bluuebunny/crossref_metadata_2025 huggingface dataset:
Phase engineering of transition metal compounds for boosting lithium/sodium storage
Authors: Li Xiaofeng , Huang Jinzhen , Wang Ran , Zhao Li , Zhang Yumin , Gao Tangling , Yao Tai , Song Bo
Published: October 2021

The rapid development of lithium ion batteries (LIBs) and sodium ion batteries (SIBs) requires novel anode materials with high performance. Phase engineering has been regarded as a promising strategy used for enhancing the electrochemical performance of LIBs and SIBs due to its superiority of selectively synthesizing the phases with favorable electrochemical performance and reasonably designing the electrode materials with multiphase regulation. Recently, much progress has been made in phase engineering, including the strategies of phase transition and applications of phase engineering in lithium/sodium storage. This Research Update summarizes the structure and electrical characteristics of transition metal compounds with multiple phases, various strategies for their phase transition engineering, and advanced applications in lithium/sodium storage. Moreover, we also offer general perspectives on current obstacles and future chances in this emerging field, including exploration on the sodium/lithium storage mechanism toward different phases, understanding on structure–mechanism–performance relationships in conjunction with theoretical and experimental research, development of new materials with phase transition and new phase transition strategies, and design of a phase interface (phase junction) with novel phase engineering.
Structural elucidation of vascular plant photosystem I and its functional implications
Authors: Li Xiuxiu , Yang Gongxian , Yuan Xinyi , Wu Fenghua , Wang Wenda , Shen Jian-Ren , Kuang Tingyun , Qin Xiaochun
Published: October 2021

In vascular plants, bryophytes and algae, the photosynthetic light reaction takes place in the thylakoid membrane where two transmembrane supercomplexes PSII and PSI work together with cytochrome b6f and ATP synthase to harvest the light energy and produce ATP and NADPH. Vascular plant PSI is a 600-kDa protein–pigment supercomplex, the core complex of which is partly surrounded by peripheral light-harvesting complex I (LHCI) that captures sunlight and transfers the excitation energy to the core to be used for charge separation. PSI is unique mainly in absorption of longer-wavelengths than PSII, fast excitation energy transfer including uphill energy transfer, and an extremely high quantum efﬁciency. From the early 1980s, a lot of effort has been dedicated to structural and functional studies of PSI–LHCI, leading to the current understanding of how more than 200 cofactors are kept at the correct distance and geometry to facilitate fast energy transfer in this supercomplex at an atomic level. In this review, we review the history of studies on vascular plant PSI–LHCI, summarise the present research progress on its structure, and present some new and further questions to be answered in future studies.
The use of R in photosynthesis research
Authors: Liu Yasi , Wang Xiangping , Fan Dayong , Lai Jiangshan
Published: October 2021

R is one of the most commonly used analytical tools in the plant sciences. To identify key trends in general reported R use and patterns in photosynthesis research, we explored the frequency of R use in 2966 articles published in the 377 journals with ‘photosynthesis’ in the title from 2010 to 2019 using the Web of Science search. Solutions provided by each R package cited in the articles or online sources was recorded and classified. The percentage of research articles reporting R use increased linearly from 3.6% in 2010 to 12.5% in 2019. The three main categories of R package solutions were ‘general statistical calculations and graph packages’ (G); ‘photosynthesis special-purpose packages’ (S); and ‘genetic and evolutionary packages’ (E). The top five R packages cited were nlme (G), lme4 (G), multcomp (G), plantecophys (S), and ape (E). The increasing popularity of R use in photosynthesis research is due to its user-friendly and abundant open-source codes online for handling specific issues, particularly in fitting photosynthesis models. These findings are limited by the number of articles and online sources, but they reveal a significant increase in usage in photosynthesis research over the past decade and have a bright prospect in the future.
Investigating the impact of light quality on macromolecular of
Authors: Iwasaki Kenji , Szabó Milán , Tamburic Bojan , Evenhuis Christian , Zavafer Alonso , Kuzhiumparambil Unnikrishnan , Ralph Peter
Published: October 2021

Diatoms (Bacillariophyceae) are important to primary productivity of aquatic ecosystems. This algal group is also a valuable source of high value compounds that are utilised as aquaculture feed. The productivity of diatoms is strongly driven by light and CO2 availability, and macro- and micronutrient concentrations. The light dependency of biomass productivity and metabolite composition is well researched in diatoms, but information on the impact of light quality, particularly the productivity return on energy invested when using different monochromatic light sources, remains scarce. In this work, the productivity return on energy invested of improving growth rate, photosynthetic activity, and metabolite productivity of the diatom Chaetoceros muelleri under defined wavelengths (blue, red, and green) as well as while light is analysed. By adjusting the different light qualities to equal photosynthetically utilisable radiation, it was found that the growth rate and photosynthetic oxygen evolution was unchanged under white, blue, and green light, but it was lower under red light. Blue light improved the productivity return on energy invested for biomass, total protein, total lipid, total carbohydrate, and in fatty acids production, which would suggest that blue light should be used for aquaculture feed production.
Structural and hydraulic responses of humid tropical soils to lime and organic residue amendments
Authors: Francis Ronen , Bramble De Shorn E. , Wuddivira Mark N. , Gouveia Gregory A.
Published: October 2021

