bluuebunny/crossref_metadata_2025 huggingface dataset:
Male androphilia, fraternal birth order, and female fecundity in Samoa: A 10-y retrospective
Authors: Semenyna Scott W. , Gómez Jiménez Francisco R. , VanderLaan Doug P. , Vasey Paul L.
Published: December 2023

Two separate but related literatures have examined familial correlates of male androphilia (i.e., sexual attraction and arousal to masculine adult males). The fraternal birth order effect (FBOE) is a widely established finding that each biological older brother a male has increased the probability of androphilia 20–35% above baseline rates. Other family demographic variables, such as reproduction by mothers, maternal aunts, and grandmothers, have been used to test evolutionary hypotheses that sexually antagonistic genes lead to androphilia among males, lowering or eliminating reproduction, which is offset by greater reproductive output among their female relatives. These proposed female fecundity effects (FFEs), and the FBOE, have historically been treated as separate yet complementary ways to understand the development and evolution of male androphilia. However, this approach ignores a vital confound within the data. The high overall reproductive output indicative of an FFE results in similar statistical patterns as the FBOE, wherein women with high reproductive output subsequently produce later-born androphilic sons. Thus, examination of the FBOE requires analytic approaches capable of controlling for the FFE, and vice-versa. Here, we present data simultaneously examining the FBOE and FFE for male androphilia in a large dataset collected in Samoa across 10 y of fieldwork, which only shows evidence of the FBOE.
Deformation twin traces on gold surfaces: A pathway to tailored epitaxial growth of 1D semiconductors
Authors: Portal Lotan , Polishchuk Iryna , Zilberberg Rotem , Levi Mor , Koifman-Khristosov Maria , Katsman Alexander , Pokroy Boaz
Published: December 2023

The field of one-dimensional semiconducting materials holds a wide variety of captivating applications, such as photovoltaic cells, electronic devices, catalysis cells, lasers, and more. The tunability of electrical, mechanical, or optical attributes of a semiconductor crystal relies on the ability to control and pattern the crystal’s growth direction, orientation, and dimensions. In this study, we harvest the unique properties of crystallographic defects in Au substrates, specifically twin boundaries, to fabricate selective epitaxial growth of semiconducting nanocrystals. Different crystallographic defects were previously shown to enhance materials properties, such as, screw dislocations providing spiral crystal growth, dislocation outcrops, and vacancies increasing their catalytic activity, dislocation strengthening, and atomic doping changing the crystal’s electrical properties. Here, we present a unique phenomenon of directed growth of semiconductor crystals of gold(I)-cyanide (AuCN) on the surface of thin Au layers, using traces of deformation twins on the surface. We show that emergence of deformation twins to the {111} Au surface leads to the formation of ledges, exposing new {001} and {111} facets on the surface. We propose that this phenomenon leads to epitaxial growth of AuCN on the freshly exposed {111} facets of the twin boundary trace ledges. Specific orientations of the twin boundaries with respect to the Au surface allow for patterned growth of AuCN in the <110> orientations. Nano-scale patterning of AuCN semiconductors may provide an avenue for property tuning, particularly the band gap acquired.
“The denigration of Korean men’s genitals”
Authors: Brown Lucien
Published: December 2023

This paper presents a critical discourse analysis of metapragmatic commentary in online news surrounding the
emergence of a new offensive gesture in South Korea. This new offensive hand shape is a “precision grip” gesture whereby the thumb
and index finger are pursed together to represent small size. In May 2021, male-dominated online communities started to take
offence at the prevalence of this gesture in advertising campaigns, viewing it as a misandrist emblem mocking them for the size of
their genitals. Conservative media sources ratified their stance of “taking offence”, which they treated as part of an ongoing
“gender conflict”. Although this view drew opposition from progressive sources, I argue that male communities backed by the
conservative media were able to utilise the stance of taking offence to redirect gender politics and further their misogynistic
agendas. The results advance our understanding of “taking offence” as a social action in populist, multimodal and post-digital
discourses.
LEACS: a learnable and efficient active contour model with space-frequency pooling for medical image segmentation
Authors: Wang Bing , Yang Jie , Zhou Yunlai , Yang Ying , Tian Xuedong , Zhang Guochun , Zhang Xin
Published: December 2023

Diseases can be diagnosed and monitored by extracting regions of interest (ROIs) from medical images. However, accurate and efficient delineation and segmentation of ROIs in medical images remain challenging due to unrefined boundaries, inhomogeneous intensity and limited image acquisition. To overcome these problems, we propose an end-to-end learnable and efficient active contour segmentation model, which integrates a global convex segmentation (GCS) module into a light-weighted encoder-decoder convolutional segmentation network with a multiscale attention module (ED-MSA). The GCS automatically obtains the initialization and corresponding parameters of the curve deformation according to the prediction map generated by the ED-MSA, while provides the refined object boundary prediction for ED-MSA optimization. To provide precise and reliable initial contour for the GCS, we design the space-frequency pooling operation layers in the encoder stage of ED-MSA, which can effectively reduce the number of iterations of the GCS. Beside, we construct ED-MSA using the depth-wise separable convolutional residual module to mitigate the overfitting of the model. The effectiveness of our method is validated on four challenging medical image datasets. Code is here: https://github.com/Yang-fashion/ED-MSA_GCS
MamoRef: an optical mammography device using whole-field CW diffuse reflectance. Presentation, validation and preliminary clinical results
Authors: Carbone Nicolás A , Vera Demián A , Victoria Waks-Serra M , García Héctor A , Iriarte Daniela I , Pomarico Juan A , Pardini Pamela A , Puca Silvana , Fuentes Nora , Renati María E , Capellino Pablo H , Osses Romina
Published: December 2023

