bluuebunny/crossref_metadata_2025 huggingface dataset:
Modern C++17 data pre-processing HLS Datflow Template Library
Authors: Janson T. , Kebschull U.
Published: February 2023

Developing and implementing algorithms for detector read-out using FPGAs is traditionally done by using a hardware description language like VHDL, Verilog, or System Verilog. In the proposed approach here, we discuss an alternative way using higher level languages like the Intel HLS Compiler. Intel HLS supports C++17 standard and is ideal to apply methods from Modern C++ to implement complex algorithms more easily. In this work, we have developed a dataflow template library. This enables a shorter development time for increasingly complex algorithm requirements, which is also important for next-generation experiments in the future.
Research of transient temperature measuring based on thin-film thermocouple and Wi-Fi wireless DAQ method
Authors: Cui Y. , Xie Y. , Yin J.
Published: February 2023

The thin-film thermocouple temperature sensor is a new type
of temperature sensor which was emerged with the development of
thin-film materials. It features on a small heat capacity and a
rapid response speed for transient temperature measurement on the
surface of objects. The existing temperature data acquisition
systems for filamentary thermocouples do not yet meet the conditions
for distortion-free measurement of transient temperature signals in
terms of sampling frequency and transmission rate. In addition, it
is less flexible in terms of data transmission methods, while the
cold end of the thermocouple compensation method has not yet
compensated for the non-linear phenomenon of thermocouples, which
affects the final measurement accuracy. This paper devised a
wireless temperature data acquisition system for K-type thin-film
thermocouples using a Wi-Fi wireless network to transmit sampling
data, then applied the devised system as a data acquisition method
to investigate the measurement of transient temperatures in
conjunction with thin-film thermocouple sensors. The results of
performance test indicated that the devised system is capable of
transient temperature measurement of K-type thin-film thermocouples
in the range of 0–650°C with a maximum sampling rate of
100 kHz, a temperature resolution of 0.16 degrees Celsius, an
accuracy of 0.2% after non-linear compensation and the ability to
measure transient temperature signals with a maximum frequency
component of 25 kHz. Taken advantage of the devised wireless data
acquisition system to measure the impulse response of a thin-film
thermocouple sensor specimen, the meausured response curve is
consistent with the law of first-order system, and the time constant
of the sensor was obtained as approximately 1.16 ms. A comparison
between the existing data acquisition apparatuses of type K
thermocouple was made. The limitations of the devised system are
also discussed.
Two-point functions of composite twist fields in the Ising field theory
Authors: Castro-Alvaredo Olalla A , Mazzoni Michele
Published: February 2023

All standard measures of bipartite entanglement in one-dimensional quantum field theories can be expressed in terms of correlators of branch point twist fields, here denoted byand. These are symmetry fields associated to cyclic permutation symmetry in a replica theory and having the smallest conformal dimension at the critical point. Recently, other twist fields (composite twist fields), typically of higher dimension, have been shown to play a role in the study of a new measure of entanglement known as the symmetry resolved entanglement entropy. In this paper we give an exact expression for the two-point function of a composite twist field that arises in the Ising field theory. In doing so we extend the techniques originally developed for the standard branch point twist field in free theories as well as an existing computation due to Horváth and Calabrese of the same two-point function which focused on the leading large-distance contribution. We study the ground state two-point function of the composite twist fieldand its conjugate. At criticality, this field can be defined as the leading field in the operator product expansion ofand the disorder fieldµ. We find a general formula forlog〈Tμ(0)Tμ†(r)〉and for (the derivative of) its analytic continuation to positive real replica numbers greater than 1. We check our formula for consistency by showing that at short distances it exactly reproduces the expected conformal dimension.
Introduction
Authors: Lerner Renée Lettow
Published: February 2023

The introduction begins by discussing different views of the jury in popular culture. It sets up the contrast between professional judges and lay jurors, and the tension between predictable law and popular justice. It describes the differences between two main families of legal systems: the common law and the civil law. Common law legal systems—found in England and its former colonies—traditionally use a jury to decide facts. Civil law systems developed on the continent of Europe and have spread to Latin America, Africa, and Asia. They traditionally use professional judges to decide cases. But many civil law systems now use jurors in criminal cases, often through the mixed panel of professional judges and lay jurors. Ironically, in common law countries the use of juries is in steep decline. The future of the jury depends on finding ways to use them efficiently and effectively.
Why use lay jurors? The ancient and medieval world
Authors: Lerner Renée Lettow
Published: February 2023

This chapter explores why ancient and medieval societies used juries, and reveals that many of the reasons are still relevant today. Ancient Athenian juries were a radical expression of popular democracy, meant to fully represent the views of citizens. They had the advantage of keeping elites in check, but the drawback of unpredictable decisions. Medieval English juries did not originate with the Anglo-Saxons, but rather with the Norman kings. English juries were a more effective method of resolving disputes than the ordeals—and a cheap one. Criminal defendants had to consent to jury trial, and were crushed to death if they did not. Contrary to common belief, Magna Carta as originally understood did not guarantee the right to a jury. At first, juries were self-informing, expected to come into court knowing their verdict. But after the Black Death of 1348, juries relied more on hearing evidence at trials.
Defining peace
Authors: Richmond Oliver P.
Published: February 2023

