bluuebunny/crossref_metadata_2025_split huggingface dataset:
Complex hyperbolic triangle groups of type [𝑚,𝑚,0;3,3,2]
Authors: Povall Sam , Pratoussevitch Anna 
Published: February 2020

In this paper we study discreteness of complex hyperbolic triangle groups of type[m,m,0;3,3,2][m,m,0;3,3,2], i.e., groups of isometries of the complex hyperbolic plane generated by three complex reflections of orders3,3,23,3,2in complex geodesics with pairwise distancesm,m,0m,m,0. For fixed mm, the parameter space of such groups is of real dimension one. We determine intervals in this parameter space that correspond to discrete and to non-discrete triangle groups.
10 Improving Communication About Death Between Primary and Secondary Care: A Quality Improvement Project
Authors: Arumugam J , Laud R , Naydenova P 
Published: February 2020

Abstract

Introduction
Communication between the hospital and primary care regarding the death of a patient is incredibly important. Previous literature surrounding this area has shown that it is often done poorly, resulting in substandard documentation. Furthermore, lack of information for General Practitioners (GPs) means it is difficult for them to enter discussions with families, which can negatively impact on the bereavement process.
The previous expectation was that an electronic discharge summary was completed, but that this was not optimally designed to inform GPs about the circumstances surrounding the death. Reasons given that summaries were not completed included: the busy workload of junior doctors and the lack of awareness of their importance.

Methods
The aim of our quality improvement project was to ensure 80% of GPs received notification and information about a patient’s death by August 2018.
Following an initial cycle to assess the baseline notification rates, we developed a standardized death notification letter following feedback from local GPs. This included information such as date of death, if the coroner had been informed and a brief summary of events. Following introduction of the letter, we recorded the uptake and then gained further feedback regarding the ways in which it could be improved. A final cycle was then implemented.

Results
Baseline data showed an electronic discharge letter was only being completed in 13.3% of cases (n=3/21). Following introduction of the new letter, 83.6% were completed (n=56/67).

Conclusions
In conclusion, the introduction of a simple and standardized letter template has vastly increased the notification of GPs about a patient’s death from our hospital. Limitations of our project included the varying numbers of deaths in audited periods and some hospital teams having a separate process in place.
19 “Love The Day Job Still;” ”More Job Satisfaction;” “I Will Never Give Up My GeriGP Job;” - Results of the BGS GeriGP Workforce Survey 2018
Authors: Davies K , Kalmus E , Keeble M , Lawn L 
Published: February 2020

Abstract

Background
In 2017, two GPs decided to form the GeriGP group, for BGS GP members with a particular interest in the care of older people. GPs are increasingly using their holistic approach and expertise in new models of care within the community and the acute setting ("GeriGP" roles), and many no longer work in traditional General Practice.

Introduction
By late 2018, the group had around 100 members. The committee recognised the vital role GeriGPs could play in the development and delivery of innovative models of care for older people, as recommended in the NHS Long Term Plan1 and 2019 GP Contract2. There was no data available about GeriGP roles, which appeared to have arisen in an ad hoc fashion. An online survey was undertaken with the aim of using the results to engage with national policy makers and to identify pathways into these roles to improve recruitment and retention of the GP workforce.3

Methods
We are grateful to the BGS who collated 58 questions for the online questionnaire, which was sent to all GeriGP members between October and December 2018. There were five main categories: role and venue; employment conditions; indemnity; appraisal; qualifications and training. Most questions had space for free-text comments.

Results
47/100 GeriGP members responded; 68% respondents held GeriGP roles of whom 62% were practising GPs. 60% of all respondents were over 45 years old. 30 job descriptions covered community frailty hubs, intermediate care, community hospitals, care homes, acute front door, visiting services and memory clinics. 60% were community based. Rates of pay and types of contract varied dramatically. GP appraisal was often difficult due to patients having frailty or dementia, with contradictory advice common. 45% had difficulty accessing training and two-thirds of jobs were gained by word-of-mouth. 87% in GeriGP roles were more likely to continue practicing medicine because of this role, yet career development barriers existed at all levels. Many comments concurred with a plea for a ``primary care geriatrics specialty'', and repeatedly the joy of having time for patient-centred care was the driving force behind experienced GPs opting to continue in GeriGP roles.