Objective. MamoRef is an mammography device that uses near-infrared light, designed to provide clinically relevant information for the screening of diseases of the breast. Using low power continuous wave lasers and a high sensitivity CCD (Charge-coupled device) that captures a diffusely reflected image of the tissue, MamoRef results in a versatile diagnostic tool that aims to fulfill a complementary role in the diagnosis of breast cancer providing information about the relative hemoglobin concentrations as well as oxygen saturation. Approach. We present the design and development of an initial prototype of MamoRef. To ensure its effectiveness, we conducted validation tests on both the theoretical basis of the reconstruction algorithm and the hardware design. Furthermore, we initiated a clinical feasibility study involving patients diagnosed with breast disease, thus evaluating the practical application and potential benefits of MamoRef in a real-world setting. Main results. Our study demonstrates the effectiveness of the reconstruction algorithm in recovering relative concentration differences among various chromophores, as confirmed by Monte Carlo simulations. These simulations show that the recovered data correlates well with the ground truth, with SSIMs of 0.8 or more. Additionally, the phantom experiments validate the hardware implementation. The initial clinical findings exhibit highly promising outcomes regarding MamoRef’s ability to differentiate between lesions. Significance. MamoRef aims to be an advancement in the field of breast pathology screening and diagnostics, providing complementary information to standard diagnostic techniques. One of its main advantages is the ability of determining oxy/deoxyhemoglobin concentrations and oxygen saturation; this constitutes valuable complementary information to standard diagnostic techniques. Besides, MamoRef is a portable and relatively inexpensive device, intended to be not only used in specific medical imaging facilities. Finally, its use does not require external compression of the breast. The findings of this study underscore the potential of MamoRef in fulfilling this crucial role.
Machine learning techniques for sequential learning engineering design optimisation
Authors: Humphrey L R , Dubas A J , Fletcher L C , Davis A
Published: December 2023

When designing a fusion power plant, many first-of-a-kind components are required. This presents a large potential design space across as many dimensions as the component’s parameters. In addition, multiphysics, multiscale, high-fidelity simulations are required to reliably capture a component’s performance under given boundary conditions. Even with high performance computing (HPC) resources, it is not possible to fully explore a component’s design space. Thus, effective interpolation between data points via machine learning (ML) techniques is essential. With sequential learning engineering optimisation, ML techniques inform the selection of simulation parameters which give the highest expected improvement for the model: balancing exploitation of the current best design with exploration of uncertain areas in the design space. In this paper, the application of an ML-driven design of experiment procedure for the sequential learning engineering design optimisation of a fusion component is shown. A parameterised divertor monoblock is taken as a typical example of a fusion component requiring HPC simulation to model. The component’s geometry is then optimised using Bayesian optimisation, seeking the design which minimises the stress experienced by the component under operational conditions.
Multiterminal nonreciprocal routing in an optomechanical plaquette via synthetic magnetism
Authors: Tang Zhi-Xiang , Xu Xun-Wei
Published: December 2023

Optomechanical systems with parametric coupling between optical (photon) and mechanical (phonon) modes provide a useful platform to realize various magnetic-free nonreciprocal devices, such as isolators, circulators, and directional amplifiers. However, nonreciprocal router with multiaccess channels has not been extensively studied yet. Here, we propose a nonreciprocal router with one transmitter, one receiver, and two output terminals, based on an optomechanical plaquette composing of two optical modes and two mechanical modes. The time-reversal symmetry of the system is broken via synthetic magnetism induced by driving the two optical modes with phase-correlated laser fields. The prerequisites for nonreciprocal routing are obtained both analytically and numerically, and the robustness of the nonreciprocity is demonstrated numerically. Multiterminal nonreciprocal router in optomechanical plaquette provides a useful quantum node for development of quantum network information security and realization of quantum secure communication.
Application of Regularization Methods in the Sky Map Reconstruction of the Tianlai Cylinder Pathfinder Array
Authors: Yu Kaifeng , Zuo Shifan , Wu Fengquan , Wang Yougang , Chen Xuelei
Published: December 2023

The Tianlai cylinder pathfinder is a radio interferometer array to test 21 cm intensity mapping techniques in the post-reionization era. It works in passive drift scan mode to survey the sky visible in the northern hemisphere. To deal with the large instantaneous field of view and the spherical sky, we decompose the drift scan data into m-modes, which are linearly related to the sky intensity. The sky map is reconstructed by solving the linear interferometer equations. Due to incomplete uv coverage of the interferometer baselines, this inverse problem is usually ill-posed, and regularization method is needed for its solution. In this paper, we use simulation to investigate two frequently used regularization methods, the Truncated Singular Value Decomposition (TSVD), and the Tikhonov regularization techniques. Choosing the regularization parameter is very important for its application. We employ the generalized cross validation method and the L-curve method to determine the optimal value. We compare the resulting maps obtained with the different regularization methods, and for the different parameters derived using the different criteria. While both methods can yield good maps for a range of regularization parameters, in the Tikhonov method the suppression of noisy modes are more gradually applied, produce more smooth maps which avoids some visual artefacts in the maps generated with the TSVD method.
The buckling performance of a piezoelectric laminated composite plate via static method
Authors: Mao Chenyang , Liu Lei , Zhou Bo , Zhu Xiuxing , Wang Haijing
Published: December 2023

