bluuebunny/crossref_metadata_2025 huggingface dataset:
Development of a transportable neutron imager for localization of radioactive sources
Authors: Altıngün A.M. , El Bitar Z. , Gendre Q. , Buridon V. , Schoepff V. , Carrel F. , Amoyal G. , Kanj A. , Pellicioli M. , Schuler J.
Published: January 2025

Locating radioactive hot spots presents a significant challenge for the nuclear industry and security applications, such as waste management, decommissioning, radiation protection, and the management of nuclear accidents. The detection of fast-neutron emissions offers an alternative technique to gamma imaging for verifying the location of radioactive materials, particularly in cases where gamma imagers face challenges in detection. In this study, we present the performance of a prototype gamma-neutron imaging system based on a custom-fabricated plastic scintillator, designed to effectively discriminate between signals from gamma radiation, fast neutrons, and thermal neutrons.

We conducted Geant4 simulations to investigate neutron interactions within the plastic scintillator and compared the simulation results with experimental data. Additionally, we performed experiments on the prototype using a proton beam at the CYRCé facility at IPHC, utilizing a CMOS Monolithic Active Pixel Sensor (MAPS) called MIMOSIS to analyze the beam profile. Through these efforts, we examined neutron interactions with our scintillator, validated the prototype's imaging capabilities under proton beam exposure, and conducted a calibration study of its energy response.
A high accuracy CMOS peak detection and holder ASIC for neutron detectors
Authors: Ren Jiayi , Liu Hongbin , Yin Weigang , Li Qicai , Lai Yanling , Yu Li , Zeng Lixin , Luo Hong , Chen Shaojia , Shen Peixun , Jiang Xingfen , Zhou Jianrong , Zhuang Jian , Zhao Yubin , Sun Zhijia
Published: January 2025

With the completion and operation of a series of high-performance neutron sources, such as the China Spallation Neutron Source (CSNS), various neutron scattering spectrometers have continuously increased their performance requirements. One important aspect is to reduce collisions between scattered neutrons and air molecules during neutron scattering experiments, thereby reducing background noise and obtaining highly accurate experimental measurement results. This paper presents an application-specific integrated circuit (ASIC) dedicated to position-sensitive Helium-3 tubes neutron detector, which introduces peak detection and holder (PDH) circuits on the basis of traditional front-end electronics. Through a specific design, the switches and holding capacitor of the PDH module are isolated, ensuring that the holding voltage is not affected by switch noise, and maximizing the measurement accuracy of the PDH module. The 8 channel ASIC, realized in 0.18 μm CMOS technology, has a 10 fC to 1 pC input signal range with a linearity error within 0.22% to 1%. The PDH module is supplied with a single voltage of 1.8 V with a total power consumption of 350 μW with a layout area of 361 μm × 68 μm. The ASIC further enhances system integration, allowing the analog-to-digital conversion module to employ low-speed ADCs, thereby reducing the overall power consumption of the readout system. This enables the entire detector to operate in a vacuum environment, providing a new electronic readout solution for future neutron scattering and imaging experiments.
PMEDM process parameter optimization for machining superalloy MONEL 400
Authors: Kumar Abhishek , Nikam Manoj , Jagadeesha T , Rehman Ateekh Ur , Bhongade Ajay S , Shivagond Teli
Published: January 2025

MONEL 400, widely used in industries such as high-temperature applications, chemical processing, automotive, and marine sectors, presents significant machining challenges due to its high strength and tendency for work-hardening. This research explores powder-mixed electrical discharge machining (PMEDM), a modern technique incorporating conductive metal powders, specifically graphite and silicon, combined with dielectric fluid to improve machining performance. The study investigates into how to machine MONEL 400 with copper as the cathode, focusing on important process parameters such as powder concentration, peak-current, and pulse on duration. This study also compared impact of PMEDM to conventional EDM, and results demonstrated improvements in material removal rate, tool wear rate, and surface roughness. Graphite powder significantly reduced tool wear, while silicon powder significantly enhanced surface finish. Using Buckingham’s theorem and regression analysis, this study presented semi-empirical models for the rate of material removal and looks at how the powder additives’ dielectric properties have changed to improve performance. The research aims to improve sustainable machining practices while providing environmental benefits.
Comparing three generations of D-Wave quantum annealers for minor embedded combinatorial optimization problems
Authors: Pelofske Elijah
Published: January 2025

