bluuebunny/crossref_metadata_2025_split huggingface dataset:
Die design optimization for connecting rod using simulation modeling and taguchi methodology
Authors: Yadav Siddharth , Gautam Sujeet Kumar , Upadhyaya Rajat , Singh Niranjan Kumar , Singh Kamlesh Kumar , Namdev Anurag 
Published: August 2024

Abstract
This paper presents a novel approach to optimizing the die design for forging used in connecting rods. The combination of Taguchi (orthogonal L9) and the finite element method (FEM) was employed to achieve this optimization. The main objective of this study was to analyze the impact of design parameters on die-filling and yield improvement. The orthogonal L9 design was generated with three input parameters and one response variable. These input parameters were derived from the design dimensions of the forging tool, specifically flash land, draft, and flash thickness. The response variable was the maximum yield percentage, which was obtained through finite element simulations of the forging processes. By conducting an orthogonal analysis, the relationships between the response variable and the input parameters were established. The simulation results were then used to compare the outcomes of two different designs. It was found that preform one outperformed the other design, achieving an impressive yield of 88% at a forging load of 1.37 × 104 N, with complete die filling observed.
Preparation and performance of hydrotalcite and montmorillonite composite as flame retardant in asphalt pavement
Authors: Tang Ning , Jiang Yi-Yu , Wu Limei , Sun Yi-han 
Published: August 2024

Abstract
The increasing use of tunnel bitumen pavements has led to a corresponding rise in fire hazards. To improve the fire safety of these pavements, a novel flame retardant material has been developed, which incorporates carbonate intercalated magnesium aluminum hydrotalcite (MALC) and calcium-based montmorillonite (MMT) to form intercalation composites. The resulting MALC/MMT composite, along with 4,4’-methylenebis(isocyanate) (4,4’-MDI), was added in specific proportions to the bitumen, producing a flame retardant modified bitumen. The flame retardant performance was assessed through aging and combustion tests. The results indicate that the most effective flame retardant performance was achieved with a MALC:MMT ratio of 2:1 and a composite dosage of 5%. This study presents a straightforward and effective method for developing a novel inorganic flame retardant.
Development of fishbone powder and carbon-jute fiber reinforced unsaturated polyester based novel green composites: investigation of tensile, impact strength, and morphology microstructure
Authors: Dikshit Iti , Singh Ravinder Pal , Singh Gurminder , Sharma Neeraj 
Published: August 2024

Abstract
In the last decade, hybrid composites have been the subject of significant advancements and study. This fast expansion necessitated the development of lightweight composite material with enhanced mechanical strength. In the past few years, the utilization of organic wastes from the food industry, like powder from cow bone, pig bone, and fishbone, has substantially improved the mechanical characteristics of composite materials. Owing to the increasing growth of the meat-based fisheries industry, fish bones are readily available. These bones are often thrown, causing environmental damage. Hence, a sustainable and unique hybrid composite was created employing fish bone powder (FBP) as filler in carbon/jute fibers reinforced polyester matrix. The hybrid composite was compression-molded. FTIR, SEM, and EDS studies were used to characterize the composite. The ASTM standard was used as a reference to explore the mechanical strength (tensile and impact). Additionally explored are the effects of alkali treatment of jute fiber on the above-mentioned processes. It was revealed that the inclusion of FBP and alkali treatment enhanced the mechanical characteristics of the composite. Fishbone powder with a particle size range of 200–250 μm and a weight percentage of 10 to 15% had significant fiber attachment which resulted in improved strength. The produced green composites have proven to be a viable choice for bio-waste treatment in the food sector.
Navigating Cultural Differences
Authors: Jamison Nicole , Kirova Anna 
Published: August 2024

