bluuebunny/crossref_metadata_2025 huggingface dataset:
Quantising a Hamiltonian curl force
Authors: Berry M V , Shukla Pragya
Published: August 2024

Classical curl forces are position-dependent Newtonian forces (accelerations) that are not the gradient of a scalar potential, and in general cannot be described by Hamiltonians. However, a special class of curl forces can be described by Hamiltonians, with the unusual feature that the kinetic energy is anisotropic in the momentum components. Therefore they can be quantised conventionally. We quantise the simplest such case: motion in the plane, with a curl force azimuthally directed and linear. As expected, the quantum propagator, and the way this drives Gaussian wavepackets, directly reflects the spiralling classical curl force dynamics. Two classes of stationary states—eigenfunctions of a continuous spectrum for the unbounded Hamiltonian—are described. They possess unusual singularities and an unfamiliar quantisation condition; their explanation requires asymptotics and unfamiliar singularities in the underlying families of classical trajectories. The analysis is supported and illustrated numerically.
Distinguishing quality of eco-print steaming technique using different types of natural dyes
Authors: Nurmasitah S , Widowati W , Mardliyyah R
Published: August 2024

The textile dyeing process using synthetic dyes will produce waste in the form of water which needs to be reprocessed so as not to pollute the environment, accordingly it is necessary to explore safer alternative dyes such as dyes from natural materials. The natural materials being used as dyes in the steaming technique eco-print are secang wood (Biancaea sappan L. Tod.), tingi wood (Ceriops tagal), tegeran wood (Cudrania javanensis), merr wood (Arcangelisia flava (L.) Merr.) and mangosteen peel (Garcinia mangostana L.). This study aims to investigate the quality of the steaming technique eco-print using five types of natural dyes observed from the aspects of color inclination and motif sharpness. This is an experimental study using data collection techniques and observation sheets, which are then analyzed descriptively. The results of the study in terms of color inclination indicate that natural dyed eco-print resulting from mangosteen peel has the lowest value (38.9%). In terms of motif sharpness, natural dyed eco-print resulting from tingi wood has the lowest level of sharpness (53.25%).
Analysis of Engine performance and Emission of HPLPM Exhaust with Catalytic Converter Distance Variation
Authors: Septiyanto Angga , Roziqin Ahmad , Suwahyo  , Kriswanto  , Hapsoro Bayu Bagas , Fauzi Ikhwal , Hangga Arimaz , Wiratama Bayu , Suni Alfa Faridh , Fauzi Mahfudh , Maftukhin Arrizki Muhammad
Published: August 2024

This research aims to measure the performance and emission of motorcycle engines using three types of mufflers. Original Equipped manufacturer (OEM), High Performance Low Pollution Muffler (HPLPM), and free flow exhaust were used in this research with various placement distances of the catalytic converter. This research utilized a quantitative method experimental approach. The independent variable used was the placement distance of the copper-based catalytic converter; 65 cm, 75 cm, and 95 cm. The fuel used in the vehicle was gasoline RON 90. Test data was collected at idle, 1000, 3000, and 5000 RPM. Performance testing involved engine rotations ranging from 3500 to 8500 RPM, with increments of 250 RPM and used 1:1 transmission ratio during testing. The results of the testing using the HPLPM exhaust integrated with the catalytic converter showed a reduction in exhaust gas emissions while simultaneously improving engine performance compared to the OEM exhaust. In this study, the catalytic converter installed in HPLPM exhaust positioned at 75 cm resulted in an effective reduction in exhaust gas emissions at each engine rotation, and it also enhanced vehicle performance, achieved the highest torque of 16.14 Nm at an engine rotation of 5500 RPM. As for the highest power, it reached 16.9 HP at an engine rotation of 8500 RPM.
Internet of Things (IoT)-Based Electrical Panel Monitoring System Utilizing Infrared Thermography Analysis
Authors: Suryanto Agus , Ammar Sa’id
Published: August 2024

Monitoring an electrical panel is an activity performed to ensure the electrical panel’s condition is optimal, thus facilitating the proper distribution of electrical supply in a given location. To maintain such conditions, regular maintenance and monitoring processes are necessary for an electrical panel. Monitoring of the electrical panel should ideally be carried out routinely to ensure its proper functioning, enabling effective distribution of electrical energy. The objective of creating an Internet of Things (IoT)-based electrical panel monitoring system in this research is to facilitate technicians in monitoring and assessing the condition of electrical panels. This enables them to perform these tasks at any time and from anywhere, solely through a smartphone, without the need to physically visit each individual electrical panel location. This also serves the purpose of promptly identifying any imbalances and early damages occurring within the electrical panel before they escalate into more severe issues. This research employs the PZEM-004T sensor to measure current, voltage, and power values, while also utilizing the DHT22 sensor to measure temperature values. The acquired data will be processed using the ESP32 microcontroller, which is connected to the internet and integrated with the Blynk application on a smartphone. This enables a process of Internet of Things (IoT)-based monitoring through the smartphone interface. Additionally, the electrical panel will also be analyzed using infrared thermography to obtain the results of heat distribution mapping. The research outcomes indicate the successful creation of the electrical panel monitoring system, which can perform measurement processes. The achieved accuracy levels are also considered satisfactory. Where the accuracy rates are 98.90% for current value, 99.84% for voltage value, 98.44% for power value, and 90.60% for temperature value. The results of heat mapping obtained using infrared thermography also demonstrate favorable outcomes, wherein the temperature mapping of components within the electrical panel remains within the range of normal temperature values.
Manufacture Of Bagasse And Resin Waste Based Ring Holder
Authors: Ihsani Ade Novi Nurul , Widowati  , Krisnawati Maria , Agustin Eny Widhia , Larasaty Shinta
Published: August 2024