Quantum annealing (QA) is a novel type of analog computation that aims to use quantum mechanical fluctuations to search for optimal solutions of Ising problems. QA in the transverse Ising model, implemented on D-Wave quantum processing units, are available as cloud computing resources. In this study we report concise benchmarks across three generations of D-Wave quantum annealers, consisting of four different devices, for the NP-hard discrete combinatorial optimization problems unweighted maximum clique and unweighted maximum cut on random graphs. The Ising, or equivalently quadratic unconstrained binary optimization, formulation of these problems do not require auxiliary variables for order reduction, and their overall structure and weights are not highly variable, which makes these problems simple test cases to understand the sampling capability of current D-Wave quantum annealers. All-to-all minor embeddings of size 52, with relatively uniform chain lengths, are used for a direct comparison across the Chimera, Pegasus, and Zephyr device topologies. A grid-search over annealing times and the minor embedding chain strengths is performed in order to determine the level of reasonable performance for each device and problem type. Experiment metrics that are reported are approximation ratios for non-broken chain samples, chain break proportions, and time-to-solution for the maximum clique problem instances. How fairly the quantum annealers sample optimal maximum cliques, for instances which contain multiple maximum cliques, is quantified using entropy of the measured ground state distributions. The newest generation of quantum annealing hardware, which has a Zephyr hardware connectivity, performed the best overall with respect to approximation ratios and chain break frequencies.
First-principles investigation of Ra doping effects on structural, electronic, and optical properties of BaTiO3 perovskite for solar cell applications
Authors: Chahar Sonia , Mishra Krishna Kumar , Sharma Rajnish
Published: January 2025

This study investigates the properties of radium-doped barium titanate (BaTiO3). Using the generalized gradient approximation (GGA) based on the Perdew–Burke–Ernzerhof (PBE) approach, the bandgap energies of pure BaTiO3 (indirect band 1.61691 eV) and RaTiO3 (direct band 1.63612 eV) were determined. The orbital nature of Ba, Ra, Ti, and O atoms was analyzed through density of state and projected density of state analyses for pure BaTiO3, RaTiO3, and Ra-doped BaTiO3 (x = 0.25, 0.50, 0.75). The optical properties of these materials, including dielectric constant, susceptibility, optical conductivity, polarizability (real and imaginary), absorption coefficient, refractive index, extinction coefficient, and reflectivity, were thoroughly examined. The findings provide insights into the potential applications of these materials in solar cells, optoelectronic devices, and flexible electronic devices.
Bottom-up analysis for carbon emissions from passenger and freight transport sectors in Xi’an: a city-level study using MOVES and LMDI models
Authors: Bo Ya’nan , Zhang Liyuan , Zhong Jiahao , Zhong Wei , Zhu Pengyue
Published: January 2025

Road transportation is identified as one of the primary contributors to urban carbon emissions. This study employed a localized MOVES model, integrating high-resolution urban vehicle data, along with a categorical LMDI decomposition model, to conduct a detailed bottom-up analysis of carbon emissions from passenger and freight vehicles in Xi’an. The MOVES model was utilized to evaluate the inter annual variability of carbon emissions from road transportation sources. The LMDI models assessed the impact of six factors, focusing on microscopic traffic activities such as passenger/freight volume and turnover, vehicle ownership, mileage, carbon emission rate, vehicle types, and fuel types. The research indicates that carbon emissions in Xi’an increased significantly between 2012 and 2021, rising from 21.95 to 51.15 million tons, with an average annual growth rate of 9.9%. Passenger vehicles are the primary contributors to this increase. The emission patterns of passenger and freight vehicles differ notably due to various factors. For passenger transport, which includes passenger cars and school buses accounting for 97% of emissions, per capita vehicle turnover is the primary influencing factor. In contrast, for freight transport, combination long-haul trucks dominate emissions, comprising 65% of total freight emissions, with freight volume being the key influencing factor. By analyzing the factors driving carbon emissions from passenger and freight vehicles, this study provides valuable insights for reducing road traffic emissions in Xi’an and similar regions.
Integrating dynamic thermal strategies for solar-powered battery-ultracapacitor with prognostic EMS for HEVs
Authors: Kaushik Shraddha , Rachananjali K
Published: January 2025

The challenge of thermal comfort and energy efficiency in hybrid electric vehicles (HEVs) in changing weather and dynamic driving scenarios is the primary objective of this study. Traditional energy management systems (EMS) frequently fall short in terms of maximizing energy efficiency and guaranteeing reliable operation. The paper proposed a novel prognostic EMS that combines dynamic thermal management with solar-powered battery-ultracapacitor (UC) systems in order to get over these limitations. In addition to controlling battery cooling and cabin air conditioning, this EMS uses predictive control to control energy transfer between the battery, UC, and solar (PV) system. The technology improves energy efficiency and self-sufficiency by taking into consideration real-time elements like driving conditions, ambient temperature, and solar power. The proposed EMS achieves over 80% self-sufficiency in all circumstances, according to simulation data, with a 1% increase in energy consumption over a 24 h period, as opposed to 2–3% with conventional techniques. Over the span of a 6 h control period, it sustains high rates of self-consumption with little fluctuation (0.5%). The EMS also lowers runtime and dissipation losses, which boosts profitability by 2% and lowers overall energy consumption by 9%. For HEVs, the EMS offers an efficient and sustainable solution that enhances thermal comfort, energy efficiency, and environmental sustainability.
Investigation of hybrid nano-enhanced phase change materials by experimental evaluation and optimizing thermal performance for energy storage applications
Authors: Deshpande Pradnya Sameer , Jyothilakshmi R , N Srikantha , B S Sridhar
Published: January 2025

