bluuebunny/crossref_metadata_2025 huggingface dataset:
Masters and teachers, housing innovations in designs of the professors of the Faculty of Architecture in the Warsaw University of Technology at the beginning of the 20th century
Authors: Tulkowska Karolina
Published: September 2019

The Faculty of Architecture in the Warsaw University of Technology (FA WUT) was established in the first quarter of the 20th century, when in European architecture and art, traditional trends were intertwined with new ideas, which inspired building´s creativity. In 1915, the Society of Science Courses and the Association of Technicians attempted to create a Polish university and polytechnic in Warsaw. Finally, at the newly created technical university, an independent architectural faculty was established. The members of the Organizing Committee and future professors represented the diversity of the architectural environment, both thanks to the education in various European schools (polytechnics, military schools and art academies), as well as the different aesthetic interests. This diversity was fully reflected in the architectural creativity of that period. At the beginning of the 20th century, the traditional craft thinking turned into the scientific interpretation of spatial activities, which stimulated the interest in novelty. The innovation was understood as in humanistic disciplines -like the ability to discover and test the solutions which deviate from the standard and which induce a rapid change in quality. Innovations of this period took the form of abstract and realistic ideas, methods based on alternative sets of criteria and technologies. They concerned the urban and architectural scale as well as the detail. In the particularly demanding living environment design, they manifested themselves in many objectively new values, such as functionalism, social housing, extensive typology of dwelling layouts, innovative reinforced concrete constructions of open plans, new standards of insolation, ventilation and many others. The paper is a summary of analyses regarding modern thoughts about living, present in selected projects and realizations of FA WUT professors, 1918-1939. We discuss the project of an extremely minimalist villa in Gdynia designed by Bohdan Lachert and Józef Szanajca (1926), Barbara and Stanisław Brukalski house at Niegolewski Street in Warsaw (1928), considered the first implementation of avant-garde architecture in Poland, the sanatorium house in Konstancin (Skolimów) by Helena and Szymon Syrkus (1930-1931) or the housing estate of the Warsaw Housing Cooperative. The aim of the analyses is to define innovative solutions: more functional, efficient and human-friendly, spatial and technical innovations, in the scale of the building, housing estate and a wider urban and social environment.
Disturbance Analysis and Their Impact On Delays in Construction Process
Authors: Meszek Wieslaw , Rejment Mariusz , Dziadosz Agnieszka
Published: September 2019

Despite the development of: modern technologies, the software supporting the management of construction projects, popularizing of the tools for data analysis and numerous studies on factors interfering the efficient course of the construction process, the delays are still a phenomenon often present in the construction industry. Based on the literature, it should be noted that the main goal of the researchers is to try to rank the factors causing delays in the construction and their classification into groups. Frequently, the classification criterion is the participant’s status in the investment process (a designer, a contractor, an investor, etc.); the general macro division into factors related to an investor/a company, a contract, the external environment or the division by resources, i.e. human factors, hardware factors and material factors. The subject of investigations of the authors of this article is to identify the types of disturbances causing delays and their classification depending on the scale and degree of influence on the further implementation of construction processes based on the implementation of a commercial and service building. Analysing the course of the implementation of the construction project, it is possible to indicate those factors that cause the necessity to engage considerable resources and change the sequence of processes to minimize the delay. Therefore, it is important to monitor the processes and control of work progress indicators, enabling early detection of delays and planning alternative solutions.
The Spatial Organization of Ancient Greece Cities, Case study: Priene City from Hellenistic period (Third Century BC)
Authors: Al-Sabbagh Hadeel , Gorgees Manar
Published: September 2019

The city of Priene is one of the most important historical cities and represents a basic reference of the gridiron plans which has applied in many contemporary cities in the world. Priene city was built on the slope of a steep topography with a rigid grid system, this contradiction made the city unique. However, urban studies did not give much attention to the spatial organization of historical cities by quantitative methods. This paper investigates the main planning characteristics and the spatial organization of ancient Greece cities in term of axiality and convexity by generating axial lines of the city. The spiritual and mundane zones such as Agora, Acropolis and other civic buildings were located on the integrated spaces which are directly connected to the city gates. The spatial articulation between the religious and secular spaces was clear to enrich the spatial values of the city. Space syntax analysis has shown a lower degree of axial integration of convex spaces, a high degree of axiality, little deformation of the system, more synchrony, and moderate intelligibility.
Modification of the structure and Properties of Fine-Grained Concrete with Carbon Black Dispersion
Authors: Ivanovich Yakovlev Grigory , Pavlovich Grakhov Valery , Drochytka Rostislav , Fedorovna Gordina Anastasia , Vladimirovna Nikitin Svetlana , Vyacheslavovna Begunova Ekaterina , Fedorovich Buriyanov Alexander , Anatolievich Repin Alexander
Published: September 2019

