bluuebunny/crossref_metadata_2025 huggingface dataset:
Utilization of Nongkhai Black Jasmine Rice Bran Oils for Development of Functional Drink Emulsion
Authors: Kittipongpittaya Ketinun , Suwan Teerawan , Kullamethee Piyarach , Puangploy Premsak , Yimchom Pattaranan , Intaratul Tanyaporn
Published: September 2023

Rice bran is a nutritious by-product from rice milling process. It is usually used as animal feed otherwise rejected as waste that could raise environmental issues. This research aims at utilizing oil extracted from Nongkhai black jasmine rice bran to develop an oil-in-water emulsion drink. Oil was extracted from Nongkhai black jasmine rice bran using hexane as a solvent by Soxhlet extraction method. Nongkhai black jasmine rice bran gave an oil yield of 12.38%. The extracted oil contained total phenolic 120.03 ± 1.26 g GAE/g oil, flavonoid 46.90 ± 0.69 g QE/g oil and a-oryzanol 236.73 ± 7.54 g/g oil. The antioxidant activity of the oil tested by DPPH, ABTS, and FRAP were 1676.63 ± 76.86, 592.75 ± 46.22, 1.31 ± 0.22 g Trolox equivalent/g oil, respectively. An oil-in-water emulsion beverage was then developed by dispersing 1% (w/w) of Nongkhai black jasmine rice bran oil with 0.1% (w/w) of Tween80/Span80 (1:1 w/w) as emulsifiers in water. The sweetness of the emulsion beverage was adjusted by adding erythritol mixed with stevia extract sweetener at 0.1, 0.2, 0.3, and 0.4 % (w/v). After pasteurization, all emulsion beverages were subjected to Just-about-right and 9-point hedonic sensory tests using a randomized complete block design. The emulsion containing 0.4 % sweetener had the highest overall liking score of 7.0 ± 1.1, representing moderate liking. The emulsion beverage contained -oryzanol 13.3 ± 0.3 g/mL with the antioxidant activity tested by ABTS of 267.0 ± 37.7 g Trolox equivalent/mL. In conclusion, Nongkhai black jasmine rice bran is a source of bioactive lipids that can be utilized as an ingredient in a plant-based functional drink emulsion.
Manganese Constituent in Stainless Steels Oxidized in Oxygen Containing Water Vapor at 800 °C: High Temperature Oxidation and Volatilization
Authors: Sangsuebsri Methanan , Pokwitidkul Suwijak , Wiman Panya , Tanaka Youhei , Thublaor Thammaporn
Published: September 2023

Many industrial operations, such as solid oxide fuel cells (SOFCs) or combustion processes, have water vapor environments. Stainless steel was applied as part of these applications at high temperatures. The present work investigates high and low manganese content stainless steel that oxidized in an oxygen-containing 5% water vapor at 800 °C. SEM and EDX were performed to analyze oxide formation and ICP-OES was used to detect the volatile species that evaporated from steel surfaces. The results show that manganese in steel increases spallation and reduces Cr volatilization rates in high Mn stainless steel. The average Cr volatilization of high Mn samples is 0.09 × 10-11 g cm-2 s-1, which is about 14 times lower than the ones (1.25 × 10-11 g cm-2 s-1), while Fe and Mn volatilization rates increase by 10 and 62 times, respectively.
Blood Volume Sequestration in Cardiotomy Reservoirs: An In-Vitro Evaluation
Authors: Reeder Gary D. , Pfefferkorn Robert O. , Newton Samuel E.
Published: September 2023

An in-vitro evaluation of the dynamic volume loss of several clinically available cardiotomy reservoirs was conducted. The reservoirs were grouped according to microfiltration rating (20 to 40 u) and the dynamic sequestration of each was examined over a blood flow range of 0 to 8 L/min. A statistically significant decrease in both static and dynamic volume loss was found to be associated with increasing microfiltration pore size. Furthermore, significant differences in volume sequestration were demonstrated between devices within each group over the blood flow range of 0 to 3200 ml/min. The Dideco D-744 reservoir was found to produce the least volume sequestration over this flow range. The Dideco D-742 and Bard H-710F exhibited somewhat greater volume losses over the same flow range. The Bard H-700F and American Bentley BCR- 3500 and Q-220F exhibited the greatest static and dynamic volume losses of the reservoirs tested. Total recoverable blood volume was evaluated and the Dideco D-744, D-742 and Bard H-710 were found to be superior, in this respect, to the other devices examined in this series.

The data presented demonstrates that, of the devices tested, the D-744, D-742 and H-710F are superior to the others in high cardiotomy flow applications where sequestration may be of significant concern.
Hyperthermic Antiblastic Perfusion in Extracorporeal Circulation: Surgical Technique and Results in the Treatment of Extemities’ Tumor
Authors: Vaglini M. , Santinami M. , Nava M. , Belli F. , Prada A. , Ammatuna M. , Cascinelli N.
Published: September 2023

Regional perfusion in extracorporeal circulation is finding more and more applications in the treatment of extremities’ tumors. In order to avoid any influence from surgical variables rises the necessity of a standardization of the technique.

