bluuebunny/crossref_metadata_2025_split huggingface dataset:
Impurity atom configurations in diamond and their visibility via scanning transmission electron microscopy imaging
Authors: Propst D , Kotakoski J , Åhlgren E H 
Published: September 2023

Abstract
Dispersed impurities in diamond present a flourishing platform for research in quantum informatics, spintronics and single phonon emitters. Based on the vast pool of experimental and theoretical work describing impurity atoms in diamond, we review the configurations by the chemical element discussing the relevant atomic configurations and most important properties. Dopant structures expand from single to co-doping configurations, also combined with carbon vacancies. Despite of their importance, not much is known about the exact atomic configurations associated with the dopant structures beyond computational models, partially due to difficulties in their microscopic observation. To assess the visibility of these structures, we carry out image simulations to show that the heavier dopants may be easily discernible in scanning transmission electron microscopy annular dark field images, with a window of visibility of up to over

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10 nm in defocus. We further present the first atomic resolution images of an impurity atom configuration (substitutional Er atom) in the diamond lattice, confirmed by a comparison to the simulated images. Overall, our results demonstrate that there is a vast research field waiting for the microscopy community in resolving the exact atomic structure of various impurity atom configurations in diamond.
Association Between Optimism and Incident Stroke Among Stroke Survivors: Findings From the English Longitudinal Study of Ageing
Authors: Chilcot Joseph , Hackett Ruth A 
Published: September 2023

AbstractBackgroundPersonality has been implicated in stroke death. However, the role of personality in stroke incidence is unclear.PurposeOur primary aim was to investigate associations between optimism, determination, control, and the “Big Five” personality traits on incident stroke. A secondary aim was to assess the potential mediating role of health behaviors in the personality-stroke relationship.MethodsA total of 3,703 stroke-free participants from the English Longitudinal Study of Ageing provided data on personality using the Midlife Development Inventory at Wave 5 (2010/11). Self-reported incident stroke was assessed from Waves 6 to 8 (2012–2017). Associations were modeled using discrete-time survival proportional odds logistic models. Analyses were adjusted for sociodemographic factors, history of other cardiometabolic diseases, and health behaviors.ResultsOver 6 years follow-up there were 125 incident strokes. Higher optimism (hazard ratio [HR] = 0.66; 95% confidence interval [CI] 0.53, 0.82), openness (HR = 0.72; 95% CI 0.53, 0.98), and conscientiousness (HR = 0.59; 95% CI 0.42, 0.84) were associated with reduced incident stroke risk in unadjusted models. After adjustment for sociodemographic factors and history of cardiometabolic disease, only the association between optimism and incident stroke remained significant (HR = 0.72; 95% CI 0.57, 0.92). The effect of optimism remained significant in a final model adjusting for health behaviors (HR = 0.75; 95% CI 0.60, 0.96). There was evidence of a small but significant mediating effect of physical activity.ConclusionsHigher trait optimism was associated with reduced stroke risk. This association was partially mediated by physical activity albeit the effect was small, and caution warranted inferring causality. The interplay of personality, behavior, and clinical risk factors in stroke incidence and survivorship needs further investigation.
56 Audit of assessment, prevalence, and treatment of osteoporosis for patients attending the inflammatory bowel disease Service in Mullingar Regional Hospital
Authors: Foley M , Quirke Z , Kirca M , Moloney D 
Published: September 2023

Abstract

Background
Courses of steroids are common in patients with Inflammatory Bowel Disease (IBD) and are a risk factor for developing osteoporosis. Osteoporosis is a clinically silent entity and osteoporosis-related fractures are associated with chronic pain, disability, and impact quality of life. Screening of high-risk populations is the mainstay of fracture prevention. In this audit, we aimed to assess adherence to international guidelines for osteoporosis risk assessment and bone protection.

Methods
A retrospective audit was performed with a random sampling of 10% of the patients attending between October 2021 to October 2022 the IBD outpatient clinic in Mullingar Regional Hospital. Data included demographics, IBD diagnosis, FRAX tool components, FRAX score, bone health screening, DEXA results, and use of bone mineral protection. Clinical practice was compared against European Crohn’s and Colitis Organisation (ECCO) recommendations on bone protection in IBD.