Piezoelectric materials are widely used as actuators, due to the advantages of quick response, high sensitivity and linear strain-electric field relationship. The previous work on the piezoelectric material plate structures are not enough, however such structures play a very important role in the practical design. In this paper, the buckling performance of piezoelectric laminated composite plate (PLCP) is analyzed based on static method to parametric study the buckling control. The stress components of the matrix layer are formulated based on electro-mechanical coupling theory and Kirchhoff’s classical laminated plate theory. Buckling differential governing equation of PLCP is obtained by using the equilibrium conditions. The solution of the governing equation is assumed as a sum of a series of trigonometric shape functions, and then its expression is obtained by using static method. The effectiveness of the developed method is validated by the comparison with finite element method. Especially, the developed method can be used for engineering applications more easily, and it does not require to rebuild the calculation model as finite element method during the calculation and analysis of PLCP. The buckling performance of PLCP and its influencing factors are numerically analyzed through the developed method. The buckling performance of PLCP is reasonably increased by parametric studying different loads, laying angle, laying sequence, height of the matrix plate, and layer size. This paper is a valuable reference for the design and analysis of PLCP.
Investigating the role of processing temperature on the microstructure evolution, mechanical properties, and corrosion behaviour of equal channel angular pressed AZ31 Mg alloy
Authors: Raghu Ram Mohan Reddy K , Mrudula G , Elipey Manoj Kumar , Singaiah Kanumuri , Prabhakar G V N B
Published: December 2023

AZ31 magnesium (Mg) alloy was subjected to equal channel angular pressing (ECAP) through Bc route at three different temperatures (200, 250 and 300 °C) to investigate the role of processing temperature on the microstructure evolution. All the sample were processed for one complete cycle which includes 4 consecutive pressings. Workpiece processed at 200 °C has shown relatively higher grain refinement (2.1 ± 1.4 μm) compared with the samples processed at 250 °C (5.6 ± 2.7 μm) and 300 °C (7 ± 5.5 μm) from a starting size of 36 ± 4.1 μm. Increased hardness was measured for the ECAPed samples at 200 °C due to the higher level of grain refinement. Workpiece produced at 200 °C exhibited higher tensile strength (270.9 ± 6.3 MPa) compared with the other processed samples and base alloy. Surface energy measurements from the contact angles show the positive effect of grain refinement on increasing the hydrophilic nature of AZ31 alloy. Corrosion experiments from the potentiodynamic polarization studies demonstrate lower corrosion current for the base alloy compared with all of the processed alloys. The deteriorated corrosion performance in the ECAPed alloys can be claimed to the increased crystal imperfections due to ECAP. From the results, it is understood that the lower processing temperatures are preferable to achieve higher level of grain refinement in ECAP of AZ31 Mg alloy. Excellent mechanical properties can be achieved in AZ31 alloy by ECAP and the decreased corrosion resistance is a concern to pay more attention.
Pregnant women’s experiences of extreme exposure to bushfire associated smoke: a qualitative study
Authors: Davis Deborah , Barnes Katelyn , Williamson Rebecca , Behie Alison M , Phillips Christine , Aroni Rosalie , Roberts Celia , Kurz Ella , Schoenaker Danielle , Nolan Christopher J
Published: December 2023

In 2019/2020, multiple bushfires burned across south-east Australia converging into unprecedented megafires that burned 5.8 million hectares. From October 2019–February 2020, 80% of Australians were affected by smoke from these fires, exposing them to dramatic increases of PM2.5 in the air at an average level of ∼70 μg m3 per day, well above the World Health Organisation recommendation of ∼10 μg m3. Maternal exposure to PM2.5 has been associated with negative birth outcomes and an increased rate of birth defects, yet there is a dearth of literature regarding how pregnant women deal with exposure to bushfire smoke. The aim of this study was thus to investigate how pregnant and postpartum women experienced severe bushfire smoke associated with the 2019–2020 bushfires in south-east Australia and the strategies they used to mitigate exposure to smoke for themselves and their unborn or newborn children. Forty-three women who were exposed to fire and/or smoke from the 2019–2020 bushfires participated in one-on-one semi-structured interviews via phone or videoconference. These women were selected purposively from a larger group of women who had elected to be interviewed. After interview, data were transcribed and thematically analysed using the four phases of disaster response (prevention, preparedness, response, recovery) as a frame. Overall, our results indicated that public health advice failed to meet the unique needs of this group. While many protected their properties appropriately and were reasonably well prepared for evacuation, they were unprepared for the disruption to vital services including power and communications. Women exposed to smoke inundation were unprepared for this outcome and self-initiated a variety of strategies. The support of community was also key to recovery. There is a clear need for specific recognition of the needs of pregnant women across all phases of disaster response, incorporating public health messaging, peer support, and access to resources.
Decision making in emergency laparotomy: updated results of an international multi disciplinary judgement analysis study
Authors: Perin Giordano , Ghirardo Sergio , Favero Alberto , Bellio Gabriele , Hormis Anil , Cresswell Andrew
Published: December 2023

Aims

The aim of our study is to assess how professionals take decisions when evaluating suitability of patients for emergency laparotomy or palliation.

