bluuebunny/crossref_metadata_2025 huggingface dataset:
Highly coherent mid-infrared wideband supercontinuum generation by a silica cladded silicon nitride core buried waveguide
Authors: Adhikary Somen , Ghosh Dipankar , Basu Mousumi
Published: August 2024

Optical waveguides with semiconductor cores are drawing considerable research interest in the domain of supercontinuum (SC) generation in recent times. In this work, we design a square-core silicon nitride buried waveguide with a silica-clad, aiming for a wideband spectrum generation in the mid-IR region when operated at the standard telecommunication wavelength of 1550 nm. Among different such silicon nitride square-core buried waveguides, we propose a typical design with dimensions of 400 nm × 400 nm along its height and width, capable of producing a highly coherent broadband intensity spectrum ranging from 810 nm to 5441 nm after propagating through just a few millimeters of the waveguide. The group velocity dispersion maintains minimal value over a broad wavelength range in the mid-IR region, while the nonlinear coefficient is estimated to be sufficiently high. The nonlinear pulse propagation through such a waveguide leads to achieving an SC spanning over 2.76 octaves, sufficiently broader than previously reported silicon nitride-based waveguides. Furthermore, our calculations confirm the highly coherent nature of the generated SC. To the best of our knowledge, this is the first report of SC generation maintaining a high degree of coherence over such a wide wavelength range in the mid-IR zone using a square-core silicon nitride buried waveguide.
Magnetoresistance in two-dimensional materials and van der Waals heterostructures
Authors: Xin Na
Published: August 2024

Magnetoresistance (MR) refers to the alteration in electrical resistance within a material when influenced by a magnetic field. Studying MR at the atomic level holds a significant interest both in fundamental research and practical applications. Atomically thin two-dimensional (2D) van der Waals materials and their heterostructures offer an unprecedented platform to investigate MR, thanks to the very broad range of properties and no requirement for lattice matching. Here, we review the various mechanisms of MR effect in 2D materials and their heterostructures, including tunneling MR, extremely large unsaturated MR, layer MR, and colossal MR, as well as explore their potential in device applications. Furthermore, we discuss the limitations and main challenges that still exist for the development of practical devices based on MR and provide our considerations towards real applications.
Relative molecular orientation can impact the onset of plasticity in molecular crystals
Authors: Grennan Hugh P , Burch Alexandra C , Bahr David F
Published: August 2024

Creating or moving dislocations is the first step to dissipating mechanical energy via plastic deformation under contact loading. In molecular crystals there is both a lattice that defines crystal orientation and a relative orientation of the basis of the molecules. We define a normalization parameter which relates strain at yield, the hardness of the bulk crystal, and a distance parameter analogous to a Burgers vector that nominally predicts the relative ease of initiating plasticity in this broad class of materials. Analyzing the yield behavior of 10 different molecular crystals of varying space groups shows the inter-molecular orientation predicts the experimentally observed applied stress needed to nucleate dislocations. When molecules are oriented ‘parallel’ relative to one another the normalized maximum shear stress at the onset of plasticity is on the order of 3–5 times lower than when molecules within the crystal are ‘anti-parallel’, and molecules with a more equiaxed shape fall in between these bounds. This provides an initial indication of a structural feature which predicts the relative ease of initiating plasticity during contact loading in molecular crystals.
On the feasibility of detecting quantum delocalization effects on relativistic time dilation in optical clocks
Authors: Hu (胡杨林) Yanglin , Lock Maximilian P E , Woods Mischa P
Published: August 2024

We derive the predicted time dilation of delocalized atomic clocks in an optical lattice setup in the presence of a gravitational field to leading order in quantum relativistic corrections. We investigate exotic quantum states of motion whose relativistic time dilation is outside of the realm of classical general relativity, finding a regime where

24

Mg

optical lattice clocks currently in development would comfortably be able to detect the special-relativistic contribution to the quantum effect (if the technical challenge of generating the necessary states can be met and the expected accuracy of such clocks can be attained). We find that the gravitational contribution, on the other hand, is negligible in this setup. We provide a detailed experimental protocol and analyse the effects of noise on our predictions. We also show that the magnitude of our predicted quantum time dilation effect remains just out of detectable reach for the current generation of

87

Sr

optical lattice clocks. Our calculations agree with the predicted time dilation of classical general relativity when restricting to Gaussian states.
Quantum-enhanced learning with a controllable bosonic variational sensor network
Authors: Liao Pengcheng , Zhang Bingzhi , Zhuang Quntao
Published: August 2024