Results
Of 150 charts reviewed, 39 charts were missing essential data and 8 had a diagnosis other than IBD. All 103 patients included in the analysis had received &gt;3 months of systemic steroid use, of which 50 had a diagnosis of Crohn’s disease and 63 with ulcerative colitis. Two (2%) patients had a FRAX risk assessment for osteoporosis, and 22 (21%) had a DEXA ordered, of which 7 (7%) were by the IBD clinic. Two (2%) patients had a previous fragility fracture and 3 (3%) had been diagnosed with osteoporosis. Bone protection was used in 21 (20%) patients receiving steroids, including calcium and vitamin D supplementation (n = 19), and bisphosphonate (n = 2).

Conclusion
There are low rates of osteoporosis screening for IBD patients attending this service. There was inadequate data in the charts to calculate FRAX scores to assess osteoporosis prevalence. An intervention tool is currently being designed and the audit cycle will be completed with a repeat audit after implementation.
72 Are so-called ‘mechanical’ falls in later life as benign as we think? Data from TILDA
Authors: Keane B , McMahon G , Lavan A , Briggs R 
Published: September 2023

Abstract

Background
‘Mechanical’ or simple falls are those due to slips or trips, and in the absence of injury are often considered benign. Older people with ‘mechanical’ falls are often not referred for a comprehensive falls assessment. The aim of this study was to assess if ‘mechanical’ falls were a risk factor for future falls, falls-related injuries/fractures, and fear of falling.

Methods
Participants ≥65 years (n = 2,820, mean 73 years) from TILDA were included and followed from Waves 1–5 at 2-yearly intervals (8-year follow-up). ‘Mechanical’ falls were falls caused by a simple slip/trip as reported by participants. Incidence of future falls (total falls/unexplained/injurious) and fracture (hip/wrist/vertebral/other) was by self-report at each Wave. Logistic Regression models reporting odds ratios (OR) assessed the association between explained falls and future further falls/fracture and fear of falling, adjusted for relevant covariates.

Results
Over 15% (441/2,820) of participants reported ‘mechanical falls’ within the last year at Wave 1, and there was a high prevalence of established falls risk factors, e.g. polypharmacy (32%), heart disease (24%), among this cohort. ‘Mechanical’ falls were associated with a significantly increased likelihood of future injurious falls (OR 1.50 (1.21–1.870; p &lt; 0.001)), unexplained falls (OR 1.27 (1.00–1.62); p 0.050), and fracture (OR 1.37 (1.06–1.76); p 0.015), in fully adjusted models. Reporting ≥2 ‘mechanical’ falls was independently associated with development of fear of falling (OR 1.96 (1.27–3.03); p = 0.002) and was more strongly associated with all future fall types than reporting a single ‘mechanical’ fall.

Conclusion
Older people with recent simple falls are significantly more likely to present with falls causing injury, unexplained falls, and fracture during follow-up. If simple falls are recurrent, they also have a higher likelihood of developing fear of falling. Comprehensive falls assessment, addressing established risk factors, should therefore be considered for older people with ‘mechanical’ falls, particularly if recurrent.
115 Association between muscle strength, body composition and stroke incidence- findings from the UK biobank prospective cohort study
Authors: Hayes S , Parra S , Morales C C , Forbes J , Whiston A , Pell J 
Published: September 2023

Abstract

Background
Stroke incidence is growing. Muscle strength and muscle mass are inversely associated with cardiovascular health and the ageing process. The aim of this study was to examine the association between components of body composition and incident stroke.

Methods
UK Biobank is a prospective, population-based study wherein 348,198 participants aged 40–69 years (56% women) were recruited. The associations of handgrip strength and muscle mass (kg) with stroke incidence over follow-up were investigated using Cox-proportional hazard models.

Results
Among 348,198 participants, 5,480 (0.02%) participants developed a fatal or non-fatal stroke event over the mean follow-up period of 8.92 (SD 1.15) years. Findings demonstrated inverse and independent associations between hand grip strength and stroke incidence (HR: 0.92, 95% CI 0.89; 0.95, p &lt; 0.001) and stroke mortality (HR: 0.85, 95% CI 0.78; 0.92, p = 0.005) in the full-adjusted models. Findings also show inverse associations between body fat and stroke incidence (HR: 0.93, 95% CI 0.87; 0.99, p = 0.02) and stroke mortality (HR: 0.83, 95% CI 0.71; 1.00, p = 0.02). Muscle mass was not associated with stroke risk or mortality.