Bagasse is one of the wastes that can be used as goods that have a function. The purpose of this study is to utilize bagasse waste with a mixture of resin to be used as useful goods. The method used in the creation of this ring place goes through the stages of exploration (documentation, literature study, and observation), design, and embodiment. The maturity of the concept designed is very influential on the success of the realization of a work to be made. The shape chosen in creating the place of the ring is a hexagon and a cone. The basic material used is bagasse waste with resin. The techniques used in making ring holders consist of making the design and manufacturing stages of the product. Product manufacturing consists of material mixing, molding and finising.
Study Of Natural Lighting Design In Sustainable Education Buildings
Authors: Setiawan Moch Fathoni , Santoso Eko Budi , Purnomo Andi
Published: August 2024

Natural lighting can be said to be good if during the day the light that enters the room is bright enough and the distribution of light in the room is even or does not cause disturbing contrast. The determining factors that affect the intensity of natural lighting in space include the orientation of the building to the sun, the external reflection component caused by the reflection of light against the incoming light barrier. Natural lighting design is one of the factors in building construction planning. Sustainable building is an architectural principle that seeks to minimize the negative impact on the building environment with efficiency and moderation in the use of materials, energy, and the wider ecosystem. One of the building energy efficiency efforts is to optimize the design of natural lighting in buildings while still prioritizing elements of building comfort. This study aims to examine the design of natural lighting in sustainable education buildings. The method used is descriptive analysis with a sustainable building approach. The result is that almost all the spaces measured do not meet SNI standards. This is caused by windows that are not wide enough, the presence of building obstructions, the use of dark glass materials, inappropriate furniture layout and the presence of spaces that are far from the building envelope.
The modified Gerchberg–Saxton algorithm for subwavelength resolution holographic image with speckle suppression
Authors: Zhou Yucheng , Pan Yifeng , Gong Peng , Wu Shijun , Qiu Shiqiang , Zhou Qinghong
Published: August 2024

The Gerchberg–Saxton algorithm is widely recognized as one of the most popular methods for calculating phase-only holograms. However, due to bandwidth limitations, this iterative method is not suitable for designing subwavelength resolution holograms. To address this challenge, we have modified the angular spectrum method (ASM) by incorporating additional information to compensate for lost high-frequency details in inverse propagation. In order to mitigate optical speckle artifacts that arise in the computational process, we have integrated the double amplitude freedom (DAF) into our approach. Furthermore, we have implemented a narrow probability distribution in the initial phase mask as a key strategy to minimize fluctuations in the intensity of the reconstructions. Our proposed method has successfully achieved subwavelength resolution reconstructions with reduced speckle noise.
Dark field photon scattering state measurements from bumps on a gold nanofilm
Authors: Nasir Abbas , Wang Hongze , Liu Xuefeng , Xiong Jichuan
Published: August 2024

A dark and bright field (BF) imaging technique explored plasmonic phenomena arising from bumps on a gold nanofilm coated on a silica substrate. The study employs dark field (DF) polarization indirect microscopic imaging to investigate the scattering photon state and reveal the spatial distribution characteristics with distinct multipolar features, contrasting with those observed in the BF imaging configuration. Computational simulations utilizing the finite-difference time-domain method were conducted to understand this behaviour further and consider the experimental setup’s impact. The observations of varying multipolar scattering features with changes in the incident angle of the DF illumination suggest that the excitation of plasmonic effects differs for light beams incident at different angles.
Compact passive system for speckle-free uniform illumination in RGB laser projectors based on incoherent focusing
Authors: Lapchuk Anatoliy , Prygun Olexander , Gorbov Ivan , Borodin Yuriy , Kryuchyn Andriy , Butok Olexander , Morozov Yevhenii
Published: August 2024

A theoretical analysis of the hardware mechanisms for subjective speckle suppression in RGB laser projectors has revealed that achieving a compact speckle-free passive laser illumination system with uniform illumination requires simultaneous reduction of temporal, spatial, and polarization coherence of the illumination laser beam, along with light intensity homogenization. To address this, we propose a compact passive optical scheme based on incoherent focusing of the laser beam using arrays of prisms with varying heights. The system also incorporates depolarization of a portion of the laser beam and an optical diffractive optical element employing a pseudo-random binary sequence to enhance speckle reduction and improve uniform illumination quality. We demonstrate that such a system can be assembled using readily available laser light sources and optical elements, and its operational principle is experimentally validated.
Real-time full Stokes quantitative imaging with a pixelated polarization camera
Authors: Chen Kaiquan , R V Vinu , Liao Dongyang , Tang Miaomiao , Chen Ziyang , Pu Jixiong
Published: August 2024