This chapter examines the different versions of peace, including the concepts of negative, positive, liberal, hybrid, everyday or emancipatory peace. Each of these approaches offers different levels of security and rights for society. Negative peace draws on the view that violence is intrinsic to human nature. Meanwhile, positive peace is defined as long-term stability, sustainability, and social justice. The chapter then looks at everyday and hybrid peace, before considering the role of political realism in political theory. It also discusses liberal peace theory and framework, which can be broken down into a number of intellectual and practical traditions: victor’s peace, constitutional peace, institutional peace, and civil peace.
Peace in history: towards the Enlightenment
Authors: Richmond Oliver P.
Published: February 2023

This chapter looks at the development of peacemaking until the Enlightenment, the early strands of which emerged in response to the limitations of the victor’s peace. Peace was also represented in early political philosophy and understandings of religious tolerance. Perhaps one of the most famous early legal instruments of peace within a state was the English Magna Carta (1215), which introduced human rights and the principle of habeas corpus. Peace treaties were also drawn together in more complex ways with the emergence of constitutionalism and institutions. International law was becoming an essential part of the international system and its approach to peace, which offered hope that a wider European peace, also drawing upon influences from further afield, could for once be achieved.
The development of an international peace architecture
Authors: Richmond Oliver P.
Published: February 2023

This chapter details the development of an international peace architecture (IPA). Geopolitics and the diplomatic and military balance of power strategies formed the first stage of an IPA. The second stage emerged after the First World War and added democracy, self-determination, and international law and organization to the IPA framework. Meanwhile, the third stage emphasized the expansion of human rights, equality, and citizenship. After the Cold War, stage four offered a framework that came to be known as liberal peacebuilding. Stage five focused on the rebuilding of the state in the context of American hegemony and global capitalism, while stage six is currently in process.
Epilogue: new agendas for peace
Authors: Richmond Oliver P.
Published: February 2023

This epilogue explores the new agendas for peace. It begins by providing a summary of the historical evolution of peace. The modern period saw interests extend to social, gender, equality, and social justice issues. Ultimately, these developments coalesced into an international peace architecture (IPA). The chapter then clarifies how older notions of peace still play a significant role in the foundation layers of the IPA. New layers of the IPA and newer generation of peace thinking and practice may involve hybrid notions of peace resting upon pluralism; local and global redistribution; sustainability and global justice; and the recognition of a range of everyday and transnational peace agencies.
Suburbs at flood tide
Authors: Abbott Carl
Published: February 2023

This chapter analyzes the suburban explosion after World War II, emphasizing the experience of predominantly white, English-speaking nations. Key themes are the massive construction of freestanding houses for individual households, government promotion of homeownership through mortgage assistance, and the role of freeway construction in facilitating suburbanization by automobile. A second topic is the development of New Towns or semi-independent satellite communities as an alternative to sprawl. New Towns were a major factor in development of the urban periphery in England and Northern Europe, weakly imitated in the United States, and again a major factor in countries such as China and Korea. The third topic is race and ethnicity, exploring the role of government in protecting racial separation in suburbs in the United States and South Africa, outward movement of Black and Latino households in the United States, and the increasing ethnic variety in twenty-first-century suburbs in Britain and North America.
Suburban work
Authors: Abbott Carl
Published: February 2023

This chapter emphasizes suburbs as places of work and commerce as well as places to live. Manufacturing began to decentralize in the nineteenth century into peripheral industrial districts and new industrial suburbs like Pullman, Illinois, and Bournville, England. The second half of the twentieth century brought the invention and explosive growth of the suburban shopping mall, supplanted by mile after mile of commercial strip development along suburban highways. Office work also decentralized, leading to edge cities, which became suburban downtowns with clusters of high-rise towers rivaling the old downtowns of middle-sized cities. Suburban industrial parks and office parks with low-rise buildings are also the incubators of knowledge suburbs such as Silicon Valley and Tsukuba Science City with economies based on research and technological innovation.
105 COVID-19 IN OLDER ADULTS: INPATIENT OUTCOMES IN A LEVEL 3 IRISH HOSPITAL
Authors: Young C , Moore M , Gyenes M , Sheehan O , Ahmed S
Published: February 2023

Background

COVID-19 has proved devastating in older persons. Previous studies reveal a mortality rate of 31% for hospitalised patients over 70.1 We examine outcomes for older COVID patients in our hospital.

Methods

We conducted a Hospital In Patient Enquiry Scheme review for patients coded as COVID-19 between 19/03/2020–19/02/2021 (n = 674). Older adults were defined as those aged over 65 years at time of admission. Age, sex, length of stay and survival were collected. Data was collated by ‘wave’: (Wave 1 n = 294, 2 n = 105, 3 n = 275). We reviewed whether patients had a CT pulmonary angiogram (CTPA) on the National Integrated Medical Imaging System.

Results

42.3% of COVID patients in our hospital were older persons (n = 285). This remained stable throughout the pandemic (Wave 1 44.2%, Wave 2 44.7%, Wave 3 39.3%). Mean length of stay was 19.7 days for older adults vs 7.4 for those under 65. Older persons had a higher mortality rate at 30.9% vs 3.6%. Overall incidence of PE was low at 1.9% (1.1% in older persons). However, the likelihood of a CTPA being positive for those over 65 was much higher at 42.9% vs 17.9%. While there was improvement in mortality rates in older persons from Wave 1 (31.5%) to 2 (19.1%), our data showed a significant rise in mortality in Wave 3 (35.2%). This compares to a different pattern in younger people, with mortality rates by wave at 6.7%, 0% and 1.7%.

