bluuebunny/crossref_metadata_2025 huggingface dataset:
Efficient modeling of double absorber layered structure in perovskite solar cells using machine learning techniques
Authors: Prasanna J Lakshmi , Goel Ekta , Kumar Amarjit
Published: August 2023

This research article investigates the perovskite solar cells double absorber layer structure with 13 different absorber layer combinations. Our primary objective is to explore the potential for achieving high efficiency in perovskite solar cells. We present a double-layer structure for high efficiency, leveraging double absorber layers in perovskite solar cells expands spectral absorption and reduces thermalization losses, thereby enhancing power conversion efficiency and stability. Double absorber layer perovskite solar cells adaptability and integration potential further promise efficiency and reliability advancements. Through a comprehensive examination of all possible combinations of absorber layers we have identified a double absorber layer structure that exhibits an impressive efficiency exceeding 35%. To further enhance our understanding of the underlying factors influencing efficiency, we generated a dataset of 3490 samples. These samples were characterized by 20 input features and four attributes, including the efficiency of the perovskite structure. Leveraging machine learning approach, we developed model using the Random Forest algorithm to predict the efficiency and classify the structures into four distinct classes. Our findings contribute valuable insights into the optimized design of perovskite solar cells, offering a pathway towards achieving higher efficiencies and advancing the field of renewable energy.
Doping impacts of La2O3 on physical, structural, optical and radiation shielding properties of (30-x)BaCO3–30TiO2–40SiO2-xLa2O3 (0 ≤ x ≤ 6) glasses for optoelectronic applications
Authors: Mishra Rajat Kumar , Kumari Savita , Shweta  , Sen Prince , Avinashi Sarvesh Kumar , Fatima Zaireen , Thomas Harel , Ghosh Manasi , Dey Krishna Kishor , Gautam Chandkiram
Published: August 2023

Herein, synthesis of novel barium silicate glasses doped with La2O3 in the system (30-x)BaCO3–30TiO2–40SiO2-xLa2O3, BTSL (0 ≤ x ≤ 6) via fast melt-quenching technique was carried out. Further, to confirm the amorphous behaviour of prepared glass samples, x-ray diffraction (XRD) and field emission scanning electron microscopy (FESEM) were carried out. The density of all prepared glasses was determined using Archimedes’ principle and found to be in an increasing manner. To investigate the doping influence of La2O3 on the glasses, few more physical properties like molar volume (Vm), polaron radius (rp), and field strength (Fs) were also studied and found to be increased due to incorporation of La2O3 into BTSL glassy system. Moreover, to explore the structural, functional, and bonding mechanism of the glasses, FTIR, Raman and 29Si-MAS-ssNMR spectroscopies were performed. Further, to investigate the numerous optical parameters, UV–visible spectroscopy was executed, and energy band gaps were found in the decreasing manner as increasing the La2O3 concentrations. Additionally, to study the optoelectronic properties, refractive indices (η) and optical dielectric constant (ε) were determined and revealed the increasing behaviour and found suitable material for optoelectronic devices. Furthermore, the radiation shielding parameters, mass attenuation coefficient (MAC), linear attenuation coefficient (LAC), etc were determined using Phy-X/PSD software and these parameters are increased owing to the doping of La2O3. Among all fabricated glasses, (30-x)BaCO3–30TiO2−40SiO2−6La2O3, BTS6L glass exhibited outstanding optical and radiation attenuation properties; can be tailored for the fabrication of optoelectronic and radiation protection devices.
Renormalizing one-point probability distribution function for cosmological counts in cells
Authors: Chudaykin Anton , Ivanov Mikhail M. , Sibiryakov Sergey
Published: August 2023

We study the one-point probability
distribution function (PDF) for matter density averaged over
spherical cells. The leading part to the PDF is defined by spherical collapse dynamics, whereas the next-to-leading
part
comes from the integration over fluctuations around the
saddle-point solution. The latter calculation receives sizable
contributions from short modes and must be
renormalized. We propose a new approach to renormalization by
modeling the effective
stress-energy tensor for short perturbations. The model
contains three free parameters. Two of them are related to the
counterterms in the one-loop matter power spectrum and
bispectrum, one more parameterizes their redshift dependence.
This relation can be used to impose priors in fitting the
model to the PDF
data.
We confront the model with
the results of high-resolution N-body
simulations and find excellent agreement for cell radii
 r
* ≥ 10 Mpc/h at all redshifts down to z = 0. Discrepancies at a few
per cent level are detected at low redshifts for r
* ≤
10 Mpc/h and are associated with two-loop corrections to the
model.
Preliminary Study of Photometric Redshifts Based on the Wide Field Survey Telescope
Authors: Liu Yu , Lin Xiao-Zhi , Xue Yong-Quan , Le Huynh Anh N.
Published: August 2023

