bluuebunny/crossref_metadata_2025 huggingface dataset:
Various optimized artificial neural network simulations of advection-diffusion processes
Authors: Sari Murat , Gulen Seda , Celenk Pelin
Published: September 2024

The aim of this research is to describe an artificial neural network (ANN) based method to approximate the solutions of the natural advection-diffusion equations. Although the solutions of these equations can be obtained by various effective numerical methods, feed forward neural network (FFNN) techniques combined with different optimization techniques offer a more practicable and flexible alternative than the traditional approaches to solve those equations. However, the ability of FFNN techniques to solve partial differential equations is a questionable issue and has not yet been fully concluded in the existing literature. The reliability and accuracy of computational results can be advanced by the choice of optimization techniques. Therefore, this study aims to take an effective step towards presenting the ability to solve the advection-diffusion equations by leveraging the inherent benefits of ANN methods while avoiding some of the limitations of traditional approaches. In this technique, the solution process requires minimizing the error generated by using a differential equation whose solution is considered as a trial solution. More specifically, this study uses a FFNN and backpropagation technique, one of the variants of the ANN method, to minimize the error and the adjustment of parameters. In the solution process, the loss function (error) needs to be minimized; this is accomplished by fitting the trial function into the differential equation using appropriate optimization techniques and obtaining the network output. Therefore, in this study, the commonly used techniques in the literature, namely gradient descent (GD), particle swarm optimization (PSO) and artificial bee colony (ABC), are selected to compare the effectiveness of gradient and gradient-free optimization techniques in solving the advection-diffusion equation. The calculations with all three optimization techniques for linear and nonlinear advection-diffusion equations have been run several times to obtain the optimum accuracy of the results. The computed results are seen to be very promising and in good agreement with the effective numerical methods and the physics-informed neural network (PINN) method in the literature. It is also concluded that the PSO-based algorithm outperforms other methods in terms of accuracy.
KCaAs and KCaP: promising half-Heusler compounds for UV protection and thermoelectric applications
Authors: Hammadache O , Mesbah S , Houari M , Khelifa-Kerfa K , Benghanem M , Lantri T , Belarbi B
Published: September 2024

This study investigates the structural, electrical, optical, and thermoelectric properties of the half-Heusler compounds KCaAs and KCaP using the Full-Potential Linearized Augmented Plane Wave (FP-LAPW) method within the framework of density functional theory. Our analysis reveals that both compounds exhibit favourable characteristics for high-performance applications. Specifically, KCaAs and KCaP show high static refractive indices and significant reflectivity in the ultraviolet (UV) range, making them ideal for UV protection and optical devices. Thermoelectric analysis indicates that both materials are p-type semiconductors with high Seebeck coefficients at low temperatures, high electrical conductivity, and relatively low thermal conductivity. The temperature-dependent figure of merit (

ZT

) reveals robust thermoelectric performance across a wide temperature range, with maximum

ZT

values of approximately 0.77 for both compounds. These results suggest that KCaAs and KCaP are promising candidates for thermoelectric applications, offering significant potential for energy conversion and sustainable energy solutions.
Multi-objective simulated annealing-based quantum circuit cutting for distributed quantum computation
Authors: Hou Guangwu , Zhu Changhua , Sun Yi
Published: September 2024

In the current noisy intermediate-scale quantum (NISQ) era, the number of qubits and the depth of quantum circuits in a quantum computer are limited because of complex operation among increasing number of qubits, low-fidelity quantum gates under noise, and short coherence time of physical qubits. However, with distributed quantum computation (DQC) in which multiple small-scale quantum computers cooperate, large-scale quantum circuits can be implemented. In DQC, it is a key step to decompose large-scale quantum circuits into several small-scale subcircuits equivalently. In this paper, we propose a quantum circuit cutting scheme for the circuits consisting of only single-qubit gates and two-qubit gates. In the scheme, the number of non-local gates and the rounds of subcircuits operation are minimized by using the multi-objective simulated annealing (MOSA) algorithm to cluster the gates and to choose the cutting positions whilst using non-local gates. A reconstruction process is also proposed to calculate the probability distribution of output states of the original circuit. As an example, the 7-qubit circuit of Shor algorithm factoring 15 is used to verify the algorithm. Five cutting schemes are recommended, which can be selected according to practical requirements. Compared with the results of the mixing integer programming (MIP) algorithm, the number of execution rounds is efficiently reduced by slightly increasing the number of nonlocal gates.
Design of a high-gain, low-ECC 2x2 MIMO antenna for 28 GHz 5G wireless communication system
Authors: Pant Mohit , Malviya Leeladhar
Published: September 2024

In this paper, a 2 × 2 MIMO antenna with inset feed is designed for the frequency Range 2 (FR2) millimeter wave frequencies such as n257 (26-29.5 GHz), n258 (24.25-27.5 GHz), and n261 (27.5-28.35 GHz). The MIMO antenna is designed and fabricated using low loss Rogers RT/duroid 5880 substrate having dimension of 1.4λ
0×2.8λ
0×0.073λ
0, where λ
0 is the free-space wavelength operating at 28 GHz.The defected ground structure (DGS) minimized the surface waves current. Thus DGS are used to increased the gain and the isolation of the proposed MIMO antenna design. The gain of the MIMO antenna reported is 10.3 dBi with 97.01% radiation efficiency at 28 GHz resonant frequency. The -10 dB impedance bandwidth lies between 26.95-29.50 GHz, which covers the 5G frequency bands. The isolation is ≥28 dB and envelope correlation coefficient (ECC) is 10 −5, respectively, in the complete operating band.
Geometric parameter control for tunable resonance frequencies in asymmetric nanodots: equilibrium states and dynamic response
Authors: Sandoval Pedro , Mancilla Cristian , Tasso Nicolas , Saavedra Eduardo , Escrig Juan
Published: September 2024

