bluuebunny/crossref_metadata_2025 huggingface dataset:
Languages for learning
Authors: Minardi Silvia
Published: February 2022

More than 25 years have passed since CLIL was first introduced in schools all over Europe with objectives, methods and organizational structures that often also vary from one country to another. Time has passed, and still without a precise framework of reference, CLIL shows its great potential as well as its drawbacks. Using data from research conducted in Italy with four CLIL teachers who teach physics through a foreign language, this article aims to highlight the possibility that CLIL can serve to make every teacher, regardless of the subject, aware of the role that language can play in learning. The data collected, which refer to the Italian education system, emphasize the central role of the subject teacher in CLIL implementation. They also draw attention to the need for important changes in the CLIL agenda for the coming years.
Satisfaction with Group-Based Appointments among Patients with Opioid use Disorder in an Urban Buprenorphine Clinic
Authors: Akyar Serra , Nyaku Amesika , Lao Kristyn , Ruthberg Stephanie , Zerbo Erin A.
Published: February 2022

Background: Successful implementation of group-based appointments can increase capacity to treat patients, reduce costs, and improve productivity. We sought to understand the acceptability of group-based appointments for opioid use disorder (OUD) in an urban clinical setting that treats predominantly ethnic minority populations. Methods: A survey collecting data on demographics, substance use, co-morbid psychiatric conditions, and satisfaction with group-based opioid treatment (GBOT) was conducted among patients 18 years and older with OUD attending an urban buprenorphine clinic between December 2019 and February 2020. Results: Thirty-nine patient surveys were completed. Among participants, 64.1% identified as Black/African American and 76.9% identified as male. The mean age was 51.2 years. Participants reported overall high levels of satisfaction with group-based appointments though GBOT was not strongly preferred over individual visits. On a 5-point Likert scale, 69.2% of participants agreed or strongly agreed that their medical needs were met during group-based appointments. A majority of participants agreed or strongly agreed that medical information received from the clinical team (97.4%) and other patients (82.1%) were valuable. Most participants (82.1%) reported adherence to treatment plans became easier since attending GBOT. Age and self-identified employment status as disabled or retired were positively associated with total satisfaction scores. Conclusions: Patients in a predominantly Black/African American and Hispanic/Latinx community with co-occurring mental health disorders and other substance use reported overall satisfaction with GBOT and would recommend this modality to other patients.
Rates of Discontinuation and Non-Publication of Trials for the Pharmacologic Treatment of Alcohol use Disorder
Authors: Hartwell Micah , Sajjadi Nicholas B. , Shepard Samuel , Whelan John , Roberts Jamie , Ford Alicia Ito , Beaman Jason , Vassar Matt
Published: February 2022

Objective:With approximately 15 million individuals in the United States meeting criteria for Alcohol Use Disorder (AUD), advancing effective medication-assisted treatment options is crucial. This advancement stems from the publication of clinical trial (CT) results. The primary objective of this study was to assess the rates of discontinuation and non-publication of results in CTs focused on the pharmacologic treatment of AUD and to assess associated factors. Design: A cross-sectional study was completed after acquiring trials focused on AUD within the ClinicalTrials.gov database. Inclusion criteria for CTs were the use of a pharmaceutical intervention with an outcome measure of alcohol intake or craving, conducted between October 2008 through September 2018. The primary outcome measures were the frequency of trial discontinuation and non-publication. Discontinuation was assessed as the listed status on ClinicalTrials.gov. Publications were identified through verification of listings on ClinicalTrials.gov, or via searches of PubMed, Embase, and Google Scholar. If publications were not found, correspondence to trial contacts were sent. Data analysis occurred on December 5th, 2020. Results: Of 235 trials returned from the search, 87 met inclusion criteria. Our study found that 12.6% (11) of CTs involving pharmaceutical treatments for AUD were prematurely terminated, and 39.1% (34) had no published results. Recruitment and lower cutoff of targeted age groups were significantly associated with discontinuation and non-publication, respectively. Conclusions: Scientific evidence advances faster when all results are known—furthering the progress of positive studies, while avoiding duplicative efforts to test the same hypotheses with the same methods, thereby reducing scientific waste. Given the number of unpublished AUD trials, potentially useful information regarding treatment for individuals with AUD may be inaccessible to clinicians while also adding to the abundance of research waste. Key points Question: What are the rates of discontinuation or non-publication of clinical trials for pharmacological treatments for AUD and associated factors? Findings: Among 87 trials, 11 (12.6%) were prematurely terminated and 34 (39.1%) did not reach publication, with trials that included participants 21 years and older more likely to reach publication than those with younger participants. Meaning: Low publication rates of CTs for pharmacological treatments of AUD may (1) stunt the advancement of AUD research, (2) decrease the value in funding AUD research from government entities, and (3) needlessly expose participants to potentially harmful interventions.
Standardizing conductor surface roughness for DC gas-insulated equipment-a careful analysis on local morphology
Authors: Chen Geng , Xu Hao , Xu Yongsheng , Shao Yuming , Wang Cong , Li Chuanyang , Tu Youping
Published: February 2022