The emergence of quantum sensor networks has presented opportunities for enhancing complex sensing tasks, while simultaneously introducing significant challenges in designing and analyzing quantum sensing protocols due to the intricate nature of entanglement and physical processes. Supervised learning assisted by an entangled sensor network (SLAEN) (Zhuang and Zhang 2019Phys. Rev.X9041023) represents a promising paradigm for automating sensor-network design through variational quantum machine learning. However, the original SLAEN, constrained by the Gaussian nature of quantum circuits, is limited to learning linearly separable data. Leveraging the universal quantum control available in cavity quantum electrodynamics experiments, we propose a generalized SLAEN capable of handling nonlinear data classification tasks. We establish a theoretical framework for physical-layer data classification to underpin our approach. Through training quantum probes and measurements, we uncover a threshold phenomenon in classification error across various tasks—when the energy of probes exceeds a certain threshold, the error drastically diminishes to zero, providing a significant improvement over the Gaussian SLAEN. Despite the non-Gaussian nature of the problem, we offer analytical insights into determining the threshold and residual error in the presence of noise. Our findings carry implications for radio-frequency photonic sensors and microwave dark matter haloscopes.
Public control of coal resources of the United States’ Powder River Basin for a managed decarbonization transition
Authors: Cha J Mijin , Grubert Emily
Published: August 2024

The United States (US) has set aggressive targets for reaching a carbon pollution-free power sector by 2035 and a net-zero economy by 2050. Reaching these goals will require both rapid expansion of zero- and negative-carbon infrastructure and a phase-out of unabated fossil fuel infrastructure. New subsidy and regulatory actions focus on eliminating coal emissions at the point of consumption either through carbon capture and storage (CCS) or coal-fired power plant retirement. Yet, these pathways have opposite implications for coal production: CCS is coal intensive, while coal retirement is not. Despite a record of chaotic and harmful transition and significant social scientific research suggesting better outcomes from managed, coordinated decline, these mechanisms rely on uncoordinated private decision making by mine and plant owners. Coal mining has rapidly declined since peak production in 2008. Production has dropped by half; bankruptcies are the norm; and coal mine and power plant host communities have experienced highly disruptive decline as a result of this unmanaged transition. Given this history, we argue the current market-based, plant-driven governance approach could worsen transition challenges, including potentially stranding costly CCS investments. We argue that the US should complement its extensive investments in technology demonstrations with innovative governance demonstrations to facilitate a just energy transition. Specifically, we argue that the Powder River Basin, which is the US’ largest coal basin and consists primarily of federally leased coal, should be brought under public control for managed decline both to meet emissions reduction targets and advance a just energy transition.
Unsupervised underwater image enhancement with improved CycleGAN
Authors: An Yongli , Zhang Wenpeng , Ji Zhanlin
Published: August 2024

Due to the complexity of underwater environments, acquiring high-quality paired underwater images poses a significant challenge. Water’s absorption and scattering of light often result in images with low contrast, color deviations, and blurred details. To address these challenges, this paper proposes an improved unsupervised learning model based on CycleGAN. This model uses a two-part generator to separate content and style features from underwater images. The model integrates content and style features through a multi-scale fusion module, then uses a decoder to reconstruct them into clear images, enhancing image quality with style transfer techniques. Our experiments show that our algorithm performs better than other advanced models in terms of PSNR and SSIM indices, respectively. It can also produce good-quality enhanced images. Furthermore, feature point matching experiments were conducted to demonstrate the practicality of our model.
Mitigating rim bending in fused silica micro shell resonators by a chamfered mold
Authors: Yu Hoon , Kim Taeyun , Ju Seongmin , Kwon Tae-Yoon
Published: August 2024

In this work, we addressed the bending of a micro shell resonator’s rim toward the stem during glass-blowing process. This phenomenon occurs due to increased heat loss at the mold’s edge and reduced heat flux at the side of the Gaussian heat source. To mitigate rim bending and the subsequent reduction in capacitance between the rim and 3D electrodes, which can degrade performance in micro glass-blown shell resonators for gyroscopes, we propose two potential mold solutions, using short-stem mold and chamfered mold. To quantitatively compare resonators created by these two types of molds, we calculated the noise factor for predicting its gyroscope performance. From these calculations, we find out that using the chamfered mold enables us to increase in the resonator’s effective mass, eigenfrequency, angular gain, and quality factor, consequently reducing the noise factor compared to using the short-stem mold. We also demonstrated these results by manufacturing shell resonators and measuring its vibrational characteristics. After metalization of the glass shell resonator, Q factor and eigen frequency of n = 2 vibration mode along the primary (secondary) axis were measured to 622,466 ± 6,427 (619,793 ± 6,402) and 4,343 ± 40 Hz (4,350 ± 40 Hz), respectively. This simulation process will assist us in getting insight into understanding a shell resonator as a gyroscope, designing a mold and determining experimental conditions.
Non-monotonic flow variations in a stylized (TASEP-based) traffic model featuring cars searching for parking
Authors: Anfray Valentin , Nicolas Alexandre
Published: August 2024

