bluuebunny/crossref_metadata_2025 huggingface dataset:
Nanoimprint lithography-based replication techniques for fabrication of metal and polymer biomimetic nanostructures for biosensor surface functionalization
Authors: Nowduri Bharat , Britz-Grell Anette , Saumer Monika , Decker Dominique
Published: January 2023

Nanostructuring is a promising and successful approach to tailor functional layers and to improve the characteristics of biosensors such as signal transmission and tighter cell-surface coupling. One of the major objectives in biosensing and tissue engineering is the development of interfaces that mimic the natural environment of biosystems composed of extracellular matrix biomolecules. Nevertheless, effective techniques to reconstruct the random distribution of these biomolecules are still not well established. For this reason, the presented work demonstrates different methods based on nanoimprint lithography to replicate randomly distributed natural nanostructures with complex geometries into different polymers and metals. The fidelity of the replicated nanostructures has been evaluated by atomic force microscopy and the attributes of the fabrication processes have been discussed. Finally, different replication techniques have been combined for the biomimetic nanostructuring of the dielectric passivation layer as well the metal electrode surface to develop novel whole-surface-nanostructured microelectrode arrays.
Atomic layer deposition (ALD)-constructed TaS2 nanoflakes for cancer-related nucleolin detection
Authors: Huang Yazhou , Lv Junyan , Zhang Yunfei , Shao Yinfeng , Yang Dongfang , Cong Yuan , Huang Jiacai , Bian Rong
Published: January 2023

Sensitive detection of nucleolin (NCL) is of great significance for the early diagnosis of cancer. In this work, as a new type of two-dimensional (2D) transition metal dichalcogenides (TMDCs), TaS2 nanoflakes (NFs) were precisely constructed by atomic layer deposition (ALD) on carbon fiber paper (CFP) with high specific surface area. In situ observation showed that the nucleation and growth of TaS2 nanoflakes were precisely controlled by the number of ALD cycles, thereby regulating their electrochemical properties. The electrochemical performance of TaS2NFs was observed in depth, and compared with that of traditional 2D TMDCs. Due to the high surface area and conductivity, anodic/cathodic current of ∼1570 μA of TaS2NFs/CFP can be obtained. Subsequently, an electrochemical biosensor based on ALD-constructed TaS2NFs/CFP for cancer-related NCL detection was fabricated. Due to the excellent electrochemical performance of TaS2NFs/CFP, ultrasensitive detection of NCL in the linear range of 0.1 pM–10 nM with a detection limit of 0.034 pM was achieved.
Full-field in vivo imaging of nanoparticles using benchtop cone-beam XFCT system with pixelated photon counting detector
Authors: Li Liang , Zhang Siyuan , Zhang Wenli , Lu Hongbing
Published: January 2023

Objective. X-ray fluorescence computed tomography (XFCT) is a promising noninvasive technique for in vivo imaging of high-Z elements (e.g. gadolinium (Gd) or gold (Au)). In this study we upgraded our experimental XFCT system using a flat panel photon counting detector with redesigned pinhole collimation in order to achieve 3D XFCT images during one scan. Approach. Aiming at the characteristics of pinhole-collimated cone-beam XFCT imaging, a new scatter correction algorithm was proposed to estimate the normalized spectrum of scatter background based on K–N formula and realize correction by a weighted least squares method. Then, images were quantitatively reconstructed by a maximum likelihood iterative algorithm with the attenuation correction. Main results. The potential on full-field in vivo XFCT imaging of this new system was investigated. An imaging experiment of a PMMA phantom with the diameter of 35 mm was carried out for quantitative evaluation of the system performance. Results show that 2 mg ml−1 Gd solutions can be successfully reconstructed with a 45 min cone-beam XFCT scan. In vivo XFCT imaging experiments of mice with injection of Gd nanoparticles (GdNPs) were also performed and demonstrated in this paper. A mouse was injected through the tail vein with 20 mg ml−1 NaGdF4 solution and then anesthetized with isoflurane during the cone-beam XFCT scan. Significance. The distribution of the GdNPs inside the mouse can be well reconstructed so that the deposition of NPs in vivo can be clearly observed, which indicates the feasibility of the proposed system for full-field XFCT of small animals and further potential in relevant in vivo research.
Research on fatigue crack quantitative monitoring based on eddy current sensor with an interactive induction coil layout
Authors: Fan Xianghong , He Yuting , Chen Tao
Published: January 2023

To reduce the number of sensor channels, this paper proposes an eddy current sensor with an interactive induction coil layout. First, the crack monitoring principle of the sensor is analyzed, and fatigue crack monitoring experiment is carried out. It is found that the cracks can be quantified according to the characteristic points of the sensitivity variation curve. Then, a permalloy plate is used for reinforcing the sensor, and the crack monitoring accuracy test is carried out, which shows that the crack monitoring accuracy error of the sensor is no more than 0.1 mm. Finally, the sensor network is built by the sensor according to the dangerous parts of the butt joint structure determined by the finite element analysis. And fatigue crack monitoring experiment is carried out, which shows that the sensor network can determine the position and length of the fatigue crack, and the error is no more than 0.1 mm.
Novel polyhedral mechanical metamaterial exhibiting negative Poisson’s ratio
Authors: Sorrentino A , Castagnetti D
Published: January 2023