We propose and experimentally demonstrate a quantitative full Stokes parameter extraction system to address the intrinsic constraints of conventional polarization imaging systems regarding real-time-imaging and characterization of polarization features. The simultaneous extraction of all four Stokes parameters is employed by designing a compact optical scheme with two equal intensity parallelly propagating polarized beams generated prior to the detection with a polarization camera. Moreover, the approach utilizes the polarization multiplexing feature of the pixelated camera for the design of the real-time full Stokes parameter extraction system. The stability and reliability of the system are verified through rigorous testing on standard half-wave plates and quarter wave plates. Additionally, the quantitative imaging capability of the technique is tested with a standard birefringent resolution target. Finally, the efficacy of the approach in real-time imaging and characterization is demonstrated by extracting the polarization dynamics of an object coded on a liquid crystal panel.
Surface profile inspection for large structures with laser scanning
Authors: Ding Ke , Wu Chunlin , Luo Miao , Su Zhilong , Ding Hu , Ye Yimin , Zhang Dongsheng
Published: August 2024

Fringe projection profilometry is a powerful tool that is widely applied to shape measurement of objects in engineering. Limited by the light intensity of the projection unit, this technique is difficult to be applied to surface inspection of large structures, especially in outdoor applications. In this study, a line laser source is selected as the light projection unit. The line laser beam is controlled to scan the surface with the predefined angular speed while a stationary imaging unit captures images. An image fusion strategy has been proposed to construct grating images with a constant phase shift, which facilitates full-field phase shifting in determination of the structural profile. The accuracy of the measurement method is discussed and compared with a commercial 3D laser scanner. The proposed technique has also been applied to the surface topography of the wind turbine blades. The experimental results show that the bulging defects on the surface of the wind turbine blade model are detectable, which shows the feasibility of the proposed method in characterization of surface profile on large structures.
Effect of low-content crumb rubber modification on the performance of bitumen and asphalt
Authors: Haroon Waqas , Ahmad Naveed
Published: August 2024

The performance of flexible pavements is greatly influenced by rutting, fatigue, and durability, leading to premature failures under environmental conditions. The limitations of traditional bitumen in flexible asphalt pavements are due to the significant rise in traffic loads and volumes. The reason for incorporating tire waste into bitumen is its incredible qualities and economical price as a bitumen modifier. The quality of crumb rubber (CR)-modified bitumen mainly depends on the concentration of low-content CR dispersed into the base bitumen. The primary target of this research is to modify the bitumen with low-content CR to improve the thermal properties, rheology, rutting resistance, fatigue resistance, and moisture-damaged performance. The three concentrations, i.e., 5%, 10%, and 15% of CR, were selected based on extensive preliminary trials when dispersed in conventional 60/70 penetration grade bitumen. The consistency and mixture test results concluded that the optimum dosage of CR-10% provides a 20% improvement in thermal performance, a 15% increase in rheological stability, a 25% enhancement in rutting resistance, a 30% boost in fatigue resistance, and a 10% reduction in moisture damage susceptibility. The inclusion of CR makes rubberized asphalt an attractive and effective solution for highway construction, aligning with sustainable construction practices. The findings demonstrate that low-content CR-modified asphalt improved the durability of asphalt mixtures against moisture-induced damage and other benefits, such as reduced cracking and maintenance requirements. The CR technology led to a significant subsidization in the environmental impact of asphalt paving from 5 to 10% compared to standard paving applications.
Are genomic language models all you need? Exploring genomic language models on protein downstream tasks
Authors: Boshar Sam , Trop Evan , de Almeida Bernardo P , Copoiu Liviu , Pierrot Thomas
Published: August 2024

Motivation

Large language models, trained on enormous corpora of biological sequences, are state-of-the-art for downstream genomic and proteomic tasks. Since the genome contains the information to encode all proteins, genomic language models (gLMs) hold the potential to make downstream predictions not only about DNA sequences, but also about proteins. However, the performance of gLMs on protein tasks remains unknown, due to few tasks pairing proteins with the coding DNA sequences (CDS) that can be processed by gLMs.

Results

In this work, we curated five such datasets and used them to evaluate the performance of gLMs and proteomic language models (pLMs). We show that gLMs are competitive and even outperform their pLMs counterparts on some tasks. The best performance was achieved using the retrieved CDS compared to sampling strategies. We found that training a joint genomic-proteomic model outperforms each individual approach, showing that they capture different but complementary sequence representations, as we demonstrate through model interpretation of their embeddings. Lastly, we explored different genomic tokenization schemes to improve downstream protein performance. We trained a new Nucleotide Transformer (50M) foundation model with 3mer tokenization that outperforms its 6mer counterpart on protein tasks while maintaining performance on genomics tasks. The application of gLMs to proteomics offers the potential to leverage rich CDS data, and in the spirit of the central dogma, the possibility of a unified and synergistic approach to genomics and proteomics.