Conclusion
Handgrip strength and body fat were inversely associated with a higher risk of stroke among middle-aged participants in this population-based cohort study. These findings support the importance of body composition and muscle strength evaluation in screening for stroke risk among adults 40+ years old without pre-existing disease.
180 Comparative performance of a new 3-item health index in predicting mortality: a seven-year follow-up study
Authors: Knight S , Ward M , Duggan E , Xue F , Kenny R A , Romero-Ortuno R 
Published: September 2023

Abstract

Background
The effectiveness of health measures in predicting mortality remains a critical aspect of clinical practice. This study aimed to evaluate the performance of a novel 3-item Health Index (HI) and compare it with existing frailty measures, the Frailty Index (FI) and Frailty Phenotype (FP), for predicting all-cause mortality in a cohort of older, community-dwelling adults.

Methods
Mortality data spanning seven years, encompassing multiple confounding variables, were analysed using Cox proportional regression. The 3-item HI was developed based on resting-state systolic blood pressure sample entropy (sBP SampEn), Sustained Attention Reaction Time (SART) performance, and gait speed. Hazard Ratios (HR) and Area Under the Curve (AUC) were derived for comparative analysis.

Results
In total, there were 4,265 participants (178 deceased) in the study (mean age = 61.6 ± 8.2 years; 54% female) from The Irish Longitudinal Study on Ageing (TILDA). The new 3-item HI demonstrated superior predictive ability for all-cause mortality compared to the FI and FP, with an AUC of 0.71, surpassing the AUC values of 0.68 and 0.62 for the FI and FP, respectively. Categorising individuals into ‘Low-Risk’, ‘Medium-Risk’, and ‘High-Risk’ groups, the High-Risk group of the HI exhibited a HR of 9.14 (95% CIs: 4.21, 19.86), while the Frail group of the FI and FP displayed HRs of 4.12 (95% CIs: 2.77, 6.12) and 6.87 (95% CIs: 3.58, 13.19), respectively. Furthermore, the 3-item HI remained a significant predictor of mortality even after comprehensively adjusting for confounding variables.

Conclusion
The objectively measured new 3-item HI demonstrated superior predictive ability for all-cause mortality compared to (mostly self-reported) count-based frailty measures currently employed in clinical practice. To facilitate wider utilisation, we have developed a user-friendly MATLAB App, freely available to researchers and clinicians, allowing easy calculation of the 3-item HI in various healthcare settings. The implementation of this innovative health assessment tool could advance risk prediction and inform decision-making in patient care.
203 Secondary hyperparathyroidism is associated with poor physical performance in older adults: results from the TUDA study
Authors: Fitzpatrick D , Lannon R , Laird E , Ward M , Hoey L , Hughes C F , Strain J J , Cunningham C , McNulty H , Molloy A M , McCarroll K 
Published: September 2023

Abstract

Background
Vitamin D deficiency frequently leads to secondary hyperparathyroidism and is associated with frailty and sarcopenia. However, the role of hyperparathyroidism in the pathophysiology of frailty and impaired physical function is unclear. In this study, we evaluated the relationship between secondary hyperparathyroidism and poor physical performance as assessed by the Timed-Up-and-Go (TUG) test.

Methods
Participants were from a cross-sectional study of Irish adults aged &gt;60 years. Those with eGFR &lt;30 mL/min and serum calcium ≥2.5 mmol/L were excluded to avoid hyperparathyroidism due to renal impairment and primary hyperparathyroidism. We also excluded participants on drugs that may affect parathyroid hormone (PTH): (teriparatide, denosumab, activated forms of vitamin D), factors affecting physical function (glucocorticoid use: current or past &gt;3 months and history of stroke) and those with an MMSE &lt;24. Hyperparathyroidism was defined as a PTH ≥65 nmol/L and abnormal physical performance by TUG ≥12 seconds. The relationship between hyperparathyroidism and abnormal TUG was explored in logistic regression.

Results
There were 3,405 participants. 72.4% were female and mean age was 77.5 +/−7.6 years, with 36.7% having a TUG ≥12 seconds. Secondary hyperparathyroidism was significantly associated with TUG ≥12 (OR: 1.34; CI: 1.04–1.74, p = 0.026) after adjustment for age, sex, body mass index, serum 25-hydroxyvitamin D, eGFR, dairy intake, alcohol use, smoking, diabetes mellitus, cardiovascular disease (ischaemic heart disease, heart failure) and peripheral artery disease.

