bluuebunny/crossref_metadata_2025_split huggingface dataset:
System design for improving the detection effect of wafer surface particles
Authors: Chen Gengyang , He Pan 
Published: January 2025

Abstract
Wafer is an important basic material in semiconductor manufacturing, mainly used for the production of integrated circuits and microelectronic devices. Surface defects on wafers can affect lithography and subsequent processes, leading to circuit failure, with particle defects accounting for the largest proportion. This article focuses on the particle defects on the wafer surface and analyzes the optical scattering field distribution of particles using the Mie scattering theory. The relationship between the system collection angle and the scattered light intensity is also studied. It is found that when the tilt angle is 75°, using a larger collection angle is more conducive to the detection of surface particle defects. The experimental system has two channels that can receive scattered light signals, the narrow channel uses a lens to collect scattered light at 3°–15°, while the wide channel uses an ellipsoidal mirror to collect scattered light at 25°–70°. The experimental object is silicon dioxide particles with a radius of 500 nm on the wafer surface. After comparing the vertical incidence and oblique incidence (incidence angle of 75°) experiments, it was found that the wide channel detection effect was the best under oblique incidence, which verified the simulation results and research conclusions.
2724 The impact of preoperative comprehensive geriatric assessment on anticholinergic burden in older surgical patients
Authors: Bown L , Chandler A , Male R , Humphry N 
Published: January 2025

Abstract

This service evaluation reviewed the impact of the Perioperative Care of Older People Clinic (POPS) on Anticholinergic Burden (ACB) in older surgical patients and identified areas for improvement. The study assessed 75 patients aged ≥65 years, revealing widespread anticholinergic use. Among patients on anticholinergics, 34% experienced a reduction in ACB post-POPS review. However, maintaining these changes at ≥6 months was challenging, with 50% of patients experiencing a change in their ACB score due to new prescriptions or the re-initiation of old medications. The study identified communication gaps at the POPS-primary care interface affecting de-prescribing efforts, underscoring the need for improved discharge letters, systems to flag high ACB patients, and a universal ACB tool.

Introduction
The UK’s ageing population is increasingly undergoing surgery, and older adults are at higher surgical risk partly due to anticholinergic use. POPS is a relatively new initiative aimed at reducing ACB in this demographic, but the sustainability of these reductions is not well understood. This service evaluation aims to fill this gap and suggest solutions for maintaining reduced ACB levels.

Methods
Retrospective data from 75 patients from 2022–2023 who met the criteria for ACB evaluation pre- and post-POPS review, with follow-up at ≥6 months, were included.

Results
Post-POPS, ACB was reduced in 34% of patients, with a median decrease of −2. However, ACB increased again in 50% of patients at ≥6 months, with re-initiation of amitriptyline and furosemide contributing to the rise in 67% of these cases.

Conclusions
CGA effectively reduces ACB in older surgical patients, but sustaining these reductions poses significant challenges. Communication difficulties at the POPS-primary care interface likely contribute to the re-initiation of medications, indicating a need for standardised discharge summaries and a universal system for evaluating and flagging high ACB patients to maintain improvements.
2874 An assessment of analgesia and laxative prescriptions for patients admitted with neck of femur fractures
Authors: Ferry J , Macrae A 
Published: January 2025

Abstract

Introduction
Neck of femur (NOF) fractures can cause significant morbidity in elderly patients. Adequate pain control is essential for early mobilisation and improved outcomes. Health board prescription protocols exist offering a multi-modal analgesia approach as well as laxatives on the electronic platform (HEPMA). The aim of this quality improvement (QI) project was to assess adherence to these protocols.

Methods
Patients over 65 with isolated NOF fractures admitted to trauma wards from ED at a single district general hospital were included. Baseline data was collected from patients admitted between October to December 2023. Post-intervention data collected from April to June 2024. Prescriptions for regular and breakthrough opioids, regular paracetamol and laxatives on admission to the trauma wards were audited. Day 3 and day 5 review of pain and bowel status were also audited.

Intervention
An information session was delivered at the time of staff change over to senior house officers and junior clinical fellows to ensure they were aware of the NOF fracture analgesia and bowel protocol and available electronic prescribing bundles.