In humid tropical environments, where soils are characteristically acidic and low in organic matter, lime and organic residues have been used to improve soil quality. A systematic consideration of their interaction is, therefore, crucial for land-based ecosystem management. A 28-day incubation pot study was carried out to investigate the main and interactive effects of lime and organic residue type (corn stover and vermicompost) on aggregate stability under rapid wetting (WSAr), saturated hydraulic conductivity (Ksat), and soil water repellency (SWR) on three acidic soils with contrasting clay content from Trinidad: Cunupia (Aquic Hapludalfs), Sangre Grande (Fluvaquentic Endoaquepts), and Talparo (Aquertic Eutrudepts). Organic residue had a significant (P ≤ 0.001) increasing effect on WSAr and Ksat for all three soils, this being highest for corn stover and lowest for no residue. Lime and organic residue interactive effects were only significant (P ≤ 0.05) for WSAr in the Cunupia soil, where lime significantly reduced WSAr in the vermicompost and no residue, but not in the corn stover treatment. Soil water repellency increased with clay content and was highest in the lime–corn stover treatment of the Talparo soil. Overall, our results suggest that applying crop residue with lime may help minimise the short-term deleterious effects of lime on the structural and hydraulic properties of humid tropical soils. Nonetheless, future experiments with a wider range of soils and organic residues need to be carried out for a longer term to validate our results.
Metaphor in education
Authors: Ahlgren Katrin , Golden Anne , Magnusson Ulrika
Published: October 2021

This special issue explores the use of metaphor in education from a multilingual perspective in two Scandinavian
countries, Norway and Sweden. In this introduction, we include a brief overview of earlier research in the domain and identify
common factors noteworthy to discuss in relation to the multilingual context, for instance, the notion of creativity and speaker
legitimacy in a second language context. The issue includes six articles comprising multilingual school children, youth,
university students, adult migrants, and indigenous minorities. Several of the articles focus on second language acquisition, use
and assessment, while others deal more with social issues, including unequal power relations and prejudices that newcomers
encounter in everyday life.
Mashi – this language was in my ears
Authors: Golden Anne , Steien Guri
Published: October 2021

In order to understand the process of learning new languages as adults, we need to take into account learners’ past experiences with all of their language(s), as such experiences shape attitudes and conceptualizations. In this paper, we present an analysis of metaphorical expressions in the narrated linguistic biographies of (former) refugees from the Democratic Republic of Congo (DRC) in Norway. The participants speak a multitude of languages, e.g., different local Congolese languages, Congolese national languages (Lingala or Swahili), French (the official language of the DRC), in addition to Norwegian (the language of the host society). Attention is paid to how the participants’ expressions align with conceptual metaphors emerged from work in Cognitive Linguistics, such aslanguage is an object,language is a personandlanguage is an identity marker, as well as specificationslike language is a toolandlanguage is a possession. We argue that awareness of conceptualizations of ‘language’ can contribute to the development of language training pedagogies that better reflect learners’ past experiences.
Same-sign tetralepton signature in type-II seesaw at lepton colliders *
Authors: Bai Xu-Hong , Han Zhi-Long , Jin Yi , Li Hong-Lei , Meng Zhao-Xia
Published: October 2021

The same-sign tetralepton signature via the mixing of neutral Higgs bosons and their cascade decays to charged Higgs bosons is a unique signal in the type-II seesaw model with the mass spectrum

. In this study, we investigate this signature at future lepton colliders, such as the ILC, CLIC, and MuC. Direct searches for doubly charged scalar

at the LHC have excluded

GeV in the

decay mode. Therefore, we choose

GeV as our benchmark scenarios. Constrained by direct search,

is the only viable decay mode for

GeV at the

TeV ILC. With an integrated luminosity

, the promising region, with approximately 150 signal events, corresponds to a narrow band in the range of

GeV. Meanwhile, for

GeV at the

TeV CLIC, approximately 10 signal events can be produced with

. For heavier triplet scalars

GeV, although the

decay mode is allowed, the cascade decays are suppressed. A maximum event number

can be obtained at approximately

GeV and

for

GeV with

at the

TeV CLIC. Finally, we find that this signature is not promising for

GeV at the

TeV MuC. Based on the benchmark scenarios, we also study the observability of this signature. In the

mode, one can probe

GeV at future lepton colliders.
Fusion of spherical-octupole pairs of colliding nuclei for compact and elongated configurations *
Authors: Jain Shivani , Sharma Manoj K. , Kumar Raj
Published: October 2021

The deformation and associated optimum/uniquely fixed orientations play an important role in the synthesis of compound nuclei via cold and hot fusion reactions, respectively, at the lowest and highest barrier energies. The choice of optimum orientation (

) for the ‘cold or elongated’ and ‘hot or compact’ fusion configurations of quadrupole (

) deformed nuclei depends only on the +/- signs of

-deformation [J. Phys. G: Nucl. Part. Phys. 31, 631-644 (2005)]. In our recent study [Phys. Rev. C 101, 051601(R) 2020], we proposed a new set of

(different from the values reported for quadrupole deformed nuclei) after the inclusion of octupole deformation (up to

) effects. Using the respective

of

-deformed nuclei for cold and hot optimum orientations, we analyzed the impact of the soft- and rigid-pear shapes of octupole deformed nuclei on the fusion barrier characteristics (barrier height

and barrier position

). This analysis is applied to approximately 200 spherical-plus-

deformed nuclear partners, that is, 16O, 48Ca+octupole deformed nuclei. Compared with the compact configuration, the elongated fusion configuration has a relatively larger impact on the fusion barrier and cross-sections owing to the inclusion of deformations up to