The Wide Field Survey Telescope (WFST) is a dedicated time-domain multi-band (u,g,r,i, andz) photometric survey facility under construction. In this paper, we present a preliminary study that assesses the quality of photometric redshifts based on WFST by utilizing mock observations derived with the galaxy catalog in the COSMOS/UltraVISTA field. We apply the template fitting technique to estimate photometric redshifts by using the ZEBRA photometric-redshift code and adopting a modified set of adaptive templates. We evaluate the bias (median relative offset between the output photometric redshifts and input redshifts), normalized median absolute deviation (σNMAD) and outlier fraction (foutlier) of photometric redshifts in two typical WFST observational cases, the single 30 s exposure observations (hereafter shallow mode) and co-added 50 minutes exposure observations (hereafter deep mode). We find bias ≲0.006,σNMAD≲ 0.03, andfoutlier≲ 5% in the shallow mode and bias ≈0.005,σNMAD≈ 0.06, andfoutlier≈ 17%–27% in the deep mode, respectively, under various lunar phases. Combining the WFST mock observational data with that from the upcoming CSST and Euclid surveys, we demonstrate that thezphotresults can be significantly improved, withfoutlier≈ 1% andσNMAD≈ 0.02.
Subtype classification of attention deficit hyperactivity disorder with hierarchical binary hypothesis testing framework
Authors: Gao Yuan , Ni Huaqing , Chen Ying , Tang Yibin , Liu Xiaofeng
Published: August 2023

Objective. The diagnosis of attention deficit hyperactivity disorder (ADHD) subtypes is important for the refined treatment of ADHD children. Although automated diagnosis methods based on machine learning are performed with structural and functional magnetic resonance imaging (sMRI and fMRI) data which have full observation of brains, they are not satisfactory with the accuracy of less than

80
%

for the ADHD subtype diagnosis. Approach. To improve the accuracy and obtain the biomarker of ADHD subtypes, we proposed a hierarchical binary hypothesis testing (H-BHT) framework by using brain functional connectivity (FC) as input bio-signals. The framework includes a two-stage procedure with a decision tree strategy and thus becomes suitable for the subtype classification. Also, typical FC is extracted in both two stages of identifying ADHD subtypes. That means the important FC is found out for the subtype recognition. Main results. We apply the proposed H-BHT framework to resting state fMRI datasets from ADHD-200 consortium. The results are achieved with the average accuracy

97.1
%

and an average kappa score 0.947. Discriminative FC between ADHD subtypes is found by comparing the P-values of typical FC. Significance. The proposed framework not only is an effective structure for ADHD subtype classification, but also provides useful reference for multiclass classification of mental disease subtypes.
COVID Protection Behaviors, Mental Health, Risk Perceptions, and Control Beliefs: A Dynamic Temporal Network Analysis of Daily Diary Data
Authors: Jones Christopher M , O’Connor Daryl B , Ferguson Stuart G , Schüz Benjamin
Published: August 2023

Background

To control infections, behavioral non-pharmaceutical interventions (NPIs) such as social distancing and hygiene measures (masking, hand hygiene) were implemented widely during the COVID-19 pandemic. At the same time, adherence to NPIs has also been implied in an increase in mental health problems. However, the designs of many existing studies are often poorly suited to disentangle complex relationships between NPI adherence, mental health symptoms, and health-related cognitions (risk perceptions, control beliefs).

Purpose

To separate between- and temporal within-person associations between mental health, health-related cognitions, and NPI adherence.

Methods

Six-month ecological momentary assessment (EMA) study with six 4-day assessment bouts in 397 German adults. Daily measurement of adherence, mental health symptoms, and cognitions during bouts. We used dynamic temporal network analysis to estimate between-person, as well as contemporaneous and lagged within-person effects for distancing and hygiene NPIs.

Results

Distinct network clusters of mental health, health cognitions, and adherence emerged. Participants with higher control beliefs and higher susceptibility were also more adherent (between-person perspective). Within-person, similar findings emerged, additionally, distancing and loneliness were associated. Lagged findings suggest that better adherence to NPIs was associated with better mental health on subsequent days, whereas higher loneliness was associated with better subsequent hygiene adherence.

Conclusions

Findings suggest no negative impact of NPI adherence on mental health or vice versa, but instead suggest that adherence might improve mental health symptoms. Control beliefs and risk perceptions are important covariates of adherence—both on between-person and within-person level.
55 Outcomes of FDG PET-CT in Surveillance of Residual Nodal Metastases Following Non-Surgical Management of Head and Neck Squamous Cell Carcinoma: A Retrospective Review
Authors: Arun S , Roy R , Doddi M , Davies H
Published: August 2023

Aim

Assessing the role of positron emission tomography-computed tomography (PET-CT) surveillance in detecting residual disease in nodal metastasis, following non-surgical treatment of Head and neck squamous cell carcinoma (HNSCC), such as chemoradiotherapy or radical radiotherapy. To analyse differences in outcomes between HPV positive and HPV negative cancers.

Method

Retrospective analysis of 327 patients in South Wales, with histologically proven HNSCC was conducted. All patients were treated non-surgically and post-treatment PET-CT scans were obtained. Patients with PET-CT showing incomplete responses had further analysis of outcomes assessed via surgical histology of the nodes. Outcomes in patients with p16 positive disease were recorded to determine outcomes in HPV positive individuals.

Results

64 individuals had residual nodal tumours according to PET-CT. 18 out of 43 patients had a negative histology for malignancy, of which 12 showed p16 positive disease. PET-CT showed a false positive in 41.8% of patients, with a positive predictive value of 58%. 225 patients in total were p16 positive, and 38 out of the 64 residual patients had p16 positive disease. There was no significant difference in outcomes between p16 positive and negative patients.

