bluuebunny/crossref_metadata_2025 huggingface dataset:
Structural and optical properties of Pr doped CuInS2 thin films synthesized by chemical bath deposition
Authors: Sengupta S , Pateria M A
Published: April 2021

The Pr doped CuInS2 thin films have been prepared by chemically bath deposition technique at 80°Ctemperature. The semiconducting films are grown in bath containing aqueous solution of copper (II) chloride dihydrate, Indium (III) chloride, thiourea, TEA, ammonia (25%). Pr is used as the doping element. Chloride dehydrates is used for the copper ion source, Indium chloride for indium ion source and thiourea for sulphur ion source, TEA is a complexing agent and ammonia maintains the pH. The SEM Studies of Pr doped CuInS2 films show that at lower volume polyhedral shaped particle appears on the surface. No voids are seen. But at higher volume of Pr; voids are seen on the surface. Particle looks like accumulated woolen balls or cubic like grains. Agglomeration of particle increases with volume and hence particle size also increases. In the XRD of prepared sample characteristic peaks of chalcopyrite phase appears between (240- 800) in all the films. Hall measurement shows that resistivity of Pr (6ml) doped film is very high. The conductivity of all doped films is higher than undoped film. In general, increased doping will leads to increased conductivity. In the Photoluminescence study the emission peak appears at wavelength 575nm, 550nm and 525nm wavelength. High transmittance, low reflectance found in the visible region in the entire prepared sample. The absorption peaks fall in the visible region. High Photocurrent is found, and in dark current study the linear behavior between voltage and current are seen. Quite good photosensitivity is observed in Pr doped CuInS2 films.
Acoustical characterization of nickel aluminide (Ni3Al) at low temperatures
Authors: Pandey Krishna Kumar , Lahariya Vikas , Tiwari Balgovind , Mathuriya Abhilasha Singh
Published: April 2021

Present research work deals with the acoustical characterization of Nickel Aluminide (Ni3Al) at low temperature region from 10K to 50K. Particularly, the Ultrasonic waves have been used as a Non-destructive testing (NDT) tool to characterize this Ni3Al. For this purpose, in our technique, the two parameters such as the nearest-neighbour distance and the hardness parameter is taken as two input parameters. Ultrasonic attenuation due to the cause of e-p (electron-phonon) interaction has been evaluated from 10K to 50K, for longitudinal as well as shear waves along <100> crystallographic direction and the elastic constants (second order) for this intermetallic alloy of nickel and aluminium is also evaluated in low temperature region and the obtained results have been discussed.
Full potential study of electronic and thermoelectric properties of GdNiSb compound
Authors: Satyam Jagdish Kumar , Saini Sapan Mohan
Published: April 2021

In the present work we have investigated electronic and thermoelectric properties of GdNiSb compound. The calculations have been performed using local spin density approximation (LSDA) with Hubbard parameter (U) included for exchange correlation effect. The calculated results of a cubic half-Heusler phase of GdNiSb compound shows semiconducting behaviour due to a narrow band gap (0.279 eV) is opened. Thermoelectric properties such as electrical conductivity (σ/τ), Seebeck coefficient (S) and figure of merit (ZT) was calculated. Values of thermoelectric parameters show that GdNiSb compound could be used as potential material for thermoelectric applications.
Polaronic Relaxation and Variable-Range-Hopping Conductivity in Fe3O4 Nanoparticles
Authors: Swetha A K , Pradeep B H , Mallikarjun R , Singh S , Joshi R S
Published: April 2021

We report the polaronic relaxation and Variable Range Hopping (VRH) conductivity in 100nm average particle size cold pressed Fe3O4 nanoparticles. The crystal structure was studied using XRD showing spinel structure with (311) intense peak. The AC transport in the cold pressed powder was studied from 10 K to room temperature and from 100 Hz to 5.5 MHz. It was observed that the solid couples capacitively with the perturbing electric field initially and as the frequency increases it becomes more inductive. The impedance data was modelled using modified Havriliak–Negami relaxation model. It was observed that the cold pressing introduces an asymmetric broadening in the relaxation process. The change in impedance with temperature showed a drastic drop at around 120 K due to Verwey transition in real as well as imaginary part. The change in DC resistance with temperature indicated VRH mechanism of charge transport in the solid with a metal insulator transition at around 120 K. The relaxation times calculated indicated that the hopping process has an attempt frequency of the order of 30 microseconds. The activation energy change across the phase transition with relaxation time and resistance indicated that the charge transport is coherent. The activation energy of ∼0.05eV above Varway transition indicated that the transport is small polaronic in nature.
Dielectric, Microhardness and Thermal Properties of Swift Ion (Au3+) Irradiated NLO Single Crystal: 2-Amino-5-Nitropyridinium Sulfamate (2A5NPS)
Authors: Rajkumar M. Ambrose , Ajith P. , Anbarasu S. , Anand Devarajan Prem
Published: April 2021

