bluuebunny/crossref_metadata_2025 huggingface dataset:
Descriptive norms caused increases in mask wearing during the COVID-19 pandemic
Authors: Heiman Samantha L. , Claessens Scott , Ayers Jessica D. , Guevara Beltrán Diego , Van Horn Andrew , Hirt Edward R. , Aktipis Athena , Todd Peter M.
Published: July 2023

Human sociality is governed by two types of social norms: injunctive norms, which prescribe what people ought to do, and descriptive norms, which reflect what people actually do. The process by which these norms emerge and their causal influences on cooperative behavior over time are not well understood. Here, we study these questions through social norms influencing mask wearing during the COVID-19 pandemic. Leveraging 2 years of data from the United States (18 time points; n = 915), we tracked mask wearing and perceived injunctive and descriptive mask wearing norms as the pandemic unfolded. Longitudinal trends suggested that norms and behavior were tightly coupled, changing quickly in response to public health recommendations. In addition, longitudinal modeling revealed that descriptive norms caused future increases in mask wearing across multiple waves of data collection. These cross-lagged causal effects of descriptive norms were large, even after controlling for non-social beliefs and demographic variables. Injunctive norms, by contrast, had less frequent and generally weaker causal effects on future mask wearing. During uncertain times, cooperative behavior is more strongly driven by what others are actually doing, rather than what others think ought to be done.
Intact predictive processing in autistic adults: evidence from statistical learning
Authors: Pesthy Orsolya , Farkas Kinga , Sapey-Triomphe Laurie-Anne , Guttengéber Anna , Komoróczy Eszter , Janacsek Karolina , Réthelyi János M. , Németh Dezső
Published: July 2023

Impairment in predictive processes gained a lot of attention in recent years as an explanation for autistic symptoms. However, empirical evidence does not always underpin this framework. Thus, it is unclear what aspects of predictive processing are affected in autism spectrum disorder. In this study, we tested autistic adults on a task in which participants acquire probability-based regularities (that is, a statistical learning task). Twenty neurotypical and 22 autistic adults learned a probabilistic, temporally distributed regularity for about 40 min. Using frequentist and Bayesian methods, we found that autistic adults performed comparably to neurotypical adults, and the dynamics of learning did not differ between groups either. Thus, our study provides evidence for intact statistical learning in autistic adults. Furthermore, we discuss potential ways this result can extend the scope of the predictive processing framework, noting that atypical processing might not always mean a deficit in performance.
Effect of topdressing time on spring maize yield and nitrogen utilization in black soil of northeast China
Authors: Zheng Yu , Ji Jinghong , Liu Shuangquan
Published: July 2023

Topdressing time is crucial to achieving a high yield. To determine the optimum topdressing time for spring maize in the black soil of northeast China in the “one base and one topdressing” mode, the effects of topdressing time of nitrogen (N) fertilizer on maize yield, N utilization, and inorganic N residue and distribution were investigated by using 15N labeling technique. Four treatments were designed: no N fertilizer (N0), N fertilizer topdressing at jointing stage (N1), N fertilizer topdressing at belling stage (N2), and N fertilizer topdressing at tasseling stage (N3). The results showed that compared with N1 and N3, the maize yield, N uptake and N use efficiency (NUE) in N2 treatment significantly increased by 12.1% and 24.7%, 10.0% and 16.0%, and 26.4% and 38.9%, respectively (P < 0.05). The later the topdressing time, the more inorganic N remained in the soil profile (0–60 cm). The rate of potential N loss was higher when the topdressing time was too early or too late. Compared with N1, the residual amount of 15N in the soil profile (0–60 cm) of N2 and N3 treatments increased by 17.2% and 44.8%, respectively. The soil inorganic N (SIN) accumulation in the deep soil profile (40–60 cm) of N2 treatment decreased by 7.6% and 42.7%, respectively, as compared with N1 and N3. Therefore, the application of N fertilizer at the belling stage was beneficial to the high yield and efficient production of maize in the black soil region of Northeast China.
The immune responses of Oreochromis niloticus against Prohemistomum vivax encysted metacercariae infection with the evaluation of different biomarkers stressors
Authors: Younis Nehal A. , Thabit Hasnaa , El-Samannoudy Salma I. , Attia Marwa M.
Published: July 2023

This study aimed at evaluating the immunological status of Oreochromis niloticus (O. niloticus); so, a total of 120 O. niloticus were collected from different farms located in Kafr El-Sheikh Governorate in Egypt during the period from January 2021 to January 2022. The fish were surveyed for commonly encysted metacercariae present in different organs such as gills, spleen, liver, kidney, and muscles. The collected encysted metacercariae were of the family Cyathocotylidae (Prohemistomum vivax) with a prevalence of 25%. Different cell-mediated immune responses such as Major histocompatibility class II alpha (MHC-IIα), Toll-like receptor 7 (TLR-7), Interleukin (IL-8), and Clusters of differentiation 4 (CD4) were assessed in different organs such as gills, spleen, liver, kidney, and muscles which revealed an elevation in different genes in infected organs as a reaction from the body against parasitic infection. In addition, the liver enzymes; aspartate aminotransferase (AST), and alanine aminotransferase (ALT), were assessed in the serum of O. niloticus as well as blood glucose, cortisol levels, and lysozyme activity were estimated to record higher levels in the infected fish in comparison with the control non-infected ones.
Human-influenced diets affect the gut microbiome of wild baboons
Authors: Moy Madelyn , Diakiw Laura , Amato Katherine R.
Published: July 2023

