACE had high uncertainty (few events). A 0·1-point increase in the FI was associated with more adverse events (incidence rate ratio, IRR 1·43, 95% confidence interval 1·34 to 1·53), treatment-related adverse events (1·35, 1·22 to 1·50), serious adverse events (2·04, 1·80 to 2·30), hypoglycaemia (1·18, 1·04 to 1·34), MACE (hazard ratio 3·02, 2·49 to 3·68) and withdrawal (odds ratio 1·45, 1·30 to 1·62).

Interpretation

Frailty is associated very modest attenuation of treatment efficacy for glycaemic outcomes and with greater incidence of both adverse events and MACE. Frailty was rare in most trials. While these findings support calls to relax HbA1c-based targets in people living with frailty, they also highlight the need for inclusion of people living with frailty in trials as the absolute balance of risks and benefits remains uncertain.
2846 How can simulation training be used to teach skills in human factors (HF)?
Authors: Matharu EK , Jegard J , Hague S , Roj B , Kaneshamoorthy M
Published: January 2025

Introduction

Simulation training is a valuable resource to teach clinical skills and mimic emergency settings. Human factors (HF) are non-technical skills that are affected by human attitudes and behaviours. Weaknesses in human factors can cause fatal medical errors. We wanted to assess if simulation can be used as a tool to improve these. We conducted two simulation training days for medical higher specialty trainees (HST) focusing on HF.

Methods

20 HSTs participated in 10 simulated scenarios. Scenarios involved using a high-fidelity manikin and actors. The scenarios were a mixture of long and short cases, including both clinical and non-clinical scenarios with a HF focus. Pre- and post-session questionnaires were used to rate confidence levels in a series of specific HF. A 10-point Likert scale was used.

Results

The majority of participants had a firm understanding of the importance of human factors in healthcare, especially the importance of teamwork, compassion, communication and situational awareness. 70% of participants felt that human factors training may not be adequately considered in current training pathways due to limited formal exposure, limited time, and its importance being underestimated. There was an increase in confidence in: managing disagreements (31%), negative emotions (38%), prioritisation (28%), delegation (23%), teamwork (34%) and leadership skills (30%), dealing with uncertainty (29%), challenging hierarchy (27%), anticipation (31%). 100% felt simulation training helped to develop their attainment of human factor skills.

Conclusion

This form of simulation training was successful in improving confidence and understanding of human factors in healthcare and showcased the value of using high-fidelity training to realistically recreate the clinical environment. Going forward, this type of teaching could be integrated within the specialty training curriculum to formally improve skills in human factors and therefore improve patient outcomes and relationships between team members, thus contributing to a more positive working environment.
Immune-related adverse events in older adults receiving immune checkpoint inhibitors: a comprehensive analysis of the Food and Drug Administration Adverse Event Reporting System
Authors: Esen Buğra Han , Bektas Sevval Nur , Topcu Umur , Köylü Bahadır , Kuvvet Fadime Buket Bayram , Bahat Gulistan , Selçukbiricik Fatih
Published: January 2025

Background

Immune checkpoint inhibitors (ICIs) have revolutionised cancer therapy, yet they carry a unique spectrum of immune-related adverse events (irAEs). Given the ageing global population and the underrepresentation of older adults in clinical trials for ICIs, we investigated the occurrence and characteristics of irAEs in older versus younger adults as well as among different age subsets within the older adult population.

Methods

We analysed the U.S. Food and Drug Administration Adverse Event Reporting System database reports from 2015 to 2023, focusing on ICIs. We categorised irAEs into 11 distinct types and performed descriptive and multivariate analyses to compare the prevalence and clinical characteristics of irAEs across different age groups, adjusting for potential confounding factors.

Results

Among 47 513 patients aged 18–100 reporting irAEs, the 65–74 and 75–84 age groups had significantly increased risks compared to 18–64 (OR 1.13, 95% CI [1.09–1.18]; 1.15 [1.1–1.21]). Cardiovascular irAEs rose with age, peaking at 75–84, while endocrine irAEs decreased. Hepatobiliary, gastrointestinal and ocular irAEs decreased with age, but renal and musculoskeletal irAEs increased, showing higher risks in older adults. Serious outcomes slightly decreased in the 85+ group, while the proportion of deaths increased with age.

Conclusion

We discuss the potential changes in the immune system contributing to the decreased prevalence of irAEs in the oldest age group. Additionally, conservative treatment approaches and underreporting of irAEs in older patients may influence these findings. Our findings highlight the need for personalised decision-making for ICI therapies, considering performance status and comorbidities rather than age alone.
Goals of care discussions and treatment limitation decisions in European acute geriatric units: a one-day cross-sectional study
Authors: Piers Ruth , Pautex Sophie , Rexach Cano Lourdes , Leners Jean-Claude , Vali Ahmed Marc , De Brauwer Isabelle , Kayhan Koçak Fatma Ö , Hrnciarikova Dana , Cwynar Marcin , Alves Mariana , Pilgram Erwin H , van Bruchem-Visser Rozemarijn L
Published: January 2025

Background

It is important to pursue goal-concordant care and to prevent non-beneficial interventions in older people.

