bluuebunny/crossref_metadata_2025_split huggingface dataset:
Introduction to Part II
Authors: Cureton Adam 
Published: January 2025

Abstract
This chapter introduces the second part of the book. The aims of Part II are to illustrate some practical implications of the Sovereignty Conception of Reason (SCR) in two related ways. It explores many substantive interests of reason that we have simply because we have the power of reason. It also considers some specific requirements of reason that follow from these substantive interests in combination with the Sovereignty Conception’s Partial Principle of Justifiability (SCR-PPJ). The substantive interests of reason and specific requirements they favor help us to interpret the main features of the SCR. They also suggest that, with further development, the SCR has significant potential to fit well with reflective common sense and ordinary language about the nature of a rational and reasonable person and what reason requires of us. This introductory chapter provides some background and context for the chapters of this part that follow. The chapter discusses the two main aims of Part II, describes the approach to addressing them as well as some of its limits, and characterizes the general argumentative strategy for moving from substantive interests of reason through the Sovereignty Conception of Reason’s Partial Principle of Justifiability to specific requirements of reason. The substantive final interests of reason and corresponding rational requirements that will be explored in Part II concern explanation, unity, specificity, harmony, knowledge, avoiding error, enlightenment, rational nature itself, several kinds of freedom, happiness, natural perfection, respect and expressions of respect, and friendship, community, and other forms of solidarity.
Explanation, Unity, Specificity, Affinity, and Harmony
Authors: Cureton Adam 
Published: January 2025

Abstract
As rational and reasonable people, we necessarily care about explanation, unity, specificity, affinity, and harmony for their own sake. We want explanations and cannot rest content with appeals to fate, luck, or “just-so” stories. We want systematicity and are unsatisfied with outliers, overgeneralizations, gaps, and heterogeneity. We want harmony and are disturbed by conflict and dissonance. Part of being a rational and reasonable person is to have innate and final drives to ask “why” questions about everything, to organize all things into systems, and to resolve any conflicts among them. This chapter explores these substantive final interests of reason by drawing on themes in Kant’s work and on reflective common sense. It also considers some presumptive laws of reason that are justifiable to rational persons on the basis of our interests of reason in explanation, unity, specificity, affinity, and harmony. As rational people with these interests of reason, we could or would support laws that presumptively require us to reflect and investigate in various ways, to make certain assumptions, to develop a systematically unified conception of happiness, to resolve disagreements among people, and to cooperate with them. Lying and intimidation tend to undermine these interests, for example the use of fear to discourage people from raising or pursuing “why” questions about religious matters. Our interests of reason in explanation, systematic unity, and harmony also favor presumptive laws that concern freedom of communication and thought, educating children, and affording people opportunities for careful reflection.
Freedoms
Authors: Cureton Adam 
Published: January 2025

Abstract
Our power of reason includes substantive final interests in promoting and protecting five distinct kinds of freedom that relate to our power of choice. We have interests of reason in preserving and protecting our ability to make choices, to choose without hindrance from our desires, feelings, and other incentives, to choose on the basis of a complete, accurate, and unified understanding of ourselves and our situation, to act in the ways we choose to act by choosing to do them, and to choose according to our own character. The aim of this chapter is to explore these five kinds of freedom that relate to our power of choice, to examine corresponding interests of reason we have in promoting and protecting these freedoms in everyone, and to explore some presumptive laws of reason favored by these interests. Each type of freedom, despite appearances, is compatible with our negative freedom to make choices without being caused or determined to do so. The interests of reason we have in promoting these freedoms support presumptive laws that fit well with ordinary ideas about the importance of promoting and protecting the freedom of everyone. Rational human persons who care about these freedoms in themselves and others could or would endorse laws of reason that presumptively prohibit various kinds of coercion, violence, deception, and manipulation, as well as ones that presumptively require us to break any habits we have, to exercise self-control, to choose for ourselves, and to develop and maintain our own character.
Thermophysical properties
Authors: Leachman Jacob W , Wilhelmsen Øivind , Matveev Konstantin I 
Published: January 2025

