bluuebunny/crossref_metadata_2025 huggingface dataset:
Joint Optimization of Probabilistic Shaping and Geometric Shaping for Faster-than-Nyquist Signaling
Authors: Kang Weimin
Published: September 2024

We propose a joint optimization algorithm of probabilistic shaping and geometric shaping for faster-than-Nyquist (FTN) signaling. The theoretical analysis and bit error performance both represent that the FTN probabilistic-geometric shaping method is superior to the conventional Nyquist regular QAM system. When spectral efficiency (SE) is 3.077 bits/s/Hz, the proposed 16QAM FTN probabilistic-geometric shaping scheme can obtain 1.65 dB theoretical gain compared to the conventional Nyquist regular 16QAM system, while the simulation gain is 2.90 dB with spectral efficiency at 3.077 bits/s/Hz. The proposed 16QAM FTN probabilistic-geometric shaping scheme can obtain 1.63 dB theoretical gain compared to the conventional FTN regular 16QAM system, while the simulation gain is 3.28 dB with spectral efficiency at 3.282 bits/s/Hz. Therefore, the proposed method is reliable, which can be regarded as a potential scheme for the 6G communications.
Design and Implementation of TDMA Scheduling Based on BRKGA
Authors: Xiaoying Shuai , Yuxia Yin
Published: September 2024

Messages in wireless Ad hoc networks may require intermediate multi-hop forwarding from the source to the target node. To find an optimum contend-free time slots scheduling solution in Ad hoc, a TDMA (Time Division Multiple Access) scheduling scheme based on BRKGA (Biased Random-key GA) is proposed. The algorithm divides the population of generation k into elite group and rest group. The elite solutions are copied directly to the next generation. One parent from the elite group and another parent from the rest population are randomly selected to crossover a new solution. The worst Pm solutions of the population of generation k are replaced by the mutants. The simulation results demonstrate that the TDMA based on BRKGA exhibits better performance in terms of lower frame length and higher channel utilization.
Plaid Fabric Image Retrieval Based on Wavelet Transform and SIFT Features
Authors: Zhao Pengyu , Liu Yuan , Zhang Xiaoting
Published: September 2024

This study presents a method for plaid fabric image retrieval that combines wavelet and SIFT features to address the challenges of accuracy and efficiency in fabric retrieval due to diverse fabric types. The process starts with cropping plaid fabric images and applying histogram equalization to improve brightness and contrast. Texture is enhanced using the Sobel operator, and the Haar wavelet transform extracts image high-frequency components in various directions. Wavelet features are then derived through histogram statistics. The SIFT algorithm is utilized to describe local features by capturing key points and directional information. A codebook aggregates these features from the fabric database, and VLAD encoding generates a vector for the image features, which is further reduced to 256 dimensions via PCA. A similarity-weighted fusion method combines the wavelet and SIFT features, achieving an mAP of 0.67 and an average retrieval time of 1.1 seconds per image. This method significantly enhances plaid fabric retrieval, aiding in fabric design and production.
Study on ECG Signal Classification and Athlete Health Analysis Based on Attention Mechanism
Authors: Zhu Dong , Zhu Haiyan
Published: September 2024

In the training and competition process of athletes, their bodies are subjected to various levels of load and stress. As an important diagnostic tool, ECG signals can provide deep insights into the cardiac function of athletes, including heart rate, rhythm, and changes in cardiac electrical activity. By conducting a thorough examination of ECG readings, we are able to quickly identify possible heart conditions or irregularities, which is essential for preserving the heart health of athletes. However, ECG signals are highly complex and multidimensional. To accurately classify these signals, it is necessary to select the most representative and discriminative features. However, this is not an easy task, and the selection of effective features remains a pressing issue. To address this problem, this paper proposes the CSNet classification network model. This framework eradicates disruptions in electrocardiogram signals, performs attribute extraction via a direct network configuration, and combines channel focus mechanisms and spatial focus mechanisms to enhance attribute representation and categorization capabilities. Furthermore, to retain the temporal information of ECG signals, we introduce the Gated Recurrent Unit (GRU), which helps to better capture temporal patterns and dependencies in the signals, thus enabling more accurate classification of ECG signals.
Bi-DAUnet: Leveraging BiFormer in a Unet-like Architecture for Building Damage Assessment
Authors: Dong Chao , Zhao Xi
Published: September 2024

In recent years, Convolutional Neural Networks (CNNs) have become an important research direction in the field of building damage assessment. Particularly, deep neural networks based on the U-shaped architecture and skip connections have achieved significant breakthroughs in the task of architectural damage assessment. Despite the impressive performance of CNNs, effectively capturing global and long-range semantic information remains a challenge due to the local nature of their convolutional operations. To address this issue, we propose a novel architectural damage assessment model called Bi-DAUnet, which adopts a BiFormer structure similar to U-Net. In this model, we employ a U-shaped encoder-decoder architecture based on BiFormer and combine it with skip connections to achieve global semantic feature learning. Specifically, we utilize a hierarchical BiFormer with a dual-layer routing attention mechanism as the encoder to extract contextual features of architectural images. In the symmetric decoder, a BiFormer Block is introduced to fuse shallow and deep features of the feature maps and learn the correlation between pixels at distant locations. Experimental results indicate that the U-shaped encoder-decoder network based on BiFormer achieves superior performance in the task of architectural damage assessment compared to fully convolutional methods.
Simulation Study of the Damage Effect of Typical Fragment on UAV Target
Authors: Cui Kaibo , Sun Haitao , Deng Huiyong
Published: September 2024