Through numerical simulations, we delve into the examination of the equilibrium state and dynamic response of asymmetric nanodots. Within these nanodots, we identify two distinct equilibrium states—single domain and vortex. Our findings reveal a direct correlation between the number and frequencies of peaks and the minimum energy configuration, which is contingent upon the physical parameters of the system. This observation implies the potential to intentionally manipulate a desired set of frequencies by precisely controlling the geometric parameters of the system.
On the analytical soliton approximations to damping forced Zakharov-Kuznetsov equation arising in dissipative nonthermal magnetized plasma
Authors: El-Awady E I , Hussain S , Akhtar N
Published: September 2024

This paper aims to analyse the nonlinear characteristics of ion-acoustic solitary waves (IASWs) in a plasma system that is collisional and homogeneous in nature. The system under consideration comprises positive ions, negative ions, and nonthermal electrons and is influenced by an ambient magnetic field. To analyse the system, we utilize the reductive perturbation technique (RPT) and obtain the damped forced Zakharov-Kuznetsov (DFZK) equation. The DFZK equation provides a solitary wave solution when an external periodic force is present. Through numerical analysis of DFZK, we have observed that different parameters, e.g., the nonthermal parameters (r, q), the direction cosine, the temperature ratio of a positive ion to an electron, the temperature ratio of a negative ion to an electron, the density ratio of a negative ion to a positive ion source strength, and the source frequency, affect the phase velocity and the structures of IASWs significantly. This finding could help clarify the plasmas observed in the D- and F-regions of Earth’s ionosphere, as well as in laboratory experiments where pair ions and nonthermal electrons are key characteristics.
Analysis of molecular interactions of an aqueous benzoates with glycolic and lactic acid: spectroscopic, acoustic, and volumetric approach
Authors: Gill Ashpinder Kaur , Chakraborty Nabaparna , Juglan K C
Published: September 2024

Volumetric as well as Acoustic properties for the ternary liquid combination (water + sodium methyl p-hydroxybenzoate + glycolic acid/lactic acid) are evaluated at several temperatures using a Densimeter (DSA 5000 M) over the range of concentrations (0.000, 0.015, 0.025, 0.035) mol.kg−1. Several thermo-acoustical properties were computed utilizing the experimental data. These values were then used to derive several parameters, including the apparent molar volume(

V

∅

); partial molar volume

(

V

∅

0

)
;

apparent molar isentropic compression

(

K

∅
,
S

)
;

transfer properties(Δ

V

∅

0

,

Δ

K

∅
,
s

0

); partial molar isentropic compression

(

K

∅
,
s

0

)
;

apparent molar expansibility (

E

∅

0

) as well as its first derivative (

∂

E

ϕ

0

/
∂
T

) P; and coefficient of thermal expansivity(

α

p

). The obtained results are explained by analyzing the several interactions that take place inside the liquid system by implementing the theory of co-sphere overlap. Utilizing these thermodynamical parameters, the interaction coefficients are computed to evaluate the ternary mixture corresponding to the interactions between solutes and solvents. FTIR spectrum analysis revealed the presence of H-bonds along with the other molecular interactions in the analyzed systems, as shown by the shifting of the O-H stretching band.
Geometric structures and adsorption energies of mixed methanol and C60 cationic clusters produced within helium nanodroplets
Authors: Atta Sobia , Niaz Shanawer , Goulart Marcelo , Rasul Bilal
Published: September 2024

Mass spectrometry is a useful technique for studying molecular cluster sizes, their distributions, compositions, and stability. Methanol and fullerenes are among the species identified in the interstellar medium and, due to their high abundance, their interactions are an interesting investigation topic. A mass spectrometric study of mixed clusters of methanol and C60 inside helium nanodroplets is presented. Anomalies in the distribution intensities or magic numbers were observed for

[
C

H

3

OH
]

4

[

C

60

]

m

+

,
1
≤
m
≤
7
.

Water molecules within clusters were also detected, arising as one of the products of intermolecular methanol dehydration. Optimized and supposedly stable geometrical structures of these molecules are presented along with corresponding HOMO–LUMO gaps and adsorption energies. A linear decrease in adsorption energy and saturation at a critical cluster size was noticed.
Effect of transition metals (Fe, Ru and Os) on the elastic, thermodynamic, electronic, magnetic and thermoelectric properties of three Nd-filled arsenide skutterudites based on first-principles computations
Authors: Chaki Tanmay , Mandal Pradip Kumar
Published: September 2024

