bluuebunny/crossref_metadata_2025 huggingface dataset:
P-frames and rhetorical moves in applied linguistics conference
abstracts
Authors: Yoon Jungwan , Casal J. Elliott
Published: February 2020

This chapter examines the use of formulaic
phrase frames (p-frames) in the rhetorical construction of Applied
Linguistics Conference Abstracts (CAs). We consider both the
distribution of p-frames across rhetorical moves/steps and the
strength of the association of p-frames with individual moves/steps
in 625 accepted AAAL 2017 CAs, all freely available on the
organization’s website. We manually tagged the corpus for rhetorical
moves/steps and identified p-frames of 5 and 6 words (29 per million
threshold) using kfNgram (Fletcher 2012). Results highlight that
p-frames play a prominent role in the realization of CA writers’
rhetorical goals both in the prevalence of p-frame use (roughly 1.7
instances per text in our data) and in the close relationship that
many p-frames exhibit with particular rhetorical functions.
Optically induced birefringence in dye-doped blue phase liquid crystals
Authors: Lin  , Kuo  , Huang  , Wu  , Lin  , Lee
Published: February 2020

This paper investigates the photoinduced change of refractive index in dye (methyl red, MR)-doped blue phase (DDBP) cells by illumination of a pump beam. Through excitation of light irradiation with proper photon energy, MR can transform from trans-state to cis-state and
successively diffuse and anisotropically adsorb on the inner glass substrate of the DDBP cell along the direction perpendicular to the polarisation of the pump beam. The adsorbed MR molecules can effectively rotate the orientation of the liquid crystal (LC) molecules and thereby modulate the
effective refractive index of the DDBP cell. The SEM images of the adsorbed regions of the illuminated DDBP samples were also taken for discussing the relation between the pump intensity and the photoinduced birefringence.
BAF45D knockdown decreases cell viability, inhibits colony formation, induces cell apoptosis and S-phase arrest in human pancreatic cancer cells
Authors: Liu Zengyi , Liu Lihua , Sun Ruyu , Liu Chao
Published: February 2020

Pancreatic cancer, an extremely aggressive malignancy, is resistant to chemo- or radiotherapy. The rapid progression of pancreatic cancer without distinctive clinical sign makes early diagnosing and/or treating very difficult. BAF45D, a member of the d4 domain family, is involved in oncogenic processes. However, the role of BAF45D in pancreatic tumorigenesis is largely unclear. Our goal is to examine BAF45D protein expression after lentivirus-mediated Baf45d RNAi and explore the effects of BAF45D knockdown on cell proliferation, cell apoptosis, and cell cycle of human pancreatic cancer cells. Here our results showed that Baf45d RNAi downregulated BAF45D protein levels and decreased cell viability, increased cell apoptosis, and decreased colony formation in BxPC-3 cells. Moreover, BAF45D knockdown induced S-phase arrest in BxPC-3 cells. Our results here suggest that BAF45D may play a crucial role in tumorigenic properties of human pancreatic cancer cells.
Optical studies of ferroelectric and ferroelastic domain walls
Authors: Nataf G F , Guennou M
Published: February 2020

Recent studies carried out with atomic force microscopy or high-resolution transmission electron microscopy reveal that ferroic domain walls can exhibit different physical properties than the bulk of the domains, such as enhanced conductivity in insulators, or polar properties in non-polar materials. In this review we show that optical techniques, in spite of the diffraction limit, also provide key insights into the structure and physical properties of ferroelectric and ferroelastic domain walls. We give an overview of the uses, specificities and limits of these techniques, and emphasize the properties of the domain walls that they can probe. We then highlight some open questions of the physics of domain walls that could benefit from their use.
Application of Tikhonov Regularization for 1D Geothermal Heat Flux Ill-Posed Inverse Problem: A Case Study on Chad Sedimentary Basin
Authors: Salim Christopher , Mariyanto Mariyanto , Bohal Yolanda Mustika , Sihombing Hilda Liliana
Published: February 2020

Subsurface heat flux information is important in geothermal exploration. With the information, geophysicists can map exactly the thermal potential in a particular area. Based on the surface heat flux, inverse modeling produces the 1D subsurface heat flux distribution. However, inverse problems in the geothermal system are generally ill-posed. Small changes in the data can cause large changes in the solution and the solution may not be unique. To solve the mentioned non-linear and ill-posed equation above, Tikhonov regularization is a choice for stabilizing the inverse calculation. This paper demonstrates how Tikhonov regularization is useful to solve subsurface heat flux distribution both in the synthetic model and real model. Based on surface heat flux distribution from the direct problem, the preconditioned conjugate gradient algorithm calculates the subsurface heat flux. With the correct choice of the regularization parameter, the inverse model fits the initial model. For the testing purposes in real-world conditions, Chad sedimentary basin located in Chad and Nigeria is used as a model. A high geothermal gradient is found in this area. Therefore, geothermal explorations are on the rise recently. Its thermal conductivity, heat production, and stratigraphy data from previous researches provide information about the initial model. The heat flux curve generated from inversion matches the initial noisy model with the error of around 10−9 mW/m2. Therefore, to answer the increasing energy demand, this method can be highly applicable to future geothermal prospecting.
Application of Remote Sensing for Determination of Power Plant Area: Case Study of Lumut Balai, South Sumatra
Authors: Winanti S S , Latuconsina N , Herdani A N , Kumara D A
Published: February 2020