Results
A total of 169 patients were included. 84 prior to the intervention and 85 post intervention. Prior to the intervention accuracy for regular opioid prescription was 72.6%, PRN 83.3%, laxatives 81.8%, Paracetamol 88.1%. Post intervention respectively 87.1%, 94.1%, 92.9% and 91.9%. We demonstrated statistically significant change (p &lt; 0.05) in regular, PRN opioid and laxative prescribing. No change in paracetamol, Day 3 and 5 pain and bowel reviews was found.

Conclusion
A positive change in prescribing accuracy was demonstrated. Potential barriers to appropriate analgesia prescribing may be lack of awareness of protocols and hesitancy in prescribing opioids in elderly frail patients. Information sessions will continue to run to ensure appropriate prescribing for NOF patients on admission. Further data will be available following further educational and poster interventions.
2880 Reducing emergency Re-attendance in frailty SDEC patients
Authors: Twigg M , Martire J , Woolridge J , Gilpin R 
Published: January 2025

Abstract

Background
Frailty Same Day Emergency Care (FSDEC) is a service designed to identify and manage frail older people at the hospital front door with a view to provide early Comprehensive Geriatric Assessment, implement management and where appropriate support a same day discharge home.

Introduction
In September 2023 the FSDEC service opened with 6 assessment spaces adjacent to A&E. This project aimed to quantify the rate of re-admission for patients seen in FSDEC and explore approaches to improve performance.

Methods
This QIP utilised a PDSA approach. Baseline re-admission data was collected from a 2- week period in October 2023. Notes were reviewed for all patients seen in FSDEC during this timeframe and reviewed for evidence of any 30-day emergency re-attendances. Cases were then reviewed to identify any links between the 2 attendances and any preventative measures that could have been taken. Following PDSA cycle 1 frailty nurse telephone follow up was implemented. PDSA cycle 2 was a stress test of this (limited) service during winter pressures. PDSA cycle 3 followed expansion of Community Integrated Response Hub (CIRH) and discharged patients being able to self-refer for support once discharged.

Results
FSDEC 7-day re-attendance reduced from 10% to 5% after introduction of frailty nurse follow up. This was not sustained over challenging winter months with variable staff availability but did recover in Summer 24. There has also been a gradual improvement in 30-day re-admission by PDSA cycle 3 following roll-out of self-referral to CIRH.

Conclusion
Emergency re-admissions have reduced following implementation of frailty nurse telephone follow up and expansion of community services including patient access to CIRH for help following discharge from FSDEC. Addressing staffing model could allow for a more consistent follow up service. There is scope to trial this approach on geriatric ward discharges.
2545 The burden of frailty in a West London hospital: a case for an acute ‘front door’ team with robust links with community services
Authors: Brook S , Barnard R , Al-Haddawi Y , Wiggam A , Chaudhuri S , Murden M , Todorov G 
Published: January 2025

Abstract

Introduction
Global estimates indicate over half of individuals aged 85 and older are frail (1), costing the UK healthcare system approximately £5.8 billion annually (2). Locally, over 6500 patients aged 65+ are admitted to West Middlesex University Hospital (WMUH) every six months. The proposed frailty team aims to implement early comprehensive geriatric assessments (CGAs) through a multidisciplinary approach. Timely CGAs can increase the likelihood of patients remaining in their own homes at 6 and 12 months (3), reduce length of stay (LoS), and lower healthcare costs, contingent upon available community infrastructure. WMUH serves multiple boroughs, necessitating coordination with various community services to support discharges. These services include Hospital at Home and Integrated Community Response Services.

Objective
To gather baseline data on frail patients admitted before the introduction of a ‘Front Door Frailty’ team.

Methods
Data were collected for all medical admissions to WMUH from 1st to 14th July 2022, including:

Results
From 459 admissions over 2 weeks, 278 patients (61%) were ≥ 65 years old. Among these patients:

Conclusions
A high percentage of acute admissions at our hospital are characterised by frailty. Through early identification, multidisciplinary management, and improved links with local community services, the new acute frailty team aims to decrease length of stay and improve patient experience.
2797 Continuing therapy from intermediate care units to home: why wait?
Authors: Kinch-Mayhew C , Clift E 
Published: January 2025

Abstract

Background
Patients triaged as routine, discharged home from Intermediate Care Units (ICUs) in East Sussex wait 4 weeks until rehabilitation continues by the Community Therapy Team (CTT).