The study shows that adding carbon black (soot) in the form of an aqueous dispersion into the composition of fine-grained concrete leads to an increase in bending and compressive strength of the samples: at a soot concentration of 0.005% by weight of cement, respectively, to 37.63 and 15.99%, at a concentration of 0.02% up to 26.39 and 26.39% due to compaction of the structure of the cement matrix. An intensification of cement hydration processes has been noted, confirmed by the results of IR-spectral, differential-thermal analyses and studies of the cement matrix microstructure in the composition of fine-grained concrete. On the surface of new formations in the composition of modified soot dispersion, the formation of needle-like crystals has been observed. On their surfaces, structures of spherulites formed with sizes ranging from 100 to 200 nm, which are typical for calcium hydro-sulfonic aluminates of 3CaO·Al2O3·3CaSO4·32H2O type. The formation of spherulites is observed in the pores of the cement matrix, which contributes to additional compaction of the structure of fine-grained concrete.
Eco Energy Land - Envisioning the Międzyodrze Island in Szczecin: The New Approach to the Urban Design
Authors: Januszkiewicz Krystyna , Golebieski Jakub
Published: September 2019

This paper deal with the possibilities of architectural design in the process of creating a zoro-energy city, which encompasses environmental quality of life in highly-urbanized areas. Nowadays, the urban pollution is rising on a global scale. This problem is particularly noticeable in Poland. According to the latest WHO report, 36 of the 50 most polluted cities in the European Union are located in Poland. The paper is focused on a new possibility to resolve the problem of air pollution in developing polish cities by advanced architectural design. One of the examples of cities implementing the zero-energy strategy may be Szczecin. In the process of designing new urban districts in the post-industrial area of the Międzyodrze Islands new opportunities to implement energy self-sufficiency can be given. The first part of the paper presents the need to use renewable energy sources and technologies that clean the atmosphere from nitrogen oxides in the processes of revitalization of degraded urban areas. The second part presents the results of the research program Climate Change Adapted Architecture and Building Structures which has been conducted by Krystyna Januszkiewicz (the Faculty of Civil Engineering and Architecture for a few years at West Pomeranian University of Technology (WPUT) in Szczecin. The presented designs of application of titanium dioxide technology with photovoltaic technology were developed with co-operation of WPUT students. In conclusion, the paper emphasizes the usage of titanium technology and photovoltaic technology as a special independent structures in the urban space. This is indispensable to improve citizens’ health and to clear the atmosphere as well as to stop the emission of new pollution resulting from the dynamic development of polish cities.
Effect of POFA Foamed Concrete Block on Indoor Air Temperatures
Authors: Awang Hanizam , Arminda Wenny
Published: September 2019

Palm oil fuel ash (POFA) is a by-product produced from the combustion of biomass, including palm oil fibre and kernel shell; it is commonly used as an alternative fuel to generate electricity in palm oil mills. The disposal of this ash around the mill is usually uncontrolled, causing environmental problems. To reduce the ash’s negative impact on the environment, several studies have sought to incorporate this waste into the production of concrete, mortar and paste. Incorporation of POFA can enhance the mechanical, material and thermal properties of foamed concrete. This study examines the effect of replacing cement with POFA in a lightweight foamed concrete mix with a density of 900 kg/m3 and cement-to-sand ratio of 1:1.5 on indoor air temperatures. The POFA foamed concrete was cast to produce blocks measuring 100 mm × 200 mm × 500 mm. A single-storey building with a floor area of 20 m2 and height of 3 m was built and tested, and an actual test of indoor and outdoor temperatures was conducted. Comparison of actual and simulated data using simulation software showed that the indoor air temperature of the POFA foamed concrete block is lower than the outdoor air temperature. Using POFA foamed concrete blocks as a wall material decreased the indoor air temperature by up to 5.69 °C. The average indoor air temperature of a building with POFA foamed concrete blocks was 29.11 °C, which is close to that of a building with clay brick (29.12 °C). These temperatures are lower than those of buildings with normal concrete walls.
Review on the Social Conflicts of Land Acquisition and Demolition and its causes in China: From the Perspectives of Stakeholders and Institutions
Authors: Zhai Yu
Published: September 2019

In China, with the accelerating process of urbanization, social conflicts usually occur during the process of land acquisition and demolition, which has brought about large negative social impacts. Faced with the needs of the practice, this paper conducts a comprehensive review to sort out the performances of conflicts, to explore the causes and to provide some suggestions from both the stakeholders and institutional perspective. The study contends that there are three main manifestations of social conflicts in land acquisition and demolition: (1) violent enforcement of demolition; (2) differences in compensation needs; and (3) problems of landless people’s disorderly struggle. At the same time, in order to solve these problems, the government should establish a sense of “service-oriented governance”, distinguish the relationship between public interests and personal interests, enrich the public feedback channels to enhance the public’s right to speak. For developers, the government should strengthen control and avoid corruption caused by the combination of officials and businessmen. Finally, the government should improve the compensation and supervision mechanism for land acquisition and demolition, fundamentally solving the chaotic state that no great laws to follow.
Investigation of the Soil-Geosynthetic Interaction Using Direct Shear Testing and FEM Method
Authors: Vlcek Jozef , Valaskova Veronika
Published: September 2019