The Totally Asymmetric Simple Exclusion Process (TASEP) is a paradigm of out-of-equilibrium Statistical Physics that serves as a simplistic model for one-way vehicular traffic. Since traffic is perturbed by cars cruising for parking in many metropolises, we introduce a variant of TASEP, dubbed SFP, in which particles are initially cruising at a slower speed and aiming to park on one of the sites adjacent to the main road, described by a unidimensional lattice. After parking, they pull out at a finite rate and move at a normal speed. We show that this stylized model, which breaks many of the conservation rules applicable in other TASEP variants, exhibits singular features, in particular non-monotonic variations of the steady-state current with the injection rate and re-entrant transitions in the phase diagram, for some range of parameters. These features are robust to variations in the update rule and the boundary conditions. Neither the slow speed of cruising cars nor the perturbation of the flow due to pull-out maneuvers, taken in isolation, can rationalize these observations. Instead, they originate in a cramming (or ‘paper jam’) effect which results from the coupling of these mechanisms: injecting too many cars into the system saturates the first sites of the road, which prevents parked cars from pulling out, thus forcing cruising cars to travel farther along the road. These strong discrepancies with even the qualitative trends of the baseline TASEP model highlight the importance of considering the effect of perturbations on traffic.
Data-driven acceleration of multi-physics simulations
Authors: Meinecke Stefan , Selig Malte , Köster Felix , Knorr Andreas , Lüdge Kathy
Published: August 2024

Multi-physics simulations play a crucial role in understanding complex systems. However, their computational demands are often prohibitive due to high dimensionality and complex interactions, such that actual calculations often rely on approximations. To address this, we introduce a data-driven approach to approximate interactions among degrees of freedom of no direct interest and thus significantly reduce computational costs. Focusing on a semiconductor laser as a case study, we demonstrate the superiority of this method over traditional analytical approximations in both accuracy and efficiency. Our approach streamlines simulations, offering promise for complex multi-physics systems, especially for scenarios requiring a large number of individual simulations.
Training coupled phase oscillators as a neuromorphic platform using equilibrium propagation
Authors: Wang Qingshan , Wanjura Clara C , Marquardt Florian
Published: August 2024

Given the rapidly growing scale and resource requirements of machine learning applications, the idea of building more efficient learning machines much closer to the laws of physics is an attractive proposition. One central question for identifying promising candidates for such neuromorphic platforms is whether not only inference but also training can exploit the physical dynamics. In this work, we show that it is possible to successfully train a system of coupled phase oscillators—one of the most widely investigated nonlinear dynamical systems with a multitude of physical implementations, comprising laser arrays, coupled mechanical limit cycles, superfluids, and exciton-polaritons. To this end, we apply the approach of equilibrium propagation, which permits to extract training gradients via a physical realization of backpropagation, based only on local interactions. The complex energy landscape of the XY/Kuramoto model leads to multistability, and we show how to address this challenge. Our study identifies coupled phase oscillators as a new general-purpose neuromorphic platform and opens the door towards future experimental implementations.
Improvement in Early Scar Maturation by Nanofat Infiltration: Histological and Spectrophotometric Preliminary Results From a Split Scar–Controlled, Randomized, Double-Blinded Clinical Trial
Authors: Ramaut Lisa , Moonen Linde , Geeroms Maxim , Leemans Gaelle , Peters Ellen , Forsyth Ramses , Gutermuth Jan , Hamdi Moustapha
Published: August 2024

Background

The regenerative properties of stromal vascular fraction (SVF) in wound healing and scar formation are a subject of increasing clinical interest.

Objectives

Although preclinical studies have confirmed the angiogenetic, proliferative, and antifibrotic properties of SVF, there is limited clinical evidence from randomized controlled clinical trials.

Methods

Twelve patients who underwent abdominoplasty were included in this clinical study. Nanofat was mechanically obtained intraoperatively and infiltrated intradermally in the sutured surgical wound, randomly assigned to either the left or the right side. The abdominal scar was evaluated with the Patient and Observer Scar Assessment Scale, whereas erythema and pigmentation were measured with a reflectance spectrophotometry device (Mexameter, Courage + Khazaka electronic GmbH, Köln,Germany). Histological analysis and electron scan microscopy of tissue biopsies were performed at 8 months.

Results

The treated side of the scar showed significantly less erythema at 3- and 6-month follow-ups, but this difference reduced after 12 months. Patients reported better scar scores at the 6-month follow-up with a significantly better color at the treated side. Observers reported better overall scar scores at the treated side at 3-, 6-, and 12-month follow-ups, with better vascularization, pigmentation, and thickness. There was no statistically significant difference in terms of histological analysis between the 2 groups. There was no difference in the occurrence of adverse events between both sides.

Conclusions

Infiltration of nanofat exhibited promising results in surgical scar maturation characterized by less erythema and better texture. More clinical trials with a larger sample size are warranted to better elucidate the possible benefits of SVF on surgical scar formation.