Subduction zone located beneath Sumatra, Indonesia causes the formation of volcanic sequences, which can be associated with the potential of geothermal energy. One of them is Lumut Balai area in South Sumatra. A study of using remote sensing method was conducted as one of the preliminary methods to find out the geothermal potential in the Lumut Balai area. In this case, an analysis of regional geology maps, Landsat 8 OLI / TIRS, and digital elevation model (DEM) was carried out. The geothermal potential is obtained based on a combination of anomalies in land surface temperature (LST), the normalized difference vegetation index (NDVI), and distribution of alteration zones. The analysis of NDVI result shows the Lumut Balai area dominated by mostly moderate to high level of vegetation density up to 0.88. Whereas, the LST result shows the maximum value, which is 40.3°C located at the residential area in the north and the open land in the northwest of Lumut Balai. The correlation between the results of LST and NDVI has been shown in geothermal surface manifestations, that have vegetation less than 0.88 while the temperatures show a higher value up to 40°C than the surrounding its area. While the results of the DEM analysis provide topographic information, the slope in the study area used to determine the area for development of power plant. The power plant more likely to be located in the southwest and northeast of Lumut Balai where it has flat terrain and not in the near-fault area.
Reservoir Temperature Calculation of Immature Geothermal Water from Hot Spring Around the Slamet Volcano
Authors: Iswahyudi S , Siswandi  , Attabik L W , Saifrudin N A
Published: February 2020

The temperature of some geothermal reservoirs around Slamet Volcano can be estimated from hot spring water geochemistry around it. Calculation of reservoir temperature from immature hot water samples has the potential to cause uncertainty. This is due to a mixture of geothermal water and meteoric water. The manifestation of the geothermal water appears in several different places, including on the southern slope of Slamet Volcano which consists of Pancuran-7 and Pancuran-3 Hot Springs. On the northwest slope of Slamet Volcano, several manifestations also appear, namely Pancuran-13 and Pengasihan in the Guci Area and Sigedong Hot springs in Sigedong Area. This study uses geochemical methods of geothermal water and hot springs water sample data from previous studies for analysis of geoindicators and geothermometers. Reservoir temperature calculation is based on the content of silica and enthalpy of immature geothermal water and meteoric water in the study area. Based on the Cl- Li-B geoindicator analysis, it was interpreted that there were 3 geothermal systems with different reservoirs around Slamet Volcano, namely the Baturaden, Guci and Sigedong Systems. Based on the Na-K-Mg plot for the geothermometer, the five hot springs around Slamet Volcano are included in the immature water group. Based on the enthalpy vs. silica analyses, the geothermal reservoir temperatures for Baturaden, Guci, and Sigedong are 204°C-210°C, 187°C-196°C and 181°C.
Surface and Subsurface Fracture Zones Modeling Using Automatic Lineament Analysis and Geostatistical Method, with Case Study of Wayang Windu Geothermal Field, West Java, Indonesia
Authors: Heriawan Mohamad Nur , Hafizsyah Rifqy Adwin , Hanunah Jihan Syifa , Hede Arie Naftali Hawu , Malik Dwiyogarani
Published: February 2020

Geological structures such as faults and fractures in a geothermal prospect area might be an indication of a permeable zone for geothermal fluids through fractures that appear inside the rocks. Such geological structures can be identified by lineaments in satellite images and aerial photographs. In this study, we determine the effect of pixel size on the results of automatic lineament extraction and examine the relationship between lineaments at the Wayang Windu geothermal field (WWGF) and nearby geothermal areas, automated lineament results which were extracted from digital elevation models (DEMs) with pixel sizes of 0.5 m, 1 m, 2 m, 3 m, 4 m, 5 m, 10 m, 15 m, and 20 m based on aerial photographs, DEM Nasional (DEMNAS) images, and Shuttle Radar Topography Mission (SRTM) images. Under similar parameters, larger pixel sizes revealed fewer and longer lineaments than smaller pixel sizes. The type of image (i.e., satellite images or aerial photographs) used for lineament extraction did not affect the results. Based on lineament density maps, the lineaments from images with smaller pixels had a wider distribution area than those with larger pixels. Surface geothermal manifestations, such as hot springs, showed good correlation with lineaments found in images with smaller pixel sizes (≤ 5m), which were found in moderate to high lineament density zones. Based on the lineaments extracted from SRTM images, each geothermal field in southern Bandung (Patuha, WWGF, Darajat, Kamojang) had a local geological structure that greatly correlated with the lineament extraction results. All of the lineaments in the geothermal fields were primarily oriented in the NE–SW direction (i.e., N65°E for Patuha, N51°E for WWGF, N57°E for Darajat, and N24°E for Kamojang). Subsurface fracture zone modeling was conducted at WWGF to estimate the permeability zones based on the fracture density from production well data using the Ordinary Kriging (geostatistical) method. The results revealed the direction of subsurface fracture dips and strikes as well as the relationship between subsurface fracture geometries and surface lineament structures. In general, the subsurface fracture zones featured strikes in a NE–SW direction, with dip angles ranging from 74° to 85° and fracture density ranging from 36 to 43 fractures per 10 m. Additionally, the fracture density linearly corresponded to the depth of wellpads. Compared to the surface lineament extraction map, the majority of lineaments were in the NE–SW direction, similar to the major strike of the subsurface fracture zones.
The Subsurface Geology and Hydrothermal Alteration of the Dieng Geothermal Field, Central Java: A Progress Report
Authors: Shalihin M G J , Utami P , Nurpratama M I
Published: February 2020