UAV poses a serious threat to ground troops and combat personnel in modern operations, and fighting against UAV is called an important task of air defense operations. Taking DJI UAV as the object, this article researches the typical blasting debris of the prefabricated damage effect of drone target through modeling simulation and simulation calculation, which is focused on damage simulation analysis of the drone battery, power plant, camera and other key components, and studies the damage condition of fragments in different direction and at different speeds, which can improve theoretical basis and reference for fighting against the drone and its swarm.
Preparation and performance study of organic small molecule photovoltaic donor materials in solar cells
Authors: Xiong Ping , Fu Ning , Zhang Yifan
Published: September 2024

In this study, PDPAT-BDT-BT was used as a donor material, combined with PC61BM and PC71BM as acceptor materials, to prepare a hybrid thin film for organic solar cells. In photovoltaic performance tests, this film shows advantages and good characteristics. The experimental results show that the PDPAT-BDT-BT polymer shows good performance in terms of thermal stability, optical properties, and electrochemical properties. It also shows better photovoltaic performance in the hybrid system with PC71BM, which lays a good foundation for its potential application in organic solar cells.
ZnIn2S4-based heterostructured photocatalysts for CO2 reduction: A mini review
Authors: Feng Yi , Guo Ruitang , Qiu Zhongzhu
Published: September 2024

ZnIn2S4 (ZIS)’s superior photocatalytic CO2 reduction efficacy, coupled with its distinct layered architecture and narrow energy band profile, makes it an intriguing target for CO2 conversion studies. This article evaluates the photogenerated charge transfer mechanism and photocatalytic CO2 reduction (PCR) efficacy of varied ZIS-based heterostructure catalysts. ZIS-based heterojunctions are initially classified, ensuing discourse on advanced engineering techniques enhancing heterojunction phot catalysts’ PCR functionality like co-catalyst incorporation and morphologic manipulation. The concluding section provides an overview of the present study state and future progression in regard to ZIS-based heterostructured photocatalysts for PCR.
Phase sequence selection method of double-circuit transmission lines on the same tower based on a comprehensive index
Authors: Lu Xiaoyan , Hu Jianqiao , Peng Zhengwei , Ma Peihua , Zhang Kun , Gao Feng
Published: September 2024

The non-transposition erection of transmission lines will lead to the imbalance of electrical parameters, which will affect the protection and automatic reclosing. The best phase sequence arrangement is determined by comprehensively considering the comprehensive indexes (current imbalance, secondary current, and recovery voltage) of double transmission un-transposed lines with shared towers. PSCAD/EMTDC electromagnetic transient simulation software is applied to build a typical 750kV transmission line model for simulation analysis, and the comprehensive indexes under different phase sequence arrangements are studied. The analysis reveals that the arrangement of phase sequence exerts a significant consequence of the comprehensive index. The findings indicate that the margin and different secondary current and recovery voltage indexes, double transmission un-transposed lines with shared towers can be erected in the same direction or in different phase sequences to reduce the current imbalance.
Determination of the optimal number of detectors for the multiangle wire beam scanning method
Authors: Banshchikova M. , Bulavskaya A. , Grigorieva A. , Miloichikova I. , Stuchebrov S.
Published: September 2024

The implementation of control over the characteristics of the beam is an important stage in the conduct of experiments within the field of accelerator physics. The multiangle scanning method based on the reconstruction of the electron beam profile image from projection data can be used to determine the distribution of beam intensities in the transverse plane. In order to reduce the time required for measurement, it is proposed that a set of detecting elements be used in place of a single detecting element when employing this method. This work presents a scheme for optimized data collection using the multiangle scanning method and evaluates the applicability of the modernized approach. For this, a numerical experiment was conducted to determine the beam profile using different numbers of detecting elements. The results of this study demonstrate that the use of multiple detecting elements for the implementation of the multiangle scanning method reduces the measurement time and ensures high quality of the reconstructed beam profile images. It was demonstrated that the minimum number of detecting elements necessary to ascertain a specific beam profile is ten.
Green ammonia imports could supplement long-duration energy storage in the UK
Authors: Palazzi Carlo , Nayak-Luke Richard , Verschuur Jasper , Salmon Nicholas , Hall Jim W , Bañares-Alcantara René
Published: September 2024

There is growing recognition of the need for long-duration energy storage to cope with low frequency (i.e. seasonal to multi-annual) variability in renewable energy supplies. Recent analysis for the UK has estimated that 60–100 TWh of hydrogen storage could be required to provide zero-carbon backup for renewable energy supplies in 2050. However, the analysis did not consider the potential role of green energy imports as a supplement to domestic energy storage. Using a global spatially-explicit model of green hydrogen/ammonia production and shipping we estimate the lowest import costs for green ammonia to the UK, and compare them with the levelized costs of energy storage across scenarios of varying domestic renewable energy production. The results indicate that imported green ammonia could offer a cost-comparable alternative to domestic hydrogen production, storage and power generation, whilst increasing energy system resilience through supply diversification, at a similar or cheaper delivered energy cost compared to a hydrogen-only storage system. In countries lacking the geological potential for low-cost hydrogen storage, green ammonia imports could have an even more significant role.
Tropical Laurent series, their tropical roots, and localization results for the eigenvalues of nonlinear matrix functions
Authors: Negri Porzio Gian , Noferini Vanni , Robol Leonardo
Published: September 2024

