bluuebunny/crossref_metadata_2025 huggingface dataset:
Cocatalyst versus precatalyst impact on the vinyl-addition polymerization of norbornenes with polar groups: looking at the other side of the coin
Authors: Bermesheva Evgeniya V. , Nazarov Ivan V. , Kataranova Ksenia D. , Khrychikova Anna P. , Zarezin Danil P. , Melnikova Elizaveta K. , Asachenko Andrey F. , Topchiy Maxim A. , Rzhevskiy Sergey A. , Bermeshev Maxim V.
Published: October 2021

Polymers derived from norbornenes with polar groups are of interest as modular templates and materials for membrane processes and microelectronic applications due to the attractive combination of their properties.
Broadband near-infrared BaMSi3O9:Cr3+ (M = Zr, Sn, Hf) phosphors for light-emitting diode applications
Authors: Zhang Yan , Liang Yanjie , Miao Shihai , Chen Dongxun , Yan Shao , Liu Jingwei
Published: October 2021

Cr3+-Doped BaMSi3O9 (M = Zr, Sn, Hf) NIR-emitting phosphors have been developed, which exhibit a broad NIR emission band over 650–1200 nm with a tunable band maximum longer than 800 nm and a FWHM of more than 155 nm upon blue light excitation.
New quinoxaline-based VEGFR-2 inhibitors: design, synthesis, and antiproliferative evaluation with in silico docking, ADMET, toxicity, and DFT studies
Authors: Alanazi Mohammed M. , Elkady Hazem , Alsaif Nawaf A. , Obaidullah Ahmad J. , Alkahtani Hamad M. , Alanazi Manal M. , Alharbi Madhawi A. , Eissa Ibrahim H. , Dahab Mohammed A.
Published: October 2021

A new series of 3-methylquinoxaline-based derivatives having the same pharmacophoric features of VEGFR-2 inhibitors have been synthesized and evaluated for their antiproliferative activities against MCF-7 and HepG-2 cells.
Large-scale and clean preparation of low-defect few-layered graphene from commercial graphite via hydroxyl radical exfoliation in an acidic medium
Authors: Du Wenqiao , Yu Zaiqian , Wang Xin , Wu Jingdong , Zhang Long
Published: October 2021

Mechanism diagram of hydroxyl radical stripping graphite.
Highly sensitive urine glucose detection with graphene field-effect transistors functionalized with electropolymerized nanofilms
Authors: Fenoy Gonzalo E. , Marmisollé Waldemar A. , Knoll Wolfgang , Azzaroni Omar
Published: October 2021

Graphene field-effect transistors are able to successfully monitor glucose in urine samples, showing their potential towards the fabrication of point-of-care glucose testing devices.
XPS quantification of oxygen vacancies in mesoporous and non-mesoporous CeO2: comment on an article by Thill et al., J. Mater. Chem. A, 2020, 8, 24752–24762
Authors: Paparazzo Ernesto
Published: October 2021

The present Comment emphasises that accurate speciation of the chemistry of the cerium in the authors' catalysts requires careful consideration of the line shape of XPS Ce 3d spectra characteristic of CeO2 and Ce2O3 oxides.
Phase formation and performance of solid state reactive sintered Ce0.8Gd0.2O2−δ–FeCo2O4 composites
Authors: Fischer Liudmila , Neuhaus Kerstin , Schmidt Christina , Ran Ke , Behr Patrick , Baumann Stefan , Mayer Joachim , Meulenberg Wilhelm A.
Published: October 2021

Reactive sintering of composites for use as OTM is a promising method enabling lower sintering temperatures as well as low-cost raw materials. Phase formation and distribution during sintering plays a vital role in the performance of the composites.
Correction: Elucidating the formation and active state of Cu co-catalysts for photocatalytic hydrogen evolution
Authors: Schubert Jasmin S. , Kalantari Leila , Lechner Andreas , Giesriegl Ariane , Nandan Sreejith P. , Ayala Pablo , Kashiwaya Shun , Sauer Markus , Foelske Annette , Rosen Johanna , Blaha Peter , Cherevan Alexey , Eder Dominik
Published: October 2021

Correction for ‘Elucidating the formation and active state of Cu co-catalysts for photocatalytic hydrogen evolution’ by Jasmin S. Schubert et al., J. Mater. Chem. A, 2021, DOI: 10.1039/d1ta05561e.
Misaligned disks induced by infall
Authors: Kuffmeier M. , Dullemond C. P. , Reissl S. , Goicovic F. G.
Published: October 2021