. Its agreement with available experimental data for the 16O+150Sm reaction (

=0.205,

=-0.055) also improves when the optimum orientation degree of freedom is fixed in view of octupole deformations. This reinforces the fact that nuclear structure effects play an important role in the nuclear fusion process. Thus, octupole deformed nuclei can be used for the synthesis of heavy and superheavy nuclei.
Do we need to use regularization for the thermal part in the NJL model? *
Authors: Xue Kai , Yu Xiaozhu , Wang Xinyang
Published: October 2021

The Nambu–Jona-Lasinio (NJL) model is one of the most useful tools for studying non-perturbative strong interactions in matter. Because it is a nonrenormalizable model, the choice of regularization is a subtle issue. In this paper, we discuss one of the general issues regarding regularization in the NJL model, which is whether we need to use regularization for the thermal part by evaluating the quark chiral condensate and thermal properties in the two-flavor NJL model. The calculations in this work include three regularization schemes that contain both gauge covariant and invariant schemes. We found that, regardless of the regularization scheme we choose, it is necessary to use regularization for the thermal part when calculating physical quantities related to the chiral condensate and to not use regularization for the thermal part when calculating physical quantities related to the grand potential.
Catechol functionalized ink system and thrombin-free fibrin gel for fabricating cellular constructs with mechanical support and inner micro channels
Authors: Zhou Ying , Fan Yuchao , Chen Zhi , Yue Zhilian , Wallace Gordon
Published: October 2021

The development of 3D bio printing technology has contributed to protocols for the repair and regeneration of tissues in recent years. However, it is still a great challenge to fabricate structures that mimic the complexity of native tissue, including both the biomechanics and microscale internal structure. In this study, a catechol functionalized ink system was developed to produce tough and elastic scaffolds with built-in micro channels that simulate the vascular structure. And a skin model was designed to evaluate the cytocompatibility of the scaffolds. The mechanical support stemmed from the double network based on catechol-hyaluronic acid (HACA) and alginate, the micro channels were generated using sacrificial gelatin. HACA/alginate and gelatin were firstly printed using a 3D extrusion printer. Thrombin-free fibrinogen were then mixed with human dermal fibroblasts and introduced to the printed scaffolds to induce gelation. An immortal human keratinocyte cell line was introduced on top of the cellular construct to mimic the full thickness skin structure. The printed scaffolds demonstrated high elasticity and supported the formation of a double-layered cell-laden skin like structure. The results suggest the 3D printing platform developed here provides a platform for skin regeneration and could be explored further to engineer functional skin tissue by incorporation of other types of cells.
A note on the asymptotic behavior of radial solutions to quasilinear elliptic equations with a Hardy potential
Authors: Itakura Kenta , Tanaka Satoshi
Published: October 2021

The quasilinear elliptic equation with a Hardy potential
<mml:math xmlns:mml="http://www.w3.org/1998/Math/MathML" alttext="normal d normal i normal v left-parenthesis StartAbsoluteValue x EndAbsoluteValue Superscript alpha Baseline StartAbsoluteValue nabla u EndAbsoluteValue Superscript p minus 2 Baseline nabla u right-parenthesis plus StartFraction mu Over StartAbsoluteValue x EndAbsoluteValue Superscript p minus alpha Baseline EndFraction StartAbsoluteValue u EndAbsoluteValue Superscript p minus 2 Baseline u equals 0 in bold upper R Superscript upper N Baseline minus StartSet 0 EndSet">

d
i
v

(

|

x

|

α

|

∇
u

|

p
−
2

∇
u
)
+

μ

|

x

|

p
−
α

|

u

|

p
−
2

u
=
0

in
 

R

N

−
{
0
}

\begin{equation*} {\mathrm {div}}(|x|^\alpha |\nabla u|^{p-2}\nabla u) + \frac {\mu }{|x|^{p-\alpha }}|u|^{p-2}u = 0 \quad \text {in} \ {\mathbf {R}}^N-\{0\} \end{equation*}

is considered, where

N
∈

N

N\in {\mathbf {N}}

,

p
>
1

p>1

and

α
∈

R

\alpha \in {\mathbf {R}}

,

μ
∈

R

−
{
0
}

\mu \in {\mathbf {R}}-\{0\}

. In this note, the asymptotic behaviors of radial solutions are obtained divided into three case

μ
>

|

(
N
−
p
+
α
)

/

p

|

p

\mu >|(N-p+\alpha )/p|^p

,

μ
=

|

(
N
−
p
+
α
)

/

p

|

p

\mu =|(N-p+\alpha )/p|^p

and

μ
>

|

(
N
−
p
+
α
)

/

p

|

p

\mu >|(N-p+\alpha )/p|^p

. This equation also appears as the Euler-Lagrange equation related to the weighted Hardy inequality
<mml:math xmlns:mml="http://www.w3.org/1998/Math/MathML" alttext="integral Underscript normal upper Omega Endscripts StartAbsoluteValue nabla u left-parenthesis x right-parenthesis EndAbsoluteValue Superscript p Baseline StartAbsoluteValue x EndAbsoluteValue Superscript alpha Baseline d x greater-than-or-equal-to StartAbsoluteValue StartFraction upper N minus p plus alpha Over p EndFraction EndAbsoluteValue Superscript p Baseline integral Underscript normal upper Omega Endscripts StartAbsoluteValue u left-parenthesis x right-parenthesis EndAbsoluteValue Superscript p Baseline StartAbsoluteValue x EndAbsoluteValue Superscript alpha minus p Baseline d x">

