bluuebunny/crossref_metadata_2025 huggingface dataset:
What Causes Residential Mortgage Defaults?
Authors: Torous Walter , Torous William , Thompson Anne
Published: September 2024

The U.S. residential mortgage market is very large, totaling approximately $13 trillion in debt as of 2023, and defaults occur with regular frequency, increasing significantly during times of financial stress. For example, during the aftermath of the Great Financial Crisis , almost 1 in 20 U.S. residential mortgages in 2010 were 90 plus days past due and considered in default. Given the adverse implications of default on a household's financial well being and ability to access housing, economists and policy makers have expended much effort to understand why households default on their mortgages. An important issue to resolve in this research is the relative importance of negative equity in a home versus adverse life events in driving mortgage default decisions. Why a household defaults matters. Forgiveness of principal is costly and addresses only defaults related to negative equity. By contrast, to the extent that defaults follow negative life events then lowering monthly mortgage payments while the household resolves its difficulties would allow families to keep their homes while not requiring banks to foreclose on them. To answer these questions requires understanding what factors “cause” mortgage defaults. While many papers document an association between default and various explanatory variables, an association does not necessarily imply causation. For example, it has been empirically documented in the aftermath of the Great Financial Crisis that homeowners residing in warm climates in the United States were more prone to default than homeowners residing in cold climates. Did climate cause mortgage defaults? While there certainly was an association between climate and mortgage defaults, no one has claimed that climate caused homeowners to default. Likewise, previous studies have documented an association, sometimes very strong, between default and negative equity but research based on a potential outcomes framework finds that very few defaults can be causally attributed to strategic reasons in which negative life events are not necessary. The stark difference in these conclusions necessitates a closer examination of what factors cause mortgage defaults. .
Menstrual Health
Authors: Hunter Erin C. , Olumide Adesola O. , Sommer Marni
Published: September 2024

Menstruation refers to the periodic flow of blood from the uterus exiting the body through the vagina. Menarche (the first menstruation) signals the onset of reproductive maturity in females and is a result of the shedding of the wall of the uterus that occurs when there is no implantation of a fertilized ovum. The menstrual cycle commences on the first day of menstrual blood flow until the day before the next menstrual blood flow, and the cycle lasts an average of 28 days.

Menstrual health refers to the state of complete physical, mental, and social well-being related to the menstrual cycle and is integral to both human rights to dignity and reproductive health as well as achieving multiple Sustainable Development Goals. The concept of menstrual health as a holistic framework encompasses the factors that contribute to the menstrual experiences of girls, women, and all people who menstruate—as well as the broader impacts of those menstrual experiences on well-being.

The menstrual cycle has historically been neglected in global health discussions. The inaccessibility and inadequacy of information, support, and resources necessary for experiencing optimal menstrual health can have consequences for the physical health, well-being, social participation, education, and economic opportunities of individuals who menstruate. Timely provision of accurate, age-appropriate information about the menstrual cycle and the practical aspects of experiencing menstrual periods is important for girls who will soon reach menarche—and also for the wider population to foster appropriate social support and inclusive environments that accommodate the needs of those who menstruate. Such needs include access to effective and affordable menstrual materials and appropriate sanitation facilities with waste disposal mechanisms, timely diagnosis and treatment for menstrual discomforts and disorders, and freedom from menstrual stigma. Promoting menstrual health thus requires comprehensive efforts to promote menstrual health education, address pervasive menstrual stigma, challenge social norms that perpetuate discrimination based on menstruation, and improve access to necessary resources for addressing menstrual needs.
Asteroid Ryugu and the Hayabusa2 Mission
Authors: Watanabe Sei-ichiro , Kikuchi Shota
Published: September 2024

The carbonaceous type (C-type) asteroid Ryugu is a near-Earth object measuring ~1 km in equatorial diameter. C-type asteroids of this size are seldom found in the near-Earth region, making Ryugu an invaluable target for a sample return mission. Studying Ryugu offers insights into the Solar System formation and the transportation of volatile components from the asteroid belt to the early Earth. The Hayabusa2 spacecraft, developed by the Japan Aerospace Explosion Agency (JAXA), was launched on an H-IIA rocket in December 2014. It reached Ryugu in June 2018, and for 17 months, it closely observed the asteroid using optical and thermal imagers, a near-infrared spectrometer, and a laser altimeter. The spacecraft deployed three small rovers and a lander onto Ryugu surface, allowing for in-depth imaging and measurements. Furthermore, Hayabusa2 executed two precise touchdowns on different regions of the asteroid for sampling and initiated an impact experiment that created an artificial crater on Ryugu. During the second touchdown, subsurface materials ejected from the artificial crater were collected. Hayabusa2 departed from Ryugu in November 2019 and returned a capsule containing Ryugu samples to Earth in December 2020. Having successfully completed its sample return mission, Hayabusa2 is now en route to its next objective: a rendezvous with a small, rapidly rotating asteroid in July 2031.

