bluuebunny/crossref_metadata_2025 huggingface dataset:
Historical Demography: Methods
Authors: Siiskonen Harri
Published: August 2023

Africa has the least-known demographics in the world. Until the mid-20th century, not even the size of the population was precisely known in many areas of sub-Saharan Africa. Significant problems in African historical demography have been the lack of relevant sources, and the fragmentary and nonsystematic nature of the available records.

Since the late 1970s, African historical demography has taken noticeable steps forward by the adaptation of new methods in analyzing old “new” sources and by combining information of these scattered scanty records. These methods have been tightly connected with the nature of accessible sources. Until the establishment of permanent mission stations in the interior of Africa travel accounts, diaries, and maps of explorers, traders, and hunters are the most important literary sources informing about population and the way of life of African communities. Oral tradition and ethnological evidence complement travelers’ observations based on short visits. Methods used in history, ethnology, and anthropology are relevant in analyzing these descriptive sources.

Church registers have played an important role in Western historical demography. From sub-Saharan Africa, there are sporadic lists available of baptisms and marriages from the Congo area since the 17th century, but analyzing trends in fertility or mortality has proved challenging.

Discovering of complete continuous series of church registers from southern and eastern Africa in the late 1980s and 1990s enabled longitudinal analysis of fertility and mortality. Adapting methods used in Western historical demography, like family reconstitution, opened a new phase in African historical demography, but there are several limitations with parish registers, like under-registration of infant and child mortality and births. However, statistical methods provide tools to overcome systematic weaknesses related to these data.

Early population enumerations in Africa were restricted to the European population residing on the trading posts located on the coast. The first countrywide censuses conducted during the colonial period were imperfect concerning fertility, mortality, and age of the population and usually underestimated the size of the population. The reliability of censuses began to improve only since the 1960s when they were conducted following the United Nations’ data gathering principles. Modern censuses are widely used sources in making back-projections to population development during the first half of the 20th century. Demographic and health surveys available from the 1970s focus on fertility and reproductive health complement noticeably the census data. Understanding African population development since the turn of the 20th century can be deepened by mixed and comparative use of censuses, surveys, and parish registers and by utilizing methods familiar in history and anthropology, demography, and statistics.
Nucleon Clustering in Light Nuclei
Authors: Freer Martin
Published: August 2023

The ability to model the nature of the strong interaction at the nuclear scale using ab initio approaches and the development of high-performance computing is allowing a greater understanding of the details of the structure of light nuclei. The nature of the nucleon–nucleon interaction is such that it promotes the creation of clusters, mainly α-particles, inside the nuclear medium. The emergence of these clusters and understanding the resultant structures they create has been a long-standing area of study. At low excitation energies, close to the ground state, there is a strong connection between symmetries associated with mean-field, single-particle behavior and the geometric arrangement of the clusters, while at higher excitation energies, when the cluster decay threshold is reached, there is a transition to a more gas-like cluster behavior. State-of-the-art calculations now guide the thinking in these two regimes, but there are some key underpinning principles that they reflect. Building from the simple ideas to the state of the art, a thread is created by which the more complex calculations have a foundation, developing a description of the evolution of clustering from α-particle to 16O clusters.
San Francisco
Authors: Howell Ocean
Published: August 2023

San Francisco has a reputation as a liberal city. But history shows that San Francisco’s liberalism must be regarded as evolving, contested, and often internally contradictory. The land that became the city was originally home to the Yelamu people, a small tribe in the Ohlone language group. Spanish missionaries arrived in 1776, but the Spanish empire only had a tenuous hold on the place—it was the furthest outpost of empire. By 1821, when the Mexican government took the land, most of the Native population had perished from disease. Immediately after the Americans took the place, in 1848, gold was discovered in the foothills of the Sierra Nevada, and the world rushed in. The population increased 2,400 percent in one year, and fewer than half of the new residents had been born anywhere in the United States. Well into the 20th century, elite San Franciscans worried that the rest of the country viewed their city as a barbarous place, full of foreign libertines seeking fortune and pleasure. These narratives masked the extent to which San Francisco’s economy was corporatized from the early days of the Gold Rush. They also present an image of racial liberalism that ultimately must be regarded as a myth. However, there is some truth in the view that the city has been a comparatively tolerant place, where various subcultures could thrive. San Francisco’s status as a bohemian place, a wide-open town, has always sat in tension with its role as a headquarters of global, corporate capital.
The Making of the Arab Caribbean, c. 1870–1930
Authors: Norris Jacob
Published: August 2023

