bluuebunny/crossref_metadata_2025 huggingface dataset:
Photography in Uruguay (1840–1985)
Authors: Broquetas Magdalena
Published: August 2023

Photography arrived in Uruguay in February 1840, a few months after the invention of the daguerreotype was publicly announced in Paris. Throughout the 19th century it was used for multiple purposes, in various historical contexts, and in different activities. In its initial stage, until the 1920s, photography was used for commercial portraits and was used by the state to create a national identity, reinforce patriotic sentiment, and monitor and control the population.

In the 20th century, the artistic movements that brought together amateurs in photography clubs became better known. At the same time, the expansion of at-home photography brought with it an increase in the number of camera users and significant changes in compositional styles, as well as in social perceptions of photography as a means for memory and identity construction. Concurrently, photography found its way onto the pages of the leading newspapers, supplements, and illustrated magazines that from 1930 until the late 1970s were the main source of information and entertainment for most Uruguayans. Throughout this period, photojournalism influenced the formation of public opinion and the preservation of the political and social order.
The Puerto Rican Nationalist Party
Authors: Power Margaret
Published: August 2023

From the early 1920s through the mid-1950s the Partido Nacionalista Puertorriqueño (PNPR; Puerto Rican Nationalist Party) led the fight for an independent Puerto Rico. The PNPR began in 1922, when a group of middle-class men broke with the Partido Unión (Union Party) after it removed independence from its platform. During the 1920s the PNPR sought to defend Puerto Rican culture, advance its goal of achieving national sovereignty, and, simultaneously, maintain friendly relations with the United States.

The PNPR promoted Puerto Rico’s reinsertion into Latin America. Puerto Rico shared a history, language, faith (Catholicism), and culture with the former Spanish colonies throughout the Americas. By emphasizing these similarities, the Nationalists hoped to encourage Puerto Ricans’ embrace of their Hispanic heritage and rejection of US rule. The Nationalists also understood that Puerto Rico needed the support of its “sister republics” across the Americas. To generate solidarity with their goals, the PNPR sent the party’s vice president, Pedro Albizu Campos, on a tour of Latin America from 1927 to 1930.

In 1930 the PNPR elected Albizu Campos as its president. Under his leadership, the party adopted a more confrontational stance toward Washington. It also worked to broaden its base by forming various organizations for young men and women. The PNPR succeeded in attracting members from multiple classes, genders, and races. The party also established branches in New York City, the site of the largest diasporic Puerto Rican community in the United States.

Public support of the Nationalist Party was highest during the 1930s, when soaring unemployment, low pay, and increased poverty caused by the Depression heightened many Puerto Ricans’ disappointment with US rule. Growing dissatisfaction with US colonialism and approval of the Nationalists convinced the US government to increase repressive measures against the pro-independence party. In 1937, Puerto Rican police, acting under the orders of the US-appointed governor, fired on peaceful Nationalist Party marchers, killing nineteen and wounding close to two hundred. The US government also imprisoned Nationalist Party leaders in the Atlanta Federal Penitentiary between 1937 and 1943.

During the 1940s and 1950s, support for the Nationalists declined. Luis Muñoz Marín, leader of the Popular Democratic Party, worked with the US government to ostensibly end US colonial rule in Puerto Rico through the archipelago’s transition to the status of Free Associated State. To alert the world that Puerto Rico remained a US colony, the PNPR launched an unsuccessful insurrection in Puerto Rico in 1950 and attempted to assassinate President Truman in Washington, DC. In 1954, four Nationalists attacked the US Congress to denounce US colonialism in Puerto Rico once again. Although the party still exists today, its adherents and influence are a shadow of what they were.
Object-Fronting in Archaic Chinese
Authors: Pan Victor Junnan , Jiao Yihe
Published: August 2023

The SOV order is very productive in Archaic Chinese. Most scholars believe that Archaic Chinese has SVO as basic word order and that SOV is derived by fronting the direct object from the postverbal position to a preverbal position. The most frequent cases involving object fronting in Archaic Chinese are those with pronominal objects. For instance, when the direct object is an interrogative pronoun, a demonstrative, or an ordinary personal pronoun appearing in a negative sentence, it is usually fronted to a preverbal position. Historically, object fronting has already been observed in oracle bone script, and gradually disappeared in the Han dynasty (202 bce–220 ce). After the Wei and Jin dynasties (220–420 ce), object fronting was extremely rare, and it only occurred in fixed expressions, which even stay in Modern Chinese in the early 21st century. Object fronting in Archaic Chinese can be roughly classified into two categories: unmarked object fronting and marked object fronting. The former category includes cases in which the object is positioned in a preverbal position or a pre-prepositional position without any morphosyntactic marking devices, while the latter category includes cases in which the fronted object can be either preceded or followed by some morphosyntactic markers. For instance, a fronted object can be followed by shì (是) or zhī (之), both of which are the most frequent markers co-occurring with a fronted object in Archaic Chinese. Given that both zhī (之) and shì (是) were used as pronouns and demonstratives in Archaic Chinese, when they appear in sentences involving object fronting, some scholars treat them as resumptive pronouns referring to the object NP. Due to the presence of the resumptive pronoun, object NP is allowed to be fronted in a preverbal position. In fact, there is no fixed position as a landing site for fronted objects in Archaic Chinese; instead, different preverbal positions exist. Fronted objects can be followed by functional elements of different categories: negative elements such as bù (不), wèi (未), mò (莫), and wú (无); ordinary adverbs such as qián (前) ‘before’ and jūn (均) ‘all’; modal verbs such as néng (能) ‘be able to’, dé (得) ‘be able to’, gǎn (敢) ‘dare’, and kěn (肯) ‘be willing to’; control verbs such as rěn (忍) ‘bear’ and zhī (知) ‘know’; conjunctions such as yì (亦) ‘and’, yòu (又) ‘and, as well as’, and shàng (尚) ‘yet’; and modal adverbs such as qí (其) indicating a rhetorical meaning, jiāng (将) ‘will, would’ and qiě (且) ‘will, would’. Object fronting in Archaic Chinese is closely linked to information structure. For instance, when the focalized element in a negative sentence is the direct object, then such an object will be fronted.
Critical Applied Linguistics
Authors: Pennycook Alastair
Published: August 2023

