bluuebunny/crossref_metadata_2025 huggingface dataset:
No-tillage farming enhances widespread nitrate leaching in the US Midwest
Authors: Huang Yawen , Ren Wei , Lindsey Laura E , Wang Lixin , Hui Dafeng , Tao Bo , Jacinthe Pierre-Andre , Tian Hanqin
Published: August 2024

Conservation tillage has been promoted as an effective practice to preserve soil health and enhance agroecosystem services. Changes in tillage intensity have a profound impact on soil nitrogen cycling, yet their influence on nitrate losses at large spatiotemporal scales remains uncertain. This study examined the effects of tillage intensity on soil nitrate losses in the US Midwest from 1979–2018 using field data synthesis and process-based agroecosystem modeling approaches. Our results revealed that no-tillage (NT) or reduced tillage intensity (RTI) decreased nitrate runoff but increased nitrate leaching compared to conventional tillage. These trade-offs were largely caused by altered water fluxes, which elevated total nitrate losses. The structural equation model suggested that precipitation had more pronounced effects on nitrate leaching and runoff than soil properties (i.e. texture, pH, and bulk density). Reduction in nitrate runoff under NT or RTI was negatively correlated with precipitation, and the increased nitrate leaching was positively associated with soil bulk density. We further explored the combined effects of NT or RTI and winter cover crops and found that incorporating winter cover crops into NT systems effectively reduced nitrate runoff but did not significantly affect nitrate leaching. Our findings underscore the precautions of implementing NT or RTI to promote sustainable agriculture under changing climate conditions. This study provides valuable insights into the complex relationship between tillage intensity and nitrate loss pathways, contributing to informed decision-making in climate-smart agriculture.
Unveiling the role of past vapor pressure deficit through soil moisture in driving tropical vegetation productivity
Authors: Verma Akash , Ghosh Subimal
Published: August 2024

The impact of soil moisture (SM) and vapor pressure deficit (VPD) on gross primary productivity (GPP) variability in ecosystems is a topic of significant interest. Previous studies have predominantly focused on real-time associations between SM, VPD, and carbon uptake, attributing SM as the principal driver of GPP variability due to its direct and indirect effects through VPD. Using an information theory-based process network approach, we discovered that the influence of past VPD, mediated through its effects on SM, emerges as the primary driver of GPP variability across tropical regions. The past VPD conditions influence GPP directly and also affect SM in real-time alongside GPP, which subsequently impacts GPP variability. Examining land-atmosphere feedback using information theory reveals that past VPD conditions influence SM, but not the reverse. These causal structures explain the consistent decline in GPP with increasing VPD trends observed in tropical regions, which are not consistent with SM trends. Our findings emphasize the importance of considering the influence of past VPD mediated by SM when analyzing complex land-vegetation-atmosphere interactions.
Indian Ocean Dipole (IOD) forecasts based on convolutional neural network with sea level pressure precursor
Authors: Tao Yuqi , Qiu Chunhua , Wang Dongxiao , Li Mingting , Zhang Guangli
Published: August 2024

Forecasting the Indian Ocean Dipole (IOD) is crucial because of its significant impact on regional and global climates. While traditional dynamic and empirical models suffer from systematic errors due to nonlinear processes, convolutional neural networks (CNN) are nonlinear in nature and have demonstrated remarkable El Niño Southern Oscillation (ENSO) and IOD forecasting skills based on oceanic predictors, particularly sea surface temperature and heat content. However, it is difficult to measure heat content and easily introduces uncertainties, prompting the need to explore atmospheric predictors for IOD forecasts. Based on sensitivity prediction experiments, we identified the sea level pressure (SLP) signal as a crucial predictor, which forecasts IOD at a 7 month lead. In addition, the CNN model improves monthly forecasting accuracy while reducing errors by 13.43%. Utilizing the heatmap analysis, we elucidated that the multi-seasonal predictability of the IOD primarily originates from mid-latitude climate variability. Besides ENSO signals in the Pacific Ocean, our study highlights the significant impact of remote climate forcing in the South Indian Ocean, tropical North Indian Ocean, and Northwest Pacific Ocean on IOD forecasts. By introducing the SLP precursor and extratropical zones into IOD forecasts, our study offers fresh insights into the underlying dynamics of IOD evolution.
Scaling of entangling-gate errors in large ion crystals
Authors: He Wenhao , Zhang Wenhao , Yuan Xiao , Shen Yangchao , Zhang Xiao-Ming
Published: August 2024

Trapped-ion has shown great advantages in building quantum computers. While high fidelity entangling-gate has been realized for a few ions, how to maintain the high fidelity for large scale trapped-ions remains an open problem. Here, we present an analysis of arbitrary scale ion chains and focus on motional-related errors, reported as one of the leading error sources in state-of-the-art experiments. We theoretically analyze two-qubit entangling-gate infidelity in a large ion crystal under the phase insensitive configuration. To verify our result, we develop an efficient numerical simulation algorithm that avoids exponential increases in of the Hilbert space dimension. For the motional heating error, we derive a much tighter bound of gate infidelity than previously estimated