Tropical roots of tropical polynomials have been previously studied and used to localize roots of classical polynomials and eigenvalues of matrix polynomials. We extend the theory of tropical roots from tropical polynomials to tropical Laurent series. Our proposed definition ensures that, as in the polynomial case, there is a bijection between tropical roots and slopes of the Newton polygon associated with the tropical Laurent series. We show that, unlike in the polynomial case, there may be infinitely many tropical roots; moreover, there can be at most two tropical roots of infinite multiplicity. We then apply the new theory by relating the inner and outer radii of convergence of a classical Laurent series to the behavior of the sequence of tropical roots of its tropicalization. Finally, as a second application, we discuss localization results both for roots of scalar functions that admit a local Laurent series expansion and for nonlinear eigenvalues of regular matrix valued functions that admit a local Laurent series expansion.
‘Political Knowledge’ of India in Berlin
Authors: Roy Baijayanti
Published: September 2024

This chapter examines the study of ‘practical aspects’ of modern India at the Oriental Seminar and its successor organizations, all affiliated to the University of Berlin (then Friedrich-Wilhelms-Universität).‘Practical knowledge’ of foreign countries began to be cultivated in Berlin from the days of the Wilhelmine Empire, for the benefit of German colonial officers and increasingly from the 1920s, businesspersons. The institutions that continued the tradition of the Oriental Seminar included Ausland Hochschule or the Academy for the Study of Foreign Countries (established in 1936) and the faculty for the ‘Study of Foreign Countries’ (Auslandswissenschaften) formed in 1940. The SS, or rather its secret service, the SD (Sicherheitsdienst) exerted considerable control on this last named faculty, which aimed to train diplomats and spies who were to be imbued with Nazi ideology and made ready to serve Nazi political goals. Teachers of Indian subjects (various Indian languages and Realien) at the Oriental Seminar and its heirs included German academics as well as some Indian scholars. Among them were the Indian anti-colonialist intellectuals, Tarachand Roy and Devendra Nath Bannerjea and German scholars of modern Indian languages, Reinhard Wagner and Hermann Beythan. In 1942, the Indologist Ludwig Alsdorf also joined the Faculty for the Study of Foreign Countries. By examining the profiles and activities of these scholars, this chapter establishes that they were expected to offer their knowledge and expertise about India to Nazi politics, not just in the classroom but also beyond (e.g. by disseminating German propaganda in India in modern Indian languages).
Emotions
Authors: Shoemaker David
Published: September 2024

This chapter lays out the variety of emotional responses in which blame and praise may consist, depending on their context and what they seek. It starts with a detailed discussion of anger, in which two distinct forms emerge: slighted and goal-frustrated. The former is the emotional paradigm of what is labelled acknowledgment-seeking blame. Its positive counterpart is gratitude, which also seeks acknowledgment, in the form of gratification. There are also various types of non-acknowledgment-seeking emotional forms of blame and praise, including disdain, contempt, disappointment, and regret (on the negative side) and admiration and pride (on the positive side). These are discussed in terms of what their proper targets are. Narcissists, it is argued, are capable of being the proper targets of only the non-acknowledgment-seeking forms, as acknowledgment requires some fairly robust empathic capacities that they lack.
Fitmakers
Authors: Shoemaker David
Published: September 2024

While the previous chapter argued that many forms of blame/praise need only to be fitting to be apt, and not deserved, it was left open what precisely makes them fitting. This chapter claims that, for acknowledgment-seeking forms of blame/praise, their fitmaker is the targeted agent’s quality of will. While this has been argued for elsewhere, what’s needed is a defense against a variety of challenges, many of them from the “new school,” where there are thought to be several examples of blameworthiness without poor quality of will. First, “old school” challenges are thwarted, those that appeal to moral luck, manipulation, or negligence. Then there is a defense against the new school challenges: corporate blameworthiness, taking responsibility for faultless behavior, and having supposedly rational or reasonable racist/sexist attitudes. None of these challenges succeeds, either because they secretly smuggle in quality of will, or because the actions/attitudes described aren’t blameworthy.
Bayesian Statistics in Management Research: Theory, Applications, and Opportunities
Authors: Mackey Tyson B. , Dotson Jeffrey P.
Published: September 2024

Bayesian statistics deserve a more prominent place in strategic management methodology. Bayesian methodology shines in its ability to both model heterogeneity and simultaneously model endogenously chosen strategies and heterogeneity in the effect of a strategy on firm-level outcomes. Moreover, within the broader class of Bayesian methods, some methodologies present solutions to a pernicious problem—that of essential heterogeneity, in which typical methods of accounting for endogenously chosen strategies, e.g., instrumental variables, treatment effects models, or random-coefficient models, fail when the effects of strategies on outcomes are heterogeneous across firms. Research about Bayesian inference, including discussions of the theoretical underpinnings of Bayesian statistics and how to implement an empirical workflow using Bayesian statistics, can be useful for building bespoke models to fit theoretical questions pertaining to management research.
Human Rights
Authors: Brownlee Kimberley , Cruft Rowan
Published: September 2024