In this paper we propose a new surgical technique with subsequent results based on the experience at the National Cancer Institute of Milan on 89 consecutive patients treated by regional hyperthermic antiblastic perfusion without significant complications.
Right Ventricular Assist with Conventional Cardiopulmonary Bypass Equipment
Authors: Corrigan Michael , DiGregorio Paul J. , Soto Jose , Freeman Gary S. , Markowitz Alan
Published: September 2023

A technique of supporting a patient with perioperative right ventricular failure has been developed and used clinically. The method is simple, inexpensive, effective, and involves only conventional cardiopulmonary bypass equipment.
Bentley Gas-STAT: Our Clinical Experience
Authors: Harloff Michael , Palen Steve
Published: September 2023

An on-line, real-time blood gas monitoring system will provide the perfusionist with an accurate trend of the ever-changing pH fluctuation and gas exchange.

With very little adaptation to our perfusion circuit using the Bentley, Gas-STAT Device, we are now able to monitor the arterial and venous pH, pCO2, pO2, as well as the blood temperature.

Its ease of calibration and initial battery life of 14 hours allows continuous monitoring over a prolonged bypass time. This added parameter enables the perfusionist to respond to the immediate needs of the patient.

As a result we are able to anticipate potentially hazardous events that can occur unexpectedly at any time. Equipment fatigue, such as membrane failure, can be diagnosed with absolute certainty, and therefore, a perfusion catastrophe can be averted.
Granulocyte Elastase Release during Extracorporeal Oxygenation: Effects of Bubble, Membrane, and Hollow Fiber Oxygenators
Authors: Wolf B. , Lo H.B. , Zeplin H.E. , Pauquet D. , Hildinger K.H. , Reinards R. , Messmer B.J. , Greiling H.
Published: September 2023

Activation or lesions of PMN-granulocytes among other effects result in release of proteases i.e., elastase (E). Plasma E is mainly inactivated by alpha 1-proteinase inhibitor (alpha 1-PI) by formation of E-alpha 1-PI complexes. However, E may be able to destroy plasma proteins (i.e., clotting factors, immunoglobulins, etc.) before complex formation occurs. The effects of extracorporeal oxygenators on blood cells were investigated in samples of 26 patients before, during and up to three days after extracorporeal circulation (ECC) and oxygenation in open heart surgery. Three types of oxygenators were compared in clinical use: bubble (A), membrane (B), and hollow fiber (C). A significant increase of E alpha 1-PI concentrations is observed during ECC. The extent of E release depends on time of ECC and on the type of extracorporeal oxygenator (E alpha 1-PI levels at the end of ECC: 1514 +/- 557 ng/ml −A, 842 +/ 480 ng/ml − B, 506 +/ 128 ng/ml −C). Complex levels increase further on and reach maxima 2h after the end of ECC. The increase of E in plasma is more pronounced than other hemolytic parameters. E-alphal-PI complex levels thus seem to be a sensitive indicator for leukocyte lesions and/or activation during extracorporeal oxygenation.
Liver Transplantation: The University of Pittsburgh Medical Center Experience
Authors: Calder Wayne A.
Published: September 2023

PURPOSE: To provide the perfusion community with a literature review of liver transplantation and the four year liver transplant experience at the University of Pittsburgh Medical Center

METHODS:

define the various diagnoses associated with liver transplantation

describe past and present immunosuppressant therapy

describe the development and use of a heparinless veno-venous extracorporeal circulation system

describe the development and use of past and present rapid-infusion systems

correlate liver disease diagnosis with blood usage and survival

CONCLUSION: Liver transplantation is fast becoming a service operation:

operative mortality has decreased from 10% to less than 1%

operative blood loss and blood usage has been significantly reduced

gastrointestinal engorgement has essentially been eliminated
A Quality Assurance Program for Perfusion
Authors: Winn B.A. , Hurdle M.B. , Riley J.B. , Riley K.P.
Published: September 2023

The Quality Assurance Program for Perfusion (QAPP) is designed to minimize injury to a cardiac patient through risk management.

The QAPP is a flexible manual that includes guidelines for managing human resources and contains several universal forms for use in documenting pre-pump patient status, equipment maintenance, durable and disposable equipment and justification for their use, product failure CPB procedural audits, and staff development. The QAPP contains tables outlining the risks, hazards and accidents associated with ECC equipment; protocols for routine ECC preparation; special and emergency CPB procedures; and an extensive bibliography.

The periodic audit of the QAPP contents will allow common team knowledge of protocols and physicians' orders to meet hospital accrediting body requirements and to reduce risks and hazards associated with ECC.
Utilization of the Bentley BOS-CM50 Capillary Fiber Membrane Oxygenator with a Bio-Medicus Pump for Long-Term Right Ventricular Assist: A Case Report
Authors: Chrostowski Ann Marie , Palanzo David A. , O’Neill Martin J. , Harrison Lynn H.
Published: September 2023

Following six vessel coronary artery bypass surgery, a 67-year-old man developed acute hypoxia and severe pulmonary hypertension secondary to a protamine reaction. Right ventricular bypass with oxygenation was required using a Bio-Medicus pump and Bentley BOS-CM50 capillary fiber membrane oxygenator. This helped to lower the pulmonary artery pressure from 36 mmHg to 9 mmHg. Arterial blood gases were maintained with a pH of 7.35-7.50, pCO2 30-40 mmHg, and PO2 60-200 mmHg, and activated clotting times (ACT) were kept above 480 seconds. The oxygenator was used for 14 hours without complications and removed from the circuit when the patient's mean pulmonary artery pressures were kept below 20 mmHg, and pO2s above 60 mmHg with the patient supported on the ventilator. The patient was subsequently weaned off right ventricular bypass after 66 hours of support.