Elastic, electronic, magnetic, thermodynamic, and thermoelectric properties of three neodymium-filled skutterudites NdT4As12 (T = Fe, Ru and Os) have been investigated using density functional theory. The bulk moduli increase with the atomic numbers of the transition metals. All materials are stiff, while the Os compound is the stiffest. A considerable ionic contribution is seen in their inter-atomic bonding. The Fe compound possesses the highest Debye temperature, while the Os compound has the highest melting temperature. GGA+U formalism predicts the semimetallic nature of all the compounds, but their total DOS differs near the Fermi level in both spin channels. The contributions of the Nd-f and T-d electrons differ in the three compounds and two methods. GGA+U predicts the highest magnetic moment in the Fe compound, followed by the Ru and Os compounds. The thermoelectric figure of merit shows no systematic variation with z of the transition metals and in the high temperature region it increases with temperature pretty fast. The highest value of ZT is 0.32 in the Ru compound in the spin-down channel while it is 0.24 in the spin-up channel in the Fe compound, both at 1000 K.
Thermodynamic and dielectric properties of hexagonal barium titanate near the phase transitions
Authors: Yurtseven Hamit , Kiraci Ali
Published: September 2024

The critical behavior of the thermodynamic quantities is studied for the two phase transitions near the transition temperatures (74 K and 222 K) in the hexagonal (h) BaTiO3. A linear relationship has been established between the variations of the frequency shifts and of the dielectric constant by using the literature data in h-BaTiO3. Temperature and pressure dependence of the mode Grüneisen parameters (

γ

p

and

γ

T

) are also described by a power-law formula as the other thermodynamic parameters near Tpt in h-BaTiO3. Our results show that they explain the observed behavior adequately, in particular soft-mode frequency, dielectric constant, thermal expansion, the excess specific heat and the entropy near Tpt in h-BaTiO3. Temperature dependence of the isobaric mode Grüneisen parameter (

γ

p

), enthalpy and the Gibbs free energy, which we have evaluated, can be compared with experiments in h-BaTiO3.
SPICE Simulation Assisted-Dynamic Rds(on) Characterization in 200V Commercial Schottky p-GaN HEMTs Under Unstable Phases
Authors: Liu Xinzhi , Shafie Suhaidi , Amran Mohd Radzi Mohd , Azis Norhafiz
Published: September 2024

This paper presents a comprehensive analysis of dynamic and static RDS(ON) in Schottky p-GaN High Electron Mobility Transistors (HEMTs), highlighting the impact of off-state and hot electron trapping on device performance. The authors observed significant hysteresis in the transfer characteristics of a 200V commercial Schottky p-GaN, attributing this to charge trapping effects. A novel experimental setup, employing a multi-pulse test synchronous buck converter circuit with additional gate control and a clamping circuit, enabled precise characterization of dynamic RDS(ON) under varying conditions, including unstable phases with overcurrent. This method effectively mimics solar PV input scenarios, exposing the device to high dv/dt and di/dt stresses, which are critical for evaluating GaN device stability under transient conditions. This research also reveals that increased gate resistance reduces energy losses, challenging traditional expectations by demonstrating the nuanced gate charge dynamics of GaN HEMTs. This study overall contributes to the understanding of GaN device behavior, offering a novel approach for accurately characterizing dynamic RDS(ON) under unstable stages, furtherly advances the GaN device in complex renewable energy power converter applications.
FT-IR Analysis Results of Rolling and Temperature Effects on Flexible Substrate
Authors: Choi S Y , Moon S J , Lee J M , Lee K Y , Bae B S
Published: September 2024

This research investigates the complexities of molecular structural analysis applied to film substrates post the rolling process, concentrating specifically on characterizing flexible substrate materials, particularly polyimide (PI) film. By deliberately adjusting the number of rolling cycles and temperature parameters, a meticulous series of scratch tests was conducted. Following this, comprehensive sample analyses were carried out employing Fourier Transform Infrared (FT-IR) spectroscopy, enabling a thorough exploration of the molecular composition and structural integrity of the substrates. Our experimental findings confirm that molecules with weaker bonds tend to dissociate under physical stresses like rolling. While the dissociation of bonds does not strictly correlate proportionally with the frequency of stress application, a weakening of bonds is observed, particularly after repeated stress applications, indicating the susceptibility of molecular bonds to external stress.
Effect of polymer coating on magnetocaloric properties of garnet
Authors: Sultana Jolaikha , Chhetri Santosh Karki , Hu Jin , Pollard Shawn , Mishra Sanjay R
Published: September 2024

In this study, Gd3Fe5O12 nanoparticles were synthesized using the sol–gel autocombustion method and subsequently coated with polyvinylpyrrolidone (PVP) polymer. The study focuses on understanding the influence of PVP coating on garnet particles’ magnetic and magnetocaloric properties. The crystallite size upon PVP-coating remained unaltered, but the grain size and surface area of coated particles increased. The magnetization of PVP-coated particles decreased by around 11% as compared to the uncoated particles at 5 K. Mössbauer and photoelectron spectroscopy confirmed the presence of a paramagnetic phase Fe3+ in the PVP-coated nanoparticles responsible for the reduction in magnetization value. The maximum value of magnetic entropy change (−ΔS
m
) for uncoated Gd3Fe5O12 was 3.78 Jkg−1 K−1 at 37.5 K with a 5T applied field, accompanied by a relative cooling power (RCP) of 382 Jkg−1. On the other hand, for PVP-coated Gd3Fe5O12, the maximum −ΔS
m
was 3.38 Jkg−1 K−1 at 57.5 K with a 5T applied field, and the RCP was 308 Jkg−1. The observed maximum magnetic entropy changes at higher temperatures for the PVP-coated Gd3Fe5O12 sample are noteworthy. This characteristic indicates that the PVP-coated garnet may have an advantage in terms of usability over a wider temperature range compared to the uncoated counterpart, which can potentially be a promising material for applications in cryogenic temperature magnetic refrigeration.
Thrust estimate method of an on-orbit Hall thruster using Hall drift current
Authors: REN 任 Ziying 姿颖 , WEI 魏 Liqiu 立秋 , LIU 刘 Zexin 泽欣 , HU 扈 Yanlin 延林 , HAN 韩 Liang 亮 , LI 李 Hong 鸿 , DING 丁 Yongjie 永杰 , ZHONG 钟 Xiufeng 秀峰
Published: September 2024

