bluuebunny/crossref_metadata_2025 huggingface dataset:
Deploying an IoT-based remote physics lab platform to enhance experimental physics education in remote regions
Authors: Castaño Fabian Andres , López Eduin , Jaramillo Jhon Alejandro , Navarro Victor , Osorio Jaime
Published: September 2024

For several years, the educational gap in certain Latin American countries and around the world has become increasingly evident. The limited access to cutting-edge knowledge and technologies to strengthen student training processes has emerged as a significant problem, leading to increased inequality in job opportunities in these regions and progressive setbacks in social and economic development. One way to mitigate this problem has been to provide access to information through telecommunications. However, integration with educational processes has been deficient, especially in the areas of science, technology, engineering, and mathematics. This work proposes the development of a remote physics laboratory platform for experimental validation of models explaining certain physical phenomena. This platform is based on the Internet of Things (IoT) paradigm, allowing students and teachers to connect with these experiences coveringtopics in mechanics, electricity and magnetism, optics, and thermodynamics from remote regions. These laboratories utilize physical setups in educational institutions that have been modified to provide connectivity and remote control capabilities based on IoT. Finally, a framework for implementing new remote laboratories based on the IoT paradigm through an open-source platform is presented. The system has been tested and validated with high school and early university students to verify its usefulness, showing the potential to enhance educational processes by providing laboratory access to students and teachers from primary education to secondary education and university-level professional programs.
Localized electronic states induced by the presence of two defective resonators in electronic comb-like waveguides structure
Authors: Machichi Siham , Touiss Tarik , Elamri Fatima Zahra , Ezzarfi Abdelouahid , Falyouni Farid , Bria Driss
Published: September 2024

In this paper, we use the transfer matrix method to determine the band structure and electrical transmission rate of a one-dimensional electronic comb-like waveguide system. This structure is made up of the periodicity of finite GaAs quantum wire (QWR) (segment) grafted in its extremity by a vertical Ga

1
−
x

Al
x
As QWR (resonator). In this perfect structure, we replace the resonator situated in the middle of the periodic structure by a composed resonator made of vertical superposition of two resonators of different Al concentrations (x
01 and x
02). These defective resonators induce electronic localized states, inside the electronic band gaps of the perfect structure, with higher energy values depending on the geometrical (lengths) and the physical (x
01, x
02) parameters of the defective resonators. When the length d
02 of the upper resonator composed of Al concentration

x

02

=
0.3

increases, these localized electronic states move to lower energies; conversely, when the concentration x
02 increases, they move to higher energies. We also show that there is an important effect of changing the localized states of two resonators connected in cascade with different concentrations. Our results may be relevant to the design of electronic guidance, filtering, and detection systems.
Watermarking method based on double-threshold correspondence imaging with lossless host image
Authors: Wei Yi , Sun Mingze , Bai Xing , Yu Zhan , Li Ying , Ouyang Zongguang , Wang Daili , Zhou Xin
Published: September 2024

A watermarking method based on double-threshold correspondence imaging (DTCI) with lossless host image is proposed, which employ every bit of the 8-bit grayscale host image without changing picture. This image watermarking method firstly processes the host image to obtain symbolic attribute arrays (SAAs). Then the watermark image is performs DTCI operations to rearrange the order of the speckle patterns according to the SAAs. Because there is not any additional information embedded into the host image, it ensures the watermark image with not only complete imperceptibility but also a significant capacity. When the authorized users utilize both the binary numbers of host image and the rearranged speckle patterns as the key, the watermark image can be easily retrieved. Additionally, the suggested method demonstrates remarkable robustness in the face of ‘Salt and Pepper’ noise and cropping attacks.
Pixel Circuit Design for X-ray Detection Utilizing a-IGZO Thin-Film Transistors
Authors: Hoo Lee Jang , Jin Kim Young , Kang Park Hye , Jae Moon Seung , Wei Lei , Seong Bae Byung
Published: September 2024

In recent advancements, X-ray detectors have made significant progress. Active pixel sensors exhibit superior Signal-to-Noise Ratio (SNR) compared to passive counterparts. The conventional pixel circuit for X-ray detectors has three transistors and one capacitor. We focused on simplifying this pixel to enhance resolution. Our research introduces and verifies a novel pixel circuit developed for high-resolution X-ray detectors. The proposed pixel circuit is composed by two n-type thin-film transistors and one capacitor. It requires two scan pulses and three operational stages. This structure can effectively reduce the component area of the pixel circuit. We designed RPI LEVEL = 35 amorphous TFT model and simulated for verify our proposed pixel circuit. In results, proposed pixel circuit successfully operated and shows 2.5 μV when the equivalent resistance of detector (RDetector) is 10 MΩ, and 8.38 V when RDetector is 1 MΩ. To minimize the harmful effects of X-ray exposure, reducing the dosage is essential. Sensitivity and low noise are crucial factors, and the proposed circuit offers a compact design, increased sensitivity, and higher output voltage.
Numerical study of AC loss and H-formulation for high temperature superconductors
Authors: Revathi S , Garkki B
Published: September 2024