∫
Ω

|

∇
u
(
x
)

|

p

|

x

|

α

d
x
≥

|

N
−
p
+
α

p

|

p

∫
Ω

|

u
(
x
)

|

p

|

x

|

α
−
p

d
x

\begin{equation*} \int _\Omega |\nabla u(x)|^p |x|^\alpha dx \ge \Biggl | \frac {N-p+\alpha }{p} \Biggr |^p \int _\Omega |u(x)|^p |x|^{\alpha -p} dx \end{equation*}

for

u
∈

C
c
∞

(

R

N

)

u \in C_c^\infty ({\mathbf {R}}^N)

and

N
−
p
+
α
≠
0

N-p+\alpha \ne 0

, where

Ω
\Omega

is a domain of

R

N

{\mathbf {R}}^N

.

The rectifiability of oscillatory solutions to the ordinary differential equation with one-dimensional

p
p

-Laplacian is also studied, and an answer to an open problem is given.
723 Neuroendoscopy versus Craniotomy in Basal Ganglia Haemorrhage: A Systematic Review and Meta-Analysis
Authors: Tan T K , Merola J , Zaben M , Gray W , Leach P
Published: October 2021

Aim

Basal ganglia haemorrhage (BGH) is the most common type of intracerebral bleed with high morbidity and mortality rate. The efficacy between craniotomy and endoscopic approach in BGH is still debatable and advancement in minimally invasive technique has made endoscopic approach the preferred option. The aim of this systematic review and meta-analysis was to evaluate the outcomes of craniotomy and endoscopic approach in BGH.

Method

Databases of PubMed, EMBASE, MEDLINE and CENTRAL were systematically searched from its inception until December 2020. All randomized clinical trials and observational studies comparing craniotomy versus endoscopic approach in BGH were included.

Results

Twelve studies enrolling 1297 patients (craniotomy:675, endoscopy:632) were included for qualitative and quantitative analysis. Endoscopic approach was associated with significantly lower postoperative mortality (OR:0.35, P < 0.00001), higher haematoma evacuation rate (MD:4.95, P = 0.0002), shorter operative time (MD:-117.03, P < 0.00001), lesser intraoperative blood loss (MD:-328.47, P < 0.00001), higher postoperative Glasgow Coma Scale (GCS) (MD:1.14, P = 0.01), higher postoperative Glasgow Outcome Scale (GOS) (MD:0.44, P = 0.05), shorter length of hospital stay (MD:-2.90, P < 0.00001), lower complication rate (OR:0.30, P = 0.0004), lower infection rate (OR:0.29, P < 0.00001) and lower modified Rankin Scale (mRS) (MD:-0.57, P = 0.004) compared to craniotomy. No significant difference was detected in reoperation, intracranial infection, re-bleeding.

Conclusions

The best available evidence suggest that endoscopic approach has better outcomes in mortality rate, operative time, haematoma evacuation rate, intraoperative blood loss, length of hospital stay, mRS, postoperative GCS and GOS compared with craniotomy in the management of BGH. However, there is a need for high quality randomised controlled trials with large sample size for definite conclusions.
244 Traumatic Brain Injury Related Paediatric Mortality and Morbidity in Low- And Middle-Income Countries: A Systematic Review and Meta-Analysis
Authors: Bandyopadhyay S , Kawka M , Marks K , Richards G , Taylor E , Sravanam S , Petrinic T , Thango N , Figaji A , Peter N , Lakhoo K
Published: October 2021

Aim

Three million cases of paediatric traumatic brain injury (pTBI) occur annually, the majority of which occur in low-and-middle-income countries (LMICs). However, there is a paucity of data on the outcomes of pTBI available. We aimed to systematically review and synthesise the reported morbidity and mortality from pTBI in the published literature about LMICs.

Method

A systematic review and meta-analysis were conducted. MEDLINE, EMBASE, Global Health, and Global Index Medicus were searched for relevant articles from January 2000 to May 2020. Observational or experimental studies on pTBI (individuals between the ages of 0 to 16 years) in LMICs were included. Morbidity data were descriptively analysed, and a random-effects model was used to pool mortality rates. PROSPERO ID: CRD42020171276.

Results

We included 145 studies from 38 countries representing 174073 patients with pTBI. Males were twice (95% CI: 1.6 – 2.4) as likely to have a pTBI than females. Where available, mild TBI represented ≥ 60% of all pTBI cases in most reports (n = 24/43, 56%). The commonest cited cause of pTBI was road traffic accidents (n = 16643/43083, 39%), followed by falls (n = 10927/43083, 25%). 4385 patients (n = 4385/18092, 24%) had a reduction from normal function on discharge. On average, there were 6.7 deaths per 100 cases of pTBI.

Conclusions

Only 38 LMICs have published data on the volume and burden of pTBI in their country. Limited data available suggests that young male children are at a high-risk of pTBIs in LMICs, particularly from road traffic accidents.
420 Impact of Surgical Training on Long-Term Patient Outcomes in Sleeve Gastrectomy
Authors: Ghosh A , Lo C , Reddy M , Khan O
Published: October 2021

Aim

Although few studies have examined the impact of surgical training on early postoperative outcomes in bariatric surgery, there is limited data on longer-term outcomes in trainee-performed cases. Our aim was to evaluate the effect of surgical training on weight loss outcomes following laparoscopic sleeve gastrectomy (LSG).

