bluuebunny/crossref_metadata_2025 huggingface dataset:
Current Trends in the Management of a Complex Polyp: Endoscopy versus Surgery
Authors: Khan Mahnoor , Visrodia Kavel , Sethi Amrita
Published: July 2024

Many colorectal cancers arise from either adenomatous polyps or sessile serrated lesions. However, due to the implementation of screening guidelines at the age of 45 years and the ability to perform therapeutic endoscopic polyp resections, the incidence and mortality of colorectal cancer has been decreasing in the United States. Polyps can be distinguished not only by pathology, but characterized by their complexity depending on the size, location, and morphology. Historically, polyps that were endoscopically more challenging to resect were referred for surgical resection. However, due to rapid advancement in endoscopic techniques and availability of tools, many of these complex polyps can be safely and effectively resected endoscopically. In this section, we review the different methods and potential challenges associated with endoscopic resection techniques including endoscopic mucosal resection, endoscopic submucosal dissection, or endoscopic full-thickness resection of a complex polyp.
Copper ratio obtained by generalizing the Fibonacci sequence
Authors: Özkan Engin , Akkuş Hakan
Published: July 2024

In this study, we define a new generalization of the Fibonacci sequence that gives the copper ratio, and we will call it the copper Fibonacci sequence. In addition, inspired by the copper Fibonacci definition, we also define copper Lucas sequences, and then we give the relationships between the terms of these sequences. We present some properties, such as the Binet formulas, special summation formulas, special generating functions, etc. We find the relationships between the roots of the characteristic equation of these sequences and the general terms of these sequences. What is interesting here is that the relationships obtained from that between the roots of the characteristic equation of these new sequences and the terms of the sequences are satisfied in both roots. In addition, we examine the relationships between these sequences with the classic Fibonacci and Lucas sequences. Moreover, we calculate some identities of these sequences, such as Cassini and Catalan. Then Catalan transformation is applied to these sequences, and their terms are found. Furthermore, we apply Hankel transform to the Catalan transform of these sequences. Besides, we associate the terms of the Hankel transformation of the Catalan copper Fibonacci sequence with the classical Fibonacci numbers and the terms of the Hankel transformation of the Catalan copper Lucas sequence with the terms of the copper Lucas sequence. We present the application of copper Fibonacci and copper Lucas sequences to hyperbolic quaternions. Finally, the terms of the copper Fibonacci and copper Lucas sequences are associated with their hyperbolic quaternion values.
Providing sexual health care for international students in Australia: a qualitative study of a general practice team approach
Authors: Vagholkar Sanjyot , Mahadeva Janani , Xiang Yang , Li Jiadai , Kang Melissa
Published: July 2024

Background Provision of culturally responsive sexual health care for international students is important, given the large numbers of international students in Australia and known lower levels of health literacy among this cohort. Team-based care in general practice has the potential to provide this care. Methods A qualitative study that developed and evaluated a team-based model of care for female, Mandarin-speaking, international students in a university-based general practice. The model involved patients attending a consultation with a Mandarin-speaking nurse with advanced skills in sexual health who provided education and preventive health advice, followed by a consultation with a GP. Evaluation of the model explored patient and healthcare worker experiences using a survey and a focus group of patients, and interviews with healthcare workers. Data were analysed using a general inductive approach. Results The consultation model was evaluated with 12 patients and seven GPs. Five patients participated in a focus group following the consultation. Survey results showed high levels of patient satisfaction with the model. This was confirmed via the focus group findings. Healthcare workers found the model useful for providing sexual health care for this cohort of patients and were satisfied with the team approach to patient care. Conclusions A team-based approach to providing sexual health care for international students was satisfactory to patients, GPs and the practice nurse. The challenge is providing this type of model in Australian general practice under the current funding model.
Flexible liquid-diode microtubes from multimodal microfluidics
Authors: Yang Chaoyu , Li Wenzhao , Zhao Yuanjin , Shang Luoran
Published: July 2024

Directional transport of liquids is of great importance in energy saving, chemical/biomedical engineering, and microfluidics applications. Despite considerable progress in engineering different open surfaces to achieve liquid manipulation, the realization of diode-like liquid transport in enclosed spaces is still challenging. Here, a flexible diode microtube is presented for directional liquid transport within confined spaces using pulsed microfluidics. The microtubes exhibit sophisticated microstructures on the inner wall, replicated from a precisely controlled flow configuration in the microfluidic channel. Under the effect of asymmetric pinning and unbalanced Laplace pressure, such microtubes enable directional liquid transport in closed channels. More importantly, by integrating in situ flow lithography with the microfluidic system, segmented liquid diodes are fabricated as assembly units for the construction of fluidic–electronic circuits that perform logic operations. These results demonstrate the capacity of the present liquid-diode microtubes for flexible, directional, and programmable liquid transport. We believe that it can open an avenue for designing advanced fluidic circuit-based devices toward versatile practical applications.
GPCR–MAPK signaling pathways underpin fitness trade-offs in whitefly
Authors: Fu Buli , Liang Jinjin , Hu Jinyu , Du Tianhua , Tan Qimei , He Chao , Wei Xuegao , Gong Peipan , Yang Jing , Liu Shaonan , Huang Mingjiao , Gui Lianyou , Liu Kui , Zhou Xuguo , Nauen Ralf , Bass Chris , Yang Xin , Zhang Youjun
Published: July 2024