Conclusion

In a large Irish cohort of patients hospitalised with COVID-19, 42.3% were older adults. Length of hospital stay was 3 times longer and mortality was 10 times higher than patients under 65. Older adults were also more likely to have a positive CTPA. Further study is needed to evaluate the long term effects of COVID-19 in our older population.

Reference

Zerah et al, Journals of Gerontology. Series A, Biological Sciences and Medical Sciences. 2021 Feb 25; 76 (3): e4–e12.
144 DEVELOPING AN INTEGRATED POST DIAGNOSTIC PATHWAY FOR PERSONS LIVING WITH DEMENTIA—EXPERIENCES OF A REGIONAL SPECIALIST MEMORY SERVICE
Authors: McHale C , Fallon A , Domsa M , McGuinn C , Tobin F , Sheridan L , Dookhy J , Coughlan T , O'Neill D , Kennelly S
Published: February 2023

Background

The frequently heterogeneous nature of a dementia presentation confers the need for a personalised approach to post-diagnostic supports. It’s an essential right for persons living with dementia (PlwD) and their families/supporters to have access to a comprehensive diagnosis and a responsive holistic pathway of care thereafter. We report our development of an integrated specialist-clinic/community post-diagnostic pathway responsive to the evolving personal needs of PlwD and their care-supporters.

Methods

This pathway was developed in an iterative inclusive-design methodology with input from hospital/community clinical specialists, health and social care professionals, senior nursing, PlwD and their care supporters. The post-diagnostic process starts at diagnosis disclosure, followed for all six-weeks later with a designated post diagnostic clinic, where a single point of contact to address any concerns in between visits is established.

Results

Iterative review cycles have identified integral components of an effective pathway: Guidance to live well with their personal manifestation of dementia; Acknowledgment of biopsychosocial elements of care; Timely access to comprehensive geriatric assessment via ambulatory hub MDT and/or and Integrated care team for older persons offering home assessment & intervention; Prevention of ‘harmful-events’ e.g. falls/delirium/hospitalisation; Timely access to therapies e.g. SLT/OT focussed on enhanced life at home/assistive technology; facilitation and planning of palliative care.

Other aspects include signposting to community resources and forward planning e.g. Citizen’s Information Centres; Peer support and education through designated training; Promotion of brain health- Exercise Programmes; social/cognitive stimulation e.g. Men’s sheds, Walking groups & Memory Resource Rooms; Opportunities for research involvement; Enhanced relationships with national organisations e.g. embedded ASI dementia advisor.

Conclusion

This approach has developed into a fully integrated holistic care-pathway where specialist-clinic, ambulatory-hospital, community older persons, and third sector services work together to provide the right care, at the right time, in the right place for PlwD and their families.
145 EDITH (EMERGENCY DEPARTMENT IN THE HOME): FACTORS THAT INFLUENCE CONVEYANCE RATES TO HOSPITAL
Authors: Davis A J , Doyle C , Dhonaill R N , Nally S M , Namara R M
Published: February 2023

Background

The EDITH team has provided an alternative care pathway for older adults in need of emergency services. Patients are attended to by a doctor and Occupational Therapist in their own home as an alternative to an emergency department presentation. The conveyance rate for transfers to hospital is 7.2% of total patients treated by the EDITH service. It is imperative to identify this patient group and look for commonalities in same. This assists with service planning and also identifies high risk patients who may need transfer to hospital; thus ensuring patients are prioritised appropriately within the service.

Methods

Following an audit of a subsample (n = 230) of the entire EDITH patient population (3,137 patients), 26 patients were transferred to hospital. Analysis of the Health Care Record was completed to identify similarities in this population group and compare same with the ‘typical patient profile’.

Results

It was found that 38% of patients had a recent ED presentation (in the past month) and 31% had a prolonged hospital stay (> 2 weeks in past year). 57% had a documented change in functional baseline over past 2 weeks. 46% of patients were transferred to level 4 acute hospitals for medical follow up and 54% were transferred to level 3 hospitals or rehabilitation facilities for MDT input. 77% of patients had a Clinical Frailty Scale score of 6 and above (moderately frail) compared with 62% of the non-conveyance population. Presenting complaints included: falls 35%, respiratory issues 12%, pain management 12%, gastrointestinal issues 12%.

Conclusion

Risk factors for conveyance to hospital for EDITH patients have been identified. This knowledge can potentially be used to triage patients and ensure timely review from EDITH for this high risk patient group.
159 BARRIERS AND FACILITATORS TO IMPLEMENTING NON-PHARMACOLOGICAL STRATEGIES TO MANAGE RESPONSIVE BEHAVIOURS OF NURSING HOME RESIDENTS WITH DEMENTIA
Authors: O'Donnell E , Holland C , Swarbrick C
Published: February 2023

Background

Many nursing home residents with dementia exhibit responsive behaviours including agitation and aggression. Psychotropic drugs are often prescribed to manage responsive behaviours but increase the rate of falls, strokes and death in residents with dementia. Therefore, the aim of this research is to conceptualise the barriers and facilitators to implementing non-pharmacological strategies to manage responsive behaviours.

