bluuebunny/crossref_metadata_2025_split huggingface dataset:
Study of Development Scenarios for Bottoming Unit Binary Cycle to Utilize Exhaust Steam from Back Pressure Turbine Geothermal Power Plant
Authors: Nandaliarasyad Naufal , Maulana Dimas Taha , Darmanto Prihadi Setyo 
Published: February 2020

Abstract
Binary cycle using organic working fluid or ORC system has been applied in geothermal and some other industrial processes to recover low grade and waste energy to generate electricity. The conventional system to utilize geothermal energy is a condensing system or back pressure system which depend on a turbine used in the system. Two units of the power plant in Flores, Indonesia are using back pressure turbine, which means that there is still a chance to increase the electrical power of the steam which is released through the turbine. The amount of exhaust steam available from these two units power plant is more than 62,000 kg per hour with 99°C of temperature and around 2,430 kJ/kg enthalpy. This research is trying to get the optimum power that can be generated by the ORC regarding other consideration parameters such as ambient temperature, thermodynamics condition of resource steam, and energy conversion of each apparatus. It is the aim of this paper to present a thermodynamic study on the utilization of ORC as the bottoming cycle with various types of working fluids to produce additional electricity. Several working fluids are chosen to find the optimum ORC system to utilize this exhaust steam such as isobutane, butane, isobutene, isopentane, propane, propyne, neopentane, R245fa, R236fa, and R134a. ORC system used in this research is simple ORC with basic components such as Pre-Heater, Evaporator, Expander, Condenser, and Pump. The properties of working fluids are calculated by REFPROP. The results show that this binary cycle can generate up to 2.25 MW with the thermal efficiency around 10% depend on the working fluid used. Two working fluids in this scenario that provide the best power generated are Propyne and Isopentane. The type of working fluid must also be considered, propyne is a wet type while isopentane is a dry type working fluid.
The Application of Numerical Simulation Result for Geothermal Financial Model with Probabilistic Approach: A Comprehensive Study
Authors: Winofa Nevi Cahya , Lesmana Ade , Pratama Heru Berian , Saptadji Nenny Miryani , Ashat Ali 
Published: February 2020

Abstract
Feasibility of developing a geothermal project depends on the financial return generated from the investment. One of the strategies to achieve optimum return is formulating a financial model with a high level of confidence. Technical input parameters in the financial model are determined by the amount of available geothermal reserve in the form of a field development scenario. The best method for predicting geothermal reserve is a numerical simulation. The objective of this study is to determine the electricity tariff to generate 30 MW, 60 MW, and 110 MW which meet the 50% of the Rate of Return value will be equal or not exceed 16% (P50) for a specific geothermal field with a probabilistic approach. This study started with determining the technical input parameters: the number of production wells; make­up wells; and injection wells from each development scenarios based on numerical simulation result that has been studied by another researcher. The electricity tariff that meets the P50 of Rate of Return at 16% was calculated for those scenarios. Then, the tariffs were evaluated based on the Average Cost of Electricity Generation (BPP) on the relevant local grid. The result shows that the tariff or/and generation cost need to be negotiated. Moreover, total investment and economic indicators forecasting indicated that the investment was attractive. Lastly, sensitivity analysis shows that Rate of Return strongly affected by well drilling cost and power plant cost (EPCC).
Pre-feasibility Study of Condensing Wellhead Generating Unit Utilization in Partially Vapor Dominated System
Authors: Dahlan M A , Pratama H B , Saptadji N M 
Published: February 2020