Industrialized diets that incorporate processed foods and are often high in simple sugars and fats and low in fiber have myriad health impacts, many of which may operate via impacts on the gut microbiota. Examining how these diets affect the gut microbiota can be challenging given that lab animal models experience altered environmental contexts, and human studies include a suite of co-varying cultural and environmental factors that are likely to shape the gut microbiota alongside diet. To complement these approaches, we compare the microbiomes of wild populations of olive baboons (Papio anubis) with differential access to human trash high in processed foods, simple sugars, and fats in Rwanda’s Akagera National Park. Baboons are a good model system since their microbiomes are compositionally similar to those of humans. Additionally, this population inhabits a common environment with different social groups consuming qualitatively different amounts of human trash, limiting variation in non-dietary factors. Using 16S rRNA gene amplicon sequencing we find that baboons with unlimited access to human trash have reduced microbial alpha diversity and reduced relative abundances of fiber-degrading taxa such as Ruminococcaceae, Prevotellaceae, and Lachnospiraceae. In contrast, baboons with limited access to human trash have a microbiome more similar to that of baboons with no access to human trash. Our results suggest that while a human-influenced diet high in processed foods, simple sugars, and fats is sufficient to alter the microbiome in wild baboons, there is a minimum threshold of dietary alteration that must occur before the microbiome is substantially altered. We recommend that data from wild primate populations such as these be used to complement ongoing research on diet-microbiome-health interactions in humans and lab animal models.
Combining ability analysis of yield and biomass allocation related traits in newly developed wheat populations
Authors: Shamuyarira Kwame W. , Shimelis Hussein , Figlan Sandiswa , Chaplot Vincent
Published: July 2023

Increasing biomass allocation to the root system may increase soil-organic carbon stocks and confer drought adaptation in water-limited environments. Understanding the genetic bases and inheritance of biomass allocation is fundamental for drought tolerance breeding and soil health. The objective of this study was to determine the general and specific combining ability, maternal effects and the mode of gene action controlling the major yield and biomass allocation related traits in wheat to identify good combiners for breeding and enhanced carbon sequestration. Ten selected wheat genotypes were crossed in a full diallel mating design, and 90 F2 families were generated and evaluated in the field and greenhouse under drought-stressed and non-stressed conditions. Significant differences were recorded among the tested families revealing substantial variation for plant height (PH), kernels per spike (KPS), root biomass (RB), shoot biomass (SB), total plant biomass (PB) and grain yield (GY). Additive gene effects conditioned PH, SB, PB and GY under drought, suggesting the polygenic inheritance for drought tolerance. Strong maternal and reciprocal genetic effects were recorded for RB across the testing sites under drought-stressed conditions. Line BW162 had high yield and biomass production and can be used to transfer favourable genes to its progeny. The parental line LM75 maintained the general combining ability (GCA) effects in a positive and desirable direction for SB, PB and GY. Early generation selection using PH, SB, PB and GY will improve drought tolerance by exploiting additive gene action under drought conditions. Higher RB production may be maintained by a positive selection of male and female parents to capture the significant maternal and reciprocal effects found in this study.
Xanthone synthetic derivatives with high anticandidal activity and positive mycostatic selectivity index values
Authors: Rząd Kamila , Ioannidi Rachel , Marakos Panagiotis , Pouli Nicole , Olszewski Mateusz , Kostakis Ioannis K. , Gabriel Iwona
Published: July 2023

With the current massive increases in drug-resistant microbial infection as well as the significant role of fungal infections in the death toll of COVID-19, discovering new antifungals is extremely important. Natural and synthetic xanthones are promising derivatives, although only few reports have demonstrated their antifungal mechanism of action in detail. Newly synthetized by us xanthone derivative 44 exhibited strong antifungal activity against reference and fluconazole resistant C. albicans strains. Our results indicate that the most active compounds 42 and 44 are not substrates for fungal ABC transporters (Cdr1p and Cdr2p) and Mdr1p, the main representative of the major facilitator superfamily efflux pumps, membrane proteins that are responsible for the development of resistance. Moreover, fungicidal mode of action reduces the probability of persistent or recurrent infections and resistance development. In this light, the demonstrated killing activity of the examined derivatives is their undoubted advantage. Novel synthesized compounds exhibited moderate cytotoxicity against human cell lines, although the selectivity index value for human pathogenic strains remained favourable. Our results also indicate that novel synthetized compounds 42 and 44 with antifungal activity target yeast topoisomerase II activity. In summary, further validation of xanthones applicability as antifungals is highly valuable.
Evaluation and comparison of pharmacokinetic profiles and safety of two extended-release buprenorphine formulations in common marmosets (Callithrix jacchus)
Authors: Fabian Niora J. , Mannion Anthony J. , Jamiel Morgan , Anderson David. J. , Rower Joseph E. , Reilly Christopher A. , Menegas William , Muthupalani Sureshkumar , Ta Christina , Fox James G. , Kramer Robin , Haupt Jennifer L.
Published: July 2023