In order to realize the thrust estimation of the Hall thruster during its flight mission, this study establishes an estimation method based on measurement of the Hall drift current. In this method, the Hall drift current is calculated from an inverse magnetostatic problem, which is formulated according to its induced magnetic flux density detected by sensors, and then the thrust is estimated by multiplying the Hall drift current with the characteristic magnetic flux density of the thruster itself. In addition, a three-wire torsion pendulum micro-thrust measurement system is utilized to verify the estimate values obtained from the proposed method. The errors were found to be less than 8% when the discharge voltage ranged from 250 V to 350 V and the anode flow rate ranged from 30 sccm to 50 sccm, indicating the possibility that the proposed thrust estimate method could be practically applied. Moreover, the measurement accuracy of the magnetic flux density is suggested to be lower than 0.015 mT and improvement on the inverse problem solution is required in the future.
The Impact of Age on Emergency Department Stay and Hospital Outcomes in Nursing Home Residents
Authors: Davey Naomi , Keating Donal , Farrelly Angelina , Noonan Claire , Chacko Sherry Theckanath , Soh Josephine
Published: September 2024

Background

Nursing home residents (NHR) often face challenges receiving appropriate care in acute settings. The national Urgent And Emergency Care Daily Situation Report highlights the number of individuals aged over 75 awaiting hospital beds in the Emergency Department (ED), potentially influencing care decisions based on age over individual needs.

Methods

A six-month retrospective analysis of NHR admissions used hospital records to gather key metrics such as biographical data, pressure ulceration rates, instances of non-oral intake (NPO), length-of-stay (LOS) and inpatient mortality.

Results

Of the 128 admitted NHR, 22 were under 75 (mean 70.41 years; 66-74) and 106 were aged 75 and over (mean 84.98 years; 75-99). For the medically admitted under 75 cohort, the average ED stay lasted 1.14 days (0.36-3.72) with a hospital LOS of 11.54 days (3.54-24.9). Those under 75 admitted by the acute medical unit (AMU) spent an average of 0.62 days (0.02-1.14) in ED with a LOS of 6.52 days (0.34-11.86). For the over 75 cohort, those medically admitted spent an average of 0.8 days (0.18-2.17) in ED with a hospital LOS of 9.02 days (0.83-43.53), compared to 0.54 days in ED (0.06-1.45) with a LOS of 8.3 days (1.28-20.27) for those admitted by AMU. Pressure ulceration was found in 32% of the under 75 group and 27% of the over 75 group, with uncertain origins in 9% and 2%, respectively. Additionally, 13.6% of those under 75 and 7.5% of those over 75 were made NPO. The overall mortality rate was 18.5% (18% in the under 75 group and 15% in the over 75 group).

Conclusion

The study highlights significant differences in the care and outcomes of NHR attending the ED with younger NHR experiencing longer stays and worse outcomes. This underscores the need for age-specific strategies to enhance emergency care for NHR, ensuring that interventions are appropriately aligned with individual needs.
A Study To Investigate Fear Of Falling On An Age-Related Rehabilitation Unit
Authors: Walker Vicky , Collins Rónán , Ryan Dan , Smyth Hannah , Fitzgerald Michelle , Brennan Michael , Browne Louise , Belton Anne , Doran Edwina , Flood Eimear , Kavanagh David , Keegan Michael
Published: September 2024

Background

Fear of falling (FOF) is a lasting concern about falling that can lead an individual to avoid activities that he/she remains capable of preforming. Due to a FOF many older adults restrict their activities and subsequently increase their risk of falls. The aim of this study was to 1. Obtain a profile of FOF in an age-related inpatient population 2. Determine the severity of their FOF 3. Collect mobility status and falls history.

Methods

All current inpatients on two age-related rehabilitation units (age >/= 65 years) with sufficient communication were included. Patients were facilitated to complete The Falls Efficacy Scale International (FES-I) which is a 16-point scale that is valid and reliable. A score of 16-19 indicates a low concern, 20-27 moderate concern and 28-64 a high concern about falling. A two-point convenience sampling at summer and winter period was used. Data was anonymized and recorded using Microsoft excel.

Results

68 questionnaires were collected. 40% of patients were independently mobile (+/- a walking aid), 16% required supervision, 26% assistance of one and 18% assistance of two. 100% of patients had a FOF (FES-I score >16). 80% (N=54) of patients had a high FOF, 13% (N=9) had a medium FOF, and 7% (N=5) a low FOF. 75% (N=51) of patients had a documented falls history. 80% (N=41) of people with a falls history had a high FOF. 76% (N=13) of those with no falls history had a high FOF.