Critical applied linguistics is a field of inquiry and practice that connects questions of power and inequality—domination (constraining possibilities), disparity (inequitable access), discrimination (ideological exclusion), difference (cultural distinction), and desire (social preference)—to applied linguistic concerns. It brings together common applied linguistic interests such as classroom utterances, translations, conversations, genres, second-language acquisition, and media texts with critical sociological engagement with ideology, neoliberalism, colonialism, gender, racism, sexuality, and so on. While critical applied linguistics may therefore suggest certain domains of inquiry—language and migration, workplace discrimination, anti-racist education, and language revival, for example—it also insists that all domains of applied linguistics—classroom analysis, language testing, sign language interpreting, and language and the law—need to take into account the inequitable operations of the social world, and to have the theoretical and practical tools to do so effectively. Critical applied linguistics can also be understood as the intersection of a range of related critical projects, from critical pedagogy, critical literacies, and critical discourse analysis to critical approaches to language policy, critical language testing, and critical language awareness. As a domain of applied work, critical applied linguistics seeks not just to describe but also to change inequality through forms of research, pedagogy, and activism.
History of the Italian Lexicon
Authors: D’Achille Paolo
Published: August 2023

The basis of the Italian lexicon is primarily Latin, with substrate features already existing in the languages spoken before the diverse population on the peninsula was Latinized, prior to the gradual conquest by the Romans, and with terms borrowed from Greek. In addition to the lexemes continued directly from Latin, Italian also shows a Germanic superstrate (Gothic, Lombard, Frankish) and an Arabic adstrate; many Germanisms, Arabisms and Hellenisms were borrowed in the Middle Ages. These were almost always in an adapted form, before the vernacular was given any recognition, and today form part of the “core vocabulary.” The Italian lexicon has also been supplemented by new learned Latin borrowings, exogenous lexemes, borrowings from the other languages with which Italian has been in contact, either directly or indirectly, and dialects (linguistic systems which developed independently of Tuscan/Florentine-based Italian). Similarly, there have been endogenous developments, mainly neologisms.

As mentioned, the vocabulary of Latin origin can be divided into two categories. The first one includes the “inherited” vocabulary, that is words that Italian (like all other Romance languages and dialects) inherited from Latin directly through continued verbal use. Although their number is relatively limited, they have been attested for the longest period and make up the majority of the “core vocabulary.” The second category includes Latinisms, which entered the language through learned written use, from the earliest stages of the language right up to the early 21st century. As most of these were also adapted in the process, they cannot always be clearly distinguished formally from lexemes inherited through popular use. The influx of such forms is to some extent still ongoing. In some cases, in particular in the modern and contemporary eras, it has occurred via other languages, primarily French and English.

Among the exogenous elements, that is borrowings, particularly noteworthy are the Gallicisms, Iberianisms, and Anglicisms, which entered Italian in the modern and contemporary era and were gradually integrated into the Italian lexicon (at least in writing) with adaptation by this stage no longer taking place (it was normal in earlier stages of the language). Calques remain frequent. Another remarkable phenomenon is internal loans or dialecticisms, that is lexemes once restricted to certain dialect areas or regions and that now form part of the common lexicon.

