bluuebunny/crossref_metadata_2025 huggingface dataset:
Single-layer digitized-counterdiabatic quantum optimization for p-spin models
Authors: Guan Huijie , Zhou Fei , Albarrán-Arriagada Francisco , Chen Xi , Solano Enrique , Hegade Narendra N , Huang He-Liang
Published: September 2024

Quantum computing holds the potential for quantum advantage in optimization problems, which requires advances in quantum algorithms and hardware specifications. Adiabatic quantum optimization is conceptually a valid solution that suffers from limited hardware coherence times. In this sense, counterdiabatic quantum protocols provide a shortcut to this process, steering the system along its ground state with fast-changing Hamiltonian. In this work, we take full advantage of a digitized-counterdiabatic quantum optimization algorithm to find an optimal solution of the p-spin model up to four-local interactions. We choose a suitable scheduling function and initial Hamiltonian such that a single-layer quantum circuit suffices to produce a good ground-state overlap. By further optimizing parameters using variational methods, we solve with unit accuracy two-spin, three-spin, and four-spin problems for 100%, 93%, and 83% of instances, respectively. As a particular case of the latter, we also solve factorization problems involving 5, 9, and 12 qubits. Due to the low computational overhead, our compact approach may become a valuable tool towards quantum advantage in the NISQ era.
Research on tool wear condition monitoring based on deep transfer learning and residual network
Authors: Ge Yong , Teo Hiu Hong , Moey Lip Kean , Tayier Walisijiang
Published: September 2024

To address the issues of sample scarcity and insufficient recognition accuracy in existing deep learning models for tool wear monitoring, this study developed a milling tool wear monitoring model that combines transfer learning (TL) and deep residual networks (ResNet). The model uses continuous wavelet transform to convert vibration signals into time-frequency maps, which are then fed into the network model for analysis. ResNet50 was selected as the base feature extraction model, and transfer learning techniques were employed to update the classification layer’s weights, enabling tool wear detection. The model based on ResNet-TL achieved a detection accuracy of 94%, significantly exceeding the threshold for intelligent tool wear recognition. This accomplishment markedly improves the precision and stability of tool wear state monitoring, providing more reliable technical support for tool management in manufacturing processes. Additionally, the method demonstrated superiority in addressing the small sample problem, paving the way for future research in tool wear monitoring. By integrating advanced deep learning techniques with transfer learning, the model not only enhances detection capabilities but also improves adaptability and robustness in practical industrial applications.
Exploring communities’ utilization of Jatropha based biofuels to transition towards cleaner energy sources
Authors: Gebreslassie Mulualem G , Bahta Solomon T , Fissha Filmon , Mebrahtu Akatew H , Watts-Farmer Archie , Hagos Tesfaslassie
Published: September 2024

Ethiopia is committed to using sustainable energy sources due to the limited availability of traditional fuel and their environmental damage. This study examines the viability of biofuels as an alternative fuel source in Ethiopia for community’s sustainable transition to cleaner energy. The research reviews relevant publications, policies, initiatives, and programs, identifies barriers to implementation, and collects data through literature reviews, community discussions and observations of energy experts. Ethiopia has 8.6 million hectares available for energy crops and governmental policies are encouraging the use of clean fuels. The study suggests that biofuel can support rural development and environmental sustainability. However, challenges to the widespread adoption of alternative fuels by communities exist such as flawed policies, limited technical skills, insufficient maintenance experts, a scarcity of biofuel production companies, and inadequate markets for biofuel seeds. To achieve a sustainable future through the use of clean energy in the country, policy interventions and investment strategies are necessary. All stakeholders must adopt policies and develop capacity-building programs while providing incentives for developers and users.
Asymmetries
Authors: Shoemaker David
Published: September 2024

This chapter lays out ten seeming asymmetries between the ordinary conception of blame and the ordinary conception of praise. These asymmetries include differences in the “demands” made by each, the “desert” status of each, whether there are emotions typically involved, whether it can be purely attitudinal or must be expressed, whether morality is implicated, what excusing conditions for each obtain, whether they target quality of will, whether some moral justification is needed for their deployment, whether a certain sort of standing is needed to issue them, and whether they are dangerous to those blamed or praised. Once the asymmetries are laid out, a few ways of addressing them are surveyed, a revisionary one from philosophy, and an endorsing one from psychology. Both approaches are found wanting, and this motivates a third option, to be detailed in the remainder of Part One.
Hazards
Authors: Shoemaker David
Published: September 2024

Blame’s stings are obviously hazardous, both when it’s too much or too little, creating monsters (e.g., Robert Harris) or entitled jerks. This chapter argues that praise risks symmetrical hazards. When overdone and when it’s underdone (or inconsistently done), it can create narcissists, who are both relatively unhappy themselves and hazardous to the people around them. Once narcissists are introduced to the picture, however, there is a new worry that arises: While narcissists can accept (and crave) praise, they can’t accept angry blame; it simply doesn’t latch onto them the way it does non-narcissists. If so, this suggests that there may be a deep asymmetry in the entire enterprise, that the capacities necessary for being a proper target of blame are just (asymmetrically) different from the capacities necessary for being a proper target of praise.
Conclusion
Authors: Shoemaker David
Published: September 2024