Conclusion

This the first profile of FOF in our age-related rehabilitation unit. 93% of patients reported a high or medium FOF with high rates reported independent of a history of falling. Addressing FOF with evidence-based interventions and psychological support may reduce length of stay and increase successful discharges from older person rehabilitation units.
Debulking the Myth of the ‘Social’ Admission – A Retrospective Review of Acutely Admitted Medical Patients in Wexford General Hospital
Authors: Geraghty Timothy , Kelly Rosie , Pollock Ailis , Farrell Luke , Khalid Iffat , Reardon Michael
Published: September 2024

Background

“Acopia”, “social admission” and other synonymous terms are frequently provided reasons requiring admission to acute hospitals and represent a common encounter for the Geriatric clinician. These cases are usually so called when the patient’s social circumstances are felt to need urgent attention, yet their medical health has not acutely deteriorated. Such non-diagnostic labels often mask underlying complex medical issues which can have detrimental health outcomes if not addressed appropriately. Despite this, they persist in the vernacular of modern medicine with almost half of doctors, junior and senior, finding the term useful (43.5%) and acceptable as a diagnosis (30.9%)1. We sought to examine what percentage of adult medical patients admitted to an acute hospital did not have an appreciable medical cause for their presentation.

Methods

We conducted a retrospective review of 191 patients admitted under medical teams in Wexford General Hospital across a 13-day period. Inclusion criteria included adult patients admitted under a medical team from the Emergency Department. Exclusion criteria applied to any patient admitted from OPD or by non-medical specialities.

Results

191 cases were analysed. The average age was 65.8, median age was 70 and majority were male (n=105, 55%). There were only 2 patients (1%) who had no acute medical concerns following medical review. In one, the patient’s home oxygen supply had run out and the intended delivery of oxygen had been delayed. Another patient required increased home care supports however their medical status had not changed.

Conclusion

Our findings suggest that most patients presenting to acute hospitals following a robust medical review will evidence an acute medical issue. Dismissive phrases such as “acopia” and “social admission” need to be challenged for the superficial assessment that they are, and this reductive approach must be expunged from clinical practice to avoid misdiagnosis and malpractice in the care of the older adult.
The Prevalence of Frailty Among People Experiencing Homelessness Attending a Primary Care Clinic: A Service Evaluation and Quality Improvement Initiative
Authors: Travers John , Cronin Thomas , O'Carroll Austin , Smith Susan
Published: September 2024

Background

Frailty is traditionally considered a geriatric syndrome though can present at a younger chronological age among people experiencing homelessness (PEH) due to risk factors such as poor nutrition, addiction and loneliness. Our walk-in primary care clinic for PEH has not previously recorded frailty status or prevalence among attendees, which would provide an opportunity to offer effective, evidence-based interventions. As part of a quality improvement initiative (QI), we evaluated frailty prevalence to improve our service to PEH.

Methods

The frailty status of adults presenting consecutively to a general practitioner at an urban, walk-in primary care clinic in Ireland dedicated to PEH was measured each Monday during a service evaluation in the first two months of 2024. Frail Scale (criteria: fatigue, resistance, ambulation, illness and weight loss; 0=robust, 1-2=pre-frail, 3-5=frail)) and the Clinical Frailty Scale (CFS) were used.

Results

73 adults presented (median age 41.5), 21 female (28.8%)). 24 were frail on the Frail Scale (32.9% of total presenting), of which 4 were female (19.0% of females presenting) and 20 were male (38.5% of males presenting). 43 were pre-frail on the Frail Scale (58.9% of total presenting), of which 15 were female (71.4% of females presenting) and 28 were male (53.8% of males presenting). The median CFS was 4 (vulnerable). The most common frailty indicators were fatigue (68.5%) and weight loss (64.4%).

Conclusion

Frailty and pre-frailty were highly prevalent among PEH at our primary care clinic. A third were frail and over half pre-frail. The prevalence of this reversible syndrome had not previously been evaluated. Our findings underline the opportunity to improve our service by screening for frailty among PEH and offer appropriate interventions to reverse frailty and build resilience. Service evaluation and QI initiatives can enable application of research evidence and improvement of real-world clinical care.
Experiences And Preferences Of People With Stroke And Caregivers, Around Supports Provided At The Transition from Hospital to Home
Authors: O'Callaghan Geraldine , Fahy Martin , OMeara Sigrid , Lindblom Sebastian , von Koch Lena , Langhorne Peter , Galvin Rose , Horgan Frances
Published: September 2024

Background

Transitioning home from organised stroke services poses many challenges for people with stroke (PWS) and their caregivers (CGs), requiring them to navigate through complex uncertainties. There are gaps in our understanding of appropriate support interventions for managing the transition home. In this qualitative study, we explored the perspectives of PWS and their CGs regarding their support experiences and preferences during this period.

Methods

Between November 2022 and March 2023, and within six months of hospital discharge, audio-recorded, semi-structured interviews were conducted with PWS and their CGs. All interviews were transcribed, imported into NVivo software, and analysed using reflexive thematic analysis.

Results

Sixteen interviews were conducted, nine with PWS and seven with CGs. Four themes relevant to their collective experiences and preferences were identified: (i) Need for tailored information-sharing, at the right time, and in the right setting; (ii) The importance of emotional support; (iii) Left in limbo, (iv) Inequity of access. Experiences depict issues such as insufficient information-sharing, communication gaps, and fragmented and inequitable care; while a multi-faceted approach is desired to ease anxiety and uncertainty, minimise delays, and optimise recovery and participation during transition.

