bluuebunny/crossref_metadata_2025 huggingface dataset:
Pharmacological inhibition of ENT1 enhances the impact of specific dietary fats on energy metabolism gene expression
Authors: Pain Erwann , Snowden Stuart , Oddy Joseph , Shinhmar Sonia , Alhammad Yousef M. A. , King Jason S. , Müller-Taubenberger Annette , Williams Robin S. B.
Published: August 2024

Medium chain fatty acids are commonly consumed as part of diets for endurance sports and as medical treatment in ketogenic diets where these diets regulate energy metabolism and increase adenosine levels. However, the role of the equilibrative nucleoside transporter 1 (ENT1), which is responsible for adenosine transport across membranes in this process, is not well understood. Here, we investigate ENT1 activity in controlling the effects of two dietary medium chain fatty acids (decanoic and octanoic acid), employing the tractable model system
Dictyostelium.
We show that genetic ablation of three ENT1 orthologues unexpectedly improves cell proliferation specifically following decanoic acid treatment. This effect is not caused by increased adenosine levels triggered by both fatty acids in the presence of ENT1 activity. Instead, we show that decanoic acid increases expression of energy-related genes relevant for fatty acid β-oxidation, and that pharmacological inhibition of ENT1 activity leads to an enhanced effect of decanoic acid to increase expression of tricarboxylicacid cycle and oxidative phosphorylation components. Importantly, similar transcriptional changes have been shown in the rat hippocampus during ketogenic diet treatment. We validated these changes by showing enhanced mitochondria load and reduced lipid droplets. Thus, our data show that ENT1 regulates the medium chain fatty acid-induced increase in cellular adenosine levels and the decanoic acid-induced expression of important metabolic enzymes in energy provision, identifying a key role for ENT1 proteins in metabolic effects of medium chain fatty acids.
In-plane hard magnetic BaFe12O19 thin films grown on a-plane Al2O3

11

2

¯

0

substrates
Authors: Joseph Navya , Holzmann Christian , Varvaro Gaspare , Albrecht Manfred , Thomas Senoy
Published: August 2024

Ferrimagnetic barium hexaferrite (BaFe12O19) thin films of varying thicknesses were grown on a-plane Al2O3

11

2

̅

0

substrates at elevated temperatures using pulsed laser deposition. X-ray diffraction measurements, Raman spectroscopy, and atomic force microscopy analyses were used to investigate the BaFe12O19 film growth and structure. The results indicate that the formation of an α-Fe2O3 ‘bridge layer’ promotes the growth of a BaFe12O19 phase showing an in-plane uniaxial magnetic anisotropy with an easy-axis of magnetization along the [

0001

] hexagonal c-axis direction. The crystallographic relationship between the existing phases is given by BaFe12O19

10

1

̅

0

//α-Fe2O3

11

2

̅

0

//Al2O3

11

2

̅

0

.

As the thickness increases, the fraction of the BaFe12O19 phase increases further. This is accompanied by a change in grain morphology turning from a columnar to a more elongated shape, where the short axis of the BaFe12O19 grains points along the [

0001

] easy axis direction.
Theory of size quantization in monolayers of transition metal dichalcogenides
Authors: Rasulov V R , Rasulov R Ya , Nasirov M Kh , Muminov I A , Mamatova M M
Published: August 2024

A theory of size quantization has been developed for both one-dimensional and zero-dimensional nanostructures, grown from monolayers of transition metal dichalcogenides. Expressions for the energy spectra of charge carriers have been obtained for both even and odd (relative to coordinate inversion) states in the quantum-confined line and point of monolayers of transition metal dichalcogenides, depending on their geometric dimensions. A numerical analysis of the quantum-confined energy states of electrons in nanostructures of monolayers of transition metal dichalcogenides has been conducted.
Chirality transfer torque and transverse Chirality current in the Dirac/magnetic Weyl semimetal junction
Authors: Salehi Morteza
Published: August 2024

We theoretically show that an interface formed by a three-dimensional Dirac/magnetic Weyl semimetal deflects the propagation direction of hitting Weyl fermions according to their Chirality in opposite directions. This effect leads to a Chirality current that flows parallel to the interface. There is an imbalance between the Chirality of Weyl fermions in this current whereas it does not carry any charge. Also, this phenomenon creates an indirect gap in the charge conductance that pass through the circuit. Unlike real spin, Chirality remains a good quantum number in systems characterized by very strong spin-momentum coupling. We derive a continuity equation for the Chirality density wave to elucidate how magnetization alters its dynamics and relates to the transverse Chirality current. Furthermore, we demonstrate a torque, that we called it Chirality transfer torque, imposes on the junction that its value relates to the transverse Chirality current.
Nanocrystallization tuning of structural, thermoelectric and electrical properties of SrTiO3-doped vanadate glasses
Authors: Harby Amany E , Morad Ibrahim , Fareed Shereef A , El-Desoky M M
Published: August 2024

