bluuebunny/crossref_metadata_2025 huggingface dataset:
Enhanced multiferroic properties of Co-doped BiFeO3 nanoparticles via structural changes
Authors: Wang Sihui , Li Yuqing , Lv Juncheng , Sun Tianyue , Li Fang , Wang Jian , Ming Shuoyang , Liu Yanqing , Zhang Junkai , Yang Jinghai
Published: August 2024

The present study demonstrates a rhombohedral-to-orthorhombic phase transition of BiFe1-XCoXO3 (BFCXO, x = 0, 0.01, 0.03, and 0.05) nanoparticles induced by Co ion doping. With increasing concentration of Co dopant, XRD, Raman and IR patterns exhibit lattice shrinkage and increased lattice strain; SEM and TEM images reveal a corresponding reduction in grain size; XPS spectra indicate that the Fe2+ ions are readily oxidized by Co3+ to Fe3+ ions because to the greater oxidation–reduction potential of Fe3+/Fe2+ (1.3 eV) than that of Co3+/Co2+ (0.55 eV). Effective regulation of crystal structure and microstructure significantly alters the multiferroic properties of BFCXO samples. The Co-doped samples gradually transition from antiferromagnetism to ferromagnetism. Among them, BFC0.03O reaches its maximum values at Ms ~ 0.956 emu/g for magnetization saturation and Mr ~ 0.054 emu/g for remanent magnetization. Meanwhile, BFC0.03O exhibits better ferroelectric properties compared to its pure counterpart. This study presents an effective approach for controlling the structure and characteristics of BFO-based nanomaterials for multifunctional device applications.
Multicast-based fault-tolerant multiparty state preparation of four-qubit cluster states
Authors: Meng TianTian , Wei YuZhen , Jiang Min , Chen Hong , Huang Xu
Published: August 2024

The primary aim of this study is to utilize multicast in the preparation of multi-party four-qubit cluster states. In the presence of environment noises, errors may influence the procedure of the particle distribution. To address this challenge, we propose a fault-tolerant scheme to manage the errors within the detectable channel particles. Based on the Bell chain channel, our approach could prepare arbitrary four-particle cluster state by introducing auxiliary particles, where the receiver performs the unitary operation for recovering the target states. Compared to previous multicast protocols, our scheme reduces resource consumption and operational complexity during cluster state preparation. Additionally, we analyze the system’s fidelity in incoherent environments, providing a more comprehensive understanding of the impact of noise on quantum communication systems.
Exceptional anisotropic superhydrophobicity of sword-lily striated leaf surface and soft lithographic biomimicking using polystyrene replica
Authors: Dubey Mahesh C , Mohanta D
Published: August 2024

Herein, we report unusually high anisotropic superhydrophobicity, unidirectional self-cleaning, and biomimicking of adaxial sword-lily (Gladiolus hortulanus) leaf comprising three distinct levels of surface textures. Observably, the static anisotropic wetting and rolling of water droplets are more favourable in the parallel (or, striation) direction than in the perpendicular direction. Inspired from such water repellency of the sword lily leaf surface, here bio-mimicked polystyrene (PS) leaf construct is developed through a soft lithographic technique. Considering different water droplet sizes (4–10 μl) on natural lily leaf and bio-mimicked PS construct surfaces, the respective parallel (θ
||) and perpendicular (θ
⊥) water contact angles (WCAs) stand at, θ
|| ∼143°–147°, θ
⊥ ∼156°–169°; and θ
|| ∼130°–139°, θ
⊥ ∼142°–145°. Moreover, the specimens under study exhibit roll-off angles ranging, α
|| ∼8°–23° (α
⊥ ∼16°–41°) and α
|| ∼21°–49° (α
⊥ ∼40°–55°) along parallel (and perpendicular) directions; respectively. A noticeable difference in α
⊥ and α
|| values can be ascribed to the profound three-phase contact line (TCL) pinning along the perpendicular direction taking advantage of striation as means of barrier. The roll-off angles can also alter due to a variation in the droplet volume. The unusual anisotropic superhydrophobicity and unidirectional droplet roll-off can be attributed to the entrapped air within the micro-nano texture beneath the water droplet along with the pinning effect in the perpendicular direction caused by the striated heights.
Two-dimensional refractive index distribution using polarization phase shifting interferometry and total internal reflection
Authors: Rani Mamta , Shankar Ajay , Sanghi Sujata , Yadav Mini
Published: August 2024

An effective method to measure the 2-D refractive index distribution of homogeneous liquids: acetic acid and glycerol- water mixture at different concentration and a non- homogeneous mixture of liquids: water, acetic acid, acetone and glycerin but not limited to these liquids is presented. In the present setup a combination of polarization phase shifting interferometry (PPSI) and total internal reflection (TIR) is used. The s-polarized light strikes the boundary of a right angle prism and a tested liquid droplet. When TIR occurs on the interface, the incident light has a phase variation which depends on the refractive index of adhered liquid on prism surface. Two-dimensional index distributions can be easily calculated using the relation among reflection phase shift difference and the liquid index. The results of the tested mixed liquid by proposed technique show the refractive index and its distribution in range 1.433 ± 0.031 to 1.433 ± 0.124.
Spatial patterns of the Brusselator model with asymmetric Lévy diffusion
Authors: Yin 尹 Hongwei 洪位 , Yang 杨 Shangtao 尚涛 , Wen 文 Xiaoqing 小庆 , Wang 王 Haohua 浩华 , Yang 杨 Shufen 淑芬
Published: August 2024