Method

Data was prospectively collated on patients undergoing primary LSG at a Quaternary Bariatric London teaching Hospital between 2016-2017. Inclusion criteria was BMI≥35. Exclusion criteria were BMI<35 or > 60, planned HDU admission and LSG with concomitant hiatus hernia repair. Operative time, length of stay, complications and longer-term excess weight loss was recorded with outcomes of consultant and trainee cases compared.

Results

76 LSG patients were included; 44 performed by consultants, 32 by trainees. There was no difference in age, gender, pre-operative weight, BMI and number of obesity-related comorbidities between groups. Operative time (trainee105±10.0 vs consultant91±18.1 mins) and length of stay (trainee2.6±0.4 vs consultant2.8±0.9 days) were similar between groups. There were 3 complications in the trainee group (intra-abdominal collection requiring drainage, wound infection, hypokalaemia); and 2 with consultants (wound infection, intra-operative bleeding with ICU admission). Excess Weight Loss(%) at 2 years was 55.9%±7.5% for trainee cases and 52.4%±6.7% for consultant cases(p=0.49). Excess Weight Loss(%) at 3.5 years was 54.9%±9.9% for trainee cases and 50.7%±9.9% for consultant cases(p=0.54).

Conclusions

Outcomes in trainee performed LSG are comparable to those performed by consultants. Surgical training in a high-volume teaching hospital does not appear to have detrimental effect on patient outcomes following LSG.
1559 Motivations of Medical Students and Doctors Leaving the NHS Explored in a Residency Training Application Webinar Series
Authors: Ooi S Z Y , Ooi R , Godoi A , Foo E F , Woo T , Ganesananthan S , Li C H
Published: October 2021

Aim

Traditionally, the UK has been highly regarded as a place for doctors to pursue undergraduate medical training and postgraduate training. However, recent reports show that more than 40% of UK-graduate doctors leave the country to pursue specialty training elsewhere. This paper aims to identify and evaluate the motivating factors for UK graduates to leave the NHS.

Method

An anonymised questionnaire was disseminated at a webinar series regarding the application process to pursue residency overseas. The data was independently analysed by two reviewers. A one-way ANOVA (with Tukey’s Post Hoc test) was utilised to compare the difference between motivating factors. Results were considered statistically significant for p-values <0.05.

Results

1,118 responses from the UK medical students and doctors were collected; of which, 1,001 (89.5%) were medical students, and 88 (7.9%) were junior doctors. There was a higher preference for leaving after the Foundation Programme compared to the other periods (p < 0.0001). There was no difference between leaving after core surgical/medical training and specialty training (p = 0.549). However, both were significantly higher than leaving the NHS after medical school (p < 0.0001). Quality of life and financial prospects (both P-corrected<0.0001 compared individually and to other groups) were the most agreed reasons to leave the NHS, followed by clinical and academic opportunities and, subsequently, family reasons.

Conclusions

Future work on the quality of life for doctors in the UK, especially for prospective surgical trainees, should be explored. Policymakers should focus on assessing the difference in working hours, on-call hours or wages that may differ among the healthcare systems.
932 Delivering Excellence in Orthopaedic Training - A Five Year Qualitative Study of Characteristics Valued by Trainees Voting for Trainer of The Year
Authors: Ali R , Wharton R , Li L , Waterman J
Published: October 2021

Background

Previous studies have described attributes of successful trainers. Dean et al’s (2017) systematic analysis found 12 commonly cited positive characteristics in medical literature. This paper and Nisar et al’s (2011) study which had a more exhaustive list of desirable qualities in surgical trainers formed the basis of our thematic analysis to identify trainer characteristics/behaviours valued by trainees on an orthopaedic training programme.

Method

We evaluated qualitative data from votes on the North West Thames rotation for Trainer of the Year over a 5-year period (2016-2020). We applied thematic analysis to identify 15 characteristics commonly cited by trainees in their nominations and logged how frequently each characteristic was raised.

Results

The five most popular qualities possessed by nominees are 1) prioritisation of training needs and endeavouring to create more training opportunities for trainees 2) being a source of support 3) willingness to allow trainees to operate 4) setting and facilitating the achievement of educational goals/targets 5) providing appropriate levels of supervision. All 15 valued characteristics and their frequency of mention are listed in the table presented.

Conclusions

To the best of our knowledge this is the only study which focuses exclusively on desirable qualities orthopaedic specialist trainees’ value in their trainers. ‘Advocating for trainees’ is a valued quality, also highlighted in ASIT’s 2018 analysis of the Silver Scalpel Award nominations, which is not otherwise well described in the literature. We hope our work will allow aspiring orthopaedic trainers insight into what trainee’s value most in a surgical mentor.
20 The Junior Doctor Changeover Effect – Does It Exist in General Surgery?
Authors: Baldock T , Brown L , McLean R
Published: October 2021

Introduction

Junior doctor changeover has been perceived as a period of increased risk to patients. However, there is a paucity of contemporary evidence into this ‘Changeover Effect’. The aim of this study was to evaluate the presence of an adverse patient effect during periods of junior doctor changeover.

Method

Data were requested on all patients aged 18 years or older admitted acutely under General Surgery in the North England between 2005-16. This included patient characteristics, diagnoses, co-morbidities, procedure codes, mortality and length of stay. Patients were included in the study if they were admitted during the ‘changeover week’; defined as the first day of the changeover followed by the six subsequent days. For junior trainees (FY1-CT2), this is the first Wednesday of August, December and April each year. For higher surgical trainees (ST3-8) the first Wednesday and October. Another week, four weeks prior, was chosen as a historical comparator.