Verification of the design of the reinforced earth retaining structures is usually based on the global and internal stability check. Beside the analytical solutions, numerical modelling can simulate the real behaviour of the structure including mutual interaction of the particular elements. Additionally, stress-strain relation is involved in the final verification together with the required stability of the system. Parameters such as reinforcement stiffness or interaction ability with the soil allow to calculate more realistic axial forces acting in the reinforcing elements. Analytical solutions don’t take into account the influence of the deformation of the soil mass on the overall and internal stability. Finite Element Method can describe both of these mechanisms which take place simultaneously. Estimation of the interaction parameters is crucial to determine the forces with sufficient accuracy, especially when 2ndlimit state is critical for the structure design. The paper is aimed at the laboratory testing and numerical modelling of the interaction of the geosynthetic reinforcement and the soil during the sliding described by the interaction coefficient. A direct shear test was adopted to investigate the actual value of the interaction coefficient which is related to the certain displacement of the reinforcement in the soil. There is a recommendation not to use the interface element at the soil-reinforcement contact when the grid shaped reinforcing elements such as geogrids are used for the numerical simulations. This approach was approved by the study presented in this paper. Reinforcement with the grid structure and rigid joints provides higher level of interaction with the soil environment so reduction of the shear strength at this contact is unrealistic.
Assessing the Sustainability Principles of Prishtina, Kosovo
Authors: Tahiri Adelina , Ažman Momirski Lucija
Published: September 2019

Prishtina is the capital city and at the same time the fastest-growing city of Kosovo, which is an eastern European country that is both a developing country and a post-conflict country dealing with poverty and underdevelopment. Kosovo separated from Yugoslavia in 1999, and since then it has experienced various development stages, transformations, and radical changes regarding urban planning, society, and the political system. Urban planning in combination with local politics that had no visionary urban strategies resulted in the failure of Prishtina’s planning to direct massive growth towards sustainable urban development. To confirm this hypothesis, Prishtina is studied using a set of fifteen principles of green urbanism, which serves as a tool to assess Prishtina’s sustainability principles. The results show that postwar urban development patterns have been unsustainable thus far. Prishtina lacks the majority of sustainable city principles, but there have also been positive aspects of city development. The question remains whether Kosovo as a developing country should follow the same unsustainable steps as developed countries to catch up with them, or whether it could use other means such as universities, which can act as think tanks for transforming cities. The findings of this study can be used as a reference for existing development patterns and can provide guidance for future sustainable urban planning and developments in Prishtina.
Change of Temperature in the Room with the Living Wall
Authors: Poorova Zuzana , Salem Alhosni Mohamed , Kapalo Peter , Vranayova Zuzana
Published: September 2019

With the advent of the modern industrial city, more than half of the world’s population, planners, designers and urban advocates are once again turning to plants. Green infrastructure is a key strategy to provide cleaner air and water, while improving living environments, human health and mental well being. This paper is a part of doctoral study focusing on interior green walls and their qualities in terms of air temperature, humidity and level of CO2. The paper describes living wall built in vestibule in laboratory of Technical University of Kosice, its construction, irrigation and vegetation. The paper deals with effect of green wall on only one parameter – air temperature in the room.
The Human Factor in the Revitalization of the Housing Estates
Authors: Orchowska Anita
Published: September 2019

The article presents the issues connected with revitalization of the housing estates built in the industrial technologies, regarding it as one of the key elements of the transformation process of the modern cities in Poland. The aim of this work is to draw the attention to a very important element of revitalisation- a ‘human factor’, which is the basis of any changes in the urban and architectural spaces of modern housing estates. The first aspect of transformations relates to searching for a suitable scale and the urban character of the building development, together with the available area and the functions of residents’ service. The second essential element is a social participation of the residents, their involvement in the decisions connected with the project, which range from the issues of spatial planning to the choice of specific solutions, furnishings and other details, but it also involves their participation in any works carried out for the housing estate. The residents’ participation increases their chances for happiness, a sense of identity, the bond with neighbourhood community and a better assessment of conducted architectural and urban transformations. In Western European countries, the issue of huge housing estates is commonly known and the rich experience in revitalisation covers both the more conservative methods but also the demolitions of an urban tissue and changes of the structure of building development. The aim of such changes is to achieve suitable proportions, the buildings’ aesthetics, new forms of exploitation, and also their ‘human’ scale. It is indispensable to conduct social consultations related to the use of common spaces and constructing the places of mutual integration. In this paper, the survey conducted among the residents of Sadyba housing estate in Warsaw is presented, concerning the issues of functioning of basic elements of the space and indispensable changes in the field of the comfort of use, aesthetics and the neighbourhood relations. The inhabitants of this estate react passively to a vision of basic changes in the conditions of their housing environment and are not fully ready for an active participation in the dialogue on revitalisation of the residential estate.
Gender Differences in Perception of Indoor Environmental Quality (IEQ)
Authors: Kraus Michal , Novakova Petra
Published: September 2019