The formation of spatial patterns is an important issue in reaction–diffusion systems. Previous studies have mainly focused on the spatial patterns in reaction–diffusion models equipped with symmetric diffusion (such as normal or fractional Laplace diffusion), namely, assuming that spatial environments of the systems are homogeneous. However, the complexity and heterogeneity of spatial environments of biochemical reactions in vivo can lead to asymmetric diffusion of reactants. Naturally, there arises an open question of how the asymmetric diffusion affects dynamical behaviors of biochemical reaction systems. To answer this, we build a general asymmetric Lévy diffusion model based on the theory of a continuous time random walk. In addition, we investigate the two-species Brusselator model with asymmetric Lévy diffusion, and obtain a general condition for the formation of Turing and wave patterns. More interestingly, we find that even though the Brusselator model with symmetric diffusion cannot produce steady spatial patterns for some parameters, the asymmetry of Lévy diffusion for this model can produce wave patterns. This is different from the previous result that wave instability requires at least a three-species model. In addition, the asymmetry of Lévy diffusion can significantly affect the amplitude and frequency of the spatial patterns. Our results enrich our knowledge of the mechanisms of pattern formation.
Mixing and dilution controls on marine CO2 removal using alkalinity enhancement
Authors: Khangaonkar Tarang , Carter Brendan R , Premathilake Lakshitha , Yun Su Kyong , Ni Wenfei , Stoll Mary Margaret , Ward Nicholas D , Hemery Lenaïg G , Torres Sanchez Carolina , Subban Chinmayee V , Ringham Mallory C , Eisaman Matthew D , Pelman Todd , Tallam Krti , Feely Richard A
Published: August 2024

Marine CO2 removal (CDR) using enhanced-alkalinity seawater discharge was simulated in the estuarine waters of the Salish Sea, Washington, US. The high-alkalinity seawater would be generated using bipolar membrane electrodialysis technology to remove acid and the alkaline stream returned to the sea. Response of the receiving waters was evaluated using a shoreline resolving hydrodynamic model with biogeochemistry, and carbonate chemistry. Two sites, and two deployment scales, each with enhanced TA of 2997 mmol m−3 and a pH of 9 were simulated. The effects on air-sea CO2 flux and pH in the near-field as well as over the larger estuary wide domain were assessed. The large-scale deployment (addition of 164 Mmoles TA yr−1) in a small embayment (Sequim Bay, 12.5 km2) resulted in removal of 2066 T of CO2 (45% of total simulated) at rate of 3756 mmol m−2 yr−1, higher than the 63 mmol m−2 yr−1 required globally to remove 1.0 GT CO2 yr−1. It also reduced acidity in the bay, ΔpH ≈ +0.1 pH units, an amount comparable to the historic impacts of anthropogenic acidification in the Salish Sea. The mixing and dilution of added TA with distance from the source results in reduced CDR rates such that comparable amount 2176 T CO2 yr−1 was removed over >1000 fold larger area of the rest of the model domain. There is the potential for more removal occurring beyond the region modeled. The CDR from reduction of outgassing between October and May accounts for as much as 90% of total CDR simulated. Of the total, only 375 T CO2 yr−1 (8%) was from the open shelf portion of the model domain. With shallow depths limiting vertical mixing, nearshore estuarine waters may provide a more rapid removal of CO2 using alkalinity enhancement relative to deeper oceanic sites.
Electrical Simulation of Ring Type Motor and Radial Motor with One Spool One Magnet Test Method for Green Transportation Electric Vehicle Using Finite Element Method (FEM)
Authors: Aryadi W , Dani Zulkarnain S
Published: August 2024

The purpose of this study is to determine the comparison of the electro-orbital force of the C-shaped spool ring-type motor and electro-radial motor with the test observation of one spool of one magnet, knowing the comparison of the torque of the electro-orbital of the C-shaped spool ring-type motor and electro radial motor with the test observation of one spool of one magnet, knowing the comparison of the linkage flux of the electro orbital of the C-shaped spool ring-type motor and electro radial motor with the test observation of one spool of one magnet. The research method used in this research is the Finite Element Method (FEM) carried out with MagNet 7.5 Software to determine the value of force, torque, and linkage flux in each type of motor in attractive and repulsive magnetic conditions. The simulation results are then compared to determine the value of each motor. The procedures in this research are (a) problem identification, (b) literature study, (c) determining parameters, (d) design process, (e) setup study of MagNet software, (f) simulation, (g) simulation result data, (h) data analysis. The conclusion obtained from this research is that the orbital electro motor of ring type one spool one magnet compared to radial electro motor is better in attraction condition but lower in repulsion condition. In the attraction magnet condition, the average value ratio of ring type electro motor orbital compared to radial electro motor is 1.13:1 force, 1.87:1 torque, and 1:1.18 linkage flux, and the maximum value of ring type electro motor orbital compared to radial electro motor is 1.43:1 force, 2.5:1 torque, and 1:1.2 linkage flux. In the reject condition, the average orbital ratio of ring type electro motor compared to the radial electro motor is force 1:1.01, torque 1.14:1, and flux linkage 1:1.52, and the maximum orbital value of ring type electro motor compared to the radial electro motor is force 1.89:1, torque 2:1, and flux linkage 1:1.47. This simulation can be a reference to develop green transportation to reduce fuel usage and safe the earth.
Utilization of Fly Ash and Bottom Ash as a Mixture for Making Paving Blocks
Authors: Pangestuti Endah Kanti , Julianto Eko Nugroho , Ayu Hapsari Rahma Nindya , Sholahudin Farhan , Aida Nur , Ardiasnyah Debri , Bagaskara Praba , Heriyanto Fadhila Rizqina
Published: August 2024