An organic-inorganic NLO single crystal was grown using conventional and slow cooling method or ATR (Assembled temperature reduction method). Properties of as grown crystal were tried to modify using swift heavy ion (Au3+) of various fluences ranging from 1013 ions/cm2, to 1014 ions/cm2. Dielectric property of orthorhombic crystal was studied. It was noticed that, as ion fluence increases the dielectric constant of as grown material also increases. Hardness of the undamaged and swift heavy ion irradiated crystals was studied. It was concluded that the ability of resistance of deformation of swift heavy ion implanted crystal increases with increase of ion fluences. Thermal studies were carried out and it was observed that irradiated crystal exhibits increased thermal stability with increase of ion energy and this was owing to decreased degree of crystallinity.
Progress in the study of heteropolyacid-based-nanocomposite photocatalytic materials
Authors: Pengxi Li , Peng Zhou , Zemei Guo , Jinging Yang
Published: April 2021

As a kind of mild green photocatalysts, Heteropoly acid have a good prospect in photocatalysis due to its high activity, good selectivity and non-toxicityand possess photochemical characteristics similar to those of the semiconductor photocatalysts. Heteropoly acid (HPA), which are very soluble in water and polar solvents, these compounds are activated only by UV light, which restricts the practical application of HPA. Dispersing HPA onto nanoparticle supports with high surface area is useful to increase their specific surface area and hence (photo)catalytic activity. In this paper, the application of HPA-nanoparticles composites such as HPA/TiO2 nanoparticles composites, HPA/SiO2 nanoparticles composites, HPA/ZrO2 nanoparticles composites and so on, in photocatalytic degradation of printing and dyeing wastewater, and the future research direction is prospected.
Hybrid fabrication of LED matrix display on multilayer flexible printed circuit board
Authors: Phung Thanh Huy , Jeong Jaehyeong , Gafurov Anton Nailevich , Kim Inyoung , Kim Sung Yong , Chung Hak-Jun , Kim Yoonkap , Kim Han-Jung , Kim Kyoung Min , Lee Taik-Min
Published: April 2021

This study presents a hybrid fabrication process for LED matrix on flexible multilayer printed circuit boards (PCBs). To prepare for the flexible PCB, a roll-to-roll screen printing process was developed to create a core circuit board by printing on both sides of the flexible substrate. From the core PCB, the lamination and etching processes are then used to form four layers in total. By using the proposed method, we successfully implemented the passive LED matrix display. This approach could be used for other applications that require flexible and multilayer circuits.
Extension of Mendelian Randomization to Identify Earliest Manifestations of Alzheimer Disease: Association of Genetic Risk Score for Alzheimer Disease With Lower Body Mass Index by Age 50 Years
Authors: Brenowitz Willa D , Zimmerman Scott C , Filshtein Teresa J , Yaffe Kristine , Walter Stefan , Hoffmann Thomas J , Jorgenson Eric , Whitmer Rachel A , Glymour M Maria
Published: April 2021

Weight loss or lower body mass index (BMI) could be an early symptom of Alzheimer disease (AD), but when this begins to emerge is difficult to estimate with traditional observational data. In an extension of Mendelian randomization, we leveraged variation in genetic risk for late-onset AD risk to estimate the causal effect of AD on BMI and the earliest ages at which AD-related weight loss (or lower BMI as a proxy) occurs. We studied UK Biobank participants enrolled in 2006–2010, who were without dementia, aged 39–73, with European genetic ancestry. BMI was calculated with measured height/weight (weight (kg)/height (m)2). An AD genetic risk score (AD-GRS) was calculated based on 23 genetic variants. Using linear regressions, we tested the association of AD-GRS with BMI, stratified by decade, and calculated the age of divergence in BMI trends between low and high AD-GRS. AD-GRS was not associated with BMI in 39- to 49-year-olds (β = 0.00, 95% confidence interval (CI): −0.03, 0.03). AD-GRS was associated with lower BMI in 50- to 59-year-olds (β = −0.03, 95% CI: −0.06, −0.01) and 60- to 73-year-olds (β = −0.09, 95% CI:−0.12, −0.07). Model-based BMI age curves for high versus low AD-GRS began to diverge after age 47 years. Sensitivity analyses found no evidence for pleiotropy or survival bias. Longitudinal replication is needed; however, our findings suggest that AD genes might begin to reduce BMI decades prior to dementia diagnosis.
Feeding friend and foe: ample pollen mitigates the effects of pollen theft for a gynodioecious plant,Polemonium foliosissimum(Polemoniaceae)
Authors: Brody Alison K , Burnham P Alexander , Smith Brittany
Published: April 2021

Background and Aims

Most angiosperms rely on pollinators to transport pollen and effect fertilization. While some floral visitors are effective pollinators, others act as thieves, consuming pollen but effecting little pollination in return. The importance of pollen theft in male and female reproductive success has received little attention. Here, we examined if pollen consumption by flies altered pollen receipt and exacerbated pollen limitation for a bumblebee-pollinated plant, Polemonium foliosissimum (Polemoniaceae).

Methods

To examine the effect of pollen-thieving flies, we took a three-pronged approach. First, we used single-visit observations to quantify pollen removal and pollen deposition by flies and bumblebees. Second, we manipulated pollen in the neighbourhood around focal plants in two years to test whether pollen reduction reduced pollen receipt. Third, we combined pollen reduction with hand-pollination to test whether pollen thieving exacerbated pollen limitation. Polemonium foliosissimum is gynodioecious in most populations in the Elk Mountains of central Colorado, USA. Thus, we also tested whether pollen theft affected hermaphrodites and females differently.