The gas ionization inside the gas-insulated electric power equipment increases the gas conduction current and introduces charges to the spacer surface, which results in local electric field enhancement and potentially triggers spacer flashover. In this letter, we demonstrated that micro protrusions in a finely finished conductor surface plays a significant role in inducing local gas ionization, resulting in an increased local gas conduction current. A gas conduction current using conductors with higher surface kurtosis S
ku was found approximately 10 times higher than that using an electrode with a similar S
a but a different machining procedure. The piecewise nonlinear relation between the maximum local field strength and the average roughness was calculated over different kurtosis ranges. A conductor surface roughness evaluation method which combines average height of peak S
pa with extreme probability of deviation from mean height of peak S
pku was put forward.
Retracted: A density functional theory investigation on the Au-decorated zinc oxide nanosheet as a chemical sensor for mesalamine drug detection
Authors: Rajhi Ali A , Alamri Sagr , Ebadi Ghaffar
Published: February 2022

We employed density functional B3LYP to inspect the impact of Au-decoration on a ZnO nanosheet (ZnONS) sensing performance in detection of mesalamine (MSA) drug. The interaction of the pristine ZnONS with the MSA was found to be weak, and the sensing response is about 2.8. Decorating an Au atom into the ZnONS surface increases the adsorption energy (Ead) of MSA from −5.7 to −23.7 kcal/mol. The sensing response significantly rises to 77.3 by Au-decoration. A short recovery time of 18.6 s is found for the MSA desorption from the Au-decorated ZnONS surface at 298 K. The water solvent reduces Ead of MSA to −17.8 kcal mol−1. Thus, it suggests that Au-decorated ZnONS may be highly sensitive MSA sensor with a short recovery time.
X-Ray Fine Structure of a Limb Solar Flare Revealed by Insight-HXMT, RHESSI and Fermi
Authors: Zhang Ping , Wang Wei , Su Yang , Zhang Shuangnan , Song Liming , Lu Fangjun , Zhang Shu
Published: February 2022

We conduct a detailed analysis of an M1.3 limb flare occurring on 2017 July 3, which have the X-ray observations recorded by multiple hard X-ray telescopes, including Hard X-ray Modulation Telescope (Insight-HXMT), Ramaty High Energy Solar Spectroscopic Imager (RHESSI), and the Fermi Gamma-ray Space Telescope (Fermi). Joint analysis has also used the extreme ultraviolet (EUV) imaging data from the Atmospheric Imaging Assembly (AIA) aboard the Solar Dynamic Observatory. The hard X-ray spectral and imaging evolution suggest a lower corona source, and the non-thermal broken power law distribution has a rather low break energy ∼15 keV. The EUV imaging shows a rather stable plasma configuration before the hard X-ray peak phase, and accompanied by a filament eruption during the hard X-ray flare peak phase. Hard X-ray image reconstruction from RHESSI data only shows one foot point source. We also determined the DEM for the peak phase by SDO/AIA data. The integrated EM beyond 10 MK at foot point onset after the peak phase, while the >10 MK source around reconnection site began to fade. The evolution of EM and hard X-ray source supports lower corona plasma heating after non-thermal energy dissipation. The combination of hard X-ray spectra and images during the limb flare provides the understanding on the interchange of non-thermal and thermal energies, and relation between lower corona heating and the upper corona instability.
The Preliminary Statistical Analysis of LAMOST DR8 Low Resolution AFGK Stars
Authors: Chen Y. H. , Li G. W. , Shu H.
Published: February 2022

We download the Large sky Area Multi-Object fiber Spectroscopic Telescope Data Release 8 (LAMOST DR8) low resolution catalog for 6,478,063 AFGK type stars and plot the figures of effective temperature, gravitational acceleration and metal abundance. Some small and medium mass stars are evolved from pre-main sequence or main sequence stage to planetary nebula stage or white dwarf stage by the stellar evolution code MESA. We analyze the observed statistical data and model calculation results, and then obtain some basic conclusions preliminarily. Most red giant and asymptotic giant branch stars with log g less than 0.85 have poor metal abundance. Most hot A type main-sequence stars are metal-rich stars with log g from 3.5 to 4.5. The conclusions are reasonable within a certain error range. The theory of a gap area in the Hertzsprung–Russell diagram for stellar evolutions of medium mass stars is reflected in the statistical plots. The central core hydrogen burning stage and the central core helium burning stage correspond to the peak structures in the statistical plots for gravitational acceleration. The metal abundances among A, F, G and K type stars have a wide distribution. We cannot simply replace the metal abundances of these stars with the metal abundance of the Sun when doing fine research work.
X-ray irradiation measurements of the radiation tolerance of the ITkPixV1 ATLAS pixel readout chip
Authors: Mironova M.
Published: February 2022

The ITkPixV1 chip is the pre-production pixel readout chip for the Phase-2 Upgrade of the ATLAS experiment at the HL-LHC. The harsh environment of HL-LHC, including a peak luminosity of 5 × 1034 cm−1 s−1 and an estimated total ionising dose (TID) of around 1 Grad throughout its lifetime is placing strong requirements on the radiation tolerance of the chip. The radiation tolerance of the ITkPixV1 chip has been tested in irradiation campaigns using X-rays. The digital and analog front-end have been tested up to total doses of 1 Grad (at a dose rate of 4 Mrad/h) and show no significant operational issues.
Strength prediction of seawater sea sand concrete based on artificial neural network in python
Authors: Yu Hailing , Zheng Jianlan , Lin Qiujun
Published: February 2022