The research focuses on enhancing the thermal-physical properties of single-component nanofluids to improve heat transfer and enable efficient thermal management. The study investigates the thermal performance of hybrid nano-enhanced (HyNePCM) and mono-nano-enhanced phase change materials (MoNePCM) for potential use in Thermal Energy Storage (TES) applications added in solid–solid phase change material. Experiments were conducted using 1% weight of nanoparticles, with different combinations of SiO2 and TiO2 in hybrid nano-enhancement. It was found that the enthalpy of NPG- 0.7% weight SiO2/0.3% weight TiO2 was 124.8 J g−1, surpassing that of pure neopentyl glycol (NPG). The thermal conductivity for the same combination was the highest at 0.56 W mK−1. Mono-nano enhancement, involving 1% weight SiO2 and 1% weight TiO2, displayed improved thermal conductivity compared to pure Neopentyl Glycol, at 0.36 W mK−1 and 0.38 W mK−1, respectively. The addition of nanoparticles significantly enhanced the thermal properties of the phase change material, with hybrid composites outperforming mono-nano composites due to synergistic effects between different nanoparticles.
Reading Quintilian
Authors: Loporcaro Laura
Published: January 2025

This book takes Quintilian’s Institutio oratoria as a literary work, worth reading in full. It examines how didactic authority is created and readers are guided through the work thanks to a coherent overarching framework. This framework is composed of several leitmotifs: Quintilian’s creation of a trustworthy didactic persona, statements of didactic intent and method, the depiction of an ideal didactic constellation, remarks giving the sense that the work proceeds gradually and in parallel with the pupil’s training and the author’s life, polemics against other authorities, and ‘proleptic’ strategies deflecting responsibility for the potential lack of success of students following the advice given. The consistency of the framework indicates that the Institutio is not a mere accumulation of facts but an artfully crafted whole, as does the pervasive implementation of rhetorical strategies taught in it. The first chapter analyses how Quintilian introduces himself and his project at the start of the Institutio and outlines its structure. The following three chapters ground their analysis of the leitmotifs in the discussion of central themes: Quintilian’s reception of Cicero, his conception of the ideal orator, his polemic against what he presents as two currents of stylistic corruption, and his reception of Seneca the Younger. Together, the chapters aim to give a sense of the construction, goals, and models of the work and its positioning within a specific literary-cultural context. Combining a panoramic view with in-depth analysis of single leitmotifs and themes, Reading Quintilian hopes to shed new light on the Institutio as a whole.
Playing with Anachronism? On Contemporary Oratory
Authors: Loporcaro Laura
Published: January 2025

Chapter 4 analyses Quintilian’s polemic against what he presents as contemporary stylistic corruption, and his reception of Seneca the Younger. First, it discusses how Quintilian consistently pitches his conception of good style against the two currents of ‘archaism’ and ‘modernism’, presenting the latter as more widespread and threatening to his educational project. This chapter contends that he borrows the vocabulary of effeminacy from Seneca to describe modernism and that his stylistic polemic is a prominent case of apotreptic exemplarity, a didactic strategy he recommends to teachers. Second, it argues that Quintilian presents Seneca as a bad stylist, teacher, and literary critic and as a fountainhead of modernism, and that he links him to Nero and his matricide. By linking modernism to Seneca, this chapter suggests, Quintilian presents this contemporary current of stylistic corruption as an anachronistic remnant of the Neronian past, which must be obliterated by his ‘Flavian’ educational project.
2817 University hospitals Dorset frailty virtual Ward: establishing a service
Authors: Cumming G , Bartlett T , Hedges S
Published: January 2025

Introduction

University Hospitals Dorset (UHD) wants to provide hospital level care to patients with frailty, in their own home. Our frailty virtual ward (VW) team consists of a consultant geriatrician, lead nurse, pharmacist, advanced nurse practitioner, nurses and therapists. We have a capacity of 20 patients across Bournemouth, Christchurch and Poole localities. Our patients receive care at home for acute medical conditions supported by remote monitoring, blood testing, face to face assessments and daily Geriatrician input. We are collaboratively working with our community partners seeking to provide complete CGA in the patient’s home.

Methods

Establishing the service was non-linear and required multiple improvement cycles. Our VW fits alongside our frailty SDEC, day hospital and interim care team. We developed a SOP, a patient flow pathway and processes for medication prescribing and delivery supported by the Royal Voluntary Service. We screened our frailty wards for suitable patients and in May 2023 we tested by taking our first patient home. Subsequently our processes have developed around the patient’s needs. Through multiple PDSA cycles we tested various screening techniques, 7-day Geriatrician input, nurse recruitment, remote monitoring and used patient feedback to guide further service development and improvement.

Results

We are an established frailty virtual ward with 20 beds.