Endogenous processes are represented primarily by the creation of neologisms, that is lexemes created within Italian via the normal means of word-formation (principally derivation and compounding). But attention should also be paid to semantic change: many terms already in use have developed new meanings, in some cases additional to the original meanings, and in other cases replacing them.
Phonetics of Emotion
Authors: Xu Yi
Published: August 2023

The phonetics of emotion is about the acoustic-phonetic properties of the emotional facets of human vocalization. Conventionally, these properties are studied as correlates of a person’s internal states arising from reactions to the environment, where the internal states are defined by influential psychological theories of emotion. A more recent perspective, however, views emotion as an evolved mechanism for motivating actions to proactively interact with other individuals, including, in particular, the production of emotional expressions. From this perspective, the acoustic properties of emotional vocalization are devised to actively influence the listeners in ways that may benefit the vocalizer. Interestingly, the meanings of these acoustic properties could be interpreted with knowledge of speech acoustics accumulated over the years. A key encoding mechanism is body size projection, whereby vocal properties associated with emotions like anger make the vocalizer sound large to dominate the listener, while properties associated with emotions like joy make the vocalizer sound small to appease the listener. Body size projection is encoded through three acoustic dimensions—pitch, voice quality, and formant dispersion. Furthermore, body size projection is likely accompanied by additional iconic encoding mechanisms also aimed at influencing the listener in specific ways. The acoustic properties associated with these mechanisms are not yet fully clear. Further exploration of the body size projection principle and identification of additional mechanisms may drive much of the research activity in the coming decades.
Degree Expressions in Chinese
Authors: Zhang Linmin
Published: August 2023

Degree expressions in natural language reflect how human cognition performs abstract tasks like taking measurements (i.e., mapping items to degrees on a certain scale) and conducting comparisons between measurements. There is a great variation on how different languages encode notions like degrees and scales and operate comparison, inspiring ongoing theoretical development in degree semantics. This article presents major empirical data on degree expressions in Mandarin Chinese and surveys current research on Chinese-specific phenomena.

Compared to well-known English phenomena, Chinese gradable predicates like 高gāo ‘tall, high’ seem rather syntactic-category-fluid, and due to the lack of comparative morphemes, their interpretation can be ambiguous between a comparative use and a positive/measurement interpretation. Typical degree expressions in Chinese, including the positive use, comparatives, equatives, and measurement constructions, demonstrate patterns different from those in English. Moreover, not only adjective-like words such as 高gāo ‘tall, high’, but also property nouns (e.g., 魅力mèi-lì ‘charm’, 钱qián ‘money’) and mental verbs (e.g., 喜欢xǐ-huān ‘like’) have gradable meanings and can be used to form degree expressions.

With regard to these empirical phenomena, this article focuses on the following fundamental research questions in the literature: (a) The encoding of comparison: In a language lacking comparative morphemes, how is the distinction established between the positive and the comparative interpretation? (b) Compositional derivation: How are Chinese comparatives distinct from well-studied English clausal comparatives? (c) Ontology of degrees: How do various Chinese degree expressions reveal the underlying ontological assumptions of scales and degrees?

Even though many of the research questions are still hotly debated in the existing literature, research on Chinese empirical data already brings profound implications for theoretical development of degree semantics. In particular, this article suggests a new look at variations between languages with versus without overt comparative morphemes (e.g., English -er) and invites more research on the pragmatics involved in cross-linguistic degree expressions.
Mental Health: Adolescents
Authors: LeCroy Craig Winston
Published: August 2023

Health care practitioners frequently ignore mental health problems in teens. Adolescents’ daily functioning may be hampered as they mature and are exposed to more dangerous settings. The common behavioral and mental health issues that teenagers face is critical to understanding how to best offer prevention and intervention services. Teenage mental health treatment often focuses on developing functional abilities and identifying models of care that can lessen dysfunctional symptomatology. The latest approaches to treating and preventing teenage mental health issues are presented. The mental health field has placed increased focus on implementing evidence-based treatments. In addition to treatment models, numerous additional elements must be taken into account while developing or implementing treatment.
Should we all die asleep? The problem of the normalization of palliative sedation
Authors: van Delden Johannes J M , Heijltjes Madelon T , Harwood Rowan H
Published: August 2023

Palliative sedation is a medical intervention to manage distress in dying patients, by reducing consciousness when symptom-directed therapies fail. Continuous deep sedation is ethically sensitive because it may shorten life and completely prevents communication. But sedation short of this is also common. There has been a steady increase in the use of sedation over recent decades. Sedation may have become a means to die while sleeping, rather than a method of last resort to alleviate suffering. Sedation may be requested or expected by patients, families or staff. The need for sedation may be being interpreted more loosely. The acceptance of a ‘tolerable amount of discomfort’ may have lost ground to a desire to get the final phase over with quickly. Sedation is not always a bad thing. Medical care is otherwise unable to completely control all distressing symptoms in every patient. Sedation may result from other necessary symptom control drugs. Dying when sedated can be seen by as ‘peaceful’. We feel it is necessary, however, to highlight three caveats: the need to manage expectations, the cost in terms of loss of communication, and the grey area between continuous deep sedation and euthanasia. We conclude that there may be good grounds for sedation in palliative care, and in some cases, continuous deep sedation may be used as a last resort. But the criteria of necessary and proportionate drug treatment should remain. The normalisation of sedation into dying while sleeping should be resisted.
RibDif2: expanding amplicon analysis to full genomes
Authors: Murphy Robert , Strube Mikael Lenz
Published: August 2023

Motivation

As previously described, amplicon analysis of the bacterial 16S gene has several limitations owing to fundamental characteristics of both the 16S gene and technological restrictions. Previously, RibDif was introduced to help quantify these limitations by detailed analysis of a given genera and the 16S gene profile of its members, notably multiplicity and divergence of 16S alleles within genomes as well as shared alleles between species. Apart from using amplicon analysis for only the 16S gene, amplicons derived from genus-specific genes or even functional genes are increasingly being utilized. Moreover, long-read technologies are progressively being used to sequence longer amplicons, and since these inherently contain more information, they may likely alleviate the issues proposed in RibDif.