Results

61714 patients were included in this study. Patient characteristics did not vary between the cohorts. There was no difference in 30-day mortality between changeover and non-changeover groups (2.5% vs. 2.6%, p = 0.280) or length of stay (5.3 vs 5.2, p = 0.613). Changeover week was not a predictor of increased mortality (OR 1.06, p = 0.302) following multivariate adjustment. Further analysis of the first junior and higher specialty trainee periods, August and October respectively, showed no significant difference for measured outcomes.

Conclusions

This retrospective cohort study provides contemporary evidence that the ‘changeover effect’ does not exist in acute general surgical admissions in the UK.
113 Ischaemic Bowel in The North of England: Trends in Management Approach And Patient Outcomes
Authors: Marks B , McLean R , Brown L , O'Loughlin P
Published: October 2021

Aim

Bowel ischaemia is the third most common indication for emergency laparotomy in the UK and is associated with high rates of postoperative morbidity and mortality. This study describes changes in incidence, patient characteristics, management approach and outcomes for patients with bowel ischaemia over a fifteen-year period

Method

Data for patients admitted as an emergency, with a diagnosis of bowel ischaemia, to NHS hospitals in the North of England between 2002 and 2016 were collected. This included patient demographics and co-morbidities, operations performed and outcomes. The primary outcome of interest was in-hospital death within 30 days of admission for non-operatively managed patients and 30-day post-operative mortality for those who underwent an operative intervention.

Results

The incidence of bowel ischaemia has increased as a proportion of emergency general surgery admissions by 68% over fifteen years. More patients are undergoing computerised tomography (CT) imaging has (44.0% vs. 70.3%, p<0.001) and more operations are being performed within 48 hours of admission (p<0.001). The number of patients being managed operatively has fallen from 56.7% to 38.7%. Decreased 30-day mortality rates were observed for both operatively (37.5% to 26.7%, p<0.001) and non-operatively (45.7% to 26.8%, p<0.001) managed patients. Mean length of hospital stay has remained relatively unchanged over time.

Conclusions

Ischaemic bowel is becoming increasingly common. Increased usage of CT imaging has likely resulted in decreased rates of operative management due to its ability to accurately characterise intra-abdominal pathology. Improved mortality rates were observed for both operative and non-operative management strategies.
123 Supporting A Learning System in Paediatric Emergency Pathways; Using Organisational Comparisons, Serious Incidents and Near Miss Events To Improve The Diagnosis And Treatment Of Testicular Torsion
Authors: Winters D , Mehmi A , Menzies-Wilson R , Folkard S , Ryan K , Sevdalis N , Green J
Published: October 2021

Introduction

Scrotal pain is a common presentation to the emergency department requiring prompt investigation and management to identify testicular torsion. Using national data we aim to identify key suboptimal areas in the acute diagnosis and management of testicular torsion with a view to improving outcomes.

Method

A freedom of information request was made to all Trusts in England that manage testicular torsion. Serious Incidents (SI's) were analysed to see if those with Paediatric Emergency Departments fared better than those without. In addition, a qualitative thematic analysis of the NHS England Strategic Executive Information System database from 2007-2019 was undertaken, identifying common themes associated with orchidectomies and ‘near miss’ events in children.

Results

304 serious incidents were returned with 62 Orchidectomies and 242 Near Miss Events. Misdiagnosis of symptomatic testicle was not significant when comparing ED to specialists (OR = 1.46, p = 0.3842). Atypical presentation resulting in orchidectomy was significant when comparing ED to specialists (OR = 6, p = 0.0355). Near miss events are due to a variety of factors. There was no statistical significance in incidents when comparing ED's caring for all ages with Paediatric EDs U = 807.5, z = -1.124, p = 0.261.

Conclusions

There's a need for education in ED about atypical presentation of testicular torsion and examination of scrotum in cases of lower abdominal pain. It's also vital that specialist teams are cognisant of the standard operating procedures relevant to scrotal pain. Finally, there should be a drive for annual audit in Urology and ED units with regards to testicular torsion as SI's may be under-reported.
322 Clinical Factors Predictive of Both Successful and Unsuccessful Arterial Embolization in The Management of Lower Gastrointestinal Bleeding
Authors: Thavanesan N , Van der Werf B , Shafi A , Kennedy C , O'Grady G , Loveday B , Pandanaboyana S
Published: October 2021

Aim

To develop a model of clinical factors that may predict: (1) technically and clinically successful embolization of a bleeding vessel at Digital Subtraction Angiography (DSA) for lower gastrointestinal bleed (LGIB); (2) a negative DSA in the presence of positive CT-mesenteric angiography (CTMA) for LGIB.

Method

A retrospective cohort study of all DSAs conducted with intent for embolization for acute LGIB over a 10-year period was undertaken. Pre-procedural and intra-procedural clinical variables were evaluated using uni- and multi-variate analysis.

Results

123 DSAs were evaluated. Technical success was 81% (64/78) with clinical success 78%. Technical success was associated with super-selective approach, contrast extravasation on CT, haemoglobin drop, anatomical source and time from CT to DSA on univariate analysis. On multivariate analysis time from CT to DSA was significant with a higher success probability within 120 minutes with different factors being salient depending on degree of delay. Clinical success was only associated with APTT (<27.5s). Technical failure from a negative DSA following a positive CTMA was associated with anatomical source, haemodynamic stability, platelet count and time from CT to DSA on univariate analysis. The latter three remained so on multivariate analysis.

