bluuebunny/crossref_metadata_2025_split huggingface dataset:
Investigation of the stress-strain state for the fuel tank separator
Authors: Klimovskiy D A , Yu Zhuravlev V 
Published: March 2022

Abstract
The work carried out finite element modeling for the thin-walled shell of revolution loaded uniform pressure with using MSC NASTRAN software. The simulations results allow us to study the stress-strain state of the torus rolling zone for refine the boundaries of plastic deformation. It is determined that the region of plastic deformation does not arise in the entire torus zone. This region is limited by the outer part of the torus along the generatrix edges.
Engineering of GIS for environmental monitoring of mining landscapes
Authors: Yuronen Y P , Bakhtina A V , Yuronen E A 
Published: March 2022

Abstract
Features of GIS design, designed to monitor the state of disturbed lands at open mining facilities, natural and climatic conditions in the mining area, are considered in order to inform the adoption of administrative and management decisions. The introduction of such systems will make it possible to carry out operational environmental monitoring of lands subject to technological violations, reduce the time for preparing reporting and technical documentation when designing and conducting measures aimed at land reclamation, make decisions on the technology and timing of reclamation of subsoil use facilities, and also reduce the time for making such decisions.
Model predictive and fuzzy logic controllers for reactor power control at Reaktor TRIGA PUSPATI
Authors: Sabri Minhat Mohd , Adilla Mohd Subha Nurul , Hassan Fazilah , Rashid Husain Abdul , Ahmad Anita 
Published: March 2022

Abstract
The Reaktor TRIGA PUSPATI (RTP) rely extensively on a core power control system for control reactivity to fulfilment the fundamental safety function for a nuclear reactor. It is technically challenging to operate within tight multiple parameter constraints and keep the core power output stable. At present, the power tracking performance of the system could be considered unsatisfactory which produces a relatively long settling time and high control effort. Hence, a study of a model predictive control (MPC) strategy by integrating the current Power Change Rate Constraint (PCRC) using fuzzy logic which is part of the core power control design is conducted. In this paper, the MPC design based on mathematical models of the reactor core included point kinetics model, thermal-hydraulic model, reactivity model and dynamic rod position model help to enhance core power control. The power tracking performance of the proposed control method and previous Feedback Control Algorithm-Fuzzy PCRC is compared via computer simulation with different power range operations. Overall, the results show the MPC-Fuzzy PCRC strategy provides a greater level of operational safety and optimum operation of the TRIGA reactor.
A comparative photon shielding properties of protective Window materials by using EGS5 code
Authors: Mamat Nurhakimah , Mohamad Tajudin Suffian , Hanim Aminordin Sabri Adila , Faddilah Mohd Noor Arif , Norizan Nursyafika , Zahri Abdul Aziz Mohd 
Published: March 2022

Abstract
For an X-ray room, there is a special window for radiation workers to monitor the patient during an irradiation procedure. Lead glass commonly used as protective window materials for diagnostic X-rays even it is known for its toxicity due to the lead oxide in the air which could be inhaled either during manufacturing or recycled process. Monte Carlo simulation (EGS5 code) was used to study several other types of available protective windows for its radiation shielding efficiency. In this study, the practicability of acrylic glass, plate glass and Pyrex glass systems with respect to lead glass were studied for protective window materials. The photon attenuation coefficients (μ), the percentage of transmitted and reflected photon energy spectra and half-value layer (HVL) were investigated by using simulation. Three photon source energies of 59.5 keV, 150 keV, and X-ray 150 kVp were calculated via EGS5 code to study the capability of these four glass systems as low energy photons radiation shielding materials. A thickness of 7 cm plate glass, 8 cm pyrex glass and more than 10 cm acrylic glass are adequate as a non-lead shielding material for 150 kVp X-ray to have a similar lead-glass equivalency. The use of plate glass as radiation protecting material to replace lead glass can reduce expenses as plate is way cheaper than lead but the increase thickness of plate will need special framing and concerns of its increased weight needs to be considered. However, given that the X-ray primary beam will not be directed towards the protective windows, therefore the findings are appropriate, with less thickness of plate glass could be used.
Physical properties of polyvinyl alcohol (PVAL) gel materials as phantoms for mammography
Authors: Oyiwoja Okoh Franca , Fahmi Mohd Yusof Mohd , Ahmad Kabir Norlaili , Nor Azizah Abdullah Siti 
Published: March 2022