In this concluding chapter, a summary of the arguments of the book is provided, along with a final chart detailing the full architecture of blame and praise. Added in Part Two to the design presented at the end of Part One are discussions of non-emotional forms of blame/praise (e.g., sanctions and rewards), blame’s and praise’s other- and self-directed forms, and the normative grounds of the system’s component parts, including pure attitudinal forms of blame, mocking stings, and all the other types of blaming sanctions. All that’s needed to ground blame’s (and praise’s) variety of types and modes is either fittingness or the fairness of sanctioning systems. Desert is entirely unnecessary. The chapter concludes with a discussion of a series of new data points that must be taken seriously, followed by several suggestions for different areas of focus for theorizing about responsibility going forward.
Voluntary Turnover in Organizations
Authors: Hom Peter , Seo Jungmin
Published: September 2024

Employee turnover—or voluntary resignation from employing organizations—affects both the welfare of leavers and employers. Given its import, scholarly inquiries during the 20th century have identified its causes, manifestations, and consequences. Classic theories focused on why employees quit, highlighting job dissatisfaction, job alternatives, and critical events prompting thoughts of quitting (“shocks”). Since the 21st century, scholars increasingly examined job embeddedness (forces constraining incumbents from leaving jobs), recognizing that the motives for why incumbents stay are not mirror opposites of oft-studied motives for why they leave. Empirical evidence for these perspectives, their deficiencies, and their refinements are discussed. Turnover research also investigated different types of turnover—notably, dysfunctional turnover (stellar performers leaving), collective turnover (unit-level quit rates), and turnover contagion (turnover inducing more turnover). Lastly, emerging work on different forms of job embeddedness, as well as its “dark side,” are examined.
Political Identity and the Indigenous Media in Bolivia: Ethnicity, Politics, and Communication
Authors: Ramos-Martín Juan , Barrientos-Garrido María Reneé
Published: September 2024

The history of Bolivia has been marked by racism and the exclusion of the vast majority of its own inhabitants. From colonial times, through the creation of the republic, and until the 20th century, the Indigenous population in Bolivia (which historically constitutes around 60% of the total of its inhabitants) was excluded by the state of their social and political rights, remaining absent from the decision-making mechanisms of the state, thus being excluded and silenced for centuries. Indigenous movement in Bolivia has been aHistorical stakeholder for the incursion of its peoples in Republican politics. After the Revolution of 1952 and the first recognition of universal voting rights and the attempts of agrarian and educational reforms, the first forms of political organization of these Indigenous communities were made as peasants’ unions. Precisely, the denaturation and loss of their own deep identities, leading to the forced “peasantization” of the Indigenous population, was the main claim, during the 1970s, of the Indianist-based revolutionary movements, which built their thinking around the claim of their own forms of economic, cultural, and political organization. The origins of the first experiences of community and Indigenous communication arose from the movements’ own questions, claiming for their own forms of organization, structure, and narratives, which show as a whole the identity and political and cultural complexities and specificities. Beyond the colonial elements of understanding, emerge as a dialogical sense of understanding their own cosmologies, but also vindictive, in the need to build their own communication and action mechanisms. Thus, the different cultural and cosmopolitical resistances have assumed a central role as a mobilizing element of sociopolitical awareness in the face of the powers established by the institutional management of public space, beyond the formal organization of their structures, in the construction of intersections that take advantage of interstitial spaces to develop identity stories with a clear emancipatory vocation. However, this reflection not only belongs to an exclusive past, but in a scenario as identifiable as the current onein 2024, in which one of the great issues present in social and political construction in Latin America has to do with the great problem of representation as a form of political-identity construction in the complex societies of a Global South. Focused on the definition and political-cultural configuration of the Indigenous movement, the different Bolivian subalternities, far from having forged their own discourse around the multiplicity of daily resistances, still suffer from a systematic lack of voice in the deepening of abysmal differences that necessarily refer to rerecommending the question beyond the discursive exercise, from a perspective closer to the political economy of knowledge.
The Mnemonic Effects of Retrieval Practice
Authors: Zepeda Cristina D. , Een Emily , Butler Andrew C.
Published: September 2024

Retrieval practice refers to the act of retrieving information from memory with the intent to promote learning. Although retrieval practice is often operationalized as taking a test, it can occur through many different types of learning activities (e.g., answering a question posed by a teacher, working on a practice problem, writing an essay, using flashcards, having a group discussion). Research on retrieval practice has a long history, but there has been a surge of interest since 2005 in the phenomenon. This large body of research has shown that retrieval practice produces superior long-term retention and transfer of learning to new contexts relative to activities that are predominantly used to study material (e.g., listening to a lecture, reading a textbook, watching a video)—a finding that is commonly referred to as “the testing effect.” Importantly, it is the act of retrieving that causes learning; such direct effects of retrieval practice can be distinguished from its indirect effects on learning. These indirect effects include: providing formative feedback to the learner, incentivizing study, and reducing test anxiety. Research has also identified several factors that moderate the effects of retrieval practice, including experimental design, test format, provision of feedback, and retention interval. In addition, there is ample evidence to support the conclusion that the benefits of retrieval practice are highly generalizable across learner populations, materials and skills, settings, and outcome measures. Given that the mnemonic benefits of retrieval practice are robust and generalize broadly, it is widely recommended as a learning strategy for students and a pedagogical technique for educators.
Lusotropicalismo
Authors: Bastos Cristiana , Castelo Cláudia
Published: September 2024