Level of Evidence: 5
Signature Search Polestar: a comprehensive drug repurposing method evaluation assistant for customized oncogenic signature
Authors: Zhang Jinbo , Yuan Shunling , Cao Wen , Jiang Xianrui , Yang Cheng , Jiang Chenchao , Liu Runhui , Yang Wei , Tian Saisai
Published: August 2024

The burgeoning high-throughput technologies have led to a significant surge in the scale of pharmacotranscriptomic datasets, especially for oncology. Signature search methods (SSMs), utilizing oncogenic signatures formed by differentially expressed genes through sequencing, have been instrumental in anti-cancer drug screening and identifying mechanisms of action without relying on prior knowledge. However, various studies have found that different SSMs exhibit varying performance across pharmacotranscriptomic datasets. In addition, the size of the oncogenic signature can also significantly impact the result of drug repurposing. Therefore, finding the optimal SSMs and customized oncogenic signature for a specific disease remains a challenge. To address this, we introduce Signature Search Polestar (SSP), a webserver integrating the largest pharmacotranscriptomic datasets of anti-cancer drugs from LINCS L1000 with five state-of-the-art SSMs (XSum, CMap, GSEA, ZhangScore, XCos). SSP provides three main modules: Benchmark, Robustness, and Application. Benchmark uses two indices, Area Under the Curve and Enrichment Score, based on drug annotations to evaluate SSMs at different oncogenic signature sizes. Robustness, applicable when drug annotations are insufficient, uses a performance score based on drug self-retrieval for evaluation. Application provides three screening strategies, single method, SS_all, and SS_cross, allowing users to freely utilize optimal SSMs with tailored oncogenic signature for drug repurposing.

Availability and implementation

SSP is free at https://web.biotcm.net/SSP/. The current version of SSP is archived in https://doi.org/10.6084/m9.figshare.26524741.v1, allowing users to directly use or customize their own SSP webserver.
Diffusion models for medical image reconstruction
Authors: Webber George , Reader Andrew J
Published: August 2024

Better algorithms for medical image reconstruction can improve image quality and enable reductions in acquisition time and radiation dose. A prior understanding of the distribution of plausible images is key to realising these benefits. Recently, research into deep-learning image reconstruction has started to look into using unsupervised diffusion models, trained only on high-quality medical images (ie, without needing paired scanner measurement data), for modelling this prior understanding. Image reconstruction algorithms incorporating unsupervised diffusion models have already attained state-of-the-art accuracy for reconstruction tasks ranging from highly accelerated MRI to ultra-sparse-view CT and low-dose PET. Key advantages of diffusion model approach over previous deep learning approaches for reconstruction include state-of-the-art image distribution modelling, improved robustness to domain shift, and principled quantification of reconstruction uncertainty. If hallucination concerns can be alleviated, their key advantages and impressive performance could mean these algorithms are better suited to clinical use than previous deep-learning approaches. In this review, we provide an accessible introduction to image reconstruction and diffusion models, outline guidance for using diffusion-model-based reconstruction methodology, summarise modality-specific challenges, and identify key research themes. We conclude with a discussion of the opportunities and challenges of using diffusion models for medical image reconstruction.
A case of MRI-induced headache caused by an intracranial foreign body
Authors: Tokue Hiroyuki , Tokue Azusa , Tsushima Yoshito
Published: August 2024

This case report delves into a unique occurrence of MRI-induced headaches attributed to an unsuspected intracranial foreign body. A male patient, presenting persistent headaches, experienced exacerbation of pain upon entering the MRI suite, hindering the imaging procedure. A subsequent head CT scan revealed a nail within the cranial cavity, stemming from a previous nail gun injury. Surgical removal was deemed unsafe, leading to continued observation. This case emphasizes the need for cautious exploration of abnormal symptoms in the MRI suite, urging healthcare professionals to consider potential foreign bodies. The incident underscores the risk of metallic fragments causing complications during MRI procedures and highlights the importance of thorough patient assessment before resorting to MRI imaging.
60 Audit of Outpatient Management of Sudden Sensorineural Hearing Loss at St George’s Hospital
Authors: Li A , Jaikaransingh D , Watters C
Published: August 2024

Introduction

Sudden sensorineural hearing loss (SSNHL) is an acute otological problem and early treatment is thought to improve prognosis. ENT UK guidelines advise oral steroids as first-line treatment, followed by intra-tympanic steroids if there is no improvement. The aim of this audit was to assess outpatient management of SSNHL at St George’s Hospital.

Method

Data was collated from January – March 2023 of ENT emergency outpatient clinics for patients referred for SSNHL. Those without confirmation of SSNHL on pure tone audiometry (PTA) were excluded. Further analysis was made regarding treatment received and response.

Results

Our results showed that 36 patients were referred for SSNHL. 50% (18) were confirmed to be SSNHL on PTA. 83.3% (15) received a course of oral prednisolone with 20% (3) showing significant improvement in hearing. Of the 87% (13) who did not or had partial response to corticosteroid treatment, 38% (5) subsequently received IT steroid injections. 1 patient had an isolated IT steroid injection as they presented late. Of all those who received IT Injections (6), 67% (4) showed improvement in hearing.

Conclusions

Despite a poor response rate to oral prednisolone, 62% (8) were not subsequently treated with IT steroid injections. For 6 patients, the time delay from onset of symptoms was too great suggesting IT injection would be futile, 1 patient declined, 1 patient moved out of area. Further analysis into time delay from onset of SSNHL to ENT assessment would be beneficial. Consensus on maximum time limit to benefit from intratympanic steroid injection would also be of benefit.
184 Closed-Loop Audit on Upper Limb Bite Injuries at a Major Trauma Centre
Authors: Yousefi Azimi D , Paraoan V , Jones M
Published: August 2024

Aim

To assess compliance of management of upper limb bite injuries with Departmental guidelines, generate an action plan to address areas requiring improvement, and close the loop to review outcomes.