The work presents a novel polyhedral mechanical metamaterial based on rotating triangular prisms connected by their corners, which possesses the ability to attain large values of negative Poisson’s ratio (NPR). Through a kinematic model of the proposed rotating structure, we evaluate the auxeticity of the system by varying the geometrical parameters of the polyhedrons composing the elementary cell of the structure. The kinematic results highlight the peculiar NPR of the system, whose values are nearly constant over significant strain ranges. Focusing on the most promising auxetic mechanisms we designed chiral architectures that replace the ideal hinges at the corners with curved-shape ligaments, and validated these configurations through three-dimensional printed specimens. The specimens were tested under uniaxial compression and simulated through finite element analyses. Experimental results exhibited an excellent agreement with computational predictions in terms of elastic modulus and auxeticity, showing a value of Poisson’s ratio up to −1.3 for one of the designs. Our findings demonstrate the highly auxetic property of rotating polyhedral systems, which allow the design of novel architected materials useful, for example, in biomechanical applications.
Submicrometer-scale temperature sensing using quantum coherence of a superconducting qubit
Authors: Kakuyanagi Kosuke , Toida Hiraku , Abdurakhimov Leonid V , Saito Shiro
Published: January 2023

Interest is growing in the development of quantum sensing based on the principles of quantum mechanics, such as discrete energy levels, quantum superposition, and quantum entanglement. Superconducting flux qubits are quantum two-level systems whose energy is sensitive to a magnetic field. Therefore, they can be used as high-sensitivity magnetic field sensors that detect the magnetization of a spin ensemble. Since the magnetization depends on temperature and the magnetic field, the temperature can be determined by measuring the magnetization using the flux qubit. In this study, we demonstrated highly sensitive temperature sensing with high spatial resolution as an application of a magnetic field sensor using the quantum coherence of a superconducting flux qubit. By using a superconducting flux qubit to detect the temperature dependence of the polarization ratio of electron spins in nano-diamond particles, we succeeded in measuring the temperature with a sensitivity of 1.3 µKµ

Hz

−
1

at T = 9.1 mK in the submicrometer range.
Time-resolved measurements of sub-optical-cycle relativistic electron beams
Authors: Li Cheng , Zhang Haoran , Guo Zixin , Xu Xiazhen , He Zhigang , Zhang Shancai , Jia Qika , Wang Lin
Published: January 2023

We propose an all-optical technique to record the time information of relativistic electron beams with sub-optical-cycle duration. The technique is based on the interaction of the electron beam with the ponderomotive potential of an optical traveling wave generated by two counter-propagating circularly polarized optical fields at different frequencies in vacuum. One of the optical pulses is a vortex laser pulse, and the other is a normal Gaussian laser pulse. The time information of the electron beam is mapped into the angular information, which can be converted into a spatial distribution after a drift section. Thus, the temporal profile and arrival time of the electron beam can be retrieved from the spatial distribution of the electron beam. The measurement has a dynamic range comparable to the period of the optical intensity grating formed by two counter-propagating laser pulses. This technique may have wide applications in many research fields that require sub-optical-cycle electron beams.
Any four orthogonal ququad–ququad maximally entangled states are locally markable
Authors: Hsu Li-Yi
Published: January 2023

In quantum state discrimination, the observers are given a quantum system and aim to verify its state from the two or more possible target states. In the local quantum state marking as an extension of quantum state discrimination, there are N composite quantum systems and N possible orthogonal target quantum states. Distant Alice and Bob are asked to correctly mark the states of the given quantum systems via local operations and classical communication. Here we investigate the local state marking with N

4
⊗
4

systems, N = 4, 5, 6, and 7. Therein, Alice and Bob allow for three local operations: measuring the local observable either σ

z
or σ

x
simultaneously, and entanglement swapping. It shows that, given arbitrary four

4
⊗
4

systems, Alice and Bob can perform the perfect local quantum state marking. In the N = 5, 6 cases, they can perform perfect local state marking with specific target states. We conjecture the impossibility of the local quantum state marking given any seven target states since Alice and Bob cannot fulfill the task in the simplest case.
Machine learning classification of non-Markovian noise disturbing quantum dynamics
Authors: Martina Stefano , Gherardini Stefano , Caruso Filippo
Published: January 2023

In this paper machine learning and artificial neural network models are proposed for the classification of external noise sources affecting a given quantum dynamics. For this purpose, we train and then validate support vector machine, multi-layer perceptron and recurrent neural network models with different complexity and accuracy, to solve supervised binary classification problems. As a result, we demonstrate the high efficacy of such tools in classifying noisy quantum dynamics using simulated data sets from different realizations of the quantum system dynamics. In addition, we show that for a successful classification one just needs to measure, in a sequence of discrete time instants, the probabilities that the analysed quantum system is in one of the allowed positions or energy configurations. Albeit the training of machine learning models is here performed on synthetic data, our approach is expected to find application in experimental schemes, as e.g. for the noise benchmarking of noisy intermediate-scale quantum devices.
Power-efficient in vivo brain-machine interfaces via brain-state estimation
Authors: Valencia Daniel , Leone Gianluca , Keller Nicholas , Mercier Patrick P , Alimohammad Amir
Published: January 2023