Glass-ceramic nanocrystals (GCNs) were obtained by annealing parent SrTiO3-V2O5 (SV) glasses prepared using the melt-quenching technique at the crystallization temperature, Tc. The amorphous nature and glassy behavior of the quenched glasses were confirmed by XRD, DSC and FTIR spectroscopy. In the heat-treated samples, the crystal size was found to range from 40 to 80 nm for all studied samples. It was observed that as the SrTiO3 content in the GCNs increased, density (d) steadily rose. The change of vanadium ions concentration(C) has the predominant role for changing Seebeck coefficient in both glass and GCNs samples. The nanocrystallization process at temperatures close to the onset of Tc, lasting for one hour, notably increased the electronic conductivity of the initial glasses. Consequently, the modification in nanostructure resulted in enhanced conductivity. In comparison to the original glasses, the final materials demonstrated significantly improved electrical conductivity. The accumulation of V4+-V5+ pairs at the formed interlayer zones between nanocrystallites and the glassy phase is accountable for electron hopping in the current system, which is markedly higher than in the glassy matrix. The formed nanocrystallites play a crucial role in augmenting the conductivity of such nanomaterials. The maximum obtained value of the power factor (PF) is 0.9 × 10−4 mW/mk2 for the glass sample (x = 20) reflecting a very low thermoelectric power conversion efficiency while in GCNs, the PF values were well-enhanced to 0.6 mW/m.K2 at x = 20.
Gravitational waves from more attractive dark binaries
Authors: Bai Yang , Lu Sida , Orlofsky Nicholas
Published: August 2024

The detection of gravitational waves (GWs) has led to a deeper understanding of binaries of ordinary astrophysical objects, including neutron stars and black holes. In this work, we point out that binary systems may also exist in a dark sector with astrophysical-mass macroscopic dark matter. These “dark binaries”, when coupled to an additional attractive long-range dark force, may generate a stochastic gravitational wave background (SGWB) with a characteristic spectrum different from ordinary binaries. We find that the SGWB from planet-mass dark binaries is detectable by space- and ground-based GW observatories. The contribution to the SGWB today is smaller from binaries that merge before recombination than after, avoiding constraints on extra radiation degrees of freedom while potentially leaving a detectable GW signal at high frequencies up to tens of GHz.
Primordial monopoles, black holes and gravitational waves
Authors: Moursy Ahmad , Shafi Qaisar
Published: August 2024

We show how topologically stable superheavy magnetic monopoles and primordial black holes can be generated at observable levels by the waterfall field in hybrid inflation models based on grand unified theories. In SU(5) ×U(1)χgrand unification, the monopole mass is of order 4 × 1017GeV, and it carries a single unit (2π/e) of Dirac magnetic charge as well as screened color magnetic charge. The monopole density is partially diluted to an observable value, and accompanied with the production of primordial black holes with mass of order 1017–1019g which may make up the entire dark matter in the universe. The tensor to scalar ratioris predicted to be of order 10-5–10-4which should be testable in the next generation of CMB experiments such as CMB-S4 and LiteBIRD. The gravitational wave spectrum generated during the waterfall transition is also presented. The observed baryon asymmetry can be explained via leptogenesis.
Polytropic gas cosmology and late-time acceleration
Authors: Dahmani Safae , Chaudhary Himanshu , Bouali Amine , Jas Pacif Shibesh Kumar , Ouali Taoufik
Published: August 2024

The accelerated expansion of the Universe has sparked significant interest in the mysterious concept of dark energy within cosmology. Various theories have been proposed to explain dark energy, and many models have been developed to understand its origins and properties. This research explores cosmic expansion using the Polytropic Gas (PG) approach, which combines Dark Matter (DM) and Dark Energy (DE) into a single mysterious fluid. We used the principles of general relativity and built our model within the homogeneous and isotropic framework of Friedmann-Lemaître-Robertson-Walker (FLRW) spacetime. We revised the Original Polytropic Gas (OPG) model to expand its applicability beyond the OPG, to the ΛCDM model. Our model's parameters were carefully adjusted to reflect key cosmological features of the variable PG approach. To validate our model, we performed a Markov chain Monte Carlo analysis using recent Supernova data from the Pantheon+ survey, 36 observational

data points, 162 Gamma-Ray Bursts, and 24 binned Quasars distance modulus data. The AIC and BIC criteria indicate that our model is slightly preferred over the ΛCDM model based on observational data. We also tested our model with

data, Supernova, Gamma-Ray Bursts, and Quasars and found that it exhibits a transition from a quintessential to phantom regime. The Polytropic dark fluid model (PDFM) is a promising candidate that effectively addresses the interplay between cosmic acceleration and dark energy.
The multi-faced nature of the quasicoherent mode in EDA H-mode
Authors: Grenfell G. , Gil L. , Manz P. , Silva C. , Adamek J. , Brida D. , Conway G.D. , Eich T. , Faitsch M. , Happel T. , Spolaore M. , Stroth U. , Tal B. , Vanovac B. , Wolfrum E. ,   the ASDEX Upgrade Team,   the EUROfusion Tokamak Exploitation Team
Published: August 2024

In order to extend the enhanced D-Alpha H-mode to future devices, it is crucial to understand the properties of the main signature of this regime, the quasicoherent mode (QCM), that likely clamps the pressure gradient below the ideal magnetohydrodynamic limit. The turbulent character of the QCM is investigated with scanning probes in ASDEX Upgrade. Analysis reveals the multi-faced character of the mode that spans both the confined region (where the radial electric field is negative) and the near scrape-off layer (SOL) (where it is positive). Fluctuations of density and potential at the QCM frequency are more anti-correlated towards the confined region, which is a fingerprint of electromagnetic instabilities, while they become more correlated in the SOL, as expected for a drift-wave, inducing cross-field transport across the separatrix.
The Potential of Macadamia Oil as A Substitute Alternative Transformer Oil
Authors: Romadhona G. , Winarso W. , Sapundani R. , Ramadhani I. S. , Anjani A. G.
Published: August 2024