Results

Taking these phenomena into account, we here propose RibDif2. RibDif2 retains the 16S-optimized functionality of the original RibDif but can now run any set of primers on any part of the genome in any set of organisms, be it prokaryote, eukaryote, or archaea. We demonstrate this new functionality by showing full species resolution of Pseudoalteromonas using complete rRNA-operon amplicons, as well as selection of optimally discriminatory primers for Staphylococcus and Pseudomonas. Moreover, we show a potential bias toward terrestrial bacteria relative to marine ones for primers amplifying biosynthetic gene clusters and lastly suggest optimal primers to differentiate the members of the insect genus Drosophila. We believe that RibDif2 will facilitate the work of all scientists using amplicon sequencing, especially in the era of long-read sequencing.

Availability and implementation

Ribdif2 is freely available at https://github.com/Rob-murphys/ribdif.
QuTIE: quantum optimization for target identification by enzymes
Authors: Ngo Hoang M , Thai My T , Kahveci Tamer
Published: August 2023

Target identification by enzymes (TIE) problem aims to identify the set of enzymes in a given metabolic network, such that their inhibition eliminates a given set of target compounds associated with a disease while incurring minimum damage to the rest of the compounds. This is a NP-hard problem, and thus optimal solutions using classical computers fail to scale to large metabolic networks. In this article, we develop the first quantum optimization solution, called QuTIE (quantum optimization for target identification by enzymes), to this NP-hard problem. We do that by developing an equivalent formulation of the TIE problem in quadratic unconstrained binary optimization form. We then map it to a logical graph, and embed the logical graph on a quantum hardware graph. Our experimental results on 27 metabolic networks from Escherichia coli, Homo sapiens, and Mus musculus show that QuTIE yields solutions that are optimal or almost optimal. Our experiments also demonstrate that QuTIE can successfully identify enzyme targets already verified in wet-lab experiments for 14 major disease classes.

Availability and implementation

Code and sample data are available at: https://github.com/ngominhhoang/Quantum-Target-Identification-by-Enzymes.
Aquaporin 9 causes recurrent spontaneous abortion by inhibiting trophoblast cell epithelial-mesenchymal transformation and invasion through the PI3K/AKT pathway
Authors: Ma Nana , Liu Bo , Jin Yufu , Wang Jiawei , Qin Weili , Zheng Fengque , Qin Rongyan , Li Jiaxu , Hang Fu , Qin Aiping
Published: August 2023

Background

Invasion of the endometrium by trophoblast cells is a key event during pregnancy, although the underlying mechanism remains unclear. Aquaporin 9 (AQP 9) is expressed in many eukaryotes and is associated with cell invasion. The objective of this study was to evaluate the significance of AQP9 in recurrent spontaneous abortion.

Methods

We screened the GSE22490 dataset and further differentiated aquaporin 9 expression in villi. AQP9 was evaluated as one of the key factors in abortion by injecting AQP9 overexpressed plasmid into the uterus of CD1 mice. Trophoblast cells were transfected with AQP9-overexpressing plasmid or siAQP9 to measure cell proliferation, migration, invasion, and apoptosis. Western blot was used to measure changes in the expression of invasion, epithelial-mesenchymal transformation process, and PI3K/AKT pathway. Finally, the role of AQP9 in PI3K/AKT signaling pathway was determined using the PI3K/AKT inhibitor, LY294002, and activator, 740Y-P.

Results

AQP9 is highly expressed in recurrent spontaneous abortion villus. Intrauterine injections of AQP9-overexpressing plasmid into CD1 mice resulted in atrophy and blackness of the gestational sac and increased the absorption rate, it is the causative factor of abortion. AQP9 upregulation inhibited the proliferation, invasion, migration, and epithelial-mesenchymal transformation process in vitro of trophoblast cells and increased cell apoptosis. The opposite result was observed after silencing AQP9. AQP9 overexpression also inhibited the PI3K/AKT pathway. LY294002 and 740Y-P partially recovered AQP9-induced trophoblast invasion and migration via the PI3K/AKT pathway.

Conclusions

AQP9 reduces the invasive ability of trophoblast cells by regulating PI3K/AKT signaling pathway, participating in recurrent spontaneous abortion.
SP1.1 Comparison of major abdominal emergency surgery outcomes across different organisational models of emergency surgical care: analysis of the UK NELA national database
Authors: Anand Easan , Rahman Saqib , Pucher Philip , Mercer Stuart
Published: August 2023

Aims

Emergency General Surgery (EGS) admissions are high risk and account for 14000 intensive care admissions costing over £88 million per year. This aim of this study is to understand the impact of the emergency general surgery model of care on outcomes from emergency laparotomies.