Availability and implementation

We make our inference code, 3mer pre-trained model weights and datasets available.
221 A Ward-Based Intervention to Improve Understanding of ‘Enhanced Recovery After Surgery’, and Improve Compliance with Early Post-Operative Mobilisation: A Prospective Audit
Authors: Babu S , Lee R E , Allen S , Dowson H
Published: August 2024

Aim

Enhanced recovery after surgery (ERAS) improves short-term post-operative outcomes by maintaining pre-operative function and reducing the stress response associated with surgery. Early post-operative mobilisation is a key component. This study sought to assess achievement of early mobilisation goals, identify barriers to mobilisation, and improve awareness of ERAS.

Method

Eye-catching posters were placed within view of each surgical bedspace and on the door of each bathroom. These emphasised the benefits of early mobilisation and simple steps a patient may take to improve their post-operative outcomes. Between May to July 2023 (Baseline; n=47), and August to September 2023, (Post-intervention; n=46) data were prospectively collected on adult patients who were day one post-elective or emergency general surgery.

Results

Unfamiliarity with the concept of ERAS, as well as inadequate post-operative analgesia were identified as barriers to early post-operative mobilisation. Following the implementation of ward-based educational posters, there was a 36% increase in the number of patients who were aware of the concept of ERAS (10% to 46%). 31% of patients were able to recall at least two benefits of early mobilisation as highlighted by the posters. Requests for analgesia increased by 29%. There was a 24% increase in the number of patients sitting out of bed for meals. Furthermore, completion of the recommended 4 x 60m walks also improved (77% to 87%).

Conclusions

A simple ward-based intervention resulted in heightened awareness of Enhanced Recovery and the importance of early post-operative mobilisation as well as improved compliance to the local post-operative mobility goals.
582 A Re- Audit of the Metabolic Screening for Patients with Urinary Tract Calculi and the Implementation of an Electronic Requesting Bundle
Authors: Saidani Z , Ganapathi S , Malik S , Khan F
Published: August 2024

Introduction

Renal colic is one of the commonest elective and emergency Urological presentations. As highlighted in NICE and EAU guidelines, serum calcium and uric acid levels should be measured in such patients as part of a metabolic screening. This audit aims to reassess the compliance of this at a local DGH.

Method

All patients diagnosed with a urinary tract calculus between 1/5/2023 and 31/7/2023 were included and retrospective data was collected which included the serum calcium and uric acid levels. The results were compared with a previous audit in 2022.

Results

65 patients were eligible for inclusion. 46% of patients had their serum calcium level measures in the current audit compared to 65% in 2022. 37% of patients had their uric acid level measured in the current audit compared to 46% in 2022.

Discussions

Despite previous audits and interventions by means of education and posters, there has been a decline in the metabolic screening of patients with urinary tract stones. Via the trust electronic requesting system, we have implemented a “renal colic” bundle which includes the automatic selection of FBC, UEs, CRP, INR, Serum Calcium and Serum Uric acid levels for such patients. This convenient integrated IT feature will aim to improve the metabolic screening of these patients. Key stakeholders have been educated on the importance of metabolic screening and of the newly implemented bundle. We aim to re-audit in 6 months.
718 An Audit of Chaperone Documentation in the Breast Clinic
Authors: Singh P , Marchitelli G , Geropoulos G , Elder K
Published: August 2024

Aim

The General Medical Council and the governing trust (NHS Lothian) for our local hospital provide clear guidance on the role of chaperones within the breast clinic; specifically for all intimate examinations, a chaperone should be offered regardless of the genders of practitioner and patient, and the patient’s response to this should be documented. This entitlement to a chaperone is important in protecting staff and patients. This two-cycle audit reviews the documentation of chaperones in the breast clinic at a single centre, and whether consent to intimate examination is documented.

Method

Documentation was assessed for all adults attending low-risk or new patient clinic in both cycles (from 04-10/07/23, then 13-16/11/23), reviewing the staff grade assessing the patient, whether consent was recorded, and whether a chaperone had been accepted, refused, or not documented. The second cycle was conducted after putting up posters to remind medics to document and remind nursing staff to check this data.

Results

Junior doctor documentation of offering a chaperone increased by 43.7%, although consultant and ANP documentation decreased, by 20% and 34% respectively. When accepted, the chaperone’s name is recorded in all cases, and their grade in 3% more cases following our intervention.

Conclusions

Following intervention to target the lack of documentation in clinic notes, a significant positive change has been affected in junior doctors’ records. This change has however not been seen among consultants and ANPs, highlighting the ongoing need to improve documentation standards, to keep in line with national and local guidelines, and to protect our staff and patients.
752 VTE Prophylaxis and VTE Assessment Form in Plastic Surgery: A Closed-Loop Audit
Authors: Dhannoon A , Teklay S , Caddick J , Richards H
Published: August 2024

Aim

Failure to conduct a risk assessment and administer suitable venous thromboprophylaxis in surgical patients is deemed as negligence. It was estimated that 25,000 deaths in the UK was due to VTE in 2004-2005. Seventy percentage of hospital acquired VTE is potentially preventable with appropriate VTE prophylaxis. The Trust published a form for risk assessment for VTE for surgical patient. Our aim was to examine the departments adherence to the trust guidelines.