Conclusion
Secondary hyperparathyroidism was associated with a 34% increased risk of poor physical performance. Other research has demonstrated an association between elevated PTH and sarcopenia supporting a role for its direct effect on muscle function. This study highlights the importance of ensuring both adequate vitamin D status and calcium intake in older adults to reduce the risk of secondary hyperparathyroidism and its potential negative impact on the musculoskeletal system.
205 Exploring stakeholder experiences of Comprehensive Geriatric Assessment in community and out-patient settings: a qualitative evidence synthesis
Authors: Hayes C , Fitzgerald C , O’Shaughnessy Í , Robinson K , Galvin R 
Published: September 2023

Abstract

Background
Comprehensive Geriatric Assessment (CGA) is a multidimensional interdisciplinary process that addresses an older adult’s bio-psycho-social capabilities to create an integrated and co-ordinated plan of care. While there is established quantitative evidence that demonstrates the positive impacts of CGA on clinical and process outcomes, less is known about how older adults and service providers experience CGA. This study aimed to systematically review and synthesise qualitative studies reporting the experiences of CGA of community-dwelling older adults, caregivers and healthcare professionals in the community and Out-Patient Department (OPD) setting.

Methods
This qualitative evidence synthesis involved a systematic search across 5 databases targeting qualitative or mixed methods studies that reported qualitative findings on stakeholder experiences of CGA. The protocol was registered with the PROSPERO database (Registration: CRD42021283167). The methodological quality of the included studies was appraised using the Critical Appraisal Skills Programme checklist for qualitative research. Results were synthesised according to Noblit and Hare’s seven-step approach to meta-ethnography.

Results
Fourteen studies were included where CGA was completed in the home, general practice, out-patient setting in acute hospitals and in hybrid models across the community and acute OPD settings. Synthesis identified four key themes: (1) CGA is experienced as a holistic process (2) The home environment enhances CGA (3) Time, the prevailing healthcare model and interprofessional communication influenced the success of CGA in the community (4) Conflicting perspectives on the meaningful involvement of older adults, carers and family in the CGA process.

Conclusion
The findings demonstrate that CGA in a home-based setting allows for a more holistic approach to care while increasing patient satisfaction and accessibility to healthcare. Although potential barriers to the delivery of CGA include current fragmented health service structures and a lack of understanding of CGA, factors such as enhanced communication, carer and older adult involvement in the CGA process are potential facilitators to its implementation.
217 Attitudes towards Physician-Assisted Dying among medical students in an Irish medical school
Authors: Kelly E , Carthy A Mc , Oce O , O'Connell N , Briggs R , O’Donnell D 
Published: September 2023

Abstract

Background
Physician-Assisted Dying (PAD) is a controversial topic, particularly among medical practitioners, While PAD is currently illegal in Ireland, it has been legalised in several European countries. It is likely PAD will become an increasingly contentious issue as current medical students progress through their training and over the course of their future careers.

Methods
This project comprised of a fully anonymised survey (using the platform Qualtrics), exploring Trinity College Dublin (TCD) medical students’ attitudes towards PAD. All TCD medical students, aged 18 and above, were invited to take part in the online survey. The survey included thirteen questions, addressing student: sex, age, stage of medical training, exposure to geriatric medicine rotations, opinions on training in relation to PAD, and overall attitude to PAD. A participation information leaflet containing a link & QR code to the survey was distributed to students at lectures. An email inviting students to take part in the study was also circulated. Consent was implied by completion of the survey.

Results
200 students completed the survey. 119/200 (59.5%) of students were in favour of PAD, 53/200 (26.5%) were unsure, and 28/200 (14%) were opposed to PAD. Only 42/200 (21.%) students felt that their medical training adequately prepared them for potential discussions with patients about PAD The majority of students (31/37) who had completed rotations in Gerontology also felt that they were not adequately prepared for such discussions. 173/200 students feel that additional medical training related to PAD is warranted.