Methods

Data was obtained from the NELA database. Patients were dichotomised into either EGS hospital or non - EGS Hospital. EGS hospital is defined as a hospital where >5 % of the in-hours emergency laparotomy operating is performed by an emergency general surgeon.

The primary outcome was in – hospital mortality. Secondary outcomes were ITU length of stay and duration of hospital stay. A propensity score weighting approach was used to reduce confounding and selection bias.

Results

115,509 patients were included in the final analysis. Patient characteristics were similar between the 2 groups. Following propensity score weighting, mean SMD reduced from 0.034 to <0.001.

In-hospital mortality was similar (10.8% vs 11.1%, p=0.094), with mean length of stay (16.7 vs 16.1 days, p<0.001) and ITU stay (2.8 vs 2.6 days, p<0.001) persistently longer in patients treated in EGS systems.

Conclusions

There is no significant association between the emergency surgery hospital model of care and in – hospital mortality in emergency laparotomy patients, suggesting the emergency surgery model of care can be utilised effectively without adversely affecting patient outcomes. There is, however, a significant association between the emergency surgery hospital model of care and an increased length of ITU stay and overall hospital stay. Further studies are required to examine the impact of changing models of EGS delivery in the UK.
SP1.12 Laparoscopic Hartmann’s procedure for diverticular perforation reduces length of stay and mortality
Authors: Finch Louise , Eid Joana , Mercer Stuart
Published: August 2023

Introduction

Hartmann's procedure for perforated diverticular disease is a common emergency abdominal operation; with a mean length of stay of over 2 weeks and a mortality of 8%. This study looks at whether the laparoscopic approach is feasible and might lead to improved outcomes.

Methods

The national NELA dataset was interrogated to find patients undergoing Hartmann's procedure for diverticular disease. Data were analysed according to surgical approach, length of stay and 30-day mortality.

Results

Over a 4-year period, 4061 patients underwent Hartmann's procedure for diverticular disease; 459 (11%) were started laparoscopically, and 162 (4%) were completed laparoscopically. 30 of 176 acute hospitals performed over half of laparoscopic cases, and 139 of 176 hospitals performed fewer than 1 each year. Mean length of stay was 17 days after open Hartmann's versus 11 days after the laparoscopic approach. Mortality in the open group was 8.2% versus 5.2% if surgery was started laparoscopically, and 1.3% if surgery was completed laparoscopically. This relationship remained when only patients with a predicted NELA mortality of less than 10% were considered (2.5% versus 1.4%). Observed versus expected mortality in the open group was 0.95, versus 0.63 in those undergoing laparoscopic surgery.

Conclusions

The laparoscopic approach to Hartmann's procedure for diverticulitis is associated with shorter hospital stay and reduced mortality. There is undoubtedly bias from patient selection, but some hospitals offer laparoscopy in over 50% of cases, which at least gives them the option of performing a laparoscopic Hartmann's if necessary and possible.
SP2.3 Evaluating the Impact of Electronic Documentation on the Consent Process for Laparoscopic Choelcystectomies Within a HPB Department
Authors: Fadipe Toks , Iqbal Affan , Patel Agastya
Published: August 2023

Background

Over 60,000 laparoscopic cholecystectomies are performed annually in the UK. There are common complications such as bleeding and infection. More infrequently, there are serious risks of bile leak, bile duct or visceral injury. Documented risks and additional procedures stated on a consent form often vary significantly depending on the consenting clinician. We aim to assess the effect of a transition to an entirely electronic patient record (EPR) system on the documentation of consent and the subsequent impact of standardised electronic consent forms.

Methods

Comparison of documented risks and additional procedures against gold standard EIDO consent leaflet for laparoscopic cholecystectomies performed by a tertiary centre hepatobiliary surgery department. Paper consent forms from July to September 2022 compared to electronically signed consent forms obtained from the EPR from September to November 2022. Intervention in December 2022 (introduction of automated consent forms for clinicians to use). Re-audit from December 2022 to January 2023. Descriptive statistical analysis.

Results

Twenty-one risks and four additional procedures in gold standard consent. 84% of consents performed by middle grades (53/63). Transition to EPR shows infrequent documentation of common complications, such as pain, bleeding and infection. Rarer complications such bile duct injury mentioned more often with EPR. Additional procedures poorly documented with paper consent forms not improved by transition to EPR. All risks and additional procedures documented more frequently with pre-filled consent form.

Conclusions

Large variation in the consenting process. Simple, targeted interventions have added uniformity and consistency to the consenting process. Further assessment of the consenting process for other index procedures of hepatobiliary surgery to follow.
SP3.8 Evaluation of remote surgical wound assessment in routine surgical practice: a mixed-methods pilot implementational study of a novel mobile digital intervention
Authors: McLean Kenneth , Sgrò Alessandro , Brown Leo R , Buijs Louis , Potter Mark , Harrison Ewen
Published: August 2023

Introduction

Remote postoperative wound surveillance provides an opportunity to strengthen postoperative community care and minimise the burden of surgical-site infection (SSI). This study aimed to pilot remote digital postoperative wound surveillance and evaluate the readiness for implementation in routine practice.