Arabic-speaking migrants from the Ottoman Empire embarked on mass migrations across the Atlantic in the late 19th century. Large numbers traded and settled in the Caribbean region, forming the nucleus of communities that still thrive in the early 21st century. Although underplayed in the existing historical literature on the Caribbean and modern Middle East, these Caribbean migrations were a vital part of the creation of an Arab diaspora across the Americas. In the early years of emigration out of the Ottoman Empire, mostly Christian Arabs utilized their preexisting trading bases in the ports of Western Europe to launch new exploratory ventures across the Atlantic. In many cases, the Caribbean islands were their first ports of call where they found ideal conditions for peddling small consumer goods they imported from Europe and North America. From these initial bases, they fanned out across the region, often using the Caribbean islands as stepping stones toward ventures on the mainland. A pattern developed whereby migrants sought out boomtowns around the Caribbean region where fast-expanding export economies (particularly in bananas and sugar) offered lucrative opportunities for peddlers and small-scale retailers. In cities like San Pedro Sula (Honduras), San Pedro de Macorís (Dominican Republic), and Barranquilla (Colombia), Arab traders played central roles in the rapid growth of the local economy. Taken collectively, these case studies speak of an “Arab Caribbean”—a regional sphere of migration and trade that transcended national boundaries, encompassing both the islands and the Caribbean coasts of Mexico, Central America, and South America. Despite their frequent persecution in their new places of residence, Arab migrants in the Caribbean proved remarkably resilient, utilizing their region-wide networks to regroup and adapt to the changing economic and political landscape.
Shari’a, Legal Pluralism, and Muslim Arbitration Tribunals in the West
Authors: Turner Bryan S. , Richardson James T.
Published: August 2023

Applications of the Shari’a in Western societies where Muslim minority populations are increasing must deal with growing Islamophobia in those societies. The history of the Shari’a reveals much misunderstanding and confusion about what it is and how it is viewed by Muslims. This has led to controversy concerning Islamic arbitration tribunals in the United States, Canada, and other Western nations where the consequences of increasing legal pluralism are being felt. A theoretical discussion of “legal centralism” taken from the work of major sociology-of-law theorists aids an understanding of this complicated situation of the Shari’a in the West.
Visual Arts: Renaissance
Authors: Hornik Heidi J.
Published: August 2023

With regard to European visual arts, the Renaissance is the period of artistic production (painting, sculpture, and architecture) from 1280 to 1520. The Renaissance style appeared in Western Europe and in particular on the peninsula of Italy (Italian Renaissance) and the north of the Alps (Northern Renaissance). These regions and this time frame were characterized by immense of creative productivity and although other regions are important to the Western tradition, in the history of art the focus historically has been on Italy and northern Europe. Artistic styles are often understood chronologically while combining the regions both north and south of the Alps and the three different media.
Hanson, Hamza Yusuf
Authors: Quisay Walaa
Published: August 2023

Hamza Yusuf Hanson, better known as Hamza Yusuf, is a prominent American shaykh, public intellectual, and educator. He regularly features in the Muslim 500 as among the most influential Muslims in the world. First emerging as a Muslim public figure in the mid-1990s, his impact on Muslims in the East and West has been far and wide. Yusuf cofounded the United States’ first accredited Muslim college, Zaytuna College, and set up pedagogical institutions that promote classical Islamic education, such as the Rihla program. In 2019, Yusuf was selected as a member of the Commission on Unalienable Rights convened by the Trump administration’s Secretary of State, Mike Pompeo. Yusuf was also appointed as the vice president of the Forum for Promoting Peace in Muslim Societies and the Global Center for Guidance and Renewal, both of which were founded by his shaykh, Abdallah bin Bayyah, and under the auspices of the United Arab Emirates. There, Yusuf also serves as a member of the Fatwa Council.
arithmetical tables
Authors: Azzarello Giuseppina
Published: August 2023

Greek arithmetical tables are systematic series of calculations written on papyrus and other light materials such as potsherds, wooden and wax tablets, and paper. About 150 items stemming from Egypt and covering a wide chronological range (4th century bce–13th century ce) have been published. Calculations are normally written in columns and separated by vertical and horizontal lines. They consist of addition, multiplication, squares and division, which are expressed in form of fractions (4: 2 = 2 is expressed as ½ of 4 = 2), and their results are given as the addition of juxtaposed unit fractions, a feature originating in Egyptian mathematics. Every kind of operation presents different patterns and features which can be of help in determining chronology and context. It is particularly challenging to establish the context of the tables, as they can belong to reference books used by professional accountants or be school texts. Material, handwriting, spelling, and the presence of other inscriptions on the same item, such as drawings, personal names, or even school exercises, can shed light on this point.
female life-course
Authors: Olson Kelly
Published: August 2023

The female life-course in ancient Greece and Rome ideally followed a set path, a path which would look different depending on one’s rank, status, race, and geographical location. Women of the upper and middling classes in Athens and Rome, however, were supposed to progress through childhood and marry almost immediately after puberty, producing children in their turn, raising them, and perhaps becoming widowed before dying in what people today would consider the prime of life.
Morphological and Syntactic Variation and Change in European Spanish
Authors: Serrano María José
Published: August 2023

Since the 1990s, there have been major developments in the variationist approach to morphological and syntactic variation and change in European Spanish. This research area has garnered increasing interest because of the various morphosyntactic phenomena available for study. A significant amount of work on morphological and syntactic variation and change has been devoted to analyzing the linguistic differences among variants and the social and stylistic communicative settings in which they are used. The main phenomena studied in European Spanish are classified in three main groups: variation of personal pronouns, variation of verbal forms, and variation of syntactic constructions.