The oil used in transformers is still using mineral oil, even though mineral oil derived from petroleum will be exhausted, non-renewable, non-degradable, toxic, not environmentally friendly. In this study, researchers used macadamia oil to determine the breakdown voltage value. This oil is oil derived from plants, its existence will always exist, can be renewed, can be decomposed again, non-toxic, and environmentally friendly. The value of the breakdown voltage, is the voltage limit that makes the transformer components submerged in oil connected, the oil no longer functions as an insulator. the test was carried out using an OTS 100 AF device with an electrode distance of 2.5 mm using a mushroom electrode referring to the IEC standard. The test is carried out at a temperature of 50 °C – 60 °C where this temperature is the temperature when the transformer operates. from the test results obtained a value of 57.60 kV, where this value has exceeded the standard and can be used at a network voltage of 170 kV.
The Strength Performance Analysis of Vertical Wind Turbine’s Tower on Base Transceiver Station
Authors: Al-Janan D.H. , Daniel R.J. , Bahatmaka A. , Kriswanto
Published: August 2024

Wind power plant is one of the potential sources of electricity to be developed. Due to its height, the Base Transceiver Station (BTS) tower has a possibility for the wind turbine tower. This study aims to analyze whether the BTS tower can still stand sturdy when the wind turbine load is added. This research is related to the analysis of the value of von Mises stress, displacement, and safety factors. Furthermore, a comparison will be made between the results of the analysis with the maximum limit of these factors to determine the feasibility of the BTS tower. The result of this research is that none of these three factors cross the boundaries of the material used in the BTS tower. It can be concluded that the BTS tower when the wind turbine load is added can still stand strong and technically safe.
Lab scale investigation on biocoagulant performance to remove organic from tempe liquid waste treatment
Authors: Marendra S M P , Aphirta S , Ratnaningsih R , Hadisoebroto R , Syerin L A , Sarwahita S A , Manora W
Published: August 2024

This study aims to determine the optimum coagulant dose and optimum mixing time from the use of trembesi seeds, tamarind seeds, and moringa seeds as biocoagulants in removing turbidity, TSS, BOD, and COD in a laboratory scale with variations in biocoagulant doses of 0, 10, 20, 30, 50, 70, 100, 500, 600, and 700 ppm, using coagulation speed of 200 rpm with variations of fast stirring time of 1, 2, and 3 minutes, and flocculation speed of 80 rpm with variations of slow stirring time of 15, 30, and 45 minutes. The results showed that the optimum biocoagulant dose of 500 ppm was able to remove max turbidity by 78%, 54%, and 69% for trembesi seed, tamarind seed, and moringa seed coagulants, respectively. The optimum fast mixing time is 2 minutes for trembesi seed and moringa seed coagulant, and 3 minutes for tamarind seed coagulant. Parameters BOD, COD, and TSS do not meet the quality standards of the Minister of Environment Regulation Number 5 of 2014. The speed of coagulation rotation in the reactor is 100 rpm for 1 minute and 20 rpm flocculation for 10 minutes. This study shows that the biocoagulants of trembesi seeds, tamarind seeds, and moringa seeds are effective as biocoagulants because they are able to remove >50% of the TSS parameter, but further research is needed regarding the potential of liquid waste effluent to become fertilizer.
Identification of Saponin Compounds and Antioxidant from Batu Variety of Longan Leaf Extract
Authors: Paramita Octavianti , Ansori Muhammad , Wahyuningsih  , Romiyatun Romiyatun M A , Melissa Ardelia H , Sholeha Nur Amalia , Mayangsari Effelie Dewi
Published: August 2024

This study aims to identify saponin compounds and to examine the antioxidant activity contained in batu variety of longan leaf extract from Semarang Regency. The observed longan leaves are fresh leaves, fresh leaf extract, and dry leaf extract. Longan leaves contain various bioactive compounds, one of which functions as an antioxidant. This study consists of extraction, saponin testing, and antioxidant activity which is tested using 2,2-diphenyl-1-picrylhydrazyl (DPPH) and FRAP. Fresh leaves, fresh leaf extract, and dried leaf extract contain saponin compounds. The levels of saponin compounds found in fresh leaves, fresh leaf extract, and dry leaf extract using the gravimetric method were respectively 1.539%, 1.621%, and 1.518%. The DPPH IC50 antioxidant activity values of fresh leaves, fresh leaf extracts, and dry leaf extracts were 75.495%, 25.192%, and 160.367% respectively. The antioxidant activity values tested using the FRAP method for fresh leaves, fresh leaf extract, and dry leaf extract were respectively 24.83 mM TR/g, 18.528 mM TR/g, and 12.743 mM TR/g.
Intrinsic angular momentum, spin and helicity of higher-order Poincaré modes
Authors: Babiker M , Koksal K , Lembessis V E , Yuan J
Published: August 2024