Abstract
This study evaluates the possibility of using polyvinyl alcohol (PVAL) composites as phantom material to simulate different densities of breast tissue for mammography based on their elastic properties. Three categories of PVAL gels were prepared by freezing and thawing 10 % water based PVAL (PVAL), ethanol and water based PVAL (PVAL/E) and a blend of PVAL with graphite powder (PVAL/G) solutions to mimic various breast densities. Young’s modulus (YM) of all samples was evaluated by puncture test using the texture analyser. The results recorded ranged from 0.93 to 4.79 kPa for all samples. The results indicate that the PVAL based phantoms examined could be used to simulate fatty and dense breast tissues based on the values of their densities and YM.
On the role of surface carbonate species in determining the cycling performance of all-solid-state batteries
Authors: Strauss Florian , Payandeh Seyedhosein , Kondrakov Aleksandr , Brezesinski Torsten 
Published: March 2022

Abstract
This short perspective summarizes recent findings on the role of residual lithium present on the surface of layered Ni-rich oxide cathode materials in liquid- and solid-electrolyte based batteries, with emphasis placed on the carbonate species. Challenges and future research opportunities in the development of carbonate-containing protective nanocoatings for inorganic solid-state battery applications are also discussed.
675 IMPROVING RECOGNITION OF DELIRIUM IN CRITICAL CARE PATIENTS
Authors: Meakin O , Young N , Woods S , Sherwin T 
Published: March 2022

Abstract

Introduction
Delirium is more prevalent in patients admitted to the critical care environment, those over 65 years old and living with frailty. By increasing the recognition of delirium we can improve management of patients and therefore reduce associated morbidity. Initial audit of this patient group highlighted that we are missing opportunities to screen for, diagnose and document the presence of delirium. This Quality Improvement project aimed to improve delirium screening, and therefore recognition, on the critical care unit at The Royal Bolton Hospital.

Method
A retrospective analysis of patients aged ≥65 years or with a CFS ≥5 admitted to critical care at The Royal Bolton Hospital over a 2-week period for each PDSA cycle. Three cycles were undertaken. The initial intervention was a local teaching session for medical and nursing staff on critical care. The second intervention was to display delirium information posters throughout critical care which encouraged recognition and screening of delirium.

Results
Prior to intervention 9% of this patient group were assessed for delirium on admission to critical care and 55% were re-assessed at some point during their admission. After the initial intervention these numbers significantly improved to 33% and 80% respectively. After the second intervention 8% were screened on admission and 69% were re-assessed. Missed opportunities to document delirium as a diagnosis remained similar throughout all cycles.

Conclusion
We can improve delirium screening via regular educational sessions for medical and nursing staff on critical care. Information posters do not appear to have as much impact. There is scope to improve documentation of delirium as a diagnosis which would further aid in management and outcomes. We suggest a further PDSA cycle with an intervention to address this.
685 HOSPITAL @HOME: TREATING SEVERE COVID-19 IN THE COMMUNITY
Authors: Quinn M , Walters S , McEnhill P , Oyston M , Schiff R 
Published: March 2022

Abstract

Introduction
Patient numbers during the second wave of COVID-19 threatened to overwhelm hospital capacity. Hospital @home services bring the ward to the patient; providing acute care in the home, delivered by a specialised multi-disciplinary team. Our Hospital @home was ideally placed to adapt to support the care of COVID patients in the community who would otherwise have required hospitalisation yet were unlikely to benefit from level 2/3 care. Here we report on the process and 30 day outcomes.

Methods
An evidence-based guideline for the treatment of severe COVID by Hospital @home was developed. A severe bundle pack including dexamethasone, oxygen, IV fluids and thromboprophylaxis was used at first patient contact. Patients were referred from the community or from hospital and streamed into severe or non-severe pathways. Outcome data was retrospectively extracted from the notes of all COVID positive patients admitted to hospital @home between 16/12/2020 and 14/02/2021.

Results
125 COVID patients were treated by hospital @home. Patients were triaged by infection severity: severe (n = 42, 34%) and non-severe (n = 83, 66%). Average length of stay with hospital @home was 6.8 days (IQR 4–8); equivalent to 855 occupied bed days—i.e. one 28 bed ward for 30.5 days. 33 patients were treated with the severe COVID bundle with an average Clinical Frailty Score 6.9 (IQR 6–8). 30 day outcomes for patients treated with the severe bundle were: 13 (39%) alive in the community (average CFS 6.2), 1 (3%) in hospital and 19 (57%) deceased (average CFS 7.4).

