bluuebunny/crossref_metadata_2025 huggingface dataset:
Effect of Al content on microstructure and mechanical properties of Alx(Nb3TaTi3Zr)100-x
refractory high-entropy alloys
Authors: Chen Sishuo , Bao Li , Yang Hongtao , Si Xudong , Yu Qi
Published: January 2024

In this study, seven refractory high-entropy alloys of Al
x
(Nb3TaTi3Zr)100-x
(x = 0, 5, 10, 15, 20, 25, 30) were synthesized by vacuum arc melting and characterized by various techniques, including XRD, SEM, EDS, compression tests at both 1200 °C and room temperature, as well as hardness tests. The analysis revealed that the alloys exhibit a single BCC structure when the Al content is between 0 and 15%, while the B2 phase appears at 20% and a mixed structure of BCC + B2 + σ phase at 30%. As the Al content increases, the hardness, stiffness, and room temperature yield strength of the alloy increases, while the plasticity decreases. Notably, the alloy with 25% Al content displayed the highest yield strength of 1400 MPa and Young’s modulus of 75.94 GPa at room temperature. Moreover, the hardness of the seven alloys increased from 247 HV to 490 HV with Al content from 0 to 30%. Furthermore, the alloy containing 30% Al exhibited a notable elevated-temperature yield strength of 143 MPa at 1200 °C.
Effect of hydrogen on the fretting wear mechanism of a high Nb-TiAl alloy
Authors: Qian Chunguang , Sun Yongshuo , Liu Lihua , Wen Daosheng , Wang Xinwei , Yuan Haifeng
Published: January 2024

In this paper, the effect of hydrogen placement on the microdynamic wear mechanism of high niobium-titanium-aluminum alloys is investigated. Corresponding decreases and increases in loading force and displacement amplitude cause the microslip behavior of the alloy to change from partial slip to mixed slip. Slip type in mixed fire complete slip when you, the friction coefficient fluctuates. The average friction coefficient of hydrogen-placed alloys is small compared with that of non-hydrogen-placed alloys, the maximum wear marks are not obvious, and the oxidative wear is weak. The main wear mechanisms of non-hydrogenated alloys are adhesive wear, abrasive wear and oxidative wear. The main wear mechanisms of hydrogen-placed alloys are adhesive wear and abrasive wear.
GaN based DC-DC converters for high energy physics applications
Authors: Pradas A. , Plumed G. , Arcusa A. , Echeverria I. , Galindo J. , Iglesias M. , Rivetta C. , Arteche F.
Published: January 2024

This paper introduces a prototype of a GaN-FET based 200 W DC-DC converter. Its design has been carried out to evaluate power density (or power dissipation and volume) and ensure minimal electromagnetic interference (EMI) issues that are commonly associated with the high switching frequency converters. To achieve this ANSYS HFSS-SiWave models have been developed to assess noise emissions based on the parasitic elements of PCB layout. Prototypes performance have been evaluated through extensive testing. This work offers insight into the potential of this technology in future physics detectors.
Laser Thomson scattering measurements around magnetized model in rarefied argon arcjet plume
Authors: Katsurayama H. , Wada R. , Moriyama K. , Tomita K.
Published: January 2024

To elucidate the role of the Hall effect in magnetohydrodynamic (MHD) aerobraking in
rarefied flows,we measured the radial distributions of electron temperature and density in front
of a magnetized model in a rarefied argon arcjet wind tunnel using the laser Thomson scattering
method. We also developed a water-cooled magnetized model to prevent thermal demagnetization
during the measurement. The measured electron density
distributions were in
excellent agreement
with computational fluid dynamics (CFD) predictions. It was also found that the magnetic field had
little effect on the electron density distribution around the model. In the case without the
magnetic field, the measured electron temperature almost agreed with the CFD prediction. However,
the measured electron temperature increase caused by applying the
magnetic field was about
1,000 K less than that of the CFD prediction. This discrepancy indicates that the location of
an insulating boundary in the plasma is far from the model.
The decimation scheme for symmetric matrix factorization
Authors: Camilli Francesco , Mézard Marc
Published: January 2024

Matrix factorization is an inference problem that has acquired importance due to its vast range of applications that go from dictionary learning to recommendation systems and machine learning with deep networks. The study of its fundamental statistical limits represents a true challenge, and despite a decade-long history of efforts in the community, there is still no closed formula able to describe its optimal performances in the case where the rank of the matrix scales linearly with its size. In the present paper, we study this extensive rank problem, extending the alternative ‘decimation’ procedure that was recently introduced by Camilli and Mézard, and carry out a thorough study of its performance. Decimation aims at recovering one column/line of the factors at a time, by mapping the problem into a sequence of neural network models of associative memory at a tunable temperature. The main advantage of decimation is that its theoretical performance can be studied using statistical physics techniques. In this paper we provide the general analysis applying to a large class of compactly supported priors and we show that the replica symmetric free entropy of the neural network models takes a universal form in the low temperature limit. We then study the decimation phase diagrams in two concrete cases, the sparse Ising prior and the uniform prior, for which we show that matrix factorization is theoretically possible when the ration