Method

A total of 38 patients in April 2023 and 27 patients in October 2023 presented to University Hospital Coventry. Trust electronic software was used to identify patients and collect data that reflected the standards set by the Departmental guideline, including treatment given at first presentation and subsequent management.

Results

The Departmental guideline was updated in accordance with The British Society for Surgery of the Hand. This resulted in an improved 86% of all patients, including 100% with infection, who required an operation to be completed within 24 hours. First contact practitioners provided a thorough washout in 25% of patients in the Emergency Department. An overall 30% required a formal washout in theatre by a surgeon, of which 25% required a second operation. Further, all but one patient initially discharged from the Emergency Department to Hand Trauma Clinic were managed conservatively, and 23% required more than one follow-up appointment. Additional recommendations focused on enabling better care by first contact practitioners, including clinical training for simple wound excision and washout in ED and encouraging improved documentation, as well as providing a dedicated minor ops room with accessible equipment.

Conclusions

A closed-loop audit on the management of upper limb bite injuries showed a marked improvement in achieving compliance with a revised Departmental guideline, with further recommendations targeted at enabling first contact practitioners.
249 High Output Stoma Management – a 3-Cycle Audit
Authors: Mollier J , Benroy B , Jacob M
Published: August 2024

Aim

High output stoma (HOS), defined as stoma output over 1500ml per day, occurs commonly in surgical inpatients. HOS leads to complications including dehydration, electrolyte imbalances, acute kidney injury and increased hospital stay. The Association of Stoma Care nurses (ASCN) provide guidelines for their management and prevention of complications. This 3-cycle audit aims to increase awareness of these guidelines amongst the junior doctors at Southend University Hospital.

Method

20 junior doctors were surveyed on their knowledge of HOS management. A poster and checklist were created, summarising the ASCN guidelines. The third cycle consisted of provision of teaching sessions for junior doctors working in the surgical department and improvement of the checklist. Junior doctors were re-surveyed after each intervention, looking for an improvement in knowledge and application of ASCN guidelines.

Results

The audit resulted in an overall positive impact; participants got 51% of answers correct in May 2022, then 72% of answers correct in September 2022 and 91% of answers correct in September 2023, representing improvement in reported use of IV fluids, appropriate medications, optimisation of oral intake and monitoring of electrolytes. 85% of junior doctors reported applying knowledge gained during the HOS teaching session when managing patients with HOS.

Conclusions

The audit led to good improvement in knowledge and application of the ASCN guidelines when managing HOS amongst junior doctors working in Surgery. Next steps include maintaining knowledge of HOS management among rotating junior doctors by expanding to other specialities, providing posters for non-surgical wards and delivering teaching sessions to all foundation doctors.
322 Correlation Between Quantitative Faecal Immunochemical Test (qFIT) and Colorectal Operation - Clinical Audit
Authors: Earwicker S , Foy C , McBride R , Lindsay K
Published: August 2024

Aim

To uncover any potential link between quantitative faecal immunochemical test (qFIT) result, and the colorectal operation performed; and to give insight that could assist future work in creating a tool clinicians could use to earlier predict tumour site or guide the treatment and management of colorectal cancer. Preliminary search does not show this has been studied before.

Method

Data was collected through a clinical audit with the Centre for Colorectal Surgery in Belfast City Hospital. This retrospective study into 208 patients who had an operation with the centre during 2022, manually checked the available 161 case notes of which 63 had a qFIT result. Then explored for any correlations between qFIT result to operation, tumour location, stage, and age.

Results

Patients that got a positive qFIT<100, 47.1% had a R Hemi or Extended R Hemi. 41.2% of positive qFIT<100 had an R hemi. 40% of positive qFIT<200 had a R hemi. 47.6% of qFIT results were 400+. 27.0% of the patient population got a qFIT<100. qFIT correlated with tumour stage and of the patients studied, 0 had died at the time of audit.

Conclusions

A link between positive qFIT<100 and Right Hemicolectomy was observed. A finding that could impact care of patients with colorectal cancer.
592 Standardising General Surgery Operation Notes According to Royal College of Surgeons England Guidelines
Authors: Chaudhari V , Mandal I , Mathew A
Published: August 2024

Aim

In this audit cycle, we assessed the quality of operation notes in both emergency and elective general surgery operations against the standards set by the Royal College of Surgeons of England. We particularly focussed on improving documentation with respect to operative diagnosis, estimated blood loss, whether it was an elective or emergency procedure and documentation of VTE prophylaxis in the post operative instructions.

Method

We collected data over a ten-day period of all elective and emergency general surgery theatre cases looking specifically at the four domains listed above. Following this we sent department wide emails and placed posters strategically next to the general surgery theatre computers where operation notes are written. Once this was done, we looked at the quality of documentation over a further ten-day period to see if our compliance with Royal College of Surgeons Guidelines had improved.