Ryugu is a rubble-pile asteroid, formed through the re-accumulation of fragments of a disrupted parent asteroid in the inner main asteroid belt. Its distinct spinning-top shape was likely molded by landslides, triggered by rapid rotation about ten million years after its formation. Chemically, Ryugu’s surface material closely resembles that of CI (Ivuna-type) carbonaceous chondrites, known for their primitive compositions. The high porosity of Ryugu particles hints at a past presence of ice. Moreover, the plentiful carbonates, combined with the limited presence of high-temperature inclusions larger than 30 μm, suggest that Ryugu’s parent body originated in the outer Solar System, likely beyond the Saturn orbit. Within a few million years following the formation of the Solar System, gravitational interactions with giant planets may have scattered this parent body to the inner main asteroid belt. The decay heat from the short-lived radionuclide, 26Al, then facilitated aqueous alteration of the parent body and led to the genesis of diverse organic compounds. Many low-albedo asteroids in the main belt share spectra similarities with Ryugu. This implies that the structural water in phyllosilicates and organic matter could have been transported to the early Earth through dynamical and collisional evolution of these objects.
Identity, Ideology, and the Language of Food
Authors: Gordon Cynthia , Tovares Alla
Published: September 2024

Linguistic and discourse analytic studies of food-related communication demonstrate how people construct identities and (re)create and contest ideologies that focus on food but extend well beyond it to issues of socioeconomic class, culture, gender, and privilege. Scholarship in this area considers how people engage in food-related communication across contexts, including in mealtime conversations, on restaurant menus and food packaging, in recipes, on social media, and as represented on infotainment food television. Analyzing the details of human interaction and texts also illuminates the role of specific linguistic and other communicative strategies—such as use of adjectives and metaphors—in constituting the food-related discourse that helps constitute human experience.
Visual Arts: Realism and Naturalism
Authors: Stratford Linda , Dyrness William
Published: September 2024

In the visual arts, realism and naturalism are modes of representation associated with faithfulness to physical fact. From the late medieval period forward, fine art in the West gave increasing primacy of place to realism and naturalism. Within the aesthetic category termed “realistic” or “naturalistic,” depiction is characteristically mimetic, distinguished by varying degrees of literalness. Whether based on clinically observed reality, or technique devoted to relaying impressions of clinically observed reality, artwork considered realistic or naturalistic brings to mind observable phenomena. Recognizably corporeal material such as the human figure, scenery, and objects of visible experience may be carried out as an instinctual, direct response to forms, or may be rendered in a nonidealized manner, thereby emphasizing fidelity to nature. In either case, fidelity to recognizable nature is the overriding concern. Nevertheless, while naturalism employs and asserts the facts of material life, it is not limited to facts of material life in its representations. Naturalism is a broad pictorial ideology, with divergent aims, including assigning symbolic meaning to familiar objects, underscoring the allegorical potential of common articles, and suggesting experience of the divine through encounters with nature.

Importantly, a distinction exists between the use of naturalistic effects, and practices associated with the art-historical movement known as Realism. The 19th-century movement Realism exists as a particular manifestation within the broader category of naturalism. Originating in France, Realism as a category is distinct in its use of realistic effects to capture conditions of contemporary life. In France, painters and sculptors (such as Courbet and Rodin) explored their modern subjects with a reforming zeal, giving representation to the poor most especially, and breaking with the gentility of subjects and treatments long associated with fine art. In the 19th and 20th centuries in France and beyond, artists continued to pursue the democratizing aims of Realism, by addressing public issues, fostering reforming religious piety, and encouraging social vision through the widened employment of pictorially recognizable facts of material life.
Theoretical Perspectives on Music as Black History in Latin America
Authors: Iyanaga Michael , Birenbaum Quintero Michael
Published: September 2024

The making and interpreting of music has always been an important means by which people of African descent in Latin America create and encode knowledge. As such, aspects of the rich knowledge, history, and experience of blackness are present in a wide range of musical genres and practices in Latin America. In fact, the presence in music of alternative understandings of identity and types of sociality and cosmology suggests that music-making itself might be a theory, an approach, and an enactment of decoloniality. Indeed, a decolonial perspective reveals alternative definitions of “music” and geospatial, cultural, and demographic notions of both “Latin America” and the history and politics of blackness there.
A Review of Gender and Refugee Studies in Lebanon, Jordan, and Türkiye
Authors: Tuzi Irene , Carpi Estella
Published: September 2024

Drawing upon academic sources and policy reports of nongovernmental organizations, the UN, and other bodies, it can be shown how most of these studies have often adopted a gender-binary approach, contributing to an over-focus on and to the stigmatization of “refugee women” as a self-standing category of analysis and a homogeneous social group, while differently gendered bodies on the move have been under-investigated. Although fluid understandings of gender have long since informed gender and sexuality theories, the binary approach, when coming to the field of forced migration, remained the most common way of framing displaced gendered bodies.