P

/

N

of rank to variable is below a certain threshold. This suggest that a possible route to solving algorithmically the matrix factorization problem could be to find efficient decimation algorithms; in this respect, we show that simple simulated annealing, though being effective for limited signal sizes, is not scalable.
Application of MEMS technology in the system monitoring parameters of powered roof support’s operation
Authors: Trzop K
Published: January 2024

The use of innovative technologies in hard coal production directs the development of the whole industry. The pace of environmental and social changes generates the need for continuous improvement of the coal mining process. Technological solutions of other industries that are used on a large scale are often implemented in extracting hard coal. One of the critical areas requiring continuous improvement in coal production is the machine park. This area is the most essential part of the entire production process. Machines and equipment require constant monitoring to ensure production continuity. A solution that covers this issue is the measuring and recording system that monitors the geometric parameters of the powered roof support. The system uses MEMS technologies to measure changes in the inclination of the powered roof support’s elements. The measuring system allows us to define the height and inclination of the powered roof support in the mining wall. The paper presents how the MEMS technology is used in sensors and the course of bench tests of the powered roof support, which were one of the stages determining the guidelines for the system’s operation in real conditions.
A case study of petrophysical prediction using machine learning integrated with interval inversion in a tight sand reservoir in Egypt
Authors: Abdelrahman M M G , Szabó N P
Published: January 2024

This study presents a new algorithm for reservoir characterization using borehole logging data, which integrates unsupervised machine learning techniques and interval inversion to automatically determine layers’ boundaries and petrophysical parameters. The research aims to reduce the time and manual input required for borehole inversion to estimate petrophysical parameters. The algorithm was used to predict different layer boundaries of sand-shale intercalations for both synthetic and field wireline log data. Field well logging measurements were obtained from an oil and gas field in Egypt, specifically the Jurassic reservoir. The reservoir is composed of a dense sandstone layer with significant heterogeneity due to diagenesis, which converts kaolinite into illite. The algorithm was used to predict petrophysical parameters, resulting in a decrease in porosity and permeability. The field data from the well reveals that the reservoir is made up of varying-quality sandstone, impacting storage capacity and hydrocarbon saturation. The algorithm demonstrates consistent convergence of the data at 7.5%. Overall, the integration of the new cluster technique and interval inversion can improve the time-intensive and laborious process of borehole data inversion to estimate petrophysical parameters.
An experimental study of tensile stress and deformation in an anisotropic rock
Authors: Alencar A , Muñiz-Menéndez M , Pérez-Rey I , Galindo R
Published: January 2024

Anisotropy is a very common condition in rock mass; it can be due to different factors and directly affects the failure mechanisms affecting the rock mass. For example, metamorphic rocks that are foliated, sedimentary rocks that are stratified or volcanic formations with alternating layers. Despite the existence of several studies related to anisotropy those specifically addressing the tensile strength of anisotropic rocks are quite limited. The present study is focused on the determination of the deformability, compressive and tensile strength of anisotropic rocks. It must be highlighted that the mechanical behavior of the anisotropic rock mass is dependent on the angle between the inclination of planes of weakness (e.g. foliation) and the direction of the load. Assuming a vertical load, the two extremes of tensile strength are 0°(horizontal) and 90° (vertical). A series of laboratory tests has been done in anisotropic sandstone (lithic arkose), from Burgos (Spain), including uniaxial compressive strength tests, direct tensile strength tests, and diametric compression (Brazilian tests). The tests were carried out with strain gauges that allowed estimating the elastic modulus. To determine the anisotropic direction, ultrasonic pulse wave velocity tests were also performed. The variation of strength and deformability as a function of anisotropy is analyzed, as well as the variation of elastic behavior in tensile and compressive.
Proposal for a new Green Red Water Index for geo-environmental surface water monitoring
Authors: Pawlik Marcin , Rudolph Tobias , Bernsdorf Bodo , Benndorf Jörg
Published: January 2024

One of challenges of today’s world is the long-term geo-monitoring of phenomena and processes that affect our environment after the closure of mining activities. Water resources are one of the components affected by post-mining processes. Moreover, land subsidence can be observed both during and after the cessation of mining activities. This phenomenon has an impact on the entire water management of a region. So far, radar or multispectral images have been used to identify water surfaces. This paper will present a methodology for using drones to detect water surfaces using vegetation indices such as NDVI, GRNDVI and NDWI. During their research, the authors modified the GRNDVI indicator by including the Red Edge band in the calculations. The newly developed Green Red Water Index – GRWI, makes it possible to identify water surfaces. This is important, because the change of water conditions makes it important focus more on the water supply and availability. However, analysis of the spectral bands of the different land-use classes in the Ruhr study area shown that the spectral profiles for water, soils, road and street surfaces have similar spectral characteristics and therefore difficulties may arise in distinguishing between the land-use classes shown. In this article a comparison of the indicators will be presented: NDVI, GRNDVI, NDWI and GRWI together with their statistical interpretation.
New bounds for Stein’s square function in ℝ³
Authors: Gan Shengwen , Jing Yifan , Wu Shukun
Published: January 2024