Trade-offs between evolutionary gain and loss are prevalent in nature, yet their genetic basis is not well resolved. The evolution of insect resistance to insecticide is often associated with strong fitness costs; however, how the fitness trade-offs operates remains poorly understood. Here, we show that the mitogen-activated protein kinase (MAPK) pathway and its upstream and downstream actors underlie the fitness trade-offs associated with insecticide resistance in the whitefly
Bemisia tabaci
. Specifically, we find a key cytochrome P450 gene
CYP6CM1
, that confers neonicotinoids resistance to in
B. tabaci
, is regulated by the MAPKs p38 and ERK through their activation of the transcription factor cAMP-response element binding protein. However, phosphorylation of p38 and ERK also leads to the activation of the transcription repressor Cap “n” collar isoform C (CncC) that negatively regulates
exuperantia (Ex), vasa (Va), and benign gonial cell neoplasm (Bg
), key genes involved in oogenesis, leading to abnormal ovary growth and a reduction in female fecundity. We further demonstrate that the transmembrane G protein-coupled receptor (GPCR) neuropeptide FF receptor 2 (NPFF2) triggers the p38 and ERK pathways via phosphorylation. Additionally, a positive feedback loop between p38 and NPFF2 leads to the continuous activation of the MAPK pathways, thereby constitutively promoting neonicotinoids resistance but with a significant reproductive cost. Collectively, these findings provide fundamental insights into the role of
cis-trans
regulatory networks incurred by GPCR–MAPK signaling pathways in evolutionary trade-offs and applied knowledge that can inform the development of strategies for the sustainable pest control.
Multiplexed in situ hybridization reveals distinct lineage identities for major and minor vein initiation during maize leaf development
Authors: Perico Chiara , Zaidem Maricris , Sedelnikova Olga , Bhattacharya Samik , Korfhage Christian , Langdale Jane A.
Published: July 2024

Leaves of flowering plants are characterized by diverse venation patterns. Patterning begins with the selection of vein-forming procambial initial cells from within the ground meristem of a developing leaf, a process which is considered to be auxin-dependent, and continues until veins are anatomically differentiated with functional xylem and phloem. At present, the mechanisms responsible for leaf venation patterning are primarily characterized in the model eudicot
Arabidopsis thaliana
which displays a reticulate venation network. However, evidence suggests that vein development may proceed via a different mechanism in monocot leaves where venation patterning is parallel. Here, we employed Molecular Cartography, a multiplexed in situ hybridization technique, to analyze the spatiotemporal localization of a subset of auxin-related genes and candidate regulators of vein patterning in maize leaves. We show how different combinations of auxin influx and efflux transporters are recruited during leaf and vein specification and how major and minor vein ranks develop with distinct identities. The localization of the procambial marker
PIN1a
and the spatial arrangement of procambial initial cells that give rise to major and minor vein ranks further suggests that vein spacing is prepatterned across the medio-lateral leaf axis prior to accumulation of the PIN1a auxin transporter. In contrast, patterning in the adaxial-abaxial axis occurs progressively, with markers of xylem and phloem gradually becoming polarized as differentiation proceeds. Collectively, our data suggest that both lineage- and position-based mechanisms may underpin vein patterning in maize leaves.
Building Information Modeling (BIM) application towards environmental sustainability
Authors: Abdul Rahim N S , Syed Zakaria S A , Ishak N , Ibrahim F A
Published: July 2024

The interest in Building Information Modeling (BIM) is increasing among researchers and construction industry players around the world including Malaysia. BIM is known as a technology that has the ability to perform three-dimensional (3D) visualization to eliminate clashes in design, which indirectly reduce rework and construction wastage. Since the Government of Malaysia is currently encouraging BIM, focusing on educating the construction players with reliable information about BIM is perceived as important. Therefore, this study aims to explore the awareness of contractors particularly on the BIM application towards environmental sustainability. A total of 133 responses were received from the data collection process and these data were analyzed to determine the role of BIM in contributing towards environmental sustainability from the contractors’ perspective. The finding reveals that the awareness of respondents is influenced by their knowledge on BIM. Most of the contractors are aware of BIM application towards environmental sustainability, except for reducing rework. In this context, providing or educating construction players on the BIM application towards sustainability aspects is perceived necessary to create awareness and provide a better understanding in anticipation of improved use of BIM in the construction industry.
The effectiveness of BIM features application strategies for building refurbishment project performance improvement
Authors: Shohime Nor Suraya , Ishak Nurfadzillah , Romeli Norsyakilah , Anuar Nur Hidayah Khairul
Published: July 2024