O
(
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, and we give an intuitive understanding from the trajectories in the phase space of motional modes. Our discoveries may inspire the scheme of pulse design against incoherent errors and shed light on the way toward constructing scalable quantum computers with large ion crystals.
Quality Ecoprint Results of Teak Flowers and Leaves (Tectona Grandis) on Blacu and Tencel Fabrics with Tingi Natural Dyes
Authors: Wahyuningsih S E , Atika  , Putri N A R
Published: August 2024

The results of the descriptive analysis show that on the calico fabric, the color direction of the teak flower motif leads to a yellow-orange color with the name putty, and the teak leaf motif leads to a gray-red color with the name light wood. Then on the calico fabric, the results were reviewed from the aspect of color fastness to washing the ecoprint flower and teak leaf motif soap, obtaining an average value of 4.50 with good criteria. On the tencel, the teak flower motif leads to a gray-yellow color with the name New Orleans, and the teak leaf motif leads to a gray-red color with the name bazaar. The conclusion of the study is that the quality of the ecoprint motifs of teak flowers and leaves on calico and tencel fabrics has a gray-yellow-red color direction with the result that the color fastness to soap washing is 4-4.5 with good criteria. The suggestion from this study is that you can make a teak leaf ecoprint motif on tencel fabric properly so that the fastness obtained is the same as the teak flower ecoprint motif, one of which is by increasing the fixation with alum mordant so that the solution absorbs more into the fabric.
Structural Health Monitoring at Single-span Prestressed Concrete Girder Bridge by Ambient Vibration Measurement and Identification Modal Frequency
Authors: Kusumawardani Rini , Kusbiantoro Arief , Nugroho Untoro , Prasetya Azizah Kirana
Published: August 2024

The periodic bridge maintenance is very prominent to be done to ascertain the actual condition of the structure. With the result that it can be ensured that the bridge structure can provide comfortable and safe services. Another objective that can be obtained is that the bridge structure can reach the service life as planned. To discover the condition of the bridge can be done visually or by using certain sensors which are now widely used. This study will discuss the identification of modal frequency at single-span pre-stressed concrete girder bridges using the peak picking method. Modal frequency as part of the dynamic properties of a structure will be used to find out the current and future condition of the structure. The first step is to collect vibration data using a velocity meter. The next stage is to analyze field data using the peak picking method to obtain frequency capital. From the field data analysis, it was found that the vibration frequency is 3.163 Hz as the fundamental frequency of the Kalipancur bridge structure, Semarang. Frequency data equipped with updated finite element model can be used to monitor the condition of the bridge structure in the future.
Optimization and Feasibility Analysis of Rooftop Solar Photovoltaic (PV) Power Generation System Design
Authors: Amini Khalifatun Nisa , Ridwan Mohammad Kholid , Wilopo Wahyu
Published: August 2024

The increasing global electricity demand, propelled by population growth and economic progress, presents a pressing challenge. Magelang Regency has witnessed a consistent rise in its population, resulting in a corresponding surge in the demand for electric energy. In response, this study delves into the sustainable development endeavors of Magelang Regency, with the goal of achieving accessible, reliable, and sustainable energy for its populace. Focused on designing and assessing the viability of rooftop solar photovoltaic (PV) power generation systems, this research centers on the Dinas Pendidikan dan Kebudayaan (Disdikbud) Kabupaten Magelang, a significant consumer of electricity. Data processing employed the PVSyst software, exploring four distinct design configurations. Notably, the findings reveal that a hybrid configuration employing a Central Inverter showcases optimal performance, yielding the highest annual energy production and solar fraction. These outcomes underscore the potential of rooftop solar PV systems in diminishing energy dependency, curbing costs, and aligning with sustainable development objectives. This study offers valuable insights into the pivotal role of embracing renewable energy sources to address escalating energy needs and environmental imperatives.
Optimized PI Control Design for Balancing Bicopter using Multi-Criteria Crow Search Algorithm
Authors: Apriaskar Esa , Prastiyanto Dhidik , Manaf Akhyar Abdillah , Maulana Muhammad Ahnaf , Nurhakim Rasyid Muhammad
Published: August 2024

The multi-criteria crow search algorithm proposed in this paper is a novel optimization method designed to address the control and stability challenges faced by bicopter systems. Bicopters, unmanned aerial vehicles with two rotors to use energy more efficiently, require precise control to maintain balance and maneuverability. This optimization approach leverages the Crow Search Algorithm (CSA) and aims to achieve a balanced control system for bicopters while considering multiple objectives simultaneously. The key goal of this approach is to optimize the PI control parameters employed in the bicopter system to enhance stability and maneuverability, represented by settling time and overshoot in transient response. Through a combination of exploration and exploitation, the algorithm searches for an optimal set of control parameters that satisfies these criteria, striking a better control system that can benefit from improved stability and maneuverability. As shown from the experiment, this algorithm offers a promising avenue for designing control strategies that address the inherent challenges of bicopter systems, especially after being compared to the existing approaches.
Evaluation of Road Functional Performance Using Pavement Condition Index (PCI) and International Roughness Index (IRI) Methods Using Hawkeye (Case Study: Demak Ring Road, Central Java Province)
Authors: Kartika Novianti P , Setyawan Ary , Pramesti F Pungky
Published: August 2024