Abstract
Although the disconnect between young newcomer children’s experiences at home and in early childhood settings is commonly attributed to different cultural values and practices, there is little research on how young children perceive, experience, and navigate it. This chapter draws on Vygotsky’s concept of perezhivanie to interpret a case study of a young child’s dialectical becoming in the process of creating herself as a unique subject interacting within a social and cultural environment of both home and school, as a source of her development. Through creative and imaginative activities of play and art-making, the child was engaged in creating and recreating social situations to navigate and negotiate complexities and differences between these social and cultural institutions, experiences, and influences. The chapter offers a deeper pedagogical understanding of the dynamic relationship between the social and the individual aspects of the young newcomer child’s complex subjective configurations of different social instances and systems of relationships within more complex systems of society.
Play and Early Schooling Across Cultural Communities
Authors: Roopnarine Jaipaul L , Ong’ayi Dickson M M , Parella Morgan A 
Published: August 2024

Abstract
Playful learning and its implications for social and cognitive development in children have received considerable attention from scholars in diverse disciplines. The focus in this chapter is on play and early schooling across diverse cultural communities. Topics covered include parents’ and teachers’ beliefs about play and early education, play as a part of parental engagement activities in the development of early social and cognitive skills, implementation of play-based learning in early childhood education, and connections between playful learning and developmental outcomes in children across cultural communities. Within benchmarks of establishing global early childhood education, it is recommended that playful learning should reflect developmentally appropriate objects/materials and experiences of children in their cultural communities, and that more attention should be allocated to health and social justice issues; environmental/climate change; play activities that incorporate science, technology, engineering, and mathematics; play and learning other languages; and play therapy in attending to the mental health needs of young children in school settings.
Teacher Experiences of Curriculum Implementation in South Africa
Authors: Mahadew Ashnie 
Published: August 2024

Abstract
In South Africa, early childhood care and education (ECCE) refers to the learning and development opportunities for children aged from birth to 4 years before formal schooling begins. In South Africa, this sector is primarily characterized by poor government funding, unqualified or underqualified teachers, career instability, and disparities in opportunities for the wealthy and poor. In the government’s National Development Plan, ECCE is a possible avenue to level the playing fields between the “haves and the have-nots” in the country. In response to the challenges experienced by this sector and attempting to achieve the goals of the National Development Plan, the National Curriculum Framework (NCF) for children from birth to 4 years was published. The NCF was envisioned to be used in various settings to improve the early learning experiences of young children. This chapter aims to establish teacher experiences of curriculum implementation in ECCE, and ways to improve teachers’ curriculum implementation in ECCE, using data on teachers’ perceptions of the NCF.
The Engines of National Shame and Indignation
Authors: Pham Kevin D 
Published: August 2024

Abstract
This chapter explains how the Vietnamese figures profiled in this study challenged assumptions in mainstream scholarship on national identity by showing that national identity can come from shame (rather than pride), that national shame can come from perceived inadequacies (rather than bad actions toward others), and that national responsibility means the duty to create national identity anew by harnessing shame and indignation (rather than righting the wrongs of bad actions against others). Furthermore, postcolonial and decolonial literature has tended to attribute any perception of inferiority on the part of the colonized to “internalized inferiority” and to assume the existence of an indigenous “original” culture that colonizers destroy, overlooking the fact that natives themselves sometimes questioned the existence of “original” culture. These Vietnamese figures show that colonized people can be ashamed of themselves on their own terms and be anticolonial at the same time.
Hồ Chí Minh’s Rehumanizing Blueprint
Authors: Pham Kevin D 
Published: August 2024

Abstract
This chapter interprets Hồ Chí Minh (1890–1969) as a theorist of humanization, namely, as a critic of dehumanization and an architect of rehumanization. Whereas his mentor Phan Chu Trinh saw the source of Vietnamese national shame as coming from within Vietnam, Hồ saw it as coming from Europe: capitalism. As a critic of dehumanization, he explains that the racial dehumanization faced by the Vietnamese is a consequence of capitalism and colonialism. As an architect of rehumanization, Hồ has a vision for how the Vietnamese can restore their dignity: “paternalistic democracy.” Namely, Party cadres must cultivate their revolutionary moral virtue, which will make them trustworthy in the eyes of “the people” whom they are to serve and enable them to effectively guide “the people” toward the goals of independence and communist revolution.
Women’s Relationships With Healthcare and Providers: The Role of Weight Stigma in Healthcare and Weight Bias Internalization
Authors: Wetzel Karen E , Himmelstein Mary S 
Published: August 2024

Abstract

Background
Weight stigma (devaluation due to body weight) in healthcare is common and influences one’s engagement in healthcare, health behaviors, and relationship with providers. Positive patient–provider relationships (PPR) are important for one’s healthcare engagement and long-term health.