We prove an

L
p

(

R

3

)

L^p(\mathbb {R}^3)

bounds on Stein’s square function for

p
≥
3.25

p\geq 3.25

. As an application, it improves the maximal Bochner–Riesz conjecture to the same range of

p
p

. The main method we used is polynomial partitioning.
An introduction to decoupling and harmonic analysis over ℚ_{𝕡}
Authors: Li Zane
Published: January 2024

The goal of this expository paper is to provide an introduction to decoupling by working in the simpler setting of decoupling for the parabola over

Q

p

\mathbb {Q}_p

. Over

Q

p

\mathbb {Q}_p

, commonly used heuristics in decoupling are significantly easier to make rigorous over

Q

p

\mathbb {Q}_p

than over

R

\mathbb {R}

and such decoupling theorems over

Q

p

\mathbb {Q}_p

are still strong enough to derive interesting number theoretic conclusions.
Some results for the Szegő and Bergman projections on planar domains
Authors: Wagner Nathan
Published: January 2024

The purpose of this note is to prove some boundedness/compactness results of a harmonic analysis flavor for the Bergman and Szegő projections on certain classes of planar domains using conformal mappings. In particular, we prove weighted estimates for the projections, provide quantitative

L
p

L^p

estimates and a specific example of such estimates on a domain with a sharp

p
p

range, and show that the “difference” of the Bergman and Szegő projections is compact at the endpoints

p
=
1
,
∞

p=1, \infty

for domains with sufficient smoothness. We also pose some open questions that naturally arise from our investigation.
Oscillation inequalities for Radon averages
Authors: Langowski Bartosz
Published: January 2024

We prove one-parameter oscillation estimates for the family of Radon means. The result generalizes the result of Jones, Kaufman, Rosenblatt and Wierdl.
Boundedness and compactness of Hausdorff operators on Fock spaces
Authors: Blasco Óscar , Galbis Antonio
Published: January 2024

We obtain a complete characterization of the bounded Hausdorff operators acting on a Fock space

F
α
p

F^p_\alpha

and taking its values into a larger one

F
α
q

,
 
0
>
p
≤
q
≤
∞

F^q_\alpha ,\ 0 > p \leq q \leq \infty

, as well as some necessary or sufficient conditions for a Hausdorff operator to transform a Fock space into a smaller one. Some results are written in the context of mixed norm Fock spaces. Also the compactness of Hausdorff operators on a Fock space is characterized. The compactness result for Hausdorff operators on the Fock space

F
α
∞

F^\infty _\alpha

is extended to more general Banach spaces of entire functions with weighted sup norms defined in terms of a radial weight and conditions for the Hausdorff operators to become

p
p

-summing are also included.
Further accelerating biologics development from DNA to IND: the journey from COVID-19 to non-COVID-19 programs
Authors: Tan Kee Wee , Ji Pengfei , Zhou Hang , Zhang Sam , Zhou Weichang
Published: January 2024

The Coronavirus Disease (COVID-19) pandemic has spurred adoption of revolutionary initiatives by regulatory agencies and pharmaceutical industry worldwide to deliver therapeutic COVID-19 antibodies to patients at unprecedented speed. Among these, timeline of chemistry, manufacturing and control (CMC), which involves process development and manufacturing activities critical for the assurance of product quality and consistency before first-in-human clinical trials, was greatly reduced from typically 12–15 months (using clonal materials) to approximately 3 months (using non-clonal materials) in multiple cases. In this perspective, we briefly review the acceleration approaches published for therapeutic COVID-19 antibodies and subsequently discuss the applicability of these approaches to achieve investigational new drug (IND) timelines of ≤10 months in over 60 COVID-19 and non-COVID-19 programs performed at WuXi Biologics. We are of the view that, with demonstrated product quality and consistency, innovative approaches used for COVID-19 can be widely applied in all disease areas for greater speed to clinic.
1956 Audit on the prompt mobilisation of patients following hip arthroplasty
Authors: Hama B , Illsley A
Published: January 2024

Background

Hip fractures are fractures involving the femoral head, neck or proximal shaft. They most often occur in frail, osteoporotic elderly patients following falls. Hip fractures are associated with a 30-day mortality rate of 10% and a 1-year mortality rate of approximately 30%. NICE and NHFD advise prompt mobilisation post-surgery - with patients being mobilised by the day after surgery at the latest: 1. Nice Guidelines Hip Fracture in Adults; Quality statement 6: Rehabilitation after surgery 2. NHFD KPI 4 – prompt mobilisation after surgery

Method

We carried out two audit cycles assessing the mobilisation rate of patients by the day after hip arthroplasty, at Bradford Royal Infirmary. In the first cycle, from 23 eligible patients, we found only 15 (65%) were mobilised within a day of surgery.

