bluuebunny/crossref_metadata_2025 huggingface dataset:
Tribology of Electroless Nickel and Interlayer Coatings: A Review
Authors: Haniff Bharim A. , Zakwan Sarian M. , Bahiyah Baba N.
Published: April 2021

This review emphasizes on the development of electroless nickel composite coatings by incorporating different types of material and interlayers to improve the mechanical and tribological properties of the coatings. Electroless nickel coatings are the main focus of this review as it possesses excellent mechanical and tribological properties such as, hardness, wear and corrosion resistance. Besides, electroless nickel coating may behave as lubricating as well as wear resistance coating compared to other interlayer coatings. Tribology aspect is concern on the friction and wear phenomena which involved the moving parts that measures the overall systems’ life, efficiency, and reliability. Interlayer coatings are applied to improve the adhesion between the substrate and the outer coating materials. Various materials are used as interlayers either pure or compound metallic elements.
Experimental Study On Counting Of Eggs In Egg Breaking System And Level Maintenance In Collecting Tanks
Authors: Vairavel K S , Prabhu V , Poorna Divya R
Published: April 2021

The food industry is a global collective of diverse businesses that supply much of the food energy consumed by the world population. Eggs are one of the most nutritious foods available. The versatility of eggs means that they are an important ingredient in many food products including cakes, sauces, desserts and sandwiches. In egg processing industry the approximate amount of egg processed is 14, 00,500 eggs per day including wastages. But there is no accurate method to measure the broke eggs excluding the wastages. Our Project enhances the correct measurement and provides the data that how much eggs can be break to improve the amount of egg powder produced. Our project also includes the level maintenance the collecting tank which collects yolk, albumen and whole egg separately after breaking the eggs and the suction motor can be operated automatically when the level reaches the required level, this helps in complete automation in the industry by using Programmable Logic Controller (PLC).
Synthesis, characterization and optical properties of rare earth doped barium hexaferrite nano particles
Authors: Mahapatro Jayashri , Agrawal Sadhana
Published: April 2021

In this work we have prepared a series of BaFe12O19 :xEu3+ (x=0 to 2 mol %) samples by combustion method. The prepared samples were characterized by PXRD, TEM and FTIR. The structural analysis of PXRD pattern affirms that the specimens have space group p63/mmc and hexagonal structure. The TEM micrographs show hexagonal plate like structure and the FTIR spectra show vibration between the 4f1 and 4f2 crystallographic sites of the ferric ions. The absorption spectra of the prepared specimen were obtained from UV-vis spectroscopy. The calculated band gap values range from 3.99 eV to 2.29eV.
Study of TL characteristics of CaSO4: Dy phosphor with fly ash for thermoluminescence dosimeter application
Authors: Shrivastava Umakant , Mishra Vikas , Purle Narottam , Khan Mohammad Ziyauddin , Pali Rahul , Narasingham DVK , Sarkar Sukanto , Chandel Bhusan
Published: April 2021

In recent past fly ash is only being treated as waste and a source of air and water pollution but is in fact an eco - friendly and economically beneficial resource material for various applications and has also proven its worth over a period of time. The utilization of fly ash in several novel researches will also paves the path for systematic disposal of this waste material. The present paper involves the study of Thermoluminescence (TL) of different compositions of fly ash collected from National Thermal Power Corporation, Korba, Chhattisgarh, INDIA with (CaSO4:Dy) Phosphor. Thermo luminescence Dosimeters are regarded as the badge which absorbs the radiation when persons having TLD badges are exposed to radiation. We have to investigate and compare the glow curve behavior of pure phosphor and 10 %, 20 % and 30 % fly ash doped phosphor when it is exposed to gamma irradiation Cs137.
A study of enhanced structural, microstructural and dielectric behaviour of aliovalent ions doped BaZr0.05Ti0.95O3 ceramic
Authors: Nag Bhargavi G , Badapanda Tanmaya , Khare Ayush , Shahid Anwar M
Published: April 2021

The lead-free ceramics are considered to be the best substitutes for lead based ceramics which have tremendous harmful effects regarding environmental pollution. In this concern, the lead-free ceramics have been widely attracted by research communities. In the present study we have prepared lead free BaZr0.05Ti0.95O3perovskite ceramics with various doping concentrations of Gd3+ ions by the conventional solid-state reaction method. The perovskite phase formation was studied by x-ray diffraction which indicate the transformation of crystal symmetry from orthorhombic to tetragonal structure for the Gd3+ ions doped samples. The scanning electron microscopy studies revealed the modification in grain size on doping Gd ions also the energy dispersive X-ray spectra have been obtained to study the compositional variations. The dielectric and loss studies have been performed in the large range of temperature and frequency. The low dielectric loss and high dielectric constant suggests possible applications in memory devices and ceramic capacitors. Temperature coefficient of capacitance plots have also been plotted.
A Review on characterization and application of fly ash cenosphere
Authors: Gupta T , Bokare P S
Published: April 2021