This research presents a study that explores the effectiveness of different strategies for implementing Building Information Modelling (BIM) features in enhancing the performance of building refurbishment projects. The study adopts a combined quantitative and qualitative approach to measure the significance of BIM features in relation to building refurbishment project performance improvement. It aims to uncover the correlation between BIM feature application strategies and building refurbishment project performance and provides recommendations on utilizing BIM features to improve project outcomes. The study encompasses a comprehensive review of existing literature on BIM and building refurbishment projects, followed by a mixed-methods approach. This approach involves quantitative analysis of data from refurbishment projects that have implemented BIM, as well as qualitative analysis of expert interviews with industry professionals. The findings of the expert interviews shed light on the factors influencing the effectiveness of BIM in building refurbishment projects, such as the level of BIM adoption, the availability of skilled personnel, and the integration of BIM into project workflows. The research contributes valuable insights to enhance the understanding of BIM utilization in building refurbishment projects, offering guidance to practitioners and decision-makers in leveraging BIM technologies for such endeavourrs.
Mining waste as an alternative aggregate in brick production for carbon capture and storage
Authors: Khamis Muhammad Amir Aizat , Kusin Faradiella Mohd , Iskandar Ikhwannudin
Published: July 2024

Production of waste rocks and overburden from ore mining in open-pit mines can cause undesirable environmental impacts. Thus, this study aims to tackle the issue of waste production from mining areas by utilizing mining waste to sequester CO2 and to evaluate its potential for carbon capture in cementitious material. This study attempts to evaluate the effect of mine waste ratio and carbonation curing time on physico-mechanical behavior of bricks. The bricks were fabricated using different ratios of mine waste, i.e. 20 – 40 % in the mix design. Carbonation curing between 1 – 3 hours was applied during the brick fabrication to estimate CO2 capture of the brick product. The brick performances were evaluated based on the compressive strength, water absorption and carbon capture capacity. It was found that curing time at 28 days provided the greatest compressive strength of the brick and greater performance was observed at 40 % replacement with the mine waste. Carbonation curing improved the brick performance with higher compressive strength and lower water absorption at longer exposure time of 3-hour carbonation. The resulting CO2 uptake was found to increase with the increase of carbonation time and at higher ratio of mine waste replacement. The CO2 capture capacity was between 0.45 – 0.58 % for bricks containing 20 – 40 % of mine waste, which corresponds to 9.4 – 16.3 g CO2/brick. Therefore, it has been shown that the use of mining waste as partial replacement for cementitious material was capable in improving the brick performance with incorporation of carbonation curing process.
The potential of different bio-decomposer for composting of food waste and rice husk
Authors: Zakarya Irnis Azura , Izhar Tengku Nuraiti Tengku , Raju S , Mohamad M
Published: July 2024

The research was conducted to compare the effectiveness of bio-decomposers using food waste, rice husk and black organic soil at the ratio of 2:1:1. In landfill the food waste is commonly segregate for composting. Longer decomposition times and inefficient composting approaches leads to poorer compost quality. The primary objective was to determine the physical and chemical characteristics of bio-decomposers in various compost treatments. Data analysis shows, all the bins are within the USDA's recommended range for composting. But then, bin C were most effective that possesses the following values: pH of 7.1, temperature at thermophilic stage was 46.3 °C, temperature at maturation stage was 38.0 °C, moisture content of 39.25 %, C/N ratio of 31.16 %, 2.09 % of nitrogen (N), 2.60 mg/l of phosphorus (P), and 3.68 mg/l of potassium (K). Subsequently, the second aim to measure on the growth rate of the Amaranth seed in different bins after composting. As per analysis, the Amaranth plant height was increases B at 6.95 cm, C at 7.32 cm. The number of leaves counted over a period of 30 days reveals that three bins, A, B, and C, each had 7 leaves, while bin BL at 6 numbers of leaves. In summary, bin C optimal parameters ranges shows the most effective bio-decomposer.
Comparative study between active and passive soil nailing using PLAXIS software
Authors: Razak Muhammad Auf Abd. , Nujid Masyitah Md
Published: July 2024

Many researchers have proposed several solutions to minimise the landslide problem. One proposed solution is stabilising the slope by installing nail reinforcement through simulation analysis in PLAXIS software. The study aims to analyse the stability of nailed slopes in two different types of parameters by using numerical study. The result of the parametric study was performed at various effects of moisture content and slope angle. Mohr-Coulomb and Hardening Soil models were adopted to analyse the behaviour of soil failure subjected to loadings condition of moisture content and slope angle effects. The finding results regarding the slope stability (FOS) study show that values of the FOS decreased as the slope angle and moisture content increased. This can be seen during the Mohr-coulomb model for passive soil nail system, that the FOS of moisture content at 7.1 % is 1.107, while the FOS of moisture content at 25 % is 1.063. The finding also shows that the active soil nail system is better than the passive soil nail system. This can be seen when the highest value of FOS in the Mohr-Coulomb model for active soil nail is 1.336 at 7.1 % moisture content, while passive soil nail has a FOS value of 1.107 at 7.1 % moisture content. The significance of the study has also impacted preserving the original geometry structure of nature, while people can enjoy the scenery. It also can be beneficial in terms of the cost-effectiveness of soil for nailed structures to prevent unnecessary problems in the future.
Experimental study of copper contamination in mechanical properties of residual soil under different concentration
Authors: Anyap Allentykoster Anak , Osman Muhammad Hafeez , Ismail Badrul Nizam , Albar Aniza
Published: July 2024