Human rights are claims that all human beings have to the protection of fundamental human needs, interests, and freedoms. Debates about human rights consider whether such rights exist, and if they do, whether they are necessarily institutional norms codifiable in law and correlated with government duties or are instead preinstitutional or natural in some sense. Debates about human rights focus on the moral and practical grounds for such rights, the subjects of human rights, the types of human rights—civil, political, social, material, collective—and the precise lists of rights that fall within these broad, overlapping types. Debates also address objections against human rights as a conceptual, normative, and practical framework. Objections focus on issues such as ethnocentricity, cultural imperialism, forfeitability, individualism, claimability, and an adversarial ethos, among others.
Regional Political Opposition in Russia
Authors: Baumann Julia , Dollbaum Jan Matti
Published: September 2024

Russia’s autocratization since 1999 has resulted in a diminution of political and electoral competition and the marginalization of regime opponents. Yet, while oppositional contestation has markedly decreased in national elections, regional and local races for a long time offered opportunities for electoral competition. Even if elections are organized in a way to ensure the victory of the incumbent party and candidates, at least before Russia’s full-scale invasion they provided oppositions with regular opportunities to organize and mobilize, which could serve to make the power holders’ political dominance more difficult, or, under certain circumstances, even pave the way for political contestants into a regional or local assembly.

The level of opposition activity and the type of opposition vary across Russia’s regions. Case study evidence from different regions illustrates how three interrelated factors shape opposition activity and success in a subnational context. First, structural conditions highlight the great differences among Russia’s regions and cities as to the openness of local politics to opposition actors, ranging from hegemonic polities with a high level of repression to more competitive units, where media, civil society, and political challengers can operate somewhat more freely. Second, next to the subnational political context, opposition activity is dependent on the choices of individual actors, with strategic coordination and cooperation across opposition forces; and third, the engagement of resourceful and ambitious political entrepreneurs can improve the electoral prospects of political contestants. The text closes with reflections of how the full-scale invasion of 2022 affects the conditions and choices of future opposition actors in Russia.
Gender Differences in Risk Perception: A Review
Authors: Wester Misse , Alfaro Evelyn Salas , Lama Phu Doma
Published: September 2024

Men and women perceive risks differently. This difference is systematic and shows that women have a higher risk perception for most risks compared to men. In particular, women are more concerned with environmental and climate related risks than men. One explanation put forth to account for these differences is that women by nature of their sex or gendered role are more oriented toward nurturing and caring, making them more in tune with nature. Possible explanations for why men have a significantly lower perception of risk have not received equal attention. There has also been an assumption that risk perception will influence preparedness, thus a high-risk perception should lead to a better preparedness. However, the relationship between perception and preparedness is not linear. Women’s higher risk perception does not lead to them being better prepared since women lack decision-making power or access to resources in many contexts. While it is important to include women in all stages of risk management, it is important to remember that not all women are the same, nor can women alone change the risk landscape. Instead, more attention needs to be devoted to the role of men and masculinities in order to better understand and address differences in risk perceptions and risk management strategies.
SP1.4 - PRESS survey: PREvention of surgical site infection—a global pan-specialty survey of prophylactic practices
Authors: Lathan Ross , Walshaw Josephine , Chetter Ian , Yiasemidou Marina
Published: September 2024

Aims

This survey aimed to establish current global practice across surgical subspecialties in the prevention of surgical site infection (SSI) using prophylactic measures.

Methodology

A cross-sectional survey was formulated following a published protocol, aligning with established guidelines for SSI prevention. A panel of experts provided guidance during iterative rounds of internal validation, incorporating consensus-based modifications. Prior to online dissemination via QualtricsXM link and QR code through international surgical societies, the survey underwent external validation. Recruitment strategies were through international societies, snowballing and social media.

Results

There were 1232 responses from 97 countries, with 698(56.7%) participants completing all inquiries. Responses were primarily provided by consultants or equivalent (766,75.2%), spanning all ten Royal College of Surgeons-recognised subspecialties.

Almost all surgeons (734/779,94.2%) give pre-operative antibiotic prophylaxis at or within one hour of incision. Nutritional assessments do not routinely occur, with less than half (314/734,42.8%) performed often or always. Intraoperatively, normothermia is often or always maintained with standard blankets (389/734,53.0%) and forced air warming (435/734,59.3%) and less frequently with warmed fluids (277/734,37.7%) and heated mattresses (176/734,24.0%). Most surgeons (615/734,83.8%) would use non-iodinated drapes, whereas iodinated are used less frequently (472/734,64.3%). Triclosan coated sutures are never used by almost half of all surgeons (365/734,49.7%). Most surgeons (528/734,71.9%) use a simple wound dressing after skin closure.