The condition of the road pavement can be judged from the functional performance by measuring the surface condition of the pavement and the value of surface roughness. Pavement surface condition measurements are usually carried out using the Pavement Condition Index (PCI) survey method. While the measurement of surface roughness values is usually carried out with the Roughness survey method so that the International Roughness Index (IRI) is obtained. This study tries to evaluate the value of a pavement condition by reviewing functional performance to identify the value of the pavement condition. Checking road conditions in this study was carried out using two survey methods, namely the International Roughness Index (IRI) method, the Pavement Condition Index (PCI) method. The results of the examination are analyzed so that the correlation between each method can be known. The results of the study explained that based on the results of observations of the functional condition of road pavements with the Pavement Condition Index (PCI) method using the Hawkeye 2000 tool on the Demak Ring Road section, a PCI value of 65.34 was obtained with the “Fair” category, the functional condition of the road pavement with the International Roughness Index (IRI) method of the Hawkeye 2000 tool on the Demak Ring Road section obtained a IRI value of 6.60 with the category “Medium”, and the correlation of the functional condition of road work using the Pavement Condition Index (PCI) method with the International Roughness Index (IRI) on the Demak Ring Road section has no correlation.
Regional Typology in Central Java: Urban and Rural Relation based on Cluster Analysis
Authors: Rahadini A
Published: August 2024

Urbanization and industrialization are an initial indication of the growth and expansion of urban areas to rural area. This article provides an overview of rural-urban transformation in Central Java based on population, economic and socio-politic variables. This study is part of research about regional disparity in Central Java. The aim of the study is to observe the regional typology in Central Java in two different period. The analysis departs form the concept of growth pole. The concept argues that the development of cities as the urban area is expected naturally spread to the hinterland or rural areas. Urban area is the center of regional growth process. Rural-urban transformation is designated by the decrease of agricultural sector and the increase of population in some rural region. Industrialization is referred to the transition from agriculture to manufacturing and has been assumed as progress or modernization. Cluster analysis is a multivariate statistical method for classifying objects according to their related qualities. This clustering was applied to perform the most likely cluster in Central Java using several variables at once. This study uses data from 2010 and 2020 to compare the evolution of typology. However, during the pandemic period in 2020, even most region occurred negative growth, the urban interconnectivity was established as before. The result displays in two clusters solution. Both clusters describe that the typology was established from two different methods. The first method is described as urban growth process which the industrialization comes from higher region to its surroundings (Semarang-Surakarta) and it generates corridor pattern. The second method could be interpreted as the growth process coming from the lower region (e.g., Kudus and Cilacap), where change may occur distant from the urban area.
Planning with tensor networks based on active inference
Authors: Wauthier Samuel T , Verbelen Tim , Dhoedt Bart , Vanhecke Bram
Published: August 2024

Tensor networks (TNs) have seen an increase in applications in recent years. While they were originally developed to model many-body quantum systems, their usage has expanded into the field of machine learning. This work adds to the growing range of applications by focusing on planning by combining the generative modeling capabilities of matrix product states and the action selection algorithm provided by active inference. Their ability to deal with the curse of dimensionality, to represent probability distributions, and to dynamically discover hidden variables make matrix product states specifically an interesting choice to use as the generative model in active inference, which relies on ‘beliefs’ about hidden states within an environment. We evaluate our method on the T-maze and Frozen Lake environments, and show that the TN-based agent acts Bayes optimally as expected under active inference.
synphage: a pipeline for phage genome synteny graphics focused on gene conservation
Authors: Grosboillot Virginie , Dragoš Anna
Published: August 2024

Motivation

Visualization and comparison of genome maps of bacteriophages can be very effective, but none of the tools available on the market allow visualization of gene conservation between multiple sequences at a glance. In addition, most bioinformatic tools running locally are command line only, making them hard to setup, debug, and monitor.

Results

To address these motivations, we developed synphage, an easy-to-use and intuitive tool to generate synteny diagrams from GenBank files. This software has a user-friendly interface and uses metadata to monitor the progress and success of the data transformation process. The output plot features colour-coded genes according to their degree of conservation among the group of displayed sequences. The strength of synphage lies also in its modularity and the ability to generate multiple plots with different configurations without having to re-process all the data. In conclusion, synphage reduces the bioinformatic workload of users and allows them to focus on analysis, the most impactful area of their work.

Availability and implementation

The synphage tool is implemented in the Python language and is available from the GitHub repository at https://github.com/vestalisvirginis/synphage. This software is released under an Apache-2.0 licence. A PyPI synphage package is available at https://pypi.org/project/synphage/ and a containerized version is available at https://hub.docker.com/r/vestalisvirginis/synphage. Contributions to the software are welcome whether it is reporting a bug or proposing new features and the contribution guidelines are available at https://github.com/vestalisvirginis/synphage/blob/main/CONTRIBUTING.md.
357 An Audit of Quality of Discharge Summaries in Cardiac Surgery
Authors: Sogandji N , Ali J
Published: August 2024

Aim

We performed a single-centre closed loop audit assessing the completeness and quality of e-discharge summaries following cardiac surgery against local standards.