Methods

A single-arm implementation study of remote postoperative wound surveillance in two tertiary care hospitals (clinicaltrials.gov: NCT05069103). Adults undergoing abdominal surgery received smartphone-delivered wound assessment for 30-days postoperatively (photographs and patient-reported SSI symptoms). Technology acceptance was assessed using 5-point Likert scales from the validated Telehealth Usability Questionnaire (TUQ) and summarised using means and 95% confidence intervals (CI). A mixed-methods approach was used with synthesis according to the WHO framework for monitoring and evaluating digital health interventions.

Results

200 patients participated between July 2021 and April 2022, with 115 (57.5%) undergoing emergency procedures. The 30-day SSI rate was 16.5% (n=33/200), with 72.7% (n=24) diagnosed post-discharge. Usage of the intervention was 83.0% (n=166/200), with subsequently 74.1% (n=123/166) TUQ completion. Patient acceptance was high with regards to satisfaction (4.27, CI: 4.13-4.41) and usefulness (4.07, CI: 3.92-4.23). Communication was rated lowest (3.86, CI: 3.71-4.02), related to the desire for more frequent and personalised interactions with the surgical team. Nevertheless, the majority perceived improved quality (3.72, CI: 3.56-3.89) and efficiency (4.08, CI: 3.93-4.23) over routine postoperative care.

Conclusion

Remote postoperative wound surveillance successfully demonstrates readiness for implementation according to the WHO framework. Both patients and healthcare services can benefit from enhanced community support to ensure appropriate and timely management.
SP4.8 Can we risk stratify surgical waiting lists using patient level and demographic data? A novel waiting list analyser tool
Authors: Johnson Nathan , Blow Sophie , Bassi Vinod , Mitchell Thomas , Peckham-Cooper Adam
Published: August 2023

Introduction

7.2 million patients are currently awaiting NHS treatment. It is imperative that trusts are able to interrogate waiting lists in order to understand the impact of ‘long waits’, on both patients and hospital services. An ability to prioritise, optimise and risk stratify care would be invaluable. In collaboration with clinicians, managers and patient level information and costing (PLICS) team we present a big data waiting list analyser tool that allows the delivery of patient focused decision making and analysis.

Methods

Using Structured Query Language (SQL), the analyser pulls data including waiting times (RTT), patient ethnicity and deprivation deciles directly from trust systems. The analyser cross references associated morbidity and hospital attendances to delineate the impact and resource utilisation of acute attendance whilst awaiting treatment. Coding is used to calculate additional bed or theatre requirements for every patient awaiting treatment. Financial costs, lost bed days and associated morbidity are analysed and used to identify at risk patient groups.

Results

The analyser itself takes the form of a fully interactive database. It provides dynamic analysis for any surgical procedure across three zones; waiting list times, acute presentation, and resources required to deliver elective activity. There is also a population health management section, which includes ethnicity and deprivation deciles.

Conclusions

This first of a kind analyser is an exciting new tool that will aid data driven decision making. It will allow us to target patients based not only on their waiting time, re-attendance risk but also based on their socioeconomic risk factors.
SP5.4 A review of conservative management of fingertip amputations
Authors: Downes Graeme
Published: August 2023

Aims

Fingertip amputations are a common presentation, with no definitive guideline, the decision between surgical and non-operative management of these injuries is controversial.

This review aims to identify evidence supporting the use of non-operative treatment methods for fingertip amputations. It is hoped that the evidence gathered will guide treatment decisions and identify areas for further work.

Methods

A search was conducted using Pubmed, Google Scholar and Sage journals. The search terms were ‘Fingertip semi-occlusive’ and ‘fingertip amputation dressing’.

Results

33 papers, published between 1972 and 2022 were reviewed, 1789 fingertip amputations treated non-operatively across the identified literature. There were overwhelmingly positive outcomes for fingertip amputations treated non-operatively; with healing time between 15 and 60 days, excellent two-point discrimination of between 2.5 and 6mm and low rates of infection and other complications. In the limited studies comparing non-operative to surgical treatment, better functional and aesthetic outcomes were found with non-operative management, another ceased recruitment to the surgical management arm due to the lack of benefit over non-operative management and a third found no benefit to surgery by experienced hand surgeons.

Conclusion

There is limited experimental data available in this area, and well conducted randomised control studies are needed. With that limitation in mind, the available literature provides evidence that management of fingertip amputations with dressings produces comparable, if not superior results to surgical management. Given the elimination of surgical morbidity, and ability to provide non-operative management in any location it Is recommended that this be offered as an excellent treatment modality.
SP5.8 Laparoscopy for small bowel obstruction improves outcomes
Authors: Finch Louise , Eid Joana , Mercer Stuart
Published: August 2023

Aims

Adhesional small bowel obstruction is the commonest cause of emergency general surgery. Fewer than 20% of cases are started laparoscopically, but there is huge variability across the country from 80% in some units to 0% in others. This study examines whether the laparoscopic approach reduces length of stay and mortality.