Arc- and tail-like structures associated with disks around Herbig stars can be a consequence of infall events occurring after the initial collapse phase of a forming star, consistent with the observation of luminosity bursts. An encounter event of gas with an existing star can lead to the formation of a second-generation disk significantly after the initial protostellar collapse phase. Additionally, observations of shadows in disks can be well described by a configuration of a misaligned inner and outer disk, such that the inner disk casts a shadow on the outer disk. Carrying out altogether eleven 3D hydrodynamical models with the moving mesh code AREPO, we tested whether a late encounter of an existing star–disk system with a cloudlet of gas can lead to the formation of an outer disk that is misaligned with respect to the primordial inner disk. Our models demonstrate that a second-generation disk with a large misalignment with respect to an existing primordial disk can easily form if the infall angle is large. The second-generation outer disk is more eccentric, though the asymmetric infall also triggers eccentricity of the inner disk of e ≈ 0.05 to 0.1. Retrograde infall can lead to the formation of counter-rotating disks and enhanced accretion. As the angular momentum of the inner disk is reduced, the inner disk shrinks and a gap forms between the two disks. The resulting misaligned disk system can survive for ~100 kyr or longer without aligning with each other even for low primordial disk masses given an infall mass of ~10−4 M⊙. A synthetic image for one of our models reveals shadows in the outer disk similar to the ones observed in multiple transition disks that are caused by the misaligned inner disk. We conclude that late infall onto an existing star–disk system leads to the formation of a misaligned outer disk for infall that is inclined with respect to the orientation of the inner disk. Infall might therefore be responsible for observations of shadows in at least some transition disks.
The SEDIGISM survey: The influence of spiral arms on the molecular gas distribution of the inner Milky Way
Authors: Colombo D. , Duarte-Cabral A. , Pettitt A. R. , Urquhart J. S. , Wyrowski F. , Csengeri T. , Neralwar K. R. , Schuller F. , Menten K. M. , Anderson L. , Barnes P. , Beuther H. , Bronfman L. , Eden D. , Ginsburg A. , Henning T. , König C. , Lee M.-Y. , Mattern M. , Medina S. , Ragan S. E. , Rigby A. J. , Sánchez-Monge Á. , Traficante A. , Yang A. Y. , Wienen M.
Published: October 2021

The morphology of the Milky Way is still a matter of debate. In order to shed light on uncertainties surrounding the structure of the Galaxy, in this paper, we study the imprint of spiral arms on the distribution and properties of its molecular gas. To do so, we take full advantage of the SEDIGISM (Structure, Excitation, and Dynamics of the Inner Galactic Interstellar Medium) survey that observed a large area of the inner Galaxy in the13CO (2–1) line at an angular resolution of 28′′. We analyse the influences of the spiral arms by considering the features of the molecular gas emission as a whole across the longitude–velocity map built from the full survey. Additionally, we examine the properties of the molecular clouds in the spiral arms compared to the properties of their counterparts in the inter-arm regions. Through flux and luminosity probability distribution functions, we find that the molecular gas emission associated with the spiral arms does not differ significantly from the emission between the arms. On average, spiral arms show masses per unit length of ~105–106M⊙kpc−1. This is similar to values inferred from data sets in which emission distributions were segmented into molecular clouds. By examining the cloud distribution across the Galactic plane, we infer that the molecular mass in the spiral arms is a factor of 1.5 higher than that of the inter-arm medium, similar to what is found for other spiral galaxies in the local Universe. We observe that only the distributions of cloud mass surface densities and aspect ratio in the spiral arms show significant differences compared to those of the inter-arm medium; other observed differences appear instead to be driven by a distance bias. By comparing our results with simulations and observations of nearby galaxies, we conclude that the measured quantities would classify the Milky Way as a flocculent spiral galaxy, rather than as a grand-design one.
A strong lensing model of the galaxy cluster PSZ1 G311.65-18.48
Authors: Pignataro G. V. , Bergamini P. , Meneghetti M. , Vanzella E. , Calura F. , Grillo C. , Rosati P. , Angora G. , Brammer G. , Caminha G. B. , Mercurio A. , Nonino M. , Tozzi P.
Published: October 2021