Method

The e-discharge summaries of patients who underwent cardiac surgery form 1/08/2023 to 10/08/2023 were audited against the standards set by the local hospital’s e-discharge summary template. Results and recommendations were shared at a team meeting of the hospital, and on a poster displayed in the MDT office. The same data was then collected for patients who underwent cardiac surgery from 25/10/2023 to 6/11/2023.

Results

110 patients were included across 2 cycles. Of 16 domains of interest, 5 were complete in 100% of e-discharge summaries in the first cycle, increasing to 7 in the second. The proportion of summaries with the ‘reason for admission’ misplaced in the clinical summary instead of the allocated field decreased from 43% to 40%, while proportion of GP requests with the reasoning in the allocated box rose from 55% to 57%.For those with no requests to the GP, this was initially specified in the mandatory field as N/A or equivalent in 23% rising to 48% in cycle two, whereas for those who had no ECHOs during the admission, this was specified in 20% initially, rising to 27%. The proportion avoiding acronym use decreased from 17% to 15%.

Conclusions

Even though compliance improved between the two cycles, the standard of 100% was not met for most criteria. Further team education and revision of the template itself is required to allow information reporting in a succinct, user-friendly format.
458 Post-COVID-19 Regularisation of Emergency Laparoscopic Cholecystectomies: A Single-Centred Multi-Cycle Audit
Authors: Mak R , Lee W T , Carney A , Olaifa F , Islam M , Smith T , Strachan D , Elseed A , Hard R
Published: August 2024

Aim

The COVID-19 pandemic has increased the number of emergency laparoscopic cholecystectomies due to elective surgery cancellations. However, the impact of COVID-19 on the timing of surgery remains unclear. The Association of Upper Gastrointestinal Surgery (AUGIS) advised to perform an emergency laparoscopic cholecystectomy within 72 hours of diagnosing acute cholecystitis. This audit aims to evaluate the impact of the post-COVID-19 period on the timing of emergency laparoscopic cholecystectomies.

Method

A retrospective analysis of patients who underwent an emergency laparoscopic cholecystectomy, in the post-pandemic period, between January and December 2022 was conducted. Primary outcomes include admission to imaging time, admission to theatre time, length of hospital stay, intra- and post-operative complications. Outcomes were audited against AUGIS guidelines and compared with previous audit cycles during the pre-pandemic (2019) and pandemic (2021) periods.

Results

In 2022, 411 patients underwent an emergency laparoscopic cholecystectomy. Median admission to imaging time was 11 hours (IQR 4.6-21.9). Median admission to theatre time was 70.7 hours (IQR 48.4-107.7), compared to 106.5 hours in 2019 and 76.7 hours in 2021. Median length of hospital stay was 5.6 days (IQR 4.0-8.1), compared to 7.5 days in 2019 and 5.3 days in 2021. There were 38 (9.2%) subtotal cholecystectomies, 112 (27.3%) on-table cholangiograms, and 57 (13.9%) CBD explorations performed. 61(14.8%) patients had post-op complications including 9 (2.2%) bile leaks, 5 (1.2%) retained stones, and 7(1.7%) collections.

Conclusions

Timings to emergency laparoscopic cholecystectomies continue to improve in the post-COVID-19 period and is consistent with AUGIS recommendations.
1160 Surgical Harmony: Optimising Referrals for General Surgical Excellence
Authors: Ravichandran S , Kumar A
Published: August 2024

Aim

The appropriateness of referrals is a crucial aspect of patient care. Emergency Departments often struggle to cope with increased patient attendance, and this led to the introduction of a 4-hour waiting time target. Inappropriate referrals can lead to delays in treatment, unnecessary procedures, and increased healthcare costs. The aim is to establish referral guidelines and include criteria for determining when a referral is necessary, documentation requirements, and communication and imaging protocols between the referral provider and the department.

Method

The study was conducted over 2 weeks in July 2020 during the Covid pandemic. The study included all patients referred from the ED to the General surgery department. It included both adult and paediatric patients.

Results

In this study, 78.37 % of referrals were appropriate. But 21.62 % of referrals were inappropriate. Of all the 111 referrals made, 24 patients were inappropriately referred to surgery. They were then referred to other specialities or sometimes treated by General surgery and sent home. Of these, 5 patients didn't have blood results, and 5 other patients were discharged without imaging to prove appropriateness. 19 patients had CT scans and were found to have no surgical pathology.

Conclusions

Routine use of CT scans for surgical abdomen may ameliorate inappropriate ED referrals and improve patient safety and care. Establishing guidelines to streamline when to send them to the acute abdomen pathway, educating healthcare providers, and providing feedback can help reduce inappropriate referrals, improve overall patient outcomes, and reduce the burden on the speciality and Emergency departments.
216 Skin Reducing Mastectomy and Direct to Implant Breast Reconstruction Without Mesh
Authors: Abdelmageed A E , Awad A T , El-Fayoumi T , Abdelkader A A , Shalaby M , Al-hussini M M
Published: August 2024

Background/Aim

Performing breast reconstruction in large and ptotic breasts remains technically challenging with a high incidence of unsatisfactory cosmetic result and post-operative complications. In this study, we report the experience of Alexandria Main University Hospital (AMUH) in Egypt with skin reducing mastectomy (SRM) with direct to implant breast reconstruction without the use of acellular dermal matrix (ADM) or synthetic meshes.