Results

Flies removed significantly more pollen and deposited less pollen per visit than did bumblebees. Reduction of pollen in the neighbourhood around focal plants reduced pollen receipt in both years but only nearly significantly so in 2015. In 2016, plants were significantly pollen-limited; hand-pollination significantly increased seeds per fruit for both hermaphrodites and females. However, the reduction of pollen around focal plants did not exacerbate pollen limitation for either hermaphrodites or females.

Conclusions

Our results suggest that plants tolerate significant consumption of pollen by thieves and pollinators by producing ample pollen to feed both and fertilize available ovules. Our results demonstrate that pollen limitation in P. foliosissimum is driven by lack of effective pollinators rather than lack of pollen. Teasing out these effects elucidates the relative importance of drivers of reproductive success and thus the expected response to selection by different floral visitors.
P1 “She used to be Tigger and then she was Eeyore”: A qualitative study with children and young people with CFS/ME, exploring predictors of recovery and future treatment needs
Authors: Clery Philippa , Starbuck Jennifer , Laffan Amanda , Crawley Esther
Published: April 2021

Introduction

Paediatric Chronic Fatigue Syndrome/Myalgic Encephalomyelitis (CFS/ME) is relatively common and severely disabling. At least 15% of children do not recover by 12 months. We do not know why some children recover and others do not. This study aimed to explore the barriers to recovery experienced by adolescents with CFS/ME.

Methods

I recruited adolescents (aged 11-17 years old, with CFS/ME, who were still disabled by CFS/ME after 12 months of treatment), their parents and specialist healthcare professionals were recruited from a single specialist CFS/ME service in the UK. I conducted semi-structured interviews and focus groups to explore views on treatment received including barriers and facilitators, as well as views on their future. I used thematic analysis grounded in the views of the patients to identify patterns (themes) in the data.

Results

I recruited 12 children and young people, 11 parents and 7 specialist healthcare professionals. The following themes were identified (with barriers and facilitators apparent in each theme): 1. “awareness and support” from CFS/ME services, GPs, schools and family. Poor awareness resulted in increased time-to-diagnosis, school disengagement, stigmatising experiences, and significant stress for children and parents; family support, school understanding, and validation from the service was a ‘life saver’. 2. “CFS/ME is bigger than the fatigue” described the importance of managing CFS/ME as a ‘long and hard’ chronic illness with secondary health, social and educational consequences. Participants called for holistic therapies that focus on the broader definition of recovery and facilitate re-integration into ‘normal life’. 3. “Balancing routine and control in adolescents”: Children differed on whether routines and pacing were helpful or exacerbated low mood. 4. “Individualised” treatment was important: treatment combinations were helpful in different ‘phases of recovery’, which varied depending on social context, motivations, school input, and co-morbidities.

Conclusion

Adolescents identified common facilitators and barriers to recovery and a desire for treatment that takes social factors into account, with a holistic approach using a broader definition of recovery. Children and parents identified a need for better awareness, communication and integration within and between services, including GPs and schools.
P2 3-year observation study of Plerixafor use in New Zealand
Authors: Swinn Tim , Butler Andrew
Published: April 2021

Introduction

Plerixafor, a novel CXCR4 pathway antagonist, is used to mobilise CD34-positive stem cells for autologous stem cell transplantation to treat haematological malignancy. Data regarding the rates of failure to mobilise and frequency of use of Plerixafor vary widely.

Methods

This retrospective study reviewed 203 consecutive patients with myeloma (n = 122) or lymphoma (n = 81) undergoing peripheral blood stem cell mobilisation between 1/1/2016 and 5/8/2019 at a New Zealand hospital using data from an institution transplant database and the electronic medical record.

Patients with myeloma were mobilised using cyclophosphamide and G-CSF after induction chemotherapy with cyclophosphamide, bortezomib and dexamethasone. Patients with lymphoma were mobilised with G-CSF after induction or salvage chemotherapy according to disease type.

Patients failing to mobilise sufficient stem cells either received “pre-emptive” Plerixafor added to G-CSF +/- chemotherapy during the 1st attempt or were re-mobilised after a 4-week break with Plerixafor and G-CSF alone.

Results

The success rate of mobilisation for lymphoma and myeloma patients at first attempt was 79% and 87% respectively. Plerixafor allowed successful harvest for 5 of 7 lymphoma patients and 8 of 9 myeloma patients who failed to harvest at first attempt, resulting in 88% and 94% of all patients having a successful harvest on either first or second attempt, respectively. Age greater than 60 years was a risk factor for failed mobilisation in lymphoma patients.

Conclusion

This study shows that an approach using pre-emptive and rescue Plerixafor is effective and allows haematopoietic stem cell mobilisation for ≥88% of patients. Further research is required to establish the optimal strategy for its use.
P5 A Cut Throat approach to post thyroidectomy care
Authors: McGovern J , Kurup V J , Bhaskar P , Slinger C A , McGovern Julia
Published: April 2021

Introduction

Across the UK, approximately 10,000 elective neck dissection surgeries (thyroidectomy/parathyroidectomy) are performed each year. The recognised post-operative complications of such surgeries range from mild post-operative hypocalcaemia to life threatening wound haematoma .

Aim

This project aimed to establish the awareness of the British Association of Endocrine and Thyroid Surgeons (BAETS) post thyroidectomy guidelines and provide targeted education in order to improve any identified failings in the management of this patient group.