Abstract
This chapter starts with discussing the inter- and intra-molecular interactions of the two spin isomers of hydrogen, ortho- and parahydrogen, and how statistical mechanics can be used to derive thermodynamic properties. Next, it is shown how thermodynamic properties can be calculated using equations of state (EoS). Three types of EoS are discussed: quantum cubic, statistical associating fluid theory for variable quantum-corrected Mie potential (SAFT-VRQ Mie), and multiparameter. Situations are presented where different types of EoS are preferred. A brief discussion is provided on how to estimate transport properties of hydrogen, such as viscosity, thermal conductivity, and diffusion coefficients. Quantum-corrected density functional theory methods are demonstrated for predicting surface tensions of hydrogen and mixtures with good accuracy. Finally, the properties of solid hydrogen are discussed.
Para—orthohydrogen conversion
Authors: Leachman Jacob W , Wilhelmsen Øivind , Matveev Konstantin I 
Published: January 2025

Abstract
This chapter covers interconversion between ortho- and parahydrogen and sensing compositions. Parahydrogen is the populous form below 77 K and orthohydrogen is more prevalent at higher temperatures. Ortho–parahydrogen conversion has the largest energy per mass of any material phase change at cryogenic temperatures and occurs whenever hydrogen is not at the equilibrium composition for a given temperature. Isotopic—also known as natural or self—conversion is presented first, followed by non-isotopic—also known as catalyzed—conversion. Fundamentals of catalyzed converter design are discussed next. The chapter concludes with an overview of relative and absolute sensing techniques for measuring and verifying ortho–parahydrogen compositions.
2781 Improving MDT efficiency and staff satisfaction in frailty unit
Authors: Ekwegh U 
Published: January 2025

Abstract

Introduction
As part of a larger quality improvement project focused on improving the management of older people living with frailty attending the Manchester Royal Infirmary, a Frailty Same Day Emergency Care Unit (Frailty SDEC) was established. This would require the merging of three teams: the Front Door Frailty team, the Acute Therapy team and an established Nursing team on the allocated ward area. It became apparent that an intervention was required to improve team-working and efficiency among these clinicians who had never all worked together in the same space before.

Methods
Board Rounds are well established elsewhere in the hospital and are recommended by the Royal College of Physicians’ Principles for Best Practice. We therefore tested, through four Plan-Do-Study-Act (PDSA) cycles, the approach to Multidisciplinary team (MDT) board rounds that would facilitate teamwork and efficiency in the team.

Results
Our main outcome measure was staff satisfaction. There is evidence that increased staff satisfaction improves patient outcomes; this is therefore an important metric. Furthermore, there would be other confounders on efficiency such that time to discharge would not have been an accurate measure of the impact of good board rounds. We therefore surveyed the MDT after 6 months of working through the PDSA cycles to compare the current practice with what had been the status quo at the start of the year. The overwhelming response (both quantitative and qualitative) was increased satisfaction with how the team was working together to improve patient care.

Conclusion
When setting up a new service, early attention must be given to how to ensure that newly created teams have their own personalised approach to collaborative MDT working, by establishing a Board Round culture that works for that team.
2831 Improving delirium assessment in the elderly; a systematic approach using 4AT as a screening tool for delirium
Authors: Jayakumar G , Abdulaziz M , Salem A 
Published: January 2025

Abstract

Introduction
Delirium, characterised by disturbances in attention and consciousness, is common in individuals with pre-existing medical conditions, particularly the elderly, but can affect people of any age. It can lead to significant morbidity, mortality, prolonged hospital stays, increased healthcare costs, and long-term cognitive decline. Despite its impact, delirium is often underdiagnosed and undertreated, underscoring the need for better diagnostic strategies. The 4AT tool, recognised by NICE, is valued for its rapid delirium assessment, unlike the AMT-10, which is more suited for chronic cognitive disorders.

Objective
This study was conducted to assess the usage of the 4-AT tool in the assessment of delirium to aid in the early detection of delirium in the elderly population.

Method
The retrospective review of medical records over six months was conducted and divided into two cycles to evaluate delirium assessment using the 4AT. Initially, data from 59 patients 49 at FPH and 10 at WPH established a baseline of 4-AT usage across the trust. Post-intervention, 60 patient records were reviewed to reassess 4AT usage.