Conclusion

The UHD Frailty VW has developed out of a need for an early supported discharge and admission avoidance for our older patients. Through multiple PDSA cycles, we have established a virtual model that we feel is providing safe, hospital level care for patients with acute medical presentations. We hope to expand through recruitment and funding with an aim to deliver excellent quality care to patients with frailty in their in their own home. Our ambition includes closely working with South West Ambulance Service for further admission avoidance and developing a home IV pathway.
2827 Getting the BASICS right improves recognition and management of incontinence in a hospital setting
Authors: Mohangee I , Keir S
Published: January 2025

Introduction

In hospital incontinence increases length of stay (1), in orthopaedic patients is associated with increased likelihood of discharge to an institutionalised setting (2) and can have a major negative impact, with many rating bowel and bladder incontinence as a health state the same or worse than death (3). Yet of the Geriatric Giants, it is given relatively little attention. At a busy teaching hospital, we sought to raise awareness and improve management of incontinence across our 167 beds, by using a standardised, multi-disciplinary approach involving identification of patients and use of the components of BASICS (Bladder diary, A physical assessment, Symptom profile, Infection and Constipation check and a bladder Scan, fig. 1).

Method

Baseline data of a sample of 14 patients with new urinary incontinence with their aspects of continence assessment were added to a cumulative audit. Alongside checklists, a poster was designed and placed on each ward, a local teaching session about incontinence was delivered, and data shared at our local governance meetings. Following this, a further cycle of audit was performed. Reversible causes were identified and addressed appropriately.

Results

Between cycle 1 and 2 (February and June 2024), significant improvements were seen in most aspects of BASICS assessment with notable increases in use of the bladder diary (7 to 50%) and medical examination (7 to 57%). See fig. 2 for breakdown. As a consequence, there were multiple interventions aiming to improve patient symptoms.

Conclusion

Paying consistent and sustained attention to this neglected area of practice has demonstrated a change of culture is possible. We are now incorporating continence assessment into our medical trainee audit programme to support a sustained multi-disciplinary approach and maintain improvements.
2853 A frailty education programme for care home staff
Authors: Ninan S , Printz V , Denman T
Published: January 2025

Introduction

We wished to improve the knowledge of care home staff in Leeds in identifying frailty and managing frailty related problems.

Method

We developed a frailty education course (www.leedsfrailtyeducation.co.uk) which was then refined and modified to target care home staff. We engaged key stakeholders at the council and the ICB to help develop and promote the course. The course was delivered across 4 venues in Leeds by geriatricians, a pharmacist and a community nurse.

Results

We had 128 attendees across the four days. From the feedback taken immediately after the study day (n = 69):

From the follow-up feedback (n = 19):

Attendees also valued the multi-sector, multi-professional expert presenters alongside the opportunity to meet and interact in-person.

Conclusion(s)

A dedicated study day for care home staff was well received by attendees and feedback received demonstrated self-reported lasting change to practice. Key enablers to the success of the course were: the reputation of the course locally which had been piloted and delivered in different formats previously, tailoring the material to the audience, and delivering the course in several different locations. More regular frailty teaching days can be implemented to capture more care home staff and ultimately improve care for residents.
2868 Improving bone health: a quality improvement journey implementing Scottish hip fracture audit recommendations
Authors: Balakrishnan S , Vick O , Mitchell J , McCluskey H
Published: January 2025

Introduction

Hip fractures, predominantly affecting older adults, represent a significant health concern due to high morbidity, mortality, and healthcare resource utilisation. This ongoing Quality Improvement Project within Forth Valley Royal Hospital aims to enhance adherence to recommendations from the 2023 and 2024 Scottish Hip Fracture Audit. It specifically focusses on the timely administration of Vitamin D and IV Zoledronic Acid to frail patients with hip fractures.

Method

A retrospective and prospective cohort study design was employed, analysing the records of 165 inpatients under orthogeriatric care from November 2023 to May 2024. Initial data analysis indicated low rates of IV zoledronic acid and vitamin D administration, primarily due to clinician unfamiliarity and process inefficiencies. Subsequent interventions included staff education sessions, process standardisation, and the introduction of tracking tools such as Bone Health stickers and whiteboards. Formal referral pathways and decision-making protocols were implemented to ensure comprehensive and timely patient care.

Results

The interventions led to substantial improvements in adherence rates. Between November 2023 and March 2024 vitamin D administration rates increased from 14.71% to 100%, and IV Zoledronic Acid administration rose from 12.12% to 95.45%. These improvements were achieved through systematic tracking, enhanced clinician education, and standardised care processes. Despite these gains, challenges remain in achieving 100% adherence to IV Zoledronic Acid administration and addressing initial data capture inaccuracies due to inconsistent use of referral systems.

Conclusion(s)

The project demonstrates that targeted interventions and standardised care pathways substantially improve adherence to national guidelines for hip fracture patients. Sustained efforts in education, process refinement, and collaboration with the Hip Fracture Audit Team are essential to maintain these improvements. Future proposals include integrating Vitamin D and Adcal-D3 doses into an electronic prescribing protocol and conducting detailed statistical analyses to identify further areas for improvement.
2871 Empowering community partners to provide post-diagnosis support (PDS) for persons with dementia
Authors: Hong L , Seow A , Khoo SY , Ng H , Seetharaman SK
Published: January 2025

Background

Dementia is a prevalent condition in an ageing population. Persons with dementia and their caregivers are often uncertain about what to expect after an initial diagnosis. Previous studies conducted on the experiences of informal caregivers show a clear demand to address these: providing adequate information, psychosocial support and access to services.