Introduction
NHS England (2023a) and NHS England (2023b) call for minimal delays, effective coordination processes and sharing of information for timely rehabilitation in intermediate care settings. Local patient feedback indicated poor patient satisfaction and increased clinicians’ anxiety regarding risk of deterioration due to long waits (Lewis A., Harding k., Snowdon D., BMC Health Service Research, 2018 18(1) 869).

Aim
To improve average wait times for routine ICU patients’ discharge, for ongoing community therapy input, to within 1 week by July 2024, while maintaining patient safety and improving patient satisfaction.

Method
Quality improvement methodology, using stakeholder engagement was used to determine the cause for long wait times for home therapy. PDSA cycles were engaged to determine if improvements could be made without a loss of quality of care, or impacting patient safety, while improving patient experience. These involved formal communication channels between teams and using a therapy assistant for an initial home assessment where full assessment had already been undertaken by registered therapists. Patient satisfaction surveys were undertaken to understand the experience of transition home.

Results
Baseline data indicated that waiting time for home therapy varied between 18–59 days, from discharge. After the initial PDSA cycle, waiting time reduced to between 4–10 days, and after the second cycle waits reduced further to between 3–7 days. Patients’ satisfaction improved significantly with shorter waiting times for therapy once home.

Conclusion
Therapy assistant initial visits at home reduced waiting times to within a week, and patients’ satisfaction improved with shorter waiting times. Patient safety was not compromised as there were clear protocols for appropriate escalations for unregistered staff.
2790 Changing the culture of personalised care plans in care homes: the Bromley experiment
Authors: Quirke S , Rees A , Adkin J , Garbharran U 
Published: January 2025

Abstract

Introduction
Care home residents have a greater incidence of frailty and co-morbidities. Polypharmacy and inequitable access to integrated healthcare are confounders to positive outcomes in this cohort. Providing proactive care through the Enhanced Health in Care Homes (EHCH) Framework seeks to address these inequalities using multidisciplinary team (MDT) working.

Method
A pilot MDT intervention was delivered across eleven older peoples care settings with the most ambulance conveyances in a London borough known for its ageing population. MDT members were from general practice (including pharmacist), geriatrics, ambulance service, district nursing, palliative care, psychiatry, social care, integrated care board and senior care home staff. The intervention was refined iteratively over five months via a Plan-Do-Study-Act cycle. The MDT undertook comprehensive geriatric assessments, advance care planning and structured medication reviews. Outcomes were documented in personalised care and support plans (PCSP).

Results
Sixty-nine of the most complex patients were selected to receive the intervention. 100% of these patients had a PCSP created post-intervention. A resultant system culture change led to a three-fold increase in the number PCSPs across all care settings. There was a reduction in 999 calls for 57% of MDT patients (across 8 settings) and there was 24% fewer 999 calls and hospital conveyances across the wider patient group in all MDT care settings. MDT professionals and care home staff reported high satisfaction and valued shared learning and clinical decision-making.

Conclusion(s)
This intervention addressed health inequalities of care home residents with a clear thread of advocacy for patients. Proactive personalised care planning offered opportunities for earlier diagnoses, treatment, and swifter recognition of the dying phase of life. Primary care interventions within EHCH framework could be augmented by this MDT approach for a more complex cohort of care home residents with severe frailty and greater co-morbidity profile including dementia.
2668 Polypharmacy in the elderly: are addressing the medication burden?
Authors: Olding L , Raza H , Hussain Y , Ganesaraja P , Kiczynska P , Eid S 
Published: January 2025

Abstract

Introduction
Polypharmacy represents a significant challenge in the vulnerable elderly population, where concurrent use of multiple medications increases the risk of interactions and adverse reactions, often precipitating acute events and complicated hospital stays. This necessitates thorough medication reviews to mitigate these risks; a hospital admission allows for such opportunities.