Conclusions

Our study concurs with similar literature, that primary CRT in N2 and N3 nodal metastasis followed by PET-CT surveillance minimises unnecessary neck dissections and triple modality treatment. Further research needs to be conducted however, to determine the efficacy of PET-CT surveillance compared to planned neck dissections. Furthermore, outcomes in p16 positive patients requires additional ongoing research to best determine surveillance techniques and long-term health outcomes.
1093 Opioid Requirements and Predictive Factors for Total Hip and Knee Arthroplasties. a 7-Year Major Trauma Centre Study
Authors: Zhang J , Stevenson A , Lu V , Zhou A , Bradshaw F , Duchniewicz M , Krkovic M
Published: August 2023

Aim

Total knee and hip arthroplasties have prolonged and uncertain pain and rehabilitation timelines, which can be debilitating for patients. In our study, we compare opioid requirements and analyse predictive factors between the two procedures.

Method

All patients undergoing primary total hip (THA) and knee (TKA) arthroplasties from 2015-2022 at a Major Trauma Centre were reviewed. Opioid prescriptions in the first post-operative year were calculated every month up to 6 months and then from the 7th-12th month. Overall prescribed Morphine Milligram Equivalents (MME) “strength” and days with at least one opioid prescription (“coverage”) were calculated. Demographic and comorbidity factors were also included in the multivariate model analysis.

Results

2908 THAs and 2235 TKAs were included. Patients undergoing THAs were younger (68.5 vs 70.2 years-old, p<0.001) and more commonly female (61% vs 58%, p = 0.022) compared to TKA patients. TKAs (843 MME), compared to THAs (614 MME), had significantly higher postoperative opioid strength requirement (p<0.001) and coverage requirement (p<0.001).

On comorbidity analysis, TKAs had the stronger comorbidity predictive value, with strength in the post-operative year being positively associated with heart failure (p = 0.04), kidney disease (p<0.001), connective-tissue disorders (p = 0.009), respiratory disease (p<0.001) and diabetes (p = 0.014). THA strength was associated with rheumatological conditions and diabetes (p<0.01). Both had numerous strong associations for first month opioid coverage requirements.

Conclusions

Our study enables a high-resolution breakdown of the rehabilitation and pain journey of patients undergoing THA and TKA and provides insight to patients and clinicians about factors predisposing to higher pain relief requirements.
1106 Epidemiology and Incidence of Upper Limb Fractures, a UK Level 1 Trauma Centre Perspective
Authors: Zhang J , Stevenson A , Lu V , Zhou A , Bradshaw F , Duchniewicz M , Krkovic M
Published: August 2023

Aim

Understanding the incidence and epidemiology can inform clinicians and policymakers about the needs of the population. There is no recent, large UK-based study on the epidemiology of upper limb fractures. Our study reports on the upper limb fractures treated at a major trauma centre over a 7-year period

Method

We collected data on fracture locations, age, gender, Charlson Comorbidity index (CCI), and treatment options of all upper limb fractures treated at a Level I Trauma Centre from January 2015 to 2022. Humerus, radius, and ulna fractures were each classified as proximal, diaphyseal and distal.

Results

9915 patients sustained 12502 fractures, given an overall incidence of 313 fractures per 100,000 patients per year.

The incidence of fractures per 100,000 patients/year was: Scapula-16.5, clavicle-30.9, humerus-57.5, radius-84.2, ulna-57.0, carpal-9.5, metacarpal-17.2, phalanges-38.8. The mean age and CCI were 48.2 years and 1.72, respectively. 56.4% of patients were male.

All bone fractures distal to the elbow were associated with an age younger than the mean (all p<0.001), with humerus fracture patients having the oldest mean age (54.6). Compared to the mean gender ratio, except for ulna (no association), humerus (55% female) and radius (51% female), all other locations showed significantly higher incidences of males (all p<0.001).

Conclusions

To our knowledge, this represents the first study of this type in the UK since 2006. We sought to elucidate relative incidence and demographic associations with fractures to highlight changing population needs and allow guidelines and services at a regional and national level to operate with up-to-date information.
1128 Outcomes of Early and Late Decompressive Craniectomies in Contrast to Standard Medical Management in Patients with Traumatic Brain Injury with Refractory Intracranial Hypertension: Systematic Review and Meta-Analysis Study
Authors: Minta K , Kaliaperumal C , Shaker T
Published: August 2023

Aim

The meta-analysis explored the effectiveness of early and late decompressive craniectomies versus medical management in patients with refractory intracranial hypertension after sustaining traumatic brain injury. The clinical outcomes analysed were grouped into 2 categories: favourable (good recovery and moderate disability) and unfavourable outcomes (death, vegetative state, and severe disability). Intracranial pressure has been measured post-randomisation in the studies included.

Method

Google Scholar, Cochrane and Medline search engines were utilised for data collection ranging from 1999 until present. The searched keywords encompassed: decompressive craniectomy, refractory intracranial hypertension, medical management, and traumatic brain injury. Thereafter, the data was uploaded to Review Manager for statistical analysis.

Results

Of the 122 articles, 10 randomized controlled trials were included in the meta-analysis. The analysis yielded that relative risk (RR) of overall mortality in decompressive craniectomy group vs medical management is 0.58 95% CI [0.41, 0.81] (P = 0.001). The standardised mean difference (SMD) for intracranial pressure is -2.59 95% CI [-3.72, -1.46] (P < 0.00001) between the two groups. The odds ratio considering favourable outcomes (Glasgow Outcome Scale) for patients undergoing surgery vs medical care is 1.02 95% [0.57, 1.82] (P = 0.95).