We present a strong lensing analysis of the galaxy cluster PSZ1 G311.65-18.48 (z = 0.443) using multi-band observations with Hubble Space Telescope complemented with VLT/MUSE spectroscopic data. The MUSE observations provide redshift estimates for the lensed sources and help to reduce misidentification of the multiple images. Spectroscopic data are also used to measure the inner velocity dispersions of 15 cluster galaxies and calibrate the scaling relations to model the subhalo cluster component. The model is based on 62 multiple images grouped in 17 families belonging to four different sources. The majority of them are multiple images of compact stellar knots belonging to a single star-forming galaxy at z = 2.3702. This source is strongly lensed by the cluster to form the Sunburst Arc system. To accurately reproduce all the multiple images, we built a parametric mass model, which includes both cluster-scale and galaxy-scale components. The resulting model has a rms separation between the model-predicted and the observed positions of the multiple images of only 0.14″. We conclude that PSZ1 G311.65-18.48 has a relatively round projected shape and a large Einstein radius (29″ for zs = 2.3702), which could indicate that the cluster is elongated along the line of sight. The Sunburst Arc source is located at the intersection of a complex network of caustics, which explains why parts of the arc are imaged with unprecedented multiplicity (up to 12 times).
A single-manufacturer multi-retailer integrated inventory model for items with imperfect quality, price sensitive demand and planned back orders
Authors: Barman Dipak , Mahata Gour Chandra
Published: October 2021

In this paper, we develop an integrated two-echelon supply chain inventory model with a single-manufacturer and multi-retailers in which each retailer’s demand is dependent on selling price of the product. The manufacturer produces a single product and dispatched the order quantities of the retailers in some equal batches. The production process is imperfect and produces imperfect quality of products with a defective percentage which is random in nature and follows binomial distribution. Inspection process is performed by the retailers to classify the defective items in each lot delivered from the manufacturer. The defective items that were found by the retailer will be returned to the manufacturer at the next delivery. Lead time is random and it follows an exponential distribution. We also assume that shortages are allowed and are completely backlogged at each retailer’s end. A closed form solution to maximize the expected average profit for both the centralized and the decentralized scenarios are obtained. The developed models are illustrated with the help of some numerical examples using stochastic search genetic algorithm (GA). It is found that integration of the supply chain players results an impressive increment in the profit of the whole supply chain. Sensitivity analysis is also performed to explore the impacts of key-model parameters on the expected average profit of the supply chain.
The Okabayashi Radical Hysterectomy: Basic Principle and Step-by-Step Procedure
Authors: Konishi Ikuo
Published: October 2021

Abdominal radical hysterectomy is the standard operation for stage IB–IIB cervical cancer in the world, which was established by Professor Hidekazu Okabayashi in 1921. In this article, the basic principle and step-by-step procedure of Okabayashi radical hysterectomy are presented, especially for young doctors to understand clearly the important points of this surgery and to realize its radicality and safety for better survival and quality of life of patients with cervical cancer.
Exciting the brain through micromagnetic stimulation
Authors: Cockshott Anne
Published: October 2021

Implanting minute coils into the brain for focal and directional neuronal stimulation could replace invasive neuromodulation devices and contribute to future neuroscience research.
Impact of missing pedigrees in single-step genomic evaluation
Authors: Meyer Karin
Published: October 2021

Context A common problem in mixed model-based genetic evaluation schemes for livestock is that cohorts of animals differ systematically in mean genetic merit, for example, due to missing pedigree. This can be modelled by fitting genetic groups. Single-step genomic evaluation (ssGBLUP) combining information from genotyped and non-genotyped individuals has become routine, but little is known of the effects of unknown parents in this context. Aims To investigate the effects of missing pedigrees on accuracy and bias of predicted breeding values for ssGBLUP analyses. Methods A simulation study was used to examine alternative ways to account for genetic groups in ssGBLUP, for multi-generation data with strong selection and rapidly increasing numbers of genotyped animals in the most recent generations. Key results Results demonstrated that missing pedigrees can markedly impair predicted breeding values. With selection, alignment of genomic and pedigree relationship matrices is essential when fitting unknown parent groups (UPG). Genomic relationships are complete; that is, they ‘automatically’ reference the genomic base, which typically differs from the genetic base for pedigreed animals. This can lead to biased comparisons between genotyped and non-genotyped animals with unknown parents when the two categories of animals are assigned to the same UPG. Allocating genotyped individuals to a separate UPG across all generations for each strain or breed was shown to be a simple and effective way to reduce misalignment bias. In contrast, fitting metafounders modified pedigree-based relationships to account for ancestral genomic relationships and inbreeding rather than the genomic relationship matrix. Thus, no bias due to different types of animals assigned to the same metafounders was apparent. Overall, fitting metafounders yielded slightly higher correlations between true and predicted breeding values than did UPG models, which assume genetic groups to be unrelated. Conclusions Missing pedigrees are more problematic with ssGBLUP than for analyses considering pedigree-based relationships only. UPG models with separation of genotyped and non-genotyped individuals and analyses fitting metafounders yielded comparable predictions of breeding values in terms of accuracy and bias. Implications A previously unidentified incompatibility between alignment of founder populations and assignment of genotyped and non-genotyped animals to the same UPG has been reported. Implementation of the proposed strategy to reduce ‘double counting’ is straightforward and can improve results of ssGBLUP analyses.
The rise of the new Polish far-right
Authors: Kosman Marcin
Published: October 2021