In this framework, the leading discussion revolves around how the women-focused literature in the Middle Eastern context has scarcely intertwined with the LGBTQ+ literature. The regional-based critical review, while noticing a refugee masculinity-focused literature on the rise, evidences an anachronistic compartmentalization between women-focused and LGBTQ+-focused research, which contradicts the performative interpretations of gender debated since the early 1990s while reinforcing a monolithic understanding of gendered experiences of displacement. As a result, to some extent, it can be argued that humanitarian and migration practices and policies tend to reflect the gender binarism underlying the related academic research.
Policing and Citizen Trust in Kenya: How Community Policing Shapes Local Trust-Building and Collaboration
Authors: Mutahi Patrick , Höglund Kristine , Elfversson Emma
Published: September 2024

In contexts of high insecurity and mistrust in the police, how and why do local residents still choose to collaborate with the police, and what is the role of community policing in such considerations? Research on policing in Africa has emphasized the structural and macropolitical barriers to effective police reform, including institutionalized cultures of impunity and corruption. Less attention, however, has been paid to the contextual and relational dynamics that shape police-community collaboration. We argue that a relational perspective, which centres local residents’ interactions with police and community policing structures, provides novel insights into the challenges of policing reforms. This perspective also demonstrates how contingent and incremental trust can be built in very challenging circumstances. We study these dynamics in Karagita and Kaptembwo, two low-income urban settlements in Nakuru County, Kenya, that have experienced violent crime and repeated electoral violence. Despite considerable challenges of crime, police misconduct, and political interference in these settlements, our findings point to how positive everyday interaction and community policing structures can contribute to incremental improvements in police-community relationships. In contrast to existing work on African policing that primarily highlights the challenges of police reform, this study offers insights into when reform has the potential to be effective.
Nondifferential misclassification of outcome under (near)-perfect specificity: a simulation study
Authors: Ma Weida , MacLehose Richard F , Lash Timothy L , Collin Lindsay J , Tuo Ya , Ahern Thomas P
Published: September 2024

Mismeasurement of a dichotomous outcome yields an unbiased risk ratio estimate when there are no false positive cases (perfect specificity) and when sensitivity is nondifferential with respect to exposure status. In studies where these conditions are expected, quantitative bias analysis may be considered unnecessary. We conducted a simulation study to explore the robustness of this special case to small departures from perfect specificity and stochastic departures from nondifferential sensitivity. We observed substantial bias of the risk ratio with specificity values as high at 99.8%. The magnitude of bias increased directly with the true underlying risk ratio and was markedly stronger at lower baseline risk. Stochastic departure from nondifferential sensitivity also resulted in substantial bias in most simulated scenarios; downward bias prevailed when sensitivity was higher among unexposed compared with exposed, and upward bias prevailed when sensitivity was higher among exposed compared with unexposed. Our results show that seemingly innocuous departures from perfect specificity (eg, 0.2%) and from nondifferential sensitivity can yield substantial bias of the risk ratio under outcome misclassification. We present a web tool permitting easy exploration of this bias mechanism under user-specifiable study scenarios.
Task-Based Attentional Control: The Role of Anxiety and Age
Authors: Messerlie Amanda E , Guidotti Breting Leslie M , Calamari John E , Sweet Jerry J , Geary Elizabeth K , Axelrod Jenna , Neale Alec C , Waszczuk Monika A
Published: September 2024

Objective

Attentional Control Theory (ACT) posits that anxiety impacts cognitive functioning through interference in working memory and processing efficiency, resulting in performance deficits in set-shifting and inhibition. Few studies have examined the effects of anxiety on set-shifting and inhibition in clinical samples or how these relationships might be affected by age. The current study tested whether increased age, elevated anxiety, and their interaction were associated with reduced performance on measures of set-shifting and inhibition.

Method

Symptom and neuropsychological testing data were obtained from outpatient participants presenting at an academic medical center (N = 521; mean age = 50.39 years, SD = 22.35, range = 18–90; 47.4% female; 78.3% White). The Trail Making Test Difference score was used to assess set-shifting and the Stroop Color-Word Test Interference score was used to assess inhibition.

Results

After controlling for demographic variables, ADHD diagnosis, depression symptoms, and Mild Cognitive Impairment (MCI), both age and anxiety were significant predictors of set-shifting (β = 0.45 and β = 0.18, respectively, ps < 0.001) and inhibition (β = −0.37, p < 0.001 and β = −0.19, p = 0.001, respectively). No interaction was found between age and anxiety in the prediction of set-shifting or inhibition.

Conclusion

Congruent with ACT, anxiety was associated with worse performance on measures of set-shifting and inhibition. Older age was an independent predictor of worse set-shifting and inhibition but did not moderate the relationship between anxiety and attentional control, suggesting that anxiety adversely affected working memory and processing efficiency equivalently across the adult lifespan. The results highlight the importance of anxiety assessment in neuropsychological evaluation in patients of all ages.
Are weapon allometries steeper in major or minor males? A meta-analysis
Authors: Kochensparger Sydney K , Painting Christina J , Buzatto Bruno A , McCullough Erin L
Published: September 2024