Methods

Twenty-five interviews were conducted with nursing home managers, nurses and healthcare assistants from twenty-one private and voluntary nursing homes. Reflexive thematic analysis was used to conceptualise the barriers and facilitators to implementing non-pharmacological strategies to manage responsive behaviours. Ethical approval was obtained from the University Research Ethics Committee (Ref. FHMREC20091). All participants provided written informed consent.

Results

Three themes were constructed conceptualising the barriers and facilitators to taking a non-pharmacological approach to manage responsive behaviours. Strong leadership, specialised training in gerontology or dementia care and retention of staff long term supported the development of trusting relationships with residents. Treating residents with dementia with love and respect while providing meaningful activities enhanced resident’s self-esteem, facilitating a non-pharmacological approach to managing responsive behaviours. In addition, the engagement of families in residents’ care was found to be a powerful facilitator. However, sub-optimal teamwork between nurses and healthcare assistants and a lack of multidisciplinary collaboration posed barriers to taking a non-pharmacological approach to behaviour management. Furthermore, most healthcare assistants perceived that they were not valued, this also had a detrimental impact on residents’ care.

Conclusion

Conceptualisation of the barriers and facilitators to taking a non-pharmacological approach to manage responsive behaviours enables formulation of recommendations to address these barriers. These recommendations will assist in the development of dementia policy including the national dementia strategy, to implement sustainable non-pharmacological strategies to manage responsive behaviours of nursing home residents with dementia.
160 TIME TO BIN ‘NEXT OF KIN’?—JUNIOR DOCTORS DEMONSTRATE POOR UNDERSTANDING OF THE TERM IN IRELAND
Authors: Burke B , McGurk C , Murphy D , Claffey P , O'Keeffe S , Aherne E
Published: February 2023

Background

‘Next of kin’ (NOK) is a term widely used in the healthcare setting in Ireland to indicate an individual that can be contacted in the event of an emergency when a patient is in hospital. While it has its origins in Irish inheritance law, the term confers no legal or decision-making authority to any other individuals on behalf of a patient in hospital. However, anecdotally, the term is commonly misunderstood with a false belief among healthcare staff that consent should be sought from the NOK when a patient is unable to do so. In this study we sought to assess current understanding of the term among Irish non-consultant hospital doctors (NCHDs).

Methods

Data was collected via an online survey, completed by NCHDs across a number of medical and surgical disciplines to investigate their understanding of the term. Descriptive analysis of data was performed in Excel.

Results

118 NCHDs completed the survey. While 110 (93.2%) believed a NOK was an emergency contact, 53 (44.9%) believed they assisted in decision making; 58 (49.2%) thought they could provide medical information about the patient. Forty-four doctors (37.3%) believed a NOK was permitted to make medical decisions while 59 (50%) felt they could provide consent on behalf of an incapacitated patient. Sixty-three (53.4%) believed a NOK had legal entitlement to information over and above that of another family member or friend.

Conclusion

This study highlights several misconceptions surrounding the term ‘next of kin’ in the Irish healthcare setting, particularly around the area of decision-making authority and consent. The term is confusing and unhelpful and should not be used in healthcare. ‘Contact person’ or ‘emergency contact’ are appropriate alternatives. Further education to NCHDs around consent and maintenance of patient autonomy is necessary.
162 TRENDS IN EMERGENCY DEPARTMENT USE BY OLDER PEOPLE DURING THE COVID-19 PANDEMIC
Authors: Howley F , Lavan A , McMahon G , Mehmood M , Briggs R
Published: February 2023

Background

Older people have been disproportionately affected by the COVID-19 pandemic with reports suggesting that many older people deferred seeking healthcare during the pandemic due to fear of contracting COVID-19.

The aim of this study was to examine trends of emergency department (ED) use by older people during the first wave of the COVID-19 pandemic compared to previous years.

Methods

The study site is a 1,000-bed university teaching hospital with annual ED new-patient attendance of >50,000.

All ED presentations of patients aged ≥70 years from March–August 2020, 2019 and 2018 inclusive (n = 13,989) were reviewed and compared for presenting complaint, Manchester Triage Score, and admission/discharge decision.

Results

There was a 16% reduction in presentations across the 6 months in 2020 compared to the average of 2018/2019. On average 4 fewer people aged ≥70 years presented to the ED per day in 2020.

Much of this was concentrated in March (33% fewer presentations) and April (31% fewer presentations), when the country was in ‘lockdown’, i.e. non-essential journeys were banned.

There was a 20% reduction in patients presenting with stroke and cardiac complaints.

In the three months following easing of restrictions, there was a 25% increase in falls and orthopaedic injuries when compared to 2018/2019.

Conclusion

This study demonstrates a significant decline in the number of older people presenting to the ED for unscheduled care, including for potentially time-dependent illnesses such as stroke or cardiac complaints.

Presenting to the ED remains the most frequent route by which unwell older people access acute hospital care and it is vitally important that they continue to do so in a timely manner when necessary. Given the possibility of further lockdowns and restrictions, this message needs to be communicated to older people clearly by healthcare professionals and governmental bodies to mitigate against adverse outcomes related to delayed or deferred care.
171 THE ‘WISH TO DIE’ AMONGST OLDER PEOPLE IN IRELAND IN THE CONTEXT OF THE DYING WITH DIGNITY BILL
Authors: Briggs R , Ward M , Kenny R A
Published: February 2023

Background

‘Wish to Die’ (WTD) involves thoughts of or wishes for one’s own death or that one would be better off dead.