The Bentley CM50 capillary fiber membrane oxygenator was safely used for 14 hours, which was associated with a reduction in pulmonary hypertension in a patient recovering from a protamine reaction.
Klinische Differenzialdiagnostik bei 4–12-jährigen
kieferorthopädischen Patienten
Authors: Medlitsch Astrid , Pittschieler Elisabeth
Published: September 2023

Dieser Artikel gibt einen groben Überblick über die klinische Erfahrung
und wissenschaftliche Basis bei der Behandlung von Kindern und Jugendlichen von
4–12 Jahren mit Osteopathie und Kieferorthopädie und beantwortet
folgende Fragen: Worauf kommt es speziell als Osteopath bei der Zusammenarbeit mit
Kieferorthopäden an? Welche osteopathischen Testungen sind zielführend
und sinnvoll?
Wie funktioniert Homöopathie bei Pflanzen?
Authors: Maute Cornelia
Published: September 2023

Die Autorin gibt einen Überblick über die Möglichkeiten
der homöopathischen Behandlung bei Pflanzen. Anhand einiger konkreter
Fälle wird auf die Mittelfindung für diese
„stummen“ Patienten eingegangen. Neben praktischen Dosierungs-
und Anwendungshinweisen werden die Themen Stärkung, Verletzungen,
Fraßschädlinge und Pflanzenkrankheiten angesprochen.
A fast calibration method for distributed measurement systems
Authors: Liu Qing , Lv Jiaming , Zhang Jiaying , Li Jintong , Li Jiapei , Shang Ting
Published: September 2023

Aiming at the distributed measurement system multi-equipment coordinated measurement, the data measured by each transmitting station are unified under a common coordinate system, which has the problems of complicated operation and high time and cost. In this paper, a fast calibration method for distributed measurement systems based on standard devices is proposed. The method designs a new type of architectural calibration board with non-coplanar measurement nodes, calculates the coordinates of the measurement nodes using geometric relations, solves the initial values of the system parameters, and substitutes the initial values into the L-M least squares algorithm for iterative optimization so that it only needs to carry out one scanning measurement for each reference position in the calibration process to complete the calibration. We designed an experiment in which a distributed measurement system consisting of four transmitting stations measured three standard rods (1650.073, 1156.704, and 875.950 mm) sequentially after calibration in a measuring space of 5 × 5 × 3 m3. The experimental results show that under the premise of ensuring that the measurement accuracy is better than 0.20 mm, the calibration of the parameters of the distributed measurement system can be completed within 20 min.
Weinberger Adjustment Inventory Portuguese Version: A Study of Cross-Cultural Adaptation and Measurement Invariance
Authors: Pechorro Pedro , Shircliff Katie , DeLisi Matt , Simões Mário R. , Cyders Melissa A.
Published: September 2023

We examine the psychometric properties of the Weinberger Adjustment Inventory (WAI) from a modern psychometric perspective, including second-order models, better estimation of reliability, and measurement invariance, among a sample of young adults ( N = 610, M = 21.33 years, SD = 3.09 years) from Portugal. Results indicated that only the four-factor intercorrelated confirmatory models of the WAI Distress and Restraint scales, and the two-factor intercorrelated confirmatory models of the WAI Defensiveness scales showed adequate fits. The WAI showed good reliability and distinctive correlates with other psychometric measures and criterion variables. Cross-gender measurement invariance was established. Our findings support the WAI as a valid and reliable measure.
Adverse Childhood Experiences and Treatability in Dutch Patients with Cluster B Personality Disorders Mandated to Forensic Clinical Care: A Comparison of Men Convicted for Sexual and Violent Offenses
Authors: Dekkers Denise , Keulen-de Vos Marije
Published: September 2023

Adverse childhood experiences (ACEs) have been consistently linked to interpersonal violence and are highly prevalent in correctional populations, particularly in men who perpetrate (sexual) violent behavior. Although exposure to ACEs is common in men who perpetrate interpersonal violence, less is known about the differences between men who commit sexual versus non-sexual violence. This cross-sectional study reports on the differences in prevalence of adverse childhood experiences in Dutch men who committed sexual offenses ( N = 29) versus those who committed (non-sexual) violent offenses ( N = 29), all who have been mandated to forensic clinical care. Drawing on data from a RCT-study among male forensic psychiatric inpatients with cluster B personality disorders from seven forensic hospitals in the Netherlands, the study explored potential differences in ACEs, and its relationship to treatability in the first year of forensic treatment. No significant differences were found in prevalence of childhood abuse and neglect among men convicted for sexual offenses versus those convicted for violent offenses. In our study, ACEs were not predictive of risk relating to treatability at the start of forensic treatment. Our findings suggest that taking into account trauma histories is of equal importance for both offending groups. Implications regarding trauma-informed forensic care are discussed.
Effective Control of Three Soliton Interactions for the High-Order Nonlinear Schrödinger Equation
Authors: Yao 姚 Yanli 延立 , Yi 伊 Houhui 厚会 , Zhang 张 Xin 鑫 , Ma 马 Guoli 国利
Published: September 2023