Introduction

The diagnosis of dementia is usually made by specialists in the hospital. Resources in an acute tertiary hospital are valuable and need to be carefully distributed. To better allocate resources and relieve the manpower situation, we have collaborated with our community partner to provide PDS.

Methods

A PDS team consisting of an allied health professional and a caregiver peer is established with our community partner. They conduct home visits to provide psychoeducation to help persons with dementia and their caregivers to understand more about dementia, develop personalised care plans, and coordinate support services to provide psycho-emotional support. Close communications are maintained between the PDS team and the acute hospital referral team. Multidisciplinary team meetings involving the geriatricians, nurses, case managers and community partners are also held quarterly to provide regular updates about the progress of the patients and facilitate learning.

Results

A total of 95 persons who were newly diagnosed with dementia in the previous 1.5 years were referred. 53 patients were eventually enrolled under the PDS programme and received psychoeducation and made personalised care plans. 72% were given caregiver support and 66% were linked up to community services. The average duration between date of referral to date of first home visit is 13 days.

Conclusions

In an ageing population where there is high healthcare utilisation, it is efficient to utilise services instead of duplicating them. By collaborating with community partners, we are empowering them to play a better role in supporting persons with dementia.
2883 Quality improvement initiatives to improve one year follow up as per FLS-DB National Recommendations in a welsh health board
Authors: Hutchins M , Maggs S , Williams A , Devyani  , Vegad K , Singh I
Published: January 2025

Introduction

Fracture liaison services (FLS) aim to prevent secondary fractures by ensuring high-quality care to all patients with fragility fractures above 50 years. The standard recommendation by FLS Database (FLS-DB) is to identify 80% of the expected fragility fractures, commencing treatment for 50% and monitoring 80% at 16 weeks and 52 weeks.

Methods

FLS team noted that only 18.4% (n = 92) patients were followed at one-year of the total 875 patients identified in the year 2021 (National benchmark = 22.3%). Whilst FLS team identified 42.6% (n = 1649) patients in the year 2022, an 88% increase as compared to the year 2021. But there was reduction in the one-year follow-up from 18.4% to 13.8% (n = 149) in 2022. Quality improvement methodology based on the model of improvement; Plan-Do-Study-Act cycles, was used. Process mapping for the existing FLS showed that follow-up was only ad-hoc and not formalised. Our objective was to improve follow-up at one-year.

Results

Process mapping supported the development of a separate clinic code for annual review of patients, led by a geriatrics specialty trainee and supported by the FLS Clinical Lead. The patient lists were drawn from the FLS-DB and new patients booked for one-year follow-up clinic. FLS identified more fragility fracture patients (n = 2181, 61.4%) in 2023, a further increase of 32.2% as compared to previous year. Clinical leadership and dedicated one-year follow-up clinic supported improved performance (21.4%, n = 310) in the year 2023, which is comparable to the national benchmark (22.2%).

Conclusion

Several challenges were identified including lack of accurate telephone numbers for many patients; patients are transferred to primary care at one-year but there but the is osteoporosis knowledge gap in the community and need for dedicated time for follow-up clinic. This quality initiative has streamlined our follow-up clinics but need dedicated time to meet the service demand and increased capacity.
2819 Improving Ortho-geriatric outcomes: reducing immobility and post-operative hypotension in patients with neck of femur fractures
Authors: Gupta S , Jos H , Brampton J , Sharma A
Published: January 2025

Introduction

National guidance suggests that all patients with neck of femur fractures (NOFF) should be mobilised day one post-operatively (NICE, 2023, QS16). This reduces rates of delirium, pneumonia and length of stay (Sallehuddin & Ong, Age and Ageing, 2021, 50, 356–357). Hypotension is a leading cause of immobilisation post-operatively. National guidance advises appropriate fluid resuscitation and review of polypharmacy when indicated (British Orthopaedic Association, 2007). This quality improvement project aimed to reduce post-operative hypotension and improve day one post-operative mobilisation in NOFF patients.

Method

Three months of NOFF patients were retrospectively reviewed pre-intervention. Those who did not receive surgical intervention were excluded. The proportion of NOFF patients that were unable to mobilise due to post-operative hypotension on day one was identified. We reviewed if intravenous fluids were given pre-operatively and if anti-hypertensives were held. An intervention was then implemented including educational posters and teaching sessions for doctors and nurses to encourage prescription of fluids on admission, holding of antihypertensives pre-operatively and detection and escalation of oliguria or hypotension post-operatively. Data were then re-collected in a three-month period post-intervention to ascertain if there was any change in practice.

Results

70 patients underwent NOFF repair pre-intervention compared to 54 patients who underwent the procedure post-intervention. There was a decrease in the proportion of patients unable to mobilise day one post-operatively due to hypotension from 15.7% pre-intervention to 9.3% post-intervention. There was an increase in the proportion of patients who received pre-operative intravenous fluids from 64.3% pre-intervention to 77.8% post-intervention. Of those patients who took anti-hypertensive medication, a higher proportion had this suspended pre-operatively, increasing from 82.9% pre-intervention to 88.2% post-intervention.