Conclusion

Our findings highlight that regardless of the discharge route, and even with formal support systems in place, PWS and families encounter challenges during the transition period. There is a need for more personalised and timely information-sharing to support individuals and caregivers effectively. A multi-faceted approach is recommended to alleviate anxiety, reduce delays, and provide equitable care for all involved.
The Impact of Introducing Generic Therapy Assistants to an Acute Occupational Therapy Stroke Service
Authors: Grehan Orla , Meehan Claire , Shinners Dylan , Concannon Emma , Lennon Roisin , Flattery Valerie , O'Connell Kevin
Published: September 2024

Background

It has been recommended that patients post-Stroke should receive 45 minutes of Occupational Therapy (OT) input on at least five days per week to evoke meaningful and significant improvements in patient-centred outcomes. However, service capacity cannot always meet recommended levels. Generic Therapy Assistants (GTAs) offer opportunities to bolster staffing and increase intensity and quality of OT input. This pilot aims to investigate the impact of the recruitment of two GTAs upon OT services in an acute Stroke unit.

Methods

Two GTAs were recruited to the service and underwent tailored training, followed by in-service training and supervision support. Data was collected prior to their recruitment for a four-week period (Timepoint 1) and again following their appointment (Timepoint 2). Duration of OT sessions were categorised as High (>36 minutes), Moderate (23-36 minutes) and Low Intensity (<23 Minutes). Key metrics were the number of sessions that took place, the proportion of sessions deemed low, moderate and high intensity and a functional measure of included patients using the Functional Independence Measure (FIM).

Results

Total sessions increased from 113 to 184 from Timepoint 1 to 2, and sessions deprioritized reduced from 116 to 71, with greater contact time per day during Timepoint 2. The proportion of sessions described as High Intensity increased from 45% to 63%. Twelve patients from each cohort had functional changes measured, with scores recorded on initial assessment and on discharge. Average increases of 3.75 points were observed during Timepoint 1, and 8 points at Timepoint 2.

Conclusion

The addition of two GTAs to the Stroke service in this acute hospital facilitated positive changes to the OT service capacity and delivery. Increased numbers of sessions and session duration were observed, alongside a greater proportion of sessions being of High Intensity, and greater functional improvements when compared to similar data collection prior to their recruitment.
Long-Term Outcomes of Older Adults in Ireland after Geriatric Rehabilitation for COVID-19: A Prospective Cohort Study
Authors: McCarthy Aoife , Robinson Katie , Dockery Frances , McLoughlin Kara , O'Connor Margaret , Milos Antonella , Corey Gillian , Carey Leonora , Steed Fiona , Haaksma Miriam , Whiston Aoife , Tierney Audrey , Galvin Rose
Published: September 2024

Background

COVID-19 is a contagious disease caused by the Sars-CoV-2 virus. Disease presentation and severity has evolved since its emergence in 2019. In May 2023, the World Health Organization declared the end of the COVID-19 pandemic but described it as an established and ongoing health issue. Studies to date have focused on disease presentation, prevalence and evolution and the immediate rehabilitation outcomes for older adults. There is a paucity of research reporting the long-term outcomes of older adults who have completed geriatric rehabilitation. The primary aim of this study was to describe the long-term functional outcomes of a cohort of older adults with acute COVID-19 who have completed inpatient geriatric rehabilitation.

Methods

This is a subgroup analysis of Irish data gathered as part of a pan-European prospective cohort study. Patients were recruited from two acute hospitals in the Republic of Ireland: Beaumont Hospital and University Hospital Limerick. Patients with a confirmed case of COVID-19 infection and accepted for geriatric rehabilitation in the hospital setting were eligible for recruitment. Functional ability, patient reported symptoms and quality of life were measured using the Barthel Index, the COVID-19 Yorkshire Rehabilitation Screen and the EQ-5D-5L respectively.

Results

Thirty patients were included in the subgroup analysis. The rate of mortality was 23.3% at six months after discharge from rehabilitation. Patients achieved a return to pre-admission functional ability but reported a significant increase in patient reported symptoms and their quality of life did not return to pre-admission levels when assessed at six months after discharge from rehabilitation.

Conclusion

Multidisciplinary rehabilitation for older adults with acute COVID-19 infection can assist patients to return to their premorbid functional ability. On discharge from rehabilitation, ongoing follow up of older adults is recommended to assist them to negotiate and manage ongoing symptomatology such as breathlessness or fatigue.
Proximal Humerus Fractures In The Older Adult: A Retrospective Review Of Proximal Humerus Fractures In The Emergency Department
Authors: Connolly Kieron , Green Natasha Li , Mohamed Behnazir , Coughlan Tara , McCabe Aileen
Published: September 2024

Background

This study aimed to describe the epidemiology and outcomes of older adults diagnosed with proximal humeral fractures (PHFs) in an Irish adult emergency department (ED).

Methods

A retrospective chart review was conducted on all patients (>65) who had a diagnosis of a PHF, in 2022 within an ED of a large suburban academic teaching hospital in Dublin. Assessment by the Frailty at the Front Door (FFD) team (older adults >75) for those with a PHF was also analysed.