Competition for mates can drive the evolution of exaggerated weaponry and male dimorphism associated with alternative reproductive tactics. In terrestrial arthropods, male dimorphism is often detected as non-linear allometries, where the scaling relationship between weapon size and body size differs in intercept and/or slope between morphs. Understanding the patterns of non-linear allometries is important as it can provide insights into threshold evolution and the strength of selection experienced by each morph. Numerous studies in male-dimorphic arthropods have reported that allometric slopes of weapons are shallower in large “major” males compared to small “minor” males. Because this pattern is common among beetles that undergo complete metamorphosis (holometabolous), researchers have hypothesized that the slope change reflects resource depletion during pupal development. However, no comprehensive survey has examined the generality of this trend. We systematically searched the literature for reports of weapon allometries in male dimorphic species and conducted a phylogenetically controlled meta-analysis to explore the factors influencing the difference in slopes between morphs. Our search identified 59 effect sizes from 19 studies, 50 species, and 5 orders of terrestrial arthropods. We found strong evidence that metamorphosis type influences the patterns of weapon allometries. Slopes were significantly steeper in minor males compared to major males in holometabolous species, but there was no difference in slopes between morphs in hemimetabolous species (i.e. those that undergo incomplete or no metamorphosis). These results support the hypothesis that holometabolous species face a resource ceiling during pupal development that limits the exaggeration of weapon size.
Visibility graph-based covariance functions for scalable spatial analysis in non-convex partially Euclidean domains
Authors: Gilbert Brian , Datta Abhirup
Published: September 2024

We present a new method for constructing valid covariance functions of Gaussian processes for spatial analysis in irregular, non-convex domains such as bodies of water. Standard covariance functions based on geodesic distances are not guaranteed to be positive definite on such domains, while existing non-Euclidean approaches fail to respect the partially Euclidean nature of these domains where the geodesic distance agrees with the Euclidean distances for some pairs of points. Using a visibility graph on the domain, we propose a class of covariance functions that preserve Euclidean-based covariances between points that are connected in the domain while incorporating the non-convex geometry of the domain via conditional independence relationships. We show that the proposed method preserves the partially Euclidean nature of the intrinsic geometry on the domain while maintaining validity (positive definiteness) and marginal stationarity of the covariance function over the entire parameter space, properties which are not always fulfilled by existing approaches to construct covariance functions on non-convex domains. We provide useful approximations to improve computational efficiency, resulting in a scalable algorithm. We compare the performance of our method with those of competing state-of-the-art methods using simulation studies on synthetic non-convex domains. The method is applied to data regarding acidity levels in the Chesapeake Bay, showing its potential for ecological monitoring in real-world spatial applications on irregular domains.
Unit information Dirichlet process prior
Authors: Gu Jiaqi , Yin Guosheng
Published: September 2024

Prior distributions, which represent one’s belief in the distributions of unknown parameters before observing the data, impact Bayesian inference in a critical and fundamental way. With the ability to incorporate external information from expert opinions or historical datasets, the priors, if specified appropriately, can improve the statistical efficiency of Bayesian inference. In survival analysis, based on the concept of unit information (UI) under parametric models, we propose the unit information Dirichlet process (UIDP) as a new class of nonparametric priors for the underlying distribution of time-to-event data. By deriving the Fisher information in terms of the differential of the cumulative hazard function, the UIDP prior is formulated to match its prior UI with the weighted average of UI in historical datasets and thus can utilize both parametric and nonparametric information provided by historical datasets. With a Markov chain Monte Carlo algorithm, simulations and real data analysis demonstrate that the UIDP prior can adaptively borrow historical information and improve statistical efficiency in survival analysis.
MOY 3 - Development and external validation of the “Global Surgical-Site Infection” (GloSSI) predictive model in adult patients undergoing abdominal surgery
Authors:   NIHR Global Research Health Unit on Global Surgery and GlobalSurg Collaborative
Published: September 2024

Aims

Identification of patients at high-risk of surgical-site infections (SSI) may allow surgeons to minimise associated morbidity. However, there are significant concerns with the methodological quality and transportability of models previously developed. We aimed to develop a novel score to predict 30-day SSI risk following gastrointestinal surgery across a global context, and externally validate against existing models.

Methods

This was a secondary analysis of 2 prospective international cohort studies: GlobalSurg-1 (July-November 2014) and GlobalSurg-2 (January-July 2016). Consecutive adults undergoing gastrointestinal surgery were eligible. Model development was performed in GlobalSurg-2 data, with novel and previous scores externally validated in GlobalSurg-1. The primary outcome was 30-day SSI, with two predictive techniques explored: penalised regression (LASSO) and machine learning (XGBOOST). Final model selection based on prognostic accuracy and clinical utility.

Results

There were 14,019 patients (SSI=12.3%) for derivation, and 8,464 (SSI=11.4%) for external validation. The LASSO model was selected due to similar discrimination to XGBoost (AUC: 0.738, 0.725-0.750 versus 0.737, 0.709-0.765), but greater explainability. The final score included six variables: country income, ASA grade, diabetes, and operative contamination, approach, and duration. Model performance remained good on external validation (AUC: 0.730, 0.715-0.744; calibration-in-the-large: -0.098, slope: 1.008), and demonstrated superior performance to external validation of all previous models.

Conclusion

The GloSSI score allowed accurate prediction of the risk of SSI with 6 simple variables which are routinely available at the time of surgery across global settings. This can inform use of intraoperative and postoperative interventions to modify the risk of SSI and minimise associated harm.
SP1.1 - The effect of mesh fixation on post-operative pain and recurrence in laparoscopic inguinal hernia repair
Authors: Jones Stacey , Davies Elin , Fatima Sabiha , May Thomas , Papakonstantinou Dimitrios , Sheredi Mohamed
Published: September 2024

Aims

To evaluate post-operative pain and inguinal hernia recurrence following laparoscopic totally extraperitoneal (TEP) or transabdominal preperitoneal (TAPP) techniques. Secondly, in TAPP approach to compare outcomes with method of mesh fixation.