Results

These patients had a reduced length of stay compared to the patients not mobilised by the day after surgery (15.1 vs 18.1 days). As per our data, the reasons for delayed mobilisation included 1. pain (suggest early and regular analgesia), and 2. system miss (discussed with local physiotherapy team). After four months we reaudited. Of 23 eligible patients we found an improvement in patients being mobilised - 17 patients (74%) were mobilised within a day of surgery. Once again length of stay was less in the patients who had been mobilised (21.2 vs 29.7 days). Similar reasons for delayed mobilisation remained.

Conclusion

Our interventions improved the promptness of mobilisation in patients who had undergone hip arthroplasty. This led to a reduced duration of inpatient stay and better patient outcomes. Audit limitations included population size.
1940 Delirium in acute medicine inpatients - are we still missing it? Results from an 8-year audit in a District General Hospital
Authors: Van’t Hoff C , McColl A , Johnson D , Boncey K
Published: January 2024

Introduction

Improving delirium screening in hospital patients is a recognised important goal to improve patient outcomes, with consequences of delirium including increased mortality, falls, length of stay and dependence on discharge. We undertook a rolling audit over 8-years to examine the use of screening tools to identify delirium and how many cases of delirium were potentially missed in acute medical inpatients in a District General Hospital.

Methods

4 cycles of audit were completed over an 8-year period (2015–2023) through a snap-shot prospective review of all acute medical inpatients aged over 65 years during a 24-hour period. The medical records were examined for admission delirium screen and the delirium documentation within the first 48 hours. Where a diagnosis of delirium had not been made, the notes were reviewed to see if an inference of delirium during this period could be made.

Results

A total of 873 patient notes were reviewed between 2015–2023. The completion rate of screening for delirium increased to 87% in 2023 (2015/2017/2019=3%/13%/69%). Overall, the diagnosis of delirium that was explicitly stated in the notes (made via CAM/4AT or clinical assessment) similarly increased to 32% in 2023 (2015/2017/ 2019=10%/22%/12%). However, in the recent results a delirium diagnosis was potentially still missed in 10% of cases, though this similarly had improved from prior years (2015/2017/2019=18%/13%/26%). Overall, in hospital the number of patients >65 admitted under the care of medicine with delirium in the initial 48 hours has remained constant since 2015 between 30%-42%.

Conclusions

A significant improvement in the screening for delirium has occurred between 2015 to 2023 due to multiple changes: electronic notes, pop-up notifications, obligatory completion and change from CAM to 4AT. Reassuringly, the potential missed cases of delirium have reduced also.
1957 Brushing up on oral health: Improving oral health practices in geriatric inpatients
Authors: Fernandes R , Ward C , Hope S
Published: January 2024

Introduction

Poor oral health is linked to multiple health conditions, for example pneumonia, cardiovascular and cerebrovascular disease, cancer and diabetes. Older people are particularly vulnerable to developing poor oral health due to comorbidities, medications used, and access to dental services, an effect magnified during hospital admissions. The aim of this project is to improve oral health and care received by inpatients on Healthcare for Older People (HfOP) wards.

Methods

A baseline audit of patient-response surveys on oral health access and behaviours, and care during hospital admissions was performed. HfOP inpatients aged >75 with capacity to consent were included. Plan-Do-Study-Act cycles informed interventions, focusing on education of multidisciplinary staff. First round interventions included presenting/discussing initial audit findings at a regional HfOP meeting, and working with Oral Health Practitioners to do ward-based micro-teaching and develop/distribute posters raising awareness. Second round interventions included a more in-depth certified educational session available to all HfOP staff on oral health care and promotion, and posters on how to document oral health aspects on the electronic patient record.

Results

82% (82/100) patients reported being registered with a dentist, 50% attending a dentist in the last 12 months. Initially, only 17% (17/100) reported ward staff taking measures to ensure/help support their oral health, rising to 46% (46/50) in the second audit.

Conclusions

Though patient surveys may under-represent oral health access/issues by excluding people unable to consent, and may under-represent staff support offered/provided by recall bias, our audit did highlight gaps in staff awareness/practice. Our interventions were designed to benefit all inpatients, via opportunistic ward-based education through the audit process and formal educational sessions. Limitations included logistics of ensuring access to all staff groups. Our goal is to formalise oral health training in core MDT teaching to generate systemic lasting improvement.

Other information

Registered with local trust audit programme.
1846 A bespoke teaching programme for Hospital at Home improves staff confidence in the clinical management of HaH presentations
Authors: Haf M , Hawkes O
Published: January 2024

Background

Hospital at Home (HaH) provides high acuity clinical care for patients in the community. HaH teams are varied and multidisciplinary. A successful HaH service depends upon streamlined communication between multidisciplinary team (MDT) members, facilitated by an integrated knowledge base. Whilst training protocols are under development, there are currently no published teaching programmes for HaH. We responded to this unique challenge by devising a teaching programme for the HaH team at St John’s Hospital, Livingston.

Methods

We identified learning needs within our team with a preliminary survey. We conducted a literature review to select four competency resources which were mapped to five domains: clinical care; pharmacy; service design and delivery; anticipatory care planning and palliative care; and ethical and legal guidance. We formalised a weekly teaching session and linked teaching topics to the core competencies. We conducted a review at 3 months and 6 months to assess the impact of the programme on staff learning and clinical confidence.