Industrialization in modern society comes along with soil degradation and heavy metal pollution. The presence of heavy metals changes the geotechnical properties of soils, risking the sites with the possibility of contaminated soil. Heavy metal contaminants might alter the mechanical properties and soil behaviour leading to the effects on the structural integrity. The purpose of this research is to evaluate the mechanical properties of residual soil samples contaminated with different concentrations of copper. Disturbed residual soils were induced with copper in controlled environment. Six samples were prepared, including a control sample consisting of a CuSO4 solution with a spectrum of concentrations ranging from 0 mg/L to 4000 mg/L, with interval 500 mg/L. The results of the experiment revealed that increasing the concentration led to an increase in the maximum dry density, while the optimum moisture content showed an opposite response. The increase in copper concentration resulted in a dynamic shift in the plastic limit, a decrease in the liquid limit and pH, making the soil naturally acidic. The output shows aid in the development of appropriate soil management strategies and remediation techniques to mitigate the adverse effects of copper contamination on soil quality and environmental sustainability.
Full extraction of asbuton bitumen for binder replacement in warm mix asphalt
Authors: Maha M R A , Idham M K , Hainin M R
Published: July 2024

Asbuton can be utilized as an optional binder in asphalt mixture by semi-extraction or full extraction. Full extraction of asbuton by using solvent can maximize the content of bitumen while discarding the mineral. However, different solvent content influenced the asbuton bitumen properties. Thus, this study evaluated the effect of different percentages of toluene solvent on the full extraction. Four different percentages of solvent content 1 to 4 % of toluene were used in this study. The asbuton bitumen was then tested for penetration, softening point, flash point, specific gravity, and thin film oven test. The asbuton bitumen was then used to design warm mix asphalt (WMA). Based on the Marshall mix design, the optimum bitumen content (OBC) is 6.25 %. The WMA with full extraction asbuton bitumen fulfilled the Marshall requirement by stability of 1374 kg, and 96.97% retained stability. It also produced 3.57 mm flow with 3.46 % void in mix, 15.08 % void mineral aggregatte, and 76.41 of void filled bitumen. As a result, it is discovered that full extraction asbuton can serving as the WMA binder replacement.
Pavement maintenance and surface treatment: Evaluation and prevention towards road safety aspect along Ampang Jaya road
Authors: Albar A , Rashid I D Abdul , Haron S , Azinal Abidin A A A , Ramli R
Published: July 2024

The severity of road damage, such as surface cracking or potholes putting drivers of moving vehicles at greater risk of collisions. This study aims to determine and propose the maintenance procedure and surface treatment activity carried out along Jalan Taman Putra, Jalan Bunga Raya and Jalan Perdana Utama in Ampang Jaya, Selangor. From a visual inspection, Jalan Bunga Raya and Jalan Perdana Utama was rated as B and required immediate repairs, while Rating C required to be fixed for user comfort on Jalan Taman Putra. Patch defects account for 45 % and 46 % of all defects on Jalan Taman Putra and Jalan Bunga Raya routes, respectively. Meanwhile, most defects on Jalan Perdana Utama were delamination, accounting for 38 % of all defects. The statistics on the number of road accidents show that pavement restoration work is effective when it results in a decrease in accidents between 2015 and 2021 by 42 % in Jalan Taman Putra, 33 % in Jalan Bunga Raya, and 12 % in Jalan Perdana Utama. Rehabilitating the roads had a favourable impact on Ampang Jaya, Selangor's low traffic accidents rate and raised levels of road safety. To improve road safety features, efficient supervision and maintenance efficiency are required.
Properties of concrete containing spent garnet as fine aggregate replacement
Authors: Ruslan H N , Muthusamy K , Muzafar Shah M H , Mat Yahaya F , Zulkarnain F
Published: July 2024

The use of river sand as a construction material has become a critical concern in many countries. Excessive mining for concrete production is one of the main issues that lead to environmental pollution. Simultaneously, environmental concern over discarding spent garnet from industry have led to research on using it as a partial replacement for fine aggregate in concrete. Different mixtures incorporating 10 %, 20 %, and 30 % spent garnet were studied to assess their impact on concrete’s workability, mechanical strength, and durability. This study used a concrete mix design to create concrete mixes for 48 cubes. Three types of tests such as slump, compressive strength, and water absorption test were conducted to evaluate the concrete’s properties. The findings indicate that as the amount of spent garnet used in concrete increases, the concrete becomes more workable. The optimum strength results were achieved when 20 % of the fine aggregate was replaced with spent garnet. Furthermore, concrete with up to 20 % spent garnet had lower water absorption compared to the control mix. Utilizing spent garnet as a substitute for sand in construction not only fosters sustainability but also addresses the challenge of effective waste disposal.
Establishing rainfall intensity-duration-frequency curves for Baghdad, Iraq using satellite data
Authors: Hamed Mohammed Magdy , Zeri Sarah Jabbar , Shahid Shamsuddin
Published: July 2024