We take the higher-order nonlinear Schrödinger equation as a mathematical model and employ the bilinear method to analytically study the evolution characteristics of femtosecond solitons in optical fibers under higher-order nonlinear effects and higher-order dispersion effects. The results show that the effects have a significant impact on the amplitude and interaction characteristics of optical solitons. The larger the higher-order nonlinear coefficient, the more intense the interaction between optical solitons, and the more unstable the transmission. At the same time, we discuss the influence of other free parameters on third-order soliton interactions. Effectively regulate the interaction of three optical solitons by controlling relevant parameters. These studies will lay a theoretical foundation for experiments and further practicality of optical soliton communications.
Setting an upper limit for the total TeV neutrino flux from the disk of our Galaxy
Authors: Vecchiotti V. , Villante F.L. , Pagliaroli G.
Published: September 2023

We set an upper limit for the total TeV neutrino flux expected from the disk of our Galaxy in the region |l| < 30° and |b| < 2° probed by the ANTARES experiment. We include both the diffuse emission, due to the interaction of cosmic rays with the interstellar medium, and the possible contribution produced by gamma-ray Galactic sources. The neutrino diffuse emission is calculated under different assumptions for the cosmic ray spatial and energy distribution in our Galaxy. The source contribution is instead constrained by analysis of the gamma-ray TeV sources included in the H.G.P.S. catalog. In particular, we assume that the total gamma-ray flux produced by all the sources, resolved and unresolved by H.E.S.S., is produced via hadronic interaction and, hence, is coupled with neutrino emission. We compare our total neutrino flux with the recent ANTARES measurement of the neutrino from the Galactic Ridge. We show that the ANTARES best-fit flux requires the existence of a large source component, close to or even larger than the most optimistic predictions obtained with our approach.
Temperature effect on nanotwinned Ni under nanoindentation using molecular dynamic simulation
Authors: He 何 Xi 茜 , Xu 徐 Ziyi 子翼 , Ni 倪 Yushan 玉山
Published: September 2023

Temperature effect on atomic deformation of nanotwinned Ni (nt-Ni) under localized nanoindentation is investigated in comparison with nanocrystalline Ni (nc-Ni) through molecular simulation. The nt-Ni exhibits enhanced critical load and hardness compared to nc-Ni, where perfect, stair-rod and Shockley dislocations are activated at

(
1

1
¯

1
)

,

(

1
¯

11
)

and

(
11

1
¯

)

slip planes in nt-Ni compared to only Shockley dislocation nucleation at

(
1

1
¯

1
)

and

(

1
¯

11
)

slip planes of nc-Ni. The nt-Ni exhibits a less significant indentation size effect in comparison with nc-Ni due to the dislocation slips hindrance of the twin boundary. The atomic deformation associated with the indentation size effect is investigated during dislocation transmission. Different from the decreasing partial slips parallel to the indenter surface in nc-Ni with increasing temperature, the temperature-dependent atomic deformation of nt-Ni is closely related to the twin boundary: from the partial slips parallel to the twin boundary (∼10 K), to increased confined layer slips and decreased twin migration(300 K–600 K), to decreased confined layer slips and increased dislocation interaction of dislocation pinning and dissociation (900 K–1200 K). Dislocation density and atomic structure types through quantitative analysis are implemented to further reveal the above-mentioned dislocation motion and atomic structure alteration. Our study is helpful for understanding the temperature-dependent plasticity of twin boundary in nanotwinned materials.
Tunable dual-plasmon induced transparency based on monolayer black phosphorus metamaterial and its sensing performance
Authors: Shi Rongrui , Lei Cheng , Liang Ting , Wang Taolong , Liu Shilin
Published: September 2023

In this study, we propose a monolayer periodic structure of black phosphorus (BP) metamaterials in the mid-infrared region to achieve tunable dual-plasmon-induced transparency (PIT). The dual PIT effect was regulated by changing the carrier concentration of BP. The results obtained using the finite-difference time-domain method are very similar to those obtained using coupled modal theory. More importantly, the proposed structure shows great potential for sensing, with a maximum sensitivity of 6.67 THz/RIU. Therefore, our study provides a new method for the development of sensor devices with excellent refractive index sensing.
Optical modulation in Er-doped fiber laser delivering dark pulse utilizing side polished fiber coated with Ti3AlC2 as saturable absorber
Authors: Chang Seong Hong , Tan Sin Jin , Diblawe Abdulkadir Mukhtar , Tiu Zian Cheak , Cheng Xiau San , Ahmad Fauzan , Harun Sulaiman Wadi
Published: September 2023

Dark pulse mode-locked Erbium doped fiber laser (EDFL) was demonstrated in this work by employing side polished fiber (SPF) coated with Ti3AlC2 solution using drop casting method. The modulation depth of fabricated SPF coated with Ti3AlC2 solution was characterized at 2.2%. This SPF coated structure allowed the formation of dark mode-locked pulse with improved the birefringence and nonlinearity in EDFL. The dark pulse generated was cubic-quintic nonlinear Schrödinger equation (CQNLSE) dark pulse with center wavelength at 1558.935 nm, repetition rate 1.839 MHz and pulse width 170.2 ns. Pulse stability was examined, revealing a high signal to noise ratio (SNR) of 65.86 dB. This work could serve as a foundation for the development of sustainable industry, innovation and infrastructure.
149 Power-agers: the effect of Progressive Resistance Training (PRT) on sarcopenia status of community dwelling older adults
Authors: Farrell E , Fox S
Published: September 2023

Background

The primary aim of this study is to establish whether the sarcopenia status of community-dwelling older adults could be improved using Progressive Resistance Training (PRT) in a gym-based, physiotherapy-led intervention for 7 weeks.