PLTU Tanjung Jati-B Jepara produces waste from coal combustion in the form of fly ash and bottom ash. The accumulation of waste will cause many other problems, so innovation is needed to turn it into value-added materials. One of them is to make fly ash and bottom ash into a mixture for making paving blocks. In making paving blocks with fly ash and bottom ash materials will use a mixture of materials 1: 3 and 6 mix designs. The results showed that the use of fly ash and bottom ash can produce quality B paving blocks with compressive strength values of 18.73 MPa in mix design (1 S: 3 BA) and quality C paving blocks with 7.5% water absorption in mix design and ((0.5 S : 0.5 FA): 3 BA). From these results, it can be concluded that every addition to the percentage of fly ash will reduce the compressive strength value and reduce the water absorption of the paving block. While the use of bottom ash as a substitute for sand will reduce the compressive strength value but add water absorption of paving blocks.
Exploring the Effect of Environmental and Meteorological Factors on Photovoltaic (PV) Power Generation through Clustering Analysis
Authors: Hidayat Syahroni , Fathoni Khoirudin , Hasanah Uswatun , Andrasto Tatyantoro , Nadhifatul Aryza Faila
Published: August 2024

Photovoltaic (PV) is a renewable energy solution that offers environmental sustainability and the potential to reduce greenhouse gas emissions. As PV systems become increasingly prevalent, the need for efficient monitoring, control, and optimization becomes paramount. Understanding the significance of environmental and meteorological factors, such as First Hour of Period, Distance to Solar Noon, Average Temperature, Average Wind Direction, Average Wind Speed, Sky Cover, Visibility, Relative Humidity, Average Wind Speed, Average Barometric Pressure, and Power Generated, on PV efficiency is essential for optimizing PV system design and operation. Clustering analysis is applied to identify distinct operational patterns and correlations among these parameters, providing valuable insights into PV system performance under varying conditions. The clustering analysis results in two distinct clusters, each representing specific operational characteristics of PV systems. Cluster 0 demonstrates peak generation capacity during mid-morning and afternoon hours, while Cluster 1 experiences peak generation during morning and evening hours. The silhouette coefficient of 0.708 validates the clustering results’ quality, signifying well-defined clusters and the relevance of the selected features. The findings can aid in optimizing PV system performance, guiding design decisions, and promoting the adoption of renewable energy solutions.
Reuse of Waste into Appropriate Products
Authors: Apriyani Delta , Ihsani Ade Novi Nurul , Maghfiroh Anik , Anggraeni Nelly Setyowati , Pranandari Della Puspita , Wiyono Prita Dewi
Published: August 2024

Plastic waste is increasingly becoming a concern that must be followed up in order to save the environment. Plastic waste can be used to make useful items if managed well. There are many innovations that can be made by utilizing plastic waste into appropriate products, one of which is using plastic waste into accessories. Many people use accessories to support their appearance. Accessories are a product that many people are interested in, so it is very appropriate if plastic waste management can be used as accessories.

The aim of this research is to create appropriate products by utilizing plastic waste to help save nature and create products that can be used by society. This research refers to development research procedures from Borg & Gall which are limited to preliminary studies, planning, initial product development, product validation by experts, and product revision. The results of this research are that the results obtained from the assessment of 3 expert judgments show that the accessory products produced have very good value and can be adopted by the wider community so that they are able to reduce the level of waste in the environment, not only based on the results they like, that many people like the results. from the management of plastic waste, it becomes accessories that have high selling power.
Artificial Lighting Simulation with Renewal of Indonesian National Standards (SNI) from 7062-2004 to 7062-2019
Authors: Hangga A , Nisa A M , Khoirunnisa F , Wulan A P
Published: August 2024

Light is the key to human visual perception in a learning environment. Indonesian National Standard (SNI) can be used as a reference for the minimum illuminance value in the classroom so that visual comfort was obtained in learning activities. This research aims to improve the illuminance quality according to SNI 6197: 2011 by 350 lux with the renewal of SNI 7062. So that the results of this research can be seen as the impact of updating the illuminance measurement from SNI 7062-2004 to SNI 7062-2019. E11-210 classroom, E11 Building, Universitas Negeri Semarang had dimensions of 12m x 9m x 3.5m. Measurement illuminance used general measurements and task measurements. There were two illuminance measurement standards, namely SNI 16-7062-2004 and SNI 7062-2019. Illuminance data was collected by observation and simulation. Dialux 10 software was used in the simulation of illuminance measurements. The results of observations and simulations showed that the illuminance of E11-210 classroom was around 110 – 221 lux and did not follow SNI 6917:2011. There was a modifying lamp layout and replacing of lamp types in this research so that simulation results were obtained which had the classroom illuminance according to SNI 6197:2011. The simulation results showed that using SNI 7062-2019 increased visual comfort that could be felt up to the boundaries of the room. However, using SNI 7062-2019 could increase the cost of electricity for classroom lighting for 1 hour by 42.11%.
Exploring the use of fast electron backscattering for the determination of the C/O ratios: possible applications to graphene oxide and reduced graphene oxide
Authors: Padron-Ramirez Ivan , Chao Mujica Frank J , Díaz Sánchez Ángeles , Arganis Juárez Carlos R , Nelson Pamela F , Peña Caravaca Jose P , de León Cabrera Josue Ponce , Corcho-Valdés Angel Luis , Antuch Manuel , Desdin-Garcia Luis F
Published: August 2024