Based on the artificial neural network method, the nonlinear mapping between the 28d compressive strength of seawater sea sand concrete and concrete water-cement ratio, cement content, and the sand ratio was established in Python. The results showed that with reasonable network settings, the fitting of the model training was good, and the prediction results were satisfactory. The mean relative error of prediction results was 3.16%, and the correlation coefficient was 0.974. Therefore, it is possible to use an artificial neural network to set up a compressive strength prediction model for seawater sea sand concrete. Compared with the traditional mix design method, the artificial neural network design method can decrease the number of mixing proportion adjustments and reduce the waste of labor, time, and materials.
Development, Monte Carlo simulations and experimental evaluation of a 3D range-modulator for a complex target in scanned proton therapy
Authors: Simeonov Yuri , Weber Uli , Schuy Christoph , Engenhart-Cabillic Rita , Penchev Petar , Flatten Veronika , Zink Klemens
Published: February 2022

The purpose of this work was to develop and manufacture a 3D range-modulator (3D RM) for a complex target contour for scanned proton therapy. The 3D RM is considered to be a viable technique for the very fast dose application in patient-specific tumors with only one fixed energy. The RM was developed based on a tumor from a patient CT and manufactured with high-quality 3D printing techniques with both polymer resin and aluminum. Monte Carlo simulations were utilized to investigate its modulating properties and the resulting dose distribution. Additionally, the simulation results were validated with measurements at the Marburg Ion-Beam Therapy Centre. For this purpose, a previously developed water phantom was used to conduct fast, automated high-resolution dose measurements. The results show a very good agreement between simulations and measurements and indicate that highly homogeneous dose distributions are possible. The delivered dose is conformed to the distal as well as to the proximal edge of the target. The 3D range-modulator concept combines a high degree of dose homogeneity and conformity, comparable to standard IMPT with very short irradiation times, promising clinically applicable dose distributions for lung and/or FLASH treatment, comparable and competitive to those from conventional irradiation techniques.
In-plane resonant excitation of quantum dots in a dual-mode photonic-crystal waveguide with high β-factor
Authors: Zhou Xiaoyan , Lodahl Peter , Midolo Leonardo
Published: February 2022

A high-quality quantum dot (QD) single-photon source is a key resource for quantum information processing. Exciting a QD emitter resonantly can greatly suppress decoherence processes and lead to highly indistinguishable single-photon generation. It has, however, remained a challenge to implement strict resonant excitation in a stable and scalable way, without compromising any of the key specs of the source (efficiency, purity, and indistinguishability). In this work, we propose a novel dual-mode photonic-crystal waveguide that realizes direct in-plane resonant excitation of the embedded QDs. The device relies on a two-mode waveguide design, which allows exploiting one mode for excitation of the QD and the other mode for collecting the emitted single photons with high efficiency. By proper engineering of the photonic bandstructure, we propose a design with single-photon collection efficiency of β > 0.95 together with a single-photon impurity of ϵ < 5 × 10−3 over a broad spectral and spatial range. The device has a compact footprint of

∼
50

μ

m

2

and would enable stable and scalable excitation of multiple emitters for multi-photon quantum applications.
Shuffle & untangle: novel untangle methods for solving the tanglegram layout problem
Authors: Nguyen Nghia , Chawshin Kurdistan , Berg Carl Fredrik , Varagnolo Damiano
Published: February 2022

Motivation

A tanglegram is a plot of two-tree-like diagrams, one facing the other, and having their labels connected by inter-tree edges. These two trees, which could be both phylogenetic trees and dendrograms stemming from hierarchical clusterings, have thus identically labelled leaves but different topologies. As a result, the inter-tree edges of a tanglegram can be intricately tangled and difficult to be analysed and explained by human readers. To better visualize the tanglegram (and thus compare the two dendrograms) one may try to untangle it, i.e. search for that series of flippings of the various branches of the two trees that minimizes the number of crossings among the inter-tree edges. The untanglement problem has received significant interest in the past decade, and several techniques have been proposed to address it. These techniques are computationally efficient but tend to fail at finding the global optimum configuration generating the least tangly tanglegram.

Results

We leverage the existing results to propose untanglement methods that are characterized by an overall slower convergence method than the ones in the literature, but that produce tanglegrams with lower entanglements.