Conclusion
Rapid redesign of an existing hospital @home service during the COVID pandemic offered appropriate patients the choice to have Level 1 hospital care in their home. Hospital @home has an essential role in offering alternative pathways of care to patients and optimising local healthcare capacity.
695 QUALITY IMPROVEMENT PROJECT ON TRANSFER TIMES OF ACUTE HIP FRACTURE PATIENTS FROM ED TO INPATIENT BED POST SIMULATION TRAINING
Authors: Clancy C , Mahony R , Donegan M , Meighan V 
Published: March 2022

Abstract

Introduction
The care of patients with hip fractures is a surrogate marker of trauma care. Irish hip Fracture Standard (IHFS) 1 involves patients with a hip fracture being admitted to an orthopaedic ward bed within 4 hours of attending the ED. We wanted to audit our current practice and introduce a quality improvement project to improve the timeliness and efficiency of care of our hip fracture patients compared with the gold standard IHFS 1. We introduced a 90 minute multidisciplinary simulation training programme on the hip fracture pathway to our ED in February 2021. All key stakeholders were represented; from Emergency Medicine, Orthopaedics, Nursing (EM and Orthopaedic), Radiology, Radiography, Porters (32 people overall). Because of covid-19, the training was available in person and online via zoom.

Methods
We performed a retrospective audit of patients presenting to TUH ED with a proximal third of femur fracture between 4th February and 31st March inclusive in 2020 and 2021, pre and post introduction of multidisciplinary simulation based medical education on the hip fracture pathway. Data was collected from the electronic record database (symphony). We recorded the following data;

Results
2020 n = 31 Average time to ward—8 hrs 29 mins. 26% patients reached ward &lt;4 hours. (8/31) 2021 n = 25 Average time to ward—5 hrs 58 mins (32% reduction vs 2020) 72% patients reached ward &lt;4 hours. (18/25) (46% increase vs 2020).

Conclusion
Simulation based medical education is a successful intervention to improve compliance with our hip fracture pathway, time from presentation to transfer to an orthopaedic ward bed and achieve IHFS 1.
715 REDUCING OVERTREATMENT OF TYPE 2 DIABETES IN OLDER PEOPLE LIVING IN CARE HOMES
Authors: Samarasekara N , Dinsdale E , Taylor S , Sulaiman M , Gittens A , Ahmed E , Jain A , Tang M , Ninan S 
Published: March 2022

Abstract

Introduction
Older people in care homes living with frailty are less likely to benefit from tight glycaemic control in the management of type 2 diabetes with increased risk of adverse effects for example hypoglycaemia, falls and hospital admission. We wished to ascertain the scale of the problem and reduce overtreatment. We defined overtreatment based on American Diabetes Association guidelines as being on an agent that can cause hypoglycaemia and having an HBA1C of ≤53 mmol/mol or, an HbA1c 53–64 mmol/mol with either three or more co-morbidities.

Methods
In 2016, we audited the management of type 2 diabetes in older people discharged from LTHT to care homes. We discussed our concerns with diabetes and geriatric medicine colleagues across medical, nursing and pharmacy disciplines. We engaged the support of the citywide diabetes network which comprises secondary care colleagues, general practitioners and pharmacists. We presented the findings of our initial audit to colleagues within primary and secondary care through departmental meetings and citywide network meetings. We wrote a new guideline, specifically for frail older people that was disseminated citywide through these networks. We re-audited in 2020.

Results
In total, 113 cases were reviewed in 2016 and 105 cases in 2020. In 2020, only 6% (6 patients) were overtreated compared to 38% (43 patients) in 2016.

Conclusions
There has been a marked reduction in overtreatment which should result in less adverse events. We believe the reasons for success lie in wide engagement of relevant stakeholder groups around an issue that is important, large in scale and meaningful to both patient and clinician. There are potential cost savings from reducing medications and reducing harm.
729 INCORPORATING PATIENTS’ VIEWS IN THE DESIGN OF AN EDUCATIONAL LEAFLET FOR FRAIL, OLDER PATIENTS WITH KIDNEY DISEASE
Authors: Ryan L , McNicholas J , Beckwith H ,   Kidney Care UK, Brown E A 
Published: March 2022

Abstract

Introduction
There are an increasing number of older people live with advanced kidney disease. These individuals tend to have a higher number of co-morbidities, including frailty. This group experience multiple challenges in understanding and managing their co-existing conditions. This quality improvement project aimed to incorporate patient and carers views and experiences to improve their understanding and support self-management.