The Dieng geothermal system is volcano-hosted, and its reservoir is liquid-dominated. Thermal manifestations lay at about 2,000 m asl. Previous studies suggest that the field consists of three prospect areas, namely Sileri, Sikidang-Merdada, and Pakuwaja. Dieng Geothermal Field has serious problems with mineral scaling and corrosion in the production facility. The problems, to some extent, are related to the natural characteristics of the system. In our study, cuttings from 4 of 47 wells drilled in Dieng were examined using petrography and X-Ray Diffractometry techniques to better understand the subsurface geology of the Dieng Geothermal Field, including different types of hydrothermal alteration mineralogy. The wells MG-1, MG-2 and MG-3, and MG-4 are chosen to represent the prospect areas, respectively. In general, typical hydrothermal minerals in Dieng Geothermal Field formed by near-neutral pH fluids characterized by clays (smectite, illite, chlorite), silica (quartz, cristobalite), calcite, wairakite, pyrite, epidote, and actinolite. In wells MG-3 which are located in the Sikidang-Merdada area, acidic alteration such as anhydrite, pyrophyllite, and native sulfur are present. Most notably, anhydrite occurs from the near-surface down to depths >2,000 m. These findings indicate the existence of acidic fluids at the deeper parts of the Sikidang-Merdada area. Furthermore, we utilize subsurface geological data from other wells within all the three prospect areas to complement our review.
Identifying Upflow Zone Based on Thermal Infrared (TIR) Sensor and Field Measurements at Volcanic Field
Authors: Hilman Zaki , Saepuloh Asep , Chalik Citra Aulian , Heriawan Mohamad Nur
Published: February 2020

Upflow zone identification at volcanic fields is crucial for geothermal resource exploration. The common problem to identify the upflow zone using conventional mapping method is time-consuming and the limitation of access to the area. The application of satellite imaging as ground-truthing is aimed to increase the effectiveness of upflow zone detection at geothermal fields. This study selected the volcanic field around the Bandung Basin for a model case. The data used in this study were thermal images of the Advanced Spaceborne Thermal Emission and Reflection Radiometer (ASTER) Thermal Infrared Radiometer (TIR) by the night observations. The TIR data were corrected and calibrated by Visible Near Infrared Radiometer (VNIR) to measure Land Surface Temperature (LST). We then focused our analysis around a volcanic area that showed high LST at the Papandayan crater and other manifestations. Validations were carried out by measuring surface temperature and gas concentrations including SO2 and CO2. The reading value of the gases was different on each location, but the pattern of the gases was relatively similar especially the SO2 gas pattern. The SO2 gas showed a relatively constant trend of gas concentration over time in the upflow zone, but in the outflow zone showed an increase pattern with the time whose reading values were lower than those on the upflow. On the contrary, the non-geothermal features showed that the SO2 concentration decreased with the time towards almost 0. According to the retrieved LST, the surface manifestations were located not only at the high anomaly but also at medium anomaly depending on the manifestation dimension. The gas and temperature measurements proved that LST could be used to enhance the effectiveness of upflow zone identification.
Design of Geothermal Drilling Training Curriculum as the Implementation of the National Competence Standard on Onshore Drilling
Authors: Umam Mukhamad F. , Susilo Joko , Purba Dorman P. , Adityatama Daniel W.
Published: February 2020

Indonesia is currently the second largest geothermal installed capacity in the world, with around 1948,5 MW installed capacity. However, this achievement is still far from the Indonesian Government’s target of 7000 MW installed capacity in 2025. Thus, it requires a lot of efforts, supporting policies, and a great deal of competent human resources to achieve this ambitious target. Fulfilling the need for qualified geothermal human resources will take a significant amount of time if it only relies on higher education graduates. Hence, vocational education institutions especially training centers are expected to contribute more to meet these needs. The government has issued a regulation on the Indonesian National Work Competency Standards (SKKNI) which covers aspects of knowledge, skills and work attitudes relevant to the implementation of assigned duties and terms including SKKNI of onshore drilling which is used as a reference for oil and gas and geothermal drilling. However, previous studies have identified the differences between geothermal drilling and oil and gas drilling. This might be due to the government still considers that those two are similar, so they only issued one competency standard for both fields. This paper discusses the implementation of SKKNI on onshore drilling competency standard to produce geothermal drilling curricula. The first part of this paper will map the current conditions of Indonesia’s geothermal drilling human resources development including the estimated number of human resources needed. Furthermore, this study highlights the fundamental differences between the hydrocarbon and geothermal drilling to provide a better understanding of the competency needs of labor in the geothermal industry. Several research or publications and overseas competency standards are discussed and compared to decide which material needs to be included in the curriculum. Several alternative approaches related to human resource capacity development are also proposed in this paper to support the Indonesian Government’s target in 2025.
A New Mechanism in Determining the Number of Geothermal Wells for Power Plant Development Using Stochastic Method
Authors: Salim Feri Vernando , Pratama Heru Berian , Saptadji Nenny Miryani
Published: February 2020