Objective. Advances in brain–machine interfaces (BMIs) can potentially improve the quality of life of millions of users with spinal cord injury or other neurological disorders by allowing them to interact with the physical environment at their will. Approach. To reduce the power consumption of the brain-implanted interface, this article presents the first hardware realization of an in vivo intention-aware interface via brain-state estimation. Main Results. It is shown that incorporating brain-state estimation reduces the in vivo power consumption and reduces total energy dissipation by over 1.8× compared to those of the current systems, enabling longer better life for implanted circuits. The synthesized application-specific integrated circuit (ASIC) of the designed intention-aware multi-unit spike detection system in a standard 180 nm CMOS process occupies 0.03 mm2 of silicon area and consumes 0.63 µW of power per channel, which is the least power consumption among the current in vivo ASIC realizations. Significance. The proposed interface is the first practical approach towards realizing asynchronous BMIs while reducing the power consumption of the BMI interface and enhancing neural decoding performance compared to those of the conventional synchronous BMIs.
Large mitigation potential of smoke PM2.5 in the US from human-ignited fires
Authors: Carter Therese S , Heald Colette L , Selin Noelle E
Published: January 2023

Increasing fire activity and the associated degradation in air quality in the United States has been indirectly linked to human activity via climate change. In addition, direct attribution of fires to human activities may provide opportunities for near term smoke mitigation by focusing policy, management, and funding efforts on particular ignition sources. We analyze how fires associated with human ignitions (agricultural fires and human-initiated wildfires) impact fire particulate matter under 2.5 µm (PM2.5) concentrations in the contiguous United States (CONUS) from 2003 to 2018. We find that these agricultural and human-initiated wildfires dominate fire PM2.5 in both a high fire and human ignition year (2018) and low fire and human ignition year (2003). Smoke from these human levers also makes meaningful contributions to total PM2.5 (∼5%–10% in 2003 and 2018). Across CONUS, these two human ignition processes account for more than 80% of the population-weighted exposure and premature deaths associated with fire PM2.5. These findings indicate that a large portion of the smoke exposure and impacts in CONUS are from fires ignited by human activities with large mitigation potential that could be the focus of future management choices and policymaking.
Band structure for relativistic charge carriers submitted to a helical electric field
Authors: Martínez D , Reyes J A
Published: January 2023

We study the relativistic dynamics of electrons submitted to a uniform harmonic electric fields longitudinally applied to the electron velocity. In order to obtain explicitly the set of time-dependent equations for the bi-spinors components, we write down the corresponding Dirac equation for this system. By performing a suitable transformation to this set of equations, we get a matrix equation whose eigenvalues can be found directly. We found analytically the band structure and show a break of degeneracy and the existence of three bands: two total and one partial. The thicker band preventing from the Schwinger mechanisms can be shortened by proper combination of the frequency and amplitude of the applied electric field.
1344 UNDERSTANDING PATHWAYS INTO CARE HOMES USING DATA (THE UNPICD STUDY)
Authors: Burton J K , Ciminata G , Lynch E , Shenkin S D , Geue C , Quinn T J
Published: January 2023

Introduction

Moving into a care home is a significant, life-changing experience which occurs to address care needs which cannot be supported elsewhere. UK health policy recommends against moving into a care home from the acute hospital. However, this occurs in practice. Better understanding pathways into care homes could improve support for individuals and families, service planning and policymaking. Our aim was to characterise individuals who move-in to a care home from hospital and those moving-in from the community, identifying factors associated with moving-in from hospital.

Method

A retrospective observational cohort study was conducted involving adults moving into care homes in Scotland between 1/3/13-31/3/16 using the Scottish Care Home Census (SCHC), a national individual-level social care dataset. SCHC data were linked to routine data sources including hospital admissions, community prescribing and mortality. The data were split into those moving-in from hospital and those moving-in from the community. Descriptive statistics characterising the two groups were generated and multivariate regression undertaken to identify factors associated with moving-in from hospital.

Results

A total of 23,892 individuals were included in the analysis, of whom 13,564 (56.8%) moved-in from hospital. A third came directly from an acute hospital, with 57.7% from rehabilitation or community hospitals and 7.1% from inpatient psychiatry. Being male, receiving nursing care, high frailty risk, increasing numbers of hospital admissions and diagnoses of any fracture or stroke in the six months before moving-into the care home were all significant predictors of moving-in from hospital.

Conclusions

The population moving-in to care homes from hospital are clinical distinct from those moving-in from the community. National cross-sectoral data linkage of health and social care data is feasible, but the available data are dominated by health characteristics. There is an urgent need to operationalise other meaningful variables which shape care pathways to enhance understanding and evidence.
1319 INTERACTION BETWEEN DISTINCT MULTIMORBIDITY PATTERNS AND DISABILITY AND ITS ASSOCIATION WITH FUTURE MORTALITY AMONG OLDER ADULTS
Authors: Ho H-E , Yeh C-J , Wei J C-C , Chu W-M , Lee M-C
Published: January 2023

Background

Multimorbidity patterns is associated with future mortality among older adults. However, the addictive effect of disability for distinct multimorbidity patters is unclear. Our aim was to identify the multimorbidity patterns of Taiwanese people aged over 50 years and to explore their association between multimorbidity patterns with/without disability and future mortality.