The Fly Ash Cenospheres (FAC) or alumino-silicate is one of the most valuable by-products of fly ash generated by coal thermal power plants. It is an industrial by-product of high commercial value. It is found that FAC is hollow spherical microspheres having sizes varying 5-500 µm and chemically inert particles and make them an ideal material to replace fine aggregate from cement concrete. This study presents a systematic review of observational studies on the properties and application of FAC. Different industries use FACs due to their unique properties such as hollow spherical shape and lightweight, less specific gravity, high compressive strength, high thermal resistance, and acoustic insulation, etc. The addition of FAC to concrete has found to reduce the density of concrete without compromising the strength. Other properties such as compressive strength, flexural strength, toughness, ductility, micro-structure, etc are also documented in this study. The gap in the literature is identified and reported at the end of the research report.
Numerical simulation analysis of fluid-solid coupling of water-iubricated bearings
Authors: Liu Yong , Lao Xingsheng , Dai Chunhui , Yao Shiwei
Published: April 2021

The numerical simulation analysis of the fluid-solid coupling of the ship’s boring water-lubricated bearing is carried out to study the influence law of the inclination and eccentricity of the rotating shaft on the pressure distribution and fluid flow state in the bearing. The results show that the tilt of the rotating shaft changes the shape of the inner flow passage of the water-lubricated bearing, resulting in unstable flow in the bearing. When rotating shaft is in normal, the pressure value in the water-lubricated bearing decreases first and then increases in the axial direction. However, after the rotation of the shaft is tilted, the change of the pressure value is the opposite; the stress of the rubber layer generally shows an increasing trend with the increase of the inclination angle.
Effect of titanium addition on the oxidation resistance of Fe–13Cr-5Al-0.3Ti alloy in air between 700 °C–1100 °C
Authors: Li Peng , Li Shuai , Li Yuping , Li Guoping , Liu Jie , Wang Jian , Han Peide
Published: April 2021

Cyclic oxidation tests were carried out on a Fe–13Cr–5Al–0.3Ti alloy over a temperature range of 700 °C–1100 °C in air. The composition and structure of the oxide layer were characterized by SEM and XRD, and the influence of temperature and Ti on the oxidation mechanism was analyzed. The results demonstrated that a dense α-Al2O3 oxide layer was formed on the surface of the substrate at 900 °C, which inhibited the outward diffusion of Ti and made the alloy more resistant to oxidation. However, when the temperature was increased to 1000 °C, the oxide layer could not effectively inhibit the outward diffusion of the Ti. In particular, the oxide formed on alloys treated 1100 °C was divided into two layers, where the inner layer was a dense α-Al2O3 oxide layer and the outer layer was TiO2 oxide layer.
Neural message passing on high order paths
Authors: Flam-Shepherd Daniel , Wu Tony C , Friederich Pascal , Aspuru-Guzik Alan
Published: April 2021

Graph neural networks have achieved impressive results in predicting molecular properties, but they do not directly account for local and hidden structures in the graph such as functional groups and molecular geometry. At each propagation step, graph neural networks aggregate only over first order neighbours and can only learn about important information contained in subsequent neighbours as well as the relationships between those higher order connections—over many propagation steps. In this work, we generalize graph neural nets to pass messages and aggregate across higher order paths. This allows for information to propagate over various levels and substructures of the graph. We demonstrate our model on a few tasks in molecular property prediction.
Atom cloud detection and segmentation using a deep neural network
Authors: Hofer Lucas R , Krstajić Milan , Juhász Péter , Marchant Anna L , Smith Robert P
Published: April 2021

We use a deep neural network (NN) to detect and place region-of-interest (ROI) boxes around ultracold atom clouds in absorption and fluorescence images—with the ability to identify and bound multiple clouds within a single image. The NN also outputs segmentation masks that identify the size, shape and orientation of each cloud from which we extract the clouds’ Gaussian parameters. This allows 2D Gaussian fits to be reliably seeded thereby enabling fully automatic image processing. The method developed performs significantly better than a more conventional method based on a standardized image analysis library (Scikit-image) both for identifying ROI and extracting Gaussian parameters.
Noise Exposure and Evaluation at Tire- Changing Facilities
Authors: Willson-Kerns Cory , Brazile William J
Published: April 2021

Thirty (30) personal noise-exposure samples were collected on 20 tire-changing and repair technicians in three tire-changing facilities to determine their personal noise exposures and to estimate the maximum number of tire changes that could be performed without exceeding occupational exposure limits. Of the 30 projected 8-h time-weighted average noise samples, none exceeded the Occupational Safety and Health Administration’s Permissible Exposure Limit, 1 (3%) exceeded the Occupational Safety and Health Administration’s Action Level, and 18 (60%) exceeded the American Conference for Governmental Industrial Hygienists Threshold limit Value of 85 dBA, indicating the need for a hearing loss prevention program. The average shift time for the technicians was 6 h and 42 min and the average number of tire changes was 18. Based on the projected 8-h noise exposure 95% upper confidence limits, the estimated maximum number of tires that could be changed without exceeding the Occupational Safety and Health Administration’s noise action level was 32 tires, the permissible exposure limit greater than 40 tires, and the American Conference of Industrial Hygienists’ Threshold Limit Value was less than 20 tires. In addition, area noise samples of tire-changing equipment were taken with a sound-level meter to identify the noise sources that contributed to the tire technicians’ exposures. The air ratchet, tire-changing machine, and tire-bead seater were measured at noise levels >85 dBA, increasing the risk of noise-induced hearing loss to the technicians.
Prediction of tumor purity from gene expression data using machine learning
Authors: Koo Bonil , Rhee Je-Keun
Published: April 2021

Motivation

Bulk tumor samples used for high-throughput molecular profiling are often an admixture of cancer cells and non-cancerous cells, which include immune and stromal cells. The mixed composition can confound the analysis and affect the biological interpretation of the results, and thus, accurate prediction of tumor purity is critical. Although several methods have been proposed to predict tumor purity using high-throughput molecular data, there has been no comprehensive study on machine learning-based methods for the estimation of tumor purity.