Methods

This is a non-randomised study, all participants completed the intervention. 24 participants attended the programme, n = 2 lost to follow up. Participants attended twice weekly for 7 weeks; 2 assessment sessions and 12 exercise sessions. The assessment consisted of Bioelectrical Impedance Analysis, Timed Up and Go (TUAG), five time Sit-to-Stand (5 x STS), 10 metre walk test, grip strength and Short Physical Performance Battery (SPPB). Each group had 5–7 participants complete 6 exercises in circuit; (1) weighted sit-to-stand, (2) modified deadlift, (3) farmer walks, (4) overhead press, (5) cable row, and (6) cable chest press.

Results

Data were analysed using SPSS. Pre-intervention 87.5% (n = 21) were identified as ‘probable sarcopenic’; post-intervention this decreased to 77.3% (n = 17). Sarcopenia status was not found to be significantly associated with the intervention by Chi-squared tests. No participants were classified as ‘confirmed sarcopenia’, as all were above the cut off scores for muscle mass. There was a statistically significant change in the SPPB and TUAG scores (p < 0.0041), with large effect sizes; Eta squared = 0.481 (SPPB), and 0.341 (TUAG). Improvements in 5xSTS and right grip strength had alpha values of less than p < 0.05, with large effect sizes, however they did not reach statistical significance.

Conclusion

The improvements in physical performance measures (SPPB & TUAG) are encouraging and may indicate that PRT can play a role in the long-term management of sarcopenia and promotion of independence in older adults. However, due to the lack of a control, it is difficult to ascribe the changes to the intervention itself. Further research with suitable controls and follow-up is needed to gain insights into which PRT interventions are the most effective in managing sarcopenia in older community dwellers.
170 Improving illness collaboration, communication and confidence in adults with heart failure and their spouse/partners: results from an early-phase intervention
Authors: Lyons K , Whitlatch C L , Vest A , Upshaw J , Johnson S H , Lee C
Published: September 2023

Background

Older adults with Heart Failure (HF) and their spouse/partner experience significant negative impact on their health and relationship. Yet, few interventions focus on the HF couple. Informed by the Theory of Dyadic Illness Management, the Taking Care of Us© (TCU) intervention was designed to improve illness collaboration, communication, and confidence within older couples living with HF.

Methods

A randomised controlled trial was used to explore this early-phase psychosocial intervention in comparison to an education attention-control condition. Both programs were delivered virtually over two months to couples in the United States. Thirty seven couples (adults with heart failure [AwHF] and their spouse/partners) were randomised (18 to TCU and 19 to attention-control) with 24 couples completing the follow-up assessment (12 couples per condition). AwHF were on average 69.9 (SD = 9.6) years of age, predominantly male (70%) and reported being in NYHA Stage II/III (73%). Between-group effect sizes are reported due to small sample.

Results

At follow-up, TCU AwHF reported bigger declines in dyspnoea (d = 0.66), pain interference (d = 1.23) and fatigue (d = 0.18) than the educational condition. Additionally, TCU couples reported greater improvements in collaborative HF management (d = 0.17 for AwHF; d = 0.40 for spouses), collaborative coping (d = 0.68 for AwHF; d = 0.49 for spouses), shared physical activity (d = 0.72 for AwHF), shared fun activities (d = 0.70 for AwHF; d = 0.52 for spouses), and communication as a couple (d = 0.38 for AwHF; d = 0.20 for spouses). TCU AwHF reported being more likely to reduce fluid (d = 0.35) and take a diuretic (d = 0.22) when needed; TCU spouses reported being more likely to recommend reducing salt (d = 0.37), fluid (d = 0.16), and taking a diuretic (d = 0.54) when needed. Finally, AwHF in the attention-control condition reported bigger improvements in confidence to manage HF (d = 0.18) than TCU AwHF.

Conclusion

Preliminary data of the TCU© program shows promise for improving collaboration, communication, and health in older couples with HF.
336 Exploring the barriers and facilitators to screening in Emergency Departments (ED): a qualitative evidence synthesis using the theoretical domains framework
Authors: Barry L , Galvin R , Leahy A , Egan S , Fitzgerald C , Ryan D , O’Connor M , Griffin A , Tighe S Murphy , Meskell P
Published: September 2023

Background

Validated screening tools, such as the Identification of Seniors At-Risk tool, can be utilised to detect early disease processes, risk factors and the risk of adverse outcomes. Identifying individuals in need of early intervention and targeted assessment can be achieved by implementing screening in the ED. Successful implementation can be impacted by a lack of resources and ineffective integration of screening into the clinical workflow. Tailored implementation processes and staff training, which are contextually specific to the ED setting, are facilitators to effective implementation. This review identified barriers and facilitators to screening in the ED to underpin implementation processes. Furthermore, this review focused on synthesising the experience of healthcare workers who are routinely involved in this process.