While sustained-release buprenorphine (BSR) is used as a long-lasting opioid analgesic in common marmosets (Callithrix jacchus), there are no published studies on pharmaceutical-grade extended-release buprenorphine options such as Ethiqa XR (EXR) for this species. However, BSR is a compounded product and has been reported to cause injection site reactions in multiple species, including marmosets. Additionally, now with the availability of EXR, a pharmaceutical-grade veterinary product, the use of BSR in laboratory animals is not compliant with the Guide for the Care and Use of Laboratory Animals (Guide) unless scientifically justified and approved by the IACUC. We compared pharmacokinetic and safety profiles of BSR (0.15 mg/kg) and EXR (0.1–0.2 mg/kg) administered subcutaneously to adult marmosets. Blood was collected by venipuncture of the saphenous vein at multiple time points (0.25–72 h) and analyzed by liquid chromatography-tandem mass spectrometry (LC–MS/MS). EXR between 0.1 and 0.2 mg/kg resulted in a dose-dependent increase in Cmax (1.43–2.51 ng/mL) and were not statistically different from BSR (1.82 ng/mL). Tmax, lambdaz, and t1/2 were not statistically different between formulations. Mean plasma buprenorphine concentrations for BSR and EXR exceeded the therapeutic threshold (0.1 ng/mL) within 0.25 h and lasted for > 72 h. Mild sedation, but neither respiratory depression nor ataxia, was observed for both formulations. BSR injection sites had significantly higher histopathological scores compared to EXR. Video recordings for monitoring drug-induced behavioral changes showed increased animal activity levels after BSR and EXR versus saline controls. Norbuprenorphine, a buprenorphine metabolite associated with respiratory depression, was detected in the plasma after BSR and EXR administration as well as by in vitro liver microsome assays. In conclusion, we recommend using EXR over BSR as a long-lasting buprenorphine analgesic in marmosets because EXR is a pharmaceutical-grade formulation that is compliant with FDA guidelines and the Guide as well as exhibits comparable PK and safety profiles as BSR.
Fabrication of Al/AlOx/Al junctions with high uniformity and stability on sapphire substrates
Authors: Zheng Yuzhen , Li Shuming , Ding Zengqian , Xiong Kanglin , Feng Jiagui , Yang Hui
Published: July 2023

Tantalum and aluminum on sapphire are widely used platforms for qubits of long coherent time. As quantum chips scale up, the number of Josephson junctions on sapphire increases. Thus, both the uniformity and stability of the junctions are crucial to quantum devices, such as scalable superconducting quantum computer circuit, and quantum-limited amplifiers. By optimizing the fabrication process, especially, the conductive layer during the electron beam lithography process, Al/AlOx/Al junctions of sizes ranging from 0.0169 to 0.04 µm2 on sapphire substrates were prepared. The relative standard deviation of room temperature resistances (RN) – $${\upsigma }_{{R_{{\text{N}}} }} /\left\langle {R_{{\text{N}}} } \right\rangle$$

σ

R
N

/

R
N

of these junctions is better than 1.7% on 15 mm × 15 mm chips, and better than 2.66% on 2 inch wafers, which is the highest uniformity on sapphire substrates has been reported. The junctions are robust and stable in resistances as temperature changes. The resistances increase by the ratio of 9.73% relative to RN as the temperature ramp down to 4 K, and restore their initial values in the reverse process as the temperature ramps back to room temperature. After being stored in a nitrogen cabinet for 100 days, the resistance of the junctions changed by1.16% on average. The demonstration of uniform and stable Josephson junctions in large area paves the way for the fabrication of superconducting chip of hundreds of qubits on sapphire substrates.
Development and validation of a portable articulated dynamometry system to assess knee extensor muscle strength
Authors: Myong Youho , Park Sungwoo , Cho Minwoo , Cho Seung Yeon , Lee Woo Hyung , Oh Byung-Mo , Kim Sungwan
Published: July 2023

Muscle strength assessment is important in predicting clinical and functional outcomes in many disorders. Manual muscle testing, although commonly used, offers suboptimal accuracy and reliability. Isokinetic dynamometers (IKDs) have excellent accuracy and reliability; but are bulky and expensive, offering limited accessibility. This study aimed to design a portable dynamometer that is accessible, accurate and reliable, and to validate the device in a general population. The portable articulated dynamometry system (PADS) is a portable device with an embedded high-precision load cell, designed to measure muscle strength with optimal accuracy. Seventy-two participants underwent maximal isometric and isokinetic knee extensor torque measurement with the PADS and IKD, respectively. The PADS results were cross-validated against IKD results using change in mean (CIM). Interrater and intra-rater reliabilities were assessed using intraclass correlation coefficients, standard error of measurement, and minimal detectable change. The PADS maximal knee extensor strength results were not significantly different from those by IKD (CIM: − 2.13 Nm; 95% CI − 4.74, 0.49 Nm). The PADS showed interrater reliability (Pearson’s r: 0.958; ICC: 0.979; SEM: 5.51%) and excellent intra-rater reliability (Pearson’s r: 0.912; ICC: 0.954; SEM: 8.38%). The proposed PADS may be an effective alternative to IKD, offering good accuracy, reliability, and potentially better accessibility.
Association between urinary caffeine and caffeine metabolites and stroke in American adults: a cross-sectional study from the NHANES, 2009–2014
Authors: Fan Jinming , Yuan Yajun , Zhang Xiaoting , Li Wenhan , Ma Wuqin , Wang Wenhao , Gu Jinyan , Zhou Bin
Published: July 2023