Results

We applied various machine learning models to estimate tumor purity. Overall, the models predicted the tumor purity accurately and showed a high correlation with well-established gold standard methods. In addition, we identified a small group of genes and demonstrated that they could predict tumor purity well. Finally, we confirmed that these genes were mainly involved in the immune system.

Availability

The machine learning models constructed for this study are available at https://github.com/BonilKoo/ML_purity.
Early cancer detection from genome-wide cell-free DNA fragmentation via shuffled frog leaping algorithm and support vector machine
Authors: Liu Linjing , Chen Xingjian , Wong Ka-Chun
Published: April 2021

Motivation

Early cancer detection is significant for patient mortality rate reduction. Although machine learning has been widely employed in that context, there are still deficiencies. In this work, we studied different machine learning algorithms for early cancer detection and proposed an Adaptive Support Vector Machine (ASVM) method by synergizing Shuffled Frog Leaping Algorithm and Support Vector Machine (SVM) in this study.

Results

Since ASVM regulates SVM for parameter adaption based on data characteristics, the experimental results reflected the robust generalization capability of ASVM on different datasets under different settings; for instance, ASVM can enhance the sensitivity by over 10% for early cancer detection compared with SVM. Besides, our proposed ASVM outperformed Grid Search + SVM and Random Search + SVM by significant margins in terms of the area under the ROC curve (AUC) (0.938 versus 0.922 versus 0.921).

Availability and implementation

The proposed algorithm and dataset are available at https://github.com/ElaineLIU-920/ASVM-for-Early-Cancer-Detection.

Supplementary information

Supplementary data are available at Bioinformatics online.
Impact of STIMUlant and osmotic LAXatives (STIMULAX trial) on gastrointestinal recovery after colorectal surgery: randomized clinical trial
Authors: Dudi-Venkata N N , Kroon H M , Bedrikovetski S , Lewis M , Lawrence M J , Hunter R A , Moore J W , Thomas M L , Sammour T
Published: April 2021

Background

Recovery of gastrointestinal (GI) function is often delayed after colorectal surgery. Enhanced recovery protocols (ERPs) recommend routine laxative use, but evidence of benefit is unclear. This study aimed to investigate whether the addition of multimodal laxatives to an ERP improves return of GI function in patients undergoing colorectal surgery.

Methods

This was a single-centre, parallel, open-label RCT. All adult patients undergoing elective colorectal resection or having stoma formation or reversal at the Royal Adelaide Hospital between August 2018 and May 2020 were recruited into the study. The STIMULAX group received oral Coloxyl® with senna and macrogol, with a sodium phosphate enema in addition for right-sided operations. The control group received standard ERP postoperative care. The primary outcome was GI-2, a validated composite measure defined as the interval from surgery until first passage of stool and tolerance of solid intake for 24 h in the absence of vomiting. Secondary outcomes were the incidence of prolonged postoperative ileus (POI), duration of hospital stay, and postoperative complications. The analysis was performed on an intention-to-treat basis.

Results

Of a total of 170 participants, 85 were randomized to each group. Median GI-2 was 1 day shorter in the STIMULAX compared with the control group (median 2  (i.q.r. 1.5–4) versus 3 (2–5.5) days; 95 per cent c.i. –1 to 0 days; P = 0.029). The incidence of prolonged POI was lower in the STIMULAX group (22 versus 38 per cent; relative risk reduction 42 per cent; P = 0.030). There was no difference in duration of hospital day or 30-day postoperative complications (including anastomotic leak) between the STIMULAX and control groups.

Conclusion

Routine postoperative use of multimodal laxatives after elective colorectal surgery results in earlier recovery of gastrointestinal function and reduces the incidence of prolonged POI. Registration number: ACTRN12618001261202 (www.anzctr.org.au)
P21 Appendicitis during the COVID-19 pandemic: to operate or not to operate, that is the question
Authors: Antakia Ramez , Xanthis Athanasios , Georgiades Fanourios , Hudson Victoria , Ashcroft James , Rooney Siobhan , Singh Aminder A , O'Neill John R , Fearnhead Nicola , Hardwick Richard H , Davies R Justin , Bennett John M H
Published: April 2021

Background

During the Covid-19 pandemic, non-operative management for acute appendicitis (AA) was implemented in the UK. Aim of this study was to determine the efficacy and outcomes of conservative versus surgical management of AA during the pandemic.

Materials & Methods

We conducted an observational study in a tertiary referral centre. Data was collected from patients (≥16 years) with a diagnosis of AA between 1st November 2019 to 10th March 2020 (pre-COVID period) and 10th March 2020 to 5th July 2020 (COVID period).