Results

A tailored teaching programme with domains linked to multidisciplinary competencies increases staff confidence in the clinical management of common HaH presentations. Our bespoke programme has successfully delivered teaching that caters for multiple clinical backgrounds.

Conclusions

HaH teams represent an opportunity to learn from MDT colleagues with diverse training backgrounds and offer a unique challenge in tailoring teaching to multiple learning needs. A formal programme with clear, identifiable domains linked to learning objectives provides an essential framework for staff to demonstrate engagement with professional development, allows staff to develop personal teaching skills and cultures a strong collaborative learning environment. Going forward, we aim to evaluate the impact on staff competence and formalise a cyclical HaH curriculum for circulation to the NHS Lothian HaH teams with scope for wider dissemination.
1715 A Hospital at Home service working with care homes to triage acutely unwell patients
Authors: Adenwalla F , Davies A , Thomas L , Grimstead A , Jenkins R , Kelly S , Hopkins L , Britton A , O'Shea N
Published: January 2024

Introduction

The Acute clinical team (ACT) is a Hospital at Home (H@H) service and supports care homes to look after residents who are acutely unwell but residents were being inappropriately admitted instead of being referred to ACT. This was due to the lack of awareness among staff about ACT and GPs advising homes to call 999 due to their inability to see patients.

Method

ACT would phone all the care homes three times a week to ascertain if the care home had residents who were acutely unwell or not responding to treatment initiated by the GP. Residents who were identified would be triaged and either advice would be given or patient would be seen within 24 hours.

Results

The intervention took place from 20/03/23 to 30/04/23. Total number of referrals- 33. Average age- 87 years. 5/33 (15%) were given advice and 28/33 (85%) had face to face assessment. 29/33 remained at home. 4/33 were admitted 2 died. The 28/33 who received face to face assessments had received 106 GP consultations (most were virtual) within one month of referral equating to 3.7 consultations per patient. 8/28 patients had been discharged from hospital within 28 days of referral to ACT. ACT administered parenteral fluids 11/28 patients, Intravenous antibiotics 5/28, medication review with changes 14/28.

Conclusion
2035 The Feasibility to Staff of Patient Specific Music Choice on Elderly Care Wards - A Post Intervention Survey
Authors: Allfree R , Greenaway A-M , Chatterjee A , McColl A
Published: January 2024

Introduction

Receptive music listening has been shown to reduce depression, anxiety, and agitation in older adults. However, unfiltered and disruptive noise can increase confusion and agitation. Yet, during hospitalization older patients often have little control over when and for how long they are exposed to music, the genre which is heard, or they may have no access to music. Furthermore, older persons have reduced ability to use modern technology to counter this and their sensory and functional impairments may further isolate them. This study aimed to assess the feasibility of offering two one-hour daily sessions of patient specific music (PSM) choices on an elderly-care ward.

Methods

On a district general hospital elderly-care ward a 5-day trial of offering two one-hour daily sessions of PSM, using enhanced wireless speakers optimally positioned with daily amended music playlists based on specific patient choice. Ambient noise was minimised with regular decibel monitoring. A post-intervention staff survey was completed to assess the feasibility of continuing, the perceived impact on staff and patients and potential barriers to continuation. Thematic analyses were completed on the survey.

Results

In the post-intervention feasibility survey (n=14) the majority of staff (86%) agreed that it was possible, implementable and the procedure easy to use. In the impact assessment (n=19) 80% of staff stated it had a positive effect on patients and 89% stated it had a positive effect on staff. Thematic analyses on impact identified benefits to: work, engagement, enjoyment, physical activity and well-being. Barriers that were identified included patient choice, repetition of music, patients unable to engage with the process and staff availability for consistent delivery.

Conclusion

Playing patient specific music choice was feasible and acceptable to staff with a perceived positive influence on both staff and patients. Further studies are now required to assess the impact on patient outcomes.
1840 Expanding undergraduate medical students' understanding of frailty
Authors: Bellhouse E , Maitland R , Alexander R , Colquhoun K
Published: January 2024

Introduction

In response to the recent publication of the new British Geriatrics Society undergraduate medical curriculum (1), the medical education department at Glasgow Royal Infirmary created a session focussing on frailty for medical students. The aim was to introduce the concept to students by exploring and expanding on their experiences of frailty.

Methods

We used a pedagogical approach in a 90-minute, small group session. The session was split into three activities; the first was a case of an older adult presenting acutely with urosepsis. The session dealt with acute treatment for frail patients including polypharmacy, collateral history taking, and consideration of patients wishes. The second activity presented the students with three patients with differing manifestations of frailty; students were asked to discuss the concept of ‘the dying process’, and how each patient requires different support. Finally, students were given a ‘frailty suit’ which included 'visual impairment glasses' and 'reduced dexterity gloves' then asked to complete several activities of daily living. This light hearted activity allowed students to experience reflect upon the effects of frailty.