Abstract
The development of geothermal fields needs 5-6 years from the first well drilled until the operation of the central power plant. Between the gap years, the wells will be shut in and will be re-opened when the power plant is ready. However, there is an alternative to utilize the wells with Wellhead Generating Unit (WGU), the small power plant which can generate the electricity as soon as the drilled productive wells completed. Then, the objective of this study is to decide the preferable scheme for the installed capacity of WGU with economic consideration. Correspondingly, this study uses two full factorial experimental design with Monte Carlo simulation to calculate and design the condensing turbine. Steam fraction, mass flow rate, turbine inlet pressure, and turbine exhaust pressure are the parameters to be analyzed in the Monte Carlo Simulation. The economic feasibility of the project is based on capital expenditure, decline curve analysis, and electricity price. The result of probability, P10, P50, and P90 of gross power output and Specific Steam Consumption (SSC) are 6.1, 7.9, 9.9 MWe and 1.85, 1.89, 1.93 kg/s/MWe respectively. Based on the economic evaluation, the P10, P50, and P90 of Internal Rate of Return (IRR) and Net Present Value (NPV) are 12%, 16%, 21% and 1.1 MUSD, 3.6 MUSD, 6.0 MUSD respectively over 30 years of WGU lifetime. This paper is the first study for designing the WGU combined with an economic study based on the technical evaluation to propose the best option to develop the field.
Updating the Conceptual Model of Cisolok-Cisukarame Geothermal field, West Java, Indonesia
Authors: Sumartha Ayu Gracia Ade , Kurniawan Iqbal , Wiradinata Rizky , Nandaliarasyad Naufal , Sutopo  , Pratama Heru Berian , Prabata Todheus Welly 
Published: February 2020

Abstract
The cisolok-cisukarame geothermal field is a liquid dominated geothermal system situated in Sukabumi District, West Java, Indonesia. Geothermometry survey shows that Cisolok-Cisukarame has temperature approximately 185-212°C in the reservoir. The temperature of the reservoir shows that this is a medium enthalpy geothermal system. The thermal manifestation distributed around the Cisolok-Cisukarame area when the Cisukarame indicated as the upflow zone and Cisolok as the outflow zone. It is located at the eroded volcanic area with cooling pluton acting as the heat source of the system. Based on EBTKE, Cisolok-Cisukarame geothermal field has 45 MWe possible reserve. NE-SW and N-S faults are acting as the main conduit of the geothermal system. The primary purpose of this study is to build a computer model describing the natural state condition based on the geological, geochemical, geophysical, and well temperature data from several published literature. The model was validated by using mass-heat flow profile obtained from the observation data to achieve the best representation of the actual condition. The condition was achieved by modifying the permeability structures and productivity index. This model is the first natural state model of Cisolok-Cisukarame geothermal field. The natural state model then is used to build an updating conceptual model of Cisolok-Cisukarame by using data from a result of numerical modeling. Based on the parameters obtained from the numerical modeling, a new model of Cisolok-Cisukarame geothermal field is successfully representing the heat and mass flow within the system.
1 Review of the Identification and Management of Contractures in Inpatients with Dementia In A District General Hospital
Authors: Burns R , Wightman R , Mon H , Robertson A 
Published: February 2020

Abstract

Background
Patients with dementia are at risk of contractures which are associated with pain, pressure sores, increased carer burden and reduced function (1). It has been estimated up to 55% of residents in nursing homes have a contracture (2). Locally, patients are identified and treated in care homes. We questioned why comparatively few hospital inpatients were seen.

Methods
We audited acute elderly inpatients at a large district general hospital on two days. Patients with a diagnosis of dementia were identified and then checked for contractures. Information was collected on a proforma. Patients audited on day one were excluded from day two.

Results
410 patients were audited. 100 patients were identified with dementia. 21 individual contractures were identified with the hands been the most common site (47.6%). Only three contractures had been highlighted in the medical notes. Patients with contractures were more likely to be at home with carers or in a care facility (93.7% verse 64.3%). None of the patients with contractures were independently mobile. Higher proportions (31.2% vs 8.3%) with contractures were bedbound compared to those without. Complications were identified, with two patients reporting pain and three patients having pressure sores. Only one patient was receiving treatment for their contractures. Patients with contractures were more likely to have a higher frailty score, had a previous stroke (37.5% verse 13.1%) and have a vascular type dementia (31.3% verse 14.2%).

Conclusions
Contractures were a significant problem in our inpatient population in patients with a diagnosis of dementia. A large proportion were not identified by the clerking team, not receiving treatment and beginning to have complications. Subsequently a presentation highlighting this issue was carried out to junior doctors on the elderly wards, a coding proforma for contractures was produced and a guide to management of this issue is being put together for use in the inpatient setting.