The high-temperature superconductor (HTS) plays a crucial role in power grids due to its ability to carry high current densities and withstand strong magnetic fields, making it ideal for applications like superconducting magnetic energy storage (SMES). However, integrating SMES systems with the grid introduces challenges, particularly regarding the generation of AC losses during cyclic operations, which can lead to temperature increases in HTS tape. This article presents a method for calculating AC losses and determining the magnetic field formulation at the critical state of HTS using numerical techniques. The study focuses on analyzing the charging and discharging operations of a grid-integrated SMES system based on silicon-controlled rectifiers. Additionally, the critical current of the HTS tape is determined using the four-probe method to characterize its I-V characteristics.
A novel brain network analysis method for pediatric ADHD using RFE-GA feature selection strategy
Authors: Gu Xiang , Dang Chen , Shi Tianyu , Tang Lihan , Wang Kai , Luo Xiangsheng , Zhu Yu , Feng Yuan , Wu Guisen , Zou Ling , Sun Li
Published: September 2024

Attention Deficit Hyperactivity Disorder (ADHD) is a highly prevalent childhood disorder. The diagnosis of diseases primarily relies on the subjective judgment of doctors, and the diagnostic criteria provided in different diagnostic manuals vary as well. Therefore, accurately identifying individuals with ADHD remains a challenging issue. Currently, EEG research on ADHD lacks recognized and reliable neurological biomarkers, which are essential for improving the accuracy and standardization of diagnosis and treatment. Therefore, this study employs transfer entropy to analyse effective brain network connectivity, revealing differences in brain networks of ADHD patients and exploring its potential as a neurological biomarker. Additionally, we propose an ADHD detection method based on Recursive Feature Elimination with Genetic Algorithm (RFE-GA), which utilizes the global search capability of GA and the feature selection ability of RFE for feature optimization in EEG data. This approach aims to validate the feasibility of transfer entropy as a neurological biomarker for ADHD. The results revealed the control group exhibited lower connectivity strength in the left temporal alpha and beta bands, but higher frontal connectivity strength compared to the ADHD group. Additionally, in the gamma frequency band, the control group had higher top lobe connectivity strength than the ADHD group. Through the RFE-GA feature selection method, the optimized feature set was more concise, achieving classification accuracies of 91.3%, 94.1%, and 90.7% for the alpha, beta, and gamma frequency bands, respectively. The proposed RFE-GA feature selection method significantly reduced the number of features, thereby improving classification accuracy.
All-fiber coherent supercontinuum generation in a cascade of silica, fluoride, and chalcogenide fibers
Authors: Shamim Md Hosne Mobarok , Brilland Laurent , Chahal Radwan , Troles Johann , Rochette Martin
Published: September 2024

We present an all-fiber coherent supercontinuum spanning the spectral range of 1.7–5.0 µm from a cascade of silica, ZBLAN, and chalcogenide (ChG) nonlinear fibers (NLFs). Coherence is maintained by the combined use of femtosecond pump pulses as well as by allowing deterministic spectral broadening mechanism at every stage of the cascade. The use of femtosecond pump pulses enables avoiding modulation instability (MI) at the onset of the supercontinuum generation process and thus prevent subsequent MI-seeded random noise. Once in the NLF cascade, the pump pulse is instead converted into a soliton of order maintained at N < 6 in the silica and ZBLAN NLFs, ensuring soliton fission followed by self-frequency shift of a few solitons. Finally, in the ChG NLF, spectral broadening is facilitated through self-phase modulation and dispersive wave generation. The deterministic nature of these nonlinear phenomena results in the generation of a coherent supercontinuum. The supercontinuum delivers an average power of 54 mW from an average pump power of 300 mW, yielding a power conversion efficiency of 18%. The experimental results closely align with numerical simulations, from which coherence is estimated. Such a coherent supercontinuum with a megahertz repetition rate is essential for spectroscopic systems based on optical frequency combs and applications in high-precision optical coherence tomography.
A structured framework to evaluate capsule endoscope locomotion systems
Authors: Dinkar Deepak Kumar , Shaheed M Hasan , Herrington Eldrid , Althoefer Kaspar , Thaha Mohamed Adhnan
Published: September 2024

Although capsule endoscopes have advanced significantly over the past two decades, their original passive design remains. Developing active locomotion systems for capsule endoscopes is a research-intensive field, and several such systems have been devised, using a variety of bioengineering solutions. While many of these systems are at various stages of testing-from theoretical to bench to in-vivo-only one has made it to pre-clinical trials. What is clear is the absence of a standardised system to evaluate and compare the different technologies. In this paper, we set out a structured framework with which to evaluate capsule endoscope locomotion systems (CELSs). The criteria set upon which it is based is derived from agreed clinically optimal conditions. The existing literature on CELS is then systematically reviewed and analysed using the framework, to demonstrate its validity. The average design score for existing CELS is 60.10% (range: 44.54%–78.74%). We found that the lowest-performing designs used inchworm and vibratory locomotion, whereas the highest-scoring designs all had magnetic actuation incorporated in some form. It is expected that the proposed new framework will enable clinicians, researchers, and manufacturers to consider global evaluative criteria when developing CELS and to apply them to existing and future system solutions.
Design and analysis of central gate organic thin film transistor
Authors: Rathod Arun Pratap Singh , Gowri R , Nautiyal Bhaskar , Dubey Ved Prakash
Published: September 2024