The number of geothermal wells (production, injection, make-up) should be calculated carefully to get the optimum values for the technical aspect of power plant development. However, the method for calculating the number of wells has been used is a deterministic approach that involves only a single value for every parameter. Since the result of this method is a single value, it cannot capture the uncertainties of the field parameters. Therefore, this paper proposed the newest method that applied 2-level full factorial design of experiment approach with the help from Minitab software to cover the uncertainties of the field parameters and to produce the probabilistic number of wells in combination with Monte Carlo Simulation. The proposed method has been successfully used to calculate the number of wells in the case study of Karaha-Talaga Bodas field. Based on the study, the most significant factors for determining the number of production and injection wells are the fluid enthalpy and total mass flow rate, whereas for the make-up wells number are the decline rate and make-up well capacity. 5 production wells, 1 injection well, and 4 make-up wells are the minimum requirement number of wells that should be drilled for generating 30 MW power plant capacity in 30 years.
Updating the Conceptual Model of Lumut Balai Geothermal Field, South Sumatera, Indonesia Using Numerical Simulation
Authors: Hamdani Muhamad Ridwan , Pratama Heru Berian , Sutopo
Published: February 2020

The Lumut Balai geothermal field is classified as a volcanic hydrothermal system characterized by the presence of fumaroles and hot springs. Downhole measurements indicate that this geothermal system has a liquid-dominated reservoir with temperatures of 240-260°C. This study presents a natural state model and updated the conceptual model of Lumut Balai based on published geological, geophysical, geochemical, and well data. The model was validated using available temperature data from three drilled wells. Furthermore, the mass and heat flow through the model were also validated with geoscience and well data. A match to the natural state condition was achieved by adjusting the horizontal and vertical permeability. The updated conceptual model of Lumut Balai geothermal field has been shown to be physically realistic by a numerical model. The model temperatures, mass flow, and heat flow are well-matched with the actual data, although there is still some room for further improvements.
Preliminary Financial Modelling with Probabilistic Approach for Geothermal Development Project in Indonesia
Authors: Lesmana Ade , Winofa Nevi Cahya , Pratama Heru Berian , Ashat Ali , Saptadji Nenny Miryani
Published: February 2020

The right of geothermal field concession in Indonesia is obtained by tender as per Law No. 21/2014 Article 18. In the submitted proposal, the developer candidates shall mention the plan of field development strategy, while available data is limited due to a preliminary survey or preliminary survey and exploration were just performed. Then the developer candidates must be able to formulate the financial condition of the project so that the field utilization not only sustains but also produces appropriate profits. This paper discussed some regulations which are related to the economics of geothermal development project in Indonesia and a simple example of financial modelling with a probabilistic approach using Microsoft Excel Monte Carlo simulation and analysis tool. The input data were some technical assumptions such as installed capacity, steam fraction, steam specific consumption (SSC), well’s capacity, well’s success ratio, and financial assumptions such as well’s price, power plant construction’s cost, operation and maintenance cost, and others. The output of modelling were NPV (Net Present Value), IRR (Internal Rate of Return) and parameters that were sensitive to both values, whether financially or technically. The result of simulation showed from the financial aspect, wells and power plant cost were the most sensitive parameters in IRR calculation, while well’s capacity and steam fraction were the most sensitive parameters from the technical aspect.
The bioprinting roadmap
Authors: Sun Wei , Starly Binil , Daly Andrew C , Burdick Jason A , Groll Jürgen , Skeldon Gregor , Shu Wenmiao , Sakai Yasuyuki , Shinohara Marie , Nishikawa Masaki , Jang Jinah , Cho Dong-Woo , Nie Minghao , Takeuchi Shoji , Ostrovidov Serge , Khademhosseini Ali , Kamm Roger D , Mironov Vladimir , Moroni Lorenzo , Ozbolat Ibrahim T
Published: February 2020