Results

A total of 116 patients in the pre-COVID period were included versus 91 in the COVID period. 43.1% (n = 50) of patients pre-COVID were classified as ASA 2 compared to 26.4% (n = 24) during the COVID period (p-value=0.042). 72.5% (n = 66) of the patients during the COVID period scored as high risk using the Alvarado score compared to 24.1% (n = 28) in the pre-COVID period (p-value<0.001). We observed a significant increase in radiological evaluation, 69.8% versus 87.5% of patients had a CT in the pre-COVID and COVID periods respectively (p-value=0.008). 94.9% of patients were managed operatively in the pre-COVID period compared to 60.4% in the COVID period (p-value<0.001). We observed more open appendicectomies (37.3% versus 0.9%; p-value<0.001) during the COVID period compared to the pre-COVID period. More abscess formation and free fluid were found intraoperatively in the COVID period (p-value= 0.021 and 0.023 respectively). Re-attendance rate due to appendicitis-related issues was significantly higher in the COVID period (p = 0.027).

Conclusion

Radiological diagnosis of AA was more frequent during the COVID period. More conservative management for AA was employed during the COVID-19 pandemic, and for those managed operatively an open approach was preferred. Intra-operative findings were suggestive of delayed presentation during the COVID period without this affecting the length of hospital stay.
P25 AVN and complication rate following Intracapsular fracture Neck of Femur fixation in the under 60s. – Derby experience
Authors: Sian Ross , Keane Conal , Tambe Amol
Published: April 2021

Introduction

Neck of femur fractures (NOF#) are common in Trauma and Orthopaedics and Avascular necrosis (AVN) is a major complication. Guidance advises fixation within 48 hours, with no separate guidance for under 60 years of age. We reviewed factors affecting the complication rate in intracapsular NOF#’s undergoing fixation under the age of 60.

Methodology

We retrospectively reviewed a 5 year cohort (2013-2017) of intracapsular NOF#’s with native femoral head retention. 49 patients were identified. The following were determined: • Time to fixation from presentation in ED - 0-6hrs, 6-12hrs, 12-18hrs, 18-24hrs, 24-48hrs, 48+hrs: • Fixation type - Cannulated screw (CS), Dynamic Hip Screw (DHS), DHS + CS: • Complications – AVN, Non-union: • Displaced/Undisplaced

Results

31 were undisplaced, 18 displaced. 82% (N = 40) were treated with CS, 10% (N = 5) with DHS and 8% (N = 4) with DHS + CS. Overall 21% developed AVN and 10% developed non-union. After undisplaced fractures 19% developed AVN and 10% developed non-union. After displaced fractures 22% developed AVN and 11% developed non-union. 40 patients were fixed using CS, 20% developed AVN and 12.5% had non-union. AVN occurred in 20% of those fixed with a DHS and 25% fixed with DHS and CS.

No AVN was identified in the 0-6 hr fracture fixation time range.

Conclusion

No patients receiving fixation in less than 6 hours went on to have AVN or non-union, with higher rates after this time. There was no difference in outcome regarding AVN when looking at different fixation methods. There was no difference in complications when comparing fracture displacement.
P29 Bringing into focus treatment limitation and DNACPR decisions: How COVID-19 has changed practice
Authors: Marson Ella J , Botkai Adam H , Coleman Jamie J , Evison Felicity , Atia Jolene , Wang Jingyi , Gallier Suzy , Speakman John , Pankhurst Tanya
Published: April 2021

Background

The COVID-19 pandemic has introduced further challenges into Do Not Attempt Cardiopulmonary Resuscitation (DNACPR) decisions. Existing evidence suggests success rates for CPR in COVID-19 patients is low and the risk to healthcare professionals from this aerosol-generating procedure complicates the benefit/harm balance of CPR.

Methods

The study is based at a large teaching hospital in the United Kingdom where all DNACPR decisions are documented on an electronic healthcare record (EHR). Data from all DNACPR/TEAL status forms between 1st January 2017 and 30th April 2020 were collected and analysed. We compared patterns of decision making and rates of form completion during the 2-month peak pandemic phase to an analogous period during 2019.

Results

A total of 16,007 forms were completed during the study period with a marked increase in form completion during the COVID-19 pandemic. Patients with a form completed were on average younger and had fewer co-morbidities during the COVID-19 period than in March-April 2019. Several questions on the DNACPR/TEAL forms were answered significantly differently with increases in patients being identified as suitable for CPR (23.8% versus 9.05%; p < 0.001) and full active treatment (30.5% versus 26.1%; p = 0.028). Whilst proportions of discussions that involved the patient remained similar during COVID-19 (95.8% versus 95.6%; p = 0.871), fewer discussions took place with relatives (50.6% versus 75.4%; p < 0.001).

Conclusion

During the COVID-19 pandemic, the emphasis on senior decision making and conversations around ceilings of treatment appears to have changed practice, with a higher proportion of patients having DNACPR/TEAL status documented. Understanding patient preferences around life-sustaining treatment versus comfort care is part of holistic practice and supports shared decision making. It is unclear whether these attitudinal changes will be sustained after COVID-19 admissions decrease.
P40 Cross-specialty collaboration in the development of a national survey of practice for emergency scrotal exploration
Authors: Boam Tristan , Harwood Rachel , Clement Keiran , Light Alexander , Kasivisvanathan Veeru , Hotonu Sesi , Marks Isobel
Published: April 2021

Introduction

Emergency scrotal exploration for suspected testicular torsion is a common procedure, performed by Paediatric surgeons, Urologists and General Surgeons. It is expected that there is variation in practice in the way that testes are fixed after torsion and other pathologies, both within departments and across specialties. We aim to survey UK practice, and describe the impact of patient age, surgical specialty and grade of surgeon for this procedure.