This paper presents a novel central gate organic thin-film transistor (OTFT) with electrodes in top-bottom configuration and its comparative performance analysis with conventional single and dual gate OTFTs. The central gate OTFT is comprised of a single gate electrode configured to be the center thin film. A pair of identical dielectric layers viz. top dielectric layer and a bottom dielectric layer on both sides of gate electrode to facilitate the further deposition top and bottom organic semiconductor layer over them respectively. The organic semiconductor layers (OSC) are configured as top OSC layer and a bottom OSC to accommodate two independent conduction channels. The source and drain electrodes are also deposited in pairs in top and bottom configurations. Due to the subtle modifications in the architecture the resultant output drain current of the central gate (CG) OTFT has increased manifold. It has been found in the study that the CG OTFT produces 94%, 76.36%, 80.58% higher drain current than bottom gate bottom contact (BGBC), top gate bottom contact (TGBC) and bottom gate top contact (BGTC) OTFT respectively of similar size, operating under identical voltage regime. Similarly in the case of dual gate (DG) OTFT an improvement of 5.10% has been recorded without any additional gate electrode at the same operating voltages.
Cumulative optimization of magnetoelectric composite-based wireless energy transfer
Authors: Kumar Amritesh , Newacheck Scott , Youssef George
Published: September 2024

Magnetoelectric composite-based wireless energy transfer (WET) comprising omnidirectional ring-shaped transmitter and laminated plate receiver elements have been studied experimentally and theoretically. The objective is to reveal the conditions conducive to achieving optimal power based on the device geometries, the relative orientations, and the operating conditions, including the vibrational frequency, applied electric field, bias magnetic field, and the corresponding resistive load. The reformulated physics-based model establishes the dependence of the output power on the load resistance, elucidating a strong interrelationship between the transferred power, vibrational displacement, and strain transduction coefficient based on relaxing all previous simplifying assumptions. The model ascertained the non-monotonic variation of the output power as a function of the interface coupling factor, emphasizing the crucial influence of gradual change in material properties within the strain-mediated magnetoelectric transmitter and receiver devices, i.e., an agile design framework for multiferroics-based power transfer devices.
Morphing flap driven by link with antagonistic shape memory alloy wires
Authors: Harada Yuki , Senba Atsuhiko
Published: September 2024

This paper describes a study of a morphing flap using antagonistically arranged shape memory alloy (SMA) wires as actuators. The main focus of this study is to examine how existing aircraft structures and mechanisms can be modified to make the morphing airfoil more practical. The first step is to consider the drawbacks of existing morphing airfoils and then examine the advantages of the morphing airfoil proposed in this study. Then, a morphing airfoil is proposed to realize four significant technical issues: weight reduction, compatibility with existing structures, securing internal space, and seamless skin made with shape memory polymer (SMP) films. First, elemental experiments were conducted to examine the feasibility of the mechanical design, and the feasibility of the design of a large-morphing airfoil operating test model was confirmed. Next, aerodynamic and structural-mechanical analyses are conducted while designing the experimental operating model to verify whether it could operate up to the target flap angle under simulated flight conditions. After completing the experimental model, actuation tests are conducted as a morphing wing and confirm whether the wing could operate at the target flap angle in a realistic environment. As a result, the two-way morphing flap angle was experimentally observed. It is noted that only aerodynamic force was not considered in the experiment, which is further investigated in wind tunnel tests in future study. In addition, control rate of the proposed system seems improved than conventional model because of the reduction of the wire length of the actuation system. Thus, the results obtained in this study suggested the proposed link-driven SMA wire mechanism can be applied to make the morphing airfoil more practical.
Design of energy-efficient full subtractor circuit at near threshold computing for signal processing application
Authors: Basha Mohammed Mahaboob , Gundala Srinivasulu , Madhurima V , Khan Arfat Ahmad
Published: September 2024

Energy Efficiency is a critical factor while designing integrated circuits. Therefore, a 1-bit full subtractor (FS) cell is proposed for lower power application by employing Gate Level Body Biasing (GLBB) scheme for Near Threshold Computing (NTC) application to conquer a unique module for achieving full swing borrow output.We evaluate power, delay, energy and the product of energy with delay (EDP) metrics with respect to C-CMOS full subtractor. The proposed feedback based with FS with GLBB technique has a total die area of 60.02 μm2, while the average power, delay, and energy are 1138 pW, 242 ns, and 27.53 aJ, respectively. The results revealed that our proposed subthreshold hybrid FS circuit with GLBB scheme successfully achieved more than 10.46% average power consumption, 26.58% energy consumption reductions, and 17.98% EDP savings compared to conventional CMOS configuration and other hybrid counterparts. GLBB circuits with FS achieve performance levels that are not affordable in C-CMOS, DTMOS,and GLBB with full adder configurations. Therefore, the FS circuit serves as an efficient divider circuit in terms of detecting objects for image processing applications.
Bruckner's Fourth
Authors: Korstvedt Benjamin M
Published: September 2024