Methods

We created and validated a dataset of 90 case vignettes based on real patients admitted with surgical pathology correctable only via an emergency laparotomy. We removed information concerning real life outcomes. We submitted the vignettes to consultants and trainees in surgery, anaesthesia and intensive care, asking them if they would offer an emergency laparotomy. Concordance between assessors and real life decisions, accuracy scores (the lower the value the higher the likelihood of operating on patients that survived) and inconsistency scores were calculated. Judgement Analysis methodology (binomial logistic regression) was used to identify variables relevant to the decision making process for each participant.

Results

This report includes results for the first 110 participants. Thirteen centres provided data (4 from Italy, 8 from the UK, 1 from Greece). 54 consultants, 39 registrars, 13 core trainees participated. 68 were surgeons, 26 anaesthetists and 9 intensivists. Median concordance between decision makers and real life was 78.9%. Median accuracy was 17 (IQR 11-34.3). Median inconsistency was 13% (IQR 7%-20%). Concordance, accuracy and consistency strongly correlated with each other and were better for consultants and worse for trainees. Judgment Analysis demonstrated differences between grades, specialities and institutions.

Conclusions

Different clinicians, when faced with the same information, make different decisions. Our updated data supports the adoption of multidisciplinary decision making protocols as well as senior involvement.
Frailty in Emergency Laparotomy and Laparoscopic Scottish Audit (ELLSA) Patients
Authors: McCulloch Alison , Watson Hannah , Richmond Victoria , Sturrock Claire , McCleary Andrew , Payne Christopher
Published: December 2023

Aims

Early identification of frailty is essential in the older emergency surgical patient. The latest NELA report highlights the importance of care of the elderly reviews in reducing mortality in this patient population. In our organisation, the geriatrician led Surgical Acute Frailty Team (SAFT) reviews patients aged ≥ 65 years included in the Emergency Laparotomy and Laparoscopic Scottish Audit (ELLSA). Our aim was to establish frailty identification in ELLSA patients and to review outcomes on discharge.

Methods

A subset of data collected as part of our organisation’s ELLSA was reviewed. Data included documentation of Clinical Frailty Scale Score (CFS), review pre-operatively and during admission by SAFT and discharge destinations.

Results

146 patients aged ≥ 65 years underwent emergency surgery as defined by ELLSA criteria from July 2022 to August 2023. 98.6% of patients had a documented CFS score (mean 3.6). 87.7% of patients were reviewed by SAFT; 63.3% of patients had a pre-operative frailty review. 70% of patients were discharged home independently with 7% requiring a care package on discharge.

Conclusions

In our organisation, frailty assessment in emergency laparotomy patients is significantly above the 31.8% documented in the 8th NELA report. The majority of patients are discharged home without additional support. Shared decision making is vital in this patient cohort. We have established frailty screening on admission, introduced a weekly MDT for ELLSA patients and installed a designated ELLSA patient MDT board with the aim of ensuring 100% of ELLSA patients aged ≥ 65 years have a geriatrician review.
Improving access to patient information leaflets utilising QR codes in patients undergoing emergency appendicectomy.
Authors: Louden Harriet , Lawday Samuel , Hewes James
Published: December 2023

Background

Informed consent is a cornerstone of ethical surgical practise. Patients undergoing emergency surgery have reduced time to consider their options when compared to the elective setting. Therefore, improving informed consent in this setting is critical. We aim to increase the provision of a pre-operative patient information leaflet (PIL) for patients undergoing an emergency appendicectomy by 50% over two audit cycles.

Methods

The same methodology were used for both cycles of this audit. Patients were identified through histopathology lists over a two week period. Medical notes were reviewed for documentation of provision of trust approved patient information leaflets. A QR code for an electronic version of the information leaflet was added to emergency clinic rooms, doctors handover rooms and the SHO on call bleep between audit periods.

Results

Empirical results from two audit cycles revealed that introduction of a QR code increased uptake from 0% of patients receiving the recommended appendicectomy leaflet, to 58%, achieving our aim.

Conclusion

The QR code provided a useful transportable resource, which was utilised by doctors. This provides scope for progression in provision of leaflet for other surgical issues, both in inpatient and outpatient settings, through utilisation of a QR code.
Reducing Unnecessary Group and Screen Sampling for Laparoscopic Appendicectomy: A retrospective single centre analysis.
Authors: Siddique Nayyab , O’Brien Catherine
Published: December 2023

Aims

Blood transfusion is rarely required for patients undergoing laparoscopic appendicectomies (LA) however some NHS trusts still require group and screen (G&S) sampling. This study aimed to assess G&S sampling for LA, rate of transfusion and the cost of G&S sampling at our hospital. It re-assessed these parameters after introduction of a guideline specifying that G&S are not needed routinely and should only be considered in case of high-risk patients (including those with deranged clotting, anticoagulation or profound anaemia).