Methods

The Paediatric Surgery Trainee Research Network (PSTRN) and the British Urology Researchers in Surgical Training (BURST) groups are developing an electronic national survey of practice. This will be distributed to every UK hospital; Paediatric, General and Urology Surgeons of Consultant and Middle Grade will be asked to participate if they offer this procedure as part of their current practice.

Results

After a discussion of some initial survey drafts, the PSTRN-BURST collaboration met over teleconference. The scope of the questions were broadened from looking only at fixation methods to include the initial surgical approach, methods of skin closure and a comparison between paediatric and adult practice and how the procedure changes based on the stage of puberty. The questions were refined and made more granular, and to facilitate this, the platform was changed from Google forms®, to REDCap® and finally, to Microsoft Forms®.

Conclusions

As a result of inter-specialty collaborative working, the quality of the survey questions has greatly improved. The survey is now structured in a manner that will yield the most scientifically valid conclusions and aims to benefit all clinicians that undertake emergency scrotal exploration.
P54 Framework for Delivery of Elective Orthopaedic Surgery in the United Kingdom Following the COVID-19 Pandemic
Authors: Sharkey Samantha , Narang Karamveer , Pacheco Ricardo , Anthony Christopher
Published: April 2021

Background

As we enter a second wave of the COVID-19 pandemic, a framework for safe provision of elective orthopaedic surgery must be developed in order to restore and maintain activity. The aim of this study was to explore patient attitudes to surgery and theatre efficiency in light of the COVID-19 pandemic and assess a potential framework for the delivery of such services.

Methods

Prospectively collected data on theatre timings and procedures completed per session used to assess theatre efficiency using 40 patients from June 2019 and 85 patients from June 2020. Information on patient compliance with 14-day household isolation and attitudes to surgery were collected prospectively over a 7-week period using a questionnaire (37 patients included). Follow up data was collected via telephone consultation a minimum of 2 weeks after discharge.

Results

Significant reduction in the number of points per session (p = 0.02) with a mean of 3.19 in 2019 and 2.42 in 2020. Only 18 of 31 patients were compliant with pre-operative isolation with individual failures accounting for 4 of 13 and failures by household members accounting for 9. Impact on COVID-19 and precautions on patient anxiety was mixed. No patients required symptomatic COVID-19 swab.

Interpretation

With the restrictions of COVID-19 there are significant problems with theatre efficiency, in effect losing an operation a list. Furthermore, compliance with pre-operative isolation was poor. Additional strategies will be required to re-instate an effective elective orthopaedic service, especially as the nation heads into a second wave.
P60 Impact of Acute Knee Clinic in the West of Scotland
Authors: Alfadhel Saud , Sinan Laith , Spencer Simon
Published: April 2021

Introduction

Soft tissue knee injuries are a common presentation among the young and adult population, thus, we have performed this audit to investigate the impact of introducing a new acute knee clinic in the West of Scotland with regards to delay in treatment of such injuries and potential clinical outcomes.

Methods

We have collected data from over 100 random patients with anterior cruciate ligament (ACL) injuries pre and post- the introduction of acute knee clinic in the West of Scotland and calculated the median time taken for them to see a knee specialist following their initial injury. The data was collected using a standardised proforma and analysed using Microsoft Excel. All patients included were 18-years-old and above.

Results

The introduction of an acute knee clinic has led to over 65% reduction in waiting time to see a knee specialist following a knee injury. In addition, soft tissue co-injuries such as meniscal tears were more likely to occur in patients who waited longer to be treated and thus the introduction of the knee clinic had also led to a reduction in waiting time for a definitive treatment (i.e. surgery) of patients and subsequent reduction in associated co-injuries.

Conclusion

Acute knee clinics are effective in reducing patient waiting time to be seen by a knee specialist following an ACL tear. This is particularly important as the earlier intervention is more likely to prevent subsequent meniscal and chondral injuries which in turn can provide patients with better clinical outcomes and quality of life.
P64 Improving surgical consent – a quality improvement project to enhance the consenting process
Authors: Shrivastava Manu , Brown J , Sun L , Rajagopal Rajini
Published: April 2021

Introduction

RCS guidelines on consent, recently updated, encourage a dialogue where all risks material to that patient are discussed and are clear. An audit was performed to assess whether practice at Oxford Hospitals is compliant with these guidelines – that all patients for elective surgery are consented prior to admission.

Method

Thirty-two undergoing elective Functional Endoscopic Sinus Surgery (FESS), Tonsillectomy and Septoplasty were interviewed in May-June 2019. Baseline data were presented at a local educational meeting, along with education on the recent changes to the RCS guidelines. Repeat audit took place in August-September 2020.

Results

All 32 patients were consented as per RCS guidelines and understood the reason for their surgery, but only 31% could explain the risks, and 56% could explain alternative options. Twenty (63%) consent forms were easily legible on randomised heuristic assessment. After education and change in department practice, understanding of the operation was much improved (80-100%). One outcome was to create pre-filled consent forms for common ENT operations.