Results

The session was delivered to 25 students, of which 16 provided feedback. Over 85% of students stated that the session was extremely relevant and well delivered on a Lirkart scale; comments included “...we don’t get taught about it enough in medicine”. Results highlight that students recognise the utility of frailty focussed sessions in medical education.

Conclusions

We show that students are aware of the gap in frailty curriculum and an interactive discussion focussed session is one way to enhance their understanding of frailty. We present details of the session, and further iterations of the project we hope to introduce during the upcoming academic year.

References

1. Grace M E Pearson et al. Age and Ageing 2023; Volume 52: 1–8.
1962 Improving end-of-life care in Acute Medicine: A retrospective review
Authors: Shah S , Hassan H
Published: January 2024

Background

End-of-life (EOL) care aims to anticipate, prevent and treat symptoms experienced by the dying patient. An EOL care strategy described by King’s Health Partners (KHP) outlines the ‘ICARE’ framework, created from the five priorities for the dying patient, giving generalist hospital teams a memorable prompt to consider holistic needs of patients. We aim to reconcile performance of Acute Medical Unit (AMU) in providing EOL care, against KHP's framework, to reduce patient suffering and improve care.

Methods

A prospective review was performed of all AMU deaths from March-September 2021, reviewing resuscitation status and EOL medications. Sudden deaths for full resuscitation were excluded. Following review, teaching to AMU was delivered and a wall poster of the ‘ICARE’ framework was displayed. A second prospective cycle was performed reviewing deaths from March-September 2022.

Results

50 deaths were recorded in cycle one. 21% (12/58) of dying patients were not prescribed EOL medications. Medication omission for 50% (6/12) of patients were due to lack of recognition of EOL. Other reasons included no consultant review, undecided resuscitation status and a missing prescription. In cycle two, 11% of dying patients (6/48 patients) were not prescribed EOL medications, all of which were due to lack of recognition of EOL. 12 deaths had EOL medications prescribed but had an inappropriate resuscitation status.

Conclusion

The second cycle showed a 50% reduction in deaths with EOL medication omissions, when compared to the first cycle. Reasons for medication omissions were less varied in cycle two, highlighting reduction in avoidable causes. Although not affecting patient care, a notable number of patient records had incorrect resuscitation statuses. Overall, improvement in delivery of EOL care within AMU can be seen. Future considerations involve emphasis on keeping electronic patient record up to date to avoid errors and continual provision of education to new and rolling staff.
1969 Assessing the acute hospital care of patients with a diagnosis of a learning disability and hip fracture
Authors: Wilson R , Marlor R , Madan S , Knox V , Wilkinson D
Published: January 2024

Introduction

Patients with learning disabilities (LD) often have complex medical needs resulting in onset of frailty at younger ages. This increases risk of morbidity and mortality following emergency admissions, such as acute fractured neck of femur (FNOF). This risk is further increased by communication difficulties experienced in this group. There is little information about how LD affects the quality of care of patients with FNOF as defined by the national hip fracture standards (NHFS).

Methods

This retrospective audit reviewed notes of patients with LD admitted to a teaching hospital with FNOF over 5 years. The audit examined whether the care of patients with LD complied with the NHFS and best practice tariff guidelines, regardless of age. The audit sought to explore potential disparities between patients with LD and the general population. It assessed whether steps were taken to optimise care as defined by the Royal College of Physicians toolkit for LD.

Results

46 patients were included; 22% were under the age of 60. Operative management was in line with recommendations. However, 37% did not receive appropriate bone strengthening treatment and 37% were not mobilised within the first 24 hours. This correlated with fewer patients remaining freely mobile following the admission (8.7% post-operatively vs 41.3% pre-operatively). Documentation of LD severity LD and usual behaviours was unreliable, as was documentation of key conversations, such as those regarding capacity or resuscitation.

Conclusions

This highlights the importance of addressing the increased needs of patients with LD regardless of age, to better facilitate holistic assessment and treatment of this vulnerable population. Locally we plan to minimise variation by utilising LD nurses and providing comprehensive geriatric review of all patients with LD admitted with FNOF. We recommend that data collection, including 120-day follow-up, be incorporated into routine practice for all patients with LD admitted with FNOF.
2012 The long-term clinical outcomes of older adults with frailty following acute hospital admission in Tanzania
Authors: Davidson S L , Murray A , Hardy J , Randall T , Lyimo G , Kilasara J , Urasa S , Walker R W , Dotchin C L
Published: January 2024

Background

Non-communicable disease, multimorbidity and frailty are posing considerable challenges as global populations age. Healthcare systems in Low- and Middle-Income Countries are having to rapidly adapt services to meet the needs of older people.

Objective

This study, the first of its kind in sub-Saharan Africa, aimed to establish whether screening older people for frailty on admission to hospital could be used to identify those at greatest risk of adverse outcomes.

Methods

At baseline assessment, 308 participants aged ≥60 years, admitted to medical wards at four hospitals in the Kilimanjaro Region of Tanzania, were screened for frailty using the Clinical Frailty Scale (CFS). After 10-12 months, participants, and their informants, were contacted by telephone to establish clinical outcomes. The primary outcome was all-cause mortality. Cox regression was used to estimate hazard ratios ( 95% confidence interval) for mortality, with dichotomised CFS frailty status (frail if ≥5) as the independent variable.