Results

Our compliance in regard to documentation of operative diagnosis improved from 34.88% to 60.53%. Estimated blood loss rose to 36.84% from 0%. 15.79% of operation notes included the type of procedure from 4.60% pre intervention and finally 61.54% of post operative plans now included VTE prophylaxis compared with 30% pre intervention.

Conclusions

Simple measures such as posters and department wide emails have slightly improved our compliance with national guidelines, but there is still some way to go. Our next steps will include forming proformas with the necessary information included to aid surgeons to document the necessary details for medico-legal, research and audit purposes.
639 Good Surgical Practice: Operation Notes in a Mixed EPR/Paper System
Authors: Tan J , Hui Fen K , Choudhry M
Published: August 2024

Aim

Operation notes are essential in ensuring continuity of care across different clinicians and admissions. 88% of NHS trusts have Electronic Patient Record (EPR) systems, however, 75% remain reliant on paper documentation. The Royal College of Surgeons of England details Good Surgical Practice standards which include clear and accessible operation notes. This audit aimed to measure and improve adherence to these standards in our trust, which uses a mix of paper and EPR systems.

Method

A retrospective analysis was performed on all general surgical procedures performed in Barking, Havering and Redbridge University Hospitals Foundation Trust (BHRUT) from 01 July to 19 July 2023. Data on the type of procedure, availability of the operative note on EPR, and mode of documentation was collected. A decision for early intervention was made, and a re-audit was started prospectively from 16 November 2023.

Results

197 operations were included, with 64% elective, and 36% emergency procedures. 54.8% (n= 108) had operative notes uploaded onto EPR, and 56.4% of these were typed. Following intervention, 126 operations were included in the re-audit, with 63.5% elective and 36.5% emergency procedures. 64.3% (n=81) were uploaded, and 59.3% were typed.

Conclusions

Adherence to national standards for operative documentation were suboptimal. Operative notes were not consistently uploaded onto EPR for accessibility and continuity of care beyond theatre. Early intervention including education of surgical juniors and troubleshooting of IT issues can help bridge the gap caused by the mixed use of paper and EPR systems. Current re-audit data appears promising with regards to improved adherence.
779 "Straight to Test"- Evaluating a Newly Established Cancer Referral Pathway in Weston General Hospital
Authors: Stephanos M , Roberts M , Orchard M
Published: August 2024

Background

Straight-to-test Is a relatively new way to refer suspected cancer patients from the primary care to get tested without being seen in clinic first. However, there is still confusion regarding its regulating guidelines in different NHS trusts. The rationale is that highly suspicious, fit for colonoscopy patients are referred via the pathway to get scoped without the added logistics, wait and costs of being seen in clinic first. This was introduced in Weston General hospital in January 2023.

Aim

Our aim was to audit the effectiveness of the pathway objectively by estimating cancer pickup rate, waiting times and what percentage of all diagnosed bowel cancers it identified, and at what stage.

Method

We collected the data of all patients referred via the pathway since implementation till mid-August 2023, investigated the indications for referrals, the outcomes, and the results of any performed investigations.

Results

Over 8 and half months, 140 patients were referred, with the commonest indication being a Positive FIT test (94, 67%), 99 were accepted and scoped (71%), 9 cancer patients were diagnosed in various stages, 6 of whom were operable. The average referral to endoscopy waiting time was 26 days. The pathway’s pick-up rate was one in 12, and the pathway diagnosed 15% of all bowel cancers presenting to the hospital during that period.

Conclusions

STT is a very promising tool to cut down waiting times and costs associated with cancer diagnosis between primary and secondary care, however, standard guidelines are still needed for better efficiency and performance.
986 Is the NELA Section on the CEPOD Form Completed for General Surgical Patients Upon Emergency Theatre Booking? - a Closed-Loop Audit
Authors: Noor M , Fernandes E , Hirri F , Hunter M , Richardson J
Published: August 2024

Aim

The National Emergency Laparotomy Audit (NELA) mandates the assessment of all emergencies surgical patients for inclusion in its database based on specific criteria. Fulfilment of these criteria prompts the addition of patient details and pertinent clinical information to the NELA database.

Method

In an initial audit, 50 CEPOD forms were retrospectively reviewed to assess the completion of the NELA section. A re-audit involving 40 CEPOD forms was conducted prospectively over a span of 10 days, following interventions aimed at improving NELA completion rates.

Results

The initial audit revealed that only 42.7% of the CEPOD forms completed by the general surgery team included the NELA section, indicating substantial room for improvement. Discussions with junior doctors and nurses highlighted various reasons for non-completion, notably a lack of understanding among newly rotated doctors regarding the significance of NELA. Consequently, interventions were introduced:Formal emails were sent to all surgical junior doctors.Informal discussions were held with surgical junior doctors and nurses.Posters were placed in proximity to where CEPOD forms were collected.

Upon re-audit, the completion rate significantly increased to 87.5%, marking a substantial overall improvement of 44.8%.