GO and rGO are carbon nanostructures with a wide range of applications. The carbon/oxygen ratio (C/O) is a basic parameter that determines many of its essential properties. The large-scale production of these materials requires the use of fast and representative methods to determine the C/O ratio. In the present work, the feasibility of using fast electron backscattering to determine this relationship was explored. The method is rapid and does not require previous sample treatment, its accuracy is approximately 11%–15% for C/O ∼ 10–35 and its precision is around 0.4%. It was estimated that the backscattered electrons being detected came from a sample mass of 0.04–0.4 g, depending on the synthesis method used. The accuracy of the backscatter method is approximately equal to that of EDX and XPS, but it surpasses them in precision and representativeness. Backscattering equipments are more economical when compared to the above-mentioned techniques; however, it can be affected by the presence of impurities. Therefore, we consider it an appropriate method for the large-scale control of samples of GO and rGO produced by a given technology and calibrated with a rigorous elemental analysis.
Optimization of electrical discharge machining parameters for enhanced performance on inconel 718 using Cu-Ni-B4C nanocomposite electrodes and advanced modeling techniques
Authors: Y Justin Raj , A Bovas Herbert Bejaxhin , S Rajkumar , Selvarajan L , Melese Kassahun Gashu , Majora Manaye , Wondimu Wasihun
Published: August 2024

This paper investigate into the complex field of electrical discharge machining (EDM) to improve material removal rate (MRR), electrode wear rate (EWR), and surface roughness (SR) for the machining of Inconel 718, a difficult-to-machine superalloy. The effects of discharge current, pulse duration, and pulse interval on machining performance were assessed through experiments. Response surface methodology (RSM) and artificial neural network (ANN) models, such as RNN, LSTM, and CNN, were used to optimize. Twenty runs of confirmation experiments were used to confirm the optimal process parameters found by the created models for better machining. For Inconel 718, the novel Cu-Ni-B4C nanocomposite electrode greatly enhanced EDM performance. The ideal configuration increased MRR while decreasing wear and surface roughness. Machined surfaces were inspected using SEM and EDAX analysis. With optimal settings of 50 μs pulse duration and 90 μs pulse interval, increasing current to 8 Amps increased MRR to 0.0118 g min−1, reducing EWR to 0.001 g min−1 and SR to 3.108 μm. Compared to the RNN, LSTM, and RSM models, the CNN model had the greatest R-squared (R2) score of 0.9999, suggesting greater MRR, EWR, and SR prediction.
A single-cell multimodal view on gene regulatory network inference from transcriptomics and chromatin accessibility data
Authors: Loers Jens Uwe , Vermeirssen Vanessa
Published: August 2024

Eukaryotic gene regulation is a combinatorial, dynamic, and quantitative process that plays a vital role in development and disease and can be modeled at a systems level in gene regulatory networks (GRNs). The wealth of multi-omics data measured on the same samples and even on the same cells has lifted the field of GRN inference to the next stage. Combinations of (single-cell) transcriptomics and chromatin accessibility allow the prediction of fine-grained regulatory programs that go beyond mere correlation of transcription factor and target gene expression, with enhancer GRNs (eGRNs) modeling molecular interactions between transcription factors, regulatory elements, and target genes. In this review, we highlight the key components for successful (e)GRN inference from (sc)RNA-seq and (sc)ATAC-seq data exemplified by state-of-the-art methods as well as open challenges and future developments. Moreover, we address preprocessing strategies, metacell generation and computational omics pairing, transcription factor binding site detection, and linear and three-dimensional approaches to identify chromatin interactions as well as dynamic and causal eGRN inference. We believe that the integration of transcriptomics together with epigenomics data at a single-cell level is the new standard for mechanistic network inference, and that it can be further advanced with integrating additional omics layers and spatiotemporal data, as well as with shifting the focus towards more quantitative and causal modeling strategies.
109 Compliance Rates of the WHO’s Surgical Safety Checklist, Within a District General Hospital’s ENT Department
Authors: Sadera R , Kazemi N , Hettige R
Published: August 2024

Background

The WHO’s Surgical Safety Checklist (SSC) is a required component of surgical procedures. It has been proven to decrease patient mortality. This audit’s objective was to assess the compliance with the timeout segment (specifically, the confirmation of all team members) of the SSC, at a district general hospital’s ENT department in comparison to WHO guidance.

Method

A prospective audit analysing elective and emergency theatres was undertaken over four months (1st cycle: 12/05/23- 21/06/23 and 2nd cycle: 27/07/23-20/08/23) with 19 patients for each cycle. The assessment focused on the completion of the segment’s names section, which included the names of the surgeon, surgical assistants, anaesthetic consultant, and registrar, and team leader for each case.