Aim

To describe serious illness communication and decision-making practices in hospitalised older people in Europe.

Setting/participants

Data on advance directives, goals of care (GOC) discussions and treatment limitation decisions were collected about patients aged 75-years and older admitted to 23 European acute geriatric units (AGUs).

Results

In this cohort of 590 older persons [59.5% aged 85 and above, 59.3% female, median premorbid Clinical Frailty Score (CFS) 6], a formal advance directive was recorded in 3.3% and a pre-hospital treatment limitation in 14.0% with significant differences between European regions (respectively P < 0.001 and P = 0.018).

Most prevalent GOC was preservation of function (46.8%). GOC were discussed with patients in 64.0%, with families in 73.0%, within the interprofessional hospital team in 67.0% and with primary care in 13.4%. The GOC and the extent to which it was discussed differed between European regions (both P < 0.001). The prevalence of treatment limitation decisions was 53.7% with a large difference within and between countries (P < 0.001). The odds of having a treatment limitation decision were higher for patients with pre-hospital treatment limitation decisions (OR 39.1), residing in Western versus Southern Europe (OR 4.8), belonging to an older age category (OR 3.2), living with a higher number of severe comorbidities (OR 2.2) and higher premorbid CFS (OR 1.3).

Conclusions

There is large variability across European AGUs concerning GOC discussions and treatment limitation decisions. Sharing of information between primary and hospital care about patient preferences is noticeably deficient.
Impact of Sensitive Skin on Quality of Life, Anxiety, and Depression: A Cross-Sectional Study
Authors: Park Jinseo , Cameron Shona , Flohr Carsten , Choi Mingyu , Lee Soyeon , Chung Boyoung , Park Chunwook , Kim Hyeone
Published: January 2025

Background

Sensitive skin (SS) is a common condition reported by many people worldwide. Patient interviews reveal that individuals with SS experience diminished quality of life, anxiety, and depression. Nonetheless, the impact of SS on mental health remains unclear.

Objective

To assess whether SS affects mental health and the relationship between symptom severity and its impact.

Methods

A cross-sectional study was conducted at Hallym University Kangnam Sacred Heart Hospital, Seoul, Korea, between June 2022 and March 2023. The Sensitive-Scale 10 (SS-10) was used for SS diagnosis and severity scoring; the Dermatology Life Quality Index (DLQI) and the Hospital Anxiety and Depression Scale (HADS) assessed mental health. Participants were categorized as ‘non-sensitive’ (<20), ‘sensitive’ (20–49), and ‘extremely sensitive’(≥50) based on SS-10 scores. Objective measurements included transepidermal water loss (TEWL), stratum corneum hydration (SCH), erythema, and demodex density.

Results

Of 200 participants, 146 completed the study. Participants were predominantly female (79.45%) with a mean age of 36.86 years (SD = 12.25). DLQI scores were higher in more sensitive groups (non-sensitive: 6.25, sensitive: 14.46, extremely sensitive: 18.86; P <.001). HADS-A and HADS-D scores also increased with severity (HADS-A: 4.94 in non-sensitive to 7.80 in extremely sensitive, HADS-D: 3.88 to 8.54; P <.05 for HADS-A, P <.001 for HADS-D). DLQI was significantly influenced by discomfort and redness, HADS-A by TEWL (negatively) and flushes, and HADS-D by flushes.

Conclusion

SS is associated with lower quality of life and increased anxiety and depression. Symptoms of sensitive skin substantially impact patients’ psychological well-being.
Synthesis of amide-terminated cis-stereoregular polyacetylenes
Authors: Adriani Nina , Echizen Kensuke , Nishimura Tatsuya , Maeda Katsuhiro , Taniguchi Tsuyoshi
Published: January 2025

Inspired by the reaction between organorhodium species and isocyanates to give amides, we have developed a new method of the synthesis of cis-stereoregular amide-terminated polyacetylene derivatives using isocyanates as terminating reagents in rhodium-mediated living polymerization of acetylene derivatives. The present termination reaction was applied to phenylacetylene derivatives having pendant functional groups and a nonaromatic N-propargylamide to provide the corresponding amide-terminated cis-stereoregular polyacetylenes.
Experimental evidence of bargaining power in agricultural land markets
Authors: Kionka Marlene , Kuethe Todd , Mußhoff Oliver , Ritter Matthias , Odening Martin
Published: January 2025

There is public concern about the degree to which rising farmland rental rates are driven by the perceived market influence of non-agricultural actors. We conduct a structural estimation to analyse the potential bargaining power of different types of actors in the farmland market. It allows us to infer their latent reservation utilities by exploiting equilibrium conditions, derived from a stochastic ultimatum game. Reservation utilities reflect outside options in negotiations, as they are determinants of bargaining power. We conduct economic experiments in the rental market. Our findings show that farmers and local actors have more bargaining power than non-farmers and absentee actors, respectively.