Method

All plastic surgery inpatients with a stay longer than 24 h were reviewed for VTE prophylaxis prescription for a period of two weeks. This was followed by presenting the audit results in a departmental meeting and introducing a checkbox to the handover list with posters placed in the doctors’ office. VTE assessment forms were placed in a clear divider and attached to the poster to remind doctors. Two weeks later, a re-audit was undertaken.

Results

In first audit, 22 patients were eligible for VTE prophylaxis compared to 24 in the re-audit. VTE chemoprophylaxis prescribing improved after intervention from 69.5% to 95%. Mechanical prophylaxis increased by 15.8%. Most importantly, the use of the VTE risk assessment form improved from 0 to 70%. Inappropriate chemoprophylaxis prescription reduced from 18.8% to 8%.

Conclusions

Despite the improvement in results after educating doctors and introducing the checkbox, our goal to be 100% compliant has not yet been met. Given the nature of the rapid turnover of junior doctors, a more robust system incorporating VTE assessment in the electronic system and replacing the paper form is required.
783 Routine Pre-Operative Group and Save Testing: Is It Necessary for Laparoscopic Appendicectomy?
Authors: Obayi E , Itaman U , Ibrahim B , Barghash M , Johnson A , Alkurdi Y , Mansour M
Published: August 2024

Aim

Pre-surgical group and save tests are routine but can result in unnecessary expense and theatre delays. The aim of this study is to examine the necessity of group and save testing prior to appendicectomy and evaluate the cost implications.

Method

This retrospective study analysed the records of 200 patients with appendicitis who underwent emergency appendicectomies in a busy general surgery department between March 2021 to August 2022. The study adhered to local clinical governance unit protocol. Patients who had elective appendicectomies or other emergency procedures were excluded. Data was collected on age, gender, number of samples, and requirement for peri-operative transfusion. Comparisons were drawn between patients who underwent laparoscopic, open, or converted emergency appendicectomies.

Results

Of the sample population, (median age 32, 55.5% male), 93.5% had valid pre-operative group and save tests. None required peri-operative blood transfusions. 26% of the patients only required one sample for a valid group and save due to having previous samples in the lab. 55% required two samples. 7% needed a third sample because one initial sample was rejected and 5.5% required 4 samples because the initial 2 samples were rejected. The total cost of these samples was estimated to be £3500.14.

Conclusions

Emergency appendicectomy poses minimal risk of resulting in the need for blood transfusions. Re-evaluating the need for routine pre-operative group and save testing and adopting a risk-benefit analysis approach could have a financial benefit for the NHS.
808 Whose Problem Is the Lower Gastrointestinal Bleed? a Surgical or Medical Admission. - Exploring the Management and Diagnosis of Patients Admitted with a Lower Gastrointestinal Bleeds in a District General Hospital (DGH)
Authors: Davies B L J , Ransome M , Mahapatra R , Mistry P
Published: August 2024

Aim

Lower Gastrointestinal bleeds (LGIB) are a common presentation, with a 10% 1-year prevalence in the UK. The 2015 National Confidential Enquiry into Patient Outcome and Death (NCEPOD) report highlighted a deficiency into the care of this patient group. With subsequent guidelines from The British Society of Gastroenterology (BSG) calling for a multi-disciplinary approach to care. Nevertheless, the admitting speciality for LGIB is an area of contention and differs across trusts.

Method

A Retrospective Audit was carried out in a local DGH, exploring the management and diagnosis of LGIB. Clinical practice was compared to BSG standards, admissions under the medical teams and surgical teams explored and comparisons made.

Results

Over a four-month period; the data of 160 patients was collected. Patients presenting as outpatients, with upper gastrointestinal bleeds and with other primary complaints were excluded from the study, leaving 33 patients for analysis.

Conclusions

74% of these patients were admitted under the medical team, with 17% of these needing an inpatient colonoscopy, all performed by Gastroenterologists. Of the 26% admitted under the surgical team, all had outpatient investigations booked, but none required inpatient scopes or surgical management. Despite preconceived ideas, most patients within this study were admitted under medical teams with little surgical input. An MDT approach to this cohort of patients is integral to care, however, consistency and clear pathways are needed to ensure ‘gold-standard’ care. The next steps of this project have included reviewing trust guidelines, discussions between medical and surgical teams alike, and further education.
935 Nil by Mouth in GI Surgery: Are We Starving Our Patients Longer Than We Need To?
Authors: Hern D , Van Zyl M , Rao V
Published: August 2024

Aim

Fluid intake preoperatively reduces postoperative nausea, vomiting and headache, and oral intake allows the patient to be metabolically active to respond better to surgery. However, a known risk to oral intake preoperatively is aspiration. Current guidelines state that a patient should be fasted from 6 hours preoperatively and should take clear fluids up to 2 hours preoperatively. We assessed how long GI patients admitted to the Surgical Assessment Unit (SAU) remained nil by mouth (NBM).