Assisted dying is the act of deliberately providing medical assistance to another person who wishes to end their own life. Currently, in Ireland, it is illegal to provide such assistance to people with WTD or suicidal ideation. However, a new bill that would legalise assisted dying for those with terminal illnesses, the Dying with Dignity Bill 2020, is due to be considered by lawmakers in Ireland in the coming months.

In order to inform discussion around this complex issue, we examine the prevalence and longitudinal course of WTD in a large population-representative sample of older people.

Methods

To define WTD, participants were asked: ‘In the last month, have you felt that you would rather be dead?’

Depressive symptoms were measured using the CES-D.

Mortality data were compiled by linking administrative death records to individual-level survey data from the study.

Results

At Wave 1, 3.5% of participants (279/8,174) reported WTD. Both persistent loneliness (OR 5.73 (95% CI 3.41–9.64)) and depressive symptoms (OR 6.12 (95% CI 4.33–8.67)) were independently associated with WTD.

Of participants who first reported WTD at Wave 1 or 2, 72% did not report WTD when reassessed after 2 years, and the prevalence of depressive symptoms (−44%) and loneliness (−19%) was more likely to decline in this group at follow-up.

Fifteen per cent of participants expressing WTD at Wave 1 died during a 6-year follow-up.

Conclusion

WTD amongst community-dwelling older people is frequently transient and is strongly linked with the course of depressive symptoms and loneliness.

An enhanced focus on improving access to mental health care and addressing social isolation in older people should therefore be a public health priority, particularly in the current context of the Covid-19 pandemic.
191 FRAILTY PREVALENCE AMONG GERIATRIC HOSPITAL INPATIENTS, AND ITS ASSOCIATION WITH ECONOMIC INDICATORS: A SYSTEMATIC REVIEW AND META-ANALYSIS OF 467,779 INPATIENTS
Authors: Doody P , Asamane E A , Aunger J A , Swales B , Lord J M , Greig C A , Whittaker A C
Published: February 2023

Background

Frailty is a common and clinically significant condition among geriatric populations. Although well-evidenced pooled estimates of the prevalence of frailty exist within various settings and populations, presently there are none assessing the overall prevalence of frailty among geriatric hospital inpatients. The purpose of this review was to systematically search and analyse the prevalence of frailty among geriatric hospital inpatients within the literature and examine its associations with national economic indicators.

Methods

Systematic searches were conducted on Ovid, Web of Science, Scopus, CINAHL Plus, and the Cochrane Library, encompassing all literature published prior to 22 November 2018, supplemented with manual reference searches. Included studies utilised a validated operational definition of frailty, reported the prevalence of frailty, had a minimum age ≥ 65 years, attempted to assess the whole ward/clinical population, and occurred among hospital inpatients. Two reviewers independently extracted data and assessed study quality.

Results

Ninety-six studies with a pooled sample of 467,779 geriatric hospital inpatients were included. The median critical appraisal score was 7/9 (range 7–9). The pooled prevalence of frailty, and pre-frailty, among geriatric hospital inpatients was 47.4% (95% CI 43.7–51.1%), and 25.8% (95% CI 22.0–29.6%), respectively. Significant differences were observed in the prevalence of frailty stratified by age, prevalent morbidity, ward type, clinical population, and operational definition. No significant differences were observed in stratified analyses by sex or continent, or significant associations between the prevalence of frailty and economic indicators.

Conclusion

Frailty is highly prevalent among geriatric hospital inpatients. High heterogeneity exists within this setting based on various clinical and demographic characteristics. Pooled estimates reported in this review place the prevalence of frailty among geriatric hospital inpatients between that reported for community-dwelling older adults and older adults in nursing homes, outlining an increase in the relative prevalence of frailty with progression through the healthcare system.
204 FRAILTY BUT NOT AGE IS ASSOCIATED WITH IMPAIRED ORTHOSTATIC CEREBRAL OXYGENATION
Authors: Pérez-Denia L , Claffey P , Byrne L , Rice C , Kenny R A
Published: February 2023

Background

The effects of age and frailty on cerebrovascular function are poorly understood. Here we investigate the hypotheses that aging, and frailty are accompanied by impaired regulation of cerebral oxygenation during standing in a patient population of older adults.

Methods

We recruited patients from a national Falls and Syncope service. All patients underwent an active stand test (5–10 min lying, 3 min standing) with continuous monitoring of blood pressure (BP) and heart rate. Tissue saturation index (TSI) was concurrently measured using near-infrared spectroscopy and its recovery measured at 30s after standing. Frailty was assessed as a comorbidity count using a 27-item questionnaire. Robust linear regression was used to investigate the association between TSI, age and frailty in a multivariate model with covariate adjustment, including the concurrent BP values. A p-value <0.05 was considered significant.