Results

A total of 53 older adults (>65) were identified within the study period with a PHF while 43 patients (<65) were identified. In the >65 group, seventy-nine percent (N=42) were female. The mean age was 75.6 years of age (Range 65-95). Only 21% (N=11) had operative management. Two-thirds of PHFs in the >65 group required admission to hospital (N=24) (P<0.001). The mean length of stay (LOS) was 12.9 days compared to only 4.5 days in those under the age of 65 (P= 0.14). There were 26 older adults (>75) diagnosed with a PHF. The FFD team assessed 49% (N=11) of older adults (>75) with a PHF. Only 31% (N=8) presented to ED within FFD team operational hours. The average Clinical Frailty Sale was 5 (N=11). The FFD team completed 22 inpatient MDT referrals, four HSCP community referrals, one Public Health Nurse Referral and one application for increase in home care package.

Conclusion

PHFs tended to occur in older female patients. The majority of PHFs in older adults do not have operative treatment and were associated with higher LOS. FFD teams can play a pivotal role in the assessment and treatment of older adults with a PHF. This may represent opportunities to develop integrated care pathways to maximize an individuals’ independence, to support people at home with PHFs.
Evaluation of New Frailty at the Front Door Service in a Model 3 Hospital
Authors: Breen Paul , Costelloe Niamh , Donnellan Christina
Published: September 2024

Background

Frailty at the Front Door (FFD) is a key component of integrated care for frail older persons who attend an Emergency Department (ED). This service was established in a model 3 hospital in 2023. Variable Indicative of Placement (VIP) was used to screen patients aged ≥70 years for frailty. Interdisciplinary assessments and interventions were provided by a Senior Physiotherapist and Senior Occupational Therapist (OT).

Methods

All assessments by the FFD team from June 2023 to February 2024 inclusive, were included. The variables analysed were age, gender, modified Barthel Index (mBI) score, 4AT score, Clinical Frailty Scale (CFS) score, discharge status, length of stay (LOS), referral pathways and re-presentation within 28 days. Data was analysed in Excel.

Results

There were 490 assessments over the 9-month period, 217 (44%) male and 273 (56%) female, with a mean age of 80 (SD±7.77) years. The median CFS was 5 (range 2-8) and median mBI was 17 (range 4-20). The 4AT score was ≥4 in 44 (9%) cases (indicating possible delirium and possible cognitive impairment). One hundred and eighty-four (38%) patients were discharged home from ED. Seventy (14%) patients re-presented to ED within 28 days. Acute hospital admission was required for 306 (62%) with a mean LOS of 11 (SD±0.5) days. There were 213 referrals to community services for those patients discharged home. These included Dietetics (36%), Physiotherapy (22.5%), ALONE (18%), Delirium Clinic (9.4%), OT (6%) and others (8.1%). There were 238 referrals to acute services for admitted patients, including Physiotherapy (59%), Dietetics (18.5%), OT (17%) and Speech and Language therapy (5.5%).

Conclusion

This evolving FFD service is a positive step towards improving older persons’ care in ED. Recognition of frailty in ED leads to early identification of care needs and timely referral to alternative pathways in the community and acute services as appropriate.
Reconditioning For Discharge; An OT-Led Initiative
Authors: Mahon Ella , Hogan Ellie , Webster Cara , Davis Aisling , McNally Sarah , O'Shea Diarmuid
Published: September 2024

Background

Deconditioning is the loss of functional ability in frail older adults (BGS, 2017). Many initiatives such as #EndPJParalysis address the importance of preventing functional decline in acute settings. Occupational therapists (OTs) are best equipped to lead these initiatives due to the holistic nature of the profession. This initiative aimed to complete an educational campaign among staff, patients and families about the importance of preventing deconditioning. Audit approval was granted by hospital Clinical Audit Committee.

Methods

An observational audit of patient presentation at ward level was completed. Data was gathered on clothing and sitting out status as a baseline measurement. A PR and staff education campaign was instigated. Information leaflets and posters for patients, families and staff were distributed. A re-audit was completed after 1 month.

Results

Patients in their own clothing/pyjamas increased by 8%. Patients sitting out of bed increased by 11%. Informal positive feedback from patients, families and staff suggested a cultural shift on the ward with regards to promoting patients independence.

Conclusion

Improvements post initiative were noted, however, a longer duration of the initiative would be beneficial to further promote reconditioning. OTs’ comprehensive approach is best placed to champion this reconditioning initiative. Further roll out of the campaign throughout the hospital may be of benefit. There is a wealth of educational/PR resources available for same.

Reference

British Geriatrics Society (2017) Deconditioning awareness, British Geriatrics Society. Available at: https://www.bgs.org.uk/resources/deconditioning-awareness (Accessed: 19 April 2024).
Audit of Geriatric Emergency Medicine-Unit staff compliance in providing care in line with the Age Friendly Health Systems Conceptual Framework
Authors: Williams Susan , Synnott Aoife , Murphy Hannah , O'Shaughnessy Ide , Ryan Jessie , McCarthy Aoife , Bailey Claire , Chacko Binu
Published: September 2024

Background

The Geriatric Emergency Medicine Unit (GEMU) in University Hospital Limerick (UHL) is in the Emergency Department for the assessment of those over the age of 75. The unit is staffed by a multi-disciplinary team with specialist skills in older person’s care. The aim of this audit was to determine assessment and documentation compliance with the Age Friendly Health Systems conceptual framework for older persons who present to GEMU.