Method

Data was collected throughout November from SAU. Inclusion criteria was GI surgical patients and exclusion criteria was patients on home leave. We used electronic and paper notes to determine how long patients were kept NBM and their surgical outcome. We assumed that a patient was kept NBM from their admission (as per local protocol), until either noted to no longer be NBM, having surgery or being discharged.

Results

50 patients were identified. We found that only 20% of patients kept nil by mouth went on to have surgery. Of the remaining 80%, 60% were kept nil by mouth for >6 hours, with no surgical procedures.

Conclusions

Many patients are kept NBM unnecessarily. We need to reduce this as well as the time patients are starved. Furthermore, clearer documentation is needed for commencing patients NBM, and when they can resume eating. We can move away from the culture of prolonged fasting in surgical patients by improving organisation and planning as well as increasing education on preoperative fasting.
943 Audit of Endoscopy Service Safety in District General Hospital Rated ‘Inadequate’ by the CQC
Authors: Crawford A , Carter-Tai Z , Connor E
Published: August 2024

Aim

In June 2021 the overall CQC rating of Weston General Hospital (WGH) was ‘inadequate’. A wave of changes including a merger of trusts between Bristol and Weston-Super-Mare has aimed at improving services across the board. The endoscopy service at WGH offers inpatient and outpatient investigations to thousands of patients every year. We aimed to evaluate the safety of the service offered over a 12-month period, using measures set out by the Joint Advisory Group on GI endoscopy and other published statistics.

Method

A retrospective review of periendoscopic complications in OGD, ERCP, flexible sigmoidoscopy and colonoscopy leading to re-admission within eight days of procedure or death within thirty days of procedure. Each case was analysed, using paper and digital case notes, for clinical course, outcomes and learning points.

Results

There were a total of 3428 cases between June 2021 and May 2022. There was an overall readmission rate within eight days of 0.002% (1 ERCP, 1 OGD, 4 colonoscopy). There was a mortality rate of 0.0003% (1 case of post-ERCP pancreatitis). A review of cases showed all complications were recognised complications of the given procedure and treated appropriately in a timely manner.

Conclusions

It was concluded that the endoscopy service at WGH was safe and viable. Numbers of readmissions and deaths related to endoscopy were similar to previous audits and well below the published rates of complications in literature.
1168 Documentation During Upper Gastrointestinal Surgery Admission Audit
Authors: Chaudhry A , Chaudhry D , Ghassemi N
Published: August 2024

Aim

Admissions in surgery is one of the most important part of the patient care pathway and sets the trajectory for the rest of their stay. Without good documentation, the decisions made can be missed out and this will eventually lead to deficiency in the patient’s management. In this audit we aim to analyse documentation during admissions and look at ways to improve them.

Method

A retrospective review of documentation done during the admission for 50 random admissions in upper gastrointestinal surgery was assessed using the principles from Take Ten and the Shine Toolkit. Change implemented before second audit cycle: lecture at induction on how surgical assessment unit works, how admission and post-take ward round work, how to document & clarifications of job roles. The percentage of documentation was determined and going to be presented in a local audit meeting.

Results

1st Audit Cycle vs 2nd Audit Cycle as percentage for documentation of History of Presenting Complaint (100%, 100%), NEWS (46%, 54%), Examination findings (96%, 94%), Diagnosis / Impression (94%, 94%), Advise to Patients (0%, 16%), Medication (42%, 54%) and Name of Clinician (60%, 72%).

Conclusions

The documentation during Surgical Admission improved in most areas and thus help lead to more safe and efficient patient care. However, there is still significant work that needs to be done. Further recommendations include implementing the Surgical Assessment for Emergencies (SAFE) Ward Round Tool, using electronic notes and availability of more computer on wheels.
1187 An Audit Assessing the Diagnostic Yield of Ultrasound Imaging for Suspected Acute Appendicitis in Paediatric Patients Against Royal College of Radiologists Benchmarks
Authors: Abi Osman V , Ward M , John V , Nour E , Ahmad A
Published: August 2024

Aim

Prompt and accurate diagnosis of appendicitis in children is crucial to avert the risks of delayed treatment and reduce unnecessary appendectomies resulting from false-positive diagnoses. This audit aimed to evaluate the diagnostic sensitivity of ultrasound imaging in paediatric patients presenting with suspected acute appendicitis at a District General Hospital, seeking to meet or exceed the Royal College of Radiologists' (RCR) recommended target sensitivity of over 85% (1).

Method

In this retrospective study, we analysed the medical records of 102 children aged 2-16 who underwent appendectomies (open, laparoscopic, or diagnostic) over a two-year period. Ultrasound scans and corresponding medical records were reviewed to assess the concordance between pre-operative ultrasound findings and post-operative histopathology results.

Results

Among the 102 patients evaluated, histopathology confirmed appendicitis in 77 cases. Ultrasound correctly identified 52 of these cases, resulting in a diagnostic sensitivity of 67.5%, below the RCR's advised benchmark of 85%. For the 25 patients without histopathological evidence of appendicitis, ultrasound accurately diagnosed 17.