Methods

This longitudinal cohort study used data from the Taiwan Longitudinal Study on Aging. The data were obtained from wave 3, and the multimorbidity patterns in 1996, 1999, 2003, 2007, and 2011 were analysed separately by latent class analysis (LCA). The association between each disease group with/without disability and mortality was examined using logistic regression.

Results

5124 older adults with average age of 66.7 years old were included. Four disease patterns were identified in 1996, namely, the cardiometabolic (21.6%), arthritis-cataract (11.6%), relatively healthy (61.2%), and multimorbidity (5.6%) groups. After adjusting all the confounders, the cardiometabolic group with disability showed the highest risk for mortality (odds ratio: 2.83, 95% CI: 1.70-4.70), followed by Multimorbidity group with disability (odds ratio: 2.33, 95% CI: 1.17-4.64) and relatively health group with disability (odds ratio: 1.79, 95% CI: 1.22-2.62) and cardiometabolic group without disability (odds ratio: 1.21, 95% CI: 1.01-1.45).

Conclusion

This longitudinal study reveals disability plays an important role on mortality among older adults with distinct multimorbidity patterns. Older adults with a cardiometabolic multimorbidity pattern with disability had a dismal outcome. Thus, healthcare professionals should put more emphasis on the prevention and identification of cardiometabolic multimorbidity, with routine check-up of their functional limitation.
1195 EFFECTIVENESS OF A NEW PROACTIVE MULTIDISCIPLINARY CARE SERVICE FOR OLDER PEOPLE WITH FRAILTY: A NON-RANDOMISED CONTROLLED TRIAL
Authors: Murtagh F E M , Okoeki M , Ukoha-kalu B O , Khamis A , Clark J , Boland J W , Pask S , Nwulu U , Elliott-Button H , Folwell A , Johnson M J , Harman D
Published: January 2023

Introduction

Integrated care potentially improves health outcomes for older people with frailty. We aimed to assess the effectiveness of a new, proactive, multidisciplinary care service in improving the wellbeing and quality-of-life of older people with frailty.

Methods

A community-based non-randomised controlled trial. Participants (≥65 years, electronic Frailty Index ≥0.36) received either this new integrated care service plus usual care, or usual care alone. Data collection was at 3 time points: baseline, 2-4 weeks, and 10-14 weeks; the primary outcome was patient well-being at 2-4 weeks, measured using the Integrated Patient Outcome scale, IPOS. The secondary outcome was quality-of-life, measured using EQ-5D. Wellbeing and quality-of-life at 10-14 weeks were measured to test safety and duration of effect. Data was analysed with STATA v17.

Results

199 intervention and 54 control participants were recruited. At baseline, participants were similar in age/gender/body mass index/ethnicity/living status. At 2-4 weeks, the intervention group had improved well-being (median IPOS reduction 5, versus control group increase 2, p<0.001) and improved quality of life (median EQ-5D index values increase 0.12, versus control 0.00, p<0.001); these were clinically significant. After adjusting for age, gender and living status, intervention group had an average total IPOS score reduction of 6.34 (95% CI: -9.01: -4.26, p<0.05). Propensity score matching analysis based on functional status/deprivation score showed similar results (reduction in IPOS score in intervention group 7.88 (95% CI: -12.80: -2.96, p<0.001). At 10-14 weeks, the intervention group sustained well-being improvement (median IPOS score reduction 4, versus control increase 2, p<0.001) and improved quality of life (median EQ-5D index values increase 0.06, versus control -0.01, p<0.001).

Conclusion

This new integrated care service improves the overall wellbeing and quality of life of older people with frailty at 2-4 weeks; improvement was sustained at 3 months.

Ethics Approval: IRAS-250981 and NHS Research Ethics Committee 18/YH/0470.
1199 PREVENTION AND TREATMENT OF CRITICAL ILLNESS ACQUIRED WEAKNESS IN THE ELDERLY
Authors: Costa C , Moniati F
Published: January 2023

Introduction

Critical Illness Acquired weakness (ICU-Acquired Weakness (ICU-AW)) is an umbrella term used to describe Critical Illness Myopathy (CIM) and Critical Illness Polyneuropathy (CIP). The condition exerts high prevalence in the elderly admitted in the ICU and is associated with deteriorating patient outcomes, namely mortality and morbidity. The prevalence of the syndrome is highly variable in the current literature hindering our ability to objectively quantify the scale of the problem. Moreover, several preventative methods and treatment for ICU-AW as a result of sarcopenia have been proposed in literature with some of them providing favourable outcomes.

Objectives

1. Evaluate the prevalence of ICU-AW in the elderly through a systematic review; and 2. Explore the treatment options currently available.

Methods

We conducted a systematic review using the PubMed, Embase and Cochrane databases to explore the current studies available on the diagnosis of ICU-AW syndromes. Cochrane’s Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement was our template.