Availability and implementation

One of the algorithms is implemented in Python, and available from https://github.com/schlegelp/tanglegram.
HAMdetector: a Bayesian regression model that integrates information to detect HLA-associated mutations
Authors: Habermann Daniel , Kharimzadeh Hadi , Walker Andreas , Li Yang , Yang Rongge , Kaiser Rolf , Brumme Zabrina L , Timm Jörg , Roggendorf Michael , Hoffmann Daniel
Published: February 2022

Motivation

A key process in anti-viral adaptive immunity is that the human leukocyte antigen (HLA) system presents epitopes as major histocompatibility complex I (MHC I) protein–peptide complexes on cell surfaces and in this way alerts CD8+ cytotoxic T-lymphocytes (CTLs). This pathway exerts strong selection pressure on viruses, favoring viral mutants that escape recognition by the HLA/CTL system. Naturally, such immune escape mutations often emerge in highly variable viruses, e.g. HIV or HBV, as HLA-associated mutations (HAMs), specific to the hosts MHC I proteins. The reliable identification of HAMs is not only important for understanding viral genomes and their evolution, but it also impacts the development of broadly effective anti-viral treatments and vaccines against variable viruses. By their very nature, HAMs are amenable to detection by statistical methods in paired sequence/HLA data. However, HLA alleles are very polymorphic in the human host population which makes the available data relatively sparse and noisy. Under these circumstances, one way to optimize HAM detection is to integrate all relevant information in a coherent model. Bayesian inference offers a principled approach to achieve this.

Results

We present a new Bayesian regression model for the detection of HAMs that integrates a sparsity-inducing prior, epitope predictions and phylogenetic bias assessment, and that yields easily interpretable quantitative information on HAM candidates. The model predicts experimentally confirmed HAMs as having high posterior probabilities, and it performs well in comparison to state-of-the-art models for several datasets from individuals infected with HBV, HDV and HIV.

Availability and implementation

The source code of this software is available at https://github.com/HAMdetector/Escape.jl under a permissive MIT license. The data underlying this article were provided by permission. Data will be shared on request to the corresponding author with permission of the respective co-authors.

Supplementary information

Supplementary data are available at Bioinformatics online.
2 A Systematic Review on Clinical Efficacy and Cost-Effectiveness of Reverse Total Shoulder Arthroplasty or Hemiarthroplasty on Proximal Humeral Fractures
Authors: Zallipalli S.N. , Harish Kumar P. , Bethi R.R. , Kaur V. , Shejale N.
Published: February 2022

Introduction

Proximal humeral fractures (PHF) are one of the most challenging injuries to treat and recover from. Humeral fracture stems have become popular among individuals undergoing arthroplasty because of their superior ability to reduce and repair tuberosities. This study aims to determine better clinical, functional, and radiology outcomes and cost-effectiveness surgical management of PHF and Comparison of these outcomes among the surgical option.

Method

This systematic review includes the literature from the multi-database electronic search, i.e., Medline, PubMed, Embase, and web of science based on PRISMA guideline 2009. The data from the eligible literature meeting the study criteria were extracted and analysed.

Results

Reverse total shoulder arthroplasty (RTSA) provides better patients satisfaction and more improved functional outcomes when compared with shoulder hemiarthroplasty. Taking into consideration of healthcare perspective and payer perspective, RTSA was most cost-effective when compared to a hemiarthroplasty. Our work delivers significant baseline statistics about characteristics related to cost and outcomes of surgical approach for the management of PHF. RTSA can be considered as beneficial management of fracture Of PHF following the encouraging outcome of RTSA.

Conclusions

This systematic review provides favourable short to long-term functional outcomes of RTSA.
4 Cardiovascular Disease in Women with and Without Rheumatoid Arthritis
Authors: Mousa H.
Published: February 2022

Compare the incidence of coronary artery disease (CAD) in women with rheumatoid arthritis (RA) with that in women without RA, adjusting for traditional CAD risk factors (age, smoking, race, diabetes mellitus, hypercholesterolemia, hypertension, physical inactivity, family history, and obesity). A logistic regression analysis is used to control for confounders and other variables. To compare the incidence of coronary artery disease (CAD) in women with rheumatoid arthritis (RA) with that in women without RA, adjusting for traditional CAD risk factors (age, smoking, race, diabetes mellitus, hypercholesterolemia, hypertension, physical inactivity, family history, and obesity). A logistic regression analysis will be used to control for confounders and other variables. Data analysis is limited to all women who participated in the 2010 survey and of the 7844 who completed the 2010 Women's Health Survey, 7338 (93.5%) participants did not have rheumatoid arthritis, 310 (3.9%) have rheumatoid arthritis, and 196 (2.4%) were missing. Incidence rate of CAD is measured in both groups. Data analysis will be limited to all women who participated in the 2010 survey and of the 7844 who completed the 2010 Women's Health Survey, 7338 (93.5%) participants did not have rheumatoid arthritis, 310 (3.9%) have rheumatoid arthritis, and 196 (2.4%) were missing
6 Evaluation of Surgical Transfers Within the Neonatal Intensive Care Unit
Authors: Lee L.
Published: February 2022

Aim

To assess the outcomes of neonates born between 1st March 2013–7th July 2021 transferred out of the NICU at the RUH Bath for surgical investigation. To also undertake a study of neonates transferred with suspected necrotising enterocolitis looking at types of treatment received and long-term health outcomes.

Method

A retrospective search was undertaken evaluating records on the BadgerNet UK neonatal database. Outcomes following surgical diagnosis were then evaluated using Millennium, looking at discharge summaries, clinic notes and subsequent hospital admissions.