Conclusions

The diagnostic sensitivity of ultrasound for suspected appendicitis in our paediatric cohort was below the RCR guideline, highlighting a need for improvement. To enhance diagnostic accuracy, we recommend additional training for sonographers in paediatric appendicitis imaging and consideration of second-opinion protocols for equivocal cases. Further investigation into a dedicated paediatric ultrasound service may also be another way of to improve quality of scans.
207 Acute Appendicitis and Lung Metastasis – a Rare Combination
Authors: Arora A , Maria Kouvatsou A , Ali O
Published: August 2024

Background

Lung cancer is the third most common cancer in the UK. Although widespread metastasis is common, metastasis to the appendix is rare. Here we present a case of acute appendicitis secondary to a lung metastasis.

Case Presentation

An 84-year-old man was admitted with a two-day history of right iliac fossa and suprapubic pain. He was known to have previous lung cancer treated with radical radiotherapy. Bloods on admission revealed elevated inflammatory markers with WCC 14.73 x 109/L and CRP 71.1mg/L. A Computed tomography was performed which showed acute appendicitis with perforation. An emergency laparoscopic appendicectomy was performed which showed a mid-appendiceal perforation with a localized abscess cavity. His recovery was uneventful, and the patient was discharged on postoperative day 2. Histological analysis revealed an adenocarcinoma in the appendicular lumen and within the muscle wall extending to the serosal surface. Immunochemistry profile was positive for CK, CK-19, TTF1 and Napsin A favoring a diagnosis of lung adenocarcinoma which was rationalized in the lung MDT. The patient remains under the respiratory physicians for close follow up.

Discussion

Lung metastasis to the appendix causing acute appendicitis is uncommon, with only twelve cases of appendiceal metastasis reported in the literature, ten of which presented with a perforated appendix. It may be considered as a differential for the cause of perforated acute appendicitis especially in patients with background of lung cancer.
1059 Giant Fibroepithelial Breast Polyp
Authors: Madume R , Nkuo K , Hamidi Latifi L , Singh Rait J
Published: August 2024

Introduction

Fibroepithelial polyps are common benign skin lesions rarely noted in the female nipple. In this location, they have the potential to ulcerate and cause bloody discharge.

Case History

A 55-year-old female patient presented to a breast clinic with a left nipple lesion present since childhood. The patient self-reported that the lesion had increased in size. Clinical examination revealed a 9 x 7cm lesion with a soft and pliable stem extending from the left nipple. Mammography from 2017 revealed this previously measured 6 x 6cm.

An excision biopsy under general anaesthetic preserving the nipple anatomy was undertaken on 18/8/23. There were no immediate or subsequent complications. The final histology demonstrated the excised specimen weighed 131g and measured 95 x 70 x 60mm with an 8mm base. The specimen was processed and microscopically found to be a giant fibroepithelial polyp (FEP). The central core of the lesion was formed by excessive collagen deposition. Normal dermal structures including blood vessels were still present with no glandular component and there was no evidence of atypia or malignancy.

Discussion

FEP’s are benign dermal mesenchymal tumours also known as acrochordons. They are noted most commonly on the neck, axilla, perineum and thighs but have been found in the vagina, vulva or cervix and present in <2% of cases in the nipple area. FEP’s rarely grow larger than 5cm with larger lesions are rarely reported in medical literature. It is possible to excise these lesions and preserve the nipple anatomy with careful surgical planning.
1208 Surveillance Strategy Following Curative Resection of Colorectal Cancer – What and When?
Authors: China Z , Drmota J , Chowdhury A
Published: August 2024

Aim

After curative treatment for colorectal cancer (CRC), recurrence can occur in up to 11% of patients with stage 1-3 disease. Early diagnosis of CRC recurrence is key to improving prognosis. Different follow up strategies such asdetection of carcinoembryonic antigen (CEA) and CT imaging are available and NICE broadly recommends a combination of CEA and CT testing in the first 3 years to look for recurrence. We present our local data for CRC recurrences, when it recurred and the method of detection.

Method

A retrospective review of all CRC recurrences at our local unit was conducted from 2014 to 2021. Patient demographics, site of primary cancer, staging, surgical procedure for curative treatment, recurrence, surveillance tests and timings were recorded and analysed.

Results

66 patients were identified with CRC recurrence in the 7-year period with the earliest detection occurring at 6 months and latest at 60 months. 12%, 35% and 60% of recurrences were detected in the first 6, 12 and 18 monthsrespectively. 80% of patients had positive CT findings, mostly of lung and liver metastases. 77% had abnormal CEA results, but 91% of these were in combination with CT, MRI or PET imaging. Only 9% of recurrences was detected by CEA alone.