Methods

A retrospective observational study was conducted in our centre from 01/02/2022-01/06/2022 (cycle one) and 20/04/23- 20/08/2023 (cycle two post, guideline introduction). All patients undergoing emergency LA were included. Laboratory costs of G&S sampling was estimated at £18.37 excluding consumables, CO2 emissions estimated at 116g/ test.

Results

The first cycle included 48 patients for which 85 G&S samples were sent costing £1561.45. 21 samples were rejected / not required and estimated CO2 emissions were 9.86kg. In second cycle, 32 G&S samples were sent for 52 patients, only 2 samples were rejected. No patients required blood transfusion. £973.61 and an estimated 6.1kg CO2 emissions were saved.

Conclusions

We established a guideline which negates the need for routine G&S sampling in patients undergoing LA in our hospital. Projected savings are approximately £30,000 per annum excluding theatre delay costs, personnel and other consumables. We recommend other NHS trusts should look to implement similar guidelines in order to reduce cost and CO2 impact of unnecessary testing in EGS.
Unplanned Returns to Theatres in Emergency General Surgery; What can be improved?
Authors: Salam Ammara , Alabri Badar , Patel Bhavnisha , Osunlusi Oluwafemi , Waraich Naseem
Published: December 2023

Introduction

Unplanned return to theatre impacts physical, psychological, social and financial aspects of patients and healthcare. It is a significant adverse event, which can be avoided, nonetheless reduced. This study aims to review the incidence of unplanned return to theatre in Emergency General Surgery at a District General Hospital.

Methods

A retrospective review of patients undergoing Emergency General Surgery between January 2019 to January 2021 was done. Data was obtained from the hospital management information systems. The operations were classified based on primary operation, followed by indication for the return.

Results

A total number of 1578 patients underwent emergency general surgery operations over a period of 25 months (Jan 2019-Jan 2021). The unplanned return to theatres (URTT) were 85 (5.3%), with a 90-day mortality of 16. There were 12 (14.11%) appendicectomies, 7 (8.2%) necrotizing fasciitis, 25 (29.4%) abscess, 5 (5.8%) hernias, 16 (18.8%) large bowel, 19 (22.3%) small bowel operations and 1 (1.17%) laparoscopic cholecystectomy. The total number of appendicectomies were 302 with 3.9% (12) URTT. Similarly, 4.2% (n=583) abscesses, 22.8% (n=70) large bowel operations, 6% (n=316) small bowel operations were returned. 66% of the abscesses were returned for redo/debridement.

Conclusion

Unplanned returns to theatres pose a major burden to the healthcare system. There is no established data for an acceptable rate of URTT in emergency general surgery. Most of the returns in our study, are due to haemorrhage or inadequate drainage of the abscess, both of these complications could easily be prevented with meticulous surgical technique.
Assessment of the documentation of frailty at admission in emergency general surgery admission at a tertiary care hospital
Authors: Singh Anurag , Siby Jayas , Kaur Mandeep , Sajid Muhammad
Published: December 2023

Background

NHS frailty guidelines advise that frailty score should be documented at the first time of contact for patients aged 65+ years. The Aim of this quality improvement project (QIP) was to assess the adequate documentation of frailty at the time of first encounter by the general surgery department for patients aged 65+ years.

Method

Data was collected for October 2022 for the first cycle and January and February 2023 for the second cycle. Data collection was done from an electronic database in the trust and patient notes maintained throughout the admission.

Results

136 patients were included in the QIP for the first cycle. 3/136 (2.2%) patients had documented frailty at the first encounter. These findings were discussed in the clinical governance meeting, followed by a teaching session for the junior doctors. A specific section was added in the documentation as a reminder for the team to document the frailty upon the first encounter.

212 patients were included in the second cycle and documentation of frailty improved to 39/212 (18.4%).

Conclusion

There was a lack of documentation, which improved after the intervention advised by QIP. A teaching session for new junior doctors is planned at the induction session, to strengthen the importance of frailty documentation.
Outcomes of Emergency Surgical patients with acute pathology managed without emergency laparotomy - a single site review
Authors: Bakrania Shiv , Manor Kristin , Capozzi Patrizia
Published: December 2023

Aim

To establish the outcomes of Emergency General Surgery patients admitted with acute pathology that did not progress to Emergency Laparotomy

Method

Retrospective single site review of all Emergency General Surgery patients admitted over three calendar months. Review of patient demographics, diagnostics, diagnosis and management. Identification of and further collection of data from electronic patient records for patients that did not proceed to Emergency Laparotomy despite indicative pathology.

Results

A total of 619 emergency general surgical patients were admitted from 1st January to 31st March 2023.

39 (6.3%) patients had an Emergency Laparotomy.

17 (2.7%) patients did not proceed to laparotomy despite pathology that could indicate the need for emergency laparotomy. 100% of these patients has CT imaging to diagnose the pathology.

Of the 17 patients without laparotomy 12 were female patients.

Median age of 86 years (range 42 – 91 years).

At 30 days post admission 6 patients who did not proceed to laparotomy were alive.

7 patients survived to discharge, 5 were discharged home and 2 were discharged to a Nursing Home for full nursing care requirements.