Conclusions

Enhancing awareness among doctors and nurses resulted in more than a twofold increase in completion rates. Therefore, it is recommended to discuss about NELA with each new batch of junior doctors at the commencement of their rotations to increase awareness and emphasise the importance of NELA. Moreover, conducting a larger-scale study over an extended period is advised for a more comprehensive evaluation.
1293 Audit of Initial Management of Lower Gastrointestinal Bleeding as per the British Society of Gastroenterology Guidelines
Authors: Gibbs A , Rutherfurd A , Sivakumar N , Zehra S , Zohdy M , Marimuthu K
Published: August 2024

Introduction

Lower gastrointestinal (LGI) bleeding is a frequent presentation to acute surgical teams. It can range in severity from mild to life-threatening, and most commonly presents with haematochezia. This data explores the implementation of the British Society of Gastroenterology’s guidelines at a District General Hospital lacking a management pathway for LGI bleeding.

Method

Data was collected on all patients presenting to the Emergency Department with per rectal (PR) bleeding. This was retrospectively collected from July to August 2023. Data collected included shock index at presentation, details for Oakland Scoring, hospital admission, complications, and follow up.

Results

All minor LGI bleeds (Oakland score of ≤8) were discharged with no readmission within 28 days. In July, four of 45 major bleeds were unstable, with one undergoing CT angiogram, compared to two of 27 in October with one undergoing CT angiogram. Of the 45 major bleeds in July, 32 were admitted (71.1%) and 13 were discharged (28.9 %), 5 without endoscopy. In October, 15 of 27 major bleeds were admitted (55.6%) and 12 discharged (44.4%), all with endoscopy. In July, three patients (23.1%) were re-admitted within 28 days, compared to one patient (8.3%) in October.

Conclusions

Despite integration efforts, there was minimal improvement in Oakland Scoring compliance, with many major LGI patients discharged. Nonetheless, all major bleed patients in cycle 2 had follow-up endoscopy organised and fewer patients were readmitted. This study could be improved upon with improved integration efforts for Oakland Scoring and Shock Index, such as providing the algorithm in a portable online format.
748 Case Report on Anatomical Factors That Increase the Complexity of Septal Myectomy Surgery
Authors: Hampson S , Kassouf M , Springthorpe T , Tully L , Yates M , Rathwell C , Shipolini A
Published: August 2024

Background

Hypertrophic cardiomyopathy (HCM) is the most common heritable cardiac disease characterised by myocardial hypertrophy in the absence of alternative causes. Most HCM patients have left ventricular outflow tract (LVOT) obstruction due to systolic anterior motion of the anterior mitral valve (MV) leaflet and interventricular septum thickening. Septal myectomy coupled with MV repair or replacement can resolve this obstruction.

Case

We present a 42-year-old female referred for septal myectomy and MV intervention. Preoperative investigations revealed significant obstruction, mild aortic regurgitation (AR), pectus excavatum with posterior displacement of the heart and a narrow ascending aorta (2cm in diameter). The latter complicates LVOT access and increases the risk of aortic valve (AV) damage during retraction.

The multidisciplinary team (MDT) decided against replacing the AV and MV due to the patient's young age and warfarin-associated risks. When going on bypass the patient experienced atrial fibrillation and progressed to ventricular fibrillation (VF) following electrical cardioversion.

The procedure was extended due to an unexpected subaortic membrane resection and the need for a maze procedure. Also, post-bypass imaging showed obstruction resolution but worsening of the AR (moderate), which prompted the MDT to opt for an AV replacement.

However, it became apparent that the complexity of her anatomy would require extensive surgery, leading to the decision to not proceed. There was prolonged weaning off bypass the second time because the patient developed persistent VF.

Clinical lessons

In conclusion, a thorough assessment is required by a specialist MDT team to determine the optimal treatment for complex HCM patients.
1302 Chyle Leak as a Cause of Neck Swelling Following a Right Hemithyroidectomy for Multinodular Goitre: A Case Report
Authors: Sarsam T , Kassab N , Watts S
Published: August 2024

Background

Chyle leak (cl) secondary to inadvertent thoracic duct injury (tdi) is an exceptionally rare complication of a right hemithyroidectomy.1 tdi occurs in 0.5-1.4% of patients undergoing a thyroidectomy, 1and of those, only one fourthare attained following right sided neck surgeries,2as the terminal thoracic duct (td) typically terminates in the left side of the neck.3,4,5 anatomical variations of the terminal td are well renowned, and a right sided terminal td has been previously described. 4,6 although a few cases have reported cl following right sided neck dissection, to ourknowledge, this is the first study to describe a cl following a right hemithyroidectomy alone.

Case report

We present a 72-year-old gentleman who was referred to endocrinology with a persistently low t4 on a background of normal tsh. Incidentally, he was found to have a bilateral large thyroid goitre associated with chronic dyspnoea and dysphagia. He was planned for a total thyroidectomy, however, due to intraoperative difficulties, he underwent a right hemithyroidectomy only. Four days later, he re-presented with neck swelling and breathlessness. Re-explorative surgery identified serosanguinous fluid which later tested positive for chylomicrons, confirming a chyle leak, likely from a right sided terminal td. Generally, he demonstrated a good response to conservative treatment.