Conclusions

This meta-analysis demonstrates that decompressive craniectomy significantly reduces the overall mortality and intracranial pressure in patients with TBI and refractory intracranial hypertension versus medical management. Decompressive craniectomy has a greater potential to treat TBI patients with refractory intracranial hypertension than medical care alone however more randomised clinical trials are needed to ascertain the effectiveness of the superiority of these treatments in the future research.
633 Are Laparoscopic Skills Transferable to Robotic Assisted Surgery? A Systematic Review
Authors: Behera K , Smith L , McKnight G , Coxon A , Horwood J , Cornish J , Davies M , Torkington J , Ansell J
Published: August 2023

Aim

Surgical education programs are being developed to incorporate robotic technical skills training into pre-existing curricula. With limited availability of robotic training platforms, the aim of this paper was to determine if laparoscopic training can facilitate the acquisition of robotic surgical skills.

Method

A search was conducted using PubMed, MEDLINE, Embase and Cochrane databases according to PRISMA guidelines. Original articles evaluating the transferability of laparoscopic skills into robotic surgery were included across multiple surgical specialities. Non-peer reviewed papers, conference s, and single surgeon’s experience were excluded. The primary outcome was skills transfer, secondary outcomes included; the level of participant experience, tasks performed and assessment tools used.

Results

17 papers were included. 9 (53%) showed good evidence for skill transfer from laparoscopic to robotic surgery, 7 (41%) reported no significant difference. 1 (6%) paper demonstrated prior laparoscopic training had a positive impact on robotic skill but this was diminished for senior trainees. The majority of studies compared residents at different stages of training. All papers assessed simulator surgical specific tasks. There was limited standardisation of assessment processes. No papers assessed tasks in real-life surgical practice.

Conclusions

Evidence exists to suggest that laparoscopic skills are transferable to robotic surgery in a simulation environment. This is particularly evident for surgical novices and less so for experienced laparoscopists. This could potentially enable the use of established laparoscopic training as a means of reducing the robotic learning curve. Further work is needed to assess laparoscopic to robotic skills transfer in a real-world setting.
911 How to Design a Low-Cost 3D Printed Laparoscopic Appendicectomy Simulation Model (LaApSi)?
Authors: Karki B B , Katuwal S , Walshaw J , Atkinson C , Satyal S , Loubani M
Published: August 2023

Aim

To develop a Low-cost Laparoscopic Appendicectomy Simulation (LaApSi) Model and to assess its application for surgical simulation in UK & Lower Middle-Income Countries (LMICs).

To ensure a realistic and accurate representation of the anatomy of the appendix and the laparoscopic appendicectomy procedure.

Method

Autodesk Fusion 360 software was used to design the appendix mould which was 3D printed using Ultimaker Tough PLA material. LaTeX material, Reschimica Shore 20 silicon was used & Validity Testing following simulation by HST using Face Validity & Likert 5-Point scale. LaApSi model has been recently used for the Laparoscopic workshop endorsed by RCSEd organised in LMICs and multiple times within the UK (Hull Suture Centre Laparoscopic Courses & East of England Laparoscopic course for Core Surgery).

Results

Successful Development of a local low-cost Appendix model (under £5) vs expensive market models. Prototype testing results & feedback from the users within and outside the UK are very positive and inspiring. The continuous evolvement of the LaApSi models based on the efficacy testing via face validity and Likert 5 Point Testing results has proved to be effective as evidenced by quantitative assessment where the users scored on Model specification shape, size and Texture: 90%, 96%, 92 % resemblance respectively.

Conclusions

The notion of creating low-cost LA simulation models provides a variety of potential benefits for surgical simulation in LMICs and the UK, and it warrants support from the industry and charity. These simulations aid in offering a standardised, affordable, and safe method for surgical training.
778 New Intervention: Transanal Local Excision of Rectal Lesions with CMR Versius Robotic Surgical System
Authors: Behera K , Khoo E , Reddy C , Speake D
Published: August 2023

Introduction

The Versius robotic surgical system (CMR) is a modular robotic platform. Since its launch in clinical practice in 2019 for General Surgical and Gynaecological procedures it has rapidly expanded into other clinical specialties. We describe its implementation and the world's first series of its use for trans-anal resection of significant rectal lesions.

Method

The optimum bedside unit set-up and port placement was determined in an exploratory study using dry and wet-lab models prior to clinical implementation. The early intervention panel at NHS Lothian were consulted prior to introducing the technique into clinical practice. The case series of patients undergoing robotic Trans-Anal Minimally Invasive Surgery (rTAMIS) were prospectively identified and data collected retrospectively.

Results

A total of 12 patients were included in this case series. Data was collected from cases over a 6-month period from December 2021 to June 2022. 8 patients underwent robotic TAMIS using the Versius platform. 2 cases were converted to laparoscopic TAMIS due to external arm clashes. The average length of stay in hospital was 1 day (range 0-3). There was only one Clavien-Dindo grade II morbidity.