Bruckner’s Fourth Symphony is one of the most beloved and frequently performed works in the orchestral repertoire; nevertheless, a great deal about it has remained unknown or misunderstood. The confusion centers around its extraordinary compositional history. Bruckner worked on the Fourth for more than fifteen years and created multiple versions of the work before he was finished. This book offers the first complete and coherent account of the extraordinary compositional evolution of this magnificent symphony. What emerges is the story of Bruckner’s extraordinary efforts to produce a symphony that would, as he put it, be able to “make its effect” in performance. The heart of the book is an exploration, based on comprehensive source study and critical analysis, of Bruckner’s ongoing creation on this symphony. It draws on numerous previously overlooked courses to explain the nature and significance of the versions through which the work passed, and considers the impact of its initial performances and the complicated roles played by Bruckner’s collaboration with other musicians in the later stages of the work’s evolution. The book also critiques the conventional wisdom about Bruckner and the “problem” posed by the versions of his works by deconstructing long-established myths, developing new insights, and bringing the musical logic of Bruckner’s revisions into clear focus. The book offers a searching yet accessible analysis of the music of the Fourth and a critical survey of the varying ways the work has been interpreted in performance and on recordings starting in the 1930s.
The Creation of the Fourth Symphony, 1874
Authors: Korstvedt Benjamin M
Published: September 2024

The Fourth Symphony was the third in a series of four symphonies that Bruckner completed between 1872 and 1875. This chapter situates Bruckner’s creation of the Fourth in the context of his personal and professional life during these years. It also outlines the phases of his compositional process, which began by laying out the basic frame of the music in score, then fleshing out the texture, and finishing with what the composer called “nuancing.” The chapter exemplifies these phases with key passages in his manuscripts and discusses his invention of the main theme of the Finale.
The Music of the First Version
Authors: Korstvedt Benjamin M
Published: September 2024

For a listener today, hearing the first version of Bruckner’s Fourth involves listening to what it is, as well as what it isn’t. Since the second version has long prevailed so thoroughly in concert and on recordings, it inevitably sets the standard against which the first version is heard and understood. Much of the first version music is similar to the later versions, yet much else is unique and sounds remarkably novel, indeed often daring. This chapter explores the music of the first version with an emphasis on its striking mixture of the familiar and the unfamiliar. It also considers how the unusual form of the second movement reflects the influence of Bruckner’s study of musical form in the 1860s.
The First Performances, 1881
Authors: Korstvedt Benjamin M
Published: September 2024

The Fourth was finally given its first performance in February 1881. This chapter explains the circumstances that led up to this performance. These involved the personal intervention of the conductor, Hans Richter, to overcome resistance by members of the Vienna Philharmonic, preliminary rehearsals that Bruckner led with the orchestra of the Vienna Conservatory, and his final adjustments to the score, including the deletion of a passage that has remained largely unknown since then. The music of this passage is presented in Appendix 3 in this book. The chapter also offers an account of the concert itself, which was a definite success, and of the responses of leading critics. It concludes by describing the Fourth’s second performance in December 1881, which went poorly.
The Evolution of the Finale, 1874–1888
Authors: Korstvedt Benjamin M
Published: September 2024

The Finale of the Fourth stands out in several ways. It seems to exist somewhat apart from the rest of the symphony, both in form and character. It also underwent marked, persistent change during the compositional evolution of this symphony; in fact, it is the single most profoundly reworked movement in Bruckner’s oeuvre. In this chapter, the movement is considered in the context of the “Finale Problem” that confronted the symphony after Beethoven. The chapter explores the musical changes the Finale underwent from its original conception in 1874 through its final version in 1888. Special consideration is given to the recapitulation of the movement, the section Bruckner revised most intensely. It describes the little-known variants of this passage he created in 1880 and 1881. The chapter concludes with a discussion of the significance of the five different versions of the concluding pages of the symphony.
External Validation of the TWIST Algorithm for Predicting Walking Independence Post-Acute Stroke: An Irish Prospective Cohort Study
Authors: Harte Mary , Horgan Frances , Galvin Rose , Newell Evelyn
Published: September 2024

Background

Early prediction of walking dependency post-stroke is important for clinician and patient decision-making. National stroke guidelines recommend using the ‘Time to Walking Independently after Stroke’ (TWIST) model to predict walking independence post-stroke. External validation of the TWIST model is required prior to its clinical integration. This study aimed to evaluate whether the TWIST model is a valid predictor of walking independence post-stroke in an Irish population.

Methods

This prospective cohort study recruited patients admitted to a tertiary hospital with an acute stroke from July-November 2023. The Trunk Control Test (TCT) and paretic-limb hip extensor strength (Medical Research Council (MRC) scale) were assessed within 3 days post-stroke. Walking independence (Functional Ambulatory Category) was measured at 6 or 12 weeks post-stroke based on TWIST algorithm predictions. Predictive performance was measured using the area under the curve (AUC), accuracy, sensitivity, specificity, positive and negative predictive value.

Results

Sixty-one participants (38 male, median (interquartile range) age 74 years (68-86) and National Institutes of Health Stroke Scale 7 (4-11.5)) were included. The AUC (95% CI) was 0.88 (0.81-0.96) and 0.7 (0.21-1) at 6 and 12 weeks post-stroke respectively. Predictive accuracy (95% CI) was higher at 6 weeks (88.52% (77.78-95.26)) than 12 weeks post-stroke (86.96% (66.41-97.22)). Overall, the TWIST model made accurate predictions for 83.61% (71.91-91.85) of participants.