Morphological and syntactic variants are linguistic choices constructed in a meaningful way that reveal speakers’ perceptions of real-world events and are projected stylistically onto the domain of discourse and interaction. Effective engagement with these choices requires the adoption of a broad, multifaceted notion of meaning to overcome earlier methodological controversies about studying variation at the morphological and syntactic levels because of the meaning that variants convey. In recent years, variation theory has benefited greatly from research in cognitive linguistics, a field whose basic tenet is that grammatical structures reflect the human perception of events. In fact, the most modern theoretical approach to morphosyntactic variation is based on the study of the cognitive meanings underlying variants, which is at the core of the empirical concerns of cognitive sociolinguistics. From a cognitive viewpoint, language is not a separate ability within the realm of human cognition; rather, it is developed along with all other cognitive skills. Studies of morphosyntactic variation address the social contexts in which variation takes place to adequately explain linguistic variation phenomena.

The analysis of the communicative and cognitive backgrounds of morphological and syntactic variation challenges the traditional, structural, and behavioral concepts of linguistic variability and change. Thus, the study of these changes reflects the diversity and evolution of ways of thinking.
Argument Marking in Romance
Authors: Nicolae Alexandru
Published: August 2023

The loss of inflectional case marking in the passage from Latin to the Romance languages was accompanied by a profusion of analytic strategies of argument marking in Romance. The phenomenon of analytic marking of grammatical dependencies of arguments on their head is not limited to the usage of functional prepositions but also involves the emergence of non-prepositional freestanding markers (some of which take part in mixed, analytic and synthetic, marking). Furthermore, Romance languages display complex alternative strategies of encoding grammatical relations (differential object marking and clitic doubling), the emergence of which is unquestionably related to the changes in the system of case marking and to the subtle move away from dependent marking to head marking.

This article represents an extensive survey of the non-inflectional markers (prepositional constructions marking genitive, partitive, and dative relations; non-prepositional freestanding markers; mixed marking) as well as of some more complex alternative strategies of encoding grammatical relations (differential object marking and clitic doubling), placing emphasis on the markers themselves and on their distribution. From a broader historical perspective, the emergence and consolidation of the non-inflectional strategies of marking grammatical dependencies are reflexes of the change in the head-directionality parameter (head-final in Latin to head-initial in Romance), besides the transition from dependent-marking to head-marking.

The article looks both at standard Romance varieties and at dialects and places emphasis on issues less explored in the reference literature (e.g., the non-prepositional freestanding markers found in the historical dialects of Romanian or the phenomenon of mixed marking, where inflectional and non-inflectional markers co-occur within the same construction).
Dissociative Identity Disorder
Authors: Nooney Gregory L.
Published: August 2023

Individuals with the diagnosis of dissociative identity disorder (DID) developed a myriad of methods, including the creation of an intricate inner world of alternate identities, or alters, to creatively survive the devastating effects of early childhood trauma and attachment wounds. Unfortunately, a belief in its rarity even by mental health professionals, the perceived difficulty in diagnosing and treating dissociation, and a fear of the unknown have resulted in DID’s being underdiagnosed. The result has been that many with this condition have been ineffectively treated for co-occurring disorders and have been inaccurately perceived as resistive to treatment. Detailed methods of diagnosing DID, specific steps to help stabilize clients with DID, and in-depth trauma-specific protocols are summarized, along with ways to minimize the elevated risks of compassion fatigue and countertransference in working with this population.
Minmers are a generalization of minimizers that enable unbiased local Jaccard estimation
Authors: Kille Bryce , Garrison Erik , Treangen Todd J , Phillippy Adam M
Published: August 2023

Motivation

The Jaccard similarity on k-mer sets has shown to be a convenient proxy for sequence identity. By avoiding expensive base-level alignments and comparing reduced sequence representations, tools such as MashMap can scale to massive numbers of pairwise comparisons while still providing useful similarity estimates. However, due to their reliance on minimizer winnowing, previous versions of MashMap were shown to be biased and inconsistent estimators of Jaccard similarity. This directly impacts downstream tools that rely on the accuracy of these estimates.

Results

To address this, we propose the minmer winnowing scheme, which generalizes the minimizer scheme by use of a rolling minhash with multiple sampled k-mers per window. We show both theoretically and empirically that minmers yield an unbiased estimator of local Jaccard similarity, and we implement this scheme in an updated version of MashMap. The minmer-based implementation is over 10 times faster than the minimizer-based version under the default ANI threshold, making it well-suited for large-scale comparative genomics applications.

Availability and implementation

MashMap3 is available at https://github.com/marbl/MashMap.
BJS 1 The impact of postoperative complications on quality of life after major abdominal surgery: An analysis of the Perioperative Quality Improvement database
Authors: Downey Candice , Bainbridge Jamie , Jayne David , Meads David
Published: August 2023

Aims

Postoperative complications are common, but there are limited data regarding their implications on patients’ quality of life. This work aimed to address this gap in the literature by analysing prospectively collected, high quality data to estimate the impact of postoperative complications on patients’ health-related quality of life.