Lusotropicalismo, or Lusotropicalism, was officially coined in 1951 by Gilberto Freyre when delivering an invited talk in Goa, India, during his visit to the Portuguese colonies in Africa and Asia. Freyre did not invent the concept on the spot: it evolved from his earlier analysis of Brazilian society and colonial history as a tale of three peoples (Europeans, Africans, and Indigenous)—a tale in which the Portuguese were portrayed in a positive manner, with a tendency to mix and mingle that ultimately resulted from their own history of mixtures and mingling. Albeit controversial, Freyre’s sympathetic portrayal of the Portuguese in tropical lands was valued by some intellectuals of Portugal and African colonies since the 1930s. In the 1950s, the Portuguese government invited him to visit the colonies and write about them. While claiming total independence, Freyre wrote about the Portuguese colonial endeavor with sympathy and strengthened his depiction of their overseas encounters as more fluid and benign than those of other colonizers. His views would ultimately become official doctrine of the Portuguese regime in the 1960s, precisely when other colonial regimes collapsed. Transmitted in textbooks, media, official documents, and a number of propaganda channels, Lusotropicalist ideas became deeply ingrained and naturalized under the colonial regime, which lasted until 1975. They influenced popular representations of colonial history, interracial harmony, and cultural exchanges in ways that outlasted the regime and entered the 21st century.
Archaeology of the Canary Islands
Authors: Alberto-Barroso Verónica , Delgado-Darias Teresa , Velasco-Vásquez Javier
Published: September 2024

The Canaries were the only Macaronesian archipelago to have had a stable population before the European expansion in the Atlantic in the late Middle Ages. North African indigenous populations occupied the Canary Islands in the first centuries of the 1st millennium ce and formed island communities whose historical definition amalgamates traditions from their continental origin, local adaptations, and the social dynamics generated by periods of isolation, yet also includes occasional migratory events that affected some of the islands. This shaped populations with a particular development in each part of the archipelago that is manifested in different archaeological expressions. Thus, while some traits can be regarded as held in common, such as the agropastoral resources on which subsistence depended and certain domestic models and funerary practices, other materialities reflect autonomous sociocultural processes. The European conquest and colonization of the Canary Islands in the 15th century led to the sudden disappearance of those Insulo-Amazigh cultures, even though a few aspects have survived, such as some traditions, linguistic elements, foodstuffs, and a genetic footprint that can still be identified in the modern Canary population.
Social and Behavior Change Communication in Sexual and Reproductive Health
Authors: Sood Suruchi , Rimon Jose
Published: September 2024

Social and behavior change communication (SBCC) is a core public health strategy not just for interventions designed to prevent, control, and treat disease but also for addressing the social determinants of health. Quality SBCC interventions are based on some common design, implementation, and evaluation best practices. The evidence base for using SBCC for sexual and reproductive health (SRH) includes, among other programs, family planning, maternal and neonatal health, and HIV/AIDS. Three global SBCC interventions—one on each of these topics—are presented as exemplars of best practices in public health communication programs designed to improve individual health behaviors and enable social change.

These SBCC programs employed cross-cutting approaches covering different levels of the social-ecological model while tackling multiple related health issues. While emphasizing individual roles and responsibilities, recognizing the importance of the cultural, social, and political context within which individuals live and work allowed these interventions to address social and gender norms. All three were theory-based and evidence-driven. They applied constructs from social and behavior change (SBC) theories to model causal pathways and stages or steps of behavior and community-level change. In addition, they relied on comprehensive, mixed-methods research throughout the project cycle. Other best practices included intersectoral collaboration and steps to ensure scale-up and sustainability.
Israeli Space Program: Assessing the Civilian Space Program Over the Last Decade
Authors: Paikowsky Deganit , Blasberger Avi
Published: September 2024

Over the past decade, economic trends in global space activity advanced greater commercialization and prompted established spacefaring nations to rapidly adapt their space strategies and programs. This is an underresearched area, especially concerning small states. Following a 2008 industry crisis, Israel’s space program, initially driven by national security concerns in the 1980s, experienced a need to shift toward greater scientific and commercial activities to assure its local space industry is sustainable and competitive. A 2010 national task force recommended that the Israel Space Agency (ISA) implement an initiative to foster a national space ecosystem, using the existing developed assets and by transitioning away from a state-centric model. For a decade, the ISA attempted to do so. The ISA followed the task force’s plan, promoting civilian and commercial activities. However, success has been partial. Financial limitations and a lack of national space prioritization hinder the ISA’s program’s full potential. Thus, the Israeli space ecosystem remains modest, falling short of ambitious economic goals.
Trans and Travesti Identities in 20th-Century South America
Authors: Yarfitz Mir , Butierrez Marce Joan
Published: September 2024