Rainfall intensity-duration-frequency (IDF) curves were generated for Baghdad by utilising three satellite precipitation datasets: Global Satellite Mapping of Precipitation Near Real-Time (GSMaP NRT), gauge-corrected (GSMaP GC) and Global Precipitation Measurement Integrated Multi-Satellite Retrievals for Global Precipitation Measurement (IMERG). Maximum annual rainfall data was fitted using several probability distribution methods. The calculated coefficients from the best-fit distribution were used as fitting parameters to generate IDF curves for return periods of 2, 5, 10, 25, 50 and 100 years using the Sherman equation. To address discrepancies between the satellite-derived IDF curves and observed data, bias correction was performed based on the differences. The analysis revealed that the Generalized Extreme Value Distribution model accurately described the hourly rainfall distribution. GSMaP GC exhibited the highest correlation with the observed data, making it the preferred option for generating IDF curves. The study highlighted the importance of gauge correction for satellite rainfall data to minimise the underestimation or overestimation of rainfall. GSMaP GC demonstrated reasonable accuracy in estimating rainfall in Iraq’s mainly arid climate area. By assisting in the creation of efficient methods for dealing with rainstorm events, the created IDF curves are a major step towards advancing sustainable urban stormwater management in the country.
Experimental study on the hydraulic performance of nonwoven geotextile efficiency of sustainable drainage system
Authors: Seman N A S , Mohamad Faudzi N A , Mohd Zaini Makhtar S , Ab Wahab M , Kamarudzaman A N , Hassan Z , Abdul Rashid N A
Published: July 2024

Globally, the frequency of record-breaking rainfall events has greatly risen. As a result, surface water urban flooding is becoming a bigger concern. SUDS are increasingly being used in many metropolitan areas to reduce peak surface runoff and pollutants by utilizing various designed open water structures, such as infiltration basins. Urbanization and climate change have resulted in an increase in catchment runoff, often exceeding the designed capacity of sewer systems. The purpose of this research is to study the performance of nonwoven geotextile in subsurface drainage beds to improve the efficiency of infiltration rate compared to existing drainage system. This research proposes to create a subsurface drainage bed consisting of gravel, sand, and nonwoven geotextile to act as an alternative compared to existing drainage system. This module will be run by conducting an experiment to study the characteristics of subsurface drainage bed, effects of rainfall intensity and the relationship of infiltration rate on various rainfall intensity will be studied. In conclusion, in this study, nonwoven geotextile with a thickness of 5 mm (Condition B) significantly improved infiltration rates, reducing surface runoff by up to 30 % compared to Condition A and Condition across varying rainfall intensities.
Effect of rotating gliding discharges on the lean blow-off limit of biogas flames
Authors: AKHTAR Muhammad Saqib , ALICHERIF Mhedine , WANG 王 Bing 兵 , LACOSTE Deanna A.
Published: July 2024

This study investigates the effect of a rotating gliding discharge on synthetic biogas combustion at atmospheric pressure. Synthetic biogas was produced by mixing methane and carbon dioxide. Three mixtures were considered: 100%/0%, 70%/30%, and 50%/50% of methane and carbon dioxide, respectively. The plasma effect was investigated in a low-swirl-number burner equipped with a high-voltage electrode to produce gliding discharges. The effect of plasma on the stability limits of the flame is reported for several electrical powers. During plasma-assisted combustion, the lean blow-off limits of biogas-air flames were significantly improved, which agrees with what can be found in the literature for other fuels. The electrical parameters of the discharge and the plasma emissions were measured using electric probes and emission spectroscopy, respectively. The mixture with the CO2 dilution was associated with a higher reduced electric field and higher ion production. A better understanding of the excited-species concentration evolution during plasma is necessary and will be investigated in future work.
The Changing Electoral Map of England and Wales
Authors: Furlong Jamie , Jennings Will
Published: July 2024

This book offers a definitive account of the changing electoral geography of England and Wales over the past half century. Changes in social and economic structure have altered the spatial distribution of voters and combined with changes in the parties’ appeal to those voters (and the behaviour of voters) has led to a gradual, though recently accelerating, realignment in the geographical basis of electoral competition. Constituency-level analysis of voting at general elections between 1979 and 2019 shows a swing from Labour to the Conservatives in demographically left behind areas with largely white, working-class populations and lower levels of educational attainment, while Labour's support has remained stable in places characterized by economic deprivation (economically left behind areas) and insecure employment (precariously left behind areas). Areas with improving socio-economic characteristics—typically cities where Labour have inefficiently stacked up votes—have swung towards Labour, whereas those that have experienced population and economic decline have swung towards the Conservatives. Yet not all areas follow these trends. Spatial analysis reveals clusters of seats where each party has more support than expected based on sociodemographic composition—places where, in short, place matters. In Merseyside, Labour’s vote is much higher than predicted by demographics, while this is likewise the case for the Conservatives in Lincolnshire. Qualitative case studies identify the place-based, contextual factors that help explain the unusual political characteristics in these places. The book argues for the need to recognize the importance of people, places, and parties in shaping the geography of electoral outcomes.
How changing demography drives electoral change
Authors: Furlong Jamie , Jennings Will
Published: July 2024