Methods

The national NELA database was interrogated to identify patients operated for small bowel obstruction due to adhesions. Post-operative length of stay and mortality were analysed according to surgical approach.

Results

20,597 patients with small bowel obstruction due to adhesions were identified; overall 30-day mortality was 6.2%. 3870 of these 20,597 cases (18.5%) were started laparoscopically. Mortality in this group was 3.2% compared with 7.0% in the laparotomy group. This association was also demonstrated in patients with predicted mortality <5% (0.9% v 1.4%) and with predicted mortality <10% (1.6% v 2.5%). In the laparoscopic group, more patients were discharged within 3 days (23% v 3%) and within 7 days (58% v 34%) compared to the laparotomy group. When surgery could be completed laparoscopically, all of these associations became stronger – mortality in this group was 1.9%, and 40% of patients were discharged within 3 days.

Conclusions

The laparoscopic approach to adhesional small bowel obstruction is safe and effective, and is associated with shorter length of stay and reduced mortality. The association holds even in patients converted to open surgery, and is not dependent on patient selection. Laparoscopy should be the approach of choice for adhesional small bowel obstruction.
SP5.11 A systematic review of participant descriptors reported in studies of small bowel obstruction
Authors: Rashid Adil , Kumar Mithun , Lee Matt J
Published: August 2023

Aim

Reporting of participant descriptors in studies of small bowel obstruction (SBO) can help identify characteristics associated with favourable outcomes and allow comparison with other studies and real-world clinical populations. The aim was to identify the pattern of participant descriptors reported in studies assessing interventions for SBO.

Method

This systematic review was registered with PROSPERO (CRD42021281031) and reported in line with the PRISMA checklist. Systematic searches of Ovid MEDLINE, Embase, and Cochrane Central Register of Controlled Trials (CENTRAL) were undertaken to identify studies assessing operative and non-operative interventions for adults with SBO. Studies were dual screened for inclusion. Descriptors were categorised into conceptual domains by the research team.

Results

Searches identified 2648 studies, of which 85 were included. A total of 168 unique descriptors were identified. On average, studies reported 12 descriptors. The most frequently reported descriptors were sex, age, SBO aetiology, history of abdominal surgery, BMI and ASA classification. The highest number of descriptors in a single study was 34, compared to the lowest number of descriptors which was one. Pathway factors were the least frequently described domain. Overall, 43 descriptors were reported in just one study.

Conclusion

There is a lack of consistency in participant descriptors reported in studies of SBO. Furthermore, a significant proportion of the descriptors were used infrequently. This makes it challenging to assess whether study participants are representative of the wider population. Further work is required to develop a Core Descriptor Set to standardise the reporting of patient characteristics and reduce heterogeneity between studies.
SP6.1 Short-term and long-term remission of Type 2 diabetes mellitus after Sleeve Gastrectomy (SG) vs One-Anastomosis Gastric Bypass (OAGB) vs Roux-en-Y Gastric Bypass (RYGB): A Narrative Literature Review
Authors: Balasubaramaniam Vignesh
Published: August 2023

Aim

The three most widely performed bariatric surgeries are RYGB, SG, and OAGB. Aside from the benefits of weight loss, current findings suggest that these procedures can also induce remission of T2DM. There are limited data that directly compare these three procedures. This study aims to compare the short-term and long-term remission of T2DM after RYGB, SG, and OAGB.

Methods

Three databases (Embase, PubMed, and Cochrane) were searched for randomised controlled trials, systematic reviews, meta-analyses, retrospective studies, and literature reviews that compared the effects of RYGB, SG, and OAGB on T2DM remission. The studies were published over a ten-year period (2012 - 2022). Only patients with T2DM and who had primary bariatric surgery were included.

Results

After applying the inclusion and exclusion criteria, six articles were included in the review. It was found that OAGB had superior T2DM remission and weight loss in the short-term and long-term follow-up. RYGB was noted to have the highest complication rate when compared to SG and OAGB. Moreover, in one of the studies, patients who were not taking insulin had a higher remission rate than those taking insulin.

Conclusion

This narrative literature review confirms the existing data that all three bariatric surgeries induce remission of T2DM. With the limited studies available that compared all three procedures, OAGB was found to be the superior procedure in terms of weight loss and inducing remission of T2DM. It is also worth noting that there are other independent predictive factors that have an impact on T2DM remission.
SP6.2 The Prognostic Impact of Pre-Treatment Cachexia in Patients Undergoing Resectional Surgery for Oesophagogastric Malignancy: A Systematic Review, Meta-Analysis & Meta-Regression
Authors: Brown Leo R , Sayers Judith , Yule Michael , Drake Thomas M. , Wigmore Stephen J. , Skipworth Richard J.E.
Published: August 2023

Background

Cancer cachexia is not purely an end-stage phenomenon and even influences the outcome of patients with potentially curative malignancies. This review aims to examine the effect of pre-treatment cachexia on survival in patients undergoing resection of an oesophagogastric malignancy.