Conclusions

Whilst RCS policy on completing consent prior to admission is being achieved, patient interviews suggest a lack of understanding of the operation. Standardised consent forms have the potential to enhance this understanding, as well as saving time.
P69 Intra-ocular pressure measurement in eye casualty: Which is the Fairest of Them All?
Authors: Smith Chanelle , Mamtora Sunil
Published: April 2021

Introduction

A survey completed by junior doctors who routinely run eye casualty clinics identified Goldmann applanation tonometry (GAT) as the single most time-consuming element of a standard consultation. IOP can be measured with a range of devices in the eye clinic. By identifying the most accurate and time efficient method we can save time in consultations as well as provide better outcomes for the patient.

Purpose

To compare four tonometry techniques: Goldmann applanation tonometer(GAT), Non-contact tonometer(NCT), Tonopen(TP) and Icare tonometer(ICT) to determine the most accurate and efficient method.

Method

20 subjects presenting in the casualty eye clinic were used in the study ranging between 36-75 years. Once undergoing routine ophthalmic examination from the same clinician, IOP was recorded with all devices. Three readings were taken before calculating an average value and time taken for each device for each patient. No patients were excluded from the study.

Results

The average IOP with GAT, NCT, TP and ICT was 8.5 ± 2.7, 10.3 ± 4.2, 8.6 ± 3.1, and 8.4 ± 4.5 mmHg, respectively. The average time taken with GAT, NCT, TP and ICT was 56, 132, 38 and 23 seconds, respectively. There was no significant difference in IOP measured by GAT and TP and ICT however, NCT (10.3 mm Hg, P < 0.01) measured significantly higher IOPs compared to GAT.

Conclusion

When compared to Goldmann applanation tonometer, Icare was the most accurate and efficient method. While Tonopen was fairly accurate some patients were unable to tolerate it. NCT was significantly slower compared to other devices.
P74 Long-term Survival After Minimally Invasive Resection versus Open Pancreaticoduodenectomy for Pancreatic Cancers: A Systematic Review and Meta-analysis
Authors: Gujjuri Rohan R , Kamarajah Sivesh K , Bundred James R , Jiao Long R , Hilal Mohammed Abu , White Steven A
Published: April 2021

Introduction

It remains unclear whether minimally invasive pancreaticoduodenectomy (MIPD) and open pancreaticoduodenectomy (OPD) influences long-term survival in periampullary cancers. This review aims evaluate long-term survival between MIPD and OPD for periampullary cancers.

Methods

A systematic review was performed to identify studies comparing long-term survival after MIPD and OPD. The I2 test was used to test for statistical heterogeneity and publication bias using Egger test. Random-effects meta-analysis was performed for all-cause 5-year (main outcome) and 3-year survival, and disease-specific 5-year and 3-year survival. Meta-regression was performed for the 5- year and 3-year survival outcomes with adjustment for study (region, design, case matching), hospital (centre volume), patient (ASA grade, gender, age), and tumor (stage, neoadjuvant therapy, subtype (i.e. ampullary, distal bile duct, duodenal, pancreatic)). Sensitivity analyses performed on studies including pancreatic ductal adenocarcinoma (PDAC) only.

Results

The review identified 31 relevant studies. Among all 58,622 patients, 8716 (14.9%) underwent MIPD and 49,875 (85.1%) underwent OPD. Pooled analysis revealed similar 5-year overall survival after MIPD compared with OPD (HR: 0.78, 95% CI 0.50–1.22, p = 0.2). Meta-regression indicated case matching, and ASA Grade II and III as confounding covariates. The statistical heterogeneity was limited (I2 = 12, c2 = 0.26) and the funnel plot was symmetrical both according to visual and statistical testing (Egger test = 0.32). Sensitivity subset analyses for PDAC demonstrated similar 5-year overall survival after MIPD compared with OPD (HR 0.69, 95% CI: 0.32–1.50, p = 0.3).

Conclusion

Long-term survival after MIPD is similar to OPD. Thus, MIPD can be recommended as a standard surgical approach for periampullary cancers.
P80 Meeting urological cancer targets during Covid-19
Authors: Dirie J , Hart E , Mahesan T , Fawcett W , Perry M , Janardanan S , Moschonas D , Krishnaji P , Abou-Chedid W
Published: April 2021

Introduction & Objectives

The pandemic caused by Covid-19 has caused significant strain on healthcare professionals across the globe.

Without downplaying the devastating effects of the virus itself, the collateral damage – specifically in cancer targets – has only compounded an already difficult time in medicine. Therefore, it was of the utmost importance that we: strived to continue to meet our cancer targets, and we analysed our success in addressing this.

Materials & Methods

A key factor was the proximity of a private Nuffield hospital (GN) to the primary trust. GN acted as a ‘clean site’. From 6th April 2020, 2 Xi Da Vinci robots and dedicated staff were relocated to day surgery theatres with direct: access to GN. Endoscopic procedures occurred in GN theatres. Post-operative recovery happened in GN. National guidelines were followed including COVID-19 symptom screening, isolation and preoperative nasopharyngeal swabs. All theatre staff were swabbed weekly and worked solely at GN. Patients were risk stratified prior to admittance. Cancer features and patient risk factors for COVID-19 were taken into account. Standard enhanced recovery principles were applied throughout the patient’s journey. In theatre, we worked to ensure minimal staff numbers for safe practice were present. We reviewed operations performed, alongside cancer (prostate & bladder) pathway data from March to June 2020. For comparison identical data from August to November 2019 was collected.