This chapter sets out the mechanisms that have changed Britain’s electoral geography in recent decades. We argue that the combination of changes in the geographical distribution of voters and changes in the parties’ appeal to those voters (impacting individual voting behaviour) has transformed the electoral map. We detail long-term trends in social and economic structure that have significantly altered the composition of electorates in different places: deindustrialization, higher education expansion, agglomeration, rising immigration, and ageing. The chapter draws an important distinction between areas that are ‘left behind’ according to their demographic makeup, economic deprivation, or precarious employment. We proceed to show how the sociodemographic and economic profile of constituencies in England and Wales has changed between 1979 and 2019, how the policy positions of parties have changed over the same period, and changes in the groups of voters the parties have tended to attract.
Relative decline (and growth) and the changing electoral geography of England and Wales
Authors: Furlong Jamie , Jennings Will
Published: July 2024

This chapter explores the relationship between changes in the sociodemographic characteristics of constituencies and changes in party support between 1979 and 2019. It asks how electoral support has changed for Labour and the Conservatives in places that have experienced relative improvements or decline in their socio-economic fabric. In areas that have been ‘improving’, we find a swing from the Conservatives to Labour. For Labour, the problem is that these constituencies are predominantly in major cities that have become increasingly attractive for younger graduates and professionals—areas in which they are already dominant. In contrast, using similar categories of ‘left behind’ places as the previous chapter, we show that areas that have become increasingly demographically left behind (relatively older, more working class, and less educated) have swung towards the Conservatives. Most notably, this is the case in post-industrial towns that have experienced the most prolonged socio-economic decline.
Deference to Moral Testimony and (In)Authenticity
Authors: Brick Shannon
Published: July 2024

The philosophical debate over moral testimony is a debate over whether it is appropriate to trust moral testimony. Most people who have engaged in the debate agree that it seems as though people ought to form moral beliefs by thinking through the issues on their own, rather than by trusting another person’s testimony. This chapter reports the results of two studies designed to investigate one hypothesis about why things seem this way. According to this hypothesis, we think it is inappropriate to trust moral testimony because we are committed to the ideal of personal authenticity, and we think that trusting moral testimony would put one in a condition of inauthenticity.
Do People Understand Determinism?
Authors: Murray Samuel , Dykhuis Elise , Nadelhoffer Thomas
Published: July 2024

Experimental work on free will typically relies on deterministic stimuli to elicit judgments of free will. We call this the Vignette-Judgment model. We outline a problem with research based on this model. It seems that people either fail to respond to the deterministic aspects of vignettes when making judgments or that their understanding of determinism differs from researcher expectations. We provide some empirical evidence for this claim. In the end, we argue that people seem to lack facility with the concept of determinism, which calls into question the validity of experimental work operating under the Vignette-Judgment model. We also argue that alternative experimental paradigms are unlikely to elicit judgments that are philosophically relevant to questions about the metaphysics of free will.
(What) Do We Owe Beautiful Objects? A Case for Aesthetic Obligations
Authors: Schellekens Elisabeth
Published: July 2024

This paper has two main aims. The first is to examine our normative relations to artworks and cultural artefacts threatened by damage or destruction. The second aim is to develop an argument for the notion of aesthetic obligation, offering an alternative model of explanation of our normative relations to artworks and cultural artefacts which relies neither exclusively on the object of appreciation (‘object-oriented approach’) nor on the appreciating subject (‘subject-oriented approach’). Instead, an aesthetic obligation is held to be directed primarily towards the community which appreciates the object on the grounds of its aesthetic value. That which unites an aesthetic community is the practice of valuing an object for its aesthetic character. The notion of aesthetic obligation thus relies both on the community of subjects which holds an object in high aesthetic regard and that same object’s aesthetic value.
Targeted Verifiable Subcision for Management of Cellulite on the Buttock and Thigh: Incorporation Into Real-World Lower Body Rejuvenation Approaches
Authors: Franco Johnny , Calobrace M Brad , Schulman Matthew R
Published: July 2024

Background

Cellulite affects 80% to 98% of postpubertal females, and most patients with the condition are bothered by it. Targeted Verifiable Subcision (TVS; Avéli; Revelle Aesthetics, Inc., Mountain View, CA) is a minimally invasive mechanical subcision device that reduces the appearance of cellulite dimples in the buttocks and thighs. Although clinical trials have demonstrated efficacy, information on real-world surgical and nonsurgical approaches to managing cellulite in buttocks and thighs is needed.

Objectives

To describe how TVS is being used by the authors to improve patient outcomes in the lower body in both surgical and nonsurgical settings.

Methods

Each of the authors described their current practices using TVS for lower body rejuvenation. Author practices have varied proportions of surgical vs nonsurgical cases (from 10% to 100% surgical cases) and a variety of focuses, ranging from primarily facial aesthetics to a near exclusive focus on body contouring.