The availability of coherent sources of higher order Poincaré optical beams have opened up new opportunities for applications such as in the optical trapping of atoms and small particles, the manipulation of chirally-sensitive systems and in improved encoding schemes for broad-bandwidth communications. Here we determine the intrinsic properties of integer order

m
⩾
0

Poincaré Laguerre–Gaussian (LG) modes which have so far neither been evaluated, nor their significance highlighted. The theoretical framework we adopt here is both novel and essential because it emphasises the crucial role played by the normally ignored axial components of the twisted light fields of these modes. We show that the inclusion of the axial field components enables the intrinsic properties of the Poincaré modes, notably their angular momentum, both spin and orbital as well as their helicity and chirality, to be determined. We predict significant enhancements of the intrinsic properties of these modes when compared with those due to the zero order LG modes. In particular, we show that higher order LG Poincaré modes exhibit super-chirality and, significantly so, even in the case of the first order m = 1.
Designing quantum multi-category classifier from the perspective of brain processing information
Authors: Ding Xiaodong , Xu Jinchen , Song Zhihui , Hou Yifan , Shan Zheng
Published: August 2024

In the field of machine learning, the multi-category classification problem plays a crucial role. Solving the problem has a profound impact on driving the innovation and development of machine learning techniques and addressing complex problems in the real world. In recent years, researchers have begun to focus on utilizing quantum computing to solve the multi-category classification problem. Some studies have shown that the process of processing information in the brain may be related to quantum phenomena, with different brain regions having neurons with different structures. Inspired by this, we design a quantum multi-category classifier model from this perspective for the first time. The model employs a heterogeneous population of quantum neural networks (QNNs) to simulate the cooperative work of multiple different brain regions. When processing information, these heterogeneous clusters of QNNs allow for simultaneous execution on different quantum computers, thus simulating the brain’s ability to utilize multiple brain regions working in concert to maintain the robustness of the model. By setting the number of heterogeneous QNN clusters and parameterizing the number of stacks of unit layers in the quantum circuit, the model demonstrates excellent scalability in dealing with different types of data and different numbers of classes in the classification problem. Based on the attention mechanism of the brain, we integrate the processing results of heterogeneous QNN clusters to achieve high accuracy in classification. Finally, we conducted classification simulation experiments on different datasets. The results show that our method exhibits strong robustness and scalability. Among them, on different subsets of the MNIST dataset, its classification accuracy improves by up to about 5% compared to other quantum multiclassification algorithms. This result becomes the state-of-the-art simulation result for quantum classification models and exceeds the performance of classical classifiers with a considerable number of trainable parameters on some subsets of the MNIST dataset.
Broadening the scope of anthropogenic influence in extreme event attribution
Authors: Jézéquel Aglaé , Bastos Ana , Faranda Davide , Kimutai Joyce , Le Grix Natacha , Wilson Anna M , Rufat Samuel , Shepherd Theodore G , Stuart-Smith Rupert F , Van Loon Anne F , Bevacqua Emanuele , D’Andrea Fabio , Lehner Flavio , Lloyd Elisabeth A , Moemken Julia , Ramos Alexandre M , Sippel Sebastian , Zscheischler Jakob
Published: August 2024

As extreme event attribution (EEA) matures, explaining the impacts of extreme events has risen to be a key focus for attribution scientists. Studies of this type usually assess the contribution of anthropogenic climate change to observed impacts. Other scientific communities have developed tools to assess how human activities influence impacts of extreme weather events on ecosystems and societies. For example, the disaster risk reduction (DRR) community analyses how the structure of human societies affects exposure, vulnerability, and ultimately the impacts of extreme weather events, with less attention to the role of anthropogenic climate change. In this perspective, we argue that adapting current practice in EEA to also consider other causal factors in attribution of extreme weather impacts would provide richer and more comprehensive insight into the causes of disasters. To this end, we propose a framework for EEA that would generate a more complete picture of human influences on impacts and bridge the gap between the EEA and DRR communities. We provide illustrations for five case studies: the 2021–2022 Kenyan drought; the 2013–2015 marine heatwave in the northeast Pacific; the 2017 forest fires in Portugal; Acqua Alta (flooding) events in Venice and evaluation of the efficiency of the Experimental Electromechanical Module, an ensemble of mobile barriers that can be activated to mitigate the influx of seawater in the city; and California droughts and the Forecast Informed Reservoir Operations system as an adaptation strategy.
Generalized Propensity Score Methods to Assess CKD-Associated Physiologic Factors and Risk of Kidney Failure in the Chronic Renal Insufficiency Cohort (CRIC) Study
Authors: Scialla Julia J , Mallawaarachchi Indika , Illenberger Nicholas , Brookhart M Alan , Isakova Tamara , Mitra Nandita , Ma Jennie Z ,   the CRIC Study Investigators
Published: August 2024

Epidemiologic studies have identified many biochemical risk factors for chronic kidney disease (CKD) progression that are correlates of kidney function, termed here ‘CKD-associated physiologic factors’. Uncertainty remains if these factors are risk factors or risk markers accounting for aspects of kidney function not otherwise captured. We aimed to use flexible machine learning, a dynamic covariate history including kidney function informative markers, and generalized propensity score (GPS) weighting, to better control confounding for such exposures. We studied 3,052 adults with CKD in the Chronic Renal Insufficiency Cohort Study. We established a 2-year run-in period and assembled 90 variables that characterize variability and trends of selected CKD-associated physiologic factors and confounders. Using SuperLearner, we created a GPS for each CKD-associated physiologic factor and performed GPS-weighted Cox regressions. For context, we also evaluated results from traditional multivariable Cox proportional hazards models as in prior studies. Similar to traditional approaches, bicarbonate, calcium, potassium, hemoglobin, and PTH were each associated with risk of kidney failure using GPS weighting. The GPS approach detected non-linear associations in many factors, some of which were not detected with traditional models. We conclude that many associations between CKD-associated physiologic factors and kidney outcomes remain strong after GPS weighting.
Bimodal pattern of allometric scaling along grapevine shoots
Authors: Haj-Yahya Alaa , Sorek Yonatan , Hochberg Uri , Ohana-Levi Noa , Zait Yotam , Shtein Ilana
Published: August 2024

Background and Aims

Each branch internode, with the organs growing on it, can be seen as a single morphological phytomer subunit made of structurally and functionally interrelated components. However, allometric relationships between the anatomy and morphology of these subunits remain unclear, particularly in the axial context. The aim of this study was to address this knowledge gap by measuring morpho-anatomical parameters and their allometric relationships along grapevine shoots.