Results

Overall, twenty-one studies (1544 patients) were included. The minimum reported prevalence is 20%, whereas the maximum is 76%. The overall median prevalence was 52% (Q1: 32% and Q3: 61%) with an interquartile range (IQR) of 29%. The highest IQR was found in studies using clinical examination (IQR=37%) whereas the lowest in studies using electrophysiological assessment (IQR= 21%). Moreover, several preventative measures for ICU-AW were identified and analyzed namely: nutritional alterations (high protein dies), glucose control, early mobilization, neuromuscular electrical stimulation and the ABCDEF bundle.

Conclusion

The variability in the diagnostic modalities used to measure the syndrome as well as the inconsistency in the diagnostic parameters within each modality prevent us from objectively quantifying the prevalence of ICU-AW. With regards to treatment early mobilization protocols offer promising evidence.

Reference

Vanhorebeek, Latronico, Van den Berghe G. ICU-acquired weakness. Intensive Care Med. 2020;46(4):637-53.
1203 SUPPORTING SAFE SWALLOWING OF CARE HOME RESIDENTS WITH DYSPHAGIA: HOW DOES CARE COMPARE WITH GUIDANCE?
Authors: Wilson J , Loveday H , Tingle A , Griffin H , Goerzig A
Published: January 2023

Introduction

Dysphagia affects up to 70% of nursing home residents, causes significant morbidity and increased hospital admissions. Speech and language therapists (SLT) make recommendations to reduce the risk of aspiration and support safe eating and drinking but have limited capacity to offer ongoing guidance to care home staff. This study aimed to measure the mealtime experience of residents with dysphagia, how this compared with SLT advice and what factors influenced care.

Methods

The safety of nutrition/hydration care of residents with dysphagia in 2 care homes was observed using a structured tool capturing 12 elements of expected practice. Observed practice was compared to recommendations in SLT/care-plans. Interviews with staff aimed to understand factors that contributed to how dysphagia care was delivered.

Results

SLT recommendations for 18 residents with dysphagia were predominantly focused on food/fluid modification, other safe swallowing strategies were mentioned less frequently. 66 episodes of mealtime care for 11 residents were observed. Adherence to SLT/care-plan recommendations for food texture, posture and alertness of the resident was observed on 90% of occasions, but on less than 60% of occasions for alternating food and drink, prompting resident during feeding, ensuring swallow completed and throat/mouth clear. Compliance with recommended fluid thickness was 68%; thickening was frequently not aligned to required IDDSI level. Nutrition care was less safe when residents were fed in the dining room when multiple care staff were present. Interviews with 11 care home staff found care-plans were rarely consulted, care needs were communicated verbally during handover, and training was targeted at fluid modification but not at other safer swallowing strategies. Limited knowledge about causes of coughing whilst eating/drinking drove inappropriate SLT referrals.

Conclusions

A safe swallowing culture that addresses system and workforce issues in care homes would improve the experience of residents with dysphagia and reduce their risk of aspiration.
1323 VOLUNTEER-LED ONLINE GROUP EXERCISE FOR OLDER ADULTS: A FEASIBILITY AND ACCEPTABILITY STUDY
Authors: Lim S , Meredith S , Agnew S , Clift E , Ibrahim K , Roberts H C
Published: January 2023

Introduction

The health benefits of physical activity for older people are well recognised and include reduction in falls, improvement in frailty status and physical function. Nonetheless, physical inactivity remains a significant problem among older adults. This study aimed to determine the feasibility and acceptability of implementing online volunteer-led group exercise for community-dwelling older adults.

Methods

This pre-post mixed methods study was conducted among older adults attending community social clubs. Eligible participants were aged ≥ 65 years, able to walk independently, and able to provide written consent. The intervention consisted of a once weekly volunteer-led online group chair-based exercise. The primary outcomes were the feasibility and acceptability of the intervention. Secondary outcomes included physical activity levels measured using the Community Health Model Activities Program for Seniors (CHAMPS) questionnaire, functional status (Barthel Index), and health-related quality of life (EQ-5D-5L). Outcomes were measured at baseline and at 6 months. Trials registration: NCT04672200.

Results

Nineteen volunteers were recruited, 15 completed training and 9 were retained (mean age 68 years, 7 female). Thirty participants (mean age 77 years, 27 female) received the intervention and attended 54% (IQR 37-67) of exercise sessions. One minor adverse event was reported. Participants had no significant changes in secondary outcome measures, with a trend towards improvement in physical activity levels. The intervention was acceptable to volunteers, participants, and staff. The seated exercises were perceived as safe, manageable and enjoyable. Volunteers were relatable role models providing positive vicarious experiences that improved participants confidence to exercise within a friendly, non-judgmental environment. Technological issues, or reluctance to learn how to use technology were barriers to the intervention. The social interactions and sense of belonging motivated participation.