Conclusion

The TWIST model demonstrated fair-good predictive performance when externally validated. However, it performed poorly at 12 weeks post-stroke for those with poor post-stroke trunk control (TCT < 40) but moderate hip extensor strength (≥ 3 MRC scale). Further research is needed to explore its utility in this subgroup.

Implication of Findings

The TWIST model may benefit clinicians and patients by accurately predicting walking independence post-stroke. Further research is needed to explore its utility in specific subgroups, particularly those with poor post-stroke trunk control but moderate hip extensor strength.
Are There Missed Opportunities For Falls Prevention In Older People With Fractures? Data From TILDA
Authors: Daly Simon , Carroll Thomas , Kenny Rose Anne , Briggs Robert
Published: September 2024

Background

Fractures can represent a seminal event in later life associated with significantly higher rates of functional impairment, nursing home admission and mortality. The aim of this study therefore was to measure the cumulative incidence of hip and wrist fractures longitudinally in a population-representative sample of community-dwelling older people and examine opportunities to intervene prior to the fracture.

Methods

Participants aged ≥65 years from the Irish Longitudinal Study on Ageing were included and followed from Wave 1 to Wave 5 (8-year follow-up). Falls and Fractures (Hip and Wrist) and were elicited by self-report at each wave. Participants were also asked how steady they feel when standing / walking. Logistic regression models assessed the relationship between reported falls and unsteadiness, and subsequent fracture.

Results

3,072 participants were included (Mean age 73 years, 53% female) and followed for a median of 6.3 years, with over 7% (228/3,072) reporting a fracture. Over one quarter (69/267) of fractures were preceded by an injurious fall requiring medical attention in the prior 24 months, 45% were preceded by a fall of any type (121/267). One third of participants who subsequently had a fracture (89/267), reported that they were unsteady on their feet when interviewed prior to the fracture. One fifth (19/89) of these participants accessed physiotherapy services prior to the fracture. The combination of either a fall or unsteadiness reported during the preceding 24 months significantly increased the likelihood of future fracture (Odds Ratio 2.62 (95% CI 2.05 – 3.35)).

Conclusion

Most fractures are predictable with almost two thirds heralded by falls or unsteadiness in the preceding 24 months. Falls prevention strategies, which can reduce further falls by 20-40%, targeted at those with unsteadiness and falls would likely prevent an important proportion of future fractures, and have a positive impact on health outcomes in this cohort.
Detection of Prescribing Cascades in Multimorbid Older Patients Hospitalized with Acute Unselected Illness
Authors: Daunt Ruth , McGettigan Siobhan , Kelly Lorna , Curtin Denis , O'Mahony Denis
Published: September 2024

Background

Prescribing cascades (PCs) occur when a new medication is prescribed to treat an unrecognized side-effect of another medication. PCs represent an important but often underrecognized aspect of inappropriate prescribing in older people with multimorbidity and associated polypharmacy and can result in avoidable morbidity and mortality. Numerous PCs are described in the literature, however, there are no prospective studies describing PC prevalence in older people. Therefore, we aimed to investigate the prevalence of PCs in acutely hospitalized older adults.

Methods

We undertook a prospective observational study, including adults ≥65years with polypharmacy (≥5 daily drugs) and multimorbidity (≥3 chronic disorders). Prescription medication lists were examined for the co-prescription of 31 drug pairs according to two pre-defined PC lists– ThinkCasades1 and of the explicit cascades published by Doherty et al2. PCs were defined as ‘definite’, ‘probable’, ‘possible’, ‘uncertain’ or ‘indeterminate’ according to specific criteria.

Results

We obtained prospective data on 300 patients (56% female, mean age 80.4yrs SD 7.2). 233 drug pairs were prescribed in the sequence of drug A → drug B, these occurred in 43% (n=130) of patients. Of the 233 pairs, 38% (n=88) were probable or possible PCs and 62% (n=145) were uncertain. 45 patients (15%) had ≥1 possible or probable PCs. The most commonly identified probable/possible PCs were diuretic → overactive bladder medication and calcium channel blocker → diuretic. Patients with an identified PC experienced higher mean levels of polypharmacy than patients with no PCs (11.7, SD 4.0 vs 9.6, SD 3.1, T= -4.97, p <0.001).

Conclusion

In this first-ever study to report prospective prevalence of PCs, possible or probable PCs were significantly prevalent among acutely hospitalized multimorbid older patients and were associated with higher levels of polypharmacy.McCarthy LM, et al. Drgs & aging. 2022 Oct;39(10):829-40.Doherty AS, et al. Pharmacology research & perspectives. 2022 Oct;10(5): e01008.
Circulating IL-17A and Executive Function in Middle-Aged Adults with and without Type 2 Diabetes
Authors: Morrison Laura , Dyer Adam , Bourke Nollaig , Kennelly Sean
Published: September 2024

Background

Midlife cardiovascular risk factors, such as Type 2 Diabetes Mellitus (T2DM) and obesity, are associated with a greater risk of cognitive impairment and dementia in later life, with altered peripheral inflammation postulated as a crucial mechanistic link. Yet there is a significant gap in knowledge regarding when pathogenic alterations to these systemic inflammatory responses change during the early stages of cognitive dysfunction prior to overt disease development. To assess the earliest possible signs of this link, we recruited a cohort of middle-aged cognitively-unimpaired individuals with and without uncomplicated T2DM.