Methods

Data from the Perioperative Quality Improvement Programme were analysed and included patient-level data for 19,685 adults who underwent elective major abdominal procedures in England since 2016. Postoperative complications were classified using the Clavien-Dindo classification system. Quality of life was assessed by responses to the EuroQol-5-dimension five-levels of response (EQ-5D-5L) questionnaire before surgery, and at 6 and 12 months post-surgery. Ordinal logistic regression estimated the association between Clavien-Dindo grades and quality of life.

Results

At six and twelve months post-surgery, increasingly severe postoperative complications were significantly associated with lower health-related quality of life. The effect of postoperative complications on quality of life was sustained until at least twelve months post-surgery. Between admission and twelve months post-surgery, 0.012, 0.026, 0.033, and 0.086 QALYs were lost for those experiencing a Grade I, II, III, or IV postoperative complication, respectively.

Conclusions

This is the first large-scale study of major abdominal surgery to evaluate the effect of postoperative complications on patients’ quality of life after surgery, and to provide utility values for postoperative complications using the Clavien-Dindo classification system. This work enables robust cost-utility analyses of interventions in future surgical research, and outlines the value case for research to predict, prevent and manage postoperative complications.
SUS 1 Indications for day one postoperative blood tests after emergency appendicectomy
Authors: Kho Jason , Kuan Jen Yee , Derbyshire Charles , Ward Jeremy , Rajendran Ilayaraja
Published: August 2023

Aim

Appendicitis accounts for 47,000 admissions/year in England, and commonly involves patients aged 10 to 65 years. A cost-effectiveness study was conducted to assess the need for routine day-one postoperative (D1) blood tests following emergency appendicectomy (EA).

Method

Retrospective review of all EAs was carried out between January 2022 and October 2022. Data was collected from local hospital database. Elective appendicectomies were excluded. D1 blood tests were deemed necessary in complicated EAs, with clear documentation of the indication for blood tests. Costs of blood samples (FBC=£12, U&E, LFT and bone profile=£23 and CRP=£12) were verified by local/national (NICE and CCG) sources.

Results

Fifty EAs were reviewed. 39 (78%) cases were completed laparoscopically, 9 (18%) were laparoscopic converted to open and 2 (4%) were open appendicectomies. 36/50 (72%) patients had D1 bloods, 30 (83%) of which had an uncomplicated recovery. 6 (17%) patients developed postoperative complications; diabetic ketoacidosis (DKA) (n=1), ileus (n=2), superficial wound dehiscence (n=1) and infected intra-abdominal collection diagnosed two weeks post-op (n=2) (one patient was managed conservatively with intravenous antibiotics and the other underwent radiological-guided drainage). Only 1 (2%) patient (postoperative DKA) had a clear clinical indication for D1 bloods. This translates to potential cost savings of £2350.

Conclusion

Study demonstrates potential significant cost savings if clinicians rationalise blood test requests following EAs. These findings may be extended to other emergency and elective cases. In a resource-constrained environment, it is worth considering the need for postoperative tests, which could influence length of hospital stay and further cost savings.
SUS 2 Telemedicine for diagnosis of Surgical Site Infection (SSI): Feasible, safe and sustainable
Authors: Lathan Ross , Kwan Jing Yi , Smith George , Chetter Ian , Lockwood Sonia , Yiasemidou Marina
Published: August 2023

Background

In 2019, the NHS contributed to around 25 million tonnes of CO2 equivalent, equating to around 7% of the total UK carbon footprint (CO2e) that year. A significant contributor is CO2e attributable to patient travel, which has almost doubled since 1990.

Aim

To assess the feasibility and sustainability of telemedicine for diagnosis of SSI.

Methods

Patients were reviewed remotely at 30 days with a combined outcome measure (photographs and validated questionnaire). If wound complications were identified, face-to-face review or remote management were arranged. The SusQI method of emissions calculations were used with DEFRA conversion factors based on the minimal material and equipment usage and cost in clinic. Patient postcodes were applied to conversion factors based upon mode of travel to calculate kgCO2e for patient travel. Total CO2e per remote review were subtracted from the model clinic emissions for potential savings.

Results

25 patients (M:F 1.78, 65.1±11.1 years) were reviewed remotely. The median return distance for patient travel was 26.4 miles (3.4-71.4 miles). The estimated CO2e of clinic was 13.1kgCO2e per patient. Mean emissions per patient travel was 9.7kgCO2e, giving the average simple clinic carbon footprint of 22.8 kgCO2e. Mean carbon footprint of remote follow-up was 0.47kgCO2e per patient, estimating the potential savings at 22.3kgCO2e. Four patients had wound infections, but were diagnosed and managed remotely.

Conclusions

This model shows that implementation of an asynchronous digital follow-up model is effective in substantially reducing carbon footprint of a tertiary surgical centre.
SUS 3 The Intercollegiate Green Theatre Checklist
Authors: Pegna Victoria , Robb Henry , Hurst Katie , Chu James , Testa Francesca , Beatty Jasmine Winter
Published: August 2023

Aims

The climate crisis is scientifically irrefutable and poses a major threat to human life (1,2). Healthcare services face the paradox of managing the disease burden caused by the planetary crisis, whilst simultaneously contributing to the problem (3, 4). As surgeons, we have a duty to protect our patients and as such to decrease our environmental impact: this checklist aims to provide guidance towards more sustainable surgical practises.