The long 20th century can be divided into five thematic and roughly chronological periods distinguished by new gender terminology, corporal technologies, and political strategies in the context of South American political, intellectual, and economic developments: the development of South American sexology to the mid-20th century; the first “sex change” surgeries, 1950s–1970s; violence and repression under dictatorships and democracies, 1970s–1990s; the emergence of travesti identity, 1970s–1980s; and activist movement coalitions and strategies, 1990s–2000s. Modern gender and sexual categories began to be consolidated by “experts” in new medical and social scientific fields in the late 19th and early 20th centuries, whose case studies in burgeoning urban areas conflated gender transgression and sexual orientation; some figures previously situated in gay and lesbian history can thus be reclaimed as part of a trans genealogy. The first “sex change” surgeries in Europe and the Americas in the 1950s not only opened new embodiment possibilities but also inspired new forms of legal and medical restriction. As nations returned to democracy from the region’s repressive military dictatorships of the 1970s–1980s, violence against trans and travesti communities continued, with new forms of policing and increasingly organized political resistance. The consolidation of the travesti identity was decisively influenced by the transnational circulation of hormone and silicone technologies from Brazil to other South American countries, as well as prosthetics and the common experience of sex work. From the 1990s, trans and travesti political organizing developed in conjunction with broader movements for LGBT and human rights as well as HIV/AIDS prevention campaigns. Although historical sources and scholarship are unevenly available, the rich and varied regions of South America provide a range of examples and exciting opportunities for future research, including through community-generated archival projects.
Hip-Hop Language and Linguistics
Authors: Ross Andrew S. , Westinen Elina
Published: September 2024

A significant sociopolitical event in New York City led to the emergence of the hip-hop musical genre, which is now a critical part of global popular culture and the performance landscape. In general terms, hip-hop, and in particular rap, can be understood as a form of spoken word or rhymed storytelling, accompanied by music. In the 1970s, the construction of the Cross-Bronx Expressway (1948–1972) effectively displaced many residents from the South Bronx, an area where residents were already faced with high levels of unemployment and poverty. These social conditions led to the birth of hip-hop as a performative genre that provided a space for the marginalized to express their voice. These non-mainstream origins and the limited political and societal power that accompanied these conditions led to hip-hop being seen as a form of resistance. Since these times, hip-hop has broken into the mainstream and is now a multi-billion-dollar part of the music industry.

While hip-hop has grown as a genre of music and popular culture, so too has its reach on the global scale. Initially, this meant moving beyond New York, where different variations in African American English were incorporated along with more localized social and political concerns. Later, hip-hop began to spread around the world with a particularly unique ability to cross social, cultural, and geographic boundaries, as well as sociolinguistic boundaries. Emerging in various locations, it has proved its capacity to become translocal, taking on distinctly local features in a process of establishing authenticity inclusive of slang, dialect, accent, and phonological features as well as cultural markers and references to local political and social agendas. Hip-hop’s movement around the world has seen the emergence of important work on varieties of hip-hop. The underlying thesis here is that the localization of hip-hop is not merely global hip-hop adding in a few local features, but that it is always local, particularly in its linguistic features and general thematic and topical concerns.
A modified dual preparatory method for improved isolation of nucleic acids from laser microdissected fresh-frozen human cancer tissue specimens
Authors: Kimble Danielle C , Litzi Tracy J , Snyder Gabrielle , Olowu Victoria , TaQee Sakiyah , Conrads Kelly A , Loffredo Jeremy , Bateman Nicholas W , Alba Camille , Rice Elizabeth , Shriver Craig D , Maxwell George L , Dalgard Clifton , Conrads Thomas P
Published: September 2024

A central theme in cancer research is to increase our understanding of the cancer tissue microenvironment, which is comprised of a complex and spatially heterogeneous ecosystem of malignant and non-malignant cells, both of which actively contribute to an intervening extracellular matrix. Laser microdissection (LMD) enables histology selective harvest of cellular subpopulations from the tissue microenvironment for their independent molecular investigation, such as by high-throughput DNA and RNA sequencing. Although enabling, LMD often requires a labor-intensive investment to harvest enough cells to achieve the necessary DNA and/or RNA input requirements for conventional next-generation sequencing workflows. To increase efficiencies, we sought to use a commonplace dual preparatory (DP) procedure to isolate DNA and RNA from the same LMD harvested tissue samples. While the yield of DNA from the DP protocol was satisfactory, the RNA yield from the LMD harvested tissue samples was significantly poorer compared to a dedicated RNA preparation procedure. We determined that this low yield of RNA was due to incomplete partitioning of RNA in this widely used DP protocol. Here, we describe a modified DP protocol that more equally partitions nucleic acids and results in significantly improved RNA yields from LMD-harvested cells.
MOY 2 - ‘Cachexia Index’ for Prognostication in Surgical Patients with Locally Advanced Oesophageal or Gastric Cancer: A Multicentre Cohort Study
Authors: Brown Leo , Thomson Georgina , Gardner Ellen , Chien Siobhan , Crumley Andrew , Skipworth Richard
Published: September 2024

Background

Features of cancer cachexia are known to adversely influence patient outcomes, yet few currently inform clinical decision-making. This study assessed the value of ‘cachexia index’ (CXI), a novel prognostic marker, in patients planned for curative multimodal therapy (neoadjuvant chemotherapy (NAC) and surgery) for oesophagogastric cancer.