Results

The authors' diverse approaches to integrating TVS into clinical practice are detailed, along with pearls of clinical success. TVS is discussed as a companion treatment for surgical procedures, while the patient is already under anesthesia, as well as a part of a nonsurgical approach, where the local anesthesia required for TVS can make additional energy-based procedures more comfortable for the patient. The authors provide several examples and include considerations for optimal timing and ordering of treatments.

Conclusions

TVS may become a valuable addition to the treatment armamentarium for surgical or nonsurgical buttock and thigh rejuvenation and can be integrated into surgical and nonsurgical workflows.

Level of Evidence: 4
242 The Burden of Penetrating Junctional Injuries in a UK Major Trauma Centre: A Retrospective Cohort Study
Authors: Ramaraj P , Watkins B , Super J , Abdul-Rehman1 A , Huang S , Aylwin C , Hettiaratchy S
Published: July 2024

Aim

Junctional injuries occur at the join of anatomically distinct zones. Recent battlefield casualties have shown junctional wounds account for 21% of potentially survivable deaths from haemorrhage. Although well studied in military literature, this is not the case in civilian setting. This paper aims to describe the civilian injury pattern to improve management and resource allocation.

Method

Retrospective study of all patients with penetrating injuries to a junctional zone presenting to an urban MTC in 2018. Patient records searched and data extracted on site of injury, management, and discharge code. Discharge codes were referenced with the National Schedule of NHS costs to produce a cost.

Results

132 patients, 92.4% (n=122) male; median age 27.5; in hospital mortality 0.8% (n=1). 37.9% (n=50) of injuries were buttock; 22% (n=29) neck; 18.9% (n=25) multiply injured; 8.3% (n=11) axilla; 6.8% (n=9) diaphragm; and 6.1% (n=8) groin. Median Injury Severity Score (ISS) 8; median ISS multiply injured 29; diaphragm 16; groin 9; neck 5; axilla 4; buttock 4.

46.2% (n=61) underwent surgery; 50.8% (n=67) were admitted, 7.6% (n=10) to ITU. Median length of ward-stay 3 days. 15.9% (n=21) received blood products. The overall cost was £914,076; £6925/patient. Per patient for multiply injured £19,676; diaphragm £11,435; groin £7,483; axilla £3,553; neck £3,026; buttock £2,651.

Conclusions

Junctional injuries are a significant resource burden. Buttock wounds were the most common but had the lowest median ISS and cost. Diaphragmatic injuries appear distinct in terms of ISS and cost and should be considered as separate to other junctional wounds.
983 A comparison of the Post-operative Complications Rates in the Removal of Benign Parotid Tumours: Extracapsular Dissection Versus Superficial Parotidectomy and Partial Superficial Parotidectomy
Authors: Collard J , Akhtar S
Published: July 2024

Aim

The objective of this systematic review was to assess the effectiveness of different surgical techniques in the removal of benign parotid tumours. The analysis focused on three specific postoperative complications including: recurrence rate, temporary and permanent facial nerve palsy (FNP) and Frey's syndrome. In this systematic review, patients who underwent extracapsular dissection (ECD) were compared to those who underwent superficial parotidectomy (SP) or partial superficial parotidectomy (PSP).

Method

OVID, Cochrane Library, PubMed, and Scopus databases were searched. Inclusion and exclusion criteria were applied resulting in seven papers; all of which were retrospective cohort studies.

Results

A total of 2282 patient data was pooled (1174 ECD-treated and 1108 SP and PSP-treated patients). Statistical analysis showed there was no significant difference in the rate of recurrence (log odds ratio (LOR) = -0.15, 95% confidence interval (CI): -1.11, 0.80). There were lower rates of both temporary facial nerve injury (LOR = -1.76, 95% CI: -2.75,-0.76) and Frey’s syndrome (LOR = -1.63, 95% CI: -2.90,-0.37) in the ECD treated patients. There is reasonable statistical significance suggesting that ECD has lower rates of Permanent FNP (LOR=-1.00, 95% CI: -2.35, 0.35).

Conclusions

Despite the results showing ECD favourability in terms of FNP and Frey’s syndrome, it is important to understand the limitations of this study. Confounding factors such as, tumour size and placement, patient age and gender and surgical cosmetic outcomes were not analysed in this systematic review (SR). Future research should focus on a prospective cohort study, directly comparing the different surgical techniques.
578 Optimising Emergency Theatre Efficiency with the Use of a Pre-Anaesthetic Holding Bay, a Quality Improvement Project
Authors: Vaughan-Burleigh S , Marsden L , Peagam R , Tyrrell J , Hollyman M
Published: July 2024

Aim

An efficient emergency theatre depends on the coordination of multiple surgical specialties, anaesthetists, and theatre staff. The serial nature of an operating list leads to downtime between cases. We sought to reduce delays between emergency cases by implementing a pre-anaesthetic holding bay.