Conclusions

The Versius surgical system is a safe and feasible alternative to TEMS and TAMIS. The technique allows access to the rectum with the advantages of enhanced optics and wristed instruments. We have produced a blueprint for optimised bedside unit positioning and port placement enabling resection of anterior, lateral, and posterior rectal lesions without further patient position changes. Further studies are needed for accurate outcome and cost comparisons to TEMS and TAMIS.
840 Digital Consent: Does It Have a Role in the Perioperative Workflow?
Authors: Moore C , Hart P , Loughran D , St John E
Published: August 2023

Aim

Paper consent processes often contain errors of omission, illegibility, and unwarranted variation. Missing paper-consent forms can cause delays, cancellations, and poor theatre efficiency. Digital consent reduces errors, empowers patients in clinical decision discussions and improves patient perception of Shared Decision Making (SDM). This study evaluates the roll-out of the Concentric Health digital consent application in 2022.

Method

Consent episode data was assessed from a one-year period (1st January 2022 - 18th December 2022) using Concentric analytics. Qualitative data was obtained via optional patient satisfaction surveys.

Results

63,024 consent episodes were created during the period, amounting to 51,424 completed consent episodes for 4,021 unique procedures by 1,427 clinicians across 28 specialties from 38 healthcare providers. Of the completed episodes, 36.8% were completed in advance of the day-of-surgery. 22.9% of episodes were remote. Patients were aged 0-103 years, (median 56, IQR 31). Treatment information was shared digitally with 77.7% of patients. The average patient satisfaction rating was 4.6 out of 5 (1 very poor - 5 very good, n = 8359).

Conclusions

Concentric has been introduced into practice across multiple hospitals and clinical environments, with patients reporting high satisfaction scores. Remote consent is feasible, being used by nearly a quarter of patients. Digital consent facilitates consent in advance of the day-of-surgery, giving patients adequate time for consideration and possibly optimising theatre efficiency. Digital consent applications can be considered for adoption across all units to capitalise on these benefits. Further work will investigate demographic effects on satisfaction scores.
570 Utility of Gaze-Control for Real-Time Surgical Training During Minimally Invasive Surgery - a Feasilibility Study of Eye-Tracking Technology
Authors: Le H B T
Published: August 2023

Aim

Training in laparoscopic surgery is limited to observing what the trainee is doing on the screen and reliant on verbal coaching. The idea of a physical pointer onto the screen in real-time to allow for more focused supervision and to improve communication was conceptualised. The study aims to demonstrate the feasibility and identify the challenges of using eye-tracking glasses in producing this digital pointer onto a screen.

Method

Pupil Core (Pupil Labs GmbH) eye-tracking glasses were used to calibrate the edges of a computer monitor to the pupil tracking cameras (200Hz) and the point-of-view (POV) cameras. Utilising the accompanying open-source Pupil Core software, a red-dot cursor was programmed to display in real-time on an accompanying screen. A video of a simulated laparoscopic cholecystectomy and geometric shapes were displayed onto the screen to demonstrate the technology.

Results

A red dot pointer was successfully displayed on a screen as an overlay controlled entirely by gaze. It was able to track the edges of shapes and used to point out anatomical structures in a video in real-time. Despite the tester looking away from the screen and leaving the seated position, the glasses were able to recallibrate automatically and work seamlessly after. The saccadic nature of eye movements meant that the tracing lines were not always smooth.

Conclusions

This study demonstrates that the technology exists to make this feasible. Further optimisation in software design is required to mitigate the effects of saccadic eye movements. Further studies collecting objective data is required to demonstrate a minimum viable product.
1232 Case Study "Forging a Better Future": A Ground-Breaking Student-Led EDI Curriculum at the University of Oxford
Authors: de Luca e Tuma R , Ali S
Published: August 2023

This case-study will critically analyse the novel EDI curriculum at the Oxford Medical School, including feedback from participating students and facilitators. The curriculum launched in 2020, designed and delivered with the help of students, who advocated for its creation.

The curriculum includes lectures on medical history, ally-ship, ontology, and needs of different minority groups. One of its cornerstones is group-based case discussions, where students discuss how to approach clinical scenarios of discrimination and injustice. Surveys were circulated between all participants (Years 1, 2, Graduate-Entry 1, 4(GE2) and 6(GE4)) from 2020 to 2023; as well as the doctors and students who mediated discussions in 2022-3. These were analysed in conjunction with testimonials from the curriculum's creators.

199 surveys were analysed, and responses were overwhelmingly positive. Average agreement with the statement “Overall, this session was beneficial to my training as a medical student and a future doctor” was 4.48/5; and 4.06/5 with “I feel empowered to challenge acts of harassment or discrimination in clinical settings.” Feedback from facilitators suggest that they also benefit from these discussions. Areas indicated for improvement included length of sessions, and better weaving with wider curriculum.

The experience of a stand-alone EDI curriculum at the University of Oxford yielded positive results. This case-study shows there is great appetite from students to create space to learn more about and discuss these topics. As EDI becomes an increasingly recognised need, universities can share their successes and challenges, working together to create doctors better prepared to handle these issues.
849 Quality Improvement in the Service Delivery of Early Laparoscopic Cholecystectomy (LC) for Acute Cholecystitis (AC)
Authors: Ibrahim M A H , Tsai A Y C , Campbell M , Patel S , Sunny R , Frith D , Tsironis C
Published: August 2023

Aim

Acute gallstone disease comprises 30-40% of emergency general surgery workload. Delayed cholecystectomy is related to increased readmissions, biliary complications, and costs. BSG, AUGIS and NICE guideline advocate early Laparoscopic Cholecystectomy (LC).