Methods

A team of surgical doctors used evidence-based research, grey literature and expert advice, to identify interventions that:

The interventions centre on the 5 “Rs” of sustainability and where possible abide by the triple bottom line of sustainable quality improvement. Importantly, they are designed to specifically target recognised carbon hotspots in order to achieve a maximum reduction in the carbon footprint of surgical departments.

Results

The interventions identified were collated into a checklist with 16 recommendations to be adapted for use by surgical teams on the frontline and accompanied by a compendium of relevant evidence. The Green Theatre checklist was approved by the 3 surgical colleges in the United Kingdom and distributed among their surgical membership. It has gained wide support amongst perioperative professional bodies as well as from the Greener NHS.

Conclusion

The climate crisis necessitates immediate action. The dissemination of the Green Theatre checklist across the UK will guide surgical teams on the frontline to achieve more sustainable practices, helping the NHS reach its NetZero target.
SP1.2 Accuracy of NELA score in predicting the risk of mortality following emergency laparotomy in patients aged above and below 80: A cohort study
Authors: Saji Alwin Puthiyakunnel , Hughes Ioan , Mitra Kalyan , Hajibandeh Shahin , Hajibandeh Shahab
Published: August 2023

Aims

To compare accuracy of National Emergency Laparotomy Audit (NELA) score in predicting the risk of mortality following emergency laparotomy in patients aged above and below 80.

Methods

In compliance with STROCSS statement standards, a retrospective cohort study was conducted. The study period was between January 2017 and January 2022. All adult patients with non-traumatic acute abdominal pathology who underwent emergency laparotomy in two centres were included. The Receiver Operating Characteristic (ROC) curve analysis and Hosmer & Lemeshow test were conducted to evaluate the discrimination and calibration of NELA score in predicting the risk of 30-day mortality in patients aged above and below 80 years.

Results

A total of 1458 eligible patients were included; 289 patients were aged above 80 with median age of 84 (IQR 81-87) and 1168 patients were aged below 80 with median age of 60 (IQR 46-71). The risk of 30-day mortality was 13.5 % in the above 80 group and 8% in the below 80 group. ROC curve analysis showed that the AUC of NELA score was 0.78 (95% CI 0.73-0.83) in the above 80 group and 0.89 (95% CI 0.87-0.91) in the below 80 group. The score was not well-calibrated for either group.

Conclusions

The NELA score is less accurate in predicting the risk of mortality following emergency laparotomy in patients aged above 80 compared to younger patients. This may be explained by the fact that it does not take into account the measures of age-related decline in physical status of the patients.
SP1.6 The Impact of Subspecialty Surgeon on Outcomes After Emergency Laparotomy for Inflammatory Bowel Disease
Authors: Bunce James , Doleman Bret , Lund Jonathan , Tierney Gillian
Published: August 2023

Emergency laparotomy (Em Lap) may be required in patients with inflammatory bowel disease (IBD). NELA is the largest prospectively maintained database of adult Em Laps in England and Wales and includes clinical urgency of the cases. The impact of surgeon subspecialty on outcomes after Em lap for IBD is unclear. We have investigated this association, according to the degree of urgency in IBD Em Laps, including the effect of minimally invasive surgery (MIS).

Adults with IBD in the NELA database between 2013 - 2016 were included. Surgeon subspecialty was defined as colorectal or non-colorectal. Urgencies were ‘Immediate’, ‘2-6 hours’, ‘6-18 hours’ and ’18-24 hours’. Multivariate regression was used to investigate mortality and post-operative length of stay (LOS).

There was significantly reduced mortality and LOS in IBD patients who were operated on by a colorectal surgeon in the least urgent category of Em Laps; Mortality adjusted OR 2.99 (CI 1.2 – 7.8) P=0.025, LOS IRR 1.18 (CI 1.02-1.4) P=0.025. This association was not seen in more urgent categories. Colorectal surgeons were more likely to use MIS, P<0.001 and MIS was associated with decreased LOS in the least urgent cohort, P<0.001, but not in the other urgencies.

We found improved outcomes in the least urgent cohort of IBD Em Laps when operated on by a colorectal surgeon in comparison to a non-colorectal general surgeon. In the most urgent cases, there was no benefit in the operation being performed by a colorectal surgeon. Further work on characterising IBD emergencies by urgency would be of value.
SP1.9 Emergency laparotomy for abdominal catastrophes secondary to lymphoma: a systematic review
Authors: James Butterworth , Brooker-Thompson Chad , Qureshi Yassar , Mohammadi Borzoueh , Dawas Khaled
Published: August 2023

Aim

Intestinal lymphomas can rarely present as abdominal catastrophes with perforation or small bowel obstruction. There is little data regarding their optimal surgical management and associated outcomes. We aimed to systematically review relevant published literature to assess optimal surgical approach and post-operative outcomes.

Methods

A systematic on-line literature search of Embase and Medline identified 1485 articles of which 34 relevant studies were selected, including 7 retrospective studies, 1 case series and 26 case reports. Selected articles were assessed by two reviewers to extract relevant data.