Results

There were a total of 369 cancer operations performed at our Trust from March until June 2020. In comparison, 407 cancer operations were performed in the 4 months from August until November 2019. For both timeframes, a: variety of robotic, endoscopic and open surgeries were carried, with similar numbers seen in each.

In total, we received 80 referrals for possible prostate malignancies from March – June 2020, and 150 from August – November 2019. Days to MRI was slightly better in March to June, but we did not find a statistical difference. We: found a statistically significant decrease in the number of days it took for a patient to go from referral to diagnosis.

Furthermore, we also improved on the proportion of patients who had their diagnosis told to them within 28 days, from 74% to 87%.

In total, we received 134 referrals for possible bladder malignancies from March – June 2020, and 81 from August – November 2019. We improved on days to OPA for patients and time to flexible cystoscopy, with both results carrying statistical significance. We were able to reduce time to OPA from 8 to 6 days, and time to flexible cystoscopy from 26 to 12 days.

Conclusions

This study demonstrates that with rapid development of separate ‘clean’ and ‘COVID’ sites, we successfully delivered a comparable, safe and effective cancer service. As we potentially face a second wave we share our success to see if these changes can be replicated elsewhere.
P85 Outcomes from elective colorectal cancer surgery during the SARS-CoV-2 pandemic
Authors:   Covidsurg Collaborative
Published: April 2021

Aim

This study aimed to describe the change in surgical practice and the impact of SARS-CoV-2 on mortality after surgical resection of colorectal cancer during the initial phases of the SARS-CoV-2 pandemic.

Method

This was an international cohort study of patients undergoing elective colon or rectal cancer resection, without preoperative suspicion of SARS-CoV-2. Centres entered data from their first recorded case of COVID-19 until 19 April 2020. The primary outcome was 30-day mortality. Secondary outcomes included anastomotic leak, postoperative SARS-CoV-2, and a comparison with a pre-pandemic European Society of Coloproctology cohort data.

Results

From 2073 patients in 40 countries, 1.3% (27/2073) had a defunctioning stoma and 3.0% (63/2073) had an end stoma instead of an anastomosis only. 30-day mortality was 1.8% (38/2073), the incidence of postoperative SARS-CoV-2 was 3.8% (78/2073), and the anastomotic leak rate was 4.9% (86/1738). Mortality was lowest in patients without a leak or SARS-CoV2 (14/1601, 0.9%), and highest in patients with both a leak and SARS-CoV-2 (5/13, 38.5%). Mortality was independently associated with an anastomotic leak (adjusted odds ratio 6.01, 95% confidence interval 2.58-14.06), postoperative SARS-CoV-2 (16.90, 7.86-36.38), male sex (2.46, 1.01-5.93), age >70 years (2.87, 1.32-6.20), and advanced cancer stage (3.43, 1.16-10.21). Compared to pre-pandemic data, there were fewer anastomotic leaks (4.9% versus 7.7%), an overall shorter length of stay (6 versus 7 days), but higher mortality (1.7% versus 1.1%).

Conclusion

Surgeons need to further mitigate against both SARS-CoV-2 and anastomotic leak when offering surgery during current and future COVID-19 waves based on patient, operative, and organisational risks.
P95 Preliminary Findings on Patient Satisfaction with Telepsychiatry – A Systematic Review
Authors: Tokell Marisa , Lin Chung M A , Dave Subodh , Abraham Seri , Ramkisson Roshelle , Mahalingappa Sridevi S , Pillai Anilkumar S , Matheiken Shevonne , Iliani Yaara Z , McNally Rosalind , Bamrah J S
Published: April 2021

Introduction

During the COVID-19 pandemic, mental health services have been presented with the unique challenge of providing effective and safe patient care whilst maintaining safety regulations. Telepsychiatry has emerged as a potential solution to this and is now being used across the UK to diagnose and manage mental health conditions. Evidence has shown that its effectiveness is comparable to face to face consultations, however, is much less clear regarding patient satisfaction. We therefore initiated a systematic review to establish whether patients are satisfied with tele-delivery of psychiatric care, and to identify the predictors of a positive experience with telepsychiatry.

Methods

A preliminary search was performed using five databases (MEDLINE, EMBASE, Cochrane Library, CINAHL, PsycINFO), with a date restriction between 2010-2020 to reflect advances in technology over the past decade.

Results

Preliminary data shows that patient views on telepsychiatric services are largely positive. Factors that arose in literature potentially affecting this include location, cost, privacy, digital literacy and technological issues including audio/video quality.

Conclusion

Our study so far shows that patient views on telepsychiatry are generally positive. The review is still in process, however, we anticipate that it will only further support our preliminary findings. These findings will be used to improve patient-centred delivery and provision of telepsychiatric services. We intend to produce a checklist of factors affecting patient satisfaction and test this in a national multicentre study. We are hoping that the study results and the resulting checklist will encourage greater patient involvement in setting up and delivering telepsychiatric services.
P99 Quantitative Assessment of Visual Function for Pituitary Macroadenomas: A Practical Scoring Algorithm
Authors: Lee Keng Siang , Jeffrey Sam , Bradley Karin , Atan Denize , Williams Adam , Abhinav Kumar , Teo Mario , Nelson Richard
Published: April 2021

Background

There is a myriad of existing terms by which visual capacity is recorded. The lack of a standardised categorisation of observations commonly result in ambiguities. We report the utility of a visual function score (VFS) in patients managed by transsphenoidal surgery.