The aim of this Quality Improvement (QI) project is to establish an early LC service in a tertiary hospital in central London, based on national QI Collaborative led by Royal College of Surgeons (RCS). The objectives are assessing existing management, developing strategies, and measuring outcome.

Method

The management was evaluated including surgeons’ preferences and operating barriers. Strategies were developed through process mapping and stakeholder engagements. Following the implementation, admissions including time to surgery, and reasons for non-compliance, were recorded. The intervention period was set in 4 phases between September 2019 and November 2020: Plan, Improve, Pause and Restart. The sustainability of change was monitored between January 2021 and October 2022.

Results

282 AC cases were admitted during intervention period and 68% (194) were fit and consented for surgery. The rate of early LC within 8 days increased from 11% to 61%. During the “pause” phase, the intervention was stopped, and early LC rate dropped to zero, demonstrating the importance of continuous application of strategy. The sustainability was shown during the monitoring period; 343 cases were admitted, 140 (41%) fit for surgery, 62 had surgery within 8 days (43%), and 77 within 14 days (54%).

Conclusions

The QI study significantly improved the urgent LC rate and received the RCS prize. Sustainability was demonstrated with continual reviews and adaptations.
113 Does Robotic Anterior Resection Improve the Outcomes for Patients with Rectal Cancer Over Standard Laparoscopic Surgery?
Authors: Nwabueze M , McPherson S
Published: August 2023

Background

Currently, laparoscopic anterior resection (L-AR) is the standard approach for rectal cancer (RC) treatment. Increasingly, AR procedures have been conducted robotically using the Da Vinci Surgical System (DVSS).

Its design has the potential to improve upon the operative outcomes of L-AR. However, the DVSS’s controversial price of $2,000,000 has slowed its clinical adoption. There has been speculation as to whether the clinical outcomes conferred by robotic-assisted AR (R-AR) merits the cost of the DVSS.

Aim

To review the literature on R-AR and L-AR surgery for RC, primarily comparing the clinical outcomes of each approach, with an auxiliary evaluation of cost-effectiveness.

Method

A literature search was performed using the databases OVID Embase, MedLine, and Web of Science. The keywords ‘anterior resection’, ‘rectal neoplasm’, ‘robotics’, ‘robotic surgical procedures’, and ‘laparoscopy’ were entered into each database.

141 records were initially retrieved and screened for relevance. The remaining texts that were fully available and adhered to the eligibility criteria were included in this review.

Results

Ten studies were identified. R-AR resulted in higher quality TME specimens in three studies, (p = 0.02, 0.03, 0.033). and in shorter hospital stays and longer operative times in four studies: (p = 0.03, 0.0001<, 0.001<, 0.001). Overall, R-AR had lower rates of intraoperative complications.

Conclusions

Generally, R-AR seemed to deliver better outcomes, but there is insufficient evidence to establish its superiority over L-AR. Longitudinal studies with extended research periods are required to evaluate the long-term oncological benefits of R-AR.
992 Pioneering Robot-Assisted Spine Surgery in the United Kingdom
Authors: Saha P , Lui D
Published: August 2023

Aim

The placement of a large interbody implant allows for a larger fusion area. Retroperitoneal approaches, like anterior, antero-lateral, and lateral fusion, facilitate the placement of these implants. At the same time, robot-navigation facilitate complex, minimally invasive spine surgery for posterior screw fixation. This is a single-surgeon, single-centre report on the experience of the first procedures ever performed for navigated robot-assisted spine surgery in the United Kingdom.

Method

Between October 2019 and May 2021, we identified 34 consecutive patients who underwent robot-assisted spine surgery. The demographic, intra-operative, and peri-operative data were reviewed.

Results

Of the 34 patients, 65 levels were treated in total (204 screws). 21 patients (60%) underwent single-level fixation, 14 of them (67%) were treated at the L5/S1 level, 3 at L3/L4, 3 at L4/L5 and 1 at L2/L3 level, 13 patients (40%) underwent multi-level fixation, with 4 of them treated for adult scoliosis. Eight patients underwent a supine ALALIF approach and one a lateral decubitus AL-ALIF, 7 had a pure ALIF approach, 8 patients underwent combined XLIF and AL-ALIF approach in a lateral decubitus, 6 underwent pure XLIF approach, 1 patient had previous TLIF surgery, and 3 patients underwent single position lateral surgery (lateral decubitus fusion and posterior screw fixation).

Conclusions

Minimally invasive spine surgery using robot-assisted navigation yields an improved level of accuracy, decreased radiation exposure, minimal muscle disruption, decreased blood loss, shorter operating theatre time, length of stay, and lower complication rates. Further follow-up of the patients treated will help compare the clinical outcomes with other techniques.
1170 An Experience of Arranging the UK’s First Free Robotic Surgery Workshop for Medical Students and Doctors Early in Their Careers
Authors: Ullah F , Seabrook M , Brahmbhatt K , Tyson N , Knifton H , Guy J , Melemenis A , Khan S , Sangal S
Published: August 2023

Aim

Training opportunities for Robotic Surgery training are very competitive and expensive in the era of parallel training with consultants also in a learning phase. We share our experience of providing a free Robotic Surgery workshop to medical students and junior doctors under the umbrella of Association of Surgeons in training (ASiT).