Conclusion

Simple educational interventions can reduce post-operative hypotension in NOFF patients. Developing local guidelines may facilitate persistent clinical change, as improvements following poster distribution and teaching sessions may be transient.
2888 De-prescribing anti-Hyperglycemics in the elderly—a quality improvement project
Authors: Venkatraghavan P , Gilpin R
Published: January 2025

Introduction

There has been a recent shift in guidelines regarding HbA1c targets in the frail population. NICE (June 2022) advocate individualised HbA1c targets for frail patients with diabetes in circumstances where the long-term benefit is uncertain or when a tight glycaemic control would increase the risk of poor clinical outcomes. This is backed up by randomised control trials that have showed that Hba1c levels <53 mmol/mol (7%) because of anti-hyperglycaemic therapy are associated with increased morbidity and mortality in frail patients with diabetes. This led us to explore the current standards with regards to HbA1c review and consequent anti-hyperglycaemic deprescribing in frail patients in Hereford County Hospital.

Methods

Two audit cycles have been completed from March–June 2024 with a total sample size of 28 patients. Inclusion criteria were patients aged over 65 with a history of diabetes and a Rockwood Frailty score of 5 or more.

Results

The results of the first cycle showed that only 20% of the study group had their HbA1c reviewed. Only one had evidence of de-prescribing considerations. After the first cycle, a poster was created highlighting the importance of considering deprescribing for frail patients. The results of the second cycle indicated improvements following the poster display with 22% of the study population having had their HbA1c reviewed with subsequent considerations to de-prescribe. Furthermore, the poster generated positive informal feedback and stimulated conversations with colleagues about deprescribing.

Discussion and conclusion

For frail diabetic patients presenting to the Emergency department, deprescribing their diabetic medications is often not considered. They may be on medications that could be potentially causing more harm than benefit. Staff education appears to have a positive benefit, but more work needs to be done to ensure that deprescribing is considered for these patients.
2632 Determining the feasibility of a TCD-NIRS protocol to measure cerebral haemodynamics in dementia, delirium, and depression
Authors: Edwards O , Ball J , Sensier Y , Panerai R , Beishon L
Published: January 2025

Introduction

Transcranial Doppler ultrasonography (TCD) and Near-Infrared spectroscopy (NIRS) are indirect measures of neurovascular coupling (NVC). NVC is the relationship between cerebral blood flow and neuronal activity to meet the metabolic demands of the brain. No studies have integrated TCD-NIRS to investigate the feasibility of measuring NVC in those with dementia, delirium, and depression.

Methods

32 participants (median [IQR] age 73.0 [70.0,78.5], 50% female, healthy (HC, n = 10), depression (n = 11), dementia (n = 6), delirium (n = 5)), underwent continuous cerebral blood velocity measurements in the middle (dominant MCAv) and posterior (non-dominant PCAv) cerebral arteries using TCD at rest and in response to four tasks. Heart rate (3-lead ECG), end-tidal CO (nasal capnography), blood pressure (Finometer), and prefrontal oxygenated (HbO2) and deoxygenated (HbR) haemoglobin (NIRS) were also measured. NVC was determined as absolute change in MCAv (cm/s) or concentration change for an attention task (serial subtraction), passive motor (arm movement) and passive sensory task (cotton wool), or PCAv for a visuospatial task (dot counting). We determined differences in NVC by a mixed two-way repeated measures analysis of variance, with post-hoc testing via Tukey.

Results

Resting CBv (cm/s) was significantly different between groups in MCAv (HC: 53.9 (SD = 8.09), depression: 41.9 (9.31), dementia: 42.5 (13.7), delirium: 32.6 (7.48), p = 0.002) and PCAv (p = 0.045), after correction for age and BP (p = 0.011). TCD: initial NVC responses increased for all three groups (delirium excluded) for all tasks (20–30s), (p = 0.026), but with no main effect of diagnosis. NIRS: There was a significant difference between tasks for the HbO2 and HbR responses (p = 0.046, p = 0.033). Diagnosis had a significant effect on the HbR response only (p = 0.034).

Conclusion

An integrated TCD-NIRS protocol was feasible in these patient groups to measure NVC, but less-so in delirium. Further work is needed to investigate NVC using integrated TCD-NIRS in larger sample sizes.
2661 Hospital At home—an opportune training environment for internal medicine trainees
Authors: Moore S , Furmedge D , Schiff R
Published: January 2025

Introduction

Hospital at home (HAH) is growing apace in the United Kingdom, offering hospital-delivered treatments at home. In parallel, increasingly structured alternative training pathways are being created to enable doctors to train outside of formal specialty training programmes. With a need to train doctors to work in community settings, a HAH rotation within a locally developed internal medicine training (IMT) programme at one large NHS Foundation Trust was evaluated.

Method

A questionnaire was designed to review the alignment of HAH rotation experience with the IMT curriculum and its acceptability as a clinical rotation within an IMT stage 1 equivalent programme. The questionnaire was distributed to all doctors who had previously undertaken a HAH rotation at junior clinical fellow level in the previous five years. Free-text responses were analysed with thematic analysis.