Conclusions
The enthusiasm for GeriGP roles should be seized upon to improve healthcare of older people and bolster the GP workforce. GeriGPs plan to use these results to influence policy makers nationally.

References
1. NHS Long Term Plan (https://www.longtermplan.nhs.uk/online-version/overview-and-summary).
2. 2019 GP Contract (https://www.england.nhs.uk/wp-content/uploads/2019/01/gp-contract-2019.pdf).
3. GeriGPs. (https://www.bgs.org.uk/gerigps).
79 Do Medical Students Understand the Ward Environment? A Survey of Penultimate Year Medical Students Exploring How Well Healthcare Of Older People Placements Prepare Them for Working on Hospital Wards
Authors: Poynton-Smith E , Colwill E , Sahota O 
Published: February 2020

Abstract
Medical students are expected to know how to function on hospital wards; i.e. where to find things, other Health Care Professionals’ (HCPs’) roles, and how to use certain items of equipment (GMC, 2018). This ward-based knowledge indicates that a student is ‘ward smart’.1 Whilst being ‘ward smart’ is key for many aspects of medicine, it is particularly important for students learning geriatric medicine: older patients (who make up around 42% of all inpatients)2 are more likely to have communication difficulties and to require assistance. However, formal teaching in this area seems to be somewhat neglected, with students being left to ‘pick up’ this knowledge as they go along.3,4
In our sample of 41 students in their penultimate year (most of whom were undertaking their Healthcare of Older People placement), 98% did not know how to turn on a hearing aid and only 24% knew what a Waterlow score was. Furthermore, 88% did not know how to read an oxygen flowmeter, and only 59% knew where the CPR lever on the bed was situated.
This is a significant gap in knowledge: Students may not be as prepared to work in a ward environment as expected. Students felt that their understanding would be improved by teaching sessions, more time on wards, formal ward inductions, and shadowing other HCPs: only 41.5% had had a ward induction or introduction, and less than 20% had shadowed a nurse. We propose specific teaching/practical sessions for students during their Healthcare of Older People placement centred around patient communication and understanding the ward environment.

References
1. Walker, Wallace, Mangera, & Gill, The Clinical Teacher, 2017, 14(5), 336–9.
2. NHS Digital, 2018.
3. Prince, Bozhuizen, Van der Vleuten, & Scherpbier, Medical Education 2005; 39(7):704–12.
4. Monrouxe, et al., BMJ Open 2017; 7(1):e013656.
84 Circulating Vitamin D Levels and Frailty in the British Regional Heart Study: Cross Sectional and Prospective Associations
Authors: Ahmed A , Ramsay S E , Papacosta O , Lennon L , Whincup P H , Wannamethee S G 
Published: February 2020

Abstract

Introduction
Whether Vitamin D deficiency is linked to development of frailty, independent of other health conditions, is inconclusive. In the British Regional Heart Study we aimed to examine (1) cross sectional (CS) and prospective (PS) associations between Vitamin D levels and frailty; and (2) if these are mediated by conditions linked to low Vitamin D (diabetes, chronic obstructive pulmonary disease and inflammatory markers C-reactive protein & Interleukin-6).

Methods
Baseline (2010-2012) Vitamin D in men (71-92y) was categorised as deficiency (&lt;12 ng/ml), insufficiency (12 - &lt; 20 ng/ml) and sufficiency (≥20 ng/ml) states. Frailty, assessed at baseline and follow up (2014) was classified as robust, pre-frail or frail (score 0, 1-2, or ≥3 out of 5 Fried Frailty components respectively). Multinomial regression determined CS & PS relative risk ratios (RRR) of being pre-frail or frail, relative to robust. Adjustments were made for age, BMI, season, smoking, drinking habits, social class, Vitamin D/calcium supplements, mental/physical health and potential mediators.