Conclusions

Most prophylactic measures for SSI prevention display considerable variation in practice. Surgeons agree upon pre-operative antibiotic timing, in line with strong evidence and guidance. Other measures, such as antimicrobial sutures which have strong NICE recommendations, are used invariably.
SP1.5 - PRESS survey: PREvention of surgical site infection—a global pan-specialty survey of practice
Authors: Lathan Ross , Walshaw Josephine , Chetter Ian , Yiasemidou Marina
Published: September 2024

Aims

This survey aimed to establish current global practice across surgical subspecialties in the prevention of surgical site infection (SSI).

Methodology

A cross-sectional survey was formulated following a published protocol, aligning with established global guidelines for SSI prevention. A panel of experts provided guidance during iterative rounds of internal validation, incorporating consensus-based modifications. Prior to online dissemination via QualtricsXM link and QR code through international surgical societies, the survey underwent final external validation. Recruitment strategies were through international societies, snowballing and social media.

Findings

There were 1232 responses from 97 countries, with 698(56.7%) participants completing all inquiries. Responses were primarily provided by consultants or equivalent (766,75.2%), spanning all ten Royal College of Surgeons-recognised subspecialties.

A significant majority (786/889,88.4%) routinely employs clinical examination for SSI diagnosis, while one-third (305/889,34.3%) never use the CDC criteria. Regarding surgical field preparation, less than half regularly use alcoholic povidone-iodine (339/778,43.6%) or chlorhexidine gluconate (370/778,47.6%). However, approximately one-third often or always use aqueous (478/1556,30.7%) or alcoholic (454/1556,29.2%) solutions for hand scrub.

Surgeons exhibit a higher likelihood of changing gloves (614/734,83.7%) than instruments (513/734,69.9%) to facilitate clean skin closure. Most UK surgeons (181/206,87.9%) express equipoise in randomising patients for interventions in a potential platform trial evaluating SSI prevention.

Conclusions

Significant diversity characterizes global and subspecialty-specific practices in various SSI prevention measures, attributable to conflicting guidance and limited evidentiary support for recommendations. Encouragingly, a substantial number of surgeons express readiness to contribute to a robust evidence base through participation in potential platform trials for SSI prevention.
SP1.8 - Reducing the burden to deliver remote postoperative surveillance using machine learning for surgical-site infection (SSI)
Authors: McLean Kenneth A , Sgrò Alessandro , Brown Leo R , Buijs Louis F , Potter Mark A , Harrison Ewen M
Published: September 2024

Aims

Remote postoperative wound (RPW) surveillance has been shown to improve the delivery of care and minimise the harm to patients from surgical-site infection (SSI). The burden for healthcare staff to deliver is a major barrier to implementation, therefore we aimed to develop novel methods for automated assessment of RPW surveillance to reduce this.

Methods

This was a secondary analysis of two interventional studies on RPW surveillance: “Tracking wound infection with smartphone technology” (TWIST) and “ImplementatioN of Remote Surgical wOund Assessment During the coviD-19 pandEmic” (INROADE). Adult general surgery patients could submit images of their surgical wound(s), and patient-reported outcome measures (PROMs) of SSI for 30-days postoperatively. A multi-input neural network (MNN) was developed to predict a clinical diagnosis of SSI within 48h based on symptoms and wound images. Performance was evaluated using area under the curve (AUC) and externally validated.

Results

There were 1540 submissions containing PROMs (48h SSI rate = 3.7%, n=57) and 2615 images (48h SSI rate = 3.1%, n=82). The MNN exceeded performance of the component models within the external validation subset (AUC: 0.94, 95% CI: 0.89-0.99) and remained equivalent to clinician triage (AUC: 0.92, 95% CI: 0.90-0.94). Usage to screen out “low-risk” responses prior to clinical triage was estimated to reduce the staff-time required to deliver (6.3h vs 25.5h).

Conclusion

Automated assessment can be successfully deployed within RPW surveillance pathways to reduce the burden on staff to deliver without compromising care, and allow resources to be appropriately directed to those at greatest risk of SSI.
SP2.11 - Continuous versus interrupted closure of midline laparotomy wound with absorbable suture material - A systematic review and meta-analysis of randomised controlled trials
Authors: Singh Anurag , Khan Nida , Mohammed Mazin , Singh Krishna , Sajid Muhammad
Published: September 2024

Objective

The objective of this meta-analysis is to compare the postoperative surgical outcomes of continuous versus interrupted closure of the midline laparotomy wound with absorbable suture material.

Methods

Randomised control trials (RCTs) reporting postoperative outcomes for patients undergoing closure with continuous versus interrupted closure of midline laparotomy wound with absorbable suture material were selected from medical electronic databases and meta-analysis was conducted by the guidelines of the Cochrane Collaboration using statistical software RevMan version 5.

Results

Four RCTs on 2,198 patients reporting postoperative outcomes were included. In the random effect model analysis, the wound dehiscence [odds ratio (OR) 0.93, 95%, CI (0.52, 1.64), Z = 0.26, P = 0.79] was comparable between the two groups with no heterogeneity among the included studies. Incisional hernia was also comparable between the two groups [OR 0.82, 95%, CI (0.59, 1.14), Z = 1.19, P = 0.23] with mild heterogeneity among the included studies. Wound infection was also comparable between the two groups [OR 1.30, 95%, CI (0.78, 2.17), Z = 1.01, P = 0.31] with moderate statistical heterogeneity among the included studies.