Methods

A nine point questionnaire was generated based on the guidelines published by BAETS. This questionnaire was disseminated to the junior doctors and nurse practitioners based on the surgical unit of North Tees General Hospital.

Results

Results were analysed from twenty respondents. 92% opted to call a registrar or consultant during a critical airway emergency secondary to wound haematoma rather than attempt to open the wound on the ward. Respondents displayed poor understanding of the risks of thyroid surgery (55%) and struggled to identify symptoms of hypocalcaemia (25%).

Participants showed good understanding of the need for post-operative thyroxine (100%), the correct dose of calcium gluconate required for treatment of hypocalcaemia (90%) and normal calcium levels (85%).

A video was created and distributed which highlighted front of neck anatomy and steps involved in releasing a wound haematoma. This included the ‘SCOOP’ video created by Endocrine Surgery Oxford. Data collected following the session found 93% of respondents would be more confident to intervene in future.

Conclusion

It is vital that junior doctors are well educated and equipped to deal with post-operative patients, especially those who may develop imminent airway obstruction. Our “cut throat” approach aims to ensure our first responders are decisive and effective in carrying out life saving interventions.
P16 An audit of elderly patients with a femoral fracture: is the quality of care received by patients affected by where in the femur the fracture occurs?
Authors: Javed O A , Khan M J , Abbas Y , Pillai S , Hristova K , Chiang M , Mason W
Published: April 2021

Introduction

Elderly patients with femoral fractures are often frail and require a multidisciplinary approach to optimise medical care, rehabilitation and prevention of further injury. Previously, neck of femur fracture patients were the focus of such an approach, but NICE and BOAST guidelines emphasise extending this care to other elderly trauma patients.

Methods

A retrospective analysis of 43 patients over 60 years old at Gloucestershire Hospitals NHS Foundation Trust in 2019 with a femoral fracture other than a neck of femur fracture. BOAST guideline standards were surgery within 36 hours, orthogeriatric assessment within 72 hours, a documented ceiling of treatment, falls risk assessment, bone health review, nutritional assessment and physiotherapy review.

Results

Our study showed worse outcomes in all standards for patients with femoral shaft, distal femur and periprosthetic femur fractures compared to neck of femur fractures: surgery within 36 hours (63.9% vs. 66%); orthogeriatric assessment within 72 hours (32.6% vs. 91.9%); falls risk assessment (76.7% vs. 99.6%); bone health review (41.9% vs. 99.7%); nutritional assessment (55.8% vs. 99.6%); physiotherapy review (97.7% vs. 98.9%). The group also had worse outcomes for average length of stay (19 days vs. 14 days) and 30 day mortality (9.3% vs. 8.6%).

Discussion

Our study showed a discrepancy in care received by elderly patients with femoral fractures other than neck of femur. We will introduce a proforma for all femoral fractures, present our findings to orthogeriatric, bone health and physiotherapy teams to involve them in the care of such patients and re-audit following these recommendations.
P17 An audit of Trakcare discharge times for Laparoscopic Cholecystectomy
Authors: Rapier Jacob , Hornby Steven
Published: April 2021

Introduction

Nationally 61,220 Laparoscopic Cholecystectomies are carried out annually. Those carried out as day-cases reduce providers’ costs and increase income through the best practice tariff. The system in our trust to record discharges is ‘Trakcare’.

The aim of this audit was to accurately measure the discharge times of patients undergoing elective Laparoscopic Cholecystectomies, to try and reduce the number of patients recorded as having an overnight stay by accurate data collection.

Methods

Initial data was collected for all elective Laparoscopic Cholecystectomy discharge times on Trakcare, over a 1 month period.

This data was then re-audited prospectively both from Trakcare and discharges reported by nurses/patients.

A comparison was then made of Trakcare against reported discharge times.

Results

Initially 54 operations were recorded, with 30 completed as day cases (55.6%). The re-audited data (on Trakcare) recorded 47 operations, with 15 completed as day cases (37.91%). Of these discharges we were able to capture 26 (55.32%) manually, and 11 were completed as day cases (42.31%).

Measuring these 26 with the same operations on Trakcare we were unable to show a difference in the number of cases completed as a day case (11 vs 11), with only a 33 minute decrease in the average length of stay.

Conclusion

Trakcare is a reliable tool for measuring the date of discharge for patients. The recommendations in are: scheduling surgery for a time pre-13:00 shows a higher proportion of patients discharged the same day, and continue to use Trakcare to record discharge times.
P18 An audit on the delivery of Bristol Royal Children's Hospital paediatric orthopaedic services in response to BOAST COVID-19 guidance
Authors: Benning Matthew Singh , Berwin James , Knapper Thomas , Crosswell Sebastien , Carpenter Charlotte , Kenall John , Monsell Fergal , Thomas Simon
Published: April 2021

Introduction

The COVID-19 pandemic raised concerns regarding the spread of infection by asymptomatic children. Guidance from the British Orthopaedic Association Standards for Trauma (BOAST) for the ‘management of patients with urgent orthopaedic conditions and trauma during the coronavirus pandemic’, helped structure our service in response to the pandemic. We assessed our compliance with ‘BOAST COVID-19 standards’ pertaining to children to determine whether it is possible to run a safe and effective paediatric orthopaedic service.