Methods

A retrospective documentation review took place from patients who attended GEMU between January-March 2023. Medical record numbers were selected at random from the Health and Social Care Professionals (HSCP) team data management system with individual patient records subsequently retrieved from the Therefore Emergency Medicine (EM) patient management system. Patient records were reviewed by SW, which included Nursing, EM Doctors documentation and HSCP documentation.

Results

15 charts were reviewed. Compliance varied across all areas from 0-100%. Compliance was greatest in the domains of the EWS score, mobility assessments, falls history and 4AT. Hydration and the documentation of ‘What Matters’/patient care preference were both 0%. Otherwise, compliance broadly was >50%. The first re-audit of 15 charts took place from December 2023-January 2024. Improvements were noted across all assessments, with 100% compliance additionally achieved in CFS, cognitive status, co-morbidities and nutritional intake. A second re-audit of 15 charts took place from March-April 2024, with further improvements seen in terms of lying and standing blood pressures and polypharmacy assessments.

Conclusion

Results demonstrate the continued improvements made amongst the team in adhering to the Age Friendly Health Systems Framework. Efforts are ongoing to focus specifically on the care preference component, with structured QIPs in place and a view to re-auditing in Q4 2024.
The Establishment of Geriatric Multidisciplinary Service (GEMS) for the Identification and Management of Frailty and Delirium in Emergency Care
Authors: Brick Jacqueline , Brolly Amanda , Randles Mary , O'Carroll Susan , Maher Mairin , Carmody Chris
Published: September 2024

Background

In Ireland the number of people aged 75 and over has grown by greater than 20% in recent years, as a consequence increasing numbers of older adults are presenting to emergency departments. Frailty is a multi-factorial syndrome that diminishes body reserves and impacts on the person's ability to respond to stressors, such as illness or trauma. In October 2023, a Consultant Geriatrician lead GEMS was launched to identify, assess and manage frailty and associated syndromes, this study concentrated on delirium.

Methods

All patients 75 and older are triaged by GEMS using an electronic IPM System against prioritisation inclusion and exclusion criteria, utilising a case management approach and Rockwood Clinical Frailty Scale to screen for frailty. CFS score 1 to 3 is fit and managing well, alternatively a CFS of 4 or greater initiates a Comprehensive Geriatric Assessment. A 4AT assessment identifies patients at risk and screening for delirium.

Results

The results demonstrate a total of 744 patients were reviewed by GEMS from Jan - April 2024, 67% (n=503) had a CGA completed and 72% (n=537) of the population sample are living with frailty. A CFS7 (n=121), CFS8 (n=15) and CFS9 (n=3) are severely frail 26% and moderate frailty CFS6 (n=149) 28%. The 4AT results identified 10% of patients had a positive delirium score (n=60). In addition, a total of (n=61) patients had a formal diagnosis of dementia of which (n=12) patients had a positive 4AT.

Conclusion

The data confirms the prevalence of frailty in emergency care is approximately 70% and the incidence of acute delirium is approximately 10%. These indicators significantly impact on outcomes of care and treatment plans. Therefore, substantiates the need for early identification of frailty and delirium and the requirement for a highly specialised Consultant Geriatrician Lead (GEM) Service to ensure patients are on the right journey.
Exploring The Relationship Between SSRIs, Falls, Fractures, And Bone Mineral Density In Older Irish Adults: Results From The TUDA Study
Authors: Fitzpatrick Donal , Laird Eamon , Lannon Rosaleen , Ward Mary , Hoey Leanne , Hughes Catherine , Strain JJ , McNulty Helene , Cunningham Conal , Molloy Anne , McCarroll Kevin
Published: September 2024

Background

Selective Serotonin Reuptake Inhibitors (SSRIs) are associated with an increased risk of falls and fractures, though the results from studies are inconsistent. SSRIs may cause a decline in bone mineral density (BMD), but this remains unclear. We aimed to explore the relationship between SSRI use and falls, fractures and BMD in older Irish adults.

Methods

Study participants were from a cross-sectional study of adults aged >60 years; Trinity Ulster University Department of Agriculture (TUDA) study. Falls and falls resulting in fracture in the preceding year were self-reported so participants with an MMSE < 24 were excluded. The relationship between SSRIs and falls and falls with fractures was explored in multivariate logistic regression adjusting for relevant covariates and medications: loop and thiazide diuretics, alpha and beta blockers, calcium channel blockers, ACE-inhibitors, benzodiazepines, opioids. In a subgroup with no prior diagnosis of osteoporosis or on medications for same, the relationship with SSRI's and BMD (as assessed with DXA) was explored.

Results

There were 4521 participants, 67.6% female, mean age 73.3 ± 8.1 years, 9.4% (n=427) using SSRIs. SSRI use predicted an increased risk of falls in the last year both before and after multivariate adjustment (OR 1.71, 1.37-2.14, p<0.001). In participants with falls (n=1448), those who had a fall with fracture versus a fall with no fracture were no more likely to be using SSRIs. In a subsample, (n=2178) no relationship was found between SSRI use and BMD at the hip, neck of femur or spine.

Conclusion

SSRIs use was associated with a 71% increased risk of falls though did not predict BMD or fractures. However, duration of SSRI use was not known and there was no prospective follow up. It remains unclear whether increased fracture risk in SSRI users found elsewhere is explained solely by falls risk.