While much research has been done regarding right-wing discourse in modern Europe, the literature of Polish far-right discourse is still insufficient. The present paper discusses the discursive strategies of Grzegorz Braun, one of the leaders of Confederation Liberty and Independence, which were implemented by the politician during the 2019 Gdańsk mayoral campaign. In order to provide a comprehensive analysis of Braun’s discourse, audiovisual materials were included in the study. The findings show that Braun employs positive presentation of the Catholic Church and himself, and negative presentation of his opponents (LGBT activists, immigrants, the European Union, the elites), whom Braun considers to be in an alliance against Poland and its core values under the name of the “Gdańsk Pact”.
Let it rip: the mechanics of self-bisection in asexual planarians determines their population reproductive strategies
Authors: Goel Tapan , Ireland Danielle , Shetty Vir , Rabeler Christina , Diamond Patrick H , Collins Eva-Maria S
Published: October 2021

Asexual freshwater planarians reproduce by transverse bisection (binary fission) into two pieces. This process produces a head and a tail, which fully regenerate within 1–2 weeks. How planarians split into two offspring—using only their musculature and substrate traction—is a challenging biomechanics problem. We found that three different species, Dugesia japonica, Girardia tigrina and Schmidtea mediterranea, have evolved three different mechanical solutions to self-bisect. Using time lapse imaging of the fission process, we quantitatively characterize the main steps of division in the three species and extract the distinct and shared key features. Across the three species, planarians actively alter their body shape, regulate substrate traction, and use their muscles to generate tensile stresses large enough to overcome the ultimate tensile strength of the tissue. Moreover, we show that how each planarian species divides dictates how resources are split among its offspring. This ultimately determines offspring survival and reproductive success. Thus, heterospecific differences in the mechanics of self-bisection of individual worms explain the observed differences in the population reproductive strategies of different planarian species.
Coulomb and nuclear interactions in the dynamics of weakly-bound neutron-halo breakup on heavy target *
Authors: Mukeru B. , Tomio Lauro
Published: October 2021

Within our aim to clarify some aspects of the breakup dynamics of loosely-bound neutron-halo projectiles on a heavy target, we apply the continuum discretized coupled-channel formalism to investigate the beryllium 11Be breakup on a lead 208Pb target at

= 140 MeV incident energy. By evidencing that the continuum–continuum couplings are much stronger in the nuclear breakup than in the Coulomb breakup, we conclude that the strength of these couplings in the total breakup is dominated by the nuclear contribution, with the diagonal monopole nuclear potential in the projectile–target center-of-mass having negligible effect on the total and nuclear breakup cross-sections. For this kind of reaction, we show that the condition for the total breakup to approach its dominant component in the absorption region is strongly dependent on the continuum–continuum couplings and the diagonal monopole nuclear potential.
Strain induced electronic transition in 1T′ MoTe2: high pressure Raman, x-ray diffraction, resistivity measurements and first principles theoretical studies
Authors: Ghosh Bishnupada , Saha Pinku , Mukherjee Bidisha , Samanta Debabrata , Shukla Gaurav , Mukherjee Goutam Dev
Published: October 2021

A detailed high pressure study is carried out on 1T′  MoTe2 using x-ray diffraction (XRD) and Raman spectroscopy measurements up to about 30.5 GPa along with a room temperature resistivity measurement up to 14.3(4) GPa and density functional theory calculations. Though high-pressure XRD measurements show no structural transition, all the lattice parameters exhibit anomalous changes in the pressure region 8.4 to 12.7 GPa. The compressibility of the sample is found to be reduced by almost four times above 12.7 GPa with respect to that below 8.4 GPa. The anomalies in the Raman mode corresponding to the out of plane vibrations of Mo atoms sitting in the unit cell surface indicate a strong electron–phonon coupling possibly mediated by differential strain inside the unit cell. A rapid decrease in resistivity value up to about 7.0(2) GPa of pressure agrees well with the increase in the density of states (DOS) at the Fermi energy with pressure. Pressure evolution of band structure, as well as DOS at the Fermi level, shows an enhancement of the metallic character of the sample. First principle calculations show increased stress in the x and y directions compared to the z-direction with the application of pressure.
Injectivity theorem for pseudo-effective line bundles and its applications
Authors: Fujino Osamu , Matsumura Shin-ichi
Published: October 2021