Methods

A comprehensive neuropsychological assessment was performed at baseline and at 4-year follow-up. A panel of ten serum chemokines and cytokines were measured at both time-points using high-sensitivity assays (Eotaxin, MCP-1, MIP-1β, CXCL-10, IL-6, IL-10, IL12p70, IL-17A, IFN-γ and TNF-α).

Results

Overall, 136 individuals were recruited including 90 with uncomplicated midlife T2DM (age 52.6 ± 8.3; 47% female) and 46 without (age 52.9 ± 8.03; 61% female). Cognitive trajectories were stable over time and did not differ by T2DM status. Yet on cross-sectional analyses, we observed consistent evidence across timepoints between greater circulating IL-17A and poorer performance on tests of executive function/attention (β: -0.21; -0.40, -0.02, p = 0.03 at baseline; β: -0.26; -0.46, -0.05, p = 0.02 at follow-up) as well as poorer reaction time (β: 0.34; 0.12, 0.56, p = 0.003 at follow-up). These persisted on covariate adjustment and did not differ by T2DM status.

Conclusion

We provide exploratory evidence that greater serum IL-17A levels are associated with poorer executive function in midlife. Long-term follow-up of this and other cohorts will further elucidate this relationship to provide further mechanistic insights and potentially identify individuals at greatest risk for later cognitive decline.
Losing the Postcode Lottery: An Observational Study Examining the Association Between Patient Address and Delayed Discharge in a Rehabilitation Centre
Authors: Murphy Robert Allan , Ward Andrea , Larkin Joanne , McKeag Avril , O'Connor Marie
Published: September 2024

Background

Quality and Fairness: A Health System for You published by the HSE in 2001 stated, as one of its core principles “Access to healthcare should be fair. The system must respond to people’s needs rather than have access dependent on geographic location or ability to pay.”1 Twenty years on, experience at our rehab unit suggests that inequality exists in accessing care in the community for older persons based on their residential address. The aim of our study was to examine and quantify this inequity of access.

Methods

A retrospective study was designed. Using the local patient information management system, all discharges in 2023 were identified. Baseline demographics, admission and discharge date and residential address were recorded. Delayed discharges were defined as patients for whom their rehabilitation programme is complete as agreed at the multi-disciplinary team meeting. Delayed discharge data was obtained from medical social work department who input this data to the HSE weekly. Patients were assigned a community healthcare organisation (CHO) based on address. CHO ‘A’ included two CHOs with predominantly rural areas whilst CHO ‘B’ comprised of one predominantly urban CHO.

Results

167 patients were included. 24 discharges were delayed (14.4%). Median age was 84. Total bed days lost: 935 (mean 40.6, range 3 – 232). All nine CHOs were represented. Patients living in CHO A had increased likelihood of having discharge delayed (OR: 4.82, CI 2.86 – 8.13). Conversely, those living in CHO B were less likely to have had a discharge delayed (OR: 0.39, CI 0.15 – 0.96)

Conclusion

Our study demonstrates that health inequity does exist. Patients residing in rural communities are 4 times more likely to have their discharge delayed awaiting community supports compared to urban dwellers. Ending of the discrimination of patients based on their postcode and ensuring access based on need is the very essence of Sláintecare.
What Benefits Does Local Sports Club Membership Confer On Community-Dwelling Older People In Ireland?
Authors: Flanagan Clodagh , Kenny Regius Rose Anne , Ward Mark , Briggs Robert
Published: September 2024

Background

There is a strong culture of sports club membership amongst older people in Ireland. It has been suggested that this confers health benefits due to increased physical activity and social connection, but studies examining this are currently lacking. The aim of this study therefore was to assess the relationship of sports club membership with markers of health and well-being in a large population-representative cohort of older people.

Methods

Over 3,500 participants ≥65 years at Wave 5 (mean 74 years, 54% female) of the Irish Longitudinal Study on Ageing were included. Sports club membership (GAA, soccer, rugby, tennis, golf) was elicited by self-report. Depressive symptoms (Centre for Epidemiological Studies Depression Scale), loneliness (UCLA Scale), and quality of life (Control Autonomy Self-Realization Please Scale) were assessed with internationally validated scales. Physical Activity was by self-report and mobility impairment was defined as Timed-Up-and-Go≥14s. The associations between sports club membership and these outcomes were assessed with regression models adjusted for age, sex, education, polypharmacy, chronic disease burden and heart disease.

Results

One fifth (708/3,510) of participants were a member of a local sports club. Sports club membership was associated with lower rates of depressive symptoms (Odds ratio 0.51 (95% CI 0.34,0.75)), lower levels of loneliness (Beta = -0.28 (95% CI -0.46, -0.10)) and better quality of life (Beta= 0.93 (95% CI 0.49,1.38)) in fully-adjusted models. Sports club members spent more days doing moderate physical activity per week (2.0 (95% CI 1.85,2.21) vs 1.64 (95% CI 1.54,1.73); p<0.001) and had lower likelihood of mobility impairment (Adjusted Odds Ratio 0.49 (95% CI 0.36,0.68)).