Methods

Consecutive patients newly diagnosed with locally advanced (T3/4 or ≥N1) oesophagogastric cancer were identified through the West of Scotland and South-East Scotland Cancer Networks. CXI was calculated as (L3 skeletal muscle index) x (serum albumin) / (neutrophil-lymphocyte-ratio). Sex-stratified cut-off values were determined based on area under the curve (AUC), and patients were divided into low and normal CXI groups. Primary outcomes of interest were disease progression during NAC and overall survival (≥5-years follow-up).

Results

Overall, 385 patients (72% male, median 66 years) were treated with NAC for oesophageal (n=274) or gastric (n=111) cancer across the study period. While patients with a low CXI (males: <52 [AUC: 0.691] and females: <41 [AUC: 0.759]) were older and more comorbid, disease characteristics were comparable to those with a normal CXI. Rates of disease progression during neoadjuvant chemotherapy, leading to inoperability, were higher in patients with low CXI (28% vs. 12%, aOR: 3.07 (95% CI: 1.67-5.64), p<0.001). Moreover, low CXI was associated with worsened post-operative mortality (p=0.019) and decreased overall survival (median: 14.9 vs. 56.9 months, aHR: 1.85 (95% CI: 1.42-2.42), p<0.001).

Conclusion

CXI represents a valuable marker of ‘host stage’, and a potential adjunct to routine tumour staging. This could improve prognostication and decision-making in patients with locally advanced oesophagogastric cancer.
BJS 1 - Endoscopic histopathology results in patients undergoing oesophageal cell collection device and biomarker testing for Barrett’s oesophagus surveillance
Authors: Chien Siobhan , Glen Paul , Fullarton Grant
Published: September 2024

Aims

Barrett’s oesophagus surveillance places significant burden on endoscopy services, yet is fundamental to detect early cancerous change. Oesophageal cell collection device (OCCD) testing was introduced across Scotland for Barrett’s surveillance in response to the COVID-19 pandemic. This national retrospective study presents the CytoSCOT programme results and evaluates whether OCCD testing is successfully identifying high-risk Barrett’s patients requiring urgent endoscopy.

Methods

All patients undergoing OCCD testing using Cytosponge(TM) for Barrett’s surveillance across 11 Scottish health boards over a 32-month period were identified. Patients who underwent endoscopy within 12 months of OCCD test were included. Individual patient records were interrogated to record clinical information and OCCD test result to categorise patients into risk groups: endoscopic histopathology results were analysed according to risk group and segment length. Patients were deemed high-risk if the OCCD test demonstrated atypia and/or p53 positivity.

Results

4204 Barrett’s OCCD tests were performed in 3745 patients: 608 patients had an endoscopy within 12 months and were included in this analysis. Patients with longer Barrett’s segments were significantly more likely to have an abnormal OCCD test (p<0.001). 50/608 patients (8.2%) had high grade dysplasia or cancer on endoscopic biopsies: this relays to 1.3% of the total group (50/3745). 46/50 patients (92.0%) were deemed high-risk, triggering urgent endoscopy: this rose to 100% with insufficient tests removed. There were no missed cancers within 12 months of OCCD test in our cohort.

Conclusions

OCCD testing is an effective triage tool to identify high-risk Barrett’s surveillance patients requiring further investigation with urgent UGI endoscopy within the real-world setting.
NELA 1 - Actual and predicted 30-day mortality following emergency laparotomy using National Emergency Laparotomy Audit (NELA) and American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) risk prediction tools
Authors: Moscalu Andrei , Mohsen Fatema , Battili Mamata , Timofeiov Sergiu , Sinclair Martin
Published: September 2024

Background

Emergency laparotomy (EL) is common, with >30,000 performed annually in the UK. EL has a high 30-day mortality of 9.2%, especially in the elderly. Reliable preoperative risk assessment is essential to aid decision-making and perioperative care arrangements. NELA and ACS-NSQIP risk calculators can both be used to assess risk, and both can under or over-predict mortality.

Methods

This is a multi-center, retrospective, observational, cohort study investigating the correlation between actual 30-dm (a-30-dm) and predicted 30-dm (p-30-dm) following EL using NELA and ACS-NSQIP in adults over and under 70, over 2-years, in two UK centres. Sample size was calculated at 385 cases. Statistical analysis was carried out using GraphPad Prism 10.1.1.