Conclusion

Surgeons are starting to explore the issues around futility in emergency general surgery. This snapshot retrospective review shows alignment with the very limited published literature. We recognise our numbers are extremely limited. Further data collection and analysis is needed to explore futility in emergency general surgery.
Clinical audit to assess diagnosis and severity stratification of acute pancreatitis
Authors: Woods Hannah , Roberts Rhianna , Bradley Rebecca
Published: December 2023

Background

Acute Pancreatitis (AP) has varying presentations, and guidelines recommend severity stratification of these patients to guide management. Surgical departments commonly use varying methods and/or use these methods incorrectly. The prominent Alanta criteria utilises examination findings, CT scan findings and elevated pancreatic enzymes to diagnose AP. Using the criteria incorrectly can lead to misdiagnosis and unnecessary radiation exposure. Additionally, diagnosing pancreatitis aetiology is crucial to providing targeted treatments, such as a laparoscopic cholecystectomy.

Aim

The aim of this study was to identify aspects of AP diagnosis and severity scoring requiring improvement in a large general surgery department.

Methods

We identified adult patients admitted with AP between 01.01.2023 and 31.03.2023, and retrospectively collected data points recommended by a combination of national guidelines and the Atlanta criteria. The results were presented to a panel of expert Upper Gastrointestinal Surgeons and, with the panel’s guidance, an AP protocol was created to improve severity scoring and rapid diagnosis of AP.

Results

The severity scoring was only completed in 33% of cases and incorrectly used in the majority of cases. Based on request information and cases already fulfilling the diagnostic criteria, almost half of all CT scans performed were deemed unnecessary. Results on interventions for alcohol and gallstone cases highlighted significant shortfallings.

Conclusion

Significant improvements are required in severity scoring, adherence to diagnostic criteria and targeted treatment. A pancreatic protocol has since been established in this department and further analysis will be completed to create a closed-loop audit.
The glucocorticoid dexamethasone inhibits HIF-1α stabilization and metabolic reprogramming in lipopolysaccharide-stimulated primary macrophages
Authors: Clayton Sally A , Lockwood Chloe , O’Neil John D , Daley Kalbinder K , Hain Sofia , Abdelmottaleb Dina , Bolimowska Oliwia O , Tennant Daniel A , Clark Andrew R
Published: December 2023

Synthetic glucocorticoids are used to treat many chronic and acute inflammatory conditions. Frequent adverse effects of prolonged exposure to glucocorticoids include disturbances of glucose homeostasis caused by changes in glucose traffic and metabolism in muscle, liver, and adipose tissues. Macrophages are important targets for the anti-inflammatory actions of glucocorticoids. These cells rely on aerobic glycolysis to support various pro-inflammatory and antimicrobial functions. Employing a potent pro-inflammatory stimulus in two commonly used model systems (mouse bone marrow-derived and human monocyte-derived macrophages), we showed that the synthetic glucocorticoid dexamethasone inhibited lipopolysaccharide-mediated activation of the hypoxia-inducible transcription factor HIF-1α, a critical driver of glycolysis. In both cell types, dexamethasone-mediated inhibition of HIF-1α reduced the expression of the glucose transporter GLUT1, which imports glucose to fuel aerobic glycolysis. Aside from this conserved response, other metabolic effects of lipopolysaccharide and dexamethasone differed between human and mouse macrophages. These findings suggest that glucocorticoids exert anti-inflammatory effects by impairing HIF-1α-dependent glucose uptake in activated macrophages. Furthermore, harmful and beneficial (anti-inflammatory) effects of glucocorticoids may have a shared mechanistic basis, depending on the alteration of glucose utilization.
The degree of permanent pacemaker dependence and clinical outcomes following transcatheter aortic valve implantation: implications for procedural technique
Authors: Dykun Iryna , Mahabadi Amir Abbas , Jehn Stefanie , Kalra Ankur , Isogai Toshiaki , Wazni Oussama M , Kanj Mohamad , Krishnaswamy Amar , Reed Grant W , Yun James J , Totzeck Matthias , Jánosi R Alexander , Lind Alexander Y , Kapadia Samir R , Rassaf Tienush , Puri Rishi
Published: December 2023

Aims

Conduction abnormalities necessitating permanent pacemaker (PPM) implantation remain the most frequent complication post-transcatheter aortic valve implantation (TAVI), yet reliance on PPM function varies. We evaluated the association of right-ventricular (RV)-stimulation rate post-TAVI with 1-year major adverse cardiovascular events (MACE) (all-cause mortality and heart failure hospitalization).

Methods and results

This retrospective cohort study of patients undergoing TAVI in two high-volume centers included patients with existing PPM pre-TAVI or new PPM post-TAVI. There was a bimodal distribution of RV-stimulation rates stratifying patients into two groups of either low [≤10%: 1.0 (0.0, 3.6)] or high [>10%: 96.0 (54.0, 99.9)] RV-stimulation rate post-TAVI. Hazard ratios (HR) and 95% confidence intervals (CI) were calculated comparing MACE in patients with high vs. low RV-stimulation rates post-TAVI. Of 4659 patients, 408 patients (8.6%) had an existing PPM pre-TAVI and 361 patients (7.7%) underwent PPM implantation post-TAVI. Mean age was 82.3 ± 8.1 years, 39% were women. A high RV-stimulation rate (>10%) development post-TAVI is associated with a two-fold increased risk for MACE [1.97 (1.20, 3.25), P = 0.008]. Valve implantation depth was an independent predictor of high RV-stimulation rate [odds ratio (95% CI): 1.58 (1.21, 2.06), P=<0.001] and itself associated with MACE [1.27 (1.00, 1.59), P = 0.047].