This bioprinting roadmap features salient advances in selected applications of the technique and highlights the status of current developments and challenges, as well as envisioned advances in science and technology, to address the challenges to the young and evolving technique. The topics covered in this roadmap encompass the broad spectrum of bioprinting; from cell expansion and novel bioink development to cell/stem cell printing, from organoid-based tissue organization to bioprinting of human-scale tissue structures, and from building cell/tissue/organ-on-a-chip to biomanufacturing of multicellular engineered living systems. The emerging application of printing-in-space and an overview of bioprinting technologies are also included in this roadmap. Due to the rapid pace of methodological advancements in bioprinting techniques and wide-ranging applications, the direction in which the field should advance is not immediately clear. This bioprinting roadmap addresses this unmet need by providing a comprehensive summary and recommendations useful to experienced researchers and newcomers to the field.
Study on microstructure and properties of TA1-304 stainless steel explosive welding cladding plate
Authors: Liangyu Lu , Yong Su , Jian Chen , Yu Fang , Xiaoyuan Xia , Jin Yu
Published: February 2020

Bonding TA1 and 304 stainless steel by explosive welding to obtain cladding plate. the microstructure of the bonded interface of the cladding plate was analyzed and its properties were tested. It was observed that the bonding interface of the cladding plate was periodically wavy. There is a large melting zone at the end of the interface waveform, and a vortex exists near the melting zone. The EDS surface scanning of the interface shows that there is element diffusion at the interface, and it is speculated that the bonding at the interface of the cladding plate belongs to metallurgical bonding. The microhardness measurement results show that the Vickers hardness (HV) at the interface is up to 413.10, and then the microhardness is lower with the distance from the interface junction, and gradually decreases to the same raw material. The tensile strength of 304 material after explosive welding reached 865MPa; the longitudinal shear strength of titanium-stainless steel cladding plate was 325MPa, and the transverse shear strength was 309MPa; The tested cladding plate has excellent corrosion resistance, and its corrosion resistance is between TA1 and 304. The self-corrosion current of the cladding plate is 233 μA.
Preparation of fluorine and carbon co-introduced TiO2 at low temperature with enhanced visible-light degradation performance for 2,4,6-trichlorophenol
Authors: Tang Yang , Shen Fang , Huang Hao , Shang Hongyan , Mao Hui , Ma Jun , Liao Yang , Zhao Shilin
Published: February 2020

Traditional TiO2 photocatalyst has the disadvantages of weak visible-light responsibility, fast combination of photo-generated electron and hole, which significantly degrade its photocatalytic degradation activity. Therefore, fluorine and carbon co-introduced TiO2 was synthesized at a relatively low calcination temperature via a modified sol-gel method, and then be thoroughly characterized to explore the structure-performance relationship. It was found the optimum catalyst FCT-200 prepared at calcination temperature of 200 °C exhibited remarkably enhanced visible-light absorption and restrained photo-generated carrier combination, which should be attributed to the F, C elements co-introduction, lower crystallization degree, and smaller particle size of anatase TiO2. With such advantages, the catalyst therefore demonstrated satisfactory photocatalytic degradation activity for 2,4,6-trichlorophenol (2,4,6-TCP) under visible-light irradiation. The apparent degradation rate reached as high as 0.41971 h−1, almost 42 folds higher than P25. It is anticipated that the fluorine and carbon co-introduced TiO2 photocatalyst presented in this work could provide a new insight into significantly improving the photocatalytic performance of TiO2.
An Applied Empirical Framework for Invasion Science: Confronting Biological Invasion Through Collaborative Research Aimed at Tool Production
Authors: Blackburn Gwylim S , Bilodeau Pierre , Cooke Tracey , Cui Mingming , Cusson Michel , Hamelin Richard C , Keena Melody A , Picq Sandrine , Roe Amanda D , Shi Juan , Wu Yunke , Porth Ilga
Published: February 2020

Global ecosystem functions, services, and commodities are increasingly threatened by biological invasions. As a result, there is an urgent need to manage invasive species through global collaborative research. We propose an ‘applied empirical framework’ (AEF) to aggressively confront the current global biological invasion crisis. The AEF builds on existing models for invasion science that advocate 1) standardized research designs to reveal key aspects of biological invasion, and 2) collaborative research to facilitate the sharing of resources and information. The AEF further emphasizes the need for 3) the production of research ‘tools’ (e.g., data, methodologies, technical instruments) designed for direct uptake by agencies that manage biological invasion, and 4) a taxonomically targeted approach in which task forces conduct rapid, in-depth research on top-priority invasive species across their entire geographic range. We review collaborative science and the distinctive roles played by different collaborator types. We then provide an example of the AEF in action through the BioSAFE initiative (Biosurveillance of Alien Forest Enemies), a highly collaborative project aimed at developing genomic research tools to facilitate biosurveillance and intervention for forest invasive species. We illustrate the BioSAFE approach through our research on two polyphagous insect species: the wood-borer Anoplophora glabripennis, Motschusky (Coleoptera: Cerambycidae; Asian longhorned beetle) and the defoliator Lymantria dispar, Linnaeus spp. (Lepidoptera: Lymantriidae; gypsy moth). These examples illustrate how the AEF can focus and accelerate our response to the global biological invasion crisis by applying the resource capabilities of collaborative research groups to generate management tools for top-priority invasive species.
9 The ‘Colchester Older Persons’ Evaluation for Surgery (COPES)’ Clinic: A Multidisciplinary Approach to Preoperative Management of Frail, Older Patients
Authors: Jiang Z , Mathew A , Peck L , Rudra P , Simpson J
Published: February 2020

Introduction

In 2014-15, 2.5 million patients over 75 years old underwent surgery compared to 1.5 million in 2006-7. The population is aging with increasing numbers of comorbidities, and associated frailty.1 The Royal College of Anaesthetists recommends that preoperative assessment for these complex older patients takes a “cross-specialty approach.”2 In Colchester the COPES clinic has been introduced in which selected high-risk patients are seen by a Consultant Anaesthetist and Consultant Geriatrician. This aims to medically optimise patients prior to surgery and to facilitate shared decision making.