Conclusions

A triaging approach to utilising emergency DSA may be helpful. If prolonged delay between a positive CT and DSA is anticipated, with haemodynamic stability and a near normal platelet count, the DSA may not be fruitful. Technical success may be more likely if DSA occurs within 120mins. Clinical success may be more likely if APTT is within normal range.
669 Mortality Risk Prediction for Emergency Laparotomy: Are We Utilising the Best Tool?
Authors: Barghash M , Iskandar A , Fawzy S , Elghobashy T , Salimi F , Huck C , Mansour M
Published: October 2021

Aim

Emergency laparotomy is one of the common operations performed in the UK. To aid in more objective decision making, several scoring systems have been formulated. In this project, we aimed to explore the predictive power of both NELA and P-Possum mortality scores against 30 days and 90 days observed mortality for emergency laparotomy patients.

Method

Patient details from two large district general hospitals were extracted from the NELA database over a period of three years. Pre-operative NELA, post-operative NELA, and P-POSSUM predicted mortality were calculated and compared with the observed 30 days and 90 days mortality for the entire cohort. Model discrimination (statistical accuracy) was tested by calculating the area under the receiver operating characteristic curve (AUC), which was used to assess how accurately the model could discriminate.

Results

There were 378 patients eligible for inclusion with a median age of 64. 39 patients (10.3%) died within 30 days and 52 patients (13.8%) died within 90 days. P-POSSUM score, pre-operative NELA, and post-operative NELA scores predicted the 30 days mortality as (2.7%, 3.7%, and 2.4%) and 90 days mortality as (2.9%, 4.8%, and 4%) respectively. The discriminative power for 30 days and 90 days mortality was highest for the pre-operative NELA score (AUC 0.870, CI: 0.824 – 0.916), (AUC 0.826, CI: 0.769 – 0.884) respectively.

Conclusions

Both NELA and P-Possum scores underpredicted actual 30 days and 90 days mortality. It was however noted that the pre-operative NELA mortality score showed more accurate mortality discriminative power than the other 2 tested tools.
624 Twenty Years' Experience of Coronary Artery Bypass Grafting in Patients with Reduced Left Ventricular Ejection Fraction
Authors: Di Tommaso E , Bruno V D , Annaiah A S , Oo S , Dixon L , Ascione R
Published: October 2021

Aim

Reduced Left Ventricular Ejection Fraction (LVEF) is a risk factor for patients undergoing Coronary Artery Bypass Grafting (CABG). The aim of our study was to compare short term outcomes and long-term (20 years) survival rates of patients with reduced LVEF undergoing CABG.

Method

Between 1996 and 2015, 5016 patients with reduced LVEF underwent CABG: 1024 (20.4%) had poor LVEF (< 30%) and 3992 (79.6%) had moderate LVEF dysfunction (30-49%). After excluding reoperations and combined procedures, the final sample consisted of 3867 patients. Our primary outcomes were early in-hospital mortality and complications and long-term survivals.

Results

In-hospital mortality rate was 4.4%, stroke rate 1.4% and renal failure 2.9%. Survival rates at 1, 5, 10 and 20 years were 91.1%, 76.7%, 55.1% and 22.1% respectively. Additive Euroscore and Logistic Euroscore (AUC 0.78) is less reliable compared to normal LV patients. Complete revascularization was an independent factor affecting long term survival (HR: 0.85). No difference between OPCABG and ONCABG were found.

Conclusions

CABG is still safe and most likely the best treatment option for patients with reduced LVEF. Completeness of revascularization plays an important role in long term outcomes while OPCABG has no significant advantages. Euroscore has a reduced predicting ability in this group of patients.
1625 Genome-Wide Association Analysis and Replication In 810,625 Individuals Identifies Novel Therapeutic Targets for Varicose Veins
Authors: Ahmed W U l R , Wiberg A , Ng M , Wang W , Auton A ,   23andMe Research Team, Lee R , Handa A , Zondervan K T , Furniss D
Published: October 2021

Aim

To elucidate the genetic architecture of varicose veins (VVs) and identify genes and biological pathways central to their pathobiology.

Method

We performed hitherto the largest two-stage genome-wide association study of VVs in 401,656 subjects from UK Biobank, and replication in 408,969 subjects from 23andMe, Inc (total 135,514 VVs cases and 675,111 controls). Genes and biological pathways were prioritised using several bioinformatic approaches, and potential therapeutic targets were identified in the Open Targets Platform. A weighted genetic risk score (wGRS) for VVs was constructed to compare genetic susceptibility in surgical vs non-surgical VVs patients.

Results

109 genome-wide significant (P ≤ 5 × 10-8) loci were identified in UK Biobank, 46 of which successfully replicated in the 23andMe cohort. Twenty-eight loci have not been previously reported. We mapped 237 genes to these loci, many of which are biologically relevant and tractable to therapeutic targeting or repurposing (notably VEGFA, COL27A1, EFEMP1, PPP3R1 and NFATC2). Tissue enrichment analyses implicated vascular tissue, and several genes were enriched in biological pathways relating to extracellular matrix biology, inflammation, angiogenesis, lymphangiogenesis, vascular smooth muscle cell migration, and apoptosis. The wGRS analysis demonstrated that VVs patients requiring surgery have a higher inherent genetic susceptibility than those managed non-surgically (P = 2.46 × 10−13).