Conclusions

Our data highlights that the majority of CRC recurred within 18 months of initial surgical intervention and CT was the primary modality for detection. Frequent follow up testing is resource intensive and also leads to patient anxiety. We recommend that a follow up CT at 12 months is best placed to detect CRC recurrences.
316 Clinical Significance and Diagnostic Approach for Paediatric Unilateral Tonsillar Enlargement: Insights from a Retrospective Analysis
Authors: Nelson A , Bujoreanu I , Williams M , Gaskin J
Published: August 2024

Aim

Tonsillectomy for unilateral tonsillar enlargement (UTE) in the paediatric population remains a topic of debate among ENT surgeons. The majority of UTE is benign in nature; however, concerns exist around the differential diagnosis of lymphoma which is typically found in the presence of other sinister symptoms. The aim is to identify the common features associated with UTE and malignancy to stratify risk at clinical presentation, allowing for appropriate listing of patients for diagnostic tonsillectomy.

Method

A retrospective case series analysis was performed of all paediatric tonsillectomy specimens, at Bristol Children’s Hospital and between January 2006 and January 2023. Anonymised data included patient demographic details, clinical history including history and histopathological results.

Results

Six (1.9%) lymphoma diagnoses were identified from the 321 patients that underwent tonsillectomy for UTE. Three patients had localised disease to cervical region, and three patients had systemic infiltration of disease with bony disease, oropharyngeal and abdominal disease, mediastinal disease respectively These patients presented with other signs of malignancy in addition to UTE including cervical lymphadenopathy (100%), tonsillar asymmetry (83%), alteration of appearance of tonsil including colour or visible lesion (67%), snoring (67%), dysphagia (50%), recurrent fever (17%) and weight loss (17%).

Conclusions

The incidence of malignancy in our study is low (1.9%), consistent with previously reported literature. In all cases of confirmed lymphoma, the enlarged tonsil appeared grossly abnormal on clinical examination. We suggest tonsillectomy for histology should only be performed in the presence of associated symptoms suggestive of lymphoma.
1029 Incidence of Vestibular Schwannoma on MRI for Patients with Unilateral Non-Pulsatile Tinnitus
Authors: Elmi S N , Etuk K , Farooq E , Ahmad M
Published: August 2024

Aim

This research paper aims to explore the incidence of vestibular schwannoma on MRI for patients with unilateral non-pulsatile tinnitus.

Method

A systematic review protocol was registered with PROSPERO and reported in accordance with the Preferred Reporting for Items for Systematic Reviews and Meta-Analyses (PRISMA). The search strategy was developed using key terms in the title, which was searched through a total of 4 databases, MEDLINE, Cochrane, EMBASE, and CINAHL up to April 2023. Non-English articles were not included. Studies were screened according to the inclusion and exclusion criteria by three independent reviewers.

Results

9511 papers were identified following a comprehensive literature search. Articles were then filtered for relevance and publication resulting in 96 papers. Following a full text assessment reduced the number of articles suitable for inclusion to 2. 691 patients were included in this review that matched the inclusion and exclusion criteria, with the age range of the patients being from 17-91 years old. The combined sensitivity and specificity of our study were 1.00[Cl:0.59, 1.00] and 0.00[Cl:0.00, 0.01] and PPV of 1.01%.

Conclusions

Vestibular schwannomas are slow growing tumours that are difficult to diagnose and usually manifest clinically in tinnitus, hearing loss and dizziness. Current NICE guidelines say to consider MRI for patients with unilateral non-pulsatile tinnitus however according to our study imaging for patients with unilateral non-pulsatile tinnitus does not appear to be a good indicator for vestibular Schwannoma.
472 The International Student Surgical Network-UK (InciSioN-UK) Global Surgery Conference 2023 - Addressing the Need for Global Surgery Exposure
Authors: Erhabor J , Wong W , Fareed F , Anderson R , Kotecha S , Mazzoleni A
Published: August 2024

Aim

InciSion-UK is the global surgery national working group for UK-based medical students and trainee doctors. On September 9th, 2023, InciSion-UK ran a one-day international hybrid conference to educate the target audience about global surgery. This study aimed to explore attendees' attitudes towards global surgery and evaluate the event’s impact.

Method

The InciSion-UK Global Surgery Conference 2023 was held at the Royal Colleges of Surgeons of England and featured various virtual, and in-person talks, panels, and presentations. Pre- and post-conference questionnaires were distributed via email and MedAll to all registered participants before and after the event.

Results

Out of 640 pre-conference responses, the majority were from doctors (59%) or medical students (31%) based in Europe (45.6%), Asia (31%) and Africa (22%). “Education/Teaching” (75%) and “Research” (70%) were their key areas of interest within global surgery. "Professional Development" (83%) and "Learning about Global Surgery" (71%) were cited as the main reasons for registering.

From 794 post-conference responses, participants’ confidence in global surgery increased from 2.8/5 to 4.2/5. The overall ‘helpfulness’ of the content was rated at 4.4/5. Feedback from the conference highlighted the quality of talks (40%) and technical issues (22%) as the key areas of positive and negative feedback. In future events, attendees wanted to learn more about specific surgical specialties/procedures (21.82%) and research/innovation (18.18%).

Conclusions

The InciSion-UK Global Surgery Conference 2023 educated a diverse audience of medical students and trainees and increased their confidence in global surgery. Feedback from the conference will be invaluable for developing future global surgery events.