Conclusion

Greater RV-stimulation rates post-TAVI correlate with increased 1-year MACE in patients with new PPM post-TAVI or in those with existing PPM but low RV-stimulation rates pre-TAVI. A shallower valve implantation depth reduces the risk of greater RV-stimulation rates post-TAVI, correlating with improved patient outcomes. These data highlight the importance of a meticulous implant technique even in TAVI recipients with pre-existing PPMs.
Novel methods to determine the slowness and ray-velocity vectors in viscoelastic anisotropic media
Authors: Zhou Bing , Liu Xu , Wang Pengde , Kumar Manjeet
Published: December 2023

Determination of the slowness vector and the homogeneous ray-velocity vector is critical for seismic ray tracing in a viscoelastic anisotropic medium. Three formulae, the traditional g-Hamiltonian, newly developed conjugate real ray tracing (C-RRT) and innovative g*-Hamiltonian, are employed to calculate the ray-velocity vectors with the determined slowness vectors in a viscoelastic anisotropic medium. We demonstrate the forward and reverse searching procedures to determine the ray-velocity vectors' slowness vectors.

The former implements either a linear search or an optimization method to find the slowness vectors that lead to homogeneous complex ray-velocity vectors (its real and imaginary parts are parallel). The latter is based on a new generalized cost function and applies an optimization method to find the slowness vector for a known ray direction. Using sandstone as an example material, we compare the accuracies and efficiencies of the three formulae and the two searching procedures. Our examples show that the forward searching procedure with the traditional g-Hamiltonian formula and the linearly searching method may generate unphysical solutions for qSV wave due to its cusps or triplication, but using the optimization method may not only mitigate the influence of the cusps and triplication but also significantly improve the accuracies and efficiencies almost two orders higher. For the reverse searching procedure, we propose a general form of the cost function valid for all the formulae of the ray-velocity vector and easily solved by an optimization method. The examples demonstrate that the solutions yielded by the forward and reverse searching procedures coincide well for all three body waves (qP, qSV and qSH), except for the triplication of the qSV wave. In particular, the optimization method combined with the novel g*-Hamiltonian formula may completely overcome the issues of spurious solutions and the qSV-wave cusp and triplication.
Massachusetts’ opioid limit law associated with a reduction in postoperative opioid duration among orthopedic patients
Authors: Shuey Bryant , Zhang Fang , Rosen Edward , Goh Brian , Trad Nicolas K , Wharam James Franklin , Wen Hefei
Published: December 2023

Postoperative orthopedic patients are a high-risk group for receiving long-duration, large-dosage opioid prescriptions. Rigorous evaluation of state opioid duration limit laws, enacted throughout the country in response to the opioid overdose epidemic, is lacking among this high-risk group. We took advantage of Massachusetts’ early implementation of a 2016 7-day-limit law that occurred before other statewide or plan-wide policies took effect and used commercial insurance claims from 2014–2017 to study its association with postoperative opioid prescriptions greater than 7 days’ duration among Massachusetts orthopedic patients relative to a New Hampshire control group. Our sample included 14 097 commercially insured, opioid-naive adults aged 18 years and older undergoing elective orthopedic procedures. We found that the Massachusetts 7-day limit was associated with an immediate 4.23 percentage point absolute reduction (95% CI, 8.12 to 0.33 percentage points) and a 33.27% relative reduction (95% CI, 55.36% to 11.19%) in the percentage of initial fills greater than 7 days in the Massachusetts relative to the control group. Seven-day-limit laws may be an important state-level tool to mitigate longer duration prescribing to high-risk postoperative populations.
Whole of government approaches to accelerate adolescent success: efficiency and financing considerations
Authors: Desmond Chris , Watt Kathryn , Rudgard William E , Sherr Lorraine , Cluver Lucie
Published: December 2023

The multiple domains of development covered by the Sustainable Development Goals (SDGs) present a practical challenge for governments. This is particularly acute in highly resource-constrained settings which use a sector-by-sector approach to structure financing and prioritization. One potentially under-prioritized solution is to implement interventions with the potential to simultaneously improve multiple outcomes across sectors, what United Nations Development Programme refer to as development ‘accelerators’. An increasing number of accelerators are being identified in the literature. There are, however, challenges associated with the evaluation and implementation of accelerators. First, as accelerators have multiple benefits, possibly in different sectors, they will be undervalued if the priority setting is conducted sector-by-sector. Second, even if their value is recognized, accelerators may not be adopted if doing so clashes with any of the multiple competing interests policymakers consider, of which efficiency/social desirability is but one. To illustrate the first challenge, and outline a possible solution, we conduct a cost-effectiveness analysis comparing the implementation of three sector-specific interventions to an accelerator, first using a sector-by-sector planning perspective, then a whole of government approach. The case study demonstrates how evaluating the cost-effectiveness of interventions sector-by-sector can lead to suboptimal efficiency rankings and overlook interventions that are efficient from a whole of government perspective. We then examine why recommendations based on a whole of government approach to evaluation are unlikely to be heeded. To overcome this second challenge, we outline a menu of existing and novel financing mechanisms that aim to address the mismatch between political incentives and logistical constraints in the priority setting and the economic evaluation evidence for cost-effective accelerators. These approaches to financing accelerators have the potential to improve efficiency, and in doing so, progress towards the SDGs, by aligning political incentives more closely with recommendations based on efficiency rankings.
High prevalence of trachomatous inflammation–follicular with no trachomatous trichiasis: can alternative indicators explain the epidemiology of trachoma in Côte d’Ivoire?
Authors: Atekem Kareen , Harding-Esch Emma M , Martin Diana L , Downs Philip , Palmer Stephanie L , Kaboré Achille , Kelly Michaela , Bovary Anoma , Sarr Astou , Nguessan Konan , James Fiona , Gwyn Sarah , Wickens Karana , Bakhtiari Ana , Boyd Sarah , Aba Ange , Senyonjo Laura , Courtright Paul , Meite Aboulaye
Published: December 2023