Method

A prospective study was conducted in AMUH from October 2020 till October 2022. It included twenty female patients, indicated for mastectomy and having large and ptotic breasts, excluding non-motivated patients, inflammatory breast cancer, significant clinical comorbidities as well as patients indicated for adjuvant radiotherapy. All the operations were performed as a single stage in which the SRM was done by wise pattern skin incision with creation of a dermal sling to cover the implant without the use of ADM or synthetic mesh.

Results

The implant was inserted prepectoral, under the dermal sling in 10 cases. In the remaining 10 cases, implant was inserted partially subpectoral by detaching the lower part of pectoralis major from the chest wall and suturing it to the dermal sling. The most frequent complications were delayed healing of T-junction. None of the cases experienced infection, capsular contracture, or implant loss.

Conclusions

SRM and direct to implant breast reconstruction can be safely used in patients with large and ptotic breasts. The inferior dermal sling can be used to cover the implants; thus, it allows for a-single stage breast reconstruction without the need for ADM or synthetic meshes.
780 Elective Thoracic Aortic Aneurysm Surgery: A Tertiary Center Experience
Authors: Shirke M , Badran A , Elghazouli Y , Tawil M , Harky A , Ohri S
Published: August 2024

Aim

A thoracic aortic aneurysm (TAA) is a diseased expansion of the thoracic aorta. There is morbidity associated with a dilated aorta, as well as significant mortality. Open thoracic surgery is the fundamental management for proximal lesions, offering definitive treatment with excellent results. This study aimed to summarize preoperative data and operative outcomes of patients who underwent TAA repair at our institution.

Method

Data were retrospectively collected from 234 patients who underwent elective open thoracic surgery at University Hospital Southampton for TAA disease, between 2015 and 2019. Demographics, clinical factors, surgical details, as well as outcome measures, were gathered.

Results

There were 166 males and 68 females, with an overall mean age of 66 years. The breakdown of operations comprised 105 aortic roots, 171 ascending aorta, 20 aortic arch, and 12 descending aorta cases. Mortality was associated with female gender, aortic root surgery, and prosthetic valves. Mean aortic diameters at the time of surgery for the non-genetic aortopathy and genetic aortopathy groups were respectively 4.93cm and 4.63cm in the aortic root, 5.56cm and 4.88cm in the ascending aorta, 5.08cm and 3.87cm in the aortic arch, and 6.63cm and 5.50cm in the descending aorta.

Conclusions

Several factors are associated with complications and morbidity, which should be considered when discussing the risks of intervention with patients. There were no neuroprotective strategies that altered post-operative neurological function. Current practice in our unit fits in with current international guidance.
164 Auto-Amputation of Prostate After Prostate Artery Embolisation for Benign Prostatic Hyperplasia
Authors: Patel P , Hanna G , Mahesan T
Published: August 2024

Prostate Artery Embolisation (PAE) is a treatment modality for Benign Prostatic Hyperplasia (BPH) which is considered to be effective with a low complication rate. It is used as an alternative to Transurethral Resection of the Prostate (TURP), for example, if the prostate is very enlarged or if the patient is unsuitable for general anaesthesia. This case study looks into an 84-year-old male who underwent PAE for Benign Prostatic Hyperplasia. The unusual complication of auto-amputation of the prostate which was found to be in the form of ‘a large (more than 10cm) sloughed tissue’ within the bladder. This finding was made 1 year post procedure with patient presenting with lower urinary tract symptoms, dysuria and ongoing haematuria, requiring multiple blood transfusions. Laser Cystolitholapaxy was initially done followed by Morcellation + completion TURP.

Given that this procedure is done by an Interventional Radiologist, it is important to raise awareness of it occurring and to ensure there is a standardized follow up plan available for these patients. Evidence shows TURP remains the more effective method over PAE in terms of symptom improvement. Therefore, it is important to find patients suitable for PAE by working with the Interventional Radiologists.
466 Colo-Seminal Vesicle Fistula as a Complication of Low Anterior Resection
Authors: Ravichandran M , Karim S , Niaz O , Das P
Published: August 2024

A fistula between the colon and seminal vesicles following low anterior resection is an uncommon post-operative complication. This report details the case of a 68-year-old patient diagnosed with locally advanced mid-low rectal cancer (T3N2M0). He underwent short-course radiotherapy and consolidation chemotherapy (RAPIDO), followed by laparoscopic low anterior resection. With a background of diabetes and a BMI of 36, and being registered blind, it was decided not to give him a defunctioning stoma.

The immediate post-op period was uneventful; however, six weeks post-operatively, he returned with pneumaturia. A flexible cystoscopy ruled out bladder or urethral pathology. Further investigation, including CT and MRI, revealed a fistulous connection between the sigmoid colon and seminal vesicles. An anastomotic leak was suspected, and an initial flexible sigmoidoscopy was unable to identify this due to poor bowel preparation, prompting initial conservative management. However, a repeated flexible sigmoidoscopy eventually confirmed complete anastomotic dehiscence. Despite initially being clinically well, he eventually developed testicular swelling and elevated inflammatory markers, with CT suggestive of air tracking via the vas deferens and scrotal air. He underwent laparoscopic disconnection of the anastomosis, culminating in the formation of an end colostomy and perianal proctectomy with concurrent exploration of the left scrotum and bilateral ureteric stenting.