Conclusion

The continuous suturing closure had no superiority over interrupted closure for the midline laparotomy wound on comparing wound dehiscence, incisional hernia and wound infection. Due to the paucity of the RCTs, a major multi-centre RCT is needed to validate these findings.
SP4.6 - Endoscopic versus laparoscopic management of pancreatic pseudocyst - A systematic review and meta-analysis
Authors: Singh Anurag , Khan Nida , Qasim Muhammad , Kaur Mandeep , Singh Krishna , Sajid Muhammad
Published: September 2024

Objective

The aim of this meta-analysis is to compare the postoperative surgical outcomes of endoscopic versus laparoscopic management of pancreatic pseudocyst.

Methods

Two randomised control trials (RCTs) and four comparative trials reporting postoperative outcomes for patients undergoing treatment with endoscopic transgastric or transduodenal drainage versus laparoscopic cyst-gastrectomy or cyst-jejunostomy for the pancreatic pseudocyst were selected from medical electronic databases and meta-analysis was conducted by the guidelines of the Cochrane Collaboration using statistical software RevMan version 5.4.

Results

Two RCTs and four comparative trials on 401 patients reporting postoperative outcomes were included. In the random effect model analysis, the overall success rate [odds ratio (OR) 0.81, 95%, CI (0.38, 1.72), Z = 0.54, P = 0.59] was comparable between the two groups with no heterogeneity among the included studies. Adverse events after the procedure was also comparable between the two groups [OR 0.72, 95%, CI (0.34, 1.50), Z = 0.89, P = 0.37] with no heterogeneity among the included studies. Hospital stay was shorter in the endoscopic group [Mean difference -2.71, 95%, CI (-4.14, -1.27), Z = 3.69, P = 0.0002] with high statistical heterogeneity among the included studies.

Conclusion

The patients managed with endoscopic procedures had shorter hospital stay, but the incidence of adverse post-procedure outcomes and overall success rate were comparable between the two groups. Due to the paucity of the RCTs, a major multi-centre RCT is needed to strengthen the findings of this systematic review.
SP4.8 - A Systematic Review on The Safety and Efficacy of Percutaneous cholecystolithotomy (PCCL)
Authors: Ali Ahmed Elmurtada , Hamady Mohamad , Asmar Namir , George Nicole , Vineal Owen
Published: September 2024

Aims

To summarize the evidence available thus far on the safety and efficacy of percutaneous cholecystolithotomy (PCCL). So, the research question we set out to answer is: Is PCCL a safe and efficacious procedure?

Methods

This is a secondary research project involving a literature search to gather evidence on the research question raised above. An SR protocol and search strategy are developed, literature search is conducted using two search engines: Ovid Medline and Ovid Embase. The two search terms used were: (a) (Percutaneous and (removal or extract) and (Gallstones* or Gall stone* or cholelithiasis or cholecystolithiasis*)), (b) Cholystolithomy. Our inclusion/exclusion criteria are clear and appropriate. PRISMA protocol was followed.

Results

The collected data from the 29 studies that fit our criteria is analyzed, and the results showed that the procedure is safe and effective compared to the gold standard which is laparoscopic cholecystectomy. The clinical and technical success is over 90%, and the combined complication rate is 14.8%, 9.3% major complication rate, and 6.9% minor complication rate. The 30-day mortality of the procedure is 0.8%.

Conclusions

This systematic review shows that PCCL is a safe and efficacious procedure with high technical and clinical success rates. The reported low 30-day mortality and major complication rates, despite multiple comorbidities and frequently old and sick patients, make PCCL outcomes comparable to the gold standard treatment. However, the current evidence is based on single-center data with heterogeneous reporting standards. Further research should aim at an appropriate sample size, a clear definition of recorded variables, and a refinement of current technologies and techniques.
SP4.11 - Retrospective review of achalasia management in a tertiary UGI centre
Authors: Laulloo Sufia , Jihad Mostafa , Turner Paul , Ward Jeremy , Pursnani Kishore , Date Ravindra , Rajendran Ilayaraja , Shetty Vinutha Daya
Published: September 2024

Introduction

Achalasia is a rare disorder significantly impacting quality of life (QoL). Medical management includes calcium channel blockers (CCB), Pneumatic dilatation (PD) and Peroral endoscopic myotomy (POEM). Surgical management includes laparoscopic Heller’s myotomy (HM) or more recently robotic assisted Heller’s Myotomy.

Aim

This is a retrospective study of management of patients with achalasia in a tertiary Upper GI centre.

Material and method

Data was collected retrospectively between 2013-2023 (10 years) and analysed using Prism 10. In this period, 193patients with suspected achalasia were analysed and only 89patients with confirmed diagnosis were included.