Methods

545 patients underwent elective laparoscopic inguinal hernia repair in a single centre, between October 2015 and April 2023. Surgical approach and method of mesh fixation was obtained from operation note. Patients were contacted retrospectively via telephone call. Post-operative pain was assessed using a scale (1-10). Chronic pain defined as pain persisting beyond 3 months. Hernia recurrence defined as new groin lump at site of previous repair.

Results

545 patients underwent surgery. 212 did not answer follow-up call, 43 declined to take part in study and 22 had died. 268 analysed; 167 underwent TEP and 101 TAPP inguinal hernia repair. Groups were similar in age and gender. Initial post-operative pain score in TEP group was 4.7 (range 1-10) as compared with 4.5 (range 1-10) in TAPP group.13.8% experienced chronic pain, score of 2.9 (range 2-5) in TEP group compared with 16.8%, score of 2.7 (range 2-5) in TAPP group. Hernia recurrences were similar between groups; 4.8% and 4% respectfully. Neither mesh-fixation or non-fixation techniques were found to affect post-operative chronic pain (p=0.8). Patients undergoing tacker fixation reported less hernia recurrence, 1.7% and 5.1% respectfully. No significant difference noted between absorbable and metallic tackers in terms of chronic post-operative pain and recurrence.

Conclusion

Mesh placement without fixation produced similar post-operative pain but a higher hernia recurrence than mesh-fixation techniques.
SP2.8 - The undifferentiated general surgical take over 10 years: emergency operating
Authors: Hale Emily , Bowling Kirk
Published: September 2024

Aims

The aim of this study is to further understand the specific pressures on the department’s operating theatres and capacity, and to identify areas in which we could adapt to facilitate these demands, by reviewing the undifferentiated general surgical admissions in a District General Hospital in July 2013 and July 2023.

Methods

All patients seen by the emergency general surgical team in July 2013 and July 2023 were identified retrospectively. Data was gathered using electronic notes, to analyse admissions and surgeries within 30 days. Patients were excluded if there was insufficient information available.

Results

26% (n=102/395) of all patients treated by emergency general surgical teams in July 2013 had surgery within 30 days. This proportion reduced to 23% (134/594) in July 2023, however overall volume has increased by 31%. The proportion of procedures performed on the day of admission has decreased from 10% to 7%. 3% of procedures were performed under local anaesthetic both in 2013 and 2023. Wait from admission to surgery has decreased from 2.84 days (+/-0.6, p=0.02) in 2013, to 1.9 days in 2023 (+/-0.83, p=0.02).

Conclusions

Although volume of procedures within the same 31-day period has increased throughout the 10 years, the proportion of patients that proceed to intervention has reduced marginally. This is reflected in the increasingly busy emergency operating lists throughout the country, with little change in resources to account for increasing volume. The rising proportion of patients managed conservatively may represent improving medical management of conditions, or more pragmatic management of frail patients.
SP2.9 - National Emergency Laparotomy Audit (NELA) and American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) risk prediction calculators are not accurate in predicting 30-day mortality in patients aged 80 and above
Authors: Moscalu Andrei , Timofeiov Sergiu , Saravanan Balakrishnan , Sinclair Martin
Published: September 2024

Background

30- to 50000 Emergency Laparotomies (EL) are performed annually in the UK. More than half of patients are aged 70 or over and have a high post-operative complication rate along with a 16-20% risk of 30-day mortality (30-dm). To date, the literature lacks a dedicated risk prediction tool for mortality and morbidity following EL in the elderly population.

Methods

A multi-center, retrospective study of patients aged ≥80 undergoing EL examined the correlation between predicted 30-dm using NELA and ACS-NSQIP and actual 30-dm. This occurred in two UK centers over a 2-year period. The primary outcome was defined as the correlation between actual 30-dm and NELA or ACS-NSQIP predicted 30-dm. GraphPad Prism 10.1.1. was used for statistical analysis.

Results

141 cases were included in the final analysis (Table 1). The actual 30-dm was 17.73%, NELA predicted 30-dm 13.07% (7.21;27.84), and ACS-NSQIP 9.4% (3.8;20.6). NELA correlated positively with ACS-NSQIP predicted 30-dm (R²=0.79; p<0.0001). No association was found between actual 30-dm and predicted NELA 30-dm, R²=0.01; p<0.0001 or ACS-NSQIP, R²=0.01; p<0.0001. All data is expressed as Median + IQR.

Conclusion

In octo- and nonagenarians, following an emergency laparotomy, both NELA and ACS-NSQIP are not accurate in predicting 30-day mortality.Table 1Male/female ratio0.63Age (years)84 (81;87)BMI (kg/m²)24.27 (21.43;27)Lactate (most recent preoperative value) mmol/L1.7 mmol/L (1.14;3.01)ASA grade3 (2;4)Clinical frailty score3 (3;5)Charlson Comorbidity Index4 (2;5)
SP3.3 - Real World Experience of 600+ Minimally Invasive Abdominoperineal Resections (APR) Done for Low Rectal Cancers in Tertiary Cancer Care Center
Authors: Vispute Tejas , Bansod Yogesh , Sharma Ankit , Kazi Mufaddal , Desouza Ashwin , Saklani Avanish , Singh Sanjay
Published: September 2024

Introduction

APR is standard of care surgery for low rectal cancers involving sphincter. Surgery is commonly done in minimally invasive way. Robotic surgery has recently gained popularity due to ease of procedure. Margin positivity and local recurrence still remain a challenge.