Methods

A systematic literature search of MEDLINE, EMBASE and Cochrane Library databases was conducted, from January 2000 to May 2022, to identify studies reporting the influence of pre-treatment weight loss or cachexia on patients undergoing an oesophagogastric resection for cancer with curative intent. Meta-analyses of the primary (overall survival) and secondary (disease-free survival and postoperative mortality) outcomes were performed using random-effects modelling. Meta-regression was used to examine disease stage as a potential confounder.

Results

Ten non-randomised studies, comprising 7186 patients, were eligible for inclusion. The prevalence of pre-treatment cachexia was 35% (95% CI: 24-47%). Pooled adjusted hazard ratios found cachexia to be associated with decreased overall survival (HR 1.46, 95% CI: 1.31-1.60, p<0.001). Meta-analysis of proportions confirmed decreased overall survival at 1-, 3- and 5-years in weight-losing cohorts. Pre-treatment cachexia was not a predictor of disease-free survival and further data are required to establish its influence on postoperative mortality. The proportion of patients with T3/4 tumours was a significant moderator of between-study heterogeneity (p=0.018). Cachexia appeared to have a greater effect on overall survival in studies with a higher proportion of locally advanced tumours.

Conclusions

Pre-treatment cachexia adversely influences overall survival following resection of an oesophagogastric malignancy. Consideration of weight loss, during the shared decision-making process, may improve risk-stratification and facilitate targeted interventions.
SP6.4 Economic cost-utility analysis of stage-directed oesophageal cancer treatment
Authors: Herbert Geraint , Barlow Emma , Eley Catherine , Robinson David , Powell Arfon , Lewis Wyn
Published: August 2023

Aims

Oesophageal Cancer (OC) treatment levies substantial financial burden on health services with potentially curative surgery with or without neoadjuvant offered to patients with locoregional disease. This study aimed to examine treatment costs related to Quality Adjusted Life-Years (QALYs) gained in patients that have potentially curative treatment (oesophagectomy) and those receiving best supportive care (BSC).

Methods

Consecutive 365 patients undergoing potentially curative treatment (median age 64.5 years, 308 male, 57 female, 331 adeno ca, 32 squamous cell ca, 2 high grade dysplasia, 263 neoadjuvant therapy) were studied. The cost of one-year’s treatment from referral was calculated based on current management standards within a regional cancer network and primary outcome was overall survival.

Results

QALY-adjusted survival for stage I was 48 months, stage II 30.6 months, stage III 23.0 months, and stage IV 13.0 months, with cost per QALY of £6038, £13412, £14606, and £20002 respectively. QALY-adjusted survival for patients receiving BSC was 2.24 months, with a cost per QALY of £60225. This gives an Incremental Cost-Effectiveness Ratio (ICER) per QALY for stages I to IV of £3385, £9714, £8740 and £17763 respectively.

Conclusion

Cost per QALY of potentially curative OC treatment for each stage was below national thresholds of readiness to pay per QALY, while BSC likely exceeds this. Regarding ICER-defined cost effectiveness, treatment of stage I was five-fold cheaper than stage IV OC, supporting early diagnosis as being most cost-effective.
SP6.5 Outcomes in Oesophagogastric Cancer up to 18 months following the COVID-19 pandemic
Authors: Khan Khurram , Gall Lewis , McCollum Catherine , Sundarraj Jeeva , McGovern Josh , Forshaw Matthew
Published: August 2023

Aims

COVID-19 has negatively influenced oesophago-gastric (OG) cancer prognosis with stage migration described during the first six months of the pandemic. This study investigated the medium term effect of the national lockdown on diagnosis, management and outcomes.

Methods

A retrospective cohort study of all newly diagnosed OG cancers in a single regional MDT between 1 October 2019 and 30 September 2021. Patients were divided into four 6-month period based upon date of first MDT discussion in relation to the first UK national lockdown: pre-lockdown, 0-6, 6-12 and 12-18 months post-lockdown. Electronic health records were reviewed and results compared.

Result

664 patients with OG cancers were included. Median age was 71 years (62-77) and 445 (67%) were male. 502 (76%) had adenocarcinoma. Compared with pre-lockdown, patients in the 0-6-months group were significantly older (p<0.05), symptomatic (p<0.05), and had stage migration with increased metastatic disease (p<0.05), palliative treatment intent (p<0.001) and reduced survival (p<0.05).

Compared with pre-lockdown, there was no difference in patients presenting in the 12-18 months group in terms of age (p=0.927), sex (p=0.461), performance status (p=0.666), presence of metastatic disease (p=0.971) and treatment intent (p=0.123). However, more patients in this group were symptomatic (p=0.025), presented as emergencies (p=0.032) and had a poorer overall survival (p<0.05).

Conclusion

Patients presenting 12-18 months after the initial lockdown are still experiencing poorer overall survival than those pre-pandemic. Identification and addressment of the factors contributing to the continued poor outcomes following COVID-19 is urgently required to return overall patient survival to the pre-pandemic level.