Methods

The new clinic was introduced in October 2018. The following data was collected from COPES clinic letters from October to February 2018-19 (n=46):Patient/ surgery characteristics: age, comorbidities, frailty score and any cognitive impairmentInterventions: changes to medication, specialty referral, intravenous iron, diabetes optimisation, otherOutcomes of surgery following the COPES clinic

Patients were asked to complete feedback forms to evaluate the service.

Results

52% of patients had 4-6, and 28% had 7-9 comorbidities. The majority had Rockwood frailty scores of 4 or 5. 28% of patients had medications changed, 48% had specialty referrals, 17% received intravenous iron, 8.7% required diabetes optimisation and 28% of patients had investigations including echocardiograms, MRI and CT scans. 12/46 patients had surgery deemed unlikely to go ahead after shared decision making with patients in conjunction with the multidisciplinary team involved in their care. 2 patients died of their comorbidities after deciding not to proceed with surgery. 12/46 patients underwent surgery; 4 developed post-operative complications, none died and the mean length of stay was 3.38 days. The remaining 22/46 patients are awaiting surgery. Patient feedback questionnaires (n=10) were overwhelmingly positive. Everyone felt that they were treated with respect and that their fears were addressed and they were clear in the next steps in management.

Conclusions

The introduction of the ‘COPES’ clinic has helped address frailty and multiple comorbidities by optimising patients’ medical conditions and allowing alternatives to surgery to be considered. Patients were very satisfied with the COPES clinic and felt it has prepared them for upcoming surgery.

References

1. Lin H. Frailty and post-operative outcomes in older surgical patients: a systematic review. BMC Geriatrics, 2016.

2. RCoA. Guidelines for the Provision of Anaesthesia Services. www.pre-op.org/sites/default/files/GPAS%202016.pdf
12 Exploring Hospital Discharge as An Opportunity for Falls Prevention Exercise Referral
Authors: Buckland C , Whitney J
Published: February 2020

Topic

Proactive prevention is at the core of the NHS Long Term plan and falls prevention is an important public health priority. National guidance recommends that all health professionals have competence in falls assessment and prevention and advise that older adults at risk of falls are considered for strength and balance exercise.

With rising numbers of older adults occupying inpatient beds, some clinicians may not have the skills to identify these opportunities to prevent falls. Previously, physiotherapy staff on a respiratory medicine ward were not delivering best practice in falls prevention.

Aim

Within 3 months, to achieve a 30% increase in older adults at risk of falls, being offered exercise referral at hospital discharge.

Intervention

Quality improvement methodology including stakeholder engagement and Plan-Do-Study-Act cycles were used to influence behaviour change amongst physiotherapy staff on a respiratory ward. Interventions included training and a documentation sticker. For evaluation, the weekly number of older adults at risk of falls with evidence of offer for falls prevention exercise was collected over 13 weeks and evaluated on a Statistical Process Control chart. Staff confidence scores and cohort data were also recorded and described using descriptive statistics. The NHS Improvement Sustainability Model was used to measure project sustainability.

Improvement

At baseline, 0/18 (0%) older adults had an offer for fall prevention exercise. Over the intervention period, this increased to 22/37 (59.5%) and demonstrated special cause variation that was confidently assigned to the interventions. There was a 44.5% improvement in staff confidence in offering fall prevention exercise. The project scored 53.7% using the NHS sustainability model.

Discussion

This project demonstrated favourable behaviour change in falls prevention practice amongst physiotherapy staff on a respiratory ward. There was variability in the improvement possibly as a result of contextual influences of staffing and seasonality. Hospital discharge is a good opportunity to assess falls risk in older adults and offer information and referral for exercise. Wider implementation may be useful to help older adults optimise health outcomes but will depend on organisational stakeholder support to improve sustainability.
15 Structured Geriatric Liaison Services in Mental Health Inpatient Facilities
Authors: Babu B , Khalid A , Sadiq S , Essem J , Ruiz-Mendoza E
Published: February 2020

Introduction

Older people admitted to mental health facilities may be at increased risk of deterioration in the physical co-morbidities and increased rates of mortality when admitted in acute medical settings. Our model of care focuses on intervening in the physical aspect of patients admitted in the mental health unit addressing their comorbidities and polypharmacy and offering staff support during the admission process. Our Older Mental Health Unit is based in the district hospital with a total of 22 beds for people over 65 years old distributed in two areas: dementia with behavioral and psychological symptoms (BPS) and functional disorders.