Post-operatively, he spent several days in the ITU before being transferred to the wards. Over the next 25 days, the patient clinically improved and was eventually discharged symptom-free.

The report captures the link between an anastomotic leak and a rare fistula formation between the colon and seminal vesicles after low anterior resection.
856 Malignant Melanoma of the Small Bowel Causing Multiple Simultaneous Intussusceptions; a Rare Presentation
Authors: Ponnuswamy K , Leong D , Mughal H , Abdelreheem M , Zeineldin A , Khawaja A
Published: August 2024

Background

The rare occurrence of primary melanoma in the small bowel, particularly leading to simultaneous multiple intussusceptions, presents intricate challenges in diagnosis and management. We detail a case of a male in his late 50s with multiple intussusceptions secondary to melanoma deposits in the proximal small bowel.

Case presentation

55-year-old patient presented with severe abdominal pain for 3 weeks, dark stools, unexplained anaemia, and unintentional weight loss. Imaging revealed small bowel obstruction due to intussusception caused by a polypoidal point, prompting surgical intervention. The initial laparotomy led to resecting a segment of the small bowel with the polyp, histopathology revealed malignant melanoma. Post-operatively the patient showed improvement but faced recurrent intussusceptions. Tertiary centre/multi-disciplinary team advise was sought and A PET-CT scan was done that identified 3 hotspots (likely polyps) in the proximal small bowel. Patient underwent a repeat laparotomy where 3 polyps were noted causing simultaneous intussusceptions and 68cm of proximal small bowel was resected with ileo-ileal anastomosis performed.

Discussion

This unique case highlights the rarity of simultaneous multiple intussusceptions due to small bowel melanoma deposits and emphasises the role of surgical intervention. While recognising the benefit of polyp resection during the initial surgery, the case suggests the importance of proactive management and multi-disciplinary approaches for optimal outcomes in such complex scenarios. Key takeaways include maintaining a high index of suspicion for malignancy in unusual presentations, advocating for timely expert consultation, emphasizing small bowel resection for intussusceptions, and considering resecting all identified polyps to prevent complications and improve patient outcomes.
623 Patient Reported Outcome Measures (PROMs) of Altemeier’s Procedure
Authors: O’Sullivan A , Manku B , Bleehen L , Abdelgalel K , Iqbal N , Murphy P , Ramcharan S , Singh S
Published: August 2024

Aim

Rectal prolapse (RP) is a debilitating condition that can be managed using Altemeier’s procedure (AP). We aimed to evaluate patient-reported long-term outcomes following AP focusing on symptoms, post-procedure pain and overall satisfaction.

Method

Patients who underwent AP in a District General Hospital between January 2015 and December 2022 were reviewed. Patients were contacted by telephone and interviewed using a standardised questionnaire. Likert scores and a Numeric Rating Scale (NRS) were used to assess functional outcome and pain respectively. Indication for surgery, recurrence, and data on further procedures were also collected.

Results

Out of 38 patients identified, 20 who underwent AP over the study period (mean age 78 years, s.d. 7.44, Female=20) were contactable and included in our study. In combination with RP, indications for surgery included faecal incontinence, obstructive defaecation symptoms, pain and rectal bleeding. At the time of follow up, 75% of patients reported their initial symptoms to be slightly or much better, 10% reported no change and 15% reported slightly worse symptoms. Prior to AP, 45% of patients reported no pain compared to 70% post-procedure. Severe pain was reported by 30% of patients pre-Altemeier’s compared to five percent post-procedure. Recurrence of RP occurred in 40% patients. 30% of patients required a second procedure. Overall, 80% of patients were satisfied with their outcome and 90% would recommend AP to friends and family.

Conclusions

Most patients reported better functional outcome and good overall satisfaction, despite 30% requiring a further procedure. Our study was limited by small sample size and subjectiveness of patient reporting.
1138 A Closed Loop Audit of Laparoscopic Appendicectomy Documentation with the Introduction of an Operation Note Template to Improve Adherence to the 2022 GIRFT Guidelines
Authors: Wright W
Published: August 2024

Aim

This audit aimed to assess documentation of laparoscopic appendicectomies and measure the effect of introducing an electronic operation note template. Operation documentation is of great importance to patient care, clinical communication, facilitating research and providing a legal record. In 2022, GIRFT, RCS and ASGBI produced the ‘Best practice for Laparoscopic Appendicectomy Documentation guideline (September 2022) which contained forty-four recommendations.

Method

Between 1st June 2022 and 30th September 2022, 99 laparoscopic appendicectomies were performed at Broomfield Hospital, Essex whose operation notes were appropriate to be audited against the GIRFT guideline. Subsequently, an operation note template was designed on Microsoft Word using the guideline and refined with feedback from stakeholders including the surgeons who would be using it. The template was rolled out across the general surgery department in November 2022. Laparoscopic appendicectomies carried out between 1st December 2022 and 31st March 2023 were then reaudited.