Results

95 patients with abdominal catastrophes secondary to lymphoma (predominately Burkitt (28%) and Diffuse Large B-cell lymphoma (29%)) were identified with a median age of 52 years, 40% female. The most common presentation was perforation in 69% of patients compared to obstruction (28%) and ischaemia (2%). The most common site of perforation was the ileum (32%), followed by the jejunum (27%). Small bowel resection and primary anastomosis (76%) was the most common procedure performed followed by ileocolic resection (11%), primary repair (4%) and defunctioning stoma (3%). Of those receiving small bowel resection 25% (n=18) suffered post-operative complications with a 30-day mortality of 13.8% (n=10). This compared favourably to those receiving ileocolonic resections (27% complications 18% mortality) or primary repair (25% complications and 25% mortality). Median follow-up was 8 days (range 1-96).

Conclusion

Abdominal catastrophes secondary to intestinal lymphomas are most commonly present with perforation. If suitable intra-operatively, small bowel resection offers the most favourable short-term outcomes with the lowest levels of morbidity and 30-day mortality.
SP1.11 Hospitals offering emergency laparoscopic surgery have improved outcomes
Authors: Eid Joana , Finch Louise , Mercer Stuart
Published: August 2023

Aims

Only 20% of patients requiring emergency surgery in the UK are offered laparoscopic surgery; there is wide variability in uptake of laparoscopic emergency surgery between hospitals, ranging from 0% to over 80% of cases. This study investigated whether hospitals with an advanced laparoscopic culture had improved outcomes.

Methods

The national NELA database was interrogated to identify patients requiring surgery for adhesional small bowel obstruction; this was selected because it is common (around 25% of cases in NELA) and often amenable to laparoscopic surgery. Hospitals were grouped into quintiles, according to the number of cases attempted by the laparoscopic approach; each group was assessed for length of stay and mortality.

Results

In 176 acute hospitals, 20597 operations were performed for adhesional SBO. Overall mortality was 6.2%. In the quintile with the lowest rate of laparoscopy, 4% of cases were started laparoscopically, compared with 44% in the highest quintile. In the lowest quintile, 4.8% of patients were discharged within 3 days, compared to 13.8% in the highest quintile; discharge at 7 days was 26% versus 37%. Overall, 30-day mortality in the group with the lowest rate of laparoscopy was 6.9%, compared with 5.4% in hospitals with the highest rate of laparoscopy (p<0.001).

Conclusions

Hospitals where patients with adhesional SBO are offered laparoscopic emergency surgery demonstrate shorter lengths of stay and a significantly reduced mortality. This may be due to the benefits of the laparoscopic approach; it could also be a surrogate marker for an advanced culture of emergency surgery.
SP2.1 The Impact of Cholecystectomy on The Symptom Relief and Quality of Life of Patients with Gallbladder Dysmotility
Authors: Alamin Nadeen , Fernandes Roland , Iqbal Sara , Baumert Alizee
Published: August 2023

Aims

The aim of this study was to demonstrate the impact of laparoscopic cholecystectomy on the physical and mental health of patients with gallbladder dysmotility.

Methods

Retrospective data was collected from patients who had undergone a Hepatobiliary Iminoacetic Acid (HIDA) scan between June 2012 and June 2022 in a District General Hospital in South East England. Patients diagnosed with gallbladder dysmotility were then contacted and asked to participate in a telephone interview regarding their symptoms. Their health-related quality of life was measured using the HRQoL SF-12 v2 questionnaire. Differences in the resolution of symptoms between those that had undergone a cholecystectomy and those who did not, were assessed using a chi square test. The two groups were then compared using the student t-test to assess statistically significant differences.

Results

94% (n=31/33) of participants in the non-cholecystectomy group demonstrated persistent biliary pain symptoms as opposed to the 6% (n=2/33) in the cholecystectomy group. A statistically significant improvement in five out of the eight domains of the HRQoL SF-12 questionnaire was demonstrated. These domains include PCS (physical component summary), MCS (mental component summary), mental health, general health and bodily pain.

Conclusion

The results of our retrospective analysis demonstrate an improvement in both the physical and health-related quality of life symptoms in patients who underwent laparoscopic cholecystectomy. These findings support the use of laparoscopic cholecystectomy as an effective method for managing gallbladder dysmotility.
SP2.2 Time to Pancreaticoduodenectomy in a Regional Hepatobiliary Unit in the COVID recovery era
Authors: Davidson Sophie , Metwally Abdelrahman , McClements Jane
Published: August 2023

Aims

To assess factors influencing time from multidisciplinary (MDT) discussion to surgery for patients undergoing Whipple’s resection for malignant disease in a regional HPB unit.

Methods

Patients who underwent Whipple’s resection for cholangiocarcinoma, ampullary, duodenal and pancreatic ductal adenocarcinoma between 01/02/2021–29/11/2022 were identified from a prospectively maintained operative database. The NI Electronic Care Record was used to collect data.

Results

74 patients met the inclusion criteria. 83.8% (62/74) presented as an inpatient, compared to 74% in 2020. Patients presenting as an inpatient had a significantly shorter time to surgery than those presenting as outpatients (84.7vs152.8 days, p=0.03).