Results

23/27 responded (85%). 74% had pursued IMT following their non-traditional training year. 78% agreed that HAH would be a suitable placement for a 4-month IMT rotation, with 74% interested in a HAH role following completion of training. HAH offers core content in internal and geriatric medicine. Curriculum coverage within a HAH rotation included improved confidence in clinical decision making, leadership, risk management, multidisciplinary team working and increased exposure to advanced care planning and palliative medicine. Being part of contextual, personalised medicine with shared decision making central was also cited as beneficial over traditional hospital rotations. Disadvantages were a lack of exposure to core IMT procedural skills, resuscitation and fewer opportunities to attend outpatient clinic.

Conclusion

Whilst limited to one geographical service, results indicate that HAH is a prime learning environment for internal medicine training as part of a carefully balanced programme ensuring access to all curriculum competencies. Where sufficiently developed, HAH rotations can be included in IMT programmes delivering much needed generalist skills.
2858 A network analysis of morbidities associated with mental-physical multimorbidity among Brazilian elderly people (ELSI-Brazil)
Authors: Batista SRR , Wottrich VS , Pereira EM , Silva RR
Published: January 2025

Introduction

The coexistence of two or more morbidities, including at least one mental morbidity, is defined as mental-physical multimorbidity (MP-MM). It is linked to significant poor outcomes, such as a high burden of healthcare utilisation, particularly in the elderly.

Method

To evaluate the complex connections between the 16 physical and mental morbidities among Brazilian older people from the Brazilian Longitudinal Study of Ageing, we performed a network analysis (NA), a sophisticated multivariate statistical technique to estimate all relationships between morbidities represented by an undirected grafus. The objective was to estimate patterns in a complex set of multiple aleatory variables and display them in a network map within nodes and edges representing the variables and the interrelationships among them. In this study, we applied the NA to model interrelationships among chronic physical morbidities and depression. We utilised data from 6.104 participants of the second wave (2019–2020) of the Brazilian Longitudinal Study of Ageing (ELSI-Brazil). The data were adjusted according to the Ising model with the IsingFit function by R Software. Centrality and stability measures were assessed by the bootstrap method through the bootnet library.

Findings

In this network, depression, low back pain, and hypertension were the morbidities that had the most effects on the network’s overall structure, according to an examination of the centrality metrics of the nodes (strength, proximity, and betweenness). Depression was the morbidity with the higher betweenness.

Conclusion

The model’s interpretation indicates that depression is the illness that has the highest influence on the model and would likely be the most beneficial area for intervention.
A survey of current trends in postgraduate year 2 pediatric pharmacy residencies and growth of pediatric ambulatory care pharmacy practice
Authors: Davis Margaret S , Autry Elizabeth , Bosley Tyler , Kuhn Robert
Published: January 2025

Purpose

This study sought to characterize current trends in the program structure of postgraduate year 2 (PGY2) pediatric pharmacy residencies and to describe the growth of pediatric ambulatory care as a practice specialty.

Methods

A 99-question survey was designed to collect information regarding the current structure of PGY2 pediatric pharmacy residency programs. The survey was distributed electronically to PGY2 residency program directors (RPDs) and was open for 6 weeks from September to November 2023.

Results

75 distinct programs were eligible for participation; 43 programs (response rate, 57.3%) were included in the final analysis. Of the 43 respondents, 14 (32.6%) indicated their program was at a stand-alone children’s hospital. The majority of programs (22 of 43, 51.2%) require residents to spend 7 to 9 months of their residency year on required rotations. Nineteen of 40 respondents (47.5%) indicated their residents staff in both clinical and operational areas. The most commonly reported frequency was every third weekend. Most respondents indicated requiring up to 15 presentations of varying types. A total of 41 respondents participated in the ambulatory care section of the survey; 75% of respondents (30 of 40) reported there has been growth in the number of pharmacists in pediatric ambulatory care at their institution in the last 5 years.

Conclusion

This study describes the current state of PGY2 pediatric pharmacy residency programs, including educational opportunities and trends in staffing and academic activity requirements. This study also adds to available literature on pediatric ambulatory care and potential opportunities for resident-led expansion.
Graph contrastive learning of subcellular-resolution spatial transcriptomics improves cell type annotation and reveals critical molecular pathways
Authors: Lu Qiaolin , Ding Jiayuan , Li Lingxiao , Chang Yi
Published: January 2025

Imaging-based spatial transcriptomics (iST), such as MERFISH, CosMx SMI, and Xenium, quantify gene expression level across cells in space, but more importantly, they directly reveal the subcellular distribution of RNA transcripts at the single-molecule resolution. The subcellular localization of RNA molecules plays a crucial role in the compartmentalization-dependent regulation of genes within individual cells. Understanding the intracellular spatial distribution of RNA for a particular cell type thus not only improves the characterization of cell identity but also is of paramount importance in elucidating unique subcellular regulatory mechanisms specific to the cell type. However, current cell type annotation approaches of iST primarily utilize gene expression information while neglecting the spatial distribution of RNAs within cells. In this work, we introduce a semi-supervised graph contrastive learning method called Focus, the first method, to the best of our knowledge, that explicitly models RNA’s subcellular distribution and community to improve cell type annotation. Focus demonstrates significant improvements over state-of-the-art algorithms across a range of spatial transcriptomics platforms, achieving improvements up to 27.8% in terms of accuracy and 51.9% in terms of F1-score for cell type annotation. Furthermore, Focus enjoys the advantages of intricate cell type-specific subcellular spatial gene patterns and providing interpretable subcellular gene analysis, such as defining the gene importance score. Importantly, with the importance score, Focus identifies genes harboring strong relevance to cell type-specific pathways, indicating its potential in uncovering novel regulatory programs across numerous biological systems.
Neuronal mechanisms enhancing selectivity of the innate number sense via learning
Authors: Nieder Andreas
Published: January 2025