Methods

To facilitate comparison, shoot length was normalized, and a relative position index was calculated for each internode, ranging from zero at the base to one at the apex. Scaling relationships between morpho-anatomical parameters along the axis were developed and validated by statistical modelling.

Key Results

Most morpho-anatomical parameters displayed an axial behaviour of increasing then decreasing in size from base to apex, with the exception of shoot diameter and shoot vessel density. A relative position index of 0.2 acted as the data turning point for most variables analysed. During the first phase (relative position index of <0.2), the traits of the phytomer organs are uncoupled and show weak allometric correlation, and during the second phase the traits exhibit strong allometric relationships.

Conclusions

Our findings suggest that allometric relationships along grapevine shoots are not constant; they exhibit a bimodal pattern, possibly influenced by seasonal temperatures. This work could aid in managing productivity shifts in agricultural and natural systems under global climate change and adds to basic knowledge of differentiation and development of growth units in plants.
75 Audit of Pain Control in Surgical Inpatients
Authors: Jodlowski G , Joyce D
Published: August 2024

Introduction

Pain is a significant feature in surgical patients and is complicated by multiple underlying mechanisms and co-morbidities. Optimal pain control is an important feature of care as prolonged pain can impair quality of life, reduce mobility, healing, delay hospital discharge and cause detrimental pathophysiological changes. The aim of audit is to assess the quality of pain control including side effects of analgesics in surgical inpatients at Lincoln County Hospital NHS Trust.

Method

Prospective review of patients and their clinical records was undertaken in 50 surgical inpatients and repeated in 54 patients following a departmental educational presentation. Outcomes were measured against the WHO analgesic ladder and NICE 147 guideline.

Results

Pain was managed adequately in 30% patients in the first cycle and in 46% the second cycle. Prescribing habits were inadequate in 30% of patient’s vs 16% of patients in the first cycle. Prophylactic laxatives were prescribed in 100% of eligible patients in the second cycle, and anti-emetics were offered to 92% in the first cohort vs 82% in the second. Overall, it can be seen that changeover of staff affects the prescribing habits which should be unique for all surgical inpatients.

Conclusions

Pain management of surgical patients has improved following a departmental intervention. However, measures to address pain and opiate side effects should be continued with involvement of the entire team including nurses, clinicians and pain team practitioners.
380 Audit of the Management of Suspected Ureteric Colic in Barnet Hospital Emergency Department
Authors: Dighero I , Ahmad S
Published: August 2024

Aim

Ureteric colic is a common presentation to the Emergency Department (ED) causing significant morbidity and socio-economic burden for both the patient and healthcare provider. Prompt diagnosis and symptom control aims to improve the patient experience and facilitate treatment. Our aim was to audit management within our department based on BAUS/NICE guidelines.

Method

We performed a retrospective review of 100 consecutive patients presenting to our ED with suspected ureteric colic who had a CT-KUB. Data was collected based on BAUS/NICE guidelines for management of suspected ureteric colic.

Results

98% of patients had a CT-KUB performed within 14 hours of arrival in the ED with average time to CT-KUB of 4hrs 50mins. 22% of patients had an obstructive ureteric stone identified. Of these, 45% had a stone <4.9mm, and 55% had a stone >5mm. 75% of patients with a stone identified were referred to the renal stone MDT and 45% had a repeat CT-KUB requested. 52% of patients received analgesia in the ED, with most patients receiving oral paracetamol with an average time to administration of any analgesia from triage of 3hrs 26mins. 51% of patients had their calcium measured and 4% urate measured.

Conclusions

This audit demonstrates excellence in performance in terms of diagnostic imaging for suspected ureteric colic within our department. However, we identify a need to improve appropriate analgesia administration and diagnostic work up in terms of biochemistry relevant to stone pathology through education and pathway review. A second cycle of audit is currently being completed to review these interventions.
513 A Clinical Audit on the Use of Red Cell Transfusions in a DGH’s Trauma and Orthopaedics Ward
Authors: Qamar A , Fung A
Published: August 2024

Aim

To compare the practice of prescribing, administering, and monitoring transfusions, with the current local Trust guidelines in order to determine the proportion of inappropriate blood transfusions especially in times of regional and national shortage of blood products

Method

For a six-week period in 2022, numerous endpoints were measured, reflecting the specifications of the Trust guideline. Based on the results from this initial data, a teaching session was conducted to create awareness of the Trust guideline amongst all rotational doctors. A subsequent re-audit was conducted to determine the effectiveness of the intervention. Following data analysis, further suggestions were discussed and implemented.