Results

626 cases were analyzed. A-30-dm, NELA, and ACS-NSQIP p-30-dm in the under 70s subgroup were 5.78%, 5.53%, and 3.41% respectively, with NELA and ACS-NSQIP correlating positively with a-30-dm: R²=0.12, p<0.0001 and R²=0.09, p<0.0001. In over 70s, a-30-dm was 13.96%, NELA p-30-dm 14.02% and ACS-NSQIP 9.76%, with a positive correlation between the latter two (R²=0.56, p<0.0001), but a weak one between a-30-dm and NELA (R²=0.04, p<0.0001) or ACS-NSQIP (R²=0.02, p<0.0001). For the entire cohort a-30-dm, NELA and ACS-NSQIP p-30-dm were 9.74%, 9.8%, and 6.59% respectively. NELA and ACS-NSQIP p-30-dm showed a strong positive correlation (R²=0.89; p<0.0001) with only NELA showing a strong positive correlation with a-30-dm (R²=0.31, p<0.0001); and not ACS-NSQIP (R²=0.05, p<0.0001).

Conclusion

NELA can accurately predict 30-day mortality in patients aged <70 undergoing EL but not >70. ACS-NSQIP and a-30-dm correlated in a very weak manner.
SUS 2 - Routine histological examination of haemorrhoidal tissue – an unnecessary environmental and economic expense?
Authors: Warner Naomi , Karunatileke Chatura , Hurst Katherine , Singh Anjana
Published: September 2024

Background

Modern, less invasive methods of haemorrhoid treatment, such as haemorrhoid artery ligation and radiofrequency ablation, are increasingly employed. These do not yield specimens for histological analysis. However, when open haemorrhoidectomy is performed, even in the absence of suspicious operative features and in low-risk patients, the haemorrhoid specimen is routinely sent. This has both environmental and financial costs in an increasingly pressured NHS, and negatively impacts sustainability with no clinical advantage.

Methods

We retrospectively studied 112 open haemorrhoidectomies performed at our UK hospital from February 2018 to June 2023, reviewing clinic letters, operation notes and post-operative histology.

Aims

To assess the frequency of incidental pathology identified during routine histological assessment, and the associated financial costs and carbon footprint generated.

Results

112 open haemorrhoidectomies were performed in the 5-year study period. In total, two patients with risk factors for AIN/Anal cancer were identified. There were no documented concerns of abnormal intra-operative findings. Histology mainly revealed haemorrhoid tissue alone (103) and benign polyps (8). AIN3 was detected in one of the high-risk patients. The cost per histology specimen was £93.32 (Total cost £10,451.84). Each specimen is estimated to generate 0.29kg of Carbon Dioxide equivalents (Total 32.48kg CO2e).

Conclusion

Routine histological assessment of haemorrhoidectomy specimens is time-consuming, expensive and has an avoidable carbon footprint for a low detection of incidental pathology. Our study suggests that histology should be reserved for patients with risk factors for AIN/Anal cancer, or concerning intra-operative findings. Larger scale studies, and development of national guidelines would aid clinician decision-making.
SP1.3 - Surgical Practices in Emergency Umbilical Hernia Repair and Implications for Trial Design
Authors: Walshaw Josephine , Kuligowska Anna , Smart Neil J , Blencowe Natalie S , Lee Matthew J
Published: September 2024

Aims

There is variation in the investigation, management, and surgical technique of acutely symptomatic abdominal wall hernias and optimal strategies remain to be established. This survey aimed to identify key variables influencing decision-making and preferred surgical techniques in emergency umbilical hernia care to help inform trial design and understand potential challenges to trial delivery.

Methods

A survey was distributed to surgeons through social media, personal contacts, and ASGBI lists. It comprised five sections: (i) performer of repair, (ii) repair preferences, (iii) important outcomes, (iv) antibiotic use, and (v) trial design.

Results

There were 105 respondents, of which 49 (46.6%) were consultants. The median largest defect surgeons would attempt to repair with sutures alone was 2cm (IQR 2-4cm). In the acute setting, the most common mesh preferences are preperitoneal plane placement (n=61, 58.1%), with synthetic non-absorbable mesh (n=72, 68.6%), in clean (n=41, 39.0%) or clean-contaminated (n=52, 49.5%) wounds. Respondents believed suture repair to be associated with better short-term outcomes, and mesh repair with better long-term outcomes. The trial design felt to most likely influence practice is comparing mesh and suture repair, and also comparing post-operative antibiotics versus no post-operative antibiotics. Respondents indicated that to change their practice, the median difference in surgical site infection rate and recurrence rate would both need to be 5%.

Conclusion

This survey provides insight into surgical preferences in emergency umbilical hernia management, offering guidance for future trial designs. Such designs should align with existing evidence and incorporate patient and public involvement to ensure a meaningful impact.
SP1.9 - Management of cutaneous abscesses and infected sebaceous cysts using inhaled methoxyflurane Penthrox®: a 12 month prospective observational study
Authors: Carney Alex , Birkin Rebecca , Whitehead Nicola , Heath Jennifer , Dawson Julian , Laing Richard
Published: September 2024

Aims

Incision and drainage of abscesses contribute a significant burden upon emergency general surgical theatres. The purpose of this study was to look at the safety and effectiveness of incision and drainage using inhaled methoxyflurane (Penthrox®) to reduce reliance upon surgical theatres and provide an effective alternative to local anaesthetic.