Methods

A rigorous search strategy was employed and reported using PRISMA. Subsequently, an a-priori framework of themes was formulated to facilitate the interpretation of search results. A conceptual model was then formed using ‘Best fit’ framework synthesis, this assisted in the organisation of data from relevant studies during data extraction. Dual blind screening of results was undertaken using RAYYAN as a platform. Thirty studies met the inclusion criteria. Dual appraisal of full text articles was completed using CASP, GRADE CERQual assessed confidence of findings and data extraction was performed by two reviewers collaboratively.

Results

This is the first known synthesis of qualitative research, focused on screening in the ED. Predominantly, the findings illustrate that screening in the ED is perceived as a complex and challenging process. The barriers and facilitators identified can be broadly categorised as identifying preconditions to screen, recognising motivations to screen and acknowledging the required knowledge and skills to screen.

Conclusion

Competing interests in the ED, environmental stressors such as overcrowding and an organisational culture that resists screening were clear barriers. Adequate resources and tailored education to underpin the screening process were facilitators.
6 Exploring professional-robot interactions in care settings: a case of adopting an Irish air-disinfection device in a nursing home in Japan
Authors: Kodate N , Obayashi K , Maeda Y , Scott R , Kurishima S , Okamoto Y , Ishii Y , Yu W , Suwa S , Sakata N , Masuyama S
Published: September 2023

Background

Digital welfare technologies are increasingly expected to perform a broader set of functions and roles. The worldwide COVID-19 pandemic further underscored use of technology, as it heightened the need for security and safety in care settings, with cleanliness and infection control becoming an even more important aspect of care delivery. While there are great expectations for digitalization and automation of care work, bringing new technologies such as robots into a workplace remains a challenge in terms of acceptance and usability, as well as a reflection of user preferences and needs.

Methods

An original air-disinfection ‘robot’ was developed for a cross-cultural research project, and was introduced to a residential nursing home in Japan. Prior to its instalment, seven main users (physiotherapists, nurses and social care professionals) were trained by the developer. Semi-structured interviews and focus groups were conducted before, during and after the trial in order to understand care professionals’ needs regarding and impressions of the device. The System Usability Scale (SUS) was also used to test professionals’ experience with the device.

Results

Overall, the users had a positive experience of using the robot (SUS score of 74.3/100). During the trial, the team of users changed the inorganic appearance of the robot by adding a face, hair, hands and music to it. The qualitative data reveal how additional efforts were made to transform a piece of air-disinfection equipment into an interactive and accessible robot for older adults. The appropriate size and the level of automation were also raised as essential points for design consideration.

Conclusion

There is great potential for a variety of care robots to be deployed and evaluated beyond cultural boundaries, but local knowledge and professional expertise are crucial to smooth implementation. The study ‘Harmonisation towards the establishment of Person-centred, Robotics-aided Care System’ was supported by the Toyota Foundation (D18-ST-0005, 2019–2022).
9 Impact of finding Incidentalomas in neuro-imaging in patients with acute stroke: a retrospective review
Authors: Thomas C , McSorley A
Published: September 2023

Background

Incidental Findings (IFs) appear to be increasing in frequency, which is mostly secondary to the increased use of imaging and improved imaging techniques. We endeavoured to ascertain if IFs are appropriately managed and whether the impacted inpatient care. Our review focused on neuroimaging completed in patients admitted with symptoms suggestive of acute stroke.

Methods

300 reports of CT Head and CT angiography in patients presenting with symptoms of acute stroke were reviewed retrospectively, along with the notes. Data collected included: Sex, age, Number of arterial occlusions, and number of IFs. Attempts were made to ascertain if Ifs were appropriately actioned and if this led to an increased Length-of-Stay (LOS).

Results

Of 300 cases reviewed, 53% were male, 81% were older than 60. 24% had occlusion on CT angiogram (of which >49% were in the MCA). 59% of patients had IFs. However, the total number of IFs in 300 patients was 272 (8.8% Vascular). Significant Ifs accounted for 18.4% of the total number. The commonest significant Ifs were thyroid abnormality (25%), Lung abnormality (25%), and aneurysm (25%). Insignificant IFs were identified as those that were previously known and remained stable, pulmonary nodule <5mms, thyroid nodule <1 cm, and degenerative spinal disease.

Conclusion

This retrospective review confirms that the prevalence of IFs is common at 59%. However, only 18.4% of the total number of Ifs required further action. Further review of the notes is suggested to ascertain if the increased length of stay, which most certainly negatively impacts patient care, in 3.6% of the total number of patients was necessary. Ifs will continue to appear as we increasingly perform complex imaging on patients. The key is to ascertain those that require follow up. It is the role of the healthcare professional to remain diligent to ensure this is done in a way that will not impact patient care.
19 General practitioners’ perspectives on advance care planning: a qualitative study
Authors: McAlister E , Foley T
Published: September 2023

Background

An Advance Care Plan (ACP) outlines patient preferences for future treatment for a time when capacity is lacking. With our ageing population and rising dementia prevalence, ACPs are of increasing relevance and importance; however, very few are created each year. This study aims to explore General Practitioner (GP) perspectives on ideal timing, facilitators, and barriers to ACPs.