Results

During the first cycle, the Trust’s compliance rate for filling the sections was 4%. However, following our interventions of email communications and face-to-face staff meetings to theatre personnel on the importance of completing the theatre board with the categories’ names, there was an improvement resulting in a 100% compliance for all sections. To ensure compliance continued, we presented our findings within clinical governance meetings as our secondary intervention.

Conclusions

This audit demonstrated that simple measures could help to ensure compliance to WHO protocols as well as illustrating our Trust’s compliance to WHO guidance. To ensure ongoing compliance, a third cycle with interventions ensuring that new rotating staff are informed about the significance of the WHO SSC is needed. Furthermore, it may be beneficial to conduct analysis across various surgical specialties for comparative studies.
215 Title: An Overview of Adhesional Small Bowel Obstruction Management Across Two High-Volume Tertiary Centres in the North West of England
Authors: Birkenhead P , James E , Emilian-Nita G
Published: August 2024

This study is a retrospective audit conducted in November and December 2022 across two high volume tertiary centres in Liverpool (Royal Liverpool University Hospital and Aintree Major Trauma Centre), aiming to evaluate the local diagnostic and therapeutic approaches to ASBO, benchmarked against the established Bologna ASBO Working Group Guidelines of 2017 and the NASBO recommendations. Our audit encompassed 22 patients, with a slight female predominance (59.1%), and an average age of 63.5 years. The audit revealed several critical insights, including a tendency to over-utilise abdominal X-Ray contrary to current WSES (Bologna) recommendations, suboptimal utilisation of water-soluble contrast agents in conjunction with CT imaging for ASBO diagnosis and management (36.4% adherence), delayed timing to cross-sectional imaging (averaging 11.7 hours from suspicion to imaging) and delayed time to surgical intervention (mean duration of 102.6 hours in emergency, and up to 135 hours in semi-emergency scenarios), inconsistent biochemical monitoring with notably deficient lactate surveillance (16.7%), delayed implementation of parenteral nutrition (36.4%), and a mortality rate of 13.6%, which notably exceeds the Bologna report figures.

These findings have catalysed a comprehensive re-evaluation and restructuring of our local protocols for ASBO treatment and management. Future directives include expedited diagnosis through prompt CT scanning integrated with water-soluble contrast agents at the point of entry, advocacy for both conservative and surgical intervention as clinically indicated, the promotion of a multidisciplinary approach with early involvement of dietitian team and establishment of TPN, and an overarching goal to curtail mortality rates associated with ASBO.
274 Audit of the Written and Oral Assessment of the Dissertation Component of a Laparoscopic Surgical MSc Programme Using Internal and External Benchmarks
Authors: Ajah J , Narayanan Raju R , Patel B
Published: August 2024

Aim

To critically audit the laparoscopic surgery master’s programme dissertation assessment against internal and external Quality Assurance. The main objective was to vet and benchmark the module assessment to the Queen Mary University London(Internal) & University College London(external) benchmarks. Additionally, to pinpoint areas for potential enhancement with a projected re-audit in the 2024/2025 academic session.

Method

Two separate analyses were carried out for the written dissertation and its oral presentation. The criteria assessed include the 50% rule, blind double marking, resolving differences between markers, marking trails, guidance specific to the dissertation and moderation. (internal). External benchmark criteria assessed include parity meeting, Independent i.e., double marking, reconciliation of marks, documentation of marking, guidance specific to the dissertation and moderation. The anonymous results of a total of 18 students were assessed.

Results

For the internal benchmark of the dissertation component, assessment practice surpassed the 50% rule and double blinding requirements by 200%(9 vs 18), parity marking was done after marking (external), and differences in marks were agreed upon by discussion between examiners only(both internal and external), marking trails were left electronically(internal/external), only double-blind marking was done, and moderation was not needed(both). The viva component was essentially the same except differences in marks were agreed upon by splitting the difference between examiners.

Conclusions

An area of improvement is having electronic viva marking sheets in the next academic session. This audit shows an example of good practice in academic surgical education that other similar programmes within the UK and globally can adopt.
275 Pre-Treatment Diagnosis in Lung Cancer Resections
Authors: Omran A
Published: August 2024

Aim

Measure compliance with Lung Cancer Quality Performance Indicator 15, which states that patients should have a cytological or histological diagnosis prior to definitive treatment, i.e., surgical resection. Standards: 75 %

Method

In a retrospective audit, data was collected from existing databases and case notes between November 2022 and January 2023 at Golden Jubilee University National Hospital. The data was input into and analysed using Microsoft Excel.

Results

108 patients underwent lung cancer resection between November 2022 and January 2023; 79 patients (73%) had a pre-treatment histological diagnosis. Diagnosis was obtained by means of CT-guided biopsy in 53 patients (67%), frozen sections in 14 patients (17.7%), bronchoscopy and endobronchial biopsy in 9 patients (11.3%), EBUS-TBNA in 2 patients (2.5%), and previous blind resection in 1 patient (1.2%).

Conclusions

The 75% target for preoperative histological diagnosis was not achieved. 27% of patients didn’t have pre-treatment diagnosis due toTechnical difficultiesfailed or inconclusive biopsyRadiological findings were accepted for treatment.