There are many factors creating the internal environment of the building. These factors could be biological, physical, or chemical, and they determine the indoor environmental quality. This contribution investigates the gender differences in occupants’ perception on various aspects of indoor environmental quality (IEQ). There are many studies, how the conditions of the indoor environment affect the users’ performance, health, or comfort. Generally, women are more likely to have symptoms of SBS, such as fatigue, headache, irritated or dry eyes, nose and throat, and skin symptoms. Assessments of user´s perception were carried out at the Institute of Technology and Business situated in the city of České Budějovice, South Bohemia, Czechia. The panellists (students) indicated their immediate evaluation on eight continuous scales regarding air acceptability, odor intensity, thermal comfort, humidity comfort, visual comfort, color comfort, noise load and total satisfaction. Then the percentage of dissatisfied people (PN) was estimated. The gender differences in perception of indoor environmental quality were analysed. This knowledge is necessary and useful to develop appropriate strategies to create and maintain a sustainable internal environment for education and training. Understanding the perception of the quality of the inner environment by students is essential to increase the performance and productivity of not only students but also the academic staff. The long-term low indoor environment quality can lead to poor productivity, performance and ability to learn. It is also necessary to take into account the health of students and also academic staff in the context of the hygiene of the internal environment.
Premonstratensian Convent Complex in the Polish Lands: Imbramowice in the Past and Today
Authors: Gil-Mastalerczyk Joanna
Published: September 2019

The historical architectural and urban complex of the Norbertine Sisters in Imbramowice near Kraków (Poland) is a valuable treasure trove of the spiritual and cultural heritage of the Premonstratensian Order in the Polish lands, spanning several centuries. This is a site of special religious and pilgrimage importance, and one of the oldest Norbertine convents, one of the two currently functioning Norbertine houses in Poland. Its history reflects the rich and painful history of Poland. The convent complex was funded in the 13th century by Bishop Iwo Odrowąż. Subsequently, after the fire, it was rebuilt in the 17th and the 18th century and has been functioning incessantly to this day. For over 780 years, it has been managed by the Norbertine Sisters and supported by benefactors and volunteers. Thanks to the numerous initiatives that are undertaken and the systematically performed construction work, the overall functionality of the complex has increased. The old monuments offer numerous possibilities of using their diverse wealth by all the interested persons.
Disorders window openings – family house in Lipno nad Vltavou
Authors: Dedic Martin
Published: September 2019

The aim of this paper was to assess the state of the window openings and the height positioning of the sliding window HST portal (heroal S 77 HI) and the design of the repair. During the construction-technical survey, it was found that this is an unfinished (unconditioned) new building of the family house. It is a freestanding detached family house, the object is partially recessed into the terrain. The building is built of brick technology with a wooden roof structure. It has been found that the windows are visibly damaged by the connection gap, especially from the interior side in the lower corners of the windows. At this point, the cleaner APU strip was detached from the plaster and the plaster was severely damaged. Further, measurements were made to reveal the frames of the windows and their glass fillings towards the interior. In addition to all the fixed windows, the rest of the windows fitted also showed a slight deflection and lack of anchoring. Fitting the HST portal goes against the owner´s requirements to a zero transition between the clean floor of the interior and the minimization of the staircase towards the terrace of the building.
Effective equidistribution and property (𝜏)
Authors: Einsiedler M. , Margulis G. , Mohammadi A. , Venkatesh A.
Published: September 2019

We prove a quantitative equidistribution statement for adelic homogeneous subsets whose stabilizer is maximal and semisimple. Fixing the ambient space, the statement is uniform in all parameters.

We explain how this implies certain equidistribution theorems which, even in a qualitative form, are not accessible to measure-classification theorems. As another application, we describe another proof of property

(
τ
)

(\tau )

for arithmetic groups.
One Imagination in Experiences of Beauty and Achievements of Understanding
Authors: Breitenbach Angela
Published: September 2019

I argue for the unity of imagination in two prima facie diverse contexts: experiences of beauty and achievements of understanding. I develop my argument in three steps. First, I begin by describing a type of aesthetic experience that is grounded in a set of imaginative activities on the part of the person having the experience. Second, I argue that the same set of imaginative activities that grounds this type of aesthetic experience also contributes to achievements of understanding. Third, I show that my unified account of imagination has important implications: it sheds light on two puzzling phenomena, the aesthetic value of science and the cognitive value of art.
6 The Intersection of Human Rights and Decision Making Capacity Legislation with Person Centred Approaches
Authors: Phelan Amanda , Clarke Patricia Rickard
Published: September 2019

Background

A major focus on decision making capacity (as opposed to cognitive capacity and competence) legislation in many Western countries is the integration of a human rights approach focused on self-determination and autonomy. This paper examines modern day concepts of personhood and person centred care and presents Irish and United Kingdom legal commentaries which focus on health services’ and society's approaches to risky decision making. Integrating human rights into decision making capacity legislation has been central in contemporary discourses on health and welfare.