Results

Prior to intervention, 34 units were transfused across 16 patients with the mean age being 81.88 years. Post-teaching session, 11 units were transfused with the mean age being 79.58 years. 26.4% units were transfused for active haemorrhage, none were due to major haemorrhage, compared to 18.2% for active haemorrhage post-teaching session. 73.5% transfusions were inappropriate, defined as transfusions conducted in those who did not meet the haemoglobin level (Hb) threshold stated in the guideline. This significantly reduced post-teaching session to 45.5%. Transfusion-associated circulatory overload assessment was completed in 58.8%, improving to 90.9% post-intervention.

Conclusions

Simple measures such as an induction booklet highlighting the Trust’s blood transfusion guideline ensured rotational doctors were aware of the local protocol, preventing a significant proportion of inappropriate red cell transfusions.
830 Intra-Operative Tourniquet Use in Orthopaedic Surgery: How Tight Is Too Tight?
Authors: Mills R , Sohail Z
Published: August 2024

Aim

Tourniquets are regularly used in Orthopaedic surgery as an effective means of ensuring a clear, 'bloodless' operating field. However, knowledge concerning the implementation of this commonly used appliance is infrequently tested. Our objective was to design a survey to assess the current level of knowledge surrounding the safe use of intra-operative tourniquets in Orthopaedic surgery.

Method

A survey was constructed using Google Forms, with standards comparable to BOAST Guidelines, and disseminated to Orthopaedic team members at one single centre, district general hospital. Anonymised results were collected.

Results

22 responses were collected: 36.4%(8) from consultants, 22.7% (5) from Registrars, 22.7% (5) from scrub team members and 9.1% (2) responses from SHO's. 9.1% rated their level of confidence in safe tourniquet use as '1' ('Not confident') on the Likert scale, 36.4% rated a '4', whilst 22.7% rated themselves '5' ('Very Confident'). However, despite confidence levels, only just over half (54.5%) were aware of any guidelines available concerning tourniquet use. Half correctly answered that the tourniquet should encompass more than half of limb diameter. The majority of respondents (81.8%) correctly selected the ideal tourniquet pressure (above/in relation to systolic blood pressure) required for children. However, respondents were less confident in their selection of tourniquet pressures for adults. 63.6% selected the correct recommended upper limit for ischaemic tourniquet time whilst 22.7% recommended that audible reminders be given after this every 10 minute.

Conclusions

The mixed variety of survey responses demonstrates that there is still clear room for improvement in the safe management of tourniquets.
1034 Adherence to VTE Assessment and Re-Assessment for General Surgery Inpatients
Authors: Patel S , Abbasova A , Jacob P A , Moussa R , Ihedioha U
Published: August 2024

Aim

To identify compliance with mandatory VTE assessment on admission and its re-assessment for General surgery (GS) inpatients at a District General Hospital.

Method

All adult patients (≥18 years) admitted under the General Surgery department from 21/08/2023 to 25/08/2023 were included. Patients admitted due to long stays following elective surgery with any operative approach were also included. The patient’s VTE assessment charts were reviewed for 24 hours. This was done to identify if an assessment was completed within 14 hours of admission and reassessment after 24 hours.

Results

40 patients were included in the audit.

Admission Assessment ResultsN=24/40 did not have a tick in either 'no contraindication' or 'contraindication' boxesN=11/24 did not have any tick in 'risk factors’ or bleeding risk' boxesN=20/40 had no documentation of date, time, name, or signature

24hr Later Assessment ResultsN=6/40 patient had re-assessment100% of patients who had reassessment had either 'continue' or 'change' ticked

Conclusions

Venous thromboembolism (VTE) is a frequent disease affecting more than 1 in 12 individuals during their lifetime. VTE is associated with long-term complications such as recurrence, post-thrombotic, and post-pulmonary embolism syndrome. Despite VTE prophylaxis being administered for patients, documentation of risk factors and contraindications for VTE prophylaxis administration was poor. The worst performing areas were VTE re-assessment 24 hrs after admission and indicating if there is 'no contraindication' or 'contraindication' to VTE-prophylaxis on admission. It is important to stay vigilant and check the assessment during ward rounds. Adherence to VTE assessment still needs to be studied at a later date.
1279 Compliance of Countess of Chester Hospital with the Getting It Right First Time (GIRFT) Guidance on Cauda Equina Syndrome
Authors: Jabr Y , Ghodke A , Beattie S , Thonse R , Naikoti K
Published: August 2024

Aim

Ensure timely investigations for suspected Cauda Equina Syndrome (CES) at the Countess of Chester Hospital align with GIRFT's National Suspected CES Pathway (February 2023).

Method

Retrospective audit collecting data on A&E attendances with a referred suspected cauda equina syndrome between 01/09/2022 and 31/01/2023 (pre-GIRFT guidance). 36 patients were collected and narrowed down to 27 following adherences to inclusion criteria (incl. exclusion of medical inpatients with symptoms of CES who had scans done during their stay). Data collection parameters included: [1] Time of presenting to A&E. [2] Significant neurological deficit / red flags of CES on exam. [3] Time and amount on post-void bladder scan. [4] Time of MRI request. [5] Time of MRI completion. [6] Confirmed CES on scan. [7] Transfer and further management in neurosurgery centre.

Results

Of 26 admissions (one was transferred to regional neurosurgical centre before local review), 21 showed CES signs. Mean time from MRI request to completion was 4.67 days. Only six had timely MRI completion within 4 hours, with nine patients confirming CES. Six patients were transferred to the neurosurgical centre.