Methods
This project aimed to evaluate and address the medication burden among elderly patients, following WHO’s Global Patient Safety Challenge: Medication Without Harm. 50 patient’s medications were reviewed on a elderly care ward over the space of 3 months. A ward pharmacist and a senior member of the medical team critically evaluated inpatient charts on a twice weekly basis. Any changes made to the medication regimens were documented; additionally, the general practitioner was informed of any changes.

Results
Initial data indicated that 66% of patients were on five or more medications, with a high incidence of falls and a notable anticholinergic burden. On review of the 50 patients a total number of 36 drugs were de-prescribed, 38.9% were inappropriate anti-hypertensives, 13.8% vitamins among others.

Conclusions
This project has been an enlightening endeavour, teaching us the critical nature of addressing polypharmacy. We have learned that interdisciplinary collaboration, regular medication reviews, and patient education are key to managing this complexity. To ensure long-term sustainability, we plan to institutionalise pharmacy board rounds and implement mandatory medication reviews. We aim to work closely with primary care to maintain continuity post-discharge. These efforts are expected to foster a culture of mindful prescribing and medication safety.
2884 Protein for breakfast: a simple dietary change can bring glucose stabilisation benefits in care home residents
Authors: Bhambra P , Smith A , Paris H 
Published: January 2025

Abstract

Introduction
One in four Care Home (CH) residents have diabetes, making diet crucial for controlling glucose levels (GLs). Continuous blood glucose monitoring (CGM) now offers deeper insights into GL fluctuations. Diabetes in severe frailty is often overtreated, particularly with insulin, posing risks such as hypoglycemia, avoidable hospital admissions, and labour-intensive clinical supervision. While protein and vegetables can slow glucose absorption, dietary advice for CH residents typically emphasises carbohydrates and may not be tailored to their frailty. This study investigates the impact of modifying protein intake in insulin-using diabetics to improve glycaemic control.

Method
A small pilot study assessed if protein-rich foods (e.g. eggs, peanut butter) given for breakfast stabilise GLs throughout the day. Eight diabetic CH residents using insulin were randomly selected over four months. A diabetic frailty pharmacist monitored GLs with the CGM device (Freestyle Libre) and analysed GLs after a protein-rich breakfast. Descriptive analysis and t-tests were conducted using R before and after the food intervention, and ANOVA was used to analyse significant differences in GLs.

Results
Six out of eight patients showed statistically significant reductions in GL spikes, sustained throughout the day. For the remaining two patients, the food intervention helped maintain target GLs. This led to the discontinuation of insulin in one patient, and in the second, problematic frequent hypoglycemia was mitigated by the food intervention. Clinical decisions on patient safety influenced outcomes for these two patients but were not excluded from analysis.

Conclusion
Six of the eight residents given additional protein at breakfast showed significant GL reductions, leading to decreased insulin dosing and simpler regimes. Carers reported improvements in mood, sleep, and energy levels anecdotally. A holistic dietary approach in managing diabetes in CH residents, emphasising increased morning protein intake, should be considered to enhance GL control and allow deprescribing. A larger study is planned.
2747 The impact of specialised geriatric 5 M education on mobilisation of older adult patients in acute care in five Canadian hospitals
Authors: Peterson J , Faig K , Yetman L , Robertson C , Flanagan K , Prosser J , Feltmate P 
Published: January 2025

Abstract

Background and Objectives
Research suggests that specialised education for nurses decreases frailty and improves functionality in hospitalised older adults. This study explored the impact of a specialised geriatric education program on mobilisation rates for older adult patients in acute care in 5 hospitals.

Methods
A mixed methods approach with pre- and post- intervention questionnaires (Geriatric In-hospital Nursing Care Questionnaire (Ger-INCQ) and study specific knowledge assessment) was used to explore facilitators and challenges of caring for older adults, the knowledge base and experiences of staff, and the impact of providing specialised education. Acute care nursing staff participated in a 4-hour education intervention focusing on the Geriatric 5Ms(Mind, Mobility, Medications, Multi-complexity and Matters Most) and frailty prevention. Patient level data was collected through mobility audits (I-MOVE) and observation of shift handover communication. Semi-structured interviews with staff were completed to explore the results of the questionnaires.