Methods

A literature review was undertaken charting the emergence of personhood, person centred care and human rights. Case studies of influential legal commentaries in Ireland and the United Kingdom where decision-making capacity was addressed were mapped to person centred care principles.

Results

Findings point to a convergence of discourses of human rights in contemporary approaches to health and social care as well as the evolution of legislation to support person centredness in fostering safeguarding and promoting autonomy and self-determination. Specific legal commentaries point to the need of health and social care to be mindful of paternalism and to conceptualise the concept of ‘risk’ with a particular emphasis on the inclusion and defence of the voice of the older or vulnerable person.

Conclusion

The intrinsic worth of each human is articulated through an implicit and explicit vindication of their human rights. The emergence of the third generation of human rights has argued the value of self-determination and autonomy, articulated through robust national legislation on decision-making capacity based on the core principles of person centred care approaches. This move from paternalism is imperative and is imbued in contemporary legislation and legal commentaries, which has noted the need for revisions in health and social care case management perspectives.
37 Impact of Adverse Events on the Older Inpatient Population- A Subgroup Analysis of the Irish National Adverse Events Study (INAES)
Authors: Connolly Warren , Rafter Natasha , Hickey Anne , Conroy Ronan , Condell Sarah , O'Connor Paul , Vaughan David , Walsh Gillian , Williams David
Published: September 2019

Background

Adverse events are any injuries caused by healthcare management, which result in disability, increased length of stay or death. The Irish National Adverse Event Study (INAES)(1) used the Harvard Medical Practice, 2-step methodology of retrospective chart review(2) to determine the adverse event rate in the Irish inpatient cohort.

Methods

We further analysed the INAES data in order to calculate the prevalence and determine the impact of adverse events on the older inpatient population.

Results

INAES captured 1574 randomly selected adult inpatient admissions from 8 hospitals across the Republic of Ireland in 2009. 53% were female and the median age was 55years (IQR 37years to 72years). The prevalence of adverse events was higher in those aged ≥65 compared to those aged < 65 (15.4% versus 9.3% P < 0.001). When an adverse event did occur it was more likely to result in death in the ≥65 years old group (11.4% versus 2.1%, p = 0.01). Furthermore, it was 9 times more likely that an admission would result in a fatal adverse event in those aged ≥65 compared to those aged < 65 years. A further 9% of adverse events in the ≥65 age group resulted in permanent disability and over half were thought to be preventable. Older patients who suffered from an adverse event had an increased length of stay compared to older patients who did not suffer an adverse event (16days versus 6days, p <0.001) at a cost of €9,090 for each adverse-event-associated admission.

Conclusion

Older inpatients are more likely to suffer from an adverse event than their younger counterparts. These adverse events are more likely to contribute to increased morbidity but over half are preventable. The follow-up INAES-2 study, which is currently underway, will determine if an improvement has been made after implementation of the National Clinical Programmes.
138 The Role of Health and Social Care Professional Teams in the Emergency Department: A Qualitative Study of Key Stakeholders’ Views
Authors: Cassarino Marica , Robinson Katie , Quinn Rosie , Boland Fiona , E Ward Marie , McNamara Rosa , McCarthy Gerard , Ryan Damien , O'Connor Margaret , Galvin Rose
Published: September 2019

Background

Introducing Health and Social Care Professional (HSCP) teams to the emergency department (ED) has increasingly demonstrated benefits for ED patient and process outcomes. However, there is a dearth of research exploring the views of key ED stakeholders on the role of HSCP teams in care delivery the ED. This qualitative study investigated the perspectives of a wide range of ED stakeholders about HSCPs teams working in the ED.

Methods

A total of 65 participants including older adults who had recently attended the ED and their carers/relatives, ED doctors and nurses, HSCPs and pre-hospital staff participated in four World Café style focus groups and individual interviews across two Irish hospital sites. Written and audio-recorded data were transcribed and thematically analysed.

Results

Overall, participants expressed positive views on HSCPs working in teams in the ED, with benefits for patients, staff members and the hospital (Theme 1). Having an ED-based HSCP team was described as promoting effective and timely decision-making and a more integrated approach to patient care, particularly for frail older adults with complex needs (Theme 2). Barriers and enablers for effective implementation were identified at multiple levels (Theme 3) including the ED physical environment, (e.g., space and equipment), operational factors (e.g., working hours), and relations (e.g., patient-staff or staff-staff communication); factors at system level included availability of community resources and financial pressures.