Conclusions

Trained volunteers can safely deliver online group exercise for community-dwelling older adults and the intervention was feasible and acceptable to older adults, volunteers and club staff.
1358 USING THE SUPPORTIVE AND PALLIATIVE CARE INDICATORS TOOL (SPICT) TO PRIORITISE FRAIL INPATIENTS FOR ANTICIPATORY CARE PLANNING
Authors: Boothroyd K , Nicholson A , Tevendale E
Published: January 2023

Introduction

Patients with frailty who have emergency admissions are at risk of mortality and may benefit from Anticipatory Care Planning (ACP). Appropriate identification, to target limited resource in an in-patient environment can be challenging. We conducted a prospective study on a cohort of frail in-patients with a hospital admission of ≥ 72 hours duration. We aimed to evaluate the effectiveness of the SPICT tool alongside CFS as a predictor of mortality to improve our targeting of patients for ACP.

Method

On a single day a SPICT form was completed prospectively for each inpatient on 3 hospital inpatient wards (Complex Frailty Unit, General/Orthopaedic Rehabilitation, Step-Down Unit). Patients were deemed SPICT positive if they scored on ≥ 2 General Indicators and ≥ 2 Clinical Indicators. CFS was also recorded. Electronic records of this patient cohort were followed up for 9 months.

Results

Of 66 inpatients, 58 (87.9%) were aged ≥ 65 years and had a CFS ≥ 4. Mode CFS value = 6 (23 patients, 39.7%). 32 (55.2%) were SPICT positive; 26 (44.8%) SPICT negative. At 3 months follow-up SPICT had Positive Predictive Value (PPV) 40.6% and Negative Predictive Value (NPV) 84.6% for mortality. At 6 months PPV = 56.3%; NPV = 80.8%. At 9 months PPV = 59.4%; NPV = 76.9%. SPICT negative patients with CFS 6 had mortality risk of 14.3% at 3, 6 and 9 months follow-up respectively. SPICT positive patients with CFS 6 had mortality risks of 50% at 3 months and 62.5% at 6 and 9 months.

Conclusion

SPICT is a predictor of mortality in patients with frailty during unplanned admissions to hospital of ≥ 72 hours duration. It is now used alongside CFS for all patients admitted to our Complex Frailty Unit, identifying patients most likely to benefit from inpatient ACP on discharge.
1213 IMPROVING INITIAL SCREENING, INVESTIGATION AND INTERVENTION OF BONE HEALTH IN A DAY REHABILITATION UNIT
Authors: Turkington S , Sedek H , McLoughlin A
Published: January 2023

Topic

We identified a deficiency in the identification and treatment of bone health in the Day Rehabilitation Unit. DRU is an Out-patient clinic where older people with falls or reduced mobility receive comprehensive geriatric assessment. We aimed to improve early screening for osteoporosis, prompting targeted investigation and intervention to improve patient outcomes.

Intervention

Our first intervention was consultant teaching specifically to the junior doctors working in clinic. This was followed up by the introduction of a Medical Assessment Proforma to include osteoporosis risk assessment. Finally, we had departmental wide teaching on bone health assessment. We hypothesised that a combination of clinical education and prompts in the proforma would improve our practice. A total of 205 patients where audited across an 18-month period from Sept 20 to Feb 22. We reviewed the electronic care record of patients seen in clinic to determine if bone health had been considered. A spreadsheet was designed in accordance with the NICE1 guidelines to record data. This included what supplements were prescribed, if a FRAX score had been recorded and the outcome of this.

Improvement

We noted an improvement in supplements prescribed (from 27% to 83%), FRAX score recorded (from 0% to 100%). Routine bloods including serum calcium remained unchanged (100%). Recording of Rockwood score also saw an improvement (from 0% to 49%).

Discussion

Increased use of a structured screening tool, supported by targeted education improves recognition and intervention of bone health. 54% of people who had a FRAX score done required a DEXA as per guidelines, of these 26% have osteoporosis. This early intervention helps to prevent osteoporotic fractures, therefore improving the quality of life of our elderly population.

Reference

1. Nice.org.uk. (2017). Osteoporosis: assessing the risk of fragility fracture | Guidelines| NICE. [Online] Available at: https://www.nice.org.uk/guidance/cg146.
1308 VIRTUAL FRAILTY WARD - POST DISCHARGE FRAILTY SUPPORT
Authors: Teo A , Wright H
Published: January 2023

Background

In response to the COVID pandemic when new robust discharge criteria were introduced to facilitate early discharge to optimise hospital capacity, Virtual Frailty Ward (VFW) was established. VFW provides nurse-led telephone follow-up for patients discharged primarily from the Emergency Department (ED) and the Acute Frailty unit (AFU).

Objectives

We aim to provide continuity of care by following up frail elderly patients at home, reviewing their medical, functional and social progress post discharge and ensuring they received adequate support to avoid hospital re-admission.

Methods

The service is overseen by the Lead Frailty Practitioner, supported by Consultant Geriatricians. Calls are made Monday to Friday by a team of Advanced Specialist Nurses. The case load is split up into 3 categories with different levels of priorities – 1: at least weekly calls; 2: Fortnightly calls; 3: Monthly calls. This service engages closely with community partners such as community frailty service, social care, district nurses and general practitioners.

Results

In year 1 (1/4/2020-31/3/2021), we had 598 patients on this VFW. 93 patients were referred to therapy team for urgent equipment to maintain safety, 73 patients were referred to community frailty and 112 patients had urgent discussions with GP to avoid hospital admissions. The 30 days readmissions rate was 14%. 547 patients were discharged. In year 2 (1/4/2021 – 31/3/2022), we had 297 patients. 49 patients were referred to therapy team, 32 patients were referred to community frailty team, and 41 patients required input from GP. The 30-day readmission rate was 11%. 224 patients were discharged.