Methods

Between the 16th March and 30th April 2020, we performed a prospective audit of clinic and theatre data from the paediatric orthopaedic department at the Bristol Royal Children’s Hospital against the ‘BOAST COVID-19 standards’. We also performed a retrospective audit between 16th March and 30th April 2019 for comparison.

Results

Patients booked into acute fracture clinic (AFC) and fracture clinic follow-up (FFO) reduced by 40% and 48% respectively from 2019 to 2020. A virtual fracture clinic (VFC) was implemented with increasing trend in VFC consultations. From 2019 to 2020, the number of patient initiated follow-up appointments increased in AFC and FFO from 16% to 75% and 12% to 35% respectively. Radiography was reduced; only 17% and 39% of AFC and FFO patients respectively required radiographs. On-call referrals and trauma cases reduced by almost 50% with a similar case mix year-on-year. All elective operating was cancelled in 2020.

Conclusion

By reducing clinic admissions and theatre throughput, it was possible to run an effective paediatric orthopaedic service in a busy tertiary referral centre. Our aim now is to determine the long-term efficacy.
P20 Anatomical Education during Covid-19: Ramifications for Students’ Learning
Authors: Franchi Thomas
Published: April 2021

Introduction

The world is experiencing an ongoing and serious pandemic, and as both an anatomy student and anatomy demonstrator, I felt it necessary to comment on the impact this pandemic has had and is having on students’ anatomical education, and on my concerns about the implications it might have on the future of current anatomy students.

Methods

In the form of an extended Letter to the Editor, I present some of my reflections on the above matter and suggest a number of points for anatomy students, demonstrators and institutions to consider as we move forwards.

Results

When students lost access to dissection rooms, they lost access not only to cadavers, but also to a range of other optimal learning modalities: prosections, models, pathology specimens, skeletons, and others. Previous authors have highlighted that the modern medical curriculum already restricts students’ exposure to anatomy, and indeed this pandemic has further shortened the contact time current students have received. As a result, current anatomy students are being taught anatomy without access to practical-based learning materials, be that cadavers, prosections, or models.

Conclusion

Whilst the educational disruption caused by the pandemic is clearly severe, it also presents an opportunity for pedagogical evolution and innovation. Here, I have offered a host of recommendations to those involved in anatomical education. The lasting impacts of the pandemic are still unknown, but the anatomical community has responded creatively and adaptively.
P23 Associate Principal Investigators in Trauma Trials
Authors: Bretherton Chris , Exell Lauren , Achten Juul , Costa Matt
Published: April 2021

Oxford Trauma has designed a collection of randomised clinical trials to answer important clinical questions in trauma and meaningfully engage trainees and associate principal investigators (aPI’s) with research.

These include: Children’s Radius Acute Fracture Fixation Trial (CRAFFT): • Weight-Bearing in Ankle Fractures (WAX): • Blood cEll Salvage and autoTransfusion (BEST): • Fractured Ankle Management Evaluation (FAME): • Surgery or Cast for Injuries of the EpicoNdyle in Children's Elbows (SCIENCE): • The HUmeral SHaft fracture trial (HUSH) Trainee engagement is promoted via: • Registration for the NIHR associate PI scheme with corresponding “how-to guide” for study set-up. Individually tailored points system for collaborative authorship. Automatic emailing of certificates for recruitment of participants (For ARCP evidence). A central database listing trial sites and contacts for aPI’s.

https://www.ndorms.ox.ac.uk/Oxford-Trauma-and-Emergency-Care/trainee-involvement

This has led to the recruitment of sites and participants ahead of target, including sites aPI’s have set-up from scratch.

We would love for you to join as an aPI or help us refine the model and share it with other collaborative groups!: Contact Christopher.Bretherton@ndorms.ox.ac.uk
P28 Breast Lymphedema after breast conservative surgery; an up-to-date systematic review
Authors: Abouelazayem Mohamed , Elkorety Mohamed , Monib Sherif
Published: April 2021

Background

While arm lymphedema following breast cancer treatment is a common complication; breast lymphedema following treatment is not uncommon. Several risk factors were found to contribute to breast lymphedema, including axillary surgery, high BMI, increased bra cup size, adjuvant chemotherapy, locoregional and radiotherapy boost and upper outer quadrant tumours.

Aim

We aimed to provide an up to date systematic review to help avoiding or managing breast lymphoedema after Breast conservative surgery for breast cancer.

Methods

The search term 'breast lymphedema' was combined with 'breast conservative surgery' and was used to conduct a literature research in PubMed and Medline. The term lymphedema was combined with breast, conservative and surgery to search Embase database. All papers published in English were included with no exclusion date limits

Results

A total of 2155 female patients were included in this review; age ranged from 26 to 90. Mean body mass index was 28.4, most of the studies included patients who underwent conservative breast surgery.

Incidence of breast lymphedema ranged from 24.8% to 90.4%. Several risk factors were linked to breast lymphedema after conservative breast surgery, such as body mass index (BMI), breast size, tumour size, tumour site, type of surgery and adjuvant therapy.

Treatment options focused on decongestive lymphatic therapy, including Manual lymphatic drainage (MLD), self-massaging, compression bras or Kinesio taping.