Method
Semi-structured interviews were conducted with older patients with advanced kidney disease and their carers. Interviews explored their views on ageing and frailty, how it affects them, coping strategies, resource awareness and opinions on structure and content for an educational leaflet for older people with kidney disease. The interviews were transcribed verbatim then coded into themes to inform key topics for the leaflet. These were used to generate reader-friendly questions and answers. The leaflet was reviewed and approved by the Clinical Committee and Patient Information Board in Kidney Care UK.

Results
10 individuals (8 patients and 2 carers) were interviewed. Patients were aged 62–88 years. Three were receiving haemodialysis, two peritoneal dialysis, two had a kidney transplant and three attended the advanced kidney care clinic. The five most common codes identified were ‘physical exercise’, ‘losing abilities’, ‘mobility’, ‘prevention and safety’ and ‘medical problems’. Themes identified were 1. Mood and memory, 2. Mobility and medical problems, 3. Self-help and supports, 4. Determination, 5. Impact on self and other. The leaflet title was chosen by patients and carers. Figure 1 shows the completed, published leaflet.

Conclusion
This quality improvement project used semi-structured interviews with older patients and carers affected by advanced kidney disease. The main issues they identified in relation to getting older with kidney disease were included in an educational leaflet. Partnership with Kidney Care UK has made the leaflet available across the UK. We hope it will directly address their everyday concerns.
740 ASSESSING THE IMPACT OF A DEDICATED FRAILTY MULTIDISCIPLINARY TEAM TO DELIVER A PROACTIVE VIRTUAL COMPREHENSIVE GERIATRIC ASSESSMENT
Authors: Conlon K , Harris E , Spiers E , Coleman H , Gallifent R , Farnsworth M , Chan C S 
Published: March 2022

Abstract

Introduction
Surrey Downs Health and Care (SDHC) is an innovative partnership between acute and community providers, local general practitioner (GP) federations and adult social care. The NHS Long Term Plan emphasises the importance of ageing well and supporting people living with frailty by improving integrated proactive services in the community. To achieve this, SDHC collaborated with local Primary Care Networks (PCNs) to develop a frailty multidisciplinary team (MDT) to deliver proactive virtual Comprehensive Geriatric Assessments (CGA).

Method
A monthly frailty MDT meeting was introduced across two PCNs. MDT members included a geriatrician, GP, frailty nurse, community matron, district nurse, therapists, social prescriber, paramedic practitioner and social worker. A reactive-proactive model was utilised; patients over 65-years-old already referred to the community teams were proactively screened for frailty and scored using the Clinical Frailty Scale (CFS). Patients that scored 6 and above were discussed at the MDT and a virtual CGA completed.

Results
151 patients were referred for MDT discussion over eight months. Patients had a mean age of 86 years and a modal CFS score of 6. In the 8-weeks following MDT discussion compared with the 8-weeks prior, patients attended 11% fewer GP consultations, a 9% decrease in community visits and 30% fewer emergency department (ED) attendances.

Conclusion
The implementation of a dedicated PCN frailty MDT who conducted proactive CGAs reduced patient attendance to ED and resulted in fewer consultations with community services. This success has led to a system wide implementation of the model to the other local PCNs.
763 QUALITY IMPROVEMENT PROJECT (QIP) ON IMPROVING THE USE OF THE CLINICAL FRAILTY SCALE (CFS) DURING THE COVID-19 PANDEMIC
Authors: Wijayaratne P , Vijay A , Shah A , Ene M 
Published: March 2022

Abstract

Introduction
Older people were disproportionally affected by the COVID-19 pandemic resulting in a surge in the demand for healthcare resources. The aim of this QIP was to assess and improve the compliance of using the CFS in patients over the age of 65 with COVID-19 to aid in establishing appropriate Treatment Escalation Plans (TEPs) during admission.