Methods

After a successful pilot of 20 patients, adults with ‘simple’ abscesses were enrolled over a 12-month period and given inhaled methoxyflurane for ward-based incision and drainage. Pilonidal and perianal abscesses, patients with ASA ≥3 and abscesses greater than 5cm in size were excluded. Length of admission and outcomes at 1 week, 1 month and 3 months post procedure were compared to previously audited data on simple abscess drainage in theatre to determine safety, efficacy and cost-savings.

Results

130 patients had an abscess drained using Penthrox® inhaled analgesia. 93.8% (122/130) had successful drainage with a mean admission time of 99 minutes. Eight patients reattended for further treatment (3<3 months, 3<1 month and 2<1 week); two patients required antibiotics and five required further drainage. Patients taken to theatre spent on average 34.5 hours in hospital compared to 1.65 hours for those performed using Penthrox®. A patient feedback tool captured very positive comments with no negative experiences recorded.

Conclusion

Penthrox® is a safe, effective analgesic for the incision and drainage of simple abscesses and patient experience is overwhelmingly positive. In addition, it significantly reduces the burden on emergency theatres and the hospital bed-base with an estimated minimum saving of £1704 per patient.
SP2.3 - Environmental and non-technical factors influence surgical trainees involvement in laparoscopic appendectomy in Northern Italy: a propensity score matching and survey based multicenter analysis
Authors: Cioffi Stefano Piero Bernardo , Altomare Michele , Spota Andrea , Granieri Stefano , Virdis Francesco , Cimbanassi Stefania
Published: September 2024

Aims

Laparoscopic appendectomy (LA) is an index procedure for surgical residents (R). The trends of R involvement in LA can be a quality benchmark for residency programs. The impact of clinical and non-clinical factors on such trends is still undisclosed. We aimed to investigate the prevalence of LA performed by R in the largest Italian educational network and explore the decision-making behind R involvement in LA.

Methods

We extracted data from the RESIDENT-1 (R1) multicenter trial registry and performed a propensity score matching (PSM) analysis to identify clinical and environmental differences according to the operator, surgeons(S) vs R. Additionally, to explore environmental and non-technical factors influencing the choice of the primary operator, we administered a survey to S and R in the R1 network.

Results

We enrolled 653 LA from October 2019 to October 2022, 234 (35.89%) were performed by R. We compared 231 per group after PSM. In academic hospitals and dedicated emergency surgery units LA were more frequently approached by R (57.14%vs26.84%, 51.08%vs19.05% p<0.001, respectively). The survey showed discrepant perspectives, R prioritize clinical factors, as the presence of complicated disease (25.53%vs.8.33%, p<0.015), whilst non-technical and environmental factors such as year of residency (63.1%vs.44.7%,p=0.05) and punctuality (47.2%vs.23.4%,p=0.041) were more important for S. Both groups agreed that a perioperative feedback system would improve the process of R involvement in LA.

Conclusion

Our study report a low rate of LA performed by R in northern Italy, primarily influenced by non-clinical factors. Furthermore, dedicated pathways and a well-structured perioperative teaching method could optimize the teaching process.
SP3.2 - Investigating pre-operative anaemia optimisation in patients on the colorectal cancer pathway
Authors: Sarkar Shuvam , Payne Christopher , Gray Carol
Published: September 2024

Aims

Colorectal cancer (CRC) is becoming increasingly prevalent in the United Kingdom, with over 42,000 cases diagnosed every year. CRC is most commonly diagnosed at colonoscopy. Patients are often found to have iron deficiency anaemia during pre-assessment and may require intravenous iron (IVI) replacement for preoperative optimisation. Our aim was to determine the percentage of patients on the CRC pathway requiring optimisation of anaemia and to review the pathway for patients requiring IVI preoperatively, to identify opportunities for improvements.

Methods

This study investigated 85 patients who were referred to the pre-assessment clinic (PAC) under the CRC pathway. The percentage of patients requiring IVI to optimise their anaemia was identified. The time taken to refer patients for IVI, and the time taken to infusion appointment was then established.

Results

This study found 24% of patients were anaemic, with 12% showing severe anaemia requiring IVI. The average waiting time between colonoscopy and PAC review was 24 days. Patients requiring IVI waited a further 8 days on average to be referred for replacement. There was a delay of 10 days from referral for iron before patients were given the first dose of iron, with patients waiting up to 4 weeks before the course of intravenous iron was complete.