Methods

To date, ten GPs with a range of clinical experience have been purposely sampled from the Irish College of General Practitioners database. Semi-structured interviews were conducted by phone, video call, or in person, concurrently recorded, and subsequently transcribed. The Braun and Clarke method of thematic analysis was utilised, and coding was performed using NVivo software.

Results

All GPs spoke to the importance of ACPs for care of those with dementia and believed GPs are ideally placed to have these discussions. Two themes arose regarding timing of discussion: (1) routine proactive discussion prior to potential cognitive issues arising and (2) discussion within a few appointments of diagnosis. Identified barriers to ACP include: (1) lack of patient awareness of ACPs, (2) lack of GP education on ACPs, (3) difficulty predicting disease progression, (4) poor family dynamics, (5) short appointment times, and (6) lack of remuneration. Identified facilitators include: (1) patient’s acceptance of death and understanding of diagnosis, (2) use of an established template to guide discussion, (3) presence of a trusted family member, (4) long appointment times and (5) remuneration.

Conclusion

There was universal agreement on the importance of ACPs. Inclusion of ACP teaching in the curriculum for undergraduate medical education and postgraduate GP training should be strongly considered. There is need for heightened public awareness of the Assisted Decision-Making Act and ACPs. Further qualitative and quantitative research is needed to explore this issue nationally and identify how it has been resolved internationally.
31 Stroke early supported discharge: continuing to improve patient and organisational outcomes
Authors: Carney M , O'Connor S , O'Reilly J , Shaw D N , Hanley J , Hickey P
Published: September 2023

Background

Approximately 6,000 people in Ireland had a stroke in 2020. Early Supported Discharge (ESD) is an international model of care for stroke patients. ESD improves patient outcomes while facilitating a faster discharge, through provision of stroke specific rehab at home. ESD can be expected to improve disability outcomes, quality of life and reduce length of hospital stay. A pilot ESD service was introduced in an acute hospital in 2021 and continues to provide stroke rehab for patients living within a 30-minute drive from an acute hospital.

Methods

A retrospective re-audit on routine data from 113 patients who partook in ESD from January 2021 to December 2022 from an acute hospital. Data was extracted from the ESD database and analysed.

Results

Implementation of an ESD service over 24 months between 2021 and 2022 achieved the following: (i) 50% increase in number of bed saving days between 2021 and 2022; (ii) In both 2021 and 2022, the percentage of stroke patients discharged with ESD was 25% of the total number of stroke patients; (iii) The average LOS of a stroke patient accepted to the ESD service continues to decrease. In 2021, average LOS for ESD patients was 11.7 days; 2022 it was 11 days; (iv) The number of stroke patients accepted by ESD service remains relatively unchanged. In 2021, 57 patients and in 2022, 56 patients were accepted to ESD and (v) Total FIM/FAM scores from admission to discharge with ESD continue to increase. In 2021, 8.1% increase in functional outcomes were recorded. In 2022, that increased to 9.5% demonstrating an improving independence levels when discharged with ESD.

Conclusion

The ESD service in an acute hospital continues to demonstrate Organisational and patient benefits. Participation in ESD rehabilitation impacted positively on functional performance as captured using the FIM-FAM. Ongoing implementation of ESD aims to continue to have a positive impact on length of patient stay, bed saving days and functional outcomes.
39 An audit of Vitamin D status in acute medical patients over the age of 65
Authors: Coelho D , O'Sullivan E
Published: September 2023

Background

Vitamin D is an essential nutrient for older adults in maintaining bone health, prevention and treatment of osteoporosis. It plays a fundamental role in preventing fractures. Vitamin D is seasonal, meaning it is not made during winter, and in summer is subject to the variable sunlight available in Ireland. The Department of Health Guidance in 2020 recommended adults over 65 years should be supplemented with 15 micrograms of Vitamin D daily. 55.5% of adults over 65 years have insufficient/deficient vitamin D levels in winter. The aim of the audit was to highlight the significance of routine Vitamin D testing and its management in all acute medical patients over 65 years.

Methods

A prospective audit of 50 patients aged over 65 years was conducted between December 2022 and March 2023. The data collected were Vitamin D serology results, the presence and type of Vitamin D supplement prescribed, whether the Vitamin D level was mentioned in discharge letters, and if any patient presented with osteoporotic fractures.

Results

48% of older adults were not on any Vitamin D supplement. 64% had insufficient Vitamin D levels of which 32% were truly deficient. Of those insufficient/inadequate of Vitamin D, 44% were not on any Vitamin D. Additionally, only 18% of Vitamin D results were mentioned in medical discharge letters. Overall, 30% of older adults presented with fractures and yet 10% of those were not on Vitamin D.