Method
Prospectively, clinical notes of 80 patients were reviewed to calculate the compliance of documenting the CFS on admission. Multiple Plan-Do-Study-Act (PDSA) cycles were implemented. As the first intervention, a trust-wide email message was sent to all medical doctors highlighting the importance of assessing CFS in all patients during admission. Also, reminder emails and text messages were sent to all medical doctors’ WhatsApp groups. As the second intervention, we designed an e-poster and displayed it as a screensaver on all trust computers for 2 weeks. Data was collected and analysed after each intervention.

Results
The baseline audit showed that only 42% of patients had a CFS documented during admission. The majority (55%) had a CFS above 5 and 93% of the patients had a ‘Do Not Attempt Cardiopulmonary Resuscitation (DNACPR) order in place. Compliance in assessing CFS after the two interventions was 65% and 68% respectively. In both cycles, all patients who had a CFS of 5 and above had DNACPR decisions in place. Moreover, significant variability in escalation plans was noted when the CFS was 4.

Conclusion
The compliance in assessing CFS progressively improved with each intervention. Although the CFS is a valuable tool in assisting TEPs, it should be treated as a spectrum that is independent of age, rather than a binary phenomenon. We hope to further improve compliance by arranging teaching sessions for doctors in our hospital and thereby ensure appropriate TEPs are in place.
812 GERIATRIC PERIOPERATIVE CARE IS ASSOCIATED WITH REDUCED LENGTH OF STAY IN UROLOGY PATIENTS
Authors: Parry F , Rideway A , Ibitoye S , Nitharsan R , Grange R , Braude P , Warren K , Shipway D 
Published: March 2022

Abstract

Introduction
Comprehensive Geriatric Assessment (CGA) is associated with reduced length of stay and perioperative complications in older orthopaedic, gastrointestinal and vascular surgical patients [1,2,3]. Limited published data from a single UK centre [4] reports reproducing these outcomes in a urological setting. It is unclear whether these outcomes can be repeated in other urological centres.

Method
We piloted a Geriatric Perioperative Care service delivering CGA to older emergency urology patients admitted to within a tertiary centre. The aim of the service was to reduce length of hospital stay (LOS). We evaluated it using quality improvement methodology. Patients for review were identified using age ≥ 65 and the Clinical Frailty Scale. Patients that were transferred to another hospital team prior to discharge were excluded.

Results
101 patients were included: 35 in the pre-intervention group and 66 in the post-intervention group. Mean LOS in the pre-intervention group was 7 days. In the post-intervention group, mean LOS was reduced to 3.5 days, 6 days and 5.5 days in the first, second and third months respectively.

Conclusion
We found that perioperative geriatric care was associated with reduced length of stay in older urology patients. These data would support the need for larger and/or multicentre studies to evaluate the relationship between geriatric intervention in urological inpatients and length of hospital stay. References: on request due to word count.
817 AVOIDING THAT SINKING FEELING: A QIP TO IMPROVE THE IDENTIFICATION OF POSTURAL HYPOTENSION ON A MEDICINE FOR THE ELDERLY WARD
Authors: Gilmartin C G S , Peacock M , Coultas J , Alavi N , Long S 
Published: March 2022

Abstract

Background
Postural hypotension contributes significantly to falls in frail older people. The RCP recommend that all inpatients &gt;65 years have a lying and standing blood pressure (L&SBP) performed early. We recognised that there was a need to improve the understanding, measurement and consistency of documentation for L&SBP on our ward, a 20-bedded acute MFE ward with many patients at risk of falls.

Methods
This project incorporates two PDSA cycles with three data collection points. We began with baseline measurements of the proportion of patients with: 1) L&SBP recorded within two working days of arrival 2) BP recorded at 1 and 3 minutes, and 3) documentation of associated symptoms. Patients were excluded where it was not possible or appropriate to perform L&SBP. We then carried out a qualitative questionnaire to understand the barriers for staff performing L&SBPs and potential solutions. Our first intervention was to design and deliver a teaching session to all nurses and health care assistants. After re-audit, we created a poster highlighting guidelines for measuring and documenting L&SBPs, and reinforced the learning at MDMs We reviewed the notes of all eligible patients on the ward before and after each intervention.

Results
Our questionnaire revealed useful insights including time constraints and uncertainty of where to document results—these findings allowed us to develop bespoke training for our team.

Discussion
This project demonstrates that junior doctor-led teaching and working with MDT colleagues improves the identification of postural hypotension on a ward. Reinforcement of learning is important.