Conclusions

This study has advanced our understanding of VVs pathobiology with the identification of several biologically plausible genes and pathways, many of which demonstrate strong therapeutic potential. The wGRS correlated with disease severity, representing a first step in personalised medicine approaches to VVs.
1163 Genome-wide Association Study Reveals 55 Loci Associated with Gallstone Disease
Authors: Fairfield C , Spiliopoulou A , Wigmore S , Harrison E
Published: October 2021

Aim

Gallstones have a prevalence of 20-40% in European populations and cause significant morbidity. Gallstones form from cholesterol and calcium bilirubinate and knowledge of genetic determinants remains incomplete. A genome-wide association study (GWAS) was performed to identify determinants of gallstones.

Method

A GWAS of 16,356,211 single nucleotide polymorphisms (SNPs) for 28,627 cases and 348,373 controls of European ancestry in the UK Biobank was undertaken. A logistic regression with additive allelic dosage was performed (significance: P < 5*10-8). Functional annotation and linkage disequilibrium clumping were performed to reveal distinct loci. Lead SNPs were investigated by linear regression for association with plasma lipids, liver enzymes and blood count markers.

Results

55 lithogenic loci were identified of which 27 are novel. Functional annotation revealed genes involved in metabolism of cholesterol, glucose, bile acids and bilirubin with corresponding changes in serum biomarkers caused by those lithogenic alleles. Several novel variants did not alter cholesterol or other biomarkers. Lithogenic variants within genes controlling intra- and paracellular transport may govern biliary composition (PCDHB4, NUP153, CLDN7) and promote lithogenic bile. Variants within genes which may influence gallbladder motility (ANO1, TMEM147) and cholangiocyte ciliogenesis (TBC1D32, ADAMTS20, DYNC2LI1, HNF1B) may promote gallstone formation through reduced biliary flow.

Conclusions

We identified 27 novel associations with gallstones. Impact of lithogenic alleles on serum biomarkers was highly variable demonstrating that gallstone formation is partially driven by pathways which do not influence cholesterol, glucose or bilirubin metabolism. Variants within genes that may influence biliary composition, bile flow and gallbladder motility represent new targets for research into gallstones.
850 Addressing Fertility Preservation in Patients Under the Age of 35 Diagnosed with Breast Cancer. A Ten-Year Audit in A Regional Unit
Authors: Croitoru C , Irwin G
Published: October 2021

Aim

In Northern Ireland, the incidence of breast cancer is 1,443 cases per year with 26 patients diagnosed under the age of 35; 13% increase in 5 years. The average age of first-time mothers has increased from 24 to 28.8 in 2 decades. According to European Society of Medical Oncology, young patients should be counselled on available fertility preserving options before starting cancer treatment.

Method

We have conducted a retrospective audit reviewing the management of breast cancer patients under the age of 35 in the Belfast Health and Social Care Trust, with a focus on fertility counselling and patient’s options. Data obtained from Cancer Patient Pathway System and Patients records.

Results

From July 2010 to July 2020 there were 92 patients diagnosed with breast cancer in the region. All patients are female, youngest 24 years old. 34 patients have been referred as ‘Red Flag’, 22 upgraded to ‘Red Flag’, rest as routine. 23 patients received neo-adjuvant chemotherapy as first line treatment, 68 underwent surgery in the first instance, one patient opted for private sector. Over 50% of patients had at least one child prior to referral. Less than 5% had considered pregnancy post or during treatment.

Conclusions

At present there are no established guidelines regarding the timing of conception after diagnosis and treatment. Several options do exist for fertility preservation, both standard and investigational. There is evidence of an increasing recognition of this as a priority for patients and need early education and referral to fertility services for this emerging demographic.
1267 Utility of Artificial Intelligence in the Cystoscopic Detection of Bladder Cancer: A Systematic Review and Meta-Analysis
Authors: Ganesananthan S , Ganesananthan S , Simpson B S , Norris J M
Published: October 2021

Aim

Detection of suspected bladder cancer at diagnostic cystoscopy is challenging and is dependent on clinician skill. Artificial Intelligence (AI) algorithms, specifically, machine learning and deep learning, have shown promise in accurate classification of pathological images in various specialties. However, utility of AI for urothelial cancer diagnosis is unknown. Here, we aimed to systematically review the extant literature in this field and quantitively summarise the role of these algorithms in bladder cancer detection.

Method

The EMBASE, PubMed and CENTRAL databases were searched up to December 22nd 2020 , in accordance with the PRISMA guidelines, for studies that evaluated AI algorithms for cystoscopic diagnosis of bladder cancer. Random-effects meta-analysis was performed to summarise eligible studies. Risk of Bias was assessed using the QUADAS-2 tool.

Results

Five from 6715 studies met criteria for inclusion. Pooled sensitivity and specificity values were 0.93 (95% CI 0.89–0.95) and 0.93 (95% CI 0.80–0.89) respectively. Pooled positive likelihood and negative likelihood ratios were 14 (95% CI 4.3–44) and 0.08 (95% CI: 0.05–0.11), respectively. Pooled diagnostic odds ratio was 182 (95% CI 61–546). Summary AUC curve value was 0.95 (95% CI 0.93–0.97). No significant publication bias was noted.

Conclusions

In summary, AI algorithms performed very well in detection of bladder cancer in this pooled analysis, with high sensitivity and specificity values. However, as with other clinical AI usage, further external validation through deployment in real clinical situations is essential to assess true applicability of this novel technology.