Conclusion

The audit highlighted the lack of Vitamin D supplementation in older adults. The results revealed insufficient monitoring of Vitamin D levels leading to deficiencies and correlating with presentations with fractures. All of this is detrimental to the older adult population. Highlighting the vital role of Vitamin D in bone health among clinicians and improving communication with colleagues are important areas for improving practice.
58 Review of a pilot Reablement Team service
Authors: Furey S , Lambe A , Macklin G , Richardson M , Bourke L
Published: September 2023

Background

A Reablement Team (RT) was established in a level two hospital for patients who are medically fit for discharge from either Medical Assessment Unit (MAU) or in-patient care, to prevent hospital admission and to support early discharge, through the provision of home rehabilitation. The team consists of senior grade medical social worker, occupational therapist, speech and language therapist, physiotherapist and a rehabilitation assistant. Intensive rehabilitation is provided in the home for up to 6 weeks. This study sought to evaluate service impact and performance in 2022.

Methods

A mixed method design was employed. Quantitative data was used by analysing number and nature of patients seen, discharge outcomes and pre and post outcome measures to determine goals achieved, quality of life and independence levels. Qualitative data included patient satisfaction questionnaires.

Results

In 2022, 78 patients were seen, 41 female and 37 male. Mean age of 79 years. Of the total number of patients, 59 (76%) were discharged early from hospital and 19 (24%) avoided hospital admission after attending the MAU. Underlying diagnosis of patients comprised Stroke (n = 29), progressive neurological disorders (n = 11), respiratory disorders (n = 2) orthopaedic/musculoskeletal (n = 13), falls (n = 20), patients medically unwell (n = 3). Of the patients discharged, 86% remained at home (n = 67), while 14% were readmitted. Using pre/post outcome measures, 89% reported an improvement in quality of life as measured by the ICECAP assessment and the mean increase of all patients in independence was 5.4% measured on the modified Barthel index. 91% of patients achieved one or more primary rehabilitation goals. All patients rated service satisfaction as high.

Conclusion

Findings indicate that a RT service can reduce LOS and prevent unnecessary admissions when intensive rehabilitation is provided by a dedicated team of HSCPs in the home. Additional benefits include reduction of primary care waiting list and integrated home care.
59 The effectiveness of a progressive resistance exercise class for Sarcopenic hospitalised older adults
Authors: Bailey C , Gilmore E , Tobin A , NiChonchubhair C , Speirs C , Newell E , Nolan M
Published: September 2023

Background

Sarcopenia is common in the older inpatient population with an estimated prevalence of 22.6%. A Progressive Resistance Training (PRT) program addressing sarcopenia is recommended to counteract its adverse effects of increased falls and mortality. The delivery of exercise in the acute setting can pose a challenge for health care professionals. Therefore, this study aimed to examine the effectiveness of a PRT exercise class for older adults in an acute setting.

Methods

This was an observational study using a convenience sample of older adults undergoing physiotherapy within the hospital. All participants deemed medically suitable were referred by their primary physiotherapist. Participants underwent PRT including upper and lower body exercises, twice a week. These patients also undertook regular physiotherapy outside of the class. The primary outcome measures were the five times Sit-to-Stand (5STS) and bilateral hand-grip recorded by their primary physiotherapist pre-class attendance and on their last class.

Results

A total of 10 participants engaged in the PRT class. 70% were male and 30% were female with and average age of 77.5 years. The average number of classes attended was 3.1. Participants demonstrated an improvement in sarcopenic measure of 5STS, median change of 7.9 seconds (interquartile range [IQR] 4.88–11.75 seconds), and grip strength, median improvement in left 0.96 kgs (IQR -3.85-5.18) and right 0.1kgs (IQR -1.55-1.68).

Conclusion

This PRT exercise class demonstrated an improvement in sarcopenic measures in hospitalised older adults. These results are not exclusively due to PRT class attendance however this programme is an example of an effective way to address the negative effects of sarcopenia and the identified research gap in providing exercise in the acute setting. Further research is required to examine the effect of combining nutritional education with PRT training as an intervention for older adults with sarcopenia.
79 Aiming to be champions: stroke swallow screen audit
Authors: Ward C , Johnston A-M , Cheannabhain A Ni , Diskin M , Hannon N
Published: September 2023

Background

Dysphagia post stroke has a significant impact on patient’s outcomes including mortality due to stroke associated pneumonia, length of stay, rehabilitation potential and overall quality of life. Evidence derived from both experimental and observational studies demonstrates that swallow screening following stroke has a significant protective health benefit against pneumonia, mortality, dependency and length of stay. Stroke Swallow Screening (SSS) should be completed within 4 hours of patients presenting with stroke. In 2022, 70% of patients presenting with stroke received a SSS with only 43% receiving SSS within the recommended 4 hours. The aim of this audit is to investigate how PUH compares to the international standard and the national audit of stroke findings.

Methods

Retrospective audit using the 2022 HIPE Stroke data for PUH. Audit reviewed data from January to December 2022. Sample size was the entire cohort of strokes in 2022 (88 patients). Data was analysed quantitatively using an excel spreadsheet.

Results

88 patients presented to PUH with stroke in 2022. 44% (39 patients) had a SSS completed, while only 13% (11 patients) had the screen completed within 4 hours.

Conclusion

PUH will use this patient-centred data to improve our stroke care, specifically the SSS standard as per the National Stroke Guidelines (2022). The SLT department is currently collaborating with our stroke colleagues to provide training to relevant staff. A SSS Programme is a priority quality improvement project for 2023, striving to make significant improvements to our standard of stroke care. Our goal is to become champions locally and nationally in SSS, an area that has consistently lagged behind the national and international standards for too long.