Results

Primary outcome data were obtained for 194 (63.0%) of the original participants after a mean follow-up period of 10.8 ( 0.9) months. Mean age was 75.1 years and 99 (51%) of respondents were female. A total of 100 (51.5%) respondents were deceased and hazard ratios for all-cause mortality demonstrate that those with frailty were at significantly greater risk of mortality (HR 2.27 [CI 1.39 – 3.69], p<0.01), an effect that persisted even after adjustment for age, baseline Barthel Index, education and number of chronic conditions.

Conclusion

For older people living in Tanzania, unplanned admission to hospital is associated with high mortality and frailty is a strong independent predicator. In accurately identifying which older people are at the greatest risk, frailty screening using the CFS could provide a starting point for the development of targeted care pathways and interventions.
1872 Development of an innovative digital questionnaire to screen adults for risks of Osteoporosis and Falls by a Primary Care FCP
Authors: Birch C Y
Published: January 2024

Introduction

Socio-economic costs of hip fractures are formidable. Despite osteoporosis and falls being major risk factors, preventative screening in Primary Care does not occur. Evidence shows screening older women for osteoporosis prevents hip fractures, but to make a greater clinical and economic impact simultaneous screening of falls and fracture risks is logical. This cross-sectional study evaluates an innovative digital questionnaire and computer programme to combine person-reported data with medical data, and auto-calculate fracture and falls risks without the need for clinician time.

Method

Digital questionnaires were distributed via email or SMS to adults aged ≥65 who had consented to receive electronic correspondence over a 16-week period in one medical centre. Excluded were adults in nursing/residential care or receiving palliative care. A computer programme combined patient-reported information with existing medical data required to calculate FRAX® & FRAT scores. A robot computer function retrieved fracture risk scores from the FRAX® online tool. A weekly report showed those at high/medium risk of fracture and high risk of falls. Personalised bone health and lifestyle advice was automatically distributed.

Results

632 (37%) of 1692 questionnaires were returned. Ages ranged from 65 to 92 years (M=72.5, SD=5.7), 47.8% identified as male and 52.2% female. Using NOGG UK Guidelines (2021), 217 (34%) adults were identified at amber and 46 (7%) at red fracture risk. 131 (20.7%) adults had fallen within the previous year and 122 (19%) had a high-risk FRAT score ≥3. Personalised bone health and lifestyle advice was delivered to all 632 adults.

Conclusion

This automated screening process accurately identifies adults who are falling and/or at risk of osteoporosis and enables personalised bone health and lifestyle advice to be distributed without the need for clinician time. Prevention of falls and hip fractures would result in significant savings to the NHS and Social Care budgets.
1978 Donanemab in early symptomatic Alzheimer’s Disease: Efficacy and safety in TRAILBLAZER-ALZ 2, Phase 3 Randomized Clinical Trial
Authors: Mintun M , Ritchie C , Solomon P , Sims J R , Salloway S , Hansson O , Apostolova L G , Zimmer J A , Evans C D , Lu M , Ardayfio P , Sparks J D , Wessels A M , Shcherbinin S , Wang H , Nery E S M , Collins E C , Dennehy E B , Brooks D A , Skovronsky D M ,   TRAILBLAZER-ALZ 2 Investigators, Farquharson (Non-author presenter) A
Published: January 2024

Introduction

In TRAILBLAZER-ALZ donanemab (DONA) cleared brain amyloid plaques, significantly slowing disease progression in early symptomatic Alzheimer’s disease (ESAD). Methods: TRAILBLAZER-ALZ2 enrolled participants with ESAD and amyloid and tau pathology by positron-emission tomography, randomizing (multicenter) those with low/medium-tau (n=1182) and high-tau (n=552) (missing tau n=2). Participants (randomized double-blind,1:1) received DONA (n=860)/placebo (n=876) IV every 4w for 72w. DONA participants meeting amyloid clearance treatment completion criteria at 24/52w had blinded switched to placebo.

Primary outcomes

Integrated AD Rating Scale(iADRS) change from baseline at 76w in low/medium-tau or combined (low/medium- and high-tau) populations. Statistical testing allocated most power (80% α spend) to low/medium-tau population outcomes, with the remainder for combined population outcomes, including clinical and biomarker assessments.

Results

In the low/medium-tau population iADRS change at 76w: −6.02 (DONA) and −9.27 (placebo) (difference 3.25; 95%CI, 1.88-4.62; P<0.001), 35.1% slowing of disease progression. Change in Clinical Dementia Rating Scale (CDR)–Sum of Boxes: 1.20 (DONA) and 1.88 (placebo) (difference −0.67; 95% CI −0.95 to −0.40; P<0.001), 36.0% slowing. Participants receiving DONA experienced 38.6% less risk of progressing to next disease stage vs placebo over 76w (CDR-Global score, HR=0.61; P<0.001). Amyloid clearance at 24/52/76w: achieved in 34.2%/71.3%/80.1% DONA-treated participants. Significant, positive results were observed in the combined population. Serious AEs: 17.4% (DONA), and 15.8% (placebo), with 3 deaths among DONA patients who experienced serious amyloid-related imaging abnormalities (ARIA). AEs with DONA included ARIA-E (24.0%, 6.1% symptomatic); ARIA-H (31.4%); infusion-related reactions (8.7%).