Conclusion

Our study indicates overall acceptability of HSCPs working in teams in the ED and positive views on their contribution to enhance the quality care of older adults. However, a number of operational and relational factors need to be considered to ensure feasibility and effectiveness. This information is crucial to inform implementation.
154 Specialised Memory and Attention Rehabilitation Therapy (SMART) Programme
Authors: Griffin Aislinn
Published: September 2019

Background

The population of Ireland is ageing and the number of people with dementia in the coming years will be significant and could be as high as 132,000 people by 2041 (Pierce et al 2014). This estimated prediction highlighted the importance and value of developing and implementing interventions that will meet the needs of individuals with dementia and their carers in the community. We identified the need for a cognitive rehabilitation programme in an acute hospital and developed the “Specialised Memory and Attention Rehabilitation Therapy (SMART) Programme”. The aim of the programme is to improve quality of life, cognitive ability and performance of meaningful occupations for individuals with dementia in the community.

Methods

The SMART programme uses an evidence based approach of education, process training, strategy training and function for delivery to individuals with dementia and their carers. It is a seven week programme with a three month follow up appointment. Weeks one, seven and three month follow up are 1:1 assessments where outcome measures are completed. There is a group intervention programme for five weeks which includes a patient booklet with education sheets, strategy, work and homework sheets as well as functional tasks.

Results

There was statistically significant results pre and post intervention in the Rivermead Behavioural Memory test, Canadian Occupational Performance Measure, Functional Independence Measure and the DEMQoL – Dementia quality of life questionnaire. Overall, the results showed statistically significant improvements in memory function, clinically significant gains in terms of perceived functional performance & satisfaction and objective and significant improvements in functional performance.

Conclusion

The findings have demonstrated potential to significantly improve participants’ cognitive function and have shown functional significant gains as a result both objectively and subjectively. The findings have also demonstrated the feasibility of successfully implementing a cognitive rehabilitation programme on an outpatient basis in an acute hospital setting.
171 Programme Theory to Guide the Adoption of Assisted Decision Making with Older People in Acute Healthcare: Realist Evaluation
Authors: Davies Carmel , O'Donnell Deirdre , Ní Shé Éidín , Donnelly Sarah , Fattori Francesco , Coimín Diarmuid Ó , Cooney Marie Therese , O’Brien Michelle , O’Shea Diarmuid , Kyne Lorraine , O'Shea Marie , Kroll Thilo
Published: September 2019

Background

In Ireland, the Assisted Decision-Making (ADM) (Capacity) Act and emerging Codes of Practice provide a legal framework for Healthcare Professionals (HCPs) to enable ADM for patients with impaired capacity. ADM ensures that a person’s will and preference is at the centre of all decisions related to their care. This study conducted a realist evaluation and developed a Programme Theory (PT) to highlight how ADM for older people can be operationalised within an Acute Care (AC) context.

Methods

Key informants with interest in ADM informed this evaluation. Interviews were conducted in two Acute Care (AC) sites with multidisciplinary HCPs working within older person services (n=20). Interviews with informants that recently received care within an AC setting involved older people (n=3) people with dementia (n=4) and family carers (n=5). Ethnographic observations from AC multidisciplinary team meetings also informed the review. The framework that guided the qualitative analysis was from a PT informed by literature on ADM implementation in healthcare (O'Donnell, Ní Shé, Davies et al.2018).

Results

The refined PT is supported by credible evidence that is informed by authentic experiences of decision making support in the AC setting. Validation groups (n=4) with the key informants verified the PT. Three mechanisms were identified as a positive climate and receptive environment for the adoption of formal ADM. These are:

AC settings that adopt inter-professional accountability and shared responsibility for patient care that is guided by a clear policy process. Acute care and practice that is informed by a shared commitment to person-centred care and shared decision making. HCPs that operate within an AC setting where organisational learning informs practice through inter-professional training, mentorship and peer support.

Conclusion

Involving stakeholders in PT development enhances the utility, feasibility and applicability of the results. This PT provides a framework for those planning ADM implementation within the AC settings.
184 A National Survey of Clinicians who Assess People with Suspected Dementia: Service Characteristics and Practice
Authors: Timmons Suzanne , de Siún Anna , Begley Emer , Manning Mary
Published: September 2019

Background

The Irish National Dementia Strategy (2014) identified timely diagnosis and intervention as a priority area. The National Dementia Office established a Dementia Diagnostic Project to develop a framework for diagnostic services nationally. As part of preparatory work, a national survey explored baseline peri-diagnostic practice in geriatric medicine, neurology and psychiatry of old age services.

Methods

A survey was developed by the project steering group, piloted, and then distributed to all 86 Geriatricians, 39 Neurologists, and 34 Psychiatrists of Old Age Psychiatrists in Ireland. Two reminder e-mails were sent.

Results

In total, 56 clinicians responded (response rate 35%). The majority (74%) saw 1-20 people with suspected dementia (PwSD) per month. Most referrals came from General Practitioners or other physicians; but rarely from Health and Social Care Professionals. Most people were referred specifically for their memory complaint, rather than a co-morbidity. Waiting times for urgent review varied between 24 hours and 4 years; neurology services had the longest waiting times. Only 30% saw PwSD in a dedicated clinic; about the same proportion saw PwSD in their own home; or in residential care settings. About half reported assessing people with intellectual disability and suspected dementia, mainly the neurologists.