Impact

The project has contributed to the introduction of a new service to the hospital, namely a regional service for CT-guided lung biopsy, which was granted clinical governance approval on November 1, 2023.
310 Documentation and Consent Audit in HPB Patients
Authors: Aggarwal N
Published: August 2024

Aim

Investigating documented information relating to the care of the hepatobiliary patients to ensure record-keeping standards are being met and written consent for procedures are recorded in accordance to trust and national guidance.

Method

17 patient files, selected at random, were included in this audit. Microsoft Forms application was utilised to complete the data collection. The files were audited against trust guidelines regarding documentation and consent.

Results

Although all entries were legible and signed oftentimes GMC number and designation was omitted (81%). Allergy status and drug history had also been omitted from most records (62 and 63% respectively). Regarding consent, all forms were present in the notes, and all properly described the name/ benefits/ risks of the procedure. In 77% of consent forms, it was not documented whether an information leaflet has been provided to the patient. Only the minority of patients received a carbon copy of their consent form (23%). When the carbon copy remained in the patient’s file, the consenter had failed to circle “no” indicating patient did not accept the copy in every case. Abbreviations were used in over half of the consent forms audited (54%).

Conclusions

Key areas for improvement in documentation and consent were underlined by this audit. Proper and clear highlighting of patient’s allergies and drug histories is an important area for improvement regarding documentation. Consenters should make more efforts to offer patient information leaflets and carbon copies of consent forms to patients and to document this appropriately.
329 An Audit into the Prescription of Maintenance IV Fluids for General Surgery Patients
Authors: Ravendran K
Published: August 2024

Introduction

Intravenous (IV) fluids are vital for maintaining surgical patients in a "nil by mouth" (NBM) state. They prevent dehydration, maintain electrolyte balance, support perfusion, provide nutrition, administer medications, stabilize blood pressure, monitor fluid balance, and address emergencies. The central objective of this audit is to assess the level of adherence to NICE guidelines in the surgical department concerning the prescription of IV fluids.

Method

During the pre-intervention phase, a two-week audit was conducted across three surgical wards where patients were in a nil by mouth (NBM) state. Each day, the audit involved a comprehensive review of patient records and drug charts. Additionally, inquiries were made with the respective nurses in charge to gather information on the IV fluids administered to the patients. The Intervention phase was also two weeks, across the same surgical wards. Intervention included a proforma and teaching to foundation doctors on the ward, to comply with NICE guidelines.

Results

The first cycle showed that no patients were given IV fluids according to NICE guidelines. The NICE guidelines state the following: According to the NICE guidelines, the recommended daily maintenance fluid requirements consist of:25-30 ml/kg/day of water,Approximately 1 mmol/kg/day of potassium, sodium, and chloride, andApproximately 50-100 g/day of glucose, primarily to prevent starvation ketosis (although it's important to note that this alone does not address the patient's nutritional needs).

Second cycle is currently in progress, but early signs show a positive improvement

Conclusions

IV fluids are vital for maintaining "nil by mouth" patients.
377 Nutritional Management in Acute Pancreatitis Patients and Its Effect on Recovery in a Single Institution in the UK
Authors: Cai W , Probert S , Khorshid K , Sultan B , Alkistawi F , Karamanakos S
Published: August 2024

Aim

This study aims to evaluate nutritional management of patients admitted with acute pancreatitis in a single institution in a 12-month period. This involves looking at the route of nutritional administration and nil-by-mouth status on admission.

Method

Patients admitted with acute pancreatitis from January to December 2022 at Basildon Hospital were identified using the hospital’s electronic patient records portal. Data on patient demographic, cause of pancreatitis, route of administration of nutrition were collated and analysed in Excel®.

Results

A total of 161 patients were included in this study and 84 (52.2%) were male. The commonest causes of acute pancreatitis in this cohort of patients are gallstones (34.0%) and alcohol (27.8%). Forty-one patients (25.4%) were made nil-by-mouth on admission. The median number of days a patient remained nil-by-mouth is 1 day with an interquartile range of 2 days. Out of the 120 patients who were not nil-by-mouth on admission, one was on nasogastric feeding and the rest had enteral nutrition by mouth. Of those who were nil-by-mouth on admission, 29 patients resumed enteral nutrition by mouth at a later date, 7 had nasogastric feeding, 2 had nasojejunal feeding and 3 had parenteral nutrition. Patients who were NBM on admission had significantly longer mean length of stay when compared to those who were not (p<0.05).

Conclusions

This study has shown most patients with acute pancreatitis started on oral feeding early in the course of the disease in this institution. This is in accordance with international guidelines.
591 Septal Button Service Evaluation
Authors: Mohamed J , Richards E , Jervis S
Published: August 2024

Aim

Nasal septal perforation is a defect extending through the bony or cartilaginous septum and its overlaying mucosal covering, which can impair the structural and functional properties of the nasal septum leading to patient discomfort and symptoms. Septal button is an alternative to surgical repair of the defect and the audit was aimed at reviewing outcomes of septal button insertion done in the department.

Method

It was a retrospective study involving the patients who underwent the procedure during the period between 2017 to 2023. The patients were identified from the theatre logbook and the data collected included demographics, presenting symptoms, complications and further management if required. The data was collected from the theatre documentation and clinic letter, and Microsoft excel was used to analyse the data.