In their feature article, Lorenzi et al. (2025) compiled extensive biological evidence on the ontogenetic origins of the number sense. Drawing on both behavioral and neurobiological data, they convincingly argue that the “number sense” is fundamentally innate and present from birth in numerically competent animals, including humans. At the same time, the authors acknowledge the role of learning and experience in shaping numerical cognition. This commentary builds on the idea of learning-induced changes to the number sense, extending the concept of an innate number sense to one that is modifiable through learning and experience. It summarizes evidence from single-neuron recordings and proposes neurophysiological mechanisms underlying these learning-induced changes in numerical cognition.
Enantiomeric self-aggregation of zinc 132-methyl-bacteriochlorophyll-d analogs with a porphyrin π-skeleton
Authors: Hashimoto Yamato , Tamiaki Hitoshi
Published: January 2025

Zinc dodecyl 3-hydroxymethyl-(132R/S)-methyl-pyroprotopheophorbide-a enantiomers self-aggregated in an aqueous Triton X-100 micellar solution to give chlorosome-like J-aggregates. The chiral supramolecules of the resulting zinc porphyrin self-aggregates were dependent on the stereochemistry of the asymmetric carbon atom at the 132-position. The chiral and steric effects near the 13-carbonyl group on the aggregation confirmed that the 131-oxo group hydrogen-bonded with the 31-OH group, which was requisite for the in vivo production of the chlorosomal aggregates.
Balancing Away from War: How the USA and China Can Side-step the Thucydides’ Trap
Authors: Desch Michael C
Published: January 2025

The most widely discussed contemporary work using Thucydides as a guide for 21st century grand strategy is Graham Allison’s Destined for War: Can America and China Escape Thucydides’ Trap? It is not surprising that Allison and others would look to the Peloponnesian War because another power transition is going on with China “rising” relative to the USA. The question is from a Thucydidean perspective how should major actors like China and the USA respond to these changing power dynamics? Complicating our answer to this question is that there are three ways one could think about power in the context of his History of the Peloponnesian War. Given the striking inconsistencies among them, it is necessary to read Thucydides again to ensure we get him “right” on power. Furthermore, while a few modern readers recognize that Thucydides ultimately offers a plea for moderation and restraint in foreign policy, most, if not all, are skeptical that it can come from a Realist reading of the History of the Peloponnesian War. Ironically, such a reading casts the problem of power transition in a less intractable light.
Associations between initial dialysis access types and death from dialysis withdrawal in incident patients with kidney failure
Authors: Chen Jenny H C , Johnson David W , Roberts Matthew A , Brown Mark A , Brennan Frank , Wong Germaine , Hassan Hicham Cheikh , Yeung Wing-Chi G , Kennard Alice , Davies Christopher E , Boudville Neil , Lok Charmaine E , Lim Wai H
Published: January 2025

Background

Patients receiving haemodialysis via central venous catheter (HD-CVC) have been shown to have an increased risk of all-cause mortality. It is unclear whether death from dialysis withdrawal is associated with the high mortality risk observed in patients initiated on HD-CVC.

Methods

Using the Australia and New Zealand Dialysis and Transplant (ANZDATA) Registry, we examined the association between initial dialysis access (HD-CVC, haemodialysis via arteriovenous fistula [HD-AVF], and peritoneal dialysis [PD] via PD catheter [PD-PDC]) and death from dialysis withdrawal in adult patients starting dialysis in Australia between 2005 and 2022, analysed by time-stratified adjusted Cox regression with propensity score matched cohorts.

Results

Of 47 412 incident patients followed for a median of 2.65 years (interquartile range 1.19–4.87), 8170 (17%) died from dialysis withdrawal. Compared to patients initiated on HD-AVF, patients initiated on HD-CVC were more likely to experience death from dialysis withdrawal in the first 3 years after dialysis initiation, but not after 3 years (adjusted hazard ratios 2.43 [95% confidence interval 1.95–3.02], 2.06 [1.67–2.53], 1.57 [1.40–1.76], 1.06 [0.97–1.15] for 0–6 months, >6–12 months, >1–3 years, and > 3 years after dialysis initiation, respectively). Comparison between patients initiated on HD-CVD and PD-PDC showed similar estimates. No difference in withdrawal risk was observed between patients initiated on HD-AVF and PD-PDC.

Conclusions

Patients initiated on HD-CVC were twice as likely to experience early death from dialysis withdrawal compared to patients who had initiated dialysis with HD-AVF or PD-PDC. The increased risks diminished over time and were not observed after three years on dialysis.