Conclusions

Complex anatomical variations of the td exist and thus cl should be well-recognised as a differential diagnosis of neck swelling following both left- and right-sided neck surgeries. Head and neck surgeons should consider consenting patients undergoing right sided neck surgeries for a cl.
144 Title: A Repeat Cycle Closed Loop Audit Reviewing Emergency Department Referrals for Nasal Trauma to a Major ENT Centre; Practice Standards for Safe Care
Authors: Kennard B , Bickerton R , Parker-Conway K
Published: August 2024

Background

Facial trauma is a very common presenting complaint In Emergency care, referrals to ENT Emergency clinics (EC) without proper assessment risks complications and unnecessary clinic appointments. Complications that can follow nasal trauma include, septal haematoma, infraorbital nerve trauma and nasal blockage.

Aim

To assess clinical practice when reviewing nasal trauma and provide education and guidance to assist these reviews.

Method

A closed loop 3 cycle audit reviewed the documentation of clinical reviews for patients referred to ENT EC with nasal trauma. Cases were reviewed for assessment of septal haematoma, Infraorbital nerve trauma and airflow symptoms. Data was collected, analysed, and presented at the ED departmental teaching and morning board rounds. Data was then re-audited. A new trust guideline was uploaded to the ED guidance application and data was Re-audited. Each period of data collection covered 31 days.

Results

A total of 137 patients were included. Prior to the first intervention referrals were 26% higher than in both repeat cycles. Documentation of septal haematomas and airflow symptoms improved fractionally, increasing from 79% to 85% and 32% to 33% respectively. Infra-orbital nerve status was reviewed in 5% more patients after implementation of new trust guidelines.

Conclusions

Complications of nasal fractures are poorly assessed. Small improvements can be made with departmental teaching, but these changes will likely be temporary given the high staff turnover in ED. Implementation of clear guidelines can promote lasting change. This study demonstrates the benefit of continued education and pathway development on precision care while reducing burden on outpatient clinics.
1241 Complications in Negative Appendicectomy in Order to Aid Risk- Benefit Counselling: A Single Centre Study
Authors: Buraimoh B , Mohamedahmed A Y , Bhattacharya P , Rout S
Published: August 2024

Background

Acute appendicitis is a common surgical emergency that affects 5.7-50 per 100, 000 a year in developed countries [1]. In the United Kingdom (UK), we have a high negative appendicectomy rate up to 15% [3][4].

Aim

To establish the complication rate of negative appendicectomy in a District General Hospital. To identify the demographics of appendicectomy patients.

Method

A retrospective analysis of patient notes was performed on all patients who underwent an appendicectomy from: 09/01/2021- 22/12/2021.

Results

Patients who underwent an appendicectomy for any indication other than acute appendicitis and patients who had an incomplete set of notes were excluded. A total of 210 patients were included in the study. Of the patients included, 17% underwent a negative appendicectomy (NA) which resulted in 0% post-operative complications at 30 days. These NA patients were comprised of 70% females and 30% males. Positive appendicectomy patients had a complication rate of 8%. Therefore, the overall complication rate was 8%. Mortality rate was 0%. Operative findings differed compared to histology with 27% of all appendix’s appearing normal intra-operatively but 9% of all appendix’s resulting in normal histology. Male patients represented 59.5% of patients and 40.5% were female.

Conclusions

These findings demonstrate that though the NA rate was high, these patients did not have any recorded post-operative complications. Females represent highly in this group in keeping with current literature. The histology findings highlight the importance of clinical diagnosis. This study therefore validates current UK practice of appendicectomy as gold standard management and will aid risk-benefit counselling in prospective patients.
575 Using Artificial Intelligence to Generate Medical Literature for Patients: A Comparison of Three Different Large Language Models
Authors: Pompili D , Richa Y , Collins P , Hennessey D B
Published: August 2024

Aim

Large language models (LLMs) are artificial intelligence (AI) that use deep learning techniques to understand, summarize and generate content. The potential of LLMs in healthcare is predicted to be vast. This study aims to examine the usefulness of LLMs in generating patient information leaflets (PILs).

Method

Prompts were created to generate PILs for 4 topics in urology (circumcision, nephrectomy, overactive bladder syndrome, and transurethral resection of the prostate). Prompts were given to 3 LLMs: ChatGPT-4, PaLM 2 (Google) and Llama-2 (Meta). PILs were evaluated using a validated assessment checklist by blinded reviewers and a 5-point Likert scale. Readability assessments for leaflets were conducted using the Average Reading Level Consensus Calculator.

Results

PaLM 2 had the highest overall average score (3.575), followed by Llama-2 (3.3375) and ChatGPT-4 (3.08). PaLM 2 generated PILs were of the highest quality in all topics except one and was the only AI to include images. Medical accuracy of leaflets was mixed, with all LLMs generating content containing minor errors and some instances of major error. Readability analysis identified PaLM 2 PILs as the easiest to read with an average reading level of age 14-15 (slightly difficult). Llama-2 leaflets were the most difficult with an average reading level of age 16-17 (fairly difficult).

Conclusions

LLMs can generate PILs that will help reduce the workload on healthcare professionals. However, the content generated requires human input for appropriateness and factual content. The content is also generated at a reading age above the average level for adults.