Interventions included

Results
Before the intervention, only 6.8% of patients were assessed using the 4AT tool, 55.9% with the AMT, and 37.2% without assessment. Post-intervention, the overall assessment rate rose to 62.7%, significantly increasing 4AT usage. Among 28 delirium-diagnosed patients, only 14.3% were screened with the 4AT, indicating room for further improvement.

Discussion and Conclusion
The increased use of the 4AT tool post-intervention highlights the effectiveness of educational initiatives in improving delirium screening. Early detection through the 4AT facilitates timely interventions and better patient outcomes. However, the small sample size and underutilisation among diagnosed patients suggest the need for ongoing efforts to improve its usage.
2666 End of life in care homes: what are the common prescribing patterns for residents in their last phase of life?
Authors: Reddick C , Paris HJ 
Published: January 2025

Abstract

Introduction
End-of-life (EOL) care in care homes includes patients experiencing ‘ordinary dying’ from dementia or frailty, alongside those with chronic diseases and cancer. Recognising non-specific decline is complex. The One Weston Care Home Hub (CHH) implements comprehensive EOL care, achieving 95% of deaths in the preferred place and prioritising a ‘good death’. Whilst ‘Just in Case’ (JIC) injectable medications are commonly prescribed, a broader understanding of prescribing patterns is useful for learning about medicines waste and recognition of dying. This study investigates the prevalence of common prescriptions and explores the need to re-evaluate anticipatory medications for care home residents.

Method
A qualitative audit evaluated EOL care prescribing practices in 100 care home deaths by examining medication management in patient notes. Data were collected retrospectively on parameters including the completion of palliative drug charts, issuing JIC medications, and the timeline from prescribing JIC medications to death. Information on medications administered within the last two weeks of life and the cause of death was also recorded.

Results
34% received no additional medications. Antibiotics were the most commonly issued medications; 31% patients received them, half in liquid form. Other prescriptions included oral or topical analgesia (21%), laxatives (9%), benzodiazepines (8%), and oral steroids (5%). Liquid preparations comprised half of the issued medications. 74% of patients had JIC medications issued a median of 23 days before death (range: 1–1244 days).

Discussion
The use of antibiotics in this cohort is complex: are they prescribed for successful treatment, or could braver decisions be made not to prescribe when recovery chances are limited? Injectable JIC medications are a timely proxy for recognising the terminal phase, but 26% of patients who died did not have these in place. Further study is required to determine if they were indeed not needed and how many of those prescribed were used.
2889 Pain control in musculoskeletal injuries of the elderly
Authors: Urrehman H , Elamurugan M , Maseko A , Abbott C 
Published: January 2025

Abstract

Introduction
Musculoskeletal (MSK) injuries are a common factor in acute presentations to the emergency department (ED). Effective pain management is crucial for patient comfort and recovery, yet pain control for MSK injuries admitted under the medical team often falls short of optimal standards. This quality improvement project aims to evaluate and enhance the prescription practices for pain relief in elderly patients with MSK injuries at the Wrexham Maelor Hospital (WMH) ED.

Methods
A two-cycle project was completed in which patients with MSK injuries were identified and reviewed regarding any pain relief they may have been prescribed (regular or PRN). Following cycle 1, interventions were put in place and prescribing practices were reassessed with a second cycle. Inclusion criteria: &gt;60 years of age with MSK injury described in notes. Each cycle of data collection lasted a week, with a sample size of 17 and 14 patients respectively.

Results
Cycle 1 No pain relief- 33% PRN Only- 6% Regular Only- 50% Both- 11% A significant number of patients were not receiving adequate pain relief, highlighting the need for improved pain management protocols. Interventions- Educational posters were displayed around the emergency department and the frailty hub, and a presentation was given to the frailty team. Cycle 2 (post intervention) No pain relief- 14% PRN Only- 29% Regular Only- 21% Both- 36% Post-intervention results showed a marked improvement in pain management, with fewer patients receiving no pain relief and an increase in the combined use of PRN and regular pain relief.