Methods

It is a retrospective study from prospectively maintained database from Aug 2013 to Aug 2023. Surgical and oncological outcome were analyzed using SPSS version 25 software.

Results

Total 657 minimally invasive APRs were done. All were done in supine lithotomy position. 570 were laparoscopic and 87 robotic. Mean age was 48.4 years. 6 cases were converted to open (5 lap and 1 robotic). Mean BMI was 22.3. Mean distance from anal verge was 3 cm. Majority patients were cT3 (74%). Median blood loss was 150 ml. Clavien Dindo grade III and beyond complications were seen in 11.2%. Mean hospital stay was 7 days. Mean nodes harvested were 13. Mean no of positive nodes were 1.22. Extended resections (extended TME) were 25% in lap and 42% in robotic. Poorly differentiated and signet histology was seen in 27%. CRM positivity was 6.9%. It increases to 15.5% in signet ring histology. Median follow up achieved was 46 months. Local recurrence was 5.5%. Distant recurrence was 20%. 3-year OS and DFS were 73% and 63% respectively.

Conclusion

In high volume minimally invasive surgery centre, MIS abdominoperineal resection - both laparoscopic and robotic has acceptable surgical and oncological outcomes.
SP4.3 - Pancreatoduodenectomy for malignancy with concomitant arterial resection: results from the Recurrence After Whipple’s (RAW) study
Authors: Abdelmohsin Omar , Russell Thomas B , Labib Peter L ,   RAW Study Collaborators, Aroori Somaiah
Published: September 2024

Background

Most centres are reluctant to perform pancreatoduodenectomy (PD) with concomitant arterial resection (AR) in patients with a cancer affecting the pancreatic head. This is because outcomes are poor and the potential benefits of an aggressive resection are unlikely to outweigh the potential risks, particularly in a patient with an aggressive tumour and limited life expectance. AR has been shown to correlate with higher rates of morbidity, reoperation and mortality, and reduced overall survival. However, AR may be justified in selected patients in specialist centres. This study aimed to compare the outcomes of PD patients who underwent AR to those who did not.

Methods

Data were extracted from the Recurrence After Whipple’s (RAW) study, a multicentre retrospective cohort study of outcomes of PD performed for pancreatic head malignancy (29 centres from eight countries, n=1484). Patients who underwent AR were identified and compared to those who did not undergo AR using the chi-squared test. The following were compared: length of stay (LoS), incidence of postpancreatectomy haemorrhage (PPH), and rates of unplanned return to theatre, 30-day readmission, 90-day mortality, and five-year survival.

Results

Out of 1484 patients, 8.8% did not have data regarding their AR status recorded so they were excluded. Of the rest, 25 (1.8%) underwent AR. Despite the small sample size, these patients had significantly higher rates of PPH (20.0 vs 5.9%, p=0.0004) and reduced five-year survival (12.0% vs 33.1%, p=0.03).

Conclusion

AR should be reserved for selected PD patients in specialist units. Despite our small sample size, our multicentre study demonstrated that these patients have higher incidence of PPH and reduced long-term survival
SP4.5 - Cost estimates of intra-operative cell salvage in patients undergoing major liver surgery: a retrospective cohort study
Authors: Lakha Adil Siraj , Nibber Anjan , Barbosa Antonio , von-Kier Stephen , Gordon-Weeks Alex , Landeiro Filipa
Published: September 2024

Aims

Major liver surgery is associated with a high risk of blood loss. Autologous transfusion of blood salvaged intra-operatively (cell salvage) reduces the requirement for post-operative allogenic transfusion. Allogenic transfusion is associated with risks, and blood is a scarce and costly resource. However, the cost of cell salvage in liver resection has not been previously estimated.

Objective

To estimate the cost of cell salvage in patients undergoing major liver surgery.

Methods

We analysed a cohort of 243 patients who underwent major liver surgery between 2015 and 2022 at a large tertiary referral hospital in England. Cost of cell salvage was calculated as an average price for consumables and operator time. Cost of admission including cell salvage was assessed per year.

Results

The average cost of cell salvage per patient was £433. On average, consumables costed £240 and costs associated with operating cell salvage machinery were £193. The average cost for an index admission for this cohort of patients undergoing major liver surgery with cell salvage was £24,694. When comparing the required units of allogeneic blood required to replace the red cells lost during surgery, cell salvage led to cost-savings in one of the years under analysis.