Method

The course was organised as a collaboration between ASiT and Intuitive Surgical at Leicester General Hospital Educational centre. Dedicated opportunities were designed for device training, theory, and DaVinci XI console and simulator stations. Training was provided by a Robotic Surgery Fellow and Technical team from Intuitive on voluntary basis. No fees were charged for the course.

Results

48 Delegates applied for registration. 23 were shortlisted into four groups. 13 medical students and 10 doctors were in attendance. Each Delegate was provided a dedicated time of at least 20 minutes on each station. Delegates had an opportunity to use the Console and Simulator for training exercises. Feedback from the course was resoundingly positive. To our knowledge this was the 1st free Robotic Surgery course in UK providing hands on experience to medical students and junior doctors.

Conclusions

Our experience of organizing a “Free Robotic Surgery Workshop” may be utilised nationally to increase training opportunities for medical students and junior doctors.
745 The Effect of 3D Versus 2D Training Models in Laparoscopic Skills Acquisition: A Randomised Controlled Trial of Novice Medical Students
Authors: Alampritis G , Rossou C , Patel B
Published: August 2023

Aim

Determining whether the effect of laparoscopic technical skills acquisition will be superior with the use of low-fidelity 3D training models with contours compared to flat, 2D LapPass training models in novice medical students.

Method

This was a prospective, single-centre, two-arm, randomised controlled trial. Participants were randomised equally into either 3D or 2D group and performed two standardised laparoscopic tasks: (1) grasping and manipulation and (2) intracorporeal suturing on separate days. Performance was based on the GOALS tool, completion time and number of errors via 3 assessments (baseline, interim and post-training) each session. A post-study survey was used to measure participant-perceived confidence and performance.

Results

Sixty-two participants completed the study from April to June 2022. The two groups were homogenous regarding demographic data (p>0.05). Both groups had significantly superior performance post-training compared to baseline in the two tasks via the intra-group comparison (p<0.017). In the inter-group comparison, the 3D group had statistically significantly greater improvements in GOALS score parameter and depth perception domain in all comparisons in the two tasks (p<0.05). The time improvement and error reduction also favoured the 3D group. In the post-study survey, the 3D group reported significantly greater perceived post-training confidence and performance in the suturing task only (p<0.05).

Conclusions

The 3D training models resulted in a superior laparoscopic skills acquisition for novices in two tasks compared to 2D LapPass training models and should be incorporated into laparoscopic training curricula. Further work should focus on their long-term efficacy on a competency-based endpoint.
1044 Feasibility of Anterior Abdominal Wall Hernia (Excluding Groin Hernia) Repair Under Local Anaesthetic
Authors: Naseer A , Elkorety M , Tan J , Rajput A , Bhatti T
Published: August 2023

Aim

Abdominal wall herniae (AWH) are usually performed under general anaesthetic, with limited literature on repair under local anaesthetic (LA). Local anaesthetic procedures may require higher surgical expertise which may compromise learning opportunities for trainees. We aim to explore the feasibility of performing AWH repairs under LA by evaluating patient satisfaction, impact on training opportunities and resource implications.

Method

Consecutive patients were counselled for AWH repair under LA and informed consent was obtained, with no exclusions based on BMI, type and size of the hernia. Surgery was performed by a trainee under supervision or a consultant. Ease of agreement to have surgery under LA, apprehension, pain and overall satisfaction with the procedure were assessed using a five-point Likert scale. Procedure duration and time to discharge were compared with the conventional general anesthetic procedures within the unit.

Results

Twenty patients underwent day-case AWH repair under LA. All patients agreed to surgery under LA. Nineteen (95%) patients reported no pain or apprehension during the procedure. Eighteen (90%) were happy or satisfied with the overall experience. Sixteen (80%) procedures were performed by a trainee. There was a median of 23 minutes less for theatre time and 62 min less for recovery time with LA. No postoperative problems were reported.

Conclusions

It is feasible to treat majority of abdominal wall herniae under LA, with high overall patient satisfaction, without compromising training opportunities. There are potential cost-savings by reduced theatre and recovery time utilization.
970 A Parisian Pain in the Groin; a Case of De Garengeot’s Hernia
Authors: Crompton R , McGuigan A , Neill A
Published: August 2023

Introduction

77-year-old gentleman presented with a four-day history of a painful right sided irreducible groin swelling. Background of previous bilateral mesh inguinal hernia repair thirty years prior. Differential diagnosis- recurrent incarcerated inguinal hernia.

Description

Emergency presentation with a painful right sided groin lump with history of previous inguinal hernia repair. Past medical history of AF on rivaroxaban, HTN and BPH. Patient systemically well with an irreducible lump in the right groin. CTAP showed recurrence of hernia in right inguinal region containing fat stranding and a 2cm-sized fluid-filled structure (suspected appendix). Taken to theatre the following day - oblique incision in right groin. Obvious femoral hernia identified. Haemorrhagic fluid and a necrotic appendix contained in hernia sac. Open appendicectomy performed through groin incision and femoral canal plicated using 2.0 prolene. No mesh used due to risk of contamination. Discharged day 2 post-op. Pathology confirmed acute appendicitis.