Results
At baseline, 20% of 1494 men were frail and 25% deficient in Vitamin D. Unadjusted RRR of being frail (vs robust) was 3.16 [95% CI 2.16, 4.62] in men with Vitamin D&lt;12ng/ml (reference ≥20ng/ml). Higher RRR persisted even after adjusting for covariates and potential mediating factors, [2.74; 95% CI 1.60, 4.69]. Of 977 men non-frail at baseline, 10% became frail. Men with Vitamin D &lt;12ng/ml (reference ≥20ng/ml) had higher unadjusted RRR of becoming pre-frail [1.47; 95% CI 1.04, 2.09] and frail [2.14 95% CI 1.29, 3.56] (vs robust). While the PS association with pre-frailty was completely attenuated with covariate adjustment, higher RRR for frailty remained even in the fully adjusted model [2.07 95% CI 1.07, 4.00].

Conclusions
Vitamin D &lt;12ng/ml was associated with prevalent & incident frailty in older British men, independent of disease/inflammatory states. Further research exploring Vit D therapy for improving frailty outcomes is needed.

Reference
1. Parry SW. JAGS;2016;64(11):2368–2373.
90 The Effectiveness of Volunteer-Led Physical Activity Interventions in Improving Health Outcomes for Community-Dwelling Older People: A Systematic Review
Authors: Lim S E R , Cox N J , Roberts H C 
Published: February 2020

Abstract

Introduction
Physical activity (PA) is important for older people to maintain functional independence and healthy ageing. PA interventions for community-dwelling older adults are often delivered by healthcare professionals, fitness instructors or trained members of a research team. Innovative approaches are needed to ensure that these interventions are practical and sustainable. This systematic review explores the effectiveness of volunteer-led PA interventions in improving health outcomes for community-dwelling older people.

Methods
Following PRISMA recommendations, five databases (MEDLINE, Embase, CINAHL, PEDro, Cochrane library) were systematically searched until May 2019, for studies using trained volunteers to deliver PA interventions for community-dwelling older people aged ≥ 65 years, reporting on participant outcomes. Meta-analysis was not conducted due to included study heterogeneity.

Results
Twelve papers (eight studies including three randomised controlled trials (RCTs)) were included in the review; five papers reported different outcomes from the same RCT. Intervention settings included community exercise groups (n=4), home (n=2) and care homes (n=2). All eight studies included strength and balance exercises and frequency of PA ranged from once daily to weekly sessions.
The three RCTs showed improvement in grip strength, nutritional and frailty status, and reduction in fear of falling, among 39 older adults (mean age 83 years) who received a physical training and nutritional intervention; improvement in grip strength and activity of daily living scores among 56 nursing home older adults (mean age 78 years) who received resistance exercise training; and a significantly higher proportion of older adults (n = 193, 9% improvement vs 0.5% in the control group) achieved the recommended target of 150 minutes of moderate vigorous PA per week using the Falls Management Exercise intervention.
Two studies compared volunteer and health professional-delivered PA interventions and reported that both interventions were equally effective in reducing fear of falls and improving quality of life. Two quasi-experimental studies reported improvement in functional outcomes including functional reach, timed up and go test, and chair stand. A large prospective cohort study (n = 1620) reported a reduction in disability among older adults who received volunteer-led exercise compared to control, with a hazard ratio of 0.73 (95% CI 0.62-0.86) for development of disability.

Conclusions
Trained volunteers can lead PA interventions among community-dwelling older adults with some evidence of improved health outcomes including nutritional, functional and frailty status.
92 Relocation in Care Homes (RICH) Study: The Experience of Different Stakeholders
Authors: Baron S , Bridges J , McGrath N , Roberts H C , Ibrahim K 
Published: February 2020

Abstract

Introduction
In the UK, care homes in unsuitable older buildings are closing. Involuntary relocation is associated with increased mortality and negative emotions among residents. Extensive planning can mitigate this. The aim was to understand the experience of a planned relocation between two care homes.

Methods
In the UK, care homes in unsuitable older buildings are closing. Involuntary relocation is associated with increased mortality and negative emotions among residents. Extensive planning can mitigate this. The aim was to understand the experience of a planned relocation between two care homes.