Purpose
To date, no research has yet investigated whether weight bias internalization (self-stigma due to weight; WBI) moderates the effect of weight stigma on the PPR. We predict that weight stigma in healthcare is negatively associated with (i) trust in physicians, (ii) physician empathy, (iii) autonomy and competence when interacting with physicians, and (iv) perceived physician expertise. We also predict that those with high levels of WBI would have the strongest relationship between experiences of weight stigma and PPR outcomes.

Methods
We recruited women (N = 1,114) to complete a survey about weight stigma in healthcare, WBI and the previously cited PPR outcomes.

Results
Weight stigma in healthcare and WBI were associated with each of the PPR outcomes when controlling for age, BMI, education, income, race, and ethnicity. The only exception was that WBI was not associated with trust in physicians. The hypothesis that WBI would moderate the effect of weight stigma in healthcare on PPR outcomes was generally not supported.

Conclusions
Overall, this research highlights how weight stigma in healthcare as well as one’s own internalization negatively impact PPRs, especially how autonomous and competent one feels with their provider which are essential for one to take an active role in their health and healthcare.
2229 A review of CT head scans in elderly patients admitted to hospital with falls and adherence to the NICE guidelines.
Authors: Savarimuthu S , Ahmad S , Roka A , Kar S 
Published: August 2024

Abstract

Introduction
Falls remain the leading reason for elderly people to attend emergency department (ED), which in 2023 led to 250,000 hospital admissions in the UK. A seemingly large number of geriatric patients undergo CT head as an initial workup in ED which might not be necessary, especially in minor head trauma. NICE (National Institute for Health and Care Excellence), recommended risk stratification to reduce unnecessary head scanning which may potentially reduce ED length of stay, hospitalisation and medical expense. Our study evaluated the current practice of adherence to NICE guidance on Head Injury: assessment and early management for performing CT head scans in elderly admitted to Basildon hospital.

Methods
Two cycles of retrospective data collection were undertaken across three elderly care wards. Elderly patients admitted with falls who had CT head scans were identified. Indication for scanning were evaluated to determine adherence with NICE guidelines for head injury. Between cycles, formal educational sessions were provided to Junior Doctors by departmental teaching and distributing leaflets/posters explaining NICE guidance for indication of CT head scans in head injury.

Results
Following the interventions implemented, patient compliance to the NICE guidance for undergoing CT head with a history of falls, rose from 77.33% to 93.99%. No significant difference in abnormal CT head findings were demonstrated between cycles. In addition, mortality observed between cycles was near equivalent, 12% and 11.67% respectively. The mean time for CT head scans performed also improved, from 13 hours to 4 hours.

Conclusion
We demonstrated education regarding the indication for CT head scans in elderly with falls improved the appropriateness of scans performed in accordance with NICE guidance. CT head scans performed which more robustly met NICE guidance demonstrated no difference in adverse findings or patient mortality and may have contributed to reduced mean scan time, thus improving resource allocation.
2303 Improving the assessment and management of osteoporosis in a district general hospital
Authors: Darcy B , Rose S , Zonza S , Bloom I 
Published: August 2024

Abstract

Introduction
Over 500,000 fragility fractures occur in the UK each year (1). NICE guidelines state that all women aged ≥65 and all men aged ≥75 should be considered for a fracture risk assessment. It was recognised that locally these guidelines were not being met. The aim of this quality improvement project was to improve the number of patients being assessed for osteoporosis across two medical wards.