This study investigates the potential correlation between urinary caffeine levels and the occurrence of stroke, a serious cerebrovascular disease that can lead to disability or death. The data used in this study was obtained from the National Health and Nutrition Examination Survey conducted between 2009 and 2014. The study analyzed a total of 5,339 individuals, divided into a control group (n = 5,135) and a stroke group (n = 162). The researchers utilized multiple logistic regression and smoothed curve fitting to examine the relationship between urinary caffeine and caffeine metabolites and the incidence of stroke. The study found that higher urinary caffeine levels were associated with a lower risk of stroke in Mexican American participants (odds ratio [OR] = 0.886, 95% confidence interval [CI]: (0.791, 0.993), P = 0.037). After adjusting for certain participant characteristics, it was also found that higher urinary paraxanthine levels were associated with a lower risk of stroke incidence (OR = 0.991, 95% CI (0.984, 0.999), P = 0.027). Meanwhile, the highest urinary paraxanthine levels group had 43.7% fewer strokes than the lowest level group (OR = 0.563, 95% CI (0.341, 0.929), P = 0.025). In this study, we showed a negative link between urine paraxanthine levels and the risk of stroke. Meanwhile, urinary caffeine levels were negatively associated with the incidence of stroke in Mexican Americans, but no correlation in other populations. Our findings may have predictive and diagnostic implications in clinical practice. Further extensive prospective investigations are still needed to validate our conclusions.
Spatiotemporal dynamics of confirmed case distribution during the COVID-19 pandemic in China: data comparison between 2020/04–2020/08 and 2021/04–2021/08
Authors: Fu Lin-Tao , Qu Zhong-Ling , Zeng Xin , Li Liang-Zhi , Lan Run , Zhou Yu
Published: July 2023

The COVID-19 pandemic across Chinese mainland was gradually stabilized at a low level with sporadic outbreaks, before the emergence of Omicron variant. Apart from non-pharmacological interventions (NPIs), COVID-19 vaccine has also been implemented to prevent and control the pandemic since early 2021. Although many aspects have been focused, the change of the spatiotemporal distribution of COVID-19 epidemic across Chinese mainland responding to the change of prevention and control measures were less concerned. Here, we collected the confirmed case data (including domestic cases and overseas imported cases) across Chinese mainland during both 2020/04–2020/08 and 2021/04–2021/08, and then conducted a preliminary data comparison on the spatiotemporal distribution of confirmed cases during the identical period between the two years. Distribution patterns were evaluated both qualitatively by classification method and quantitatively through employing coefficient of variation. Results revealed significant differences in the homogeneity of spatiotemporal distributions of imported or domestic cases between the two years, indicating that the important effect of the adjustment of prevention and control measures on the epidemic evolution. The findings here enriched our practical experience of COVID-19 prevention and control. And, the collected data here might be helpful for improving or verifying spatiotemporally dynamic models of infectious diseases.
Decreased left heart flow in fetal lambs causes left heart hypoplasia and pro-fibrotic tissue remodeling
Authors: Reuter Miriam S. , Sokolowski Dustin J. , Javier Diaz-Mejia J. , Keunen Johannes , de Vrijer Barbra , Chan Cadia , Wang Liangxi , Ryan Greg , Chiasson David A. , Ketela Troy , Scherer Stephen W. , Wilson Michael D. , Jaeggi Edgar , Chaturvedi Rajiv R.
Published: July 2023

Low blood flow through the fetal left heart is often conjectured as an etiology for hypoplastic left heart syndrome (HLHS). To investigate if a decrease in left heart flow results in growth failure, we generate left ventricular inflow obstruction (LVIO) in mid-gestation fetal lambs by implanting coils in their left atrium using an ultrasound-guided percutaneous technique. Significant LVIO recapitulates important clinical features of HLHS: decreased antegrade aortic valve flow, compensatory retrograde perfusion of the brain and ascending aorta (AAo) from the arterial duct, severe left heart hypoplasia, a non-apex forming LV, and a thickened endocardial layer. The hypoplastic AAo have miRNA-gene pairs annotating to cell proliferation that are inversely differentially expressed by bulk RNA-seq. Single-nucleus RNA-seq of the hypoplastic LV myocardium shows an increase in fibroblasts with a reciprocal decrease in cardiomyocyte nuclei proportions. Fibroblasts, cardiomyocytes and endothelial cells from hypoplastic myocardium have increased expression of extracellular matrix component or fibrosis genes with dysregulated fibroblast growth factor signaling. Hence, a severe sustained ( ~ 1/3 gestation) reduction in fetal left heart flow is sufficient to cause left heart hypoplasia. This is accompanied by changes in cellular composition and gene expression consistent with a pro-fibrotic environment and aberrant induction of mesenchymal programs.
Imidazolium-based mass tags for protein biomarker detection using laser desorption ionization mass spectrometry
Authors: Liu Mingxia , Xue Jinjuan , Liu Huwei , Bai Yu
Published: July 2023

Novel imidazolium-based mass tags (IMTs) were designed, synthesized and applied to simultaneous in situ analysis of multiple biomarkers on less than 10 cells.
Dynamic facial expression recognition with pseudo‐label guided multi‐modal pre‐training
Authors: Yin Bing , Yin Shi , Liu Cong , Zhang Yanyong , Xi Changfeng , Yin Baocai , Ling Zhenhua
Published: July 2023