The Montreal Cognitive Assessment was the most commonly used cognitive tool (89%), followed by the Addenbrook’s Cognitive Examination (56%). Only 17% commonly used functional brain imaging in diagnosis, mainly neurologists; half of respondents ‘never’ or ‘rarely’ used cerebrospinal fluid analysis. Multidisciplinary input was mainly from Occupational Therapists (61%), Psychology/Neuropsychology (52%), and Nursing disciplines (33%). When asked which discipline would most benefit their diagnostic service, neurologists all chose psychology input; geriatricians selected a range of disciplines.

Conclusion

The significant variability within current services who see PwSD, in terms of multidisciplinary involvement, waiting times, setting, and supporting investigations, supports the need for a national diagnostic framework.
223 Prevalence of Depression Among People with Diabetes; Comparative Analysis of Older Adults Across Three Health Systems Using Nationally Representative Data
Authors: McGrath Niamh , McHugh Sheena , Toomey Elaine , Kearney Patricia
Published: September 2019

Background

The co-occurrence of depression and diabetes is an emerging global challenge but any association is influenced by variations in prevalence, study design and measure used. We compared depression prevalence in older adults with and without diabetes across three health systems using a validated measure to examine the causal association between diabetes and depression.

Methods

We used data of adults aged over 49 years, from three nationally representative ageing datasets; The Irish Longitudinal Study on Ageing (TILDA), the English Longitudinal Study on Ageing (ELSA) and the Health and Retirement Study (HRS). Data were collected during 2009–2011 (TILDA), and 2010 (ELSA, HRS). The 8-item CESD scale categorised depression using recommended cut-off scores of < 3 for ELSA and HRS and < 8 for TILDA. Self-reported individual, environmental, behavioural risk, and health system exposure variables were selected a-priori using literature and a directed acyclic graph. Prevalence was presented as a percentage with corresponding 95% confidence intervals. Binomial logistic regression examined the odds of depression by diabetes status. Data were analysed in Stata v15 using the ‘svy’ function.

Results

Diabetes prevalence (Ireland;8%[(95%CI:7.5–8.6), England;11%(95%CI:10.6–12.0) and USA;19%[(95%CI:18.8-20.1);p<0.001]) and depression prevalence (Ireland;10%(95%CI:9.0–10.6), England;16%(95%CI:15.3-16.9), USA;14%[(95%CI:13.5-14.7);p<0.001] varied across countries. Depression was consistently higher among people with versus without diabetes (Ireland;14%(95%CI:10.9-16.6)vs.9%(95%CI:8.7–10.3),p=0.001], England;25%(95%CI:21.7-27.7)vs.15%[(95%CI:14.2-15.9),p≤0.001] and USA;19%(95%CI:16.9-20.0)vs.13%[(95%CI:12.4-13.8);p≤0.001]. The odds of depression were significantly higher in people with versus without diabetes (Ireland;OR=1.5(95%CI:1.2-1.9);p=0.001, England;OR=1.8(95%CI:1.5–2.2);p<0.000, USA;OR=1.5(95%1.3-1.7);p<0.000), but only remained significant in the English sample after adjustment; (Ireland;OR=1.2(0.8-1.6);p=0.356, England;OR=1.3(1.0–1.6);p=0.045, USA;OR=1.0(0.9-1.1);p=0.898).

Conclusion

Among older adults in different health systems, depression was consistently higher among people with versus without diabetes. The findings support incorporation of holistic approaches to diabetes management across health systems.
227 Screening for Frailty in the Emergency Department: Comparison of Tools
Authors: Macdonald Steve , Gray Simone , Kenny Laura , Shé Éidín Ní , Cooney Marie Therese
Published: September 2019

Background

Numerous tools exist to screen for frailty in clinical settings but a single international standard has not yet been adopted. Recent research indicates that more than one tool is often deployed by clinicians to diagnose frailty. This study aimed to compare the use of two screening tools in the emergency department and assess the predictive ability of keywords in triage notes to detect frailty.

Methods

Frailty screening was carried out on 198 individuals (100 female / 98 male) attending the emergency department of a large urban teaching hospital, using the Rockwood Clinical Frailty Scale and the Variable Indicative of Placement Risk (VIP) scale. Average screening time for Rockwood was 43.1 ± 21.7s, whilst average screening time for VIP was 11.8 ± 8.5s. Results were dichotomised to frail, corresponding to Rockwood scores of ≥4 or VIP scores of ≥1, or non-frail (Rockwood=1-3 or VIP=0) for comparisons. Triage notes were reviewed to find keywords associated with frail patients.