Method
This quality improvement project followed two ‘Plan Do Study Act’ (PDSA) cycles. The first cycle involved teaching sessions for junior doctors on using the FRAX tool—a tool recommended by NICE guidelines to estimate 10-year predicted absolute fracture risk. Posters and visual reminders were placed around the wards. The second cycle involved creating a sticker which was placed in patients’ medical records prompting doctors to calculate FRAX scores and document the results. Patients deemed inappropriate for bone protection and patients already receiving bone protection prior to admission were excluded.

Results
A baseline set of data showed that 0% of patients had undergone fracture risk assessment, therefore resulting in no patients being prescribed bone protection or being referred to osteoporosis clinic. Repeat assessment after the first intervention showed 29.7% of patients had undergone fracture risk assessment, 13.5% were prescribed bone protection and 16.2% referred to osteoporosis clinic. After the second intervention, 80% of patients had undergone fracture risk assessment, 10% were prescribed bone protection and 55% referred to osteoporosis clinic.

Conclusion
Use of the FRAX tool was moderately increased by the targeted training of junior doctors and markedly increased by using a visual memorandum in the patient records. This led to an increase in treatment for osteoporosis, reducing patients’ future risk of fragility fractures.

References
1. National Osteoporosis Society. Susan’s story: Osteoporosis 2017. https://www.england.nhs.uk/rightcare/wp-content/uploads/sites/40/2017/02/rightcare-susans-story-full-narrative.pdf
2264 A novel frailty specific same day emergency care (SDEC) score—an initial retrospective validation cohort
Authors: Burgess AJ , James KH , Maddock TB , Burberry DJ , Davies EA 
Published: August 2024

Abstract

Aim
Several scores have been developed to identify SDEC patients from Emergency Department (ED) triage and acute medical intakes. Scores are designed to improve system efficiency, overcrowding and patient experience but none have been developed for older adults. Previous work has shown that existing scores e.g. Glasgow Admission Prediction Score, Sydney Triage to Admission Risk Tool and the Ambulatory Score were not able to predict admission in our population (1). We have developed a novel, frailty-focused score.

Methods
The Older Person’s Assessment service (OPAS) is ED based, accepting patients with frailty syndromes aged &gt;70 years to provide a comprehensive geriatric assessment (CGA) and is extended into medical SDEC. The databases were retrospectively analysed and interactions with age, Charlson Co-morbidity index (CCI) and Clinical Frailty Score (CFS) were evaluated alongside NEWS, 4AT, including who with and where the patient resides.

Results
1011 attendances, 414 (40.9%) Male, mean age 82.3(±8.4) years, CFS 5.3(±1.2) and CCI 8.0(±1.8), 701 (69.3%) discharged same-day and 629 (62.2%) fallers. OPAS: 776 attendances, 306 (39.4%) Male, age 82.4(±8.7) years, CFS 5.3(±1.1) and CCI 7.9(±1.9), 540 (69.5%) discharged same-day, 557 (71.8%) fallers. SDEC: 234 attendances, 108 (46.2%) Male, age 81.8(±8.0) years, CFS 5.2(±1.3) and CCI 8.2(±1.7),162 (69.2%) discharged same-day, 72 (30.1%) fallers. There was significant difference between groups with NEWS (p &lt; 0.02), mortality (P &lt; 0.001) and presenting complaint (p &lt; 0.001). We used a cut-off Score &gt; 6.5 indicating admission (p &lt; 0.0001). Each variable’s weighing was determined using T-tests and Chi-squared analysis. Overall score Sensitivity 0.75, Specificity 0.63, Positive Predictive Value 0.65, Negative Predictive value 0.57, Area under Curve 0.65.