Discussion

Patients on the CRC pathway currently face significant delays in optimising iron deficiency anaemia pre-operatively. Investigating patients for anaemia at the time of colonoscopy and referring for iron replacement earlier could reduce this delay and ensure patients are optimised in a timely manner for surgery.
SP3.7 - Patient experiences of using wearable health monitors during cancer treatment: A qualitative study
Authors: Collinson Sophie , Ingram-Walpole Shannon , Jackson Corie , Chan Anthony , Merchant Zoe , Wilson Anthony
Published: September 2024

Introduction

Wearable health monitors (WHM) are being used in healthcare with increasing popularity, and offer a minimally invasive, ambulatory method of 24-hour monitoring. The aim of this study explores the patient experience of using WHMs during cancer treatment, including barriers and enablers of WHM use.

Methods

A phenomenological qualitative approach was used with single semi-structured interviews conducted in the form of focus groups with individuals enrolled in the EMBRaCE-GM study where WHMs are worn in the perioperative period of at least 6 months during treatment of either colorectal cancer, lung cancer, leukaemia/lymphoma or head & neck cancer.

Results

We identified 3 major themes of perceived patient benefit, treatment partnerships between patients and healthcare professions and barriers to the adoption. WHMs promoted positive behaviour change, prioritisation of own health and represented a form of “digital advocacy”. Potential barriers were aesthetic, experiential and technological. WHM introduction was time-sensitive, with patients finding their use acceptable at differing stages in their cancer pathway. Patients desired reciprocal interaction with WHMs and were less concerned with data accuracy.

Discussion

Our study identifies factors influencing a patient’s decision to use WHMs and their importance as a patient-centric interactive component of management. Novel findings include the optimal time to start wearing WHMs and that validity of measurements appears less of a concern for patients (in contrast to clinicians) who use wearable data and trends with their own experiences as part of a sense making exercise. Future work should focus on balancing patient and clinician expectations to provide guidance on the feasibility of WHM use in routine clinical practice.
SP3.10 - Utilisation and Outcomes of Emergency Laparoscopic Resection for Colon Cancer: A Population-based Study in England
Authors: Rashid Adil , Kuryba Angela , Braun Michael , Fearnhead Nicola , Van Der Meulen Jan , Walker Kate
Published: September 2024

Aims

To evaluate the current use and outcomes of urgent or emergency laparoscopic resection of colon cancer in the National Health Service in England.

Methods

11,182 patients from the National Bowel Cancer Audit diagnosed with colon cancer from April 2017 to March 2022 in England, who underwent urgent or emergency resection, were included. Multivariable logistic and linear regression was used to quantify factors associated with use of laparoscopic surgery and compare risk-adjusted postoperative outcomes between laparoscopic and open surgery.

Results

The use of emergency laparoscopic resection increased from 33.0% in 2017 to 47.5% in 2022, with a temporary stabilisation during the first wave of the COVID-19 pandemic (38.9% 2020/21). In risk-adjusted analyses of 9,579 patients, patients with poorer physical status [ASA 4/5 vs 1, aOR 0.35 (95% confidence interval 0.27-0.44) P < 0.001], more advanced T-stage [T4 vs T1-T2, aOR 0.26 (0.21-0.32) P < 0.001] and M-stage [M1 vs M0, aOR 0.87 (0.76-0.99) P < 0.036] were less likely to undergo laparoscopic surgery. No association was found with age, socioeconomic deprivation, or nodal stage. Patients undergoing laparoscopic resection had a shorter length of stay [adjusted mean difference -2.55 days (-3.23, -1.87), P < 0.001], lower 90-day mortality [aOR 0.75 (0.63-0.89), P = 0.001], and lower 30-day unplanned reoperation [aOR 0.82 (0.70-0.96), P = 0.014] than patients undergoing open resection.

Conclusion

There has been an increased utilisation of laparoscopic surgery in the emergency setting, and it is associated with reduced hospital stay, postoperative mortality and unplanned reoperation.
SP4.4 - Gallbladder Cancer: Radical Surgery and Prognosis
Authors: Lamara Abdelhak , Nini Badreddine
Published: September 2024

Introduction

The prognosis for gallbladder cancer remains unfavorable, with advanced forms not being uncommon. This prospective study aims to assess outcomes based on the tumor stage and prognostic factors.

Materials and Methods

Patients with gallbladder cancer were included in a retrospective study, during which factors influencing the type of resection were considered, and prognostic factors were analyzed. We used the biomedical statistics software SPSS24 and Microsoft Excel. Statistical analysis was performed using the chi-square test, with the calculation of the P-value (Pearson's test).

Results

One hundred and eighty-five patients were included in this retrospective study, with an average age of 62 years. In 24 patients, simple cholecystectomy was deemed sufficient, while radical cholecystectomy involving the gallbladder bed with lymphadenectomy was performed in 27 patients. Seventy-nine patients underwent hepatic resection (S4b–S5), and bile duct resection was necessary in 12 patients. Due to local and metastatic extension, 43 patients received palliative treatment. R0 resection was possible in 71.3% of cases. Two early reoperations were necessary, one for bleeding from the hepatic edge and the other for an abscess. T3 or T2 tumors with lymph node invasion underwent adjuvant treatment. The recurrence rate was 14.5%. The three-year survival, across all stages, was 73.4%.

Conclusion

Radical surgery of gallbladder cancer is not always possible. The tumor stage and type of resection influence the survival rate.