Results

45 patients underwent the procedure during the above time period and a total of 59 septal buttons were inserted. 87% of the buttons inserted were Custom while the others were off shelf. 26 patients kept the first septal button while others had issues after the procedures which required further intervention. Out of the 45 patients, 35 patients had one button in the audited period while 8 patients had 2 buttons and the remaining 2 had 3 buttons.

Conclusions

Septal button is an effective way of treating patients with symptomatic nasal septal perforation. The results of our patients revealed a success rate of 62% which was comparable to the previous studies done for the same procedure (Taylor et al Prosthetics for Nasoseptal Perforations: A Systematic Review and Meta-analysis).
637 Standardising Flexor Sheath Treatment and Hand Therapy in a Regional Hand Surgery Unit
Authors: Ho R , Slade R , Thornsby J , Dickson J
Published: August 2024

Aim

This project aims to compare management of flexor sheath infections in a regional hand surgery unit against guidelines set by British Society for Surgery of the Hand (BSSH).

Method

A retrospective audit of management of flexor sheath infections compared with BSSH standards between March - August 2023. Data was collected retrospectively from electronic patient records and analysed in Microsoft Excel. Data collected included pre-operative splinting, early IV antibiotics, time to theatre, return to theatre, microbiology results, tendon rupture and access to hand therapy.

Results

13 patients filled the audit criteria within the 6-month timeframe.100% of patients had appropriate early antibiotics. 92% of patients had washouts within 24 hours, with 46% of patients requiring return to theatre. Most microbiological cultures showed no growth, of those with positive swabs 21% were gram positive cocci. No tendons ruptures were observed. No patients had pre-operative splinting. Early referral to hand therapy was inconsistent, only 46% of patients had evidence of hand therapy (variable between day 5-14 post op). Hand therapy was documented in post op instructions for 1 patient.

Conclusions

Patients received good operative care with prompt antibiotics and washout. However, we were not meeting access to hand therapy targets. To standardise post operative care, we created an electronic operation note template on flexor sheath infections with specific post operative instructions as per the BSSH guidelines. A patient information leaflet with exercises is provided immediately post operatively to guide early mobilisation. A further audit cycle is underway to see the effects of intervention.
766 Audit of Stratified Treatment Escalation Plan Completion and DNACPR in Patients with Femoral Fractures – 4th Cycle
Authors: Masala I , Rashinkar S , Bairstow D , Manjunath P
Published: August 2024

Aim

Assess how many patients admitted on the fragility fractures ward (including hip, shaft, distal, periprosthetic fractures) had escalation (STEP) forms completed. We audited whether this was done in a timely fashion, which specialties and grades filled in the forms, if was there a weekend effect in form completion, and if the decisions were communicated with patients or relatives.

Method

In this 4th cycle of the audit, notes of patients admitted on the fragility fracture ward in the period 14/09/23 - 25/10/23 were examined prospectively. Paper and electronic notes were assessed for presence of escalation and DNACPR forms completion, and for evidence of discussion. Standards were set as internally as 100% for all measures: evidence of STEP form completion, completion done within 24 hours, and evidence of escalation plan discussion.

Results

30 patients were audited. STEP form completion was 100% however 13% contained minor errors, needing correction; STEP completed within 24 hours of admission to the ward = 77%; documentation of discussion if for less than full escalation 58% (cognitively intact) and 64% (cognitively impaired).

Conclusions

All patients audited had a STEP form completed. STEP form completion within 24 hours improved from cycle 3. Documentation of discussions did not meet the standard for cognitively intact and cognitively impaired patients for less than full escalation. To improve future care, posters will be displayed, audit mentioned in junior doctors' inductions, and email reminders sent to all grades. Further cycles are being planned, and e-documentation system utilisation for improvement is under consideration.
893 Addressing the Potential Harms in Vascular Surgery Inpatients with Diabetes: A Double Audit and Intervention Project on HbA1c Monitoring and Diabetes Management
Authors: Ekkunagul T , Francis J , Drever S , MacLeod C , Renwick B
Published: August 2024

Aim

Diabetes mellitus confers crucial prognostic consequences in vascular surgery patients. Derangements in long- and short-term glycaemic control predispose to increased risks of post-revascularisation amputation and overall cardiovascular morbidity and mortality. This project aims to address these potential risks by improving departmental HbA1c monitoring practice and diabetes management knowledge at a tertiary centre through a comprehensive educational intervention.

Method

A retrospective audit of HbA1c monitoring practice in vascular surgery admissions from August-September 2023 for peripheral arterial disease or diabetic foot infections was performed against a locally agreed guidance-based 3-monthly monitoring frequency. An educational audit on clinical staff’s knowledge of relevant practical and theoretical aspects to diabetes management was performed through a multiple-choice assessment. An educational teaching programme was subsequently designed and delivered. Post-intervention HbA1c monitoring was prospectively reassessed between October-November 2023, and a post-intervention knowledge assessment was performed.

Results

Mean pre-admission HbA1c values in the pre- and post-intervention admission cohorts were 78.6±18.4 mmol/mol (n=21) and 73.6±35.7 mmol/mol (n=12) respectively. Repeat HbA1cs were required in 38% of pre-intervention and 50% of post-intervention admissions. Appropriate HbA1c re-checks on indicated admissions increased from 25% to 86% post-intervention. Mean knowledge assessment performance increased from 56% to 77% with improved mean scores in all knowledge domains.