Due to the huge cost of manual annotations, the labelled data may not be sufficient to train a dynamic facial expression (DFR) recogniser with good performance. To address this, the authors propose a multi‐modal pre‐training method with a pseudo‐label guidance mechanism to make full use of unlabelled video data for learning informative representations of facial expressions. First, the authors build a pre‐training dataset of videos with aligned vision and audio modals. Second, the vision and audio feature encoders are trained through an instance discrimination strategy and a cross‐modal alignment strategy on the pre‐training data. Third, the vision feature encoder is extended as a dynamic expression recogniser and is fine‐tuned on the labelled training data. Fourth, the fine‐tuned expression recogniser is adopted to predict pseudo‐labels for the pre‐training data, and then start a new pre‐training phase with the guidance of pseudo‐labels to alleviate the long‐tail distribution problem and the instance‐class confliction. Fifth, since the representations learnt with the guidance of pseudo‐labels are more informative, a new fine‐tuning phase is added to further boost the generalisation performance on the DFR recognition task. Experimental results on the Dynamic Facial Expression in the Wild dataset demonstrate the superiority of the proposed method.
Manage migration to save liberal order
Authors: Larsen Henrik
Published: July 2023

The growing irregular immigration and asylum pressure polarizes and paralyzes the political ecosystems in the USA and Europe. It empowers the new nationalists that seek to dismantle or withdraw from the liberal international institutions (EU, NATO, United Nations), which they perceive as undermining their capacity to assert national sovereignty. To save ‘liberal order,’ therefore, the established governments and political parties on both sides of the Atlantic need to bring back a perception of internal control over external events. They need a more explicit acknowledgment of their national interests that cannot always accommodate migrants’ interest in settling in more prosperous and safer countries. The article argues that migration management must be integrated into a notion of Western grand strategy focused on the preservation of internal cohesion and sovereignty, which preconditions consensus on maintaining ‘liberal order’ in the first place.
Clinical governance implications of a Victorian coronial finding regarding contrast-related anaphylaxis for health services and private providers of radiology services
Authors: Lu Belle , Kelly Anne-Maree , Cockburn Tina
Published: July 2023

What is known about the topic? Anaphylaxis is a rare but inherent risk of treatments and investigational agents. What does this paper add? Using a recent coronial finding in Victoria, this letter explores clinical governance responsibilities of health services and private providers of radiology services with respect to anaphylaxis recognition and management. What are the implications for practitioners? There is a strong case for health service and corporate governance teams (for stand-alone clinics) to ensure that all staff have recent, adequate training to recognise and initiate treatment of anaphylaxis. Reliance on an ambulance response is not enough.
1563 IMPROVING DOCUMENTATION OF TREATMENT ESCALATION PLANS WITHIN 72 HOURS OF ADMISSION TO EAST LOTHIAN COMMUNITY HOSPITAL
Authors: Galloway S , Farren A , Johnson R
Published: July 2023

Introduction

East Lothian Community Hospital (ELCH) comprises of 95 medical beds for older patients undergoing rehabilitation following acute admission or discharge planning. Ideally, transfers from acute hospitals should have Treatment Escalation Plans (TEPs) in place, however only 67% of patients had a TEP documented electronically within three days of ELCH admission. Overnight and weekend cover is provided through nurse practitioners or Hospital at Night (off-site), therefore documented individualised plans by senior decision makers in the event of clinical deterioration is vital.

Objective

95% of patients admitted to ELCH would have a provisional TEP documented electronically within 72 hours of admission by February 2023.

Methods

Using quality improvement methodology, two Plan-Do-Study-Act cycles were completed. Firstly, a questionnaire was sent to junior doctors and nurse practitioners responsible for admitting patients to understand barriers to completing TEPs. Data was collected from electronic records on admission date, first documentation of provisional TEP (by a junior doctor or nurse practitioner) and admitting ward. The first cycle of change focused on increased awareness through posters reminding clinicians to consider TEP on admission. The second cycle of change involved two education sessions, highlighting the importance of TEP and how to approach difficult conversations.

Results

28.5% of junior clinicians did not feel comfortable discussing TEPs on admission, with barriers being time constraints, level of responsibility and concern about making incorrect decisions. The first cycle (increased awareness) showed an improvement in documented provisional TEPs within 72 hours of admission from 67% to 79%. The second cycle (two education sessions) saw a further improvement to 94%.

Conclusions

Basic interventions to increase awareness and education to address concerns surrounding TEP discussions were very effective. Future cycles are planned with new junior doctors to sustain the improvement. Next steps are to clarify the role of other medical practitioners in completing provisional TEPs.
1511 IMPROVING THE IDENTIFICATION AND MANAGEMENT OF DELIRIUM AT THE FRONT DOOR
Authors: Livie V , Crowther J
Published: July 2023

Background

Delirium is common especially in the older adult (≥65 years) and is characterised by disturbed consciousness, cognitive function or perception. It develops acutely, often has a fluctuant course and is associated with several adverse outcomes including increased length of hospital stay, increased mortality and increased incidence of developing dementia. Delirium is under-recognised, however assessment tools such as 4AT and abbreviated mental test score (AMTS) have been developed to help clinicians assess for the presence of delirium.

Method

The “TIME” bundle developed by Healthcare Improvement Scotland helps clinicians to think about underlying triggers for delirium. Baseline data collected from a care of the elderly ward showed that 26% (5/19) of patients aged ≥65 years had a delirium assessment tool used on admission. 42% (8/19) of patients were given a diagnosis of delirium on admission. Out of the 8 patients diagnosed with delirium, only 13% (1/8) of patients was assessed for urinary retention, 50% (4/8) for pain and constipation and 25% (2/8) had blood glucose measured. Several PDSA cycles were implemented including an educational session to promote early detection and management of delirium, poster detailing 4AT assessment and “TIME” bundle and use of a 4AT sticker in the medical admission booklet.