Conclusions

Our findings suggest that cell salvage has the potential to be cost-effective in patients undergoing major liver surgery. These findings should be assessed in an economic evaluation conducted alongside a randomised controlled trial.
SP4.9 - Relationship Between Classifications for Cancer Cachexia and Overall Survival in Patients with Oesophagogastric Cancer
Authors: Brown Leo R , Soupashi Maria , Yule Michael S , Laird Barry J A , Wigmore Stephen J , Skipworth Richard J E
Published: September 2024

Aim

Classifications for cancer cachexia remain heterogenous within the existing literature. The aim of this study is to compare prognostication using three established descriptors: the Fearon et al. consensus definition, Martin et al.’s weight loss grading system and the Global Leadership Initiative on Malnutrition (GLIM) criteria, in patients with oesophagogastric cancer.

Methods

Consecutive patients with newly diagnosed oesophagogastric cancer between 2019-2020 were identified from a prospectively maintained regional database. Data were retrieved regarding involuntary weight loss, body mass index, CT body composition analyses and neutrophil-lymphocyte-ratio at the time of clinical staging. This allowed comparison based on Fearon, Martin and GLIM classifications. The primary outcome of interest was overall survival.

Results

Overall, 465 patients (66.9% male, median 71 years) were diagnosed with oesophageal (72.0%) or gastric cancer (28.0%). Greater proportions of advanced stage disease were associated with Fearon (p=0.019), Martin (p=0.004) and GLIM (p<0.001) defined cachexia. Patients who met the GLIM criteria were also older and had poorer ECOG performance status (both p<0001). Each cachexia classifier was associated with worsened overall survival (all p<0.001). Following adjustment for clinicopathological confounders, Fearon (aHR: 1.54 (95%CI:1.24-1.92) and GLIM defined cachexia (aHR: 1.74 (95%CI:1.40-2.17) were both adversely associated with overall survival. Grade 4 weight-loss, as per Martin et al., had the greatest prognostic effect (aHR: 2.11 (95%CI:1.52-2.93).

Conclusion

Cancer cachexia is strongly associated with poorer survival in oesophagogastric cancer. The GLIM criteria and high Martin et al. weight loss grade appear to have the greatest prognostic value.
SP5.2 - Reducing Elective Colorectal Surgical Site Infections with Change of Gloves and Instruments Prior to Abdominal Closure; A Multicycle Audit
Authors: Walsh Kyle
Published: September 2024

Aims

Surgical site infections (SSI) carry a significant impact on patient morbidity, length of stay and antibiotic resistance. Our local colorectal unit has made several interventions over many years with no significant nor sustained improvement in the rate of SSI. The ChEETAh trial (Lancet, 2022) demonstrated a reduction in the rate of 30-day SSI by 13% with routine change of gloves and instruments (COGI) prior to abdominal closure. We aim to reduce our rate of SSI through implementation of COGI prior to abdominal closure; involving whole scrub team change of gloves and use of sterile instruments.

Methods

Adults undergoing elective colorectal surgery with an abdominal wound greater than 5cm were eligible for this study. Diagnosis of SSI was made based on at least one clinical indicator of infection or at least one symptom of SSI with data collection over 3 cycles spanning 11 months using clinical notes, imaging and microbiology results. The primary outcome was the diagnosis of a SSI involving the skin, subcutaneous, muscle or fascial layer up to 30 days post-operatively.

Results

The baseline SSI rate prior to intervention was audited at 29%. After implementation of COGI the rate fell to 23%. Further reinforcement of COGI and team education has demonstrated a further decrease in SSI to 15%. This has been sustained across a 6-month period post intervention.

Conclusions

Change of gloves and instruments is an effective, reliable and sustainable method to reduce the rate of surgical site infection in elective colorectal abdominal surgery.
SP5.8 - A survey of the actual incidence of Low Anterior Resection Syndrome in our patients and its effect on their quality of life
Authors: Umenze Franklin , Saraee Danial , Kaur Geetinder
Published: September 2024

Aim

Following rectal surgery, bowel function is often affected and leads to a constellations of symptoms called Low Anterior Resection syndrome (LARS). Whilst several risk factors have been identified from previous studies, the most important question is how these symptoms impact the quality of life (QOL) of our patients. The aim of our study was to gain an overview of LARS among our patients, identify risk factors, quantify how it affects their daily lives and recommend preventive and management options.

Method

We contacted all patients who had undergone anterior resections 01/10/2020-01/10/2023 via a telephone consultation carried out by a single doctor. Using the LARS questionnaire which has been internationally validated, we quantified the severity of LARS symptoms and effects on QOL in our patients.

Results

A total 36 patients were included in the study. We found 75% patients had no LARS, 25% had minor LARS; no patients had major LARS. 15 patients experienced tenesmus, 11 urgency, 11 accidental leakage of stool, 10 inability to control flatus and 8 frequency. Only 8.33% reported their symptoms affecting their QOL; in this group, accidental leakage of stool was the common symptom. We found no correlation between the incidence of LARS and post-operative time period. None of our LARS patients had had pre-op radiotherapy; only 10% patients who had post- op chemo developed LARS.

Conclusion

In our cohort of Anterior resection patients, most had no LARS; none had major LARS. Though some patients had some symptoms, QOL was affected in only 8.33%. Those who had symptoms were directed to our LARS clinic in Lower GI physiology for further management.
SP6.11 - What the Doctor Said: Evaluation of Discharge Information to Inpatient Colorectal Patients
Authors: Johnston Judith , Kostiw Alessia , Sadiq Miriam , Hunter Iain
Published: September 2024

Aims

To establish clarity of post operative information for patients for elective colorectal patients.