Methods

Allocated geriatrician once a week to attend MDT and medical ward rounds. 5 working days telephone consultations for advice and supporting trainees in teaching and research. We measure the impact of our intervention comparing the data predating our intervention comparing 20 patients in each period 2016 and 2018.

Results

Mean age increased from 74.3 to 77.8 in a two year period with an average of 3.5 medical co-morbidities. Reduction in polypharmacy from 7.15 to 5.5 number of medication, 58% reduction in the number of hospital transfers and 90% reduction in specialty referrals.

Conclusions

Structured Geriatric Liaison Services in Mental Health in inpatient facilities are shown to be effective in reducing acute hospital and outpatient clinic attendances minimising the challenges of management of these patients in non-mental health facilities.
18 The Use of A Multifactorial Intervention to Improve Bowel Chart Recording and Laxative Prescription in A Tertiary Geriatrics Department
Authors: Ji-Xu A , Moezinia C , Lovett N , Sharma D Krishan
Published: February 2020

Introduction

Constipation has a high prevalence of 30-40% in those aged over 65. It can lead to complications including delirium, faecal impaction, stercoral ulceration, and bowel obstruction. Although stool charts are used in geriatric wards to monitor bowel movements to guide management of constipation, they are often inconsistently recorded. Similarly, regular laxatives are often not prescribed for constipated patients due to ward pressures or unawareness regarding their importance.

Aims

Our aims were to audit the rates of recording on stool charts and laxative prescription in a geriatrics department, and to assess whether a multifactorial intervention aimed at both doctors and nursing staff improved these rates.

Methods

Two independent assessors audited the recording of stool charts, and rates of constipating medications and laxative prescription in two geriatrics wards in a tertiary UK hospital. A multifactorial intervention was implemented, consisting of didactic sessions for doctors and nurses, healthcare assistant champions to promote the recording of stool charts, and consolidation of bowel movement recording onto a single paper stool chart by the bedside rather than multiple charts. After the intervention, the data was re-audited on the same wards. Descriptive statistics and frequency tabulation were used for data analysis.

Results

Data was collected from 33 patients. Pre-intervention, stool charts were recorded daily in 13 patients, 10 patients had no stool chart record, 20 patients were on at least one constipating medication, 12 patients were prescribed at least one laxative, and 5 out of 7 patients with opiates had laxatives co-prescribed. Post-intervention, stool charts were recorded daily in 21 patients, all patients had a stool chart record, 20 patients were on at least one constipating medication, 23 patients were prescribed at least one laxative, and 2 out of 4 patients with opiates had laxatives co-prescribed. Our intervention improved daily recording on stool charts by 24%, resulted in all patients having a current stool chart and improved prescription of regular laxatives by 34%.

Conclusions

A multifactorial intervention based on educational sessions, healthcare assistants acting as champions, and consolidation of recording of bowel movements into a single chart, improved stool chart recording and prescription of regular laxatives in a tertiary geriatrics department. Future auditing will extend the sample size and generalise the intervention to other hospital departments.
38 Improving Access to Outpatient Services for Older People Using A Clinical Microsystems Approach
Authors: Tullo E , Smith A , Ridden J , Ross R , Curless R , Doshi M
Published: February 2020

Background

Northumbria Healthcare NHS Foundation Trust provides services to more than 500,000 residents in the North-East of England across multiple sites.

Local problem

Outpatient services for older people across Northumbria include specialist (eg falls) and generic clinics with differing referral routes, demands and waiting times. Referrals derive from primary care, emergency services and elsewhere; some are complex patients requiring a comprehensive geriatric assessment (CGA). Existing pathways led to variable waits for clinics, duplication and delays.

Aim was to improve the timeliness, efficiency and access to appropriate assessment first time.

Methods

We adopted a Clinical Microsystems approach (Sheffield Microsystems Coaching Academy) for improvement. Main components were team coaching, weekly “Big Room” meeting of involved staff to share understanding of current process, agree change ideas, and test these with multiple plan, do, study, act (PDSA) cycles. Impacts of each PDSA cycle were discussed in Big Room, leading to refinement of the pathway.

Interventions

Results: PDSA interventions were tested over 6 months: Development of a single triage systemCGA clinic for frail older patients.Development of shared documentation for CGA.Improved cycle and lead times for assessment

Conclusions

Our quality improvement work supported the development and implementation of a new referral triage process with CGA assessment for complex frail patients. The change has reduced patient wait times, provided early intervention and reduced duplication. Work is ongoing to determine impact on patient satisfaction and time to discharge from clinic. The approach taken by this project could be applied elsewhere to improve outpatient referral processes.
41 Using Patient Centred Care to Redesign Integrated Discharge Services in Derby
Authors: Youde J , Rawlings J , Knight J
Published: February 2020

Background

Discharge to Assess as outlined by the Department of Health was adopted in Derby in 2016. Previously the discharge pathways to community settings from the acute trust were complex. Challenges included: Operating from a traditional residential care home.No integration of community health staff and social care teams leading to delays in treatment and decision making as well as multiple referrals and hand-overs and no joint communication which was confusing for patients.Stakeholder anticipation of 6 weeks length of stay.Limited responsiveness to capacity demand within planned and unplanned community physiotherapy.Changing the culture and mind-set of staff.Different health and social care processes and procedures, IT systems, working patterns, contracts and pay scales.