The average time from MDT to surgery without neoadjuvant therapy was 57 days. 20.3% (15/74) had neoadjuvant treatment with an average time to surgery of 248 days. This has increased since 2020 from 38 and 212 days respectively, however this was not statistically significant (p=0.051).

54.1% (40/74) had staging PET-CT compared to 26% of patients in 2020. Time to surgery with a PET-CT was not significantly different to those who had no PET-CT (107vs81.9 days, p=0.18).

13 patients (17.6%) had both ERCP and EUS. 52 patients (70.2%) had either EUS or ERCP. There is a significant difference in time to surgery for patients undergoing both EUS and ERCP compared to those undergoing one endoscopic procedure (224vs65.9 days, p=0.001).

Conclusions

Use of staging PET-CT and overall time to surgery has increased since 2020 however, this was not statistically significant. Presenting as an outpatient and undergoing both ERCP and EUS were two factors identified that lead to significant delays to surgery.
SP2.5 Modified Appleby Procedure in the Treatment of Pancreatic Neoplasms
Authors: Torres Susana , Oliveira Pedro
Published: August 2023

Aims

This work aims to review the state of the art regarding the patients who may benefit from resection using the modified Appleby procedure, the pre- and post-operative procedures to increase survival, and the postoperative outcomes.

Methods

Research was conducted within the PubMed and Embase databases from July 2022 to January 2023, including single or multicenter articles relative to the modified Appleby procedure but comprising a multimodal approach to pancreatic neoplasms and not only the surgical technique, and papers concerning patients over the age of 18 years.

Results

Out of the 373 articles identified and after extracting duplicates, 267 records were accessed for a title and abstract screening. Afterward, by applying the inclusion and exclusion criteria to the remaining articles and conducting a further extensive reading of the remaining articles, 53 papers were included in this review. Secondary terms relevant to this topic were also used, allowing detection of additional research, thus totalizing the 57 publications included.

Conclusion

When applied to borderline resectable and locally advanced pancreatic cancer, the efficacy of the modified Appleby procedure alone is limited, but the combination with neoadjuvant chemotherapy offers the greatest chance of achieving an R0 resection. Many surgical technical options are available, with or without preoperative artery embolization, but the best results published to date were observed when employing robotic surgery with a retroperitoneal-first approach. However, the indication for performing this surgery and all its perioperative components are still a matter of debate.
SP2.10 Meta-analysis of adjuvant chemotherapy versus no adjuvant chemotherapy for resected stage I pancreatic cancer
Authors: Evans Daisy , Ghassemi Nader , Hajibandeh Shahin , Hajibandeh Shahab , Laing Richard W , Athwal Tejinderjit
Published: August 2023

Aims

To evaluate comparative outcomes of pancreatic cancer resection with or without adjuvant chemotherapy in patients with stage I pancreatic cancer.

Methods

A systematic search of MEDLINE, CENTRAL and Web of Science and bibliographic reference lists were conducted. All comparative studies reporting outcomes of pancreatic cancer resection for stage I cancer with or without adjuvant chemotherapy were included and their risk of bias were assessed using ROBINS-I tool. Survival outcomes were analysed using hazard ratio (HR) and odds ratio (OR) for the time-to-event and dichotomous outcomes, respectively.

Results

We included 5 comparative studies reporting a total of 4,037 patients with resected stage 1 pancreatic cancer of whom 2,374 patients had no adjuvant chemotherapy and the remaining 1663 patients received adjuvant chemotherapy. The use of adjuvant chemotherapy was associated with significantly higher overall survival rate (HR 0.73, 95% CI 0.63-0.84, p<0.00001) compared to no use of adjuvant chemotherapy. However, there was no statistically significant difference in 1-year (81.9% versus 87.4%, OR 0.51, 95% CI 0.14-1.81, p=0.30), 2-year (60.9% versus 67.5%, OR 0.88, 95% CI 0.75-1.03, p=0.10), 3-year (51.8% versus 54.3%, OR 0.99, 95% CI 0.79-1.24, p=0.93), or 5-year survival (27.4% versus 27.5%, OR 1.11, 95% CI 0.95-1.30, p=0.19) between two groups.

Conclusions

Meta-analysis of best available evidence (level 2a) demonstrates that adjuvant chemotherapy following resected stage I pancreatic cancer seems to improve overall survival compared to no use of adjuvant chemotherapy. Randomised controlled trials are required to escalate the level of evidence and confirm these findings.
SP3.4 Barriers to deceased donor kidney organ utilisation: Results of a National Transplant ACcess to Theatre (NTACT) Audit
Authors: Mujeeb Mariyam , Borbas Balint , Tanase Andrei , Aroori Somaiah
Published: August 2023

Aims

Various barriers to deceased-donor kidney utilisation exist, however, there is a lack of data on these; therefore, this national audit aims to identify the barriers to prompt kidney utilisation after the arrival of organs at the implanting centre (IC).

Methods

We conducted a multicentre, prospective audit of adult deceased-donor kidney-only transplants across 14 UK centres between February and September 2022. Data was collected on time-intervals between significant checkpoints before transplantation and perceived reasons for delays. Data was recorded on RedCap and analysed using descriptive statistics.