Conclusion
The majority of TCD medical students, across all genders, year of training and age groups, were in favour of PAD. Most students feel that their medical training does not prepare them for potential discussions about PAD in the future. Those who had clinical rotations in Gerontology did not feel more prepared for future discussions regarding PAD, suggesting the need for more formal teaching on the subject.
264 Improvements in associative memory and spatial navigation with acute transcutaneous Vagus Nerve Stimulation in Mild Cognitive Impairment: preliminary data
Authors: Dolphin H , Dyer A , Commins S , Finucane C , Dukelow T , Kennelly S 
Published: September 2023

Abstract

Background
Transcutaneous Vagus Nerve Stimulation (tVNS) is a neuromodulation technique which uses a handheld device to peripherally stimulate the afferent vagus nerve. tVNS has shown promise in augmenting memory in cognitively unimpaired populations but data in cognitively impaired populations is sparse. This investigation is timely as new therapeutic strategies to treat Mild Cognitive Impairment (MCI) are urgently needed.

Methods
VINCI-ad is an investigator-led, single-blind, sham-controlled crossover pilot study assessing the effects of tVNS in amnestic MCI. All participants have MCI (Clinical-Dementia Rating Scale—Global Score of 0.5) with amnestic neuropsychological profile (RBANS delayed memory index &lt;85). Participants are randomised over 3 study visits to baseline (no stimulation) active stimulation (at the CC of left ear) or sham stimulation (earlobe). Cognitive tests include Face-Name Association Task (FNAT), Sustained Attention Response Test (SART) and Sea Hero Quest Navigation Test (SHQ) among others.

Results
Interim data analysis of 28 participants (planned recruitment n = 40) is presented (mean age 71.5 (range 55–85), 17 male, RBANS DMI 73.3 ± 11.1). CSF ad biomarkers were positive for 75% (21/28) (AB-42460.4 pg/ml (± 83.3 pg/ml) and p-tau181 82.5 pg/ml [± 53.2 pg/ml]) and 78% (22/28) of participants had a Charleston Comorbidity Index of ≥3. Mean tVNS stimulation time pre-cognitive assessments was 21.2 minutes, with mean amplitude setting during active stimulation of 2.5 mA (1.8–4.5) and sham of 2.0 mA (0.9–3.1). During FNAT, active tVNS had no effect on facial recognition or reaction times, however recall accuracy was significantly improved (69.2% ±3.13) compared to baseline (44.7% ±3.51 p = 0.016) and sham (50.1% ±3.28 p = 0.021) and during active tVNS spatial navigation (38.94 sec [±1.68]) was quicker than baseline (51.49 sec (±3.2) p = 0.0164) and sham (51.9 sec (±3.15) p = 0 0.0038). We noted no significant improvements in SART or other cognitive tests performance during tVNS.

Conclusion
tVNS may be a useful complementary tool to augment spatial and associative memory in MCI. Further larger studies are needed to delineate precise settings in this population.
273 Improving frail care—is there a role for the geriatrician in elective waiting lists?
Authors: James K , Soppitt D , Davies E , Burberry D 
Published: September 2023

Abstract

Background
The perfect storm of an ageing population and recent pandemic has hugely impacted waiting lists. There is evidence for frailty assessment at point of referral as per the traditional Peri-Operative Care of Older People undergoing Surgery (POPS) model however our concern was for all those patients already on lengthy waiting lists. We obtained funding via the Bevan commission to look at whether a geriatrician had a role in reviewing need for surgery, intervening in medical issues and the best way to select the patients who would benefit.

Methods
We chose the cholecystectomy list to start as the ‘least frail’. We contacted all patients completing a modified CRANE (Comprehensive Risk Assessment and Needs Evaluation) questionnaire and frailty scoring. We offered a clinic appointment to any patient with a CFS (Clinical Frailty Score) over 4 or who triggered for frailty. Primary outcome was patients removed from the list, secondary outcomes included cost savings through avoiding further outpatient tests and consults, diagnoses made and patient feedback collected.

Results
Over 20% of patients were removed from the waiting list with a cost saving of around £250,000. 54 patients were offered clinic appointments, over 25 tests were ordered minimising delays in pre-operative assessment and diagnoses including dementia and hyponatraemia were made. Patient feedback was excellent. They felt there was an improvement in the health and social care needs being met following an outpatient appointment and raised the importance of good communication whilst waiting a procedure. The HFRS (Hospital Frailty Risk Score) showed the greatest specificity in selecting patients for clinic while the CRANE questionnaire was more sensitive.

Conclusion
Clearly geriatricians have a huge role to play in perioperative medicine. We have suggested a modified POPS model with a six monthly CFS score and CRANE questionnaire to identify patients who are becoming frailer while waiting. The project shows cost savings and decreased waits but more importantly improvement in patient care and satisfaction.