References
1. Souren L, Franssen, Reisberg E. Contractures and loss of function in patients with Alzheimer's disease, J. Am. Geriatr. Soc. 1995; 43(6): 650–655.
2. Offenbacher M, Sauer S, Riess J, Muller M, et al. Disabil Rehabil 2013; 36(7): 529–538.
2 PDSA Audit Improves Identification and Management of Urinary Incontinence In Post Stroke Patients
Authors: Bryant J , McErlean D , Datta-Chaudhuri M , Prakash K G , Morell J 
Published: February 2020

Abstract

Introduction
Urinary incontinence is a prognostic indicator of mortality and functional recovery in stroke. There is a small evidence base that early intervention within the first three months may improve continence status and subsequent physical and psychological consequences.

Methods
Utilising a proforma and PDSA, data was collected on the identification and assessment of urinary continence status for patients admitted to a stroke unit. Five agreed standards from NICE (2012) and RCP (2016) guidelines formed the basis of audit. Three cycles of prospective data for a total of 66 patients was collected over four months, implementing quality improvement measures after each cycle.

Results
22 participants per cycle. Cycle one demonstrated continence status was identified by the nursing team (100%), and the medical team (41%). However, standards regarding further care planning and assessment (22%), MDT input (11%) and subsequent behavioural and practical interventions (11%) was low.
Change strategy, i) awareness training, ii) development of MDT prompt sheet.
Cycle two, medical identification (82%), MDT discussion (100%), and continence specific interventions (66%), care planning decreased from 22% to 0%.
Change strategy, incontinent patients receive an individualised assessment within 7 days by the advanced nurse practitioner, this assessment should consider all available evidence-based interventions, with the aim of reducing urinary incontinence within the early phases of stroke.
Cycle three showed an overwhelming improvement to all five standards, nursing and medical identification (100%, 91.

Conclusions
PDSA style audit led to quality improvement. The identification of urinary continence status post stroke was high, but due to multifactorial elements often did not progress to assessment or intervention from the MDT. Utilising the existing role of the trainee advanced practitioner patients received evidence-based continence reviews in a timely manner, with no additional cost impact to the service.
5 Improving Diagnosis and Management of Urinary Tract Infections for Elderly Patients
Authors: Al-makdase L , Ioannou P , Tew Z Y , Khan M , Debnath M , Ogunrinde I , Shields L 
Published: February 2020

Abstract

Introduction
Diagnosis of urinary tract infection (UTI) in the elderly population is challenging as they commonly present with atypical signs and symptoms. Prevalence of asymptomatic bacteriuria in the elderly population is high. Hence, urine dipstick and urine culture are no longer diagnostic tests. UTI is over-diagnosed and overtreated in the elderly, resulting in poor antimicrobial stewardship. This project was carried out to assess and improve the current practices in the diagnosis and treatment of UTI in the Department of Medicine of the Elderly.

Methods
We reviewed current Scottish Intercollegiate Guidelines Network (SIGN) and National Institute for health and Care Excellence (NICE) guidelines on management of UTI and defined indications for performing urine dipstick and sending urine culture. We then collected and assessed data on all urine dipsticks performed, urine cultures sent, and use of antibiotics in treating UTI and asymptomatic bacteriuria in three Medicine of the Elderly wards in Aberdeen Royal Infirmary.
We carried out intervention by means of presenting and discussing findings of Plan-Do-Study-Act (PDSA) cycles in departmental multi-disciplinary Quality Improvement (QI) meetings followed by educational sessions.

Results
Our baseline data showed 77% of urine dipsticks were performed without clinical indication and 18% of patients had urine cultures sent without clinical indication. After presenting our initial findings and carrying out an educational intervention session, 25% of patients had urine dipstick done without clinical indication, and 0% of patients had urine cultures sent without clinical indication. However, over the course of four subsequent PDSA cycles, practices in investigation of UTI fluctuated but were overall consistently better than the initial practice with further interventions. In all PDSA cycles, no patients were treated for asymptomatic bacteriuria.