Conclusions

Significant MRI delays, some over 24 hours, stem from A&E challenges such as understaffing and prolonged wait times. Delays occur when the neurosurgical centre advises next-day scans. Recommendations include radiology adherence to GIRFT guidance and discussing introducing additional dedicated MSK radiologists and collaborating with A&E to streamline reviews for suspected CES. Thorough documentation is emphasised. Further review is recommended post-implementation to assess improvements in compliance with MRI requesting and scan completion timelines.
365 Completion Mastectomy After Wide Local Excision (Wle) and Sentinel Lymph Node Biopsy (Slnb) for Ductal Carcinoma Insitu (Dcis), Local Data from the Countess of Chester Hospital
Authors: Abdelmageed A , Hargreaves A , Ooi J , Harding-Mackean C , Seward J , Marikakis N
Published: August 2024

Aim

We looked at patients undergoing SLNB at time of completion mastectomy for DCIS to identify the incidence of microinvasion, invasive carcinoma and positive SLNB following completion mastectomy for DCIS.

Method

Retrospective study on a cohort group of patients who underwent completion mastectomy after WLE for DCIS for positive or close margins in the period from January 2010 to December 2021. Exclusion criteria were invasive cancer or microinvasion identified on the WLE specimen, previous ipsilateral breast cancer and recurrent cases who underwent upfront mastectomy after previous WLE for DCIS. The main limitation of the study was the limited number of cases that fit the inclusion criteria of the study in a single institution.

Results

Total 30 cases were identified that fit the inclusion criteria of the study. SLNB was performed in 25 cases (17 cases with completion mastectomy and 8 cases with WLE). Only 5 cases, did not have SLNB.

None of the studied cases showed microinvasion or invasive cancer in the final pathology in the mastectomy specimen. None of the SLNB performed was positive.

Conclusions

In view of the final mastectomy specimen showing no microinvasion or invasive cancer, combined with all SLNB results being negative, it can be posited that a significant portion of the abnormality had already been sampled in the prior WLE. Therefore, the routine use of SLNB during completion mastectomy is questionable. We would like to continue this audit prospectively and collaborate with our joint screening unit to obtain more meaningful results to support change in local practise.
446 Cor-Triatriatum Dexter: An Incidental Finding in an Adult with Rheumatic Heart Disease
Authors: Thomas R J , Jha G
Published: August 2024

Introduction

Cor-triatriatum dexter (CTD) is an extremely rare congenital anomaly, accounting for 0.025% of congenital heart defects. It typically presents in childhood; however this case describes incidental finding of CTD in an asymptomatic 49-year old male with rheumatic heart disease.

Case Presentation

A 49-year-old male presented with 2–3-month history of exertional dyspnea (NYHA grade II), orthopnea, pedal edema, and occasional palpitations. He had a prior diagnosis of rheumatic heart disease with severe mitral regurgitation. Examination revealed elevated jugular venous pressure, bilateral basal crepitations, soft S1, pansystolic murmur in mitral area, loud non-palpable S2, and right ventricular heave. Investigations showed right ventricular hypertrophy with strain on ECG, severe mitral and tricuspid regurgitation on echo, and CTD characterized by a membrane dividing the right atrium into two chambers with an 8.6mm defect. Coronary angiography revealed atherosclerotic disease. Right heart structures were otherwise normal with no pulmonary artery stenosis or Ebstein anomaly. The CTD was likely present since birth but non-obstructive, allowing the patient to remain asymptomatic until presenting with sequelae of longstanding mitral regurgitation.

Treatment and Outcome: The patient underwent MVR, TR and resection of the CTD membrane. Post-operative echo showed normally functioning prosthetic mitral valve, mild TR and no residual CTD membrane. The patient was discharged in stable condition on warfarin.

Conclusion

CTD may remain undiagnosed well into adulthood due to non-obstructive membranous anatomy. Incidental diagnosis prompted successful surgical resection alongside repair of symptomatic valvular disease. Clinicians should have high index of suspicion for detecting rare congenital anomalies in adults with acquired heart disease.
812 Audit on Chest Drain Clinic: Are We Utilising the Service Effectively?
Authors: Binti Yusri N A , Abdelrahman R , Pimprikar S
Published: August 2024

Aim

The chest drain clinic service, under the Department of Thoracic Surgery, designed to provide follow-ups for patients discharged with ambulatory chest drains. This audit assessed the clinic's effectiveness in ensuring safety, regular reviews, and its impact on costs and bed utilization.

Method

A retrospective analysis of a one-year period identified 97 patients discharged home with ambulatory chest drains. Patients progress and complications assessed throughout their follow-ups. In addition, number of bed days saved along with service costs from the day of discharge to the day of chest drain removal were calculated and analysed.

Results

The study found that 64% of these patients required only one clinic visit before their drains were removed. This led to 60% reduction in inpatient admissions, resulting in a remarkable total of 1,038 saved bed days. There was substantial cost savings, totalling approximately £361,200 over the study period. These savings allowed the service to care for an additional 173 inpatients, generating potential income of £1,038,000 for the trust.

Furthermore, minimal number of 7.2% patients required re-admission due to complications such as pain, infection, or worsening surgical emphysema. These patients could re-enter care directly from the chest drain clinic, bypassing emergency department, thereby saving time and resources.