Method

Anonymised data was collected from a prospectively maintained mandatory database of theatre activity. Exclusion criteria were non-surgical procedures, first case, out-of-hours procedures, and critical care admissions. Suitability was determined from a period pre-implementation and a pre-defined trial period to ensure safe rollout. Pre-, trial, and post-implementation were compared.

Results

349 emergency procedures were performed in three months post-implementation. After exclusion criteria 110 were suitable for pre-anaesthetic holding bay use, and in 35 (31.8%) it was utilised. Most cases were general surgery (61%), vascular surgery (15%), and gynaecology (12%). Holding bay use decreased time without a patient in the anaesthetic room from 50 to 5 minutes (p<.001) and the time between procedures from 86 to 43 minutes (p<.001). There was no difference in anaesthetic time between the groups (36 vs 38 minutes, p=.40). Over the three months 40 more in-hours cases were completed in 48 days with no difference in procedures across the periods.

Conclusions

Pre-anaesthetic holding bay use reduced theatre downtime by 90%, allowing more procedures to be performed in-hours. All specialties engaged with the holding bay but to varying extent, and ensuring investment from surgeons, anaesthetists, and theatre staff is essential. This intervention, implemented with no extra resources, has increased efficiency and improved safety in the emergency theatre list.
627 Epidemiology, Admissions Outcomes, and Mortality for Geriatric Trochanteric Fractures. A Major Trauma Centre Study
Authors: Zhang J , Shah B , Zhu J , Bradshaw F , Krkovic M
Published: July 2024

Aim

Femur trochanteric fractures are very debilitating injuries yet are under investigated in orthopaedic literature. We study the epidemiology, hospital admission factors, and mortality for elderly patients with trochanteric fractures.

Method

All patients over 65 years old at a level-1 trauma-centre with a trochanteric hip fracture from January-2015 to June-2021 were included. Fractures were subdivided with AO/OTA subclassifications into intertrochanteric (31-A1,A2,A3) and subtrochanteric (32-A1,A2) sub-types. Patient demographics, preadmission mobility, time-to-surgery, length-of-surgery, surgical fixation used, inpatient rehabilitation/mobilisation, and post-operative mortality at 1,3,6 and 12 months, were collected. Patients were followed up for minimum of 2-years. Statistical significance was p<0.05.

Results

A total of 1101 patients were included. The AO/OTA classification was: 31-A1(123), 31-A2(491), 31-A3(105), 32-A1(221), 32-A2(161). Average age was 84.9, with 72.8% patients being female. Average admission-to-surgery, surgery-time, and surgery-to-discharge-time was 21.6hours, 1.2hours, and 15.5days respectively.

Overall mortality was 7.2%(1-month), 15.4%(3-months), 20.4%(6-months) and 27.1%(12-months). There were no statistically significant associations of type of fracture, operative method, or surgery-within-36hours, with mortality at any scale. Post-operative mobilisation within 24-hours, with or without physiotherapist aid, was associated with lower mortality on all investigated time scales, compared to no mobilisation (p<0.05).

Conclusions

Our study presents a large and detailed cohort of patients with trochanteric fractures classified with AO/OTA, the first in the UK, and investigated the associations with inpatient admission and mortality outcomes. Our detailed analysis and high-resolution data will allow for cross region and country comparisons and inform guideline and quality improvement efforts.
236 Post-Splenectomy Patients: Reaudit of Current Practice at Living Well Partnership PCN
Authors: Samarth G , Pigott L , Lloyd M , Hughes M , Aggarwal P , Freeman A , Hunt P
Published: July 2024

Aim

Post-splenectomy patients are at increased risk of sepsis and overwhelming post-splenectomy infection (OPSI). This reaudit aimed to look at a primary care network’s (PCN) compliance with established immunisation guidelines and antibiotic prophylaxis post-splenectomy.

Method

A retrospective study of 29 splenectomy or asplenia patients between 2018-2022 was conducted within a primary care network. Hospital and GP records were reviewed for antibiotic prescriptions (prophylactic and emergency), vaccination records, electronic splenectomy alert and admission for infection. Interventions included a 15-minute patient intervention GP consultation and correction of EMIS coding.

Results

The 2018 audit showed that a proportion of splenectomy patients were not appropriately prescribed antibiotics. There was lack of patient insight into their condition (asplenia v splenectomy). An active, patient-centred intervention was employed to improve rates of antibiotic prescribing, perform counselling on regular recommended vaccinations and ensure correct clinical coding for follow up. Compliance to audit criteria increased across all measures between the 3 PDSA cycles. Antibiotic prophylaxis prescription increased from 53% (2018) to 71% in 2022. Emergency antibiotic prescription increased from 6% (2018) to 39% in 2022. Influenza vaccination rates increased from 71% (2018) to 82% in 2022. Following the intervention consultation, 85% of patients had appropriate antibiotic prophylaxis prescription and 64% had appropriate emergency antibiotics prescribed.

Conclusions

Prescription for emergency and prophylactic antibiotics, and correct coding for annual and 5-year vaccinations were improved for this cohort of splenectomy and asplenia patients. Patients valued a structured consultation leading to improved understanding and self-management.