Results

Between June and September 2022, prior to the introduction of the template, the average adherence to the guideline was 35%. Between December 2022 and March 2023, the average adherence was 55%, but was 89% in operation notes which used the template. Positive feedback on the template included ease of use and reduced time to complete compared to typing on a blank document.

Conclusions

This audit has demonstrated the important role templates play in significantly improving documentation and adherence to guidelines which positively affects patient care. The improvement in adherence even when the template was not used is likely due to the heightened awareness of the guideline.
116 Comparing the Effect of Using Virtual Reality Versus Simulation, to Manage an Acute Surgical Scenario, on Academic Buoyancy
Authors: Tran M T , Ahmad M , Patel K , Argyriou O , Davies A , Shalhoub J
Published: August 2024

Background

Simulation is regularly used in surgical training to allow trainees to practice skills safely. Virtual reality (VR) is a recent simulation modality which offers immersive computer-generated medical and surgical training scenarios. Much of trainee performance can be hindered by stress, self-consciousness, performance anxiety, fear of criticism and self-perceived poor task execution. Academic buoyancy is a learner’s ability to successfully deal with short-term, minor academic setbacks, such as poor grades and exam pressures, and having academic buoyancy can translate into long-term academic resilience. We aimed to compare academic buoyancy between junior doctors after managing an acute surgical scenario using VR and mannequin-based simulation.

Method

Eighteen junior doctor volunteers (Foundation and Core Trainee Year 1) were recruited, with ten participants randomly allocated to VR and eight to mannequin-based Simulation. Participants assessed and managed a 15-minute pneumothorax scenario. The academic buoyancy scale (ABS), which consists of four questions on a self-rated 7-point Likert scale, was used to measure pre-session and post-session academic buoyancy.

Results

ABS scores increased for both study groups, although this was only statistically significant for VR participants (p≤0.01), suggesting that VR may provide a more comfortable environment for trainees to hone their clinical skills. VR participants also had higher overall simulation scores than mannequin-based simulation participants, however no correlation was found between ABS scores and overall simulation scores.

Conclusions

VR as a simulation modality benefits by improving short-term markers of confidence. Future research should establish whether spaced VR teaching sessions translate into improved long-term markers of resilience.
634 Biodegradable Temporising Dermal Matrix Graft for Open Foot Wounds, an Audit from a Tertiary Vascular Unit
Authors: Shah R , Hussain I , Dindyal S , Tiruveedhula M , Emmanuel A , Thapar A
Published: August 2024

Aim

Following diabetic foot attacks many patients are left with exposed bone, which can lead to osteomyelitis and failure to heal. These patients are currently treated with simple dressings or vacuum therapy and skin grafts. However, vacuum therapy is expensive, requires intensive follow-up and can be inconvenient to patients. An alternative is to apply a polyurethane-based, biodegradable temporising matrix – currently used in burns practice. The aim of this project was to audit the safety and preliminary efficacy of the matrix in healing open foot wounds in a tertiary vascular unit.

Method

Consecutive patients receiving matrix cover from January 2021 were retrieved from the theatre database. 10 patients met our inclusion criteria, 5 males and 5 female patients with a mean age of 69 years. Five (50%) were diabetic, 10% were smokers and 40% were ex-smokers. Two patients died prior to wound healing and one patient was lost to follow-up leaving 7 patients.

Results

Safety: One patient developed surgical site infection, managed with wound washout and dressing changes with no loss of matrix. No patient developed osteomyelitis. Efficacy: Wound healing occured in 5 patients, after a median of 51 days (IQR 12 days). One patient underwent an additional skin graft on top of the matrix and healed. One patient did not heal.

Conclusions

In this early report we found a low rate of matrix infection or requirement for skin grafting. Two-thirds of wounds healed following matrix application. A comparative study of matrix vs vacuum therapy would be valuable.
1182 Ethnic Diversity in Facial Image Databases – the State of Play for Aesthetic Plastic Surgery
Authors: Zargaran A , Silva K , Sousi S , Zargaran D , Mosahebi A
Published: August 2024

Aim

The rise of social media has resulted in heightened patient expectations of cosmetic outcomes. The increasing trend of selfies and image collection may promote higher-powered predictive analytics to inform research and pre-operative consultations supporting informed consent. However, given the scattered and siloed nature of such databases, little is known regarding their composition. This study evaluated published facial image databases for ethnic representation, image quality and labelling.

Method

Databases were identified via a systematic search on PubMed, Embase, PsychInfo and Google Scholar. Databases were evaluated by two independent reviewers for demographics alongside image characteristics and governance surrounding data availability and usage.

Results

6,544,444 images of 199,579 people from 54 databases were included in the study from 1988 – 2023. The USA (n=19, 33%) and UK (n=1, 18.2%) accounted for more than half of the databases. Gender distribution across the 20 databases that provided information on this showed an approximately equal split, with 216,331 images of males and 216,459 images of females. Of the data labelled for ethnicity, the most common was Black (40.1%, n=48,425) followed by White (38.7%, n=46,738) and Asian (8.3%, n=10,061). Only one database (FERET) had longitudinal coverage of age progression. 59% of databases were publicly available, whilst 87% did not permit commercial use.