Results

Among 198 individuals screened, 149 (75.3%) were frail according to Rockwood, and 143 (72.2%) according to VIP. 25 (12.6%) of the 198 individuals were categorised as frail according to Rockwood but were non-frail according to VIP. Among these, 8 were female (8% of all female patients; 6 were 75+ years of age, and 2 were under 75) and 17 were male (17.3% of all male patients; 11 were 75+ years of age and 6 were under 75). Keywords associated with frailty were identified from triage notes, across the following categories: Falls/ mobility/ balance; Cognition; Living circumstances; Nutrition; Other frailty-associated conditions; and General deterioration.

Conclusion

Comparison of the two scales suggests that frailty could be missed if relying on a single index. This effect may be more frequent in men than women. Screening triage notes to identify frailty-associated keywords may be a helpful adjunct to existing tools.
343 Atrial Fibrillation, Orthostatic Hypotension and Cerebral Perfusion – Data from The Irish Longitudinal Study on Ageing
Authors: McNicholas Triona , Claffey Paul , O'Callaghan Susie , Briggs Robert , Newman Louise , Tobin Katy , Kenny Rose Anne
Published: September 2019

Background

It is thought that cerebral hypoperfusion in Atrial Fibrillation (AF) increases the risk of falls, cognitive impairment, and worse outcome in stroke. This aim of this study is to assess frontal lobe perfusion in response to active stand, and to assess the impact of OH on this association.

Methods

Data from wave 3 of The Irish Longitudinal Study on Ageing were used, a cohort study of community-dwelling adults aged over 50. Frontal lobe perfusion in response to orthostasis was measured using near infra-red spectroscopy (NIRS), reported as tissue saturation index (TSI%). Orthostatic hypotension (OH) was assessed using beat-to-beat blood pressure measurement. Linear regression assessed whether AF was associated with lower baseline TSI. Mixed effects linear regression assessed whether TSI differed across specific time points – 10, 20, 30, 40 60, 90, and 120 seconds. The analysis were repeated including an interaction with OH to assess the impact of OH on this association.

Results

There was no difference in baseline TSI in participants with AF compared to those without. Mixed effects models demonstrated lower TSI at 10 seconds in AF (β -0.52; 95% CI -0.88, -0.16; p-value 0.004), at 40 seconds (β -0.40; 95% CI -0.76, -0.04; p-value 0.031) and at 60 seconds (β -0.40; 95% CI --0.76, -0.04; p-value 0.028). Including an interaction with OH found that in isolated AF, TSI was lower at 10 seconds (β -0.62; 95% CI -1.04, -0.19; p-value 0.005). Those with both AF and OH had lower TSI at 40 (β -0.89; 95% CI -1.55, -0.24; p-value 0.007), 60 (β -0.89; 95% CI -1.54, -0.23; p-value 0.008) and 90 (β -0.68; 95% CI -1.33, -0.03; p-value 0.041) seconds.

Conclusion

There is evidence that frontal lobe perfusion is lower during orthostasis in individuals with AF, and that the presence of OH modifies this association.
344 The Relationship between Late Life Depressive Symptoms and Cerebral White Matter Disease is Modified by Systemic and Orthostatic Blood Pressure
Authors: Briggs Robert , Buckley Anne , Knight Silvin , Meaney Jim , Kennelly Sean , Anne Kenny Rose
Published: September 2019

Background

Cerebral white matter hyperintensity (WMH) burden is a key biological risk factor underpinning late life depression (LLD) and cerebral hypoperfusion has been identified as an important cause of WMH.

The aim of this study therefore is to clarify if orthostatic hypotension (OH) and lower systemic blood pressure (BP), both of which cause reduced cerebral blood flow, modify the relationship between depression and cerebral white matter disease in a cohort of community-dwelling older people aged ≥70 years.

Methods

This study uses data from wave 3 of TILDA. Participants were included if they were aged ≥70 years and had undergone assessment for depressive symptoms, brain MRI and cardiovascular measures.

Depressive symptoms were measured using the 8-item Centre for Epidemiological Studies Depression Scale. Scheltens Score was used by a trained radiologist to calculate overall WMH burden.

Orthostatic BP was measured by active stand. OH was defined as a drop in Systolic BP≥20 mmHg or drop in diastolic BP≥10 mmHg at 30, 60 or 90 seconds post standing.

Results

Participants with depressive symptoms (8%, 16/202) had a significantly higher burden of WMH measured by Scheltens Score (14.6 (95% CI:11.0–18.2) vs. 11.0 (95% CI:10.1–11.8); p=0.0211).

Two-way interaction models demonstrated that the association between depressive symptoms and WMH burden is significant only in those with co-existing OH. Similarly, the two-way interaction between depressive symptoms and systolic BP shows that this association remains statistically significant only in those with both depressive symptoms and lower BP, i.e. <130 mm Hg.

Conclusion

This study demonstrates that depressive symptoms are associated with cerebral WMH in a cohort of community-dwelling people aged ≥70 years but this relationship is modified by co-existing OH or lower BP.

Identifying the processes that lead to WMH accumulation and progression in depression is crucial in order to inform strategies aimed at preventing and ameliorating LLD.