Conclusion

The sticker was the most successful intervention as results showed 50% (13/26) of patients aged ≥65 years had a delirium assessment tool filled in on admission. For those diagnosed with delirium, assessment for urinary retention and blood glucose measurement improved to 78% (7/9), pain assessment improved to 67% (6/9) and 100% (9/9) of patients were assessed for constipation. In conclusion, this project has improved use of delirium assessment tools at the front door and when delirium is recognised, there is greater awareness of common underlying causes. Planned future cycles include a ward “delirium champion” to help with recognition and management of delirium.
1539 IMPROVING RECORDING OF THE CLINICAL FRAILTY SCALE BY PHYSIOTHERAPISTS IN OLDER PEOPLE'S MEDICINE: A QUALITY IMPROVEMENT PROJECT
Authors: Buckland C
Published: July 2023

Introduction

Frailty is under-recognised in hospital leading to unwarranted variation in care. National guidance recommends that all healthcare professionals can identify frailty and offer interventions to reduce risk factors for frailty. Previously, physiotherapists working in Older People’s Medicine (OPM) did not record frailty status in their clinical assessment. This quality improvement project seeks to translate and implement best practice, supporting physiotherapists to record the Clinical Frailty Scale (CFS) score within routine patient assessment, so interventions can be initiated to optimise outcomes.

Project aim

Within 3 months, to achieve a 50% increase in the number of patients with a Clinical Frailty Scale (CFS) score recorded within their physiotherapy assessment.

Methods

Plan-Do-Study-Act cycles with interventions of bespoke teaching and assessment proforma re-design were employed targeting the OPM physiotherapy team on ward 31, RVI.

Measures

The weekly number of patients with a CFS score recorded within physiotherapy assessment was collected over 13 weeks and evaluated on a run chart. Staff knowledge and skills self-assessment scores and cohort data were also recorded and described using descriptive statistics.

Results

At baseline – 0/114 (0%) physiotherapy patients had a CFS score recorded, this improved to 95/192 (49%), suggestive of effective change post interventions. Staff confidence scores also improved.

Conclusions

This project has led to improved frailty awareness and identification amongst OPM physiotherapy staff. Furthermore, these efforts are being sustained, and implemented in other areas of acute care. This work supports a collaborative approach to improving frailty care; better identification of frailty can reduce harm by informing healthcare needs, supporting patient flow, and resulting in better, safer, and more equitable care.
1569 BUILDING A HOLISTIC SERVICE FOR PATIENTS WITH PARKINSON'S DISEASE AND PSYCHIATRIC SYMPTOMS
Authors: Tullo E , Henry S
Published: July 2023

Introduction

Parkinson’s Disease (PD) is recognised by the motor symptoms of tremor, rigidity and bradykinesia. However, the prevalence of psychiatric symptoms such as low mood, anxiety and memory problems in PD is also common (20-80%). We integrated one clinical session per week from a Parkinson’s specialist psychiatrist (PDSP) into our existing MDT service, and aimed to evaluate the impact of this model on care for patients with PD.

Method

We initiated a series of Plan Do Study Act (PDSA) cycles to establish a referral pathway to our PDSP. Using electronic clinical records we collected data from a cohort of PD patients seen by our PDSP over 6 months to map symptoms, time to review, diagnosis, treatment and follow-up. We estimated the number of referrals to other services that did not need to be made over the same period due to access to our PDSP

Results

Fifty-one patients with PD were referred to our PDSP with the following symptom(s): memory impairment (53%), low mood (42%), hallucinations (10%), anxiety (8%) - all were seen within eight weeks. Of the 27 patients referred with memory impairment, review by our PDSP meant that 15 did not need onward referral to a separate mental health service. Of 14 patients with low mood (without memory impairment), review by our PDSP meant that 12 did not need onward referral.

Conclusion

Prior to the integration of a PDSP into our PD MDT patients with psychiatric symptoms needed to be referred to another clinical service, often with a long wait for assessment and treatment. With access to a PDSP, 51 patients were reviewed within eight weeks, and 27 did not need onward referral to another service. We do not yet have evidence as to how patient outcomes differ before and after integration of a PDSP into our team.
1595 WHAT IS THE IMPACT OF A PRE-HOSPITAL GERIATRICIAN LED TELEPHONE ‘SILVER TRIAGE’ FOR OLDER PEOPLE LIVING WITH FRAILTY?
Authors: Jones H T , Teranaka W , Wan B , Tsui A , Gross L , Hunter P , Conroy S
Published: July 2023

Background

The Ageing Well programme within the NHS Long Term Plan promotes person-centred care aligning with the goals of Integrated Care Systems (ICSs) in unifying health and social care aiming to increase the proportion of care to older people delivered in the community (NHS England, 2019). As most older people admitted to hospital are conveyed by ambulance services this presents a focus to reduce hospitalisation (Maynou L, Street A, Burton C, et al. Emergency Medicine Journal 2023). North Central London ICS has invested in ‘Silver Triage’ a pre-hospital telephone support scheme which sees geriatricians and emergency physicians supporting the London Ambulance Service in their clinical decision making relating to older people at the point of assessment.