Conclusions
Multidisciplinary team involvement in discussion of this QI project findings and educational sessions proved to be an effective form of intervention for improving current practice.
11 Mortality Rates for Patients Admitted to Complex Care/Care of the Elderly Wards At Southmead Hospital, Bristol
Authors: Burrell A , Woodcraft H , Devine M 
Published: February 2020

Abstract

Background
Existing data examining mortality rates following inpatient hospital admissions in the United Kingdom is either condition specific or examining all inpatient mortality based on single time point audits. This clinical effectiveness project aimed to assess 1, 3, 6 and 12 month mortality rates in patients admitted to complex care/care of the elderly (CC/CotE) wards at Southmead hospital, Bristol

Methods
Data were collected by the trust's Business Insider department and analysed by the authors. All patients admitted to the four CC/CotE wards from July-December 2017 were included. Data collected included age, gender, date of admission, length of stay, date of discharge, and date of death if applicable.

Results
2673 patients were admitted to CC/CotE wards from July-December 2017. 42.72% of patients were male, mean age of patients was 82.46 years. Mean length of stay was 16.68 days, with mean length of stay on CC/CotE ward specifically 9.08 days. 292 (10.92%) of patients died during the index admission. Overall mortality rates were:1 month: 11.34% (303 patients)3 month: 21.59% (577 patients)6 month: 30.15% (806 patients)12 month: 38.53% (1030 patients)
12 month mortality increased with age from 75 upwards (34.04% in 75-79 years, 42.94% 85-89 years, 50.27% 95-99 years, 66.67% 100-104 years) but was similar in those aged 65-69 and 70-74 (29.41% and 28.18% respectively).

Discussion
An improved understanding of mortality rates in patients admitted under CC/CotE may aid clinicians' ability to prognosticate. Appreciating that over a third of CC/CotE patients are potentially in the last year of life provides further impetus to begin advanced care planning discussions during inpatient admissions.
14 Rational Prescribing in the Frail Elderly Population: A Quality Improvement Project to Reduce Inappropriate Prescribing Using STOPP-Frail Criteria
Authors: Brooke J , Darnell R , Boltova M , Hashemi N 
Published: February 2020

Abstract

Introduction
2.5 million people in the UK are aged over 80 and up to 50% can be considered frail. Complex co-morbidities and polypharmacy are linked with adverse drug effects and negative outcomes. NICE recommends a medication review yearly, and a hospital admission provides an opportunity for this. STOPP-Frail is a screening tool designed to highlight medications that could be reduced/stopped with a view to improving quality of life. We conducted a quality improvement project to quantify levels of inappropriate prescribing at Croydon University Hospital (CUH), with a view to de-prescribing and reducing adverse drug effects.

Methods
A retrospective analysis was carried out on the Elderly Care wards at CUH. Data was collected from 60 consecutive patients discharged from 1st November 2018, utilising electronic Cerner records. Recorded medication on admission and discharge, noting any amendments in accordance with the STOPP-Frail criteria.

Results
Data collected from 60 patients; one exclusion for not meeting STOPP-Frail criteria (n=59). Median age 86 years (69 to 103 years). Mean number of medications on admission 7.42 (1 to 15). 93.2% patients had polypharmacy (defined as ≥ 4 medications). Mean number of medications on discharge 8.22; an increase of 0.8/patient.
19.4% admission medications met STOPP-Frail criteria for inappropriate prescriptions. Only 18.8% of these were reduced or stopped during admission. Gastrointestinal and cardiovascular medications were most commonly inappropriately prescribed (n=27 and 24 respectively). Most common medications not amended were lipid-lowering therapies (n=21) and proton-pump inhibitors (n= 20).

Conclusions
The opportunity to rationalise medication in the frailest patients admitted to CUH is missed in over 80% of cases. STOPP-Frail provides clear guidance to aid clinicians in reducing inappropriate prescribing. An educational programme is in place to highlight medication rationalisation and guide clinicians in the use of the STOPP-Frail tool. This includes doctors’ induction, departmental teaching, posters and computer flash cards.
16 Comparison of Characteristics and Outcomes for Older Adults Admitted to Specialty Wards Versus Outlying Wards at Royal Bournemouth and Christchurch Hospitals
Authors: Stafford A , Martin A , Tiwari D 
Published: February 2020

Abstract

Background
At Royal Bournemouth and Christchurch Hospitals (RBCH) elderly patients are admitted to either the acute medical unit or the older person’s assessment unit. If the inpatient stay is likely to be longer than 72 hours, then patients are transferred to one of three elderly care wards. If these wards are at capacity, then patients must be outlied to other wards.