Results

476 kidney-only transplants were recorded (59 excluded-incomplete/incorrect data). There were 215 donations after brainstem death (DBD) organs and 202 donation after circulatory death (DCD) organs. The median cold ischaemia time (CIT) for DBD organs was 10:51 (IQR: 08:07-14:44), and for DCD organs was 11:09 (IQR: 08:13-14:50). The national CIT recommendations were exceeded by 40% of DCD and 14% of DBD organs. The median time-interval between the organ’s arrival at IC and knife-to-skin was 04:16 (IQR 02:46-07:52). The median time-interval between anaesthetic induction and knife-to-skin was 00:55 (IQR: 00:39-01:10). In 17% of cases, crossmatch results arrived after organ arrival at IC, median delay was 02:30 (IQR: 00:56-04:27). Delays were reported in 34% of cases, availability of the surgical team, anaesthetic team, porters, and the operating theatre were the most common causes of delay.

Conclusions

A significant proportion of kidneys were implanted beyond nationally recommended CIT. This audit delineated the current timings of each stage of the transplantation process and will be used in future to set realistic targets to optimise current practice.
SP3.11 Laparoscopic Donor Nephrectomy (LDN) Training in the UK. A National Re-Audit of the Trainee Experience
Authors: Sharma Hemant , Wong Chang , El-Bakry Adham , Sharma Ajay , Ridgway Dan , Mehra Sanjay
Published: August 2023

Purpose

An Independent National-Trainee-Survey reported poor LDN training opportunities in the UK in 2014. It recommended LDN fellowships and LDN training as a part of the Transplant Curriculum. A Re-audit of the initial study was done to gauge improvement.

Methods

A short electronic survey was disseminated to surgical trainees via a web-based link (Survey-monkey) placed on the Herrick-Society forum and email/paper invitations to renal transplant units across the UK.

Results

57 (53 in 2013) responses were received from the UK in 2022. Women in transplant training are still scarce OR 0.91 (0.40-2.06, p=0.49). 03% of units in the UK offer robotic-assisted LDN at present. In comparison to 2013, in 2022, 16%vs 20% of trainees were PGY1-3; 25% vs. 14% PGY 4-6; 17% vs. 18% post-residency training; 32 % vs. 31% IMG-non-training> 2 yr. transplant experience; 10%vs 09% IMG-non training < 2 yr. transplant experience (p=0.67).

92% vs. 91% of trainees reported that they had performed <01 LDN as primary-surgeon OR 0.87 (0.32-2.37, p=0.50). Only 33 % of trainees had been on a course for LDN. There was no correlation to seniority in training grade performing donor nephrectomies as a primary surgeon (p=0.76). There was no significant advantage to trainees on rotation (p=0.71) to service trainees (p=0.69) to perform LDN as primary surgeons. The likelihood of a trainee performing >01 LDN as a primary surgeon is <1 in 30 compared to < 1 in 25 (2013).

Conclusions

This study reports no improvement in training opportunities in LDN. The Trainers have yet to utilize the previous 2014 report to augment training opportunities in the UK.
SP5.1 Paracrine Interferon signalling between cancer associated Fibroblasts and Cancer Cells correlates with poor survival after chemotherapy in Triple Negative Breast Cancer patients
Authors: Jones Stacey
Published: August 2023

Aim

To determine if expression levels of Interferon-β1 (IFNβ1) in cancer associated fibroblasts, and of Myxovirus Resistance 1 (MX1) – a downstream marker of interferon activity, in cancer cells would be predictive markers of chemotherapy response and subsequent overall survival.

Methods

Breast cancer tissue was obtained from tissue microarrays of a triple negative cohort. Expression of IFNβ1 and MX1 was determined by immunohistochemistry in 109 patients treated with adjuvant chemotherapy. The cohort was further subdivided into claudin low and high subgroups, based on immunohistochemical assessment of relative expression of claudin-3.

Results

IFNβ1 in fibroblasts was significantly, positively associated with MX1 expression in tumour cells (Spearman’s correlation r=0.210; p=0.028). High expression of IFNβ1 in fibroblasts, and of MX1 in tumour cells were each significantly associated with poorer disease-free survival (p=0.01). Dividing the cohort into claudin-low (claudin-3 negative; n=49) and claudin-high (claudin-3 positive; n=60), resulted in a stronger correlation between fibroblast IFNβ1 and tumour cell MX1 in the claudin-low group (r=0.375; p=0.008), whereas it was lost in the claudin-high group (r=0.113; p=0.389). Likewise, correlations between survival and expression of IFNβ1 in fibroblasts and MX1 in tumour cells were maintained in claudin-low cases (p<0.05) but lost in claudin-highs.

Conclusion

IFNβ1 and MX1 may be of value as predictive biomarkers of chemo-response in breast cancer patients. These correlations imitate associations with chemoresistance identified in vitro using cancer associated fibroblasts and claudin-low breast cancer cell lines. Therefore, inhibiting the paracrine cross talk-between the cell types might be a viable strategy for chemo-sensitisation of breast cancers.