Results
Registered nurses, licensed practical nurses and personal care attendants (N = 64, Mean age = 36.9, 87% female) who participated in the specialised training did not show significant change in their assessment scores. Patient (N = 99, mean age = 76.2, 54.5% female) mobilisation did not differ between phases of intervention (p = 0.08), nor was there any significant change in reporting mobility at shift handover. Ger-INCQ indicated neutral responsibility for falls incidents and retention of patient mobility, with interviews (n = 26) revealing that patients are kept immobilised for safety and workload management.

Conclusion
Staff had positive attitudes towards caring for older adults; however, their understanding and application of geriatric principles were limited and remained unchanged. Interview participants stated their work environment limits their capacity to deliver the best practice care presented in the education sessions. These findings suggest that education alone is unlikely to influence prioritisation of mobility for frail older adults in a strained acute care setting.
Research on the provincial-level centralized function of integrating neural networks with electricity billing data analysis
Authors: Zhao Fangchu , Su Xin , Lu Xiaoxiao , Si Feiya , Lang Lingling , Sun Wenlei 
Published: January 2025

Abstract
This paper proposes a provincial-scale system integrating neural networks with electricity rate data analysis to enhance prediction accuracy and anomaly detection efficiency while ensuring user privacy. At its core is the electric rate analysis neural network (EANN), which combines LSTM and GCN to effectively capture the temporal dynamics of billing data and the relational structure among users. The system also introduces a privacy protection scheme based on personalized federated learning for secure cross-regional analysis. Experiments show that EANN improves prediction accuracy by 2.3% and reduces computational latency by 6.3% compared to traditional CNN–LSTM methods.
Plasmids encode and can mobilize onion pathogenicity in Pantoea agglomerans
Authors: Shin Gi Yoon , Asselin Jo Ann , Smith Amy , Aegerter Brenna , Coutinho Teresa , Zhao Mei , Dutta Bhabesh , Mazzone Jennie , Neupane Ram , Gugino Beth , Hoepting Christy , Khanal Manzeal , Malla Subas , Nischwitz Claudia , Sidhu Jaspreet , Burke Antoinette Machado , Davey Jane , Uchanski Mark , Derie Michael L , du Toit Lindsey J , Stresow-Cortez Stephen , Bonasera Jean M , Stodghill Paul , Kvitko Brian 
Published: January 2025

Abstract
Pantoea agglomerans is one of four Pantoea species reported in the USA to cause bacterial rot of onion bulbs. However, not all P. agglomerans strains are pathogenic to onion. We characterized onion-associated strains of P. agglomerans to elucidate the genetic and genomic signatures of onion-pathogenic P. agglomerans. We collected &gt;300 P. agglomerans strains associated with symptomatic onion plants and bulbs from public culture collections, research laboratories, and a multi-year survey in 11 states in the USA. Combining the 87 genome assemblies with 100 high-quality, public P. agglomerans genome assemblies we identified two well-supported P. agglomerans phylogroups. Strains causing severe symptoms on onion were only identified in Phylogroup II and encoded the HiVir pantaphos biosynthetic cluster, supporting the role of HiVir as a pathogenicity factor. The P. agglomerans HiVir cluster was encoded in two distinct plasmid contexts: 1) as an accessory gene cluster on a conserved P. agglomerans plasmid (pAggl), or 2) on a mosaic cluster of plasmids common among onion strains (pOnion). Analysis of closed genomes revealed that the pOnion plasmids harbored alt genes conferring tolerance to Allium thiosulfinate defensive chemistry and many harbored cop genes conferring resistance to copper. We demonstrated that the pOnion plasmid pCB1C can act as a natively mobilizable pathogenicity plasmid that transforms P. agglomerans Phylogroup I strains, including environmental strains, into virulent pathogens of onion. This work indicates a central role for plasmids and plasmid ecology in mediating P. agglomerans interactions with onion plants, with potential implications for onion bacterial disease management.