Results

93 neonates were identified as being transferred out for surgical investigation. 58% of patients were male (n = 54) and 42% female (n = 39). 70 were found to have at least one surgical diagnosis, with 80 surgical diagnoses identified. 60% were diagnosed with a congenital condition (n = 42). Overall mortality rate was 7.45%. 29 neonates were transferred out with suspected necrotising enterocolitis, 62% male (n = 18) and 38% female (n = 11). Average age at time of surgical transfer was 22 days. 48.3% were confirmed to have NEC (n = 14), 24% given an alternative diagnosis (n = 7) and 27.6% found to have normal investigation findings (n = 8). Average gestation of neonates with confirmed NEC was 30+0 weeks, average birthweight 1368g (3lb).

Conclusions

There are a broad range of surgical conditions amongst infants during the neonatal period, many associated with high levels of morbidity and mortality if left untreated. It is important to identify suspected surgical conditions as soon as possible through thorough assessment and multi-disciplinary team management amongst neonatologists, paediatricians, surgeons, and transfer teams; this ensures good prognostic outcomes.
8 Improving Management for Acute Cholecystitis and Biliary Pancreatitis – the ‘Hot Gallbladder Pathway’
Authors: Abdelsaid K. , Kam C.T. , Jayasankar B. , Balasubramaniam D. , Abdulaal Y.
Published: February 2022

Aim

There is a wide variation between National Health Service (NHS) hospitals in the management of patients with acute cholecystitis and biliary pancreatitis. 20–33% of patients will make repeat visits to hospital with gallstone-related symptoms before any surgical intervention performed. We established a ‘Hot Gallbladder Pathway’ with the aim for improving outcome and decreasing complications of these patients. The aim of this quality improvement project was to assess if a district general hospital (DGH) could provide a safe and effective ‘hot gallbladder’ service with a clear pathway.

Method

Quality improvement methods were used to integrate the ‘hot gallbladder pathway’ to manage patients with acute calculous cholecystitis and biliary pancreatitis. A prospective observational study with strict inclusion/ exclusion criteria and secure online data was conducted during a 13-month period. The data were then compared against existing National Institute for Health and Clinical Excellence (NICE) guidelines and further changes were recommended.

Results

We achieved almost 70% of the patients undergoing emergency laparoscopic cholecystectomy in both group of patients who met the pathway criteria within the expected time frame, compared with the pre-implementation result of 23% and national average of only 16% in England. None of the patients suffered from intraoperative complications or 30-day mortality.

Conclusions

A clear ‘hot gall bladder pathway’ is effective at improving care for patients requiring emergency laparoscopic cholecystectomy and potentially useful for other acute Trusts which their standard is below the NICE guideline.
11 Robotic Left Lower Sleeve Lobectomy with Bronchoplasty for the Removal of a Carcinoid Tumour
Authors: Tan G. , Dunning J.
Published: February 2022

Lung carcinoid tumours constitute approximately 1–2% of all pulmonary tumours. They are derived from enterochromaffin cells, which are also known as ‘Kulchitsky cells' and generally have indolent growth and development patterns. Carcinoid tumours are categorized as typical or atypical, depending on the number of mitoses per high power field and the presence of necrosis. In terms of management, surgical resection has been recognized to be the standard treatment for pulmonary carcinoid tumours. To our knowledge, the da Vinci system and robotic surgery have not been applied in sleeve lobectomies and bronchoplasty for the removal of carcinoid tumours in the United Kingdom. Therefore, we present a case of a sleeve lobectomy with bronchoplasty procedure for the removal of a carcinoid tumour located in the left lower lobe of the patient. The bronchus was repaired using a V-lock suture & Prolene sutures with the surgery performed using the da Vinci robotic surgical system.
13 Risk Documentation in Consent Form of Open Inguinal Hernia Repair
Authors: Hassan M.
Published: February 2022

Introduction

Inguinal hernia repair is amongst the most commonly performed general surgical operations. The high case load of groin repair in our hospital has the potential to have high risk of medical legal complications. The importance of discussing these potential complications with patients, allowing them to make informed decisions about their care, and clearly documenting them during the consent process, is clear.

Aim

We aimed to assess the quality and consistency of consent forms for open inguinal hernia repairs with emphasis on the risks being documented.

Objectives

Measure the compliance of Trust consent forms with (RCS) and British Hernia Society (BHS) 2016 guidelines and European Hernia Society (EHS) International guidelines for Groin Hernia Management (2019).

Method

Retrospective consent form analysis was carried out for all (38) open inguinal hernia repairs done during July-September 2020. The documentation of 13 pre-determined risks, was analysed, some specific to open inguinal hernia repairs, others general surgical complications.

Results

A total of 38 Trust consent forms were audited. Infection (100%) and bleeding (95%) were the most commonly documented risks. The documentation of chronic infection/abscess formation (5%), numbness (60%), testicular atrophy (31%) and scarring (34%) all increased compared to the two previous audit phases, the latter two significantly so. Unfortunately, many of the risks audited (8/13) showed a decrease in compliance with documentation with only two of the examined risks meeting the standard or ‘partially’ meeting it. Notably, recurrence and damage to other structures documentation dropped by over 10% (17% drop and 31% drop, respectively).
14 NICE CG188; Hot Gall Bladder Pathway in Emergency General Surgery - Are We Following the Guidelines?
Authors: Abdelsaid K.
Published: February 2022

Aim

1 - To compare the current standard of practice to existing guidelines and to make appropriate changes. 2 - To set a clear pathway for referring patients to the ‘hot laparoscopic cholecystectomy’ pathway. 3 - Avoid inappropriate booking for laparoscopic Cholecystectomy for patients who are not fulfilling the criteria of Hot Gall Bladder Pathway. 4 - Avoid unnecessary delay in performing Laparoscopic Cholecystectomy in patient with Acute Cholecystitis and mild Biliary Pancreatitis.