Conclusion
Frailty is an important determinant in identifying whether ambulatory care is appropriate. The efficacy of the score is comparable to the results derived in validation cohorts of existing and recommended scores. We are currently prospectively testing the score but clinical judgement, alongside a MDT providing a CGA is gold standard care.
2330 Community frailty hotline service: an innovative hospital avoidance model for frailer older people in mid and South Essex health
Authors: Aggarwal D , Sweeting M , Kar S , Orpin J , Qureshi A 
Published: August 2024

Abstract

Introduction
Frailty Hotline Service (FHS) was set up initially in January 2021 to provide 24/7 advice and guidance to care home medical staff within the Mid & South Essex Health and Care Partnership footprint as a part of covid response. This was expanded to support GPs, Urgent Care Response Team (UCRT), community hospitals, hospices etc and later established as Community Frailty Hotline Service (FHS) with an aim for hospital avoidance and provide support to frailer older patients in their own places. Later, a Frailty Virtual Ward (FVW) was established to complement FHS within the MSE HCP.

Methods
FHS was led by 5 secondary care consultant geriatricians with direct access to telephone, 7 days service operating from 9 am till 10 pm weekdays and 9 am till 10 pm weekends in 1:5 rota. Unified online portal ‘Netcalls’ was used to directly call consultants. Documentation completed on dedicated Frailty Consultant Hotline Tab on SystmOne to be visible to all care providers. Data-collection automated via Netcall and SystmOne from March 2023 till January 2024.

Results
Average number of call was 487/month, 2098 advices given over 11 months. Referral mostly done by UCRT 1511 (72%) followed by GP 193 (9.19%). Hospital admission avoided in 7 days and 30 days where the advice given in 82.9% and 73.6% cases, respectively. Total bed days saved was 13,920 Cost saving was over six million. Frailty score completed in 2982 cases. FVW referral done in 853 cases (40.6%). Feedback from FVW and UCRT, 95% found FHS was useful.

Conclusion
Our innovative model of FHS with direct access to geriatrician showed a safe and efficient model to support frailer older patients in the community with appropriate signposting to FVW and other community services as an alternative to acute hospital emergency admission and treat the right patient in the right place.
2354 Clinical assessment and documentation of delirium in older patients undergoing vascular surgery: a quality improvement project
Authors: Chand C , McCarthy T , Anthony R 
Published: August 2024

Abstract

Introduction
The Centre for Perioperative Care recommends the assessment and documentation of delirium using a validated tool such as the 4-AT in older people undergoing surgery.

Aim
This quality improvement project (QIP) aimed to improve the assessment and documentation of delirium in patients aged 65 and above following vascular surgery in a tertiary centre.

Methods
Patients aged ≥65 years who had undergone vascular surgery were identified and data was collected with access to the electronic patient record system. Analysis was carried out using Microsoft Excel and SPSS. Following baseline measurements taken in August 2023, 1 plan-do-study-act (PDSA) cycle was completed between September 2023–January 2024.

Baseline measures
Baseline data collected between August 1-31st 2023 identified 51 patients, of which delirium was screened using the 4-AT tool in 39.2% (n = 20), on average 90 hours post-operatively. The 4-AT was never documented in a consultant-led surgical post-operative review (100%, n = 51). There were clinical concerns of post-operative delirium documented in 7 patients, with the 4-AT documented in 5 of those cases.

Intervention
Interventions included stakeholder discussions to identify key barriers in the assessment and documentation of delirium, multidisciplinary team education and poster reminders across the ward. These were introduced between November–December 2023.

Results
Post-intervention results reviewed between 10th-31st January 2024 showed that the 4-AT was used to screen for delirium in 61.9% of patients (n = 13), on average 45 hours post-operatively. The 4-AT was never documented in a consultant-led surgical post-operative review. In addition, 2 patients developed delirium post-operatively with the 4-AT reported in both cases.

Conclusions
This QIP has demonstrated a marked improvement in compliance with national guidelines on the assessment of delirium, highlighting the impact of multidisciplinary education in improving the perioperative clinical pathway for older people undergoing surgery. Future PDSA cycles will focus on improving the documentation of 4AT in the post-operative surgical review.