Results
Seven themes were identified and organised under three stages: pre-move (communication and involvement; preparation for the move; and attitudes towards the move), day-of-the-move (organisation of the move), and post-move (environmental change and impact; staff organisation and management; and settling in). Family and staff members reported that the pre-move information provided was inconsistent and staff did not feel involved in the planning and design process. Pre-move visits and staff and family support were beneficial for residents’ preparation for the move. All participants expressed sadness about the closure, and reported apprehension about moving. The moving day felt disorganised and stressful to staff who had to spread between the two homes. Post-move, the new care home was perceived by many participants as a ‘hotel’ rather than a home. Its larger size and confusing layout impacted negatively on residents and staff. New staff and changes in management structure were perceived by the different stakeholders to cause increased staff workload. Residents adjusted variably to the new home, with family support and staff continuity of care proving to be facilitators.

Conclusions
Despite extensive planning, relocation and adjustment was challenging. Recommendations for future relocations include: increasing involvement of staff in the planning and design of the home; ensuring consistent communication and organising staff rotas to maintain continuity of care.
104 Oral Sodium Bicarbonate Therapy for Older Patients with Chronic Kidney Disease and Low-Grade Acidosis: The BiCARB Randomised Controlled Trial
Authors: Witham M D , Band M , Chong H , Donnan P T , Hampson G , Hu M K , Kalra P , Kennedy G , Lamb E , Littleford R , McNamee P , Plews D , Rauchhaus P , Soiza R L , Sumukadas D , Warwick G , Avenell A 
Published: February 2020

Abstract

Background
Oral sodium bicarbonate is often used to treat metabolic acidosis in older people with advanced chronic kidney disease, but evidence is lacking on whether this provides a net gain in health or quality of life.

Methods
We conducted a multicentre, parallel group, double-blind, placebo-controlled randomised trial. Adults aged 60 years and over with category 4 or 5 chronic kidney disease, not on dialysis, with serum bicarbonate concentrations &lt;22 mmol/L were recruited from 27 UK centres. Participants were randomised 1:1 to oral sodium bicarbonate or matching placebo. The primary outcome was the between-group difference in the Short Physical Performance Battery at 12 months, adjusted for baseline. Other key outcome measures included generic and disease-specific health-related quality of life, anthropometry, physical performance, renal function, adverse events including commencement of renal replacement therapy, and health economic analysis.

Results
We randomised 300 participants, mean age 74 years; 86 (29%) were female. Mean baseline estimated GFR was 19 ml/min/1.73m2. Study medication adherence was 73% in both groups. No significant treatment effect was evident for the primary outcome of the between-group difference in the Short Physical Performance Battery at 12 months (-0.4 points; 95% CI -0.9 to 0.1, p=0.15). No significant treatment benefit was seen for any of the secondary outcomes. Adverse events were more frequent in the bicarbonate arm (457 versus 400). Time to commencing renal replacement therapy was similar in both groups (HR 1.22, 95% CI 0.74 to 2.02, p=0.43). Health economic analysis showed lower quality of life and higher costs in the bicarbonate arm at one year (£1234 vs £807); placebo dominated bicarbonate under all sensitivity analyses for incremental cost-effectiveness.

Conclusions
Oral sodium bicarbonate did not improve a wide range of health measures in this trial, and is unlikely to be cost-effective for use in the UK NHS in this patient group.
110 Participants and Volunteer Host Experiences of First Steps Course for Those Newly Diagnosed with Parkinson’s: A Qualitative Study
Authors: Bodger E R , Ibrahim K , Roberts H C 
Published: February 2020

Abstract

Introduction
People with Parkinson’s (PwP) and their caregivers often report poor diagnosis experiences and a lack of information, support and control over Parkinson’s. First Steps is a two-day course delivered by volunteers with Parkinson’s, which aims to help those newly diagnosed and their caregivers face the future positively and take control of Parkinson’s. This study aimed to capture the views and experiences of participants and volunteer hosts of First Steps, and evaluate if it meets those aims.

Methods
Using purposive sampling, twelve participants comprising four PwP, five caregivers and three volunteer hosts were recruited. Face-to-face, semi-structured interviews were conducted, audio-recorded, transcribed verbatim and analysed thematically.

Results
Course participants found First Steps informative, supportive, and helpful in feeling more positive about Parkinson’s. Participants were reassured by the hosts having Parkinson’s, despite prior concerns regarding seeing people who might have more advanced Parkinson’s. Some found First Steps more relatable than other support services and reported that the course complemented clinician-led courses as the content was aimed at caregivers as well as PwP, with variation in information delivery techniques. Among the PwP and caregivers, two thirds reported a lack of control over Parkinson’s and some felt First Steps had improved their control. Hosts felt they had control over Parkinson’s and perceived their role to be both challenging and rewarding.