Conclusion

Sports Club Membership is prevalent amongst community-dwelling older people in Ireland and is associated with lower rates of loneliness, depressive symptoms and mobility impairment, and better quality of life. Older sports club members should be encouraged to maintain this activity where feasible.
Overcoming a Treatment Barrier – Setting Up a Home-Based Osteoporosis Treatment with Zoledronate (HOTZ) Service
Authors: Butler Elaine , Hogan Eleanor , Sheridan Noeleen , Carroll Joanna , Dockery Frances
Published: September 2024

Background

Intravenous Zoledronic acid is an effective, once-annual treatment for osteoporosis and is indicated following hip fracture in particular, in addition to other osteoporotic fracture types. One of the barriers to its administration (as described in a survey of Geriatricians attending the FFN, BGS and IGS meetings in 2023), is a lack of facility to arrange subsequent doses because intravenous infusions are traditionally, exclusively hospital-based.

Methods

The Beaumont Hospital Fracture Liaison Service (FLS) collaborated with our local Community Intervention Team (CIT) to establish a protocol for home-based Zoledronic acid infusions. Following an initial Zoledronate dose being given in the inpatient or outpatient setting, a virtual clinic is conducted 11 months later to plan subsequent doses, as is standard practice in our unit. At these clinics, we identified those who are housebound with no means of travelling to hospital clinics as potentially eligible for the HOTZ service. Following home-based blood tests, a customised Zoledronic acid checklist addresses patient information, biochemical parameters, required infusion duration and includes a safety checklist for any rare adverse events since previous infusion. Education and training was provided by the FLS and the CIT lead to the CIT nursing staff responsible for administering the infusions.

Results

We have had four patients to date receive the HOTZ service with several further planned. No adverse events reported. The feedback from all was extremely positive, some stating that they felt everyone should have this service, and they were glad of the cost savings on taxis and avoiding the strain on family members or carers of escorting them to hospital appointments for blood tests and again for treatment.

Conclusion

Setting up a Home-based Osteoporosis Treatment Service is feasible and preliminary results show very high user-satisfaction with the service. We recommend that FLS & CIT nationally consider roll out of such services.
Psychological Health Outcomes of Older Adult Volunteers: Findings from The Irish Longitudinal Study on Ageing
Authors: Lehane Grace , Scarlett Siobhan
Published: September 2024

Background

Volunteering has been shown to alleviate the feeling of loneliness and have indirect positive effects on the subjective quality of life of older adults. Volunteering post-retirement has been shown to have a positive effect on loneliness, quality of life, and depression. This research aimed to examine the relationship between volunteering and depression, loneliness, and quality of life among a nationally representative sample of older adults in the Republic of Ireland. These measures were also examined in the context of volunteering and retirement.

Methods

Through secondary analysis of five waves of data from the Irish Longitudinal Study on Ageing (TILDA), this research explored the relationships between volunteering, retirement, loneliness, depression and quality of life. To achieve this, both cross-sectional analyses using regression models and longitudinal analysis using mixed-effects modelling were utilised.

Results

Volunteering had a significant negative association with loneliness [Incident Rate Ratio (IRR)=0.87, 95% CI=0.80,0.95, p<0.01] and depression [IRR=0.88, 95% CI=0.81, 0.96, p<0.01], and a positive association with quality of life [Beta (B)=0.69, 95% CI=0.39, 1.00, p<0.05] at baseline. These associations were not significant over time. Volunteering in retirement was associated with increased quality of life [B=0.7, 95% CI=0.2, 1.1, p<0.05], while associations between depression and loneliness and retirement were not significant. Those who volunteered in retirement experienced less depression over time [IRR=0.90, 95% CI=0.83, 0.99].

Conclusion

The findings of this study demonstrate the positive effects of volunteering on the psychological outcomes of older adults. This study also found evidence of the long-term effects of volunteering in retirement on depression, suggesting that continued participation in volunteer activities positively impacts depression. This research demonstrates the importance of increasing opportunities and promoting volunteer participation to contribute to the positive ageing of older adults.
A Novel Primary Care-Based, Practice Nurse-Led Bone Health Service for People in Long Term Care
Authors: Warlow Geraint , Toland Sarah
Published: September 2024

Background

11% of all Irish hip fractures originate in the long-term care (LTC) setting and LTC residents are at the highest risk of reduced bone density. Risk is poorly managed as no primary care framework exists. A novel practice nurse-prescriber-led service is described in which risk estimation directs stratification, investigation, and treatment of fragility fracture risk.

Methods

Baseline assessment uses FRAX (fracture risk assessment tool) to risk-stratify using NOGG (National Osteoporosis Guideline Group) risk charts and inform the need for bone mineral density (BMD) measurement. A bone health drug optimisation process ensured patients were offered treatment at appropriate intensity.