Conclusion

Breast lymphedema is a relatively common complication, yet there is no clear consensus on the definition or treatment options.
P33 Changes to acute vascular care management during the COVID-19 pandemic: The Vascular and Endovascular Research Network (VERN) COvid-19 Vascular sERvice (COVER) Tier 3 study
Authors:   VERN COVER Study Collaborative
Published: April 2021

Introduction

The COVID-19 pandemic forced rapid adaptations to healthcare provision. The COvid-19 Vascular sERvice (COVER) Study aimed to contemporaneously report changes to practice and subsequent outcomes of vascular patients managed during the pandemic.

Methods

COVER is a three-tiered international multi-centre observational cohort study aiming to quantify the specific impact of the pandemic on the provision of vascular and endovascular surgery and the adjustments made to standard vascular practice during this time. The primary outcome of Tier 3 was to identify how the management of all referred urgent vascular cases changed throughout the COVID-19 pandemic. Secondary outcomes included longitudinal data to identify condition-specific outcomes for these patients at 3, 6 months and 1 year. Over a minimum four-week period, contributing vascular centers contemporaneously collected prospective data on the management of all urgent referrals received during this time.

Results

Data from over 1693 patients worldwide has been obtained and is currently undergoing analysis. Provisional results suggest that approximately 18% of patients had significant changes to their care during the pandemic. Full descriptive results of management changes during the pandemic itself will be reported at the NRCM meeting.

Conclusions

It is anticipated that this work will highlight significant deviation in the management of urgent vascular referrals when compared to pre-pandemic best practice guidelines. It will be crucial to identify and monitor the ongoing impact this has on patient care.
P34 Characteristics, diagnosis and management of Cushing’s disease - A systematic review and meta-analysis
Authors: Koh Chan Hee , Khan Danyal Z , Digpal Ronneil , Horsfall Hugo Layard , Marcus Hani J , Korbonits Marta
Published: April 2021

Introduction

The clinical practice and research in the diagnosis and management of Cushing’s disease remains heterogeneous and challenging to this day. We sought to establish the characteristics of Cushing’s disease, and the trends in diagnosis, management and reporting in this field.

Methods

Searches of PubMed and Embase were conducted. Study protocol was registered a-priori. Random-effects analyses were conducted to establish numerical estimates.

Results

Our screening returned 159 papers.

The average age of adult patients with Cushing’s disease was 39.3, and 13.6 for children. The male:female ratio was 1:3. 8% of patients had undergone previous transsphenoidal resection. The ratio of macroadenomas: microadenomas:imaging-undetectable adenomas was 18:53:29. The most commonly reported preoperative biochemical investigations were serum cortisol (average 26.4µg/dL) and ACTH (77.5pg/dL). Postoperative cortisol was most frequently used to define remission (74.8%), most commonly with threshold of 5µg/dL (44.8%). Average remission rates were 77.8% with recurrence rate of 13.9%. Median follow-up was 38 months.

Majority of papers reported age (81.9%) and sex (79.4%). Only 56.6% reported whether their patients had previous pituitary surgery. 45.3% reported whether their adenomas were macroadenoma, microadenoma or undetectable. Only 24.1% reported preoperative cortisol, and this did not improve over time. 60.4% reported numerical thresholds for cortisol in defining remission, and this improved significantly over time (p = 0.004). Visual inspection of bubbleplots showed increasing preference for threshold of 5µg/dL. 70.4% reported the length of follow up.

Conclusion

We quantified the characteristics of Cushing’s disease, and analysed the trends in investigation and reporting. This review may help to inform future efforts in forming guidelines for research and clinical practice.
P43 Did COVID-19 Pandemic change Anaesthesia Practices in India: A Multi-centre Cross-sectional Study
Authors: Shah Priyansh , Sarang Bhakti , Gadgil Anita , Bhandoria Geetu , Khajanchi Monty , Veetil Deepa Kizhakke , Bhandarkar Prashant , Gupta Monali Mohan , Goh Dylan , Roy Nobhojit
Published: April 2021

Introduction

The anaesthetic management for surgeries during the COVID-19 pandemic has posed unique challenges. Safety of all healthcare workers is an additional concern along with heightened risk to patients during General Anesthesia (GA). COVID-19 pneumonia and aerosol generation may be exacerbated during airway intervention and GA. We aimed to assess the change in the mode of anaesthesia due to the pandemic.

Methods

A research consortium led by WHO Collaboration Centre for Research in Surgical Care Delivery in Low and Middle Income countries, India, conducted this retrospective cross-sectional study in 12 hospitals across the country. We compared the anaesthesia preferences during pandemic (April 2020) to a corresponding pre pandemic period (April 2019)

Results

A total of 636 out of 2,162 (29.4%) and 156 out of 927 (16.8%) surgeries were performed under GA in April 2019 and April 2020 respectively, leading to a fall of 13% in usage of GA. A 5% reduction in GA and a 12% increase in the usage of regional anaesthesia was observed for cesarean sections. There was no significant change in anesthesia for laparotomies and fracture surgeries. However, 14% increase in GA usage was observed in surgeries for local soft tissue infections and necrotic tissues.