Conclusion

VFW is a cost- effective service that has helped to reduce length of stay of frail elderly patients in an acute hospital setting, maintaining patient safety and prevent hospital re-admission, co-ordinated with community services. Our service has been highlighted in the recent GIRFT report on improving clinical practice.
1230 PALLIATIVE CARE MOVEMENT DISORDERS MULTIDISCIPLINARY MEETING
Authors: Davies R , Wilson E , Richfield E , Mundy C , Wright B , Stratton E
Published: January 2023

Introduction

It is well recognised that patients with Parkinson’s disease (PD) have significant symptom burden in advanced stages of their disease. Integration of movement disorder and palliative care services has been limited by concerns about resource and sustainability. We present our experience of establishing a movement disorders palliative care multidisciplinary meeting.

Method

In 2019 we established a multidisciplinary virtual bimonthly meeting between movement disorders and palliative care specialists. Referrals were accepted from movement disorder specialists, community Parkinson’s practitioners and palliative care specialists. Referring clinicians all actively applied primary palliative care approaches within their existing services. Aims of the meeting were to facilitate holistic management of complex needs, support advance care planning (ACP) and consider referral to specialist palliative care services.

Result

37 patients in total were discussed over a 2-year period (although the service was limited for a time due to COVID pressures). On average 3 new patients were discussed per meeting. Reasons for referral included motor and non-motor symptoms, support with ACP, medication advice, caregiver concerns and emotional distress. Meeting outcomes included medication adjustments, expediting reviews, hospice support, carer support, and referral to other services. Since the meetings started 23 (62%) patients have died. Of these, 30% died in hospital compared with the national average of 43.4%. The average between discussion at the meeting and death was 139 days. The meeting has generated education opportunities, triggered joint assessments and a professionals’ framework for the palliative management of patients with a movement disorder.

Conclusions

We present the experience of an MDT embedded within an early integrated palliative care service for movement disorders. The MDT has strengthened partnership working and findings suggest that alongside active primary palliative care, specialist palliative care for PD can be sustainable and resource efficient in a UK setting.
1169 QUALITY IMPROVEMENT PROGRAMME ON NON-MEDICINAL MANAGEMENT OF POSTURAL HYPOTENSION AMONG MDT MEMBERS IN THE MEDICAL WARDS (COE)
Authors: Gujjar A , Kumar A , Zaheed A , Liaqat B
Published: January 2023

Introduction

Postural Hypotension is a very common presentation in the elderly population. Appropriate knowledge to record postural hypotension and non-medicinal management for this is very important among MDT members working in the care of the elderly wards.

Method

We set out a questionnaire to assess the knowledge among MDT (multidisciplinary) members. An educational programme was initiated to improve the knowledge among MDT members. A complete audit cycle was done and the knowledge was reassessed with the same questionnaire based on the principles of the PDSA (Plan, Do, Studt and Act) cycle.

Results

It showed that the correct way of checking for postural blood pressure improved from 52.4% to 92% in recording the blood pressure. Correct identification of postural blood pressure improved from 33.3% to 88%. Self-rating of confidence to identify correctly postural blood pressure improved from 47.6% to 64% among the MDT Members. It was difficult to compare the answers about non-medicinal methods and exercises to help postural hypotension as there was heterogeneity in answers. It was also not possible to compare the impact of individual interventions on the alleviation of postural blood pressure.

Conclusion

Good improvement in the recording and non-medicinal management of Postural hypotension was observed in both the wards among the MDT Members. It is very important to have good knowledge and understanding in the management of this common condition as it helps in the identification and better management.
1291 DO PATIENTS UNDERSTAND THEIR RESPECT FORMS? A QI PROJECT REVIEWING PHRASES USED AND WHETHER THEY ARE MEANINGFUL TO PATIENTS
Authors: Mills H , O'Sullivan A , McCracken S , El Mabruk M
Published: January 2023

Background

Hospital based Quality Improvement Project focusing on adapting language used on Recommended Summary Plan for Emergency Treatment and Care (ReSPECT) forms to improve patient understanding.

Introduction

ReSPECT forms have been used to document patient wishes and appropriate escalation of treatment in our hospital since 2019. There continues to be a lack of understanding of phrases used amongst both patients and healthcare professionals; the hospital receives regular complaints. This project explored patients’ perceptions of language used and their thoughts on the ReSPECT discussion, to better guide discussions and documentation.

Methods

A questionnaire collecting qualitative and quantitative data was performed with 24 patients aged between 59-95 years old with ReSPECT forms on a medical ward (Geriatrics/ Endocrine).

Results

The phrases ‘DNACPR’ and ‘Not for ITU’ were understood by 5/24 patients (21%), ‘Ward based ceiling of care’ was understood by only 1/24 (4%) and ‘prioritising comfort care’ understood by 8/24 patients (34%). Only 6/24 (25%) of patients said they were a ‘little upset’ by their admission conversation about ReSPECT and no patients surveyed were ‘very upset’.