Methods

A new service model, joint processes and standard operating procedures was developed with the patient at the centre of the design. Trusted assessment and information sharing reduce multiple assessments and hand overs, ensuring a smoother and improved patient experience.

Outcomes

Triage of patients from the Integrated Discharge Hub to the appropriate pathway, early discharge planning, board rounds and MDT's and timely assessments combined with an enablement ethos have increased the flow of patients through the service, decreased care package hours and increased capacity through reducing both length of stay and delayed transfers of care. The health and social care teams are now delivering fully integrated care and undertaking joint training. This has led to a reduction in treatment times from 20 days to 12 days, reductions in DTOC to average of 8 days per month and improved access to community based routine therapy from 85% of referrals being seen by 6 weeks 2017-18 to 99% in 2018-19.

Conclusions

The integrated service delivers more for less resulting in significant savings in the healthcare and social care system while maintaining quality standards and outcomes.
55 Quality Improvement Project to Assess How Informed Patients are About do not Attempt Cardiopulmonary (DNACPR) Decisions?
Authors: Jayasuriya P , Amanullah Y , Kumar A , Hookey C
Published: February 2020

Introduction

Despite growing evidence regarding DNACPR decisions, there is a paucity of information given to patients regarding resuscitation decisions. The main aim of this quality improvement project was to assess and improve patients’ and their relatives’ understanding about DNACPR decisions.

Intervention

We initially surveyed 30 inpatients or their next-of-kin (if the patient lacked capacity) in a geriatric ward who had DNACPR decisions in place. Although, 86% knew the implications of a DNACPR decision, only 50% knew that a DNACPR decision would not limit them from receiving other treatment. 66% reported that the information given by the healthcare professional is “too little”.

35 questionnaires were also given to doctors of all grades to assess their practice of DNACPR discussions and barriers for discussion. Majority (95%) of doctors knew what should be included in a DNACPR discussion. Medical staff not considering DNACPR discussions during assessment, medical staff not comfortable to make the DNACPR decision and the fear of distressing the patient are the three main issues that were highlighted as barriers. 17% of doctors reported that they would have attended a cardiac arrest at least on 2-5 occasions for a patient when resuscitation was futile.

We presented this data and educated doctors on effective DNACPR discussions using video demonstrations in weekly journal clubs. All doctors were informed to distribute DNACPR

Improvement

After the intervention, only 80% understood the DNACPR discussion. 76% knew that DNACPR does not limit them from receiving other treatment. 73% reported that this was not stressful and 76% were satisfied with the discussion and reported that their questions were answered adequately. 11 out of 30 patients had received the information leaflets and all found it useful.

Discussion

Although after the intervention the percentage who understood the DNACPR decision had reduced compared to the initial audit, there was a 20% improvement in who knew that DNACPR decisions did not limit other treatment. We hope to extend this study by carrying out training sessions for doctors to improve the quality of these conversations and thereby enhance adherence to expected practice in DNACPR decision making.
65 Improving Medicines Safety for Care Homes Residents
Authors: Okoli U , Kent J , Gadhia S
Published: February 2020

Introduction

Care home residents often have multiple, chronic conditions and are receiving complex treatment regimes, yet 30–50% of prescribed medicines are not taken as recommended [1]. Polypharmacy and medication errors are common. Evidence suggests that there is a linear increase in medication errors with the number of medications a patient is prescribed.

This paper describes an approach to identity and address inappropriate polypharmacy and safety concerns in Buckinghamshire care homes. The workforce used was: primary care and care home pharmacists, technicians and geriatricians.

Methods

A successful business proposal enabled a new interdisciplinary model of care to be established. This was delivered in 2768 Buckinghamshire care home beds (63% of Bucks ICS bed capacity). The CCG pharmacists, GPs and pharmacy technicians reviewed medication for all residents followed by a medication and clinical review by a geriatrician for the most complex individuals. Other community specialist teams were included as part of a Multidisciplinary team as needed. Data on reviews, medicines stopped and safety were collected from 2013–2018.

Results

Overall 2134 medications were stopped for 1268 residents of 2102 reviewed, with 505 interventions to reduce falls risk. 942 safety issues were identified and resolved. Total savings on medicines optimisation, waste and non-elective admission prevented was £619,000. System wide safety included: community psychiatric nurse to support dementia diagnosis, specialist enteral feeding nurse reinstated and a new website to share and disseminate good practice standards.

Conclusions

Future direction of this work focuses on system wide improvements to promote multi-organisational interdisciplinary healthcare and social services professionals work in care homes. NHSE Pharmacy integrated funding has provided extra pharmacists and technicians to support the 37% of the care home beds not yet covered by March 2020.

Reference

1. Horne R, Weinman J, Elliot R, et al. 2005, NHS National Coordinating Centre for service delivery and organisation report.