A comparison between the clinical frailty scale and the hospital frailty risk score to risk stratify older people with emergency care needs

Background Older adults living with frailty who require treatment in hospitals are increasingly seen in the Emergency Departments (EDs). One quick and simple frailty assessment tool—the Clinical Frailty Scale (CFS)—has been embedded in many EDs in the United Kingdom (UK). However, it carries time/training and cost burden and has significant missing data. The Hospital Frailty Risk Score (HFRS) can be automated and has the potential to reduce costs and increase data availability, but has not been tested for predictive accuracy in the ED. The aim of this study is to assess the correlation between and the ability of the CFS at the ED and HFRS to predict hospital-related outcomes. Methods This is a retrospective cohort study using data from Leicester Royal Infirmary hospital during the period from 01/10/2017 to 30/09/2019. We included individuals aged + 75 years as the HFRS has been only validated for this population. We assessed the correlation between the CFS and HFRS using Pearson’s correlation coefficient for the continuous scores and weighted kappa scores for the categorised scores. We developed logistic regression models (unadjusted and adjusted) to estimate Odds Ratios (ORs) and Confidence Intervals (CIs), so we can assess the ability of the CFS and HFRS to predict 30-day mortality, Length of Stay (LOS) > 10 days, and 30-day readmission. Results Twelve thousand two hundred thirty seven individuals met the inclusion criteria. The mean age was 84.6 years (SD 5.9) and 7,074 (57.8%) were females. Between the CFS and HFRS, the Pearson correlation coefficient was 0.36 and weighted kappa score was 0.15. When comparing the highest frailty categories to the lowest frailty category within each frailty score, the ORs for 30-day mortality, LOS > 10 days, and 30-day readmission using the CFS were 2.26, 1.36, and 1.64 and for the HFRS 2.16, 7.68, and 1.19. Conclusion The CFS collected at the ED and the HFRS had low/slight agreement. Both frailty scores were shown to be predictors of adverse outcomes. More research is needed to assess the use of historic HFRS in the ED

Religious education and hermeneutics: the case of teaching about Islam

This article attempts to do three things: the first is an exploration of the ways in which Islam is presented in an essentialist way (with a focus on Religious Education (RE) in England and Wales), leading to stereotypes and unsubstantiated generalisations. Secondly, it provides a critique of essentialism, and finally a case is made for the role of hermeneutics in the teaching and learning of Islam

XSL: The X-Shooter Spectral Library

We are building a new spectral library with the X-Shooter instrument on ESO's VLT: XSL, the X-Shooter Spectral Library. We present our progress in building XSL, which covers the wavelength range from the near-UV to the near-IR with a resolution of R ~ 10000. At the time of writing we have collected spectra for nearly 240 stars. An important feature of XSL is that we have already collected spectra of more than 100 Asymptotic Giant Branch stars in the Galaxy and the Magellanic Clouds.Comment: 8 pages, 4 figures, to be published in the proceedings of the "GREAT-ESF Stellar Atmospheres in the Gaia Era Workshop", Brussels, Belgium, 23-24 June, 201

HATSouth: a global network of fully automated identical wide-field telescopes

HATSouth is the world's first network of automated and homogeneous telescopes that is capable of year-round 24-hour monitoring of positions over an entire hemisphere of the sky. The primary scientific goal of the network is to discover and characterize a large number of transiting extrasolar planets, reaching out to long periods and down to small planetary radii. HATSouth achieves this by monitoring extended areas on the sky, deriving high precision light curves for a large number of stars, searching for the signature of planetary transits, and confirming planetary candidates with larger telescopes. HATSouth employs 6 telescope units spread over 3 locations with large longitude separation in the southern hemisphere (Las Campanas Observatory, Chile; HESS site, Namibia; Siding Spring Observatory, Australia). Each of the HATSouth units holds four 0.18m diameter f/2.8 focal ratio telescope tubes on a common mount producing an 8.2x8.2 arcdeg field, imaged using four 4Kx4K CCD cameras and Sloan r filters, to give a pixel scale of 3.7 arcsec/pixel. The HATSouth network is capable of continuously monitoring 128 square arc-degrees. We present the technical details of the network, summarize operations, and present weather statistics for the 3 sites. On average each of the 6 HATSouth units has conducted observations on ~500 nights over a 2-year time period, yielding a total of more than 1million science frames at 4 minute integration time, and observing ~10.65 hours per day on average. We describe the scheme of our data transfer and reduction from raw pixel images to trend-filtered light curves and transiting planet candidates. Photometric precision reaches ~6 mmag at 4-minute cadence for the brightest non-saturated stars at r~10.5. We present detailed transit recovery simulations to determine the expected yield of transiting planets from HATSouth. (abridged)Comment: 25 pages, 11 figures, 1 table, submitted to PAS