Method

It was a retrospective audit of all the patients who underwent Laparoscopic Cholecystectomy through Hot Gall Bladder Pathway between 1st February 2019 to 1st March 2020.

We screened a total of 134 patients who had been included in this pathway, 36 patient excluded.

1- Acute cholecystitis with no associated organ dysfunction 63 patients

2- Mild Acute Biliary Pancreatitis 35 patients

Results

Mild Acute Biliary Pancreatitis who underwent Laparoscopic Cholecystectomy within index admission or within 2 weeks of diagnosis 69 % (25/35).

Acute cholecystitis with no associated organ dysfunction (mild or moderate; Tokyo guideline grade I or II) who underwent Laparoscopic Cholecystectomy within week of diagnosis 68.2 % (43/63).

Conclusions
20 Incidence of Acute Kidney Injury in Neck of Femur Fracture Patients During the COVID-19 Pandemic in Princess Royal Hospital, Telford
Authors: Alaguraja P. , Younas W. , Mabeza T. , Makam A. , Khaleeq T. , Reading J.
Published: February 2022

Aim

Patients undergoing surgical repair of neck-of-femur (NOF) fractures are at higher risk of acute kidney injury (AKI). NICE and BOAST have published guidelines to help prevent the occurrence of AKI, including adequate fluid resuscitation pre- and post-operatively. An audit was conducted during the COVID-19 pandemic to explore whether the department was adhering to NICE guidelines.

Method

AKI was defined, as per NICE Clinical Knowledge Summaries, as an increase in serum creatinine levels by 26 µmol/L or greater. Data was collected prospectively starting from December 2020 to February 2021 in the Princess Royal Hospital during the COVID-19 pandemic. All patients with NOFs were included and data on sex, age, comorbidities, and type of surgery were collected.

Results

In total, 32 patients were included in the audit with an average age of 82 years; of these, eleven patients had dynamic hip screws and eighteen patients had hemiarthroplasties. Five patients had chronic kidney disease, six patients had previous myocardial infarctions and thirteen patients had hypertension. Two patients (6.3%) were found to have an AKI post-surgery with increased creatinine levels of 27 and 28 µmol/L. Both had hypertension and underwent hemiarthroplasties.

Conclusions

Complications such as AKIs are reversible and preventable. Especially during the COVID-19 pandemic such complications can increase morbidity and mortality of patients suffering from NOF leading to longer hospital stays. The low rate of AKI following NOF repair in our Department of Trauma and Orthopaedic is attributable to adherence to NICE and BOAST fluid resuscitation guidelines.
22 Lessons Learned During COVID-19 Pandemic, a Worldwide Survey: Part 1 -Evolution of Global Neurosurgical Practice
Authors: Garg K. , Deora H. , Wellington J. , Tandon V. , Mishra S.
Published: February 2022

Aim

During the COVID-19 pandemic, many surveys have analysed the impact of the virus spreading on everyday medical practice, including neurosurgery. However, no one has examined the perceptions of neurosurgeons towards the pandemic, their life changes, and the strategies they implemented to deal with their patients in such a difficult time.

Method

From April 2021 to May 2021, a modified Delphi method was used to construct, pilot, and refine the questionnaire. The first part focused on the evolution of global neurosurgical practice during the pandemic. This survey was distributed worldwide among 1000 neurosurgeons. The responses were then collected and critically analysed.

Results

Outpatient department practices changed with a rapid rise in teleservices. 63.9% of respondents reported that they had changed their OT practices to emergency cases with occasional elective cases. 40.0% of respondents and 47.9% of their family members reported having suffered from COVID-19 at some time. 56.2% of the respondents reported having felt depressed in the last 1 year. 80.6% of the respondents found online webinars to be a good source of learning. 47.8% of respondents tried to improve their neurosurgical knowledge, while 31.6% spent extra time in research activities during the COVID-19 pandemic.

Conclusions

Progressive increase in operative waiting lists, preferential use of telemedicine, reduction in the tendency to complete stoppage of physical clinic services and reduction in the administration and application of PPE kits were evident across the world. Respondents’ age impacted how the clinical services and impacted mental health across the global neurosurgical fraternity.
24 Mediastinal Ectopic Parathyroid Adenoma Causing Malignant Hypercalcaemia in a Young Female - a Case Report and Review of Literature
Authors: Bell A. , Razzaq Z. , Mustafa H. , Redmond H.P.
Published: February 2022

Ectopic parathyroid tissue can pose difficulties in diagnosis and management of patients with hyperparathyroidism. Due to the embryological origins of the inferior parathyroid glands from the 3rd pharyngeal arch where they develop with the thymus; they can have variable anatomical locations, including the anterior mediastinum. While the incidence of ectopic parathyroid glands varies in the literature mediastinal parathyroid tissue is extremely rare. This anatomical variation has important diagnostic and surgical ramifications for patients and is an important topic for trainees in medical endocrinology, endocrine surgery, and cardiothoracic surgery to be aware of.