Baseline trachoma surveys in Côte d'Ivoire (2019) identified seven evaluation units (EUs) with a trachomatous inflammation–follicular (TF) prevalence ≥10%, but a trachomatous trichiasis (TT) prevalence in individuals ≥15 y of age below the elimination threshold (0.2%). Two of these EUs, Bondoukou 1 and Bangolo 2, were selected for a follow-up survey to understand the epidemiology of trachoma using additional indicators of Chlamydia trachomatis infection (DNA from conjunctival swabs) and exposure (anti-Pgp3 and Ct694 antibodies from dried blood spots [DBSs]). A two-stage cluster sampling methodology was used to select villages and households. All individuals 1–9 y of age from each selected household were recruited, graded for trachoma and had a conjunctival swab and DBS collected. Conjunctival swabs and DBSs were tested using Cepheid GeneXpert and a multiplex bead assay, respectively. The age-adjusted TF and infection prevalence in 1- to 9-year-olds was <1% and <0.3% in both EUs. Age-adjusted seroprevalence was 5.3% (95% confidence interval [CI] 1.5 to 15.6) in Bondoukou 1 and 8.2% (95% CI 4.3 to 13.7) in Bangolo 2. The seroconversion rate for Pgp3 was low, at 1.23 seroconversions/100 children/year (95% CI 0.78 to 1.75) in Bondoukou 1 and 1.91 (95% CI 1.58 to 2.24) in Bangolo 2. Similar results were seen for CT694. These infection, antibody and clinical data provide strong evidence that trachoma is not a public health problem in either EU.
A secondary analysis to determine countries and districts eligible for documented full geographic coverage for trichiasis case finding and outreaches
Authors: Kamuyu Michael K , Kelly Michaela , Somerville Stephanie
Published: December 2023

Background

The World Health Organization recommends house-to-house case searches as an option to evidence whether the elimination of trachomatous trichiasis (TT) has been reached. We sought to determine the number of trachoma-endemic countries and districts that will require either documented full geographic coverage (DFGC) or TT-only surveys.

Methods

We conducted a secondary analysis of data from the Trachoma Atlas to identify evaluation units (EUs) that require house-to-house case searches or TT-only surveys to demonstrate achievement of the elimination of TT.

Results

There were 1710 EUs with TT above the elimination prevalence target in all trachoma-endemic countries. Of those EUs, 852 (49.8%) do not have a future survey planned and will therefore potentially have to evidence through DFGC or TT-only surveys whether the elimination prevalence target for TT has been reached.

Conclusion

Of the large number of EUs that require TT-related activities, nearly half of them will need to evidence that every household in the EU has been visited by a case finder and all confirmed cases managed. Given that this is a relatively new way to evidence elimination, and countries face different sociopolitical challenges, cross-country learning and improved guidance is key to support global elimination.
Explaining the continuing high prevalence of trachomatous trichiasis unknown to the health system in evaluation units: a mixed methods explanatory study in four trachoma-endemic countries
Authors: Mwangi Grace , Harding-Esch Emma , Kabona George , Watitu Titus , Mpyet Caleb , Gemechu Alemu , Abdeta Alemayehu , Wamyil-Mshelia Teyil , Ajege Grace , Kelly Michaela , Abony Maurice , Otinda Peter , Chege Moses , Courtright Paul , Geneau Robert
Published: December 2023

Background

We explored reasons for continuing higher-than-anticipated prevalence of trachomatous trichiasis (TT) unknown to the health system in population-based prevalence surveys in evaluation units where full geographical coverage of TT case finding was reported.

Methods

A mixed-methods study in Ethiopia, Kenya, Nigeria and Tanzania was conducted. We compared data from clinical examination, campaign documentation and interviews with original trachoma impact survey (TIS) results.

Results

Of 169 TT cases identified by TIS teams, 130 (77%) were examined in this study. Of those, 90 (69%) were a match (both TIS and study teams agreed on TT classification) and 40 (31%) were a mismatch. Of the 40 mismatches, 22 (55%) were identified as unknown to the health system by the study team but as known to the health system by the TIS team; 12 (30%) were identified as not having TT by the study team but as having TT by the TIS team; and six (15%) were identified as unknown to the health system in the TIS team but as known to the health system by the study team based on documentation reviewed.

Conclusions

Incorrectly reported geographical coverage of case-finding activities, and discrepancies in TT status between TIS results and more detailed assessments, are the key reasons identified for continuing high TT prevalence.