Methods

A VFS (expressed as a percentage) with a maximum score of 20 was calculated for each eye using the Snellen VA (40% weighting: score 0-8) and Humphrey Allergan 30-2 automated visual field (60% weighting: score 0-12).

Results

280 patients (560 eyes) underwent transsphenoidal pituitary adenoma resections with complete pre and post-operative visual function assessment. Mean age 56 years; 56.4% male. 26.1% were treated by endoscopic technique and 73.9% by microscopic technique. Pre-operative vision was normal in 38.0% eyes and had full post-operative vision. In patients with pre-operative visual loss, the mean pre-operative VFS rose from 70.8% to 87.5% post-operatively. 43.8% eyes attained full post-operative vision, 28% improved, and 25.6% remained unchanged. 9 patients (2.6%) had worse immediate post-operative vision.

Discussion

The VFS is a convenient single measure of visual function that may facilitate local and national audit of transsphenoidal surgery. Studies are planned to correlate this with patient reported visual quality of life measures
P107 Safety and Efficacy of Tranexamic Acid to Minimise Perioperative Bleeding in Extrahepatic Abdominal Surgery: a systematic review and meta-analysis
Authors: Koh Amanda , Adiamah Alfred , Gomez Dhanny , Sanyal Sudip
Published: April 2021

Introduction

Perioperative bleeding is a major risk during and after surgery, which can result in increased mortality and morbidity. Tranexamic acid (TXA) in the setting of trauma, minimises perioperative bleeding and its associated risks. However, there is a lack of evidence of its use in elective abdominal surgery. This meta-analysis of randomised controlled trials (RCTs) evaluated the effectiveness and safety of TXA in elective extrahepatic abdominal surgery.

Method

A comprehensive search of Pubmed, Embase, and Clinicaltrial.gov databases was undertaken to identify RCTs from January 1947 to May 2020. The primary outcomes of intraoperative blood loss, and the secondary outcomes of need for perioperative blood transfusion, thromboembolic events, and mortality were extracted from included studies. Quantitative pooling of data was based on the random effects model.

Results

Nineteen studies reporting on 2205 patients were included. TXA reduced intraoperative blood loss (weighted mean difference (WMD) -188.35mL; 95% CI -254.65 to -121.72) and the need for perioperative blood transfusion (odds ratio (OR) 0.43; 95% CI 0.28 to 0.65). Importantly, TXA had no impact on the incidence of thromboembolic events (OR 0.49; 95% CI 0.18 to 1.35). There were no reported deaths in any of the studies.

Conclusion

TXA reduces intra-operative blood loss without an increase in complications.
P112 SMILE: Sustaining Medical Education In a Lockdown Environment.Using social media to develop a free online access medical education platform during lockdown
Authors: Pascoe John , Foster Paul , Quddus Muntasha , Kosti Angeliki , Guest Francesca , Stevens Sian , Bamford Richard , Coulston James
Published: April 2021

Introduction

SMILE is a free online access medical education (FOAMEd) platform created by two UK surgical trainees and a medical student that delivered over 200 medical lectures during lockdown.

Method

The role of Social Media in the development of SMILE was interrogated using a survey sent to all SMILE participants and by analysing activity on SMILE social media platforms.

Results

1306 students responded to the online survey with 57.2% saying they heard of SMILE through Facebook. Engagement using facebook remained highest with 13,819 members, over 800 user comments and >16,000 user reactions.

4% of the students heard of SMILE through Twitter or Instagram.

Facebook analytics revealed the highest level of traffic when lectures were most commonly held suggesting students used Facebook to access lectures.

Other educators were able to find SMILE on social media, leading to collaborations with other platforms.

Throughout the survey many mentioned how social media created and maintained a community of medical students enhancing group-based learning

Conclusions

We demonstrate that social media platforms provide popular and cost-effective methods to promote, sustain & deliver medical education for students and educators.
P115 Students experiences of graduate attribute development, a qualitative study
Authors: O'Connor Diarmuid , Geoghegan Rosemary
Published: April 2021

Introduction

Graduate attributes are recognised as the skills and values that should be acquired by all students in tertiary education, regardless of their field of study. Graduate attributes have significant relevance to employability and in enhancing students’ personal development.

This research aimed to explore students’ lived experiences of developing two graduate attributes embedded within their undergraduate medical curriculum: communication and collaboration skills.

Methods

Phenomenology was the validated, qualitative research method most suited to address the research question. Phenomenology allows one to better understand peoples’ direct, lived experiences of a particular phenomenon; in this case, graduate attribute development.

Purposefully sampled participants were chosen for semi-structured interviews, all of whom had completed the same undergraduate medical education programme. Semi-structured interviews were performed until thematic saturation occurred, at participant eight. The Braun and Clarke method of thematic analysis was utilised to identify recurring themes from the interview process.

Results

The five key themes that emerged were (1) the value placed on graduate attribute development, (2) the presence of graduate attribute learning opportunities, (3) the presence of barriers against graduate attribute development, (4) graduate attribute literacy and preconceptions and (5) the students’ transition into employment.

Conclusions

There is a need for improved graduate attribute assessment methods and the development of meaningful learning strategies that promote transformative learning opportunities.

Barriers against communication and collaboration skills development exist and need to be addressed.

Students need to better understand the relevance of communication and collaboration skills to their future professional careers before the student-to-doctor transition has occurred.