Conclusions

Gaps in departmental understanding of practical diabetes management and monitoring relevant to vascular surgery patients with diabetes were effectively addressed through the educational intervention. Referral practice for multidisciplinary diabetes optimisation and harm reduction should be a further area of focus given the patient cohort's highly elevated HbA1c measurements.
1039 Improving Escalation Pathways and Appropriate Use of E-Whiteboard Out-of-Hours Task Generation in Trauma & Orthopaedics
Authors: Ogunmwonyi I , Weight G , Farah N , Chadwick C
Published: August 2024

Aim

E-whiteboard is an electronic record system utilised across Sheffield Teaching Hospital NHS Trust. It is used to record and update patient information including observations. There is a task function which allows clinical personnel to write tasks relating to specific patients, however this should only be used outside of normal working hours. Previous inappropriate use has resulted in delays in care, especially for time critical jobs. We aimed to assess and improve the use of the E-whiteboard task system, an in-hours escalation by nursing staff.

Method

We retrospectively looked at e-whiteboard task data from 01/06/22- 31.07/22. The number of tasks, location of task generation and task content were reviewed, and tasks were further reviewed for content, urgency, and time to completion.

Following several changes in the department, includingThe introduction of the Consultant of the Week (COW) model of careWard based Junior doctorsNursing staff educationA poster on the bleep and task escalation pathway.

A subsequent reaudit from 03/03/23-10/05/23 was performed.

Results

There was a reduction in the number of inappropriate tasks generated and a decrease in the proportion of urgent tasks (from 84.6% to 29.4%) as well as tasks with patient safety implications (from 70.6% to 61.6%). Additionally, mean time to completion of tasks decreased from 5.24 to 3.61 hours

Conclusions

This improvement project has demonstrated some improvement in the use of E-whiteboard tasks, which may be due to several factors including staff education and consultant led decision making.
1110 Thoracic Theatres: Audit of Theatre Efficiency
Authors: Wong N Z J , Abah U
Published: August 2024

Aim

Turnover time is the cumulative time of processes between procedure finish (final dressing applied) and next procedure start (knife to skin). This audit aims to establish current turnover times and identify individual process times within patient turnover to improve theatre efficiency.

Method

This audit spanned between 22/5/2023-22/6/2023. Patient turnovers (N=41) from all elective thoracic procedures (N=61), across 19 operating days were examined. Operating days (N=2) with single cases were excluded from analysis. A process map was used to visualise the processes involved in patient turnover. Individual process times were extracted from Bluspier and data analysis performed using Microsoft Excel. All descriptive statistics are reported as mean±standard deviation with 95% confidence intervals.

Results

Mean procedure and turnover time were 93±16 and 94±14 minutes respectively. The audit revealed 2 main processes contributing to current turnover times, handover from theatre to recovery bay (23±8 minutes) and subsequent patient sign-in and transfer to anaesthetic room (36±6 minutes). Both processes make up 54±13 minutes of current turnover times. Recovery bay availability was influenced by ward/ ITU availability, with patients ready for discharge spent an extra 48±13 minutes in recovery pending ward transfer. This causes time blocks for the anaesthetic team who are unable to complete handover to recovery resulting in delays for subsequent patient sign-in.

Conclusions

Ideal solutions to improve turnover times would involve parallel processing with concurrent handover and patient sign-in and workforce expansion to improve ward availability. However, with limited resources, a cost-neutral solution would be difficult to achieve.
1115 The Role of Ultrasound and Computer Tomography Imaging in the Management of Suspected Acute Appendicitis at a District General Hospital: A Clinical Audit Evaluating Our Practice Against International Standards
Authors: Laouris P , Constantinou A , Haj Ali Z , Shafeik F , Adebisi A , McDonald-Nethercott M , Dai N
Published: August 2024

Aim

Definitive diagnosis of acute appendicitis (AA) continues to pose a clinical challenge. Computer tomography (CT) is the gold-standard imaging modality for diagnosis, but ultrasound (USS) remains first-line and recommended for paediatric and young patients given the absence of ionising radiation. We conducted an audit evaluating the use of imaging as a diagnostic adjunct in diagnosing AA and whether it reduced the negative appendicectomy rate in a large UK district general hospital. A high NAR has both a significant patient impact (complications, increased hospital length of stay) and healthcare resource burden.

Method

We performed a retrospective analysis of electronic health records for a pre-Covid cohort of 344 patients who underwent a coded diagnostic laparoscopy/laparoscopic appendicectomy between 1st January 2019 and 1st January 2020. Histological confirmation of appendicitis was utilised as the gold-standard.

Results

USS was performed in only 10% of patients, particularly young females (16-35), and had 44% sensitivity, 88% specificity, 57% positive predictive value (PPV) and 84% negative predictive value (NPV). CT was performed in 22% of patients with 99% sensitivity, 100% specificity, 100% PPV and 88% NVP. Use of imaging (versus DLA) was associated with greater length of stay and readmission rates.

Conclusions

Despite its widespread use, ultrasound’s low sensitivity and PPV render its clinical utility debatable, particularly in females. Additionally, by counting occasions whereby ultrasound fails to visualise the appendix as negative results, its specificity is inaccurately increased. Therefore, CT remains gold standard given its highest sensitivity and specificity for diagnosing AA and its association with a reduction in NAR.