Results

107 residents of mean age 86.2 were newly admitted to long-term care in 2023. 92 were included and 15 were excluded due to poor prognosis. 10 of the 92 residents included died in 2023. 91 patients were risk-stratified into NOGG categories as follows: Low 22%, n=20; intermediate, below intervention threshold 23%, n=21; intermediate, above intervention threshold 16%, n=15; high 19%, n=17; very high 20% n=18. 84% (n=77) of those in risk categories indicating anti-resorptive treatment were not prescribed a bisphosphonate at baseline and none were prescribed Denosumab. 84% (n=42) were prescribed Vitamin D either with or without supplemental calcium and 16% were prescribed nothing to improve bone health. Post-intervention, 100% (n=43) of patients at a risk level of NOGG ‘intervention threshold’ or above were prescribed either Vitamin D with or without supplemental calcium and 58% (n=25) were prescribed anti-resorptive therapy (denosumab =47%, n=20 or bisphosphonate = 9%, n=5). Discussion of treatment with the primary care and LTC team is periodic. At the time of data capture, 88% of residents were discussed and 12% were planned for discussion.

Conclusion

A practice nurse-prescriber led service targeting LTC residents is effective in optimising screening and prescribing. Future work could include replication in the national LTC community.
A Process Evaluation Exploring the Delivery of a CGA-Based Intervention in the ED: The SOLAR RCT
Authors: Barry Louise , Leahy Aoife , O'Connor Margaret , Corey Gillian , O'Shaughnessy Ide , Smalle Eimear , Synnott Aoife , Moran Brian , McCarthy Aoife , Carroll Ida , Meskell Pauline , Tighe Sylvia Murphy , Galvin Rose
Published: September 2024

Background

Evidence to support the delivery of CGA, to improve the care of older adults in ED, is encouraging but limited. The SOLAR trial is the first of its kind to explore this ED intervention. The trial process and delivery were underpinned by the development of a complex trial protocol, facilitation of stakeholder involvement and Multidisciplinary team (MDT)-based collaboration. The aim of this study was to utilise a mixed methods approach to explore the delivery of this trial.

Methods

Using the Medical Research Council (MRC) Framework, we investigated the trial design, implementation and delivery. Mechanisms of impact and contextual influences were explored by analysing participant recruitment logs, team activity logs and by interviewing SOLAR MDT members and trial participants. Qualitative insights were mapped to the theoretical domains framework (TDF) to inform implementation strategies.

Results

Clinical knowledge and experience is vital when delivering CGA to a complex heterogenous group in the ED. This approach is time consuming and needs to be delivered by skilled and highly motivated professionals who build positive relationships and foster a multidisciplinary and patient-centred ethos. To facilitate implementation, establishing preconditions to screening processes and involving relevant stakeholders in pre-implementation processes can facilitate acceptance of intervention operations.

Conclusion

This is the first evaluation to provide in-depth insights from both trial participants and the MDT trial team. Findings provide practical insights into the value of consistent stakeholder involvement when delivering a complex intervention. The importance of establishing a knowledgeable and highly skilled MDT team to successfully deliver CGA was emphasised. Experience in delivering complex care to a heterogenous group of older adults in the ED is vital to underpin this care and ensure CGA integration into current ED processes, this was recognised by both older adults and the trial team. A collaborative approach to CGA delivery ensured that participants had positive experiences throughout the trial.
From Hospital to Home: Applying a Co-design Approach to Determine Key Components of an Intervention to Support Transition-to-Home After Stroke
Authors: O'Callaghan Geraldine , Fahy Martin , Hall Patricia , McCartan Deirdre , Langhorne Peter , Galvin Rose , Horgan Frances
Published: September 2024

Background

When people with stroke transition from the hospital back to their homes, they and their families frequently experience multi-faceted unmet needs and feelings of abandonment. Uncertainty surrounds the fundamental components of an intervention intended to support transition-to-home after a stroke. The aim of this study was to utilise a co-design process to identify key components for a patient-centred support intervention facilitating the transition home after stroke, and to explore what might be feasible within a real-world context.

Methods

The primary researcher, a larger team of researchers, and an individual with lived experience of stroke facilitated a series of three workshops for 12 people with stroke, 6 caregivers, 26 healthcare professionals, and 6 representatives from stroke organisations. World Café methodology and Liberating Structures facilitation techniques were adapted to meet the study aim. Data collection involved making observations during workshops, summarising findings, and reaching group consensus agreement on outputs. The final output was the consequence of facilitated consensus on a prioritisation task. Individuals with lived experience of stroke contributed to study design, ethics, and co-design outputs, providing input for future research and co-facilitating workshops with the research team.

Results

The co-design group identified 10 key intervention components to support people with stroke and their families during the transition from hospital-to-home. These components focussed on enhancing collaboration, streamlining transition processes, and facilitating post-discharge support. While a stroke coordinator was considered a top priority, increased cross-setting information sharing and community-based healthcare staff in-reach, were considered most feasible to implement.

Conclusion

The co-design approach, involving a multi-stakeholder group, was strengthened by patient and public involvement. This ensured that the identified transition-to-home intervention components are meaningful and relevant for people with stroke and their families. To further refine, and feasibility test the components for generalisability within the wider Irish healthcare context, additional co-design workshops are required.