Conclusion
The quality improvement project highlights the necessity for targeted interventions to enhance pain management for elderly patients with MSK injuries in the ED. Preliminary results suggest that increased awareness and education among medical staff can potentially improve pain relief prescription rates.
2836 Age differences in efficacy of newer glucose lowering treatments for type 2 diabetes
Authors: Hanlon P , Butterly E , Wei L , Wightman H , Almazam SAM , Alsallumi K , Crowther J , McChrystal R , Rennison H , Hughes K , Lewsey J , Lindsay R , McGurnaghan S , Petrie J , Tomlinson LA , Wild S , Adler A , Sattar N , Phillippo DM , Dias S , Welton NJ , McAllister DA 
Published: January 2025

Abstract

Background
Newer glucose-lowering agents for type 2 diabetes (sodium glucose cotransporter 2 inhibitors (SGLT2i), glucagon-like peptide-1 receptor analogues (GLP1ra) and dipeptidyl peptidase-4 inhibitors (DPP4i)) improve hyperglycaemia and SGLT2i and GLP1ra reduce the risk of major adverse cardiovascular events (MACE). It is not clear whether the efficacy of these agents varies by age.

Methods
We searched Medline and Embase, plus clinical trial registries, for randomised controlled trials of SGLT2i, GLP1ra and DPP4i, versus placebo or active comparator, in adults with type 2 diabetes. Outcomes: HbA1c and MACE. Where IPD were available, we modelled age-treatment interactions for each trial. Otherwise, we assessed age distributions along with results from aggregate trial data. IPD and aggregate findings were combined in a Bayesian network meta-analysis to assess whether the efficacy differed by age.

Results
We identified 616 eligible trials (604 reporting HbA1c, 23 reporting MACE) and obtained IPD for 75 trials (6 reporting MACE). Mean age was 59.0 (10.7) years and 64.0 (8.6) in HbA1c and MACE trials, respectively. SGLT2i reduced HbA1c by 0.5–1.0% overall compared to placebo. This reduction versus placebo was attenuated in older participants (change in HbA1c 0.25 percentage-points less for 75-year-olds compared to 45-year-olds). SGLT2i showed greater relative efficacy in MACE risk reduction among older than younger people. This finding was sensitive to the exclusion of one of the IPD MACE trials, however, in all sensitivity analyses, SGLT2i were either as efficacious or more efficacious in older participants. There was no consistent difference in efficacy by age for GLP1ra or DPP4i for HbA1c or MACE.

Conclusion
Newer glucose-lowering drugs are efficacious across age and sex groups. SGLT2i are more cardioprotective in older than younger people despite smaller HbA1c reductions. Age alone should not be a barrier to treatments with proven cardiovascular benefit providing they are well tolerated align with patient priorities.
2504 Barriers perceived by medical students when considering a career in geriatric medicine
Authors: Fisher G , True S 
Published: January 2025

Abstract

Introduction
Despite the UK’s increasing life expectancy, and increase in the elderly population, there is an overwhelming lack of Geriatricians in the UK; as of 2022, there is only 1 consultant Geriatrician per 8031 individuals over the age of 65 (BGS, 2023). To meet the complex care needs of this population, there must be a focus on increasing the interest that doctors have towards Geriatric Medicine, with the overall aim being to recruit more doctors into the speciality.

Method
The aim of this review was to investigate what factors medical students perceive as barriers to pursuing a career in Geriatric Medicine and then, from identifying these, generate a set of comprehensive suggestions as to how to tackle these barriers at a medical school level to increase the interest and ultimately uptake of Geriatric Medicine. The qualitative review contains literature published between 2003 and 2023 accessed using MedLine.

Results
Six themes were identified in answering our question: (a) high emotional burden, (b) caring for patients with complex needs, (c) negative preconceptions of non-clinical factors (prestige, salary, career progression), (d) negative influence of clinical educators, (e) lack of intellectual stimulation and (f) lack of exposure to the speciality and the elderly.