Conclusion

Though overall usage of GA reduced marginally, the change was mainly contributed by anesthesia for caesarean births. The insignificant change in anaesthesia for other surgeries may be attributed to the lack of facilities for spinal anaesthesia and may reflect the risk taking behaviour of healthcare professionals in COVID-19 pandemic.
P45 Effect of One Anastomosis Gastric Bypass on Liver Function Tests: A comparison between 150 cm and 200 cm Bilio-Pancreatic Limb
Authors: Sam Miraheal Adadzewa , Hussain Abdulzahra , Pegler Maya Elizabeth , Bligh Pearson Emma Jane , Boyle Maureen , Singhal Rishi , Mahawar Kamal
Published: April 2021

Introduction

The effect of One Anastomosis Gastric Bypass (OAGB) on Liver Function Tests (LFTs) is unclear. The purpose of this study was to find out the effect of OAGB on LFTS and also if a Bilio-Pancreatic Limb (BPL) of 150 cm (OAGB-150) would deliver better outcomes than that with a BPL of 200 cm (OAGB-200).

Methods

We investigated our prospectively maintained records to obtain information on patients who underwent an OAGB-200 or OAGB-150 until 31st July 2018 in our unit.

Results

A total of 405 patients underwent an OAGB-200 (n = 234) or OAGB-150 (n = 171) in our unit between October 2012 -July 2018. There were significant improvements in Gamma-Glutamyl-Transpeptidase (GGT) levels at 1 and 2 years after OAGB-200 and significant worsening in the levels of Alkaline Phosphatase (ALP) and albumin at 1 and 2 years follow up. There was a significant improvement in GGT levels at 1 and 2 years after OAGB-150, and in Alanine Transaminase (ALT) levels at 1 year follow up. There was a significant worsening in ALP and albumin levels at both follow-up points in this group. There was no significant increase in the number of abnormal values for any of the tests in either group at both follow-up points. OAGB-150 group had a significantly lower bilirubin level at 1 year and significantly fewer abnormal ALP values at 2 years in comparison with OAGB-200 patients.

Conclusion

This study demonstrates the overall safety of OAGB with regards to its effect on LFTs with no remarkable difference between OAGB-150 and OAGB-200.
P55 FutureCOVID: Exploring the perspectives of doctors & nurses of student response during the COVID-19 pandemic
Authors:   Incision UK, The Royal Society of Medicine Students Section, MedEd collaborative (Steering group):, Veerappan Vigneshwar Raj , Kawka Michal , Dawidziuk Aleksander , Sravanam Sanskrithi , Bandhyopadhyay Soham , Byrne Matthew
Published: April 2021

Introduction

The training medical students receive means they can be used as auxiliary healthcare staff during pandemics and disasters. During COVID-10, many medical students volunteered in healthcare settings in clinical and non-clinical capacities. While there has been research into students’ perceptions of the pandemic and their role within the NHS, the perceptions of healthcare staff perceive this student response has not been explored.

Methods

COVIDAssist is a survey based cross sectional observational study of medical student volunteering during COVID-19. The study consists of a cross sectional survey of doctors & nurses who worked alongside medical students in the NHS during the pandemic. We will use qualitative and quantitative methods to analyze responses.

Results

The primary objective of the study is to assess how effective student response was in reducing the burden on healthcare teams during the pandemic. Secondary objectives are: to identify the broad specialty (e.g. medicine, surgery, primary care) and healthcare roles medical students were most beneficial) ; the GMC outcome-based skills students exhibited; the training provided to students before volunteering and what additional training could have been provided to students.

Conclusion

The outcomes of this study will help inform current and future guidance on effective student deployment during pandemics and disasters. The results are also expected to provide insight into necessary training adaptations.
P61 Impact of the COVID-19 pandemic on the presentation and management of acute appendicitis: a single-centre analysis
Authors: Pringle H , Donigiewicz U , Bennett M , Fowler G F , Walker E , Ball S , Narang S , Bethune R M
Published: April 2021

Introduction

The COVID-19 pandemic has influenced the delivery of healthcare. In accordance with the UK Joint Royal Colleges’ advice the management of acute appendicitis (AA) changed with greater consideration for non-operative management (NOM) or open appendicectomy where operative management (OM) s sought. Our aim is to share our experience of the presentation, management and outcomes for patients presenting to our Trust with AA to guide care for future viral pandemics.

Methods

This single-centre retrospective cohort study included patients diagnosed with AA in March to July 2019 compared with March to July 2020. Medical records were used to evaluate demographics, inflammatory markers, imaging, severity, management, histology, length of stay (LOS), complications and 90-day outcomes.

Results

There were 149 and 125 patients in the 2019 and 2020 cohort, respectively. 14 patients (9.4%) had NOM in 2019 versus 31 patients (24.8%) in 2020 (p = 0.001). In the 2019 OM group 125 patients (92.6%) had laparoscopic appendicectomy versus 69 (73.4%) in 2020. 59 patients (39.6%) had a CT in 2019 versus 70 (56%) in 2020. The median LOS was 4 days (interquartile range (IQR) 3 to 6 days) in 2019 and 3 days (IQR 2 to 5 days) in 2020 (p = 0.03). Two patients in each year who received NOM had treatment failure (14.3% in 2019 and 6.5% in 2020). Three patients in 2019 who had OM had treatment failure (2.2%). Of 95 patients tested for COVID-19 all but one was negative.