We present the case of a 22-year-old woman who presented as an emergency with severe hypercalcaemia. Who was subsequently found to have an ectopic mediastinal parathyroid adenoma. She underwent surgery within days of her initial presentation providing her with an immediate cure and restoring her calcium homeostasis. Despite diagnostic and operative challenges, combined care from our endocrine and cardio-thoracic surgical teams ensured an uneventful post-operative recovery for this patient.
33 ECGs in the Surgical Patient - a Review of Practice
Authors: Siva S. , Basu S.
Published: February 2022

Aim

To Identify if baseline admission ECGs are performed for all emergency surgical patients over the age of 50 being admitted directly to General Surgery from the community. Aim to have 100% of patients >50 years to have admission ECGs.

Method

We undertook a retrospective audit analysing the following parameters:

** This Hospital offers an in-hours (0900-1630, weekdays) ECG service via the cardiac physiology department.

We Conducted 3 cycles of 1 month duration each to assess findings.

Interventions:

Results

Cycle 1–50% (8/16) patients had admission ECGs. 50% (8/16) within 2 hours.

Cycle 2–54% (12/21) patients had admission ECGs. 43% (9/21) within 2 hours.

Cycle 3–71% (17/24) patients had admission ECGs. 62% (15/24) within 2 hours.

Conclusions

We noted improvement in admission ECGs through our interventions. Reminder emails were deemed useful. Barriers identified in After-hours ECGs being done on time due to clinical priorities. We identified a potential role for ECG-trained health-care professionals. 0900–1630 ECG service deemed valuable to admitting doctors. ECG machines were reviewed and found satisfactory. Possible delays in treatment could not be analysed with data collected. Hence, there is further scope to look into outcomes of delayed/missed ECGs e.g., delayed surgery / missed or alternative diagnosis.
37 Risk Documentation in the Laparoscopic Cholecystectomy Consent Form
Authors: Hassan M. , Riad M.
Published: February 2022

Background

Laparoscopic cholecystectomy is one of the most common elective operations performed with a significant risk of complications. GMC guidance on consent clearly emphasises the process of informed consent and shared decision making. Failure to warn patients of a significant complication can lead to potential medico-legal implications. The effectiveness of the consent process is evidenced in fully completed consent form.

Aim

We aim to access the quality of the consent forms for Laparoscopic cholecystectomy at our institution with emphasis on the documented risks.

Objectives

Re-audit of quality of records of consent form documentation over one month period for laparoscopic cholecystectomy. To measure the compliance of Trust consent forms with GMC guidelines.

Method

Consent forms for all elective laparoscopic cholecystectomy procedures done between July and September 2020 were obtained and retrospectively analysed. The data was collected specifically from the consent forms. A total of 39 consent forms were audited.

Results

A total of 39 consent forms were audited. The majority of the consenting was done by registrars. As with the first phase, bleeding (100%), CBD injury (97.4%), bile leak (69.2%), infection (100%), damage to local structures (79.5%), VTE (94.9%) remained well documented in the written consent. Open conversion was present on 97.4% consent forms.

8 out of 16 risks audited showed a increase in compliance whereas 8 showed an decrease compared to the previous round of the audit phase. In particular, scarring, retained stones, pancreatitis, respiratory complications, diarrhoea, and cardiac complications showed a particularly low rate.

Conclusions

Risk documentation on the consent forms remains quite varied. Education combined with a standardised consent form and patient information leaflet will improve the overall quality of consent forms.
38 Virtual Trauma Meeting-the Game Changer During COVID 19 Era. A Quantitative Comparative Analysis
Authors: Elerian S. , El Tagy H. , Munuswamy S. , Singh T. , De C.
Published: February 2022

Introduction

In an orthopaedic department, majority of plans and decision-making cases occur at the daily trauma meeting. With the advent of COVID-19 pandemic, it was challenging to deliver the standard care maintaining social distancing guidelines. Therefore, virtual trauma handover replaced the traditional face-to-face handover as a standalone solution. This study has tried to report on effectivity of the new virtual trauma handover process.

Method

This single centre observational study compared retrospectively collected data during pre-COVID-19 period (2019) and prospectively followed data from virtual trauma meetings during COVID 19 pandemic. The study analysed comparison of meeting start and finish time, attendance of key members, punctuality of attendees and interruptions during the handover process.

Results

Changing from face-to-face to virtual trauma meetings, average participation doubled from 9 to 18 with increased consultant attendance (Mean: 7.5 vs 2) -statistically significant (p < 0.05). Enhanced senior clinician participation helped in multidisciplinary decision making promptly. Punctuality of attendance noted as declining late arrivals in 28/34 face-to-face to 4/34 virtual meetings. Although meetings start-time remained similar overall, there was less interruptions during virtual handover and mean meeting span reduced by 13 minutes.