Conclusion
The barriers perceived by medical students when considering Geriatrics as a speciality are complex and multifaceted; these barriers must be tackled promptly in order to secure the next generation of Geriatricians. We suggest that this work can be used as a foundation for further qualitative studies with UK medical students to investigate barriers that are specific to UK students. From this, interventional courses designed to increase Geriatric Medicine uptake could be developed to strengthen the UK Geriatric Medicine workforce.
2789 Patient navigator coordination of transitions for older adults with fractures: family caregiver experiences
Authors: Hanson N , Skerry L , O’Keefe K , Freeze T , Nguyen C , Somal R , Faig K , Jarrett P 
Published: January 2025

Abstract

Introduction
Fall-related injuries such as fractures are on the rise as the older adult population grows in New Brunswick, Canada. These injuries can lead to hospitalisation and transitions in care that are complicated for patients and families. The objective was to investigate the impact of patient navigators (PNs) working alongside the healthcare team on patient and family experiences, as compared to the usual standard of care (SOC), for adults aged 65 and older admitted with a fracture to an Orthopaedic Unit at one hospital in New Brunswick.

Methods
A concurrent embedded mixed methods design, in which the quantitative randomised control trial had an embedded qualitative component. The results for the family caregiver qualitative component, which used an interpretive description approach, are presented.

Results
Semi-structured interviews were conducted and thematically analysed for 15 family caregivers (8 PN group, 7 SOC group). The SOC caregivers, six women and one man, had a mean age of 64.6 years (SD = 6.9 years). The mean age of the 8 women in the PN group was 61.3 years (SD = 10.1). All participants in both SOC and PN groups self-reported their ethnicity as white. Thematic analysis found that SOC group caregivers discussed patients relying on support from family and friends throughout their care journey, whereas caregivers in the PN group predominantly discussed finding PNs supportive and helpful. Both groups discussed the ongoing stress that they felt throughout the care journey of the patient for which they cared for; however, for the PN group this topic was less prevalent.

Conclusions
This study provides an understanding of the positive impacts a patient navigator can have on older adult inpatient care and transitions in care. Patient Navigators were shown to be helpful to families, particularly those of patients with higher care needs and fewer family supports.
2792 Hospital outcomes following hip fracture in older adults: does frailty matter?
Authors: Steeves A , Shanks J , Flewelling A , Faig K , Bohnsack A , Benjamin S , MacLellan C , Gionet S , Wagg J , Dutton D , McGibbon CA , Jarrett P 
Published: January 2025

Abstract

Objectives
Older adults hospitalised with a hip fracture are at risk for adverse health outcomes depending on their level of frailty. This study examined how frailty levels prior to admission impacted length of stay (LOS), requirement for alternative level of care (ALC), returning home post-discharge, and mortality.

Methods
A random sample was generated from all hip fracture patients aged 65 and older admitted to a Level One Trauma Centre in New Brunswick, Canada from 2015–2019. This sample had their frailty level determined retrospectively using the Pictorial Fit-Frail Scale and the patients’ hospital electronic health record.

Results
Our study included 189 patients (mean age: 83.2 ± 8.2, 73.0% female), representing 91 not frail to mildly frail (48.2%; NF-MF), 32 moderately frail (16.9%; ModF), and 66 severely frail (34.9%; SF) patients. The ModF patients had a longer LOS (median: 20.0 days, IQR = 22.5) compared to NF-MF patients (median: 11.0 days, IQR = 10.0, p = 0.039, Kruskal-Wallis test) and SF patients (median: 8 days, IQR = 5.5, p &lt; 0.0001, Kruskal-Wallis test). More ModF patients (56.3%) required an ALC stay in acute care compared to NF-MF (30.8%) and SF (28.8%) patients (p = 0.016, Chi-square test). More SF patients (28.8%) died in hospital or within six months post-discharge compared to NF-MF (8.8%) patients (p = 0.005, Chi-square test). Logistic regression revealed that both NF-MF (OR = 8.11, 95% CI: [3.12–21.06], p &lt; 0.001) and ModF (OR = 5.18, 95% CI: [0.85–0.95], p = 0.007) patients had greater odds of returning home compared to SF patients when accounting for sex, age, and time to surgery.

Conclusions
A patient’s level of frailty prior to hospital admission impacts various health outcomes following a hip fracture and may provide helpful information for guiding treatment as well as discussions about health care.