Conclusion

DONA treatment significantly slowed clinical progression at 76w with a safety profile consistent with earlier studies. Presented: AAIC2023.
1983 Exploring barriers to recruiting older people to a white-coat hypertension study
Authors: Mensah E , Ali K , Okorie M , Bremner S , McAlister C , Perry N , Rajkumar C
Published: January 2024

Introduction

There is a recognised association between white coat hypertension (WCH) and adverse cardiovascular outcomes in older adults. However, there is no consensus on the management of WCH in this group. The objective of the Hypertension in the Very Elderly Trial (HYVET-2) study was to assess the feasibility of randomising 100 patients >75years with WCH from General Practice in the UK to treatment or usual care. The study did not randomise any patients. In this follow up study, we sought to explore the reasons for not recruiting.

Methods

Using a mixed-methods study design, staff from 29 General Practice (GP) sites and the Clinical Research Network (CRN) in Kent, Surrey, and Sussex (KSS) were sent an online questionnaire about local research facilities and infrastructure, and HYVET-2 study methodology and target population demographics.

Results

Nineteen (19) individuals responded the questionnaires (15 primary care staff, 4 CRN staff). Using a framework approach, we identified six themes summarising challenges to HYVET-2 recruitment. These themes were: established approaches of primary care towards managing WCH in older people, target patient demographics, study design complexity, patient-facing study documents, limited research resources in primary care and identification of eligible patients using existing coding.

Conclusion

Our experience showed that recruiting older people to a WCH study from primary care was not feasible. A national scoping survey amongst primary care physicians in the UK, and a robust patient and public involvement (PPI) targeting older people with WCH might improve recruitment in future studies of WCH in older people.
1901 Determinants of hospital readmissions in older people with dementia: A scoping review
Authors: Browne B , Ali K , Tabet N
Published: January 2024

Introduction

In the UK, fifty-three percent of hospitalised older people with dementia have multimorbidity, and are at an increased risk of hospital readmission within 30 days from discharge. Between 20-40% of these readmissions are preventable [1]. Current research focused on the biological causes of readmissions. However, older people with dementia have additional psychosocial factors increasing their risk of readmission. The aim of this scoping review was to identify psychosocial determinants within the context of known biological factors.

Methods

Electronic databases MEDLINE, EMBASE, CINAHL and PsychInfo were searched from inception until July 2022. Quantitative and qualitative studies in English including adults aged 65 years and over with dementia, their care workers and informal carers were considered if they investigated readmission. An inductive approach was adopted to map determinants of hospital readmission. Identified themes were described as narrative categories.

Results

Seventeen studies including 7,194,878 participants met our inclusion criteria from a total of 4736 articles. Sixteen quantitative studies included observational cohort and randomised controlled trial designs. One American study was qualitative. Ten studies were based in the USA, and one study each from Taiwan, Australia, Canada, Sweden, Japan, Denmark, and The Netherlands. Large hospital and insurance records provided data in over 2 million patients in one American study. Identified psychosocial determinants included inadequate hospital discharge planning, limited interdisciplinary collaboration, and socioeconomic inequalities among ethnic minorities. Biological determinants included reduced mobility and accumulation of comorbidities. Use of antipsychotic medications might explain the interplay between biological and psychosocial determinants.

Conclusion

Poorly defined roles and responsibilities of health and social care professionals and poor communication during care transitions increase the risk of readmission in older people with dementia.

Reference

1. Godard-Sebillotte C, Strumpf E, Sourial N, et al. L. Primary care continuity and potentially avoidable hospitalization in persons with dementia. J Am Geriatr Soc. 2021;69(5):1208-20.
Beyond the Front Yard: The Dehumanizing Message of Accent-Altering Technology
Authors: Payne Ameena L , Austin Tasha , Clemons Aris M
Published: January 2024

Over the past decade, the artificial intelligence (AI) industry, as it relates to the speech and voice recognition industry, has established itself as a multibillion-dollar global market, but at whose expense? In this forum article, we amplify the current critiques of the architectures of large language models being used increasingly in daily life. Our commentary exposes emerging AI accent modification technology and services as agents of racial commodification and linguistic dominance, as it rests on the perceived superiority of standardized US English. We discuss our concern for such services leaching into academia. We argue that this technology follows a standardized language framework, which poses a fundamental problem of being informed by purist monolingual principles. These principles often help to perpetuate and maintain harmful raciolinguistic ideologies that result in language discrimination and the continual framing of the language practices of racially minoritized speakers as deficient. Thus, we write this piece with the intent to expose the fabricated humanity of accent modification technology whose existence perpetuates capitalism’s reliance on dehumanization for economic advancement and the legacy and reproduction of white language superiority.