Conclusions
First Steps was perceived as a helpful course, offering information and support for those newly diagnosed and their caregivers in a positive and non-clinical environment. Volunteer hosts felt more control over Parkinson’s than other participants, but there was evidence that the course helped some experience more control. Suggested course improvements included: additions to the presentation content with more emphasis on taking control, and offering group follow up sessions. This will inform current expansion across the UK.
Selection and Use of Respiratory Protection by Healthcare Workers to Protect from Infectious Diseases in Hospital Settings
Authors: Chughtai Abrar Ahmad , Seale Holly , Rawlinson William D , Kunasekaran Mohana , Macintyre C Raina 
Published: February 2020

Abstract

Objectives
Infection control policies and guidelines recommend using facemasks and respirators to protect healthcare workers (HCWs) from respiratory infections. Common types of respirators used in healthcare settings are filtering facepiece respirators (FFRs) and powered air-purifying respirators (PAPRs). Aims of this study were to examine the current attitudes and practices of HCWs regarding the selection and use of respiratory protection and determine the acceptability of a novel PAPR.

Methods
In-depth interviews were undertaken with 20 HCWs from a large tertiary hospital in Sydney, Australia. Participants were fit tested with a lightweight tight-fitting half-facepiece PAPR (CleanSpace2™ Power Unit, PAF-0034, by CleanSpace Technology®) using the TSI™ Portacount quantitative fit test method.

Results
Interview results showed that HCWs had a limited role in the selection and use of facemasks and respirators and had been using the devices provided by the hospital. The majority of subjects had no knowledge of hospital policy for the use of facemasks and respirators, had not been trained on the use of respirators, and had not been fit tested previously. Compliance with the use of facemasks and respirators was perceived as being low and facemasks and respirators were typically used only for short periods of time.
All 20 participants were successfully fit tested to the CleanSpace2™ PAPR (overall geometric mean fit factor—6768). According to the exit surveys, CleanSpace2™ PAPRs were easy to don (14/20) and doff (15/20) and comfortable to wear (14/20). Most participants believed that PAPRs provide higher protection, comfort and reusability over N95 FFR and can be used during pandemics and other high-risk situations.

Conclusions
HCWs should be aware of infection control policies and training should be provided on the correct use of respiratory protective devices. PAPRs can be used in hospital settings to protect HCWs from certain highly infectious and emerging pathogens, however, HCWs require adequate training on storage, use, and cleaning of PAPRs.
Phylogeography and palaeomodelling of Duseniella patagonica (Barnadesioideae), an early-diverging member of Asteraceae endemic to the Argentinean Monte and Patagonia
Authors: Urtubey Estrella , Stuessy Tod Falor , Justel Jose Ignacio , Nicola Marcela Viviana 
Published: February 2020

AbstractWe performed an integrated phylogeographical and palaeoclimatic study of an early-diverging member of Asteraceae, Duseniella patagonica, endemic to Argentina. Chloroplast and nuclear markers were sequenced from 106 individuals belonging to 20 populations throughout the species range. We analysed genetic spatial distribution, diversity and structure, tested for range expansion, estimated divergence times, reconstructed ancestral areas and modelled present and past species distributions based on climatic data. Duseniella diverged from its sister genera during the Late/Middle Miocene. Its ancestral area included southern Monte plus eastern and central Patagonia. A vicariant event separated Monte and Patagonian clades during the Plio-Pleistocene. This would have involved unfavourable climate, soil, elevation, volcanism and/or other geomorphological processes between 40 and 43.5°S, in the sourroundings of the Somuncura plateau. Each clade possesses its own haplotypes and nucleotypes. Two populations, one in southern Monte and the other in eastern Patagonia, contain the highest diversity and exclusive haplotypes, representing hypothetical ancestral refugia. Northern Monte and southern Patagonian populations show low to null genetic diversity, being the most recently colonized areas. Climatic models indicate that winter temperature influenced the distribution of Duseniella, with an increase in probability of occurrence during colder periods, thus enabling diversification during glacial episodes.