Conclusions

As part of adaptive changes during COVID-19 pandemic, virtual trauma handover meetings have introduced changes in delivery of existing acute trauma services. Within very few limitations, it could be an aid to improve clinician participation, easiness of having multidisciplinary opinion and decision making. Moreover, it helped to practice social distancing guidelines. Educational activities are also effectively managed through virtual meetings.
42 The Accuracy of the Multi-Slice Detector CT scan (MDCT) in Staging Borderline Respectable Periampullary Carcinoma
Authors: Issa M. , Noureldin K. , Jones L.
Published: February 2022

Aim

Assess MDCT accuracy in staging cancers periampullary cancers.

Method

Periampullary malignancies are highly aggressive with poor outcomes. Surgery is the only curative option. It is crucial to define the patients who can advantage from a Whipple’s resection and who can avoid. RCT investigated randomly 28 patients over 15 months. The patients were sub-divided into 2 groups. Group A, we relied mainly on the MDCT for preoperative staging, while in Group B staging laparoscopy was added before the abdominal exploration. Sensitivity of the MDCT and its accuracy were 100% in defining the signs of irresectability. For borderline staging, the accuracy of the scan was 62.5% and 71%, in groups A and B. The Overall accuracy of MDCT was 75%. It decreased to 68.1% for borderline lesions. The addition of staging laparoscopy to the diagnostic work up, increased the accuracy to 92.5%. The camera test was able to see occult findings which were missed in the images. Liver Mets and malignant peritoneal fluid were localized in 18% and 9% respectively. 3 cases in group A and one in group B underwent unnecessary laparotomy. Thus, the false negative incidences were 21% and 7% in group A and B, with overall incidence 14.2%.

Conclusion

MDCT is highly sensitive and specific with high stage periampullary cancers. These parameters drop in border tumours with reduced accuracy in detecting the degree of vascular abutment and distant-occult findings. Addition of other adjuncts to decrease the rate of un-indicated laparotomy.
47 Patient and Physician Positioning During Anterior Skull Base Surgery Impacts Physician Ergonomics
Authors: Maniam P. , Lucocq J. , Gohil R. , Lewis-Morgan G. , Rokade A.
Published: February 2022

Aim

The effects of anterior skull base surgery on surgeon’s ergonomics remain unclear and this study explore the impact of patient, surgeon, and screen positioning on surgeon’s ergonomics during the surgery.

Method

A total of 20 different surgical positions involving the operating surgeon, assisting surgeon, patient head position, camera position and screen position/number were simulated. For each position, the ergonomic effects on the upper limb, neck, trunk, and lower limb of surgeons were analysed using the Rapid Upper Limb Assessment (RULA) tool.

Results

The majority of scores ranged from 2 to 3 suggesting the majority of positions have acceptable postures. The average RULA score of the right side of operating surgeon was 2.8 versus 2.95 on the left-side (p = 0.297). For the assisting surgeon, the average RULA score of the right side was 3.65 versus 3.25 for the left side (p = 0.053). The average combined (left and right) RULA score for the operating surgeon was 5.76 versus 6.9 for the assisting surgeon (p<0.001). Position 17 (operating surgeon to the right of patient, assisting surgeon to the left of patient, central patient head position and two screens) is the most ergonomically favourable position. Position 2 (operating and assisting surgeon to the right of patient, patient head position to the right and one screen position to the left of patient) is the least favourable position.

Conclusions

This simulation raises awareness of risk of musculoskeletal injury in anterior skull base surgery and highlights those certain positional behaviours are better for reducing injury risk than others.
48 Consenting Surgical Patients for the Risk Associated with Contracting COVID-19 During Their Stay at the Hospital
Authors: Al Aaraj M. , Abdeen B. , Alkilani Y. , Kaul S. , Yang Y.H. , Wain M.
Published: February 2022

Aim

Literature is suggesting significant perioperative mortality and morbidity associated with COVID-19. Therefore, the Royal College of Surgeons (RCS) has produced guidance detailing additional considerations in consenting for surgery whilst COVID-19 is prevalent within society. Section 3A of this document emphasizes the need to discuss the risk of contracting COVID-19 while patients are in hospital. We conducted a multi-cycle closed-loop audit to examine the adherence to this guidance.

Method

We completed four audit cycles, each comprising data collection and educational intervention to disseminate the guidance. Data was obtained from consent forms for patients who had consented to both emergency and elective surgery over a two-month period at a large NHS Trust in London. The intervention consisted of teaching sessions, regular emails to the general surgical department, and posters displayed in common areas.

Results

Consent forms from 139 patients were reviewed over the four cycles (n = 38, 41, 28, and 32). The proportion of patients consented for the risk of contracting COVID-19 during the perioperative period rose serially between the cycles (37%, 61%, 71%, and 85% respectively), and was significantly increased between the first and last cycle (p < 0.01, two-sided Z-test). The interventions proved most effective for senior house officers who improved from consenting 8% initially to 100% on completion of the audit.

Conclusions

We demonstrate the marked effectiveness of simple interventions combined with serial auditing to disseminate this message. The same practice may help improve consenting practice at other centres whilst COVID-19 is prevalent in society.