Results

Of these 89 patients, 46 were female (48%) and 43 were male (52%). The median age was 61years (range 21-94years). 64 patients (72%) were local referrals and 25 patients (28%) were referred via the network. 3 patients (3%) were acute admissions. 45 patients (50%) received medical therapy initiated by gastroenterologists. 6 patients (6.7%) received CCB, 17 patients (19%) received endoscopic Botox and 22 patients (25%) underwent PD. 6 patients (27%) developed perforation post PD; of these, 3 patients underwent surgical repair and had a prolonged hospital stay. Of the 66 patients (74%) who underwent surgery, 55 patients (61%) had laparoscopic HM, 8 patients (9%) underwent robotic assisted HM and 1 patient (1%) had open HM. Average Length of stay was 5.8 days for laparoscopic HM and 3.9 days for robotic HM. In the laparoscopic HM group 3 patients (5%) had iatrogenic oesophageal injury repaired perioperatively and a further 5 patients (8%) needed oesophageal dilation for residual dysphagia. No complication was noted in the robotic HM group.

Conclusion

Surgery remains the treatment of choice for achalasia. Early outcomes of robotic surgery look promising, with lesser complication rates thus improving quality of life.
SP5.1 - The importance of weekly Radiology-General Surgery Multi-Disciplinary Meetings (MDMs) in the management of Emergency General Surgery (EGS) patients
Authors: Pal Shreya , Ng Zoe , Shrestha Anuj , Bartolome Lesleen Abigaelle , Bareli Leonardo , Shrestha Ashish
Published: September 2024

Aims

Most patients in Emergency-General-Surgery (EGS) require radiological investigations as part of their management plan. However, unlike cancer services where structured multi-disciplinary-meetings (MDMs) form an integral part of patient management, MDMs are not commonly practised in EGS. Our aim is to identify if having a weekly Radiology-General Surgery-MDM leads to better outcome in management of EGS patients.

Methods

A prospective study involving weekly 1-hour MDM focusing on Radiology and General Surgery was conducted from May to November 2023. These sessions were led by consultant radiologists where discussions amongst general surgical consultants and junior doctors took place. Factors taken into consideration were clinical presentation, original scan report, any missed findings on imaging and any changes to the initial management plan.

Results

A total of 85 cases were discussed during the study period, majority were initially reported by the out-of-hours radiologists. Out of those, 40 (47%) had changes to the management plan as well as missed findings that were noted as a result of Radiology-GeneralSurgery-MDM. Informal feedback gathered from junior doctors who attended revealed a significant impact in their knowledge on interpreting radiological scans in EGS.

Conclusion

Weekly Radiology-GeneralSurgery-MDMs for EGS-admissions have seen to improve overall patient outcome as a result of having a second opinion and recommending change in management plan in significant proportion of patients. It also had a positive impact on learning the clinical correlation of radiological-scans by junior-doctors who regularly attended these meetings.
SP5.3 - Systematic review and meta-analysis of the management of acute uncomplicated diverticulitis: Time to change the traditional practice
Authors: Mohamedahmed Ali Yasen , Zaman Shafquat , Vakis Stelios , Eccersley James , Thomas Pradeep , Husain Najam
Published: September 2024

Background

To evaluate comparative outcomes of outpatient versus inpatient treatment and antibiotics versus no antibiotics approach in the treatment of uncomplicated (Hinchey 1a) acute diverticulitis. The protocol of this review was registered in PROSPERO (CRD42023488826).

Methods

A systematic online search was conducted using electronic databases. Comparative studies of outpatient (OP) versus inpatient (IP) treatment and antibiotics (ABX) versus no antibiotics (NABX) approach in the treatment of uncomplicated (Hinchey 1a) acute diverticulitis were included. The primary outcome was diverticulitis recurrence. Emergency surgical resection, elective surgical resection, development of complicated diverticulitis, mortality rate, and length of hospital (LOS) were the other evaluated secondary outcomes.

Results

The literature search identified 14 studies (n=3,875) comparing NABX (n=2,008) versus ABX (n=1,867). The NABX group showed a lower disease recurrence rate and shorter LOS compared with the ABX group (P=0.01) and (P=0.004). No significant difference was observed in emergency resections (P=0.33), elective resections (P=0.73), development of complicated diverticulitis (P=0.65), hospital re-admissions (P=0.65) and 30-day mortality rate (P=0.91).

Twelve studies (n=2,286) compared OP (n=1,021) versus IP (n=1,265) management of uncomplicated acute diverticulitis. The two groups were comparable for the following outcomes: treatment failure (P=0.10), emergency surgical resection (P=0.40), elective resection (P=0.30), diverticulitis recurrence (P=0.22), and mortality (P=0.61).

Conclusion

Compared with the use of ABX, the NABX approach seems to provide similar clinical outcomes and shorter LOS. Moreover, OP treatment of Hinchey 1a acute diverticulitis is comparable with IP management and presumably leads to cost savings in depleted healthcare systems
SP6.2 - Oncological outcomes following sentinel lymph node biopsy in patients with node positive breast cancer at diagnosis who achieve an axillary pathological complete response to neoadjuvant systemic therapy
Authors: Marinescu Iulia , Wehrmann Fabian , Prichard Ruth , Boland Michael , Rutherford Claire , McCartan Damian
Published: September 2024

De-escalation of axillary surgery following neoadjuvant chemotherapy (NACT) for patients with node positive breast cancer at diagnosis have focused on ensuring a low false negative rate for those who undergo sentinel lymph node biopsy (SLN) only with limited data to date on oncological outcomes. This study aimed to assess the medium-term oncological outcome in patients who have an axillary pCR following NACT and undergo de-escalation of axillary surgery with only a SLN performed post NACT.