Conclusions

In summary, the chest drain follow-up clinic has demonstrated its effectiveness not only in patient safety and regular reviews but also in substantial cost savings, increased bed availability, and efficient re-admission procedures. This study highlights the significance of expanding and optimizing such services within healthcare institutions, benefiting both patients and healthcare providers.
852 Total Endovascular Aortic Arch Repair: Is It for Everyone and Where Is Its Evidence?
Authors: Hussain M , Jubouri M , Al-Tawil M , Tan S Z , Bashir M , Georgotellis A , Velayudhan B , Mohammed I
Published: August 2024

Background

Open total arch replacement (TAR) remains the mainstay management strategy for thoracic aortic arch pathologies. TAR evolved from the 2-stage conventional elephant trunk (CET) technique to the hybrid frozen elephant trunk (FET) which combined open surgical repair (OSR) with thoracic endovascular aortic repair (TEVAR) into a 1-stage procedure. Although FET has been able to achieve better outcomes than CET, it is still associated with complications requiring secondary reintervention. Consequently, FET is being overtaken by new generations of TEVAR devices for endoarch repair. Total endoarch repair (TER) is currently indicated in patients deemed high-risk for open surgery; however, it has shown strong potential for becoming the gold standard treatment for aortic arch pathologies. Therefore, this review aimed to highlight the evolution of aortic arch repair, focusing on TER device development, intervention criteria, and clinical outcomes.

Method

A comprehensive literature search of various databases (PubMed, Google Scholar, EMBASE, Scopus, and ResearchGate) was conducted and papers published as of July 2023 were included.

Results

Upon comprehensively searching the literature, the technical success of TER ranged from 91%-100%, mortality 0%-19%, stroke 0%-16.7%, and reintervention 0%-30.3%, using different commercially available endografts.

Conclusions

TER represents the future of aortic arch repair with comparable clinical outcomes to FET. Given its novelty, further studies with larger cohorts and longer follow-up periods are necessary. Additionally, studies directly comparing arch OSR to TER are warranted to determine superiority.
1189 Agenesis of Gallbladder - a Rare Condition with Common Symptoms
Authors: Feyang Limbu D , Shrestha K , Pal S , Shrestha A
Published: August 2024

Introduction

Agenesis of the gallbladder is a rare abnormality with an incidence of 0.01-0.06%. Although patients are asymptomatic, half of them can present with abdominal pain, particularly biliary colic. Women are affected more than men with a likelihood ratio of 3:1.

Case

This is a case of a 50-year-old lady who presented with recurrent symptoms and signs of biliary colic type pain. All her routine bloods including inflammatory markers, Liver Function Test and amylase were within normal limits. A combination of Transabdominal ultrasound (USG), CT scan, MRCP, HIDA scans concluded gallbladder agenesis without extrahepatic biliary atresia. Currently, she is being managed conservatively with analgesia and antispasmodics. She is undergoing investigations like gastroscopy to rule out other causes of her symptoms. She has been referred to tertiary centre for Endoscopic USG and Sphincter of Oddi (SOD) Manometry.

Discussion

It is interesting to see how such a rare condition presents with a typical biliary symptom. However, diagnosis begins by ruling out any structural causes for the pain with radiological investigations as mentioned above including endoscopic USG, ERCP and analysis of bile for crystals. Finally, SOD manometry performed to rule out any SOD dysfunction which also can present with similar symptoms. A combination of antispasmodic and simple analgesia is effective for management of symptoms.

Conclusions

Biliary colic symptoms are common with gallbladder agenesis. MRCP is effective investigation for diagnosis. Antispasmodic medication and simple analgesia are the treatment of choice.
8 IgG4-Related Sclerosing Disease of the Temporal Bone: A Systematic Review
Authors: Oochit K , Wong Y Y , Mihuna A , Oliwa A , Kontorinis G
Published: August 2024

Aim

IgG4-related disease (IgG4-RD) involving the temporal bone is an uncommon and underrecognized pathology often mistaken for malignancy. This systematic review is the first that aims to thoroughly analyse IgG4-RD of the temporal bone.

Method

The following databases (Ovid MEDLINE, EMBASE, Cochrane Library, and Google Scholar) were searched using the following keywords: "lgG4-RD," "skull," "skull base," "cranial," "temporal bone," "inner ear." The bibliographies of relevant articles were additionally manually searched. The JBI Critical Appraisal Checklist for Case Reports and Case Series was used to assess the risk of bias; because of the scarcity of the reports, data were available through limited case series and reports; thus, data synthesis was not possible.

Results

Seventeen studies with 22 cases of temporal bone involvement were included. The most common presenting symptoms were hearing loss, otalgia, and headache. The mastoid and petrous bone were the most affected anatomical areas. Both computed tomography and magnetic resonance imaging were used. Biopsies showed the characteristic lymphoplasmacytic infiltrate in all cases, with histopathology being the diagnostic modality that set the diagnosis. Most patients were treated with corticosteroids ± surgery or a combination of corticosteroids and immunosuppressants with 95.5% symptomatic response and disease control.

Conclusions

IgG4-RD of the temporal bone radiologically manifests as space-occupying, lytic lesions; clinically, it presents with vague otological symptoms. Diagnosis involves a thorough workup, with histopathology being crucial in setting a definite diagnosis. IgG4-RD tends to respond well to systemic corticosteroids, whereas surgery is mostly required for diagnostic purposes.