Results

304 patients (median(IQR): 71(14) years, 57% females) were recruited. Age was not associated with cerebral oxygenation after standing (β: −0.001 (−0.017 0.015), p = 0.899), even after stratification by sex (males: β: −0.010 (−0.045 0.024), p = 0.558, females: β: 0.000 (−0.017 0.018), p = 0.967). Frailty, was associated with a lower TSI at 30s after standing (β: −0.153 (−0.248–0.058), p = 0.002). After sex stratification, no associations with frailty were observed in males (β: −0.052 (−0.226 0.123), p = 0.557), while frailer females demonstrated a lower TSI at 30 seconds after standing (β: −0.179 (−0.294–0.063), p = 0.003) despite BP correction.

Conclusion

Our results suggest alternative mechanisms of cerebral oxygenation regulation independent of blood pressure (and presumably cerebral autoregulation) are involved in frailty related impairments of brain haemodynamics which are also independent of ageing. Such impairments represent novel biomarkers of frailty and represent potentially novel modifiable risk factors (independent of BP management) of hypoperfusion related disorders in clinical ageing.
207 IMPLEMENTATION OF A FRAILTY CARE BUNDLE (FCB) IN ACUTE AND REHABILITATION SETTINGS
Authors: Naughton C , Cummins H , Foubert M , Barry F , Wills T , McCullagh R , Ahern E
Published: February 2023

Background

During hospitalisation older adults are at greater risk of hospital associated decline (HAD), attributed to hospital processes that fail to prioritise fundamental care related to mobility, nutrition and cognitive health.

The study aims to enable the nursing and multidisciplinary team to prioritise early mobilisation, optimise nutrition and cognitive engagement in patients aged 60 years and older.

Methods

Four wards were recruited, two orthopaedic trauma and two orthopaedic rehabilitation. Following situational analysis on each ward, we used behaviour change theory COM-B (capability, opportunity motivation) to align the intervention components to barriers. These included inter-professional communication (mobility board with patient goals, nurse & physiotherapy huddles, daily mobility record); staff knowledge (education, coaching, posters); nutrition opportunities (assisted mealtimes, MUST tool, enhanced snack rounds) and cognition (patient information leaflet, distraction activity resources).

Data collection included observational audits of mobility measuring: % mean time walking, % patients sitting out of bed, % patients walked at last once, and nutrition: % of meals half or less eaten at baseline and 12-week follow-up. Each ward was observed from 8am to 5pm.

Results

In total mobility audit data was collected on 124 patients (pre =63, post 61), mean age 78 years (SD13.8) and 63% female. Mean data across the four wards are presented.

There were small positive changes in two mobility indicators: patients sitting out of bed (pre 69% vs post 76%); % patients walked at least once (pre 53% vs post 62%); there was no change in mean % time spent walking (pre 9% vs post 8%). Nutrition indicator: % meals <half eaten (pre 57.6% vs post 53%).

Conclusion

The FCB showed some promising trends in prioritising mobilisation and nutrition. Implementation relies on ward manager leadership, nursing team cohesion, and active role modelling from the MDT. Sustainability is likely to require ongoing facilitation resource.
210 A SYSTEMATIC REVIEW OF LONG-TERM OUTCOME COLLECTION FOLLOWING HIP FRACTURE IN IRELAND FROM 2005 TO 2021
Authors: Walsh M , Cunningham C , Brent L , Savin B , Fitzgerald M , Blake C
Published: February 2023

Background

The Irish Hip Fracture Database (IHFD) drives clinical improvements across 16 acute hospitals for over 3,500 patients annually. The IHFD aims to begin recording long-term outcomes. Past practice in Ireland could inform this activity. This review aims to identify and summarise studies that have collected long-term outcomes following hip fracture in Ireland.

Methods

A search of electronic databases (MEDLINE, Embase, Scopus, Web of Science, CINAHL) and grey literature was conducted in July 2021 for articles, abstracts, theses and reports. Search terms related to hip fracture and Ireland. Studies published from 2005–2021 were included if post-hospital discharge data were collected in the Republic of Ireland for patients with hip fracture. Study and patient characteristics, data collection methods and long-term outcomes were extracted.

Results

From all sources, 21 articles, 3 theses and 84 abstracts from 18 clinical sites were identified. Numbers of patients with hip fracture ranged from 9 to 2,483 (median 168) across publications. The most common outcome recorded was mortality (59% of publications), most frequently at 30 days and/or one year. Ascertainment methods for mortality included electronic patient records, online death notices, phone calls to family or general practitioners and the national death register. Non-mortality long-term outcomes were assessed in 64% of publications, most commonly through outpatient or virtual clinics or phone calls. They included place of residence, function, mobility and bone-health status at time-points of 30 days, 6 weeks, 3, 4, 6 or 12 months. Only 11 publications followed patients past the 1 year time-point. One third of publications did not report data collection methods.

Conclusion

Meta-analyses of results will provide estimates of mortality rates and other key hip fracture outcomes. Some long-term outcomes have been collected at most hospitals treating acute hip fracture in Ireland in the last 15 years. Qualitative research in needed to identify facilitators of follow-up to inform practice nationally.
239 IS ORTHOSTATIC HYPOTENSION ASSOCIATED WITH ALTERED CEREBRAL PERFUSION DURING ACTIVE STANDING?
Authors: Claffey P , Pérez-Denia L , Dyer A , McNicholas T , Briggs R , Finucane C , Kenny R A
Published: February 2023

Background

Orthostatic Hypotension (OH) is associated with poor health outcomes in later life including depression, cognitive impairment, frailty and falls. Whilst it is hypothesised that OH compromises cerebral autoregulation leading to hypoperfusion, this has not been robustly demonstrated to date. This study investigated the association between OH and cerebral perfusion during orthostasis using a non-invasive surrogate of cerebral perfusion, Near Infrared Spectroscopy (NIRS).