A consecutive series of patients with cytologically proven node-positive breast cancer who received NACT and achieved a nodal pCR on SLN between 2013-2021 were retrospectively analysed. Eligible patients underwent an end of treatment axillary ultrasound and if axillary nodes appeared sonographically normal a sentinel node biopsy was performed, with dual modality mapping (radioisotope and blue dye) at the time of breast surgery. The primary outcome of interest was disease free recurrence (DFS), and the secondary outcome was isolated axillary recurrence.

79 patients (median age 48 years) received NACT and had cytologically proven node-positive disease at diagnosis and attained an axillary pathological complete response (pCR) post NACT. The median nodal yield at SLN was 4 (range 1-9). Median follow up was 4.4 years. Only 1 patient experienced an axillary recurrence. Triple negative subtype had the lowest overall DFS.

In this cohort, axillary recurrence remains uncommon. The optimal surgical strategy for safe de-escalation of axillary surgery post NACT remains in focus with adjuncts such as nodal marking and targeted axillary currently under study.
SP6.13 - Management of Older Major Trauma Patients: Impact of a dedicated guideline for facilitating older trauma care within a Pan London Trauma Network
Authors: Park Stephen
Published: September 2024

Background and Aim

Older age trauma is an increasing challenge for trauma networks with many clinical protocols needing to adapt and reflect age-related changes in physiology and management. In 2018, our older trauma guidance was introduced into our trauma system to improve early recognition of injury, admission pathways, clinical management and outcomes for those aged ≥65yrs (LMTS Older Trauma Guidance). The aim of our study was to assess the impact of the guideline on our trauma processes and patient outcomes.

Methods

This retrospective analysis of TARN compared process and outcome data for patients aged ≥65yrs admitted to hospitals within the North East London and Essex Trauma Network, pre (01/01/2016-31/07/2018) and post (01/08/2018-31/07/2020) guidance introduction. The primary outcome was mortality at 30 days post injury.

Results and conclusions

There were 4317 patients pre and 3992 patient post guidance. Time to CT reduced on average by 57 minutes, Neurotrauma transfers decreased from 2116 patients to 1519 patients and more older patients were discharged for rehabilitation. Older trauma mortality reduced across the network post guidance (13.59% vs 10.64%). The greatest mortality reductions were seen in Trauma Units, (19.20% pre vs 6.99% post) with increasing benefit seen with advancing age: reduced 75-84 years by 2.20%; 85-94 years 2.41%; 95+ years by 7.44%.

This analysis suggests that dedicated guidance highlighting the special needs and risk profiles of older trauma patients significantly improves processes and outcomes. Improvements in early assessment and time to imaging appear to result in enhanced survival. Further research at a system level is required.
SP7.1 - Risk Profile of Administration of 3- and 4-factor Prothrombin Complex Concentrate in Adult Anticoagulated Trauma Patients: A Systematic Review and Meta-Analysis
Authors: Newman Charles , Melhuish Jake , Spence-Jones Helen , Shepherd Joanna
Published: September 2024

Aims

To establish thromboembolic complication (TC, primary outcome) and mortality (secondary outcome) Odds Ratios (ORs) following 3-factor Prothrombin Complex Concentrate (PCC3, Comparator Group [CG] 1) and 4-factor Prothrombin Complex Concentrate (PCC4, CG2) administration, compared to Fresh Frozen Plasma (FFP) alone, in adult Vitamin K antagonist-anticoagulated trauma patients.

Methods

Systematic database and grey literature searches were performed. Random effects model meta-analyses were undertaken for each of this study’s outcomes, producing ORs and 95% Confidence Intervals (95%CIs). The I2 statistic was used to quantify interstudy heterogeneity. Inverse Variance, Mann-Whitney U and Kruskal-Wallis tests were used to examine interstudy demographic/treatment differences. Risk of bias was assessed with the Newcastle-Ottawa Scale, study quality with the GRADE tool.

Results

8 papers met inclusion criteria (CG1 n=3, CG2 n=3), 2 were excluded due to insufficient reported information. TC incidence was not significantly increased following PCC3 administration (ORcombined effect1.57, 95% CI 0.24-10.51, p=0.64). Meta-analysis was not performed on TC incidence in CG2 owing to only 1 paper reporting this outcome. Mortality risk was not significantly increased following PCC3 (ORcombined effect1.61, 95%CI 0.27-9.51, p=0.60) or PCC4 (ORcombined effect2.19, 95%CI 0.96-4.98, p=0.06) administration. Admission Injury Severity Score (ISS) and age varied significantly between papers included in CG1 (mean­ISS=15.5, 95%CI=12.0-20.1, p<0.05, meanage=75.3years, 95%CI=65.5-86.7, p<0.05) and CG2 (meanISS=15.1, 95%CI=13.4-17.0, p<0.05, meanage=79.2years, 95%CI=74.7-84.1, p<0.05).

Conclusion

TC risk is not overtly increased following PCC3 administration, compared to FFP. The same is true for mortality risk following PCC3 and PCC4 administration. There is substantial room for bias in the results reported, further research is warranted.