Epidemiology and natural history of central venous access device use and infusion pump function in the NO16966 trial

Background: Central venous access devices in fluoropyrimidine therapy are associated with complications; however, reliable data are lacking regarding their natural history, associated complications and infusion pump performance in patients with metastatic colorectal cancer.<p></p> Methods: We assessed device placement, use during treatment, associated clinical outcomes and infusion pump perfomance in the NO16966 trial.<p></p> Results: Device replacement was more common with FOLFOX-4 (5-fluorouracil (5-FU)+oxaliplatin) than XELOX (capecitabine+oxaliplatin) (14.1% vs 5.1%). Baseline device-associated events and post-baseline removal-/placement-related events occurred more frequently with FOLFOX-4 than XELOX (11.5% vs 2.4% and 8.5% vs 2.1%). Pump malfunctions, primarily infusion accelerations in 16% of patients, occurred within 1.6–4.3% of cycles. Fluoropyrimidine-associated grade 3/4 toxicity was increased in FOLFOX-4-treated patients experiencing a malfunction compared with those who did not (97 out of 155 vs 452 out of 825 patients), predominantly with increased grade 3/4 neutropenia (53.5% vs 39.8%). Febrile neutropenia rates were comparable between patient cohorts±malfunction. Efficacy outcomes were similar in patient cohorts±malfunction.<p></p> Conclusions: Central venous access device removal or replacement was common and more frequent in patients receiving FOLFOX-4. Pump malfunctions were also common and were associated with increased rates of grade 3/4 haematological adverse events. Oral fluoropyrimidine-based regimens may be preferable to infusional 5-FU based on these findings

East Midlands Research into Ageing Network (EMRAN) Discussion Paper Series

Academic geriatric medicine in Leicester . There has never been a better time to consider joining us. We have recently appointed a Professor in Geriatric Medicine, alongside Tom Robinson in stroke and Victoria Haunton, who has just joined as a Senior Lecturer in Geriatric Medicine. We have fantastic opportunities to support students in their academic pursuits through a well-established intercalated BSc programme, and routes on through such as ACF posts, and a successful track-record in delivering higher degrees leading to ACL post. We collaborate strongly with Health Sciences, including academic primary care. See below for more detail on our existing academic set-up. Leicester Academy for the Study of Ageing We are also collaborating on a grander scale, through a joint academic venture focusing on ageing, the ‘Leicester Academy for the Study of Ageing’ (LASA), which involves the local health service providers (acute and community), De Montfort University; University of Leicester; Leicester City Council; Leicestershire County Council and Leicester Age UK. Professors Jayne Brown and Simon Conroy jointly Chair LASA and have recently been joined by two further Chairs, Professors Kay de Vries and Bertha Ochieng. Karen Harrison Dening has also recently been appointed an Honorary Chair. LASA aims to improve outcomes for older people and those that care for them that takes a person-centred, whole system perspective. Our research will take a global perspective, but will seek to maximise benefits for the people of Leicester, Leicestershire and Rutland, including building capacity. We are undertaking applied, translational, interdisciplinary research, focused on older people, which will deliver research outcomes that address domains from: physical/medical; functional ability, cognitive/psychological; social or environmental factors. LASA also seeks to support commissioners and providers alike for advice on how to improve care for older people, whether by research, education or service delivery. Examples of recent research projects include: ‘Local History Café’ project specifically undertaking an evaluation on loneliness and social isolation; ‘Better Visits’ project focused on improving visiting for family members of people with dementia resident in care homes; and a study on health issues for older LGBT people in Leicester. Clinical Geriatric Medicine in Leicester We have developed a service which recognises the complexity of managing frail older people at the interface (acute care, emergency care and links with community services). There are presently 17 consultant geriatricians supported by existing multidisciplinary teams, including the largest complement of Advance Nurse Practitioners in the country. Together we deliver Comprehensive Geriatric Assessment to frail older people with urgent care needs in acute and community settings. The acute and emergency frailty units – Leicester Royal Infirmary This development aims at delivering Comprehensive Geriatric Assessment to frail older people in the acute setting. Patients are screened for frailty in the Emergency Department and then undergo a multidisciplinary assessment including a consultant geriatrician, before being triaged to the most appropriate setting. This might include admission to in-patient care in the acute or community setting, intermediate care (residential or home based), or occasionally other specialist care (e.g. cardiorespiratory). Our new emergency department is the county’s first frail friendly build and includes fantastic facilities aimed at promoting early recovering and reducing the risk of hospital associated harms. There is also a daily liaison service jointly run with the psychogeriatricians (FOPAL); we have been examining geriatric outreach to oncology and surgery as part of an NIHR funded study. We are home to the Acute Frailty Network, and those interested in service developments at the national scale would be welcome to get involved. Orthogeriatrics There are now dedicated hip fracture wards and joint care with anaesthetists, orthopaedic surgeons and geriatricians. There are also consultants in metabolic bone disease that run clinics. Community work Community work will consist of reviewing patients in clinic who have been triaged to return to the community setting following an acute assessment described above. Additionally, primary care colleagues refer to outpatients for sub-acute reviews. You will work closely with local GPs with support from consultants to deliver post-acute, subacute, intermediate and rehabilitation care services. Stroke Medicine 24/7 thrombolysis and TIA services. The latter is considered one of the best in the UK and along with the high standard of vascular surgery locally means one of the best performances regarding carotid intervention