Conclusion

During the COVID-19 pandemic there was no observed increase in severity of AA, patients had a shorter LOS and were more likely to have imaging. NOM proportionally increased with no observed change in outcomes.
P62 Impact of the Covid-19 pandemic on the SeaSHeL study
Authors: Joshi Nikhil , Ahmed Muhammad , Mandavia Rishi ,   on behalf of the SeaSHeL Collaborative
Published: April 2021

Introduction

The SeaSHeL Study is an ongoing national, multi-centre, cohort study investigating Sudden Sensorineural Hearing Loss (SSNHL). The study is supported by the INTEGRATE ENT Trainee Research Network and the Audiology NIHR Champions, as well as being adopted onto the NIHR Clinical Research Network. It aims to map the pathway of patients with SSNHL, develop a prognostic model to predict recovery of patients with idiopathic SSNHL and establish the impact on patients’ quality of life. Here we summarise the impact of the Covid-19 pandemic on the study and highlight methods employed to improve data collection.

Methods

Data collection commenced in October 2019 and as of August 2020, 227 patients have been recruited from 66 registered sites across England. This interim data was analysed. The primary outcome was the change in monthly patient recruitment and site registration. The secondary outcome was the completeness of the dataset.

Results

Initially, monthly site registration increased to a peak of 31 in December 2019 and monthly patient recruitment increased to a peak of 34 in February 2020. Both levels decreased during the first wave of Covid-19 with 11 patients recruited and 0 sites registered in April 2020. Both levels have been increasing since, with 21 patients recruited and 5 sites registered in August 2020. The dataset of 227 patients has 113 (49.7%) completed records.

Conclusions

This study represents the largest national cohort study into SSNHL. Despite the Covid-19 pandemic, data collection continued during the first wave and rates are now recovering to pre-Covid-19 levels. Key factors in this recovery are a collaborative research approach involving motivated trainees, an ethics amendment for follow-up data to be collected by telephone and continued engagement of collaborators through regular email correspondence and fortnightly newsletters.
P67 Integrated surgical teaching for juniors: surgical education during COVID-19
Authors: Kamble Rituja , Scantling-Birch Yarrow , Samarth Gargi , Larsson Emma , Maden Charlotte
Published: April 2021

Background

COVID-19 has impacted on the amount of formal theoretical and practical surgical teaching available for junior doctors and medical students. This added to an existing climate of variability in the undergraduate and foundation teaching curriculum. Junior doctors were subsequently reporting a lack in confidence when dealing with surgical patients. We aimed to assess the surgical learning needs of junior doctors and designed a quality improvement project that included implementing a surgical teaching programme to improve the quality of surgical education.

Methods

A baseline questionnaire was completed by foundation year one doctors to establish confidence levels in managing surgical patients and carrying out practical procedures. Two sequential improvement strategies were subsequently implemented and assessed using the Plan-Do-Study-Act methodology. Junior doctors participated in a local surgical workshop in limited numbers during cycle 1, and then attended four online webinar tutorials themed around general surgery for cycle 2.

Results

A total of 15 participants responded to the baseline questionnaire, 13 attended the workshop and a combined total of 572 viewed the four webinars. Mean confidence increase following the workshop was 113% (W = 91.0, p < 0.001). Mean knowledge increase from the online webinars was 62.3% (t = 4.67, p = 0.009) and mean confidence increase was 66.67% (p < 0.0001).

Conclusion

Junior doctors did not feel confident in assessing and managing surgically unwell patients. Implementing blended learning tools, such as online webinars, allowed the delivery of effective surgical teaching en masse and to continue the practice of social distancing during a viral pandemic.
P71 Investigating the rate of successful day case discharges for laparoscopic cholecystectomies between June-November 2019
Authors: Pancharatnam Rohan Andrew , Abraham Sheryl , Adeniran Anjolaoluwa , Candan Jonathan
Published: April 2021

Introduction

Laparoscopic Cholecystectomy (LC) is the gold standard treatment for symptomatic gallstones. The British Association of Day Surgery (BADS) recommend that at least 60% of LCs are performed as day cases. We investigated the rate of successful discharge for LCs and factors contributing to unexpected overnight stays.

Methods

Retrospective data analysis was performed on elective LCs between June-November 2019. Electronic records were reviewed for: admission and discharge date; time of procedure; length of procedure; training grade of the surgeon; use of total intravenous anaesthesia (TIVA) or volatile anaesthesia; use of IV morphine in theatre/recovery and reasons for failed discharge.

Results

A total of 119 patients underwent elective LC, of which 63 were planned day cases. 46 patients (73.0%) listed as day cases were successfully discharged the same day. LCs performed before 1pm had a success rate of 78.8% compared to 45.5% after 1pm (p < 0.05). There was no statistically significant difference in success rates due to length of procedure; training grade of the surgeon; method of induction (TIVA or Volatile) or use of IV morphine in theatre/recovery. 17 planned day cases failed same day discharge. 7 of these patients (41.2%) reported pain and 4 (23.3%) reported nausea, vomiting or dizziness.

Conclusion

This centre successfully discharged 73.0% of planned day case LCs, although only 52.9% of elective LCs were listed as day cases. Success rates were positively associated with am procedures compared to pm. We recommend a review of operation scheduling and evening staffing in order to increase the probability of discharge on the same day.