Methods

Four hundred and ninety one participants (58% female, median age 65, IQR 38–92) attending a falls and syncope service underwent measurement of beat-to-beat blood pressure (BP) by finometry and real-time frontal lobe perfusion (% TSI: Tissue Saturation Index) by NIRS during the active stand manoeuvre. We examined the association between OH and change in cerebral perfusion (delta TSI) using mixed-effects linear regression, with adjustment for important clinical covariates.

Results

Nearly two-fifths of the sample (189/491,38.5%) met criteria for OH occurring between 30 and 120 seconds after standing. Using mixed effects linear regression models, we observed a significant relationship between OH and TSI at the same timepoint (β −0.53, −0.59 to −0.46, p < 0.001) which persisted following adjustment for confounders including age, sex, baseline blood pressure, cerebrovascular and cardiovascular disease, depression/anxiety, diabetes, systolic blood pressure, antihypertensives, and antidepressants (β −0.51, −0.58 to −0.44, p < 0.001). Cerebral perfusion levels differed for those with OH compared to those without.

Conclusion

OH is independently associated with lower frontal lobe cerebral perfusion. This association may indicate disruption to dynamic cerebral autoregulation and explain the significant link between OH and poor health outcomes.
240 A COMPARISON OF THE ISAR AND THE CLINICAL FRAILTY SCALE TO PREDICT MORTALITY AND ED RE-ATTENDANCE IN OLDER ED ATTENDERS
Authors: Leahy A , Corey G , O'Neill A , Higginbotham O , Devlin C , Barry L , Cummins N , Gabr A , Shanahan E , Shchetkovsky D , Ryan D , O'Connor M , Galvin R
Published: February 2023

Background

Frailty Screening is one method by which we can risk stratify older adults to urgent assessment in the Emergency Department. The ISAR (Identification of Seniors at Risk) and Rockwood Clinical Frailty Scale (CFS) are two frailty screening tools. We assessed the validity of these tools at predicting adverse outcomes for older adults presenting to the Emergency Department.

Methods

This was a prospective cohort study. Patients over 65 were recruited, baseline demographics were obtained and a research nurse assessed them using both the CFS and ISAR. Patients were assessed by telephone interviews at one month and six months. The outcome measures assessed were mortality, ED re-attendance, hospital readmission, functional decline and institutionalisation.

Results

419 patients were recruited. 53.3% (223) were male with a median age of 76 (IQR = 10). At baseline, the median ISAR was 2 and CFS was 5. The mortality rate was 5.4% and the rate of ED re-attendance was 16.9% at one month. The relative risk of ED re-admission with an ISAR score ≥ 2 was 1.84 (1.12, 3.02) and CFS > 4 was 1.85 (1.08, 3.16). The ISAR tool ≥2 had a sensitivity of 74% (95% CI = 62.44, 83.99) and specificity of 41% (95% CI = 35.90, 46.61) when used as a diagnostic tool for ED re-admission at one month. The CFS > 4 had a sensitivity of 71% (95% CI = 57.79, 82.70) and specificity of 45% (95% CI = 39.33, 51.23) for ED re-attendance.

Conclusion

The ISAR tool ≥2 was more sensitive at predicting ED reattendance at one month in comparison to the CFS. We advocate to use this tool in the ED setting to highlight those at greatest risk of adverse outcomes and those most likely to benefit from Comprehensive Geriatric Assessment.
241 IMPLEMENTATION OF AN INTRACEREBRAL CEREBRAL HAEMORRHAGE CARE BUNDLE
Authors: Gabr A , Cunningham N , Kennedy C , Mohamed A , Okpaje B , Saleh A , Leahy A , El-Kholy K , Carrol I , Paulose S , Daly N , Harnett A , Buckley E , Kiely P , McManus J , Peters C , Quinn C , Prendiville T , Lyons D , Watts M , O’Keefe D , Galvin R , Murphy S , O'Connor M
Published: February 2023

Background

Mortality for Intracerebral haemorrhage (ICH) is 31% (Irish National Audit Stroke, 2019). An ICH care bundle focusing on acute anticoagulation reversal, blood pressure lowering, and a neurosurgical care pathway was associated with improved survival. Translating evidence-based medicine into clinical practice is challenging. The aim of this study was to determine feasibility and outcomes of implementation of a care bundle.

Methods

An ICH care bundle was developed using an iterative process involving expert stakeholder review of the evidence-based literature. A pre-and-post quasi-experimental research design was employed to evaluate this intervention. Baseline data were collected before implementation (January 2016-June 2018). Implementation took place in a staged manner in a single university teaching hospital with multiple ‘Plan Do Study Act cycles’ (June 2018 to January 2021). Data on compliance, process measures and outcomes were collected.