Kepler eclipsing binary stars. VII. the catalogue of eclipsing binaries found in the entire Kepler data set

The primary Kepler Mission provided nearly continuous monitoring of ~200,000 objects with unprecedented photometric precision. We present the final catalog of eclipsing binary systems within the 105 deg2 Kepler field of view. This release incorporates the full extent of the data from the primary mission (Q0-Q17 Data Release). As a result, new systems have been added, additional false positives have been removed, ephemerides and principal parameters have been recomputed, classifications have been revised to rely on analytical models, and eclipse timing variations have been computed for each system. We identify several classes of systems including those that exhibit tertiary eclipse events, systems that show clear evidence of additional bodies, heartbeat systems, systems with changing eclipse depths, and systems exhibiting only one eclipse event over the duration of the mission. We have updated the period and galactic latitude distribution diagrams and included a catalog completeness evaluation. The total number of identified eclipsing and ellipsoidal binary systems in the Kepler field of view has increased to 2878, 1.3% of all observed Kepler targets

Stellar populations of bulges at low redshift

This chapter summarizes our current understanding of the stellar population properties of bulges and outlines important future research directions.Comment: Review article to appear in "Galactic Bulges", Editors: Laurikainen E., Peletier R., Gadotti D., Springer Publishing. 34 pages, 12 figure

Measuring the mass of the central black hole in the bulgeless galaxy ngc 4395 from gas dynamical modeling

NGC 4395 is a bulgeless spiral galaxy, harboring one of the nearest known type 1 Seyfert nuclei. Although there is no consensus on the mass of its central engine, several estimates suggest it is one of the lightest massive black holes (MBHs) known. We present the first direct dynamical measurement of the mass of this MBH from a combination of two-dimensional gas kinematic data, obtained with the adaptive optics assisted near-infrared integral field spectrograph Gemini/NIFS and high-resolution multiband photometric data from Hubble Space Telescope's Wide Field Camera 3. We use the photometric data to model the shape and stellar mass-to-light ratio of the nuclear star cluster (NSC). From the Gemini/NIFS observations, we derive the kinematics of warm molecular hydrogen gas as traced by emission through the H2 1–0 S(1) transition. These kinematics show a clear rotational signal, with a position angle orthogonal to NGC 4395's radio jet. Our best-fitting tilted ring models of the kinematics of the molecular hydrogen gas contain a black hole with mass M={4}-3+8× {10}5 M⊙ (3σ uncertainties) embedded in an NSC of mass M=2× {10}6 M⊙. Our black hole mass measurement is in excellent agreement with the reverberation mapping mass estimate of Peterson et al. but shows some tension with other mass measurement methods based on accretion signals