Methods

Data from the first fourteen months of the scheme was analysed.

Results

Between November 2021 and January 2023 there have been 452 Silver Triage cases with 80% resulting in a decision to not convey an older person to hospital. The mode clinical frailty scale (CFS) score was 6 with no difference in conveyance rates based on CFS. Prior to triage paramedics thought hospitalisation was not needed in 44% of cases (n=72/165). Most paramedics (93%, n=154/165) found it easy to contact the team with all 176 who responded to a post triage survey answering they would use it again. Many (66%, n=108/164) felt they learnt something from the discussion, with 16% (n=27/164) reporting it changed their decision-making process.

Conclusion

Silver Triage has the potential to improve the care of older people by preventing unnecessary hospitalisation and has been well received by paramedics.
1624 IMPROVING THE QUALITY OF TEACHING WITHIN THE AGEING AND COMPLEX MEDICINE DEPARTMENT; INTRODUCING A NOVEL TEACHING PROGRAMME
Authors: Alićehajić-Bečić Ð , Rehman H , Hough S , Ali S
Published: July 2023

Introduction

Feedback from the National Training Survey (NTS) in 2018 showed suboptimal satisfaction levels within our department, particularly for local teaching and clinical supervision. A novel dedicated teaching and training programme was designed and implemented. National and local feedback from trainees highlights significant improvement in satisfaction levels across all domains.

Method

The new programme includes scheduled weekly teaching using a defined geriatrics curriculum; simulation sessions, improved opportunities for bedside teaching and workplace-based assessment, opportunities to present patients/interesting topics at weekly teaching, overhaul of our induction programme, support and supervision with QIPs/research including formal end of placement QIP presentation sessions. We reviewed national feedback alongside our own locally sourced feedback to quantify improvements in satisfaction levels and address further areas for improvement.

Results

Feedback from the NTS shows satisfaction within all domains has improved between 2018 and 2022. In particular, satisfaction with clinical supervision improved from 80.1 (below national average) to 88.33, satisfaction with our induction process improved from 75.19 to 88.89 (above national average) and satisfaction with local teaching improved from 70.83 to 81 (above national average). Local feedback showed that trainees are satisfied with the quantity and quality of teaching and training during their placement; 92.5% rated the quality of clinical supervision as very high or high quality, 95% felt the formal teaching was useful to their learning, and 90% would recommend an ACM placement at RAEI to their colleagues.

Conclusion(s)

Our teaching and training programme has improved the quality and quantity of learning experiences for junior doctors within our department. There are domains in which satisfaction remains suboptimal including “rota design” and “workload” however there are factors affecting these areas which are out of the control of our department and therefore may present challenges when trying to implement change.
1641 NALOXEGOL USE IN A POST-OPERATIVE GERIATRIC WARD: A FEASIBLE, COST-EFFECTIVE TREATMENT FOR OPIOID-INDUCED CONSTIPATION
Authors: van Rhee C , Ramesh P , Roth N , Chaudhuri S , Bharkhada K , Koizia L
Published: July 2023

Introduction

Elderly post-operative patients are susceptible to opiate-induced constipation (OIC) and many fail to open their bowels despite regular laxative prescription. Naloxegol is a gastrointestinal opiate antagonist licensed to treat OIC in patients failing laxative therapy. Naloxegol’s higher unit price than standard laxatives may present a barrier to its use by hospital pharmacies. We present a quality improvement project on the feasibility and cost-effectiveness of using of naloxegol to treat OIC in the real-world setting of a geriatric post-operative ward.

Methods

Initial Audit- Review of inpatient notes from October-November 2022 identified patients on opiates who failed laxative therapy during admission (bowels not opening for ≥3 days, despite 4 consecutive days of laxatives). Average number of bowel motions per week following failure of laxative therapy and number of laxative doses received were recorded. Total cost of laxatives was recorded for each patient. Intervention – Naloxegol was supplied to the ward for patients meeting criteria of OIC failing laxative therapy. From December 2022-January 2023, naloxegol was prescribed to these patients. Laxatives were stopped on receipt of naloxegol. Naloxegol was stopped on cessation of opiates.

Results

Baseline audit identified 63.9% patients on opiates had failed laxative therapy. Following laxative therapy failure, average number of bowel motions/week was 2.65. Average cost of laxatives per patient was £3.77. Accounting for length of admission, average cost of laxatives per day was £0.13. During the intervention period 67.2% patients on opiates failed laxative therapy. 13 patients were prescribed naloxegol. Average number of bowel motions on naloxegol was 5.1/week. Average combined cost of laxatives and naloxegol per patient was £1.93. Average combined cost of laxatives and naloxegol per day was £0.08.

Conclusions

In this small-scale quality improvement project we demonstrate that naloxegol is both clinically effective and cost-effective in treating OIC in geriatric post-operative patients failing laxative therapy.
1551 AN ANP IN DEMENTIA SERVICES AND COLLABORATIVE WORKING WITH H@H SIGNIFICANTLY IMPROVES PATIENT ACCESS TO A DIAGNOSIS OF DEMENTIA
Authors: Rowlands M , Roscrow S , Munang L , Johnston S , Rimer J
Published: July 2023

Introduction

Scotland’s National Dementia strategy (2017) highlights the need to improve identification and management of dementia. Hospital at Home (H@H) teams often identify undiagnosed cognitive decline as part of comprehensive geriatric assessment. A trainee ANP in dementia services was appointed in 2019 in West Lothian; before this, the average waiting time to memory clinic assessment was 6 months for a home visit, and 12 months for outpatient clinic review. Affiliated with REACT H@H, the ANP identified a significant unmet need for assessment of cognitive decline in a patient cohort referred to H@H.