Introduction
GMC guidance June 2014, states hospital inpatients should have a named consultant. Studies have shown that length of stay and outcomes can be affected when the patient is on an outlying ward. This issue affects many hospitals and specialties, and also impacts older frail patients at RBCH. During winter elderly care admission rates increase, and more patients are outlied. Our aim was to improve the care and outcomes for elderly care patients treated on outlying wards.

Methods
The notes of 50 specialty ward patients and 50 outlying patients were compared from the first two weeks of January and February 2019 using scanned electronic records where elderly care was responsible for their treatment. We studied demographic characteristics, length of stay, mortality, readmission within 30 days of discharge, frequency of consultant review, escalation plans, discharge destination and ward moves.

Interventions
A dedicated outlying team was created for the 2018/2019 winter to attempt to improve outcomes for outlying elderly care patients. This team consisted of a geriatrician, registrar, SHO and allied health care professionals including a physiotherapist and discharge coordinator.

Results
Our results showed that outlying patients had a significantly longer average length of stay compared to patients on specialty ward (13.8 days vs 8.2 days, p=0.01). A significantly higher proportion of patients in outlying wards did not have a consultant review every 72 hours (66% vs 8.3% specialty ward patients, p=0.001). However the specialty ward patients had a significantly higher number of readmissions within 30 days (30.6% vs 16%, p=0.04).

Conclusions
We found that despite a dedicated team, outlying patients had a significantly longer length of stay and were seen by a consultant less often than patients on a specialty ward. Further work is needed to ensure equality of care for these patients. Patients with complex medical needs are generally triaged to specialty wards, which may account for their higher readmission rate.
20 Cervical Spine Fragility Fractures in Older People: 5-Year Experience At A Regional Spine Centre
Authors: Tarawneh A M , Taqvi S , Salem K M I , Sahota O 
Published: February 2020

Abstract

Introduction
Cervical spine fractures are particularly prevalent in older people and commonly occur following a fall from standing height or less, in the presence of degenerative spinal disease. Atlanto-axial complex and odontoid process injuries are the most frequent type of fractures and are potentially life threatening. Published in-hospital and 1-year mortality rates in older people are eightfold higher than in younger patients. The aim of this study was to identify the incidence and characteristics of cervical spine fractures in older people presenting to a regional spine centre.

Methods
Clinical records and radiographs were retrospectively reviewed using our institutional registry covering a 5-year period. Data included patient age, gender, mechanism of trauma, level of fracture, stability of the fracture, treatment modality, imaging modality, and mortality rates.

Results
A total of 209 patients above the age of 70 with cervical spine fractures were treated in our centre from 2015-2019. The mean age of the patients at the time of injury was (82.4 ±7.5) years with the majority (n=117; 56%) being females.
One-hundred fifty-one patients (72.2%) experienced fractures in the atlanto-axial complex. Particularly, Dens fractures were the most commonly reported fracture (n=119; 56.9%). Most of the patients encountered stable cervical spine fractures (n=181; 86.6%) and these were managed by external immobilization with hard collar or halo vest.
Mechanism of trauma was divided into two main categories, low energy and high energy. Low energy trauma was the most common cause that lead to cervical spine fractures (n=169; 80.9%), compared to high energy trauma (n=40; 19.1%). CT scan and X-ray were the main imaging modalities utilized to detect cervical spine fractures. Whereas, MRI was only utilized in (n=51; 24.4%).
Overall mortality rate was (n=17; 8.1%) at 30 days. Out of which (n=1; 5.9%) was in a patient who was surgically treated while the remaining (n=16; 94.1%) were in those treated conservatively.

Conclusions
Cervical spine injuries in older people are clinically important. Low energy trauma particularly falls, were the main mechanism of cervical spine injury. Upper cervical spine injuries, mainly C2, is the most common cervical spine fracture and were most commonly detected using CT scan. External immobilization was our treatment of choice for most of the cervical spine injuries in the older people. These patients are very similar with respect to mean age, mechanism of injury and 30 days mortality rate as hip fracture patients.