Conclusions

Labelling of large datasets is limited without important information on ethnicity and gender. More work needs to be done to ensure that these databases are suitable for more widespread research purposes and to promote greater representation within such databases and aesthetic plastic surgery research.
57 Day-Case Laparoscopic Partial Gastrectomies in Adults: A Two-Year Study at a University Teaching Hospital
Authors: Dhanoya G
Published: August 2024

Background

Day-case surgeries allow patients to return home on the same day after undergoing their surgical procedure, allowing shorter inpatient stays, reduced hospital costs and reduced risk of hospital acquired infections amongst other benefits. Laparoscopic partial gastrectomy (LPG) is the most popular treatment option for small gastrointestinal stromal tutors (GISTS) and other benign stomach lesions. Little research, however, has been done to investigate the safety and efficacy of performing LPGs in ambulatory centres as day cases.

Aim

The aim of this study was to assess the efficacy and safety of day-case LPG procedures as a more desirable alternative to admitting patients to hospital >24hrs post LPG surgery.

Method

We wanted to use the data collected over a two-year period in our university teaching hospital to investigate patient, or other factors which might facilitate a safe same-day discharge. This was done by comparing the post-op complications and 30-day readmission rates between patients who underwent day-case procedures, and those who were admitted to hospital >24hrs post-surgery.

Results

Results showed no significant difference in complications or readmission rates between the two groups of patients.

Conclusions

Day-case LPG has the potential to become the primary treatment pathway for low-risk patients suffering from small GISTs and benign stomach lesions, as it will save valuable hospital resources and costs, with no added post-operative complications.
1 93 Exploring the Modulatory Effects of Adipose-Derived Stem Cells on Fibroblasts in Chronic Radiation-Induced Fibrosis
Authors: Onderkova A , Langridge B , Frommer M , McKenzie M , Abul A , Butler P
Published: August 2024

Background

Radiation-induced fibrosis (RIF) is a common and debilitating side effect of radiotherapy in head and neck cancer patients. Despite its prevalence, effective treatments are lacking. However, autologous fat grafting can not only restore volume in these patients but also help with local tissue regeneration. This has been attributed to adipose-derived stem cells (ADSCs)’s anti-inflammatory and pro-regenerative properties within the grafts. Yet, the precise cellular mechanisms underlying their effects on the chronic inflammatory response in RIF remain to be elucidated.

Method

This study involved collecting tissue from head and neck RIF patients, isolating and expanding ADSCs and fibroblasts in vitro, and examining their interactions through co-culture experiments. The anti-inflammatory effects of ADSCs on fibroblasts were evaluated by measuring the expression of nine genes (COL1A1, TGFB1, ACTA2, MMP1, MMP9, TNC, CCL19, CDKN2A, CDKN1A) and assessing procollagen production, key in extracellular matrix remodelling in fibrosis. Clinical outcomes were also preliminarily evaluated.

Results

ADSCs significantly altered COL1A1 expression in RIF fibroblasts, normalizing it and increasing procollagen production. However, no statistically significant variations were observed in the expression of genes related to fibroblast transformation, extracellular matrix degradation, remodelling, immune regulation, and cellular senescence.

Conclusions

This study provides insights into the cellular mechanisms by which ADSCs may affect the chronic inflammatory response in RIF, particularly through the modulation of extracellular matrix production. These findings suggest the potential therapeutic role of ADSCs in the treatment of RIF, highlighting the importance of further research to optimise therapeutic protocols, determine underlying molecular mechanisms, and assess long-term safety and efficacy.
52 Stop the Clot! Improving Extended VTE Prescriptions Following Major Abdominal Surgery
Authors: Virdee P K , Chang J
Published: August 2024

Aim

Extended VTE (eVTE) prophylaxis following major abdominal cancer surgery is well documented across national guidelines and associated with reduced VTE incidence. Following cases of VTE after major abdominal non-cancer surgery, eVTE prophylaxis is being increasingly favoured for both cancer and non-cancer patients in the General Surgery department at a district general hospital in Birmingham. To improve prescription rate of eVTE prophylaxis following major abdominal surgery where appropriate and improve the quality and consistency of eVTE prophylaxis documentation in operation notes, to reduce error and ensure safe mitigation against VTE risk following major abdominal surgery.

Method

Theatre and ward lists were reviewed across 4 weeks to identify suitable patients for inclusion. Data collected was on the indication, prescription, and documentation of eVTE prophylaxis. Following implementation of interventions, results were compared to previous audit cycles.

Results

Operation note documentation of eVTE prophylaxis was significantly improved, with documentation rate at 76.2% compared with 30.4% previously (p=0.024). Whilst overall prescription rate remained similar, 100% of cancer patients received eVTE prophylaxis when indicated, compared to only 72.7% previously.

Conclusions

The documentation rate of eVTE prophylaxis on operation notes was significantly improved following our interventions, alongside improved prescription rates of eVTE prophylaxis for cancer patients. Further cycles would benefit from data collection over a longer duration to achieve a larger sample size. Finally, a comparison of VTE incidence across cancer and non-cancer groups, before and after interventions, would be useful in determining whether eVTE prophylaxis in both subgroups should be incorporated in local guidelines.