Method

Baseline data from patients reviewed by the dementia ANP was collected between Sept 2021 – Feb 2022, including referrals from H@H. A new pathway was then introduced to streamline referrals with education and upskilling of the H@H team. Further data was collected between Sept 2022 – February 2023.

Results

In the first cohort, 161 patients were assessed by the Dementia ANP, of which 39 (24%) had been referred from H@H. 60 patients (37%) were seen as a home visit, and 101 (63%) in clinic. 2 (1%) of referrals were managed with advice only. 125 patients (78%) were given a diagnosis of dementia; other diagnoses included delirium, low mood and anxiety. In the second cohort, 168 patients were assessed by the Dementia ANP, 39 (23%) being referred from H@H. 94 (56%) were seen in clinic and 74 (44%) as home visits. 10 (6%) of referrals were managed with advice only. 138 (82%) were given a diagnosis of dementia. Time to diagnosis of dementia was reduced to 1 month for home assessment, and to 4 months for outpatient clinic assessment.

Conclusion

Appointment of a Dementia ANP to work alongside H@H significantly improved access to specialist services and time to diagnosis of dementia as part of comprehensive geriatric assessment.
1498 THE CGA BOARD ROUND – IMPROVING DOCUMENTATION AND COMMUNICATION FOR OLDER ADULT INPATIENTS, UNIVERSITY HOSPITAL HAIRMYRES
Authors: Watt M , Grannan R , Peacock L
Published: July 2023

Background

Acutely unwell hospitalised older people have better outcomes including mortality and functional status when CGA (Comprehensive Geriatric Assessment) is performed. A previous complaint, escalated to the Scottish Public Services Ombudsman, highlighted issues with CGA documentation and recording MDT discussion. This pilot project’s aim was to create a method for documenting CGA MDT plans and to embed this as routine practice for all inpatients on a Geriatrics ward.

Method

Following consultation with staff on this ward, a sticker was developed detailing status of medical and therapy input, planned discharge date and likely required support on discharge to evidence MDT discussion. This was completed weekly at the board round for each patient. The stickers were implemented over a 2-week roll-out phase, and use (and completion) of stickers were compared to a 2-week period approximately 1 month later. Feedback from ward staff was also collected via questionnaires.

Results

Initially, 98% of patients had a sticker completed (n=49/50) and 86% of all required information was documented (n=43/50). For the second round of data collection this fell to an 18% completion rate (n=7/38). Ward staff interviewed were aware of the stickers and felt they improved CGA communication (n=100%, n=8/8). Suggestions for improvement included an option to record whether families were updated, clearer options for discharge status and reasons why a patient may not have received occupational or physiotherapy.

Conclusion

The CGA board round sticker was a positively received, simple and effective intervention to improve documentation. It addressed an area which had been highlighted as requiring improvement. As expected, initial completion rates were high but rotation of staff impacted on subsequent completion rates. Establishing this as routine practice will be challenging but permanent staff present at the board round will facilitate allocation of this task and a poster highlighting this process has been displayed on the ward.
1558 THE ROLE OF COMPREHENSIVE GERIATRIC ASSESSMENT AND SHARED DECISION MAKING IN PATIENTS BEING CONSIDERED FOR ORTHOPAEDIC SURGERY
Authors: Godage P , Bell T , Hobbs H , Forsyth L , Litto E , McCluskey Mayes B , Meilak C
Published: July 2023

Introduction

Our perioperative service for older people undergoing surgery (POPS) commenced preoperative assessment of co-morbid and frail patients undergoing elective orthopaedic surgery in 2021. As part of the comprehensive geriatric assessment (CGA) and shared-decision-making process (SDM), we wanted to analyse the decisions our patients made around surgery and how many regretted having surgery.

Methods

Review of all orthopaedic patients seen by POPS between September 2021-December 2022.

Intervention

CGA and SDM on all patients.

Data collected

comorbidities, Clinical Frailty Scale (CFS), SDM outcome. Decision regret scale was sent out 6 months post op from August 2022.

Results

111 patients assessed. Median age 89 (range 60-97). Median CFS 4 (range 1-7). Median comorbidities 12 (range 2-22). Surgery considered: knee 43%, hip 33%, shoulder 10%, spine 6%, revision hip 5%, and revision knee 3%. 77% wanted to proceed with surgery and 13% did not after SDM. 5% were deemed not fit enough and 5% are still awaiting final decision outcomes. Decision regret data has been returned by 10/14 (71%) of patients who proceeded. None regretted their decision.

Conclusion

The majority of patients seen by POPS wish to proceed with orthopaedic surgery. However, 13% did not wish to proceed following SDM which is similar to the 14% of patients who regretted undergoing surgery in other settings1. Of those that have returned the 6-month post op questionnaires, none have regretted their decision. Understanding how optimisation and appropriate SDM impacts on the patient experience is important as frailty impacts adversely on patient reported outcomes in elective hip and knee surgery. Frail patients are also less likely to report their postoperative outcomes in national data sets compared to less frail patients2.

1. CPOC website

2. Cook et al (2022). The impact of frailty on patient reported outcomes following hip and knee arthroplasty. Age and Ageing.