Results

Systolic blood pressure (first 24-hours) and anticoagulant reversal were significantly better controlled post-implementation (χ2 (1, N = 91) = 5.34, P = 0.02), (χ2 (1, N = 25) = 5.85, P = 0.016), respectively. DNAR orders were significantly lower in the post-implementation group (χ2 (1, N = 25) = 5.85, P = 0.029). However, ‘Do Not Actively Resuscitate’ status did not significantly differ when accounting for low GCS as a surrogate measure for poor prognosis (χ2 (1, N = 34) = 0.00, P = 0.966). Modified Rankin Scale on discharge did not differ significantly pre-and-post-implementation (z = −0.075, P = 0.94). A greater proportion of patients survived in the post-implementation group; however, this was not statistically significant (χ2 (1, N = 133) = 0.77, P = 0.38). Length of stay significantly increased post implementation.

Conclusion

An ICH care bundle was developed based on expert stakeholder feedback. The feasibility of implementing this bundle of care was demonstrated in a real-world clinical practice setting. A cluster-randomized trial or a large registry study is the next step to evaluate the overall impact of this care bundle on patient outcomes.
29 USING QUALITY IMPROVEMENT METHODOLOGY TO VISUALISE CHANGE INTERVENTIONS TO IMPROVE MANAGING THE UNWELL CARE HOME RESIDENT
Authors: Trolan C
Published: February 2023

Background

The COVID19 pandemic highlighted deficiencies in the recognition, monitoring, escalation and de-escalation of the acutely unwell care home resident. RESTORE2 is endorsed by the British Geriatric Society as the preferred tool for use in a care home setting. It incorporates: recognition of soft-signs; NEWS2 (National Early Warning Score 2); and SBAR-D (Situation Background Assessment Recommendation-Decision). Implementing RESTORE2 required a series of change interventions in a mesosystem environment in intermediate care bed-based rehabilitation setting in an independent care home.

Methods

The Flow Coaching Academy ‘5Vs’ Framework was used. A vision of ‘CHAIN of CARE’ was developed (Care Home Assessment of Intervention Need and Communicate Act Review Evaluate). Stake-holder mapping was undertaken. A Sinek Circle distilled intentions. A global aim led to specific aims and informed driver diagrams. Problems and risks were mapped out with an Ishikawa diagram. A high-level process map of future state was and cross-functional swim-lane chart for RESTORE2 use were devised. A clinical value compass map was used to consider outcomes. PDSA cycles were used.

Results

The FCA Framework methodology, albeit without the ability to undertake ‘Big Room’ meetings due to the COVID19 pandemic restrictions, enabled the development of a care-home tailored Treatment Escalation Plan; an electronic template Nursing Handover; Multidisciplinary Safety Brief; training of all nursing team in RESTORE2; and use of NEWS2 for all residents in the intermediate care setting. Additional prompt for how to use RESTORE2 was developed.

Conclusion

Bringing about complex change in a complex mesosystem benefits from different techniques than microsystem change methodology. The 5Vs: Visualisation, Vision, Value, eVidence and inVolvement in the FCA Framework are an effective approach. The residents’ voice was largely absent in the pressures of the COVID19 pandemic.

‘The Chain of Care’ proved helpful in visualising the global aims for the clinical team.
42 EXPLORING THE IMPACT OF AGE AND FRAILTY STATUS ON THE IMMUNE RESPONSE TO COVID-19 ILLNESS USING DETAILED IMMUNO-PHENOTYPING
Authors: Dyer A , Townsend L , Naughton A , Kiersey R , Holden D , Gardiner M , Dunne J , O'Farrelly C , Cheallaigh C N , Conlon N , Bourke N
Published: February 2023

Background

Whilst age and frailty are independently associated with mortality in COVID-19 illness, the underlying immunological mechanisms explaining this remain unexplored. We aimed to explore the impact of age and frailty on the acute immune response to COVID-19 illness.

Methods

We recruited older (aged 65+; n = 33) and younger (aged 20–50; n = 43) participants with acute COVID-19 illness for clinical assessment and detailed immunophenotyping for T-cell, neutrophil, monocyte and inflammatory markers using flow cytometry. We additionally assessed circulating levels of several important pro-inflammatory cytokines. Wilxocon rank-sum, chi-square tests and linear regression were used to examine the impact of age and frailty (Clinical Frailty Score 3–9) on the immune response in COVID-19 illness. Results were compared to age-matched pre-pandemic controls (n = 40).

Results

COVID-19 illness was associated with a marked pro-inflammatory response (raised CRP, IL-6, IL-2R), lymphopenia and emergency myelopoesis (an expansion of non-classical/intermediate monocytes and immature neutrophils) in both age groups (all P < 0.001). In comparison to younger participants (35.7 ± 8.6 years), older adults (76.7 ± 7.8 years) had a more marked reduction in naïve CD4+ and CD8+ cells and a more marked expansion of activated CD4+, CD8+ and effector CD8+ T-cells (all P < 0.001). These findings were independent of illness severity (all P < 0.001). In comparison to their younger counterparts, older adults had a reduced number of CD10+ neutrophils/non-classical monocytes and greater CRP, IL-6 and IL-2R (P < 0.05), although results were attenuated on adjusting for COVID-19 severity. Frailty was not associated with any significant difference in immune cell population or pro-inflammatory response in acute COVID-19 illness.

Conclusion

Increasing age, but not frailty status, was associated with reduced naïve T-cells and a more marked expansion of activated/effector T-cells in acute COVID-19 illness. These findings have important implications for understanding impact of age on anti-viral and pro-inflammatory immune responses.