To establish comprehensiveness of discharge information for elective colorectal patients.

Methods

100 consecutive discharge summaries were collected from a busy elective colorectal unit. These were evaluated against NHS England’s discharge standards as well as a defunct local “After Care Advice’ form. Anonymous data were collated on Google Sheets and analysed.

Results

Patients had a median age of 68, with 54% being female. Operations ranged from EUA to exenteration with the most common operations being reversal of ileostomy (9%), laparoscopic right hemicolectomy (8%) and laparoscopic anterior resection (8%). The mode of length of stay was 9 days. Two patients were given the incorrect name of procedure on their discharge paperwork. 61% were not given details of investigations performed during admission with only 12% given details and timescales of tests to be performed on discharge. Follow up details were relayed to 77% on their discharge summaries. Of those that has wounds closed, 77% were not given details on how, with 97% receiving no wound care advice. Patients did not receive advice on return to activity (99%), bleeding (96%), anaesthetic limitations (100%) or driving (99%). Only 8% received information regarding VTE prophylaxis while 94% were not given infection advice. Despite these being colorectal operations, 94% did not receive any advice regarding bowel function or use of laxatives.

Conclusions

These results indicate that patients are not receiving adequate information regarding their time in hospital, their procedures or what to expect afterwards. This must improve.
SP8.4 - Retrospective comparison of core surgical trainee procedural experience gained in Scottish rural, general and tertiary hospitals
Authors: Hussein Israa , Cleland Jennifer , Walker Kenneth , Vella Mark , Yalamarthi Satheeth , Fergusson Stuart
Published: September 2024

Introduction and Aims

Core surgical trainees are placed across all hospital types in Scotland, including rural, general and tertiary hospitals. The extent and nature of the procedural experience gained in these different settings has not been previously compared in the Scottish context. Two recent studies concluded that trainees in rural hospitals have access to high case numbers across several surgical specialties. (1,2) The aim of this study is to compare the procedural experiences obtained by core surgical trainees in Scotland, across 3 different settings: in rural, district and tertiary hospitals.

Methods

Core surgical trainees who undertook training in Scotland between August 2012 to 2022 were identified through digital records (eLogbook data). Operative experiences in 6-month core surgical placements were compared between Rural General (R1), District General (A2, A3) and university/tertiary including children (A1, A4) Hospitals.

Results

After data cleaning, 241 trainees’ data were available for analysis. The mean number of procedures completed by trainees in a standard 6-month placement was 112 in R1 hospitals, 169 and 94 in A2 and A3 hospitals respectively and 140 and 116 in A1 and A4 hospitals respectively. There was no statistically significant difference between hospital settings (p = 0.072).

Conclusion

Core surgical trainees have equivalent access to surgical caseloads across all hospital settings in Scotland.

References

1. Hughes D, Wood R, Woods R, Sarap M. Resident Perspectives on the Value of Rural General Surgery Rotations: It’s Not Just About the Cases. Am Surg. 2022 Oct 1;31348221114056.

2. Sanders DL, Bell DC. Worlds apart: training in rural South Africa. Clin Teach. 2012 Apr;9(2):99–104.
SP9.1 - Enhancing Personalised Care by Introducing Frailty Management On Lower GI 2ww Pathway
Authors: Sargsyan Narek , Arunachalam Ganesh , Bernardo Janice , Sreekanth Sakthi , Humphries Francesca , Vijay Vardhini
Published: September 2024

Introduction/Aim

Increasing number of patients with suspected lower GI cancer are being sent Straight-To-Test to achieve the 28Day Faster Diagnosis Standards (FDS) following GP referral. This means that elderly frail patients may not get personalised care unique to their needs and undergo unnecessary investigations. Since 2022, we have piloted a frailty pathway incorporated into the protocol for management of LowerGI 2ww referrals. Aiming to provide a holistic and personalised geriatric assessment to improve outcomes and reduce health inequality. This study analyses the outcomes.

Methods

A prospectively maintained database of all 2ww lowerGI cancer referrals between January2022-November2023 was analysed. Patients age>75 with a frailty score>=5 or performance status>=3, dementia, poly-pharmacy or from care home were referred straight to the frailty-unit for assessment and discussion of the value of further investigation, based on a locally designed SOP. The patient journey was mapped and outcomes compared to the standard pathway.

Results

Over 22 months-period, 228 patients with suspected cancer were seen on the frailty pathway. The average number of investigations per referral was0.5 for frail patients compared to 1 for other patients on the standard pathway. 49.5% (113 patients) were found to be unfit for further investigations or declined/self-discharged. 5 patients required optimisation prior to investigation. Only 1patient was diagnosed with cancer. The 2ww standard was met in 80% of frail patients compared to 55% in >75s who were sent straight-to-test on the standard pathway. The 28-day FDS standard was met in 50% of frail patients compared with 18% in >75s.

Conclusion

The frailty pathway is an effective initiative in reducing unnecessary invasive investigations. Frail patients benefit from holistic geriatric assessment prior to invasive investigations, ensuring suitability and appropriateness.