Discussion

Extremely rare case presentation. Femoral hernias account for 3% of all hernias and De Garengeot hernias only 1% of all femoral hernias. Furthermore, De Garengeot hernia with acute appendicitis accounts for only 0.01% of femoral hernias and are much more common in females than males with a 4:1 ratio. Femoral hernias are fifteen times more common in patients who have undergone previous inguinal hernia repair with 33% of men and 4% of women with De Garengeot hernia having undergone previous right inguinal hernia repair. Difficult pre-operative diagnosis given rarity with only 30% of cases diagnosed on pre-operative imaging-initial diagnosis Amyand hernia on CT imaging.
559 Hybrid Anatomy Teaching Sessions: A New Normal?
Authors: Nelson-Rowe E , Baskaran R , Mahesh S
Published: August 2023

Aim

To evaluate the synchronous provision of hybrid teaching for a near-peer surgical anatomy teaching programme.

Method

A monthly hybrid anatomy teaching programme was delivered with an attendee choice of either online via Zoom or in-person in a lecture theatre. The teaching, delivered by clinical medical students, covered core regional anatomy with clinical surgical relevance. Attendees provided anonymous feedback via a post-session questionnaire which contained five likert-scale questions and one open-ended question to explore the attendees’ preference and reasoning for their attendance choice. The data was analysed using Microsoft Excel.

Results

A total of 45 participants attended in-person and 90 participants online across four teaching sessions. Majority of the participants were pre-clinical medical students. Likert scale analysis showed that ∼88% of participants found the session content helpful in addition to an increase in subject confidence by ∼25% across all sessions. Thematic analysis demonstrates in-person sessions as being more sociable, interactive with the ease to ask questions and pay attention, plus appreciation of provided refreshments. Online sessions are shown to be more convenient and practically accessible to students. The strongest theme highlighted was the ability to choose whether to attend in-person or online.

Conclusions

A mixed-model approach to surgical anatomy teaching serves to be beneficial to students. While both in-person and online teaching have their merits, the ability to choose between the two serves as the strongest factor among students in attending teaching. Future teaching sessions should be conducted with a mixed-model approach with added in-person incentives for students.
4 A Quantitative Image Analysis Study of Modified Kessler Extensor Repair
Authors: Kathiravelupillai A , Smith C , Pearl R
Published: August 2023

Aim

The aims of this study were to compare and measure the amount of 4.0 Prolene suture material at the tendon repair site with 2 types of knot placement in a modified Kessler technique, as placement of suture knot can impact extensor tendon healing.

Method

Thirty-two extensor tendons of 2 fresh frozen cadaveric hands were divided and repaired using the modified Kessler technique with either intratendinous or extratendinous knot placement of a 4.0 Prolene suture. Tendon repairs were sectioned, and cross-sectional photographs were analysed using quantitative image analysis.

Results

Comparison of percentage change in tendon dimension surface area showed no significant difference (p = 0.4750) between intratendinous and extratendinous knot placement to demonstrate consistency of repair. Quantitative image analysis revealed suture material occupied a significantly (p = 0.0103) larger percentage of tendon cross sectional area in intratendinous than extratendinous knot placement. In both groups this represented <10% of the total cross-sectional area of the tendon at the repair site (7.49% vs 2.92%). There was no significant relation between digit, tendon or repair zone and percentage of repair zone occupied by suture material.

Conclusions

Intratendinous knot placement occupies a larger proportion of tendon cross sectional area than extratendinous knot placement, though this is still comparatively small when a 4’0 monofilament suture is used.
23 Pancreatoduodenectomy for Malignancy: Which Patients Are High-Risk?
Authors: Russell T , Labib P ,   RAW Study Collaborators, Aroori S
Published: August 2023

Aim

In the absence of metastases, pancreatoduodenectomy (PD) is indicated in fit patients with a resectable pancreatic head/periampullary cancer. Surgeons should have a sound understanding of its complication profile for consenting purposes and to benchmark their complication rates. This study aimed to calculate the overall incidence of PD complications and identify risk factors.

Method

A multicentre retrospective cohort study of PD patients with confirmed malignancy was conducted (29 centres from 8 countries). The incidence and severity of all recorded complications was calculated. Patients who experienced any complication, major morbidity, clinically relevant postoperative pancreatic fistula (CR-POPF), post-pancreatectomy haemorrhage (PPH) and 90-day mortality were compared to those who did not experience these outcomes.

Results

In the 1348 included patients, overall morbidity and 90-day mortality were 53% and 4%, respectively. In total, 1340 complications were recorded; 72%, 18%, 6% and 4% of these were Clavien-Dindo (CD) grades I-II, III, IV and V, respectively. CR-POPF, PPH, chyle leak, bile leak and gastro-jejunal leak affected 8%, 6%, 4%, 3% and 2% of patients, respectively. Following a multivariable analysis, high body mass index (BMI, p = 0.007), American Society of Anesthesiologists (ASA) grade >II (p<0.0001) and a pylorus-resecting approach (p = 0.005) correlated with overall morbidity. In addition, ASA grade >II patients were at increased risk of major morbidity (p<0.0001) and a raised BMI correlated with CR-POPF (p = 0.001).

Conclusions

In our study, over 50% of PD patients experienced morbidity. However, most complications were CD grade I-II. High BMI, ASA grade >II and a pylorus-resecting approach were all associated with the studied adverse outcomes.