Conclusions

This first QI cycle found that overall, most patients did not understand the language commonly used on ReSPECT forms, particularly ‘ward-based ceiling of care’. The majority were not upset by the ReSPECT conversation, so a fear of upsetting the patient should not be a barrier to having a clear discussion. The next step in our QI work will be to explore phrases that are better understood by patients and then feedback findings so that we can develop a digital ReSPECT form with drop down options for phrases better understood by patients to describe ceilings of care.
1226 A MULTI-DISCIPLINARY APPROACH TO TRANSFORMING EYE CARE SERVICES FOR CARE HOME RESIDENTS
Authors: Ma N , Low S , Hasan S , Lawal A , Patel S , Nurse K , McNaughton G , Aggarwal R , Evans J , Koria R , Lam C , Chakravorty M , Stanley G , Banna S , Kalsi T
Published: January 2023

Introduction

Care home residents can have variable access to eye care services and treatments. We developed a collaborative approach between optometrists, care homes, and primary and secondary care to enable personalised patient-centred care.

Objective

To develop and evaluate an integrated model of eye care for care home residents.

Methods

Small scale plan-do-study-act (PDSA) service tests were completed in three care-homes in Southwark (2 residential, 1 nursing) between November 2021 to May 2022. Processes were compared to historical feedback and hospital-based ophthalmology clinic attendances (Mar 2019-2020). Hospital-like assessments were piloted at two care homes for feasibility and acceptability. Further piloting utilised usual domiciliary optometry-led assessment with multidisciplinary meeting access (including optometrist, GP, geriatrician, ophthalmologist and care home nurse) to reduce duplication of assessments and to evaluate MDM processes and referral rates.

Results

Examination was 100% successful at home (visual acuity and pressure measurement) compared to hospital outpatients (71.7% success visual acuity, 54.5% pressures). Examination was faster than in hospital settings (16 minutes vs 45 minutes-1 hour). Residents were away from usual activities for 32 minutes vs 6 hours for hospital visits including transport. Residents were less distressed with home-based assessments. Did-Not-Attend (DNA) rates reduced (26.7% to 0%), secondary care discharge rates improved (8.4% to 32%). Hospital eye service referral were indicated in 19% -23%, half of which were for consideration of cataract surgery. Alternative conservative plans were agreed at MDM for nursing home residents who were clinically too frail or would not have been able to comply with treatments avoiding 33% unnecessary referrals.

Conclusions

Home-based eye care assessments appear better tolerated and are more efficient for residents, health and care staff. Utilising an MDM for optometrists to discuss residents with ophthalmologists and wider MDT members enabled personalised patient-centred decision-making. Future work to test this borough wide is in progress.
SLGNN: synthetic lethality prediction in human cancers based on factor-aware knowledge graph neural network
Authors: Zhu Yan , Zhou Yuhuan , Liu Yang , Wang Xuan , Li Junyi
Published: January 2023

Motivation

Synthetic lethality (SL) is a form of genetic interaction that can selectively kill cancer cells without damaging normal cells. Exploiting this mechanism is gaining popularity in the field of targeted cancer therapy and anticancer drug development. Due to the limitations of identifying SL interactions from laboratory experiments, an increasing number of research groups are devising computational prediction methods to guide the discovery of potential SL pairs. Although existing methods have attempted to capture the underlying mechanisms of SL interactions, methods that have a deeper understanding of and attempt to explain SL mechanisms still need to be developed.

Results

In this work, we propose a novel SL prediction method, SLGNN. This method is based on the following assumption: SL interactions are caused by different molecular events or biological processes, which we define as SL-related factors that lead to SL interactions. SLGNN, apart from identifying SL interaction pairs, also models the preferences of genes for different SL-related factors, making the results more interpretable for biologists and clinicians. SLGNN consists of three steps: first, we model the combinations of relationships in the gene-related knowledge graph as the SL-related factors. Next, we derive initial embeddings of genes through an explicit message aggregation process of the knowledge graph. Finally, we derive the final gene embeddings through an SL graph, constructed using known SL gene pairs, utilizing factor-based message aggregation. At this stage, a supervised end-to-end training model is used for SL interaction prediction. Based on experimental results, the proposed SLGNN model outperforms all current state-of-the-art SL prediction methods and provides better interpretability.

Availability and implementation

SLGNN is freely available at https://github.com/zy972014452/SLGNN.
Cytoscape.js 2023 update: a graph theory library for visualization and analysis
Authors: Franz Max , Lopes Christian T , Fong Dylan , Kucera Mike , Cheung Manfred , Siper Metin Can , Huck Gerardo , Dong Yue , Sumer Onur , Bader Gary D
Published: January 2023

Cytoscape.js is an open-source JavaScript-based graph library. Its most common use case is as a visualization software component, so it can be used to render interactive graphs in a web browser. It also can be used in a headless manner, useful for graph operations on a server, such as Node.js. This update describes new features and enhancements introduced over many new versions from 2015 to 2022.

Availability and implementation

Cytoscape.js is implemented in JavaScript. Documentation, downloads and source code are available at http://js.cytoscape.org.

Supplementary information

Supplementary data are available at Bioinformatics online.