We formulate and establish a generalization of Kollár’s injectivity theorem for adjoint bundles twisted by suitable multiplier ideal sheaves. As applications, we generalize Kollár’s torsion-freeness, Kollár’s vanishing theorem, and a generic vanishing theorem for pseudo-effective line bundles. Our approach is not Hodge theoretic but analytic, which enables us to treat singular Hermitian metrics with nonalgebraic singularities. For the proof of the main injectivity theorem, we use

L

2

L^{2}

-harmonic forms on noncompact Kähler manifolds. For applications, we prove a Bertini-type theorem on the restriction of multiplier ideal sheaves to general members of free linear systems.
A plan-based causal decision theory
Authors: Rothfus Gerard J
Published: October 2021

In ‘An argument against causal decision theory’, Jack Spencer shows that standard formulations of causal decision theory run afoul of his Guaranteed Principle. In the sequential choice problem he employs to make this case, the transgression stems from an awkward discrepancy between how causalists typically value present vs future acts. This note suggests a version of causal decision theory that avoids this incongruity and so respects the Guaranteed Principle in Spencer’s problem. However, this formulation, and hence symmetric appraisal of present and future acts, is also shown to be insufficient to secure causalist satisfaction of the Guaranteed Principle in general.
SCANCell reveals diverse inter-cluster interaction patterns in systemic lupus erythematosus across the disease spectrum
Authors: Zhang Lulu , Liu Xiao , Chen Xiaoxiang , Warden Antony R , Yu Youyi , Huang Baozhen , Ding Xianting
Published: October 2021

Motivation

High-dimensional mass cytometry (CyTOF), which provides both cellular signatures and inter-cluster interactions like the antagonism between immune activation and suppression, and the pro-inflammatory synergy, sheds light on the cellular and molecular basis of disease pathogenesis. However, revealing the aberrance of inter-cluster communication networks in CyTOF datasets remains a significant challenge.

Results

Here, we developed Sample Classification and direct Association Network among Cell clusters (SCANCell) that quantifies the direct association (DA) network of cell clusters. SCANCell was applied to profile inter-cluster interaction patterns of a well-recruited systemic lupus erythematosus (SLE) cohort, including 8 healthy controls, 10 active SLE patients (APs) and 8 remission SLE patients (RPs). SCANCell identified decreased inter-cluster interactions of CD8+ T cells in APs compared with RPs, and enhanced DA of CD8+ T cells after stimulation with immunostimulatory cytokine interleukin-2 in vitro. These discoveries prove that SCANCell can uncover pathology- and drug stimulation-associated inter-cluster interactions, which potentially benefits understanding of pathogenesis and novel therapeutic strategies.

Availability and implementation

The main processing scripts of SCNACell are available at https://github.com/Lxc417/SCANCell. Other codes for the following data statistics are available from the corresponding author upon request.

Supplementary information

Supplementary data are available at Bioinformatics online.
100 Assessing the Admission Proforma: A Multi-Cycle Audit Evaluating the Quality of Documentation of The Burnsadmission Proforma At the Regional Mersey Burn Unit
Authors: Noshirwani A , Drewniak K , Parekh V , Patel S , Mandal A , Shokrollahi K
Published: October 2021

Introduction

A thoroughly completed Burns Proforma can provide vital information for the effective management of a burn and enables the sharing of information with other members of the multidisciplinary team.

Aim

We aimed to assess the quality of record-keeping of the new Burns Proforma, compared it with the previous cycle, and identified areas of improvement.

Method

Data on 76 fields on version 4.0 of the Mersey Burns Proforma was collected for 92 patients between January and February 2020. The data was compared to cycle 1of the audit collected in July 2019.

Results

Assessing the 61 comparable fields between audit cycles, 58 fields (95%) improved while 3 (5%) deteriorated. 21 fields achieved a completion rate greater than 80%. Vital information such as history, comorbidities, and drug history achieved 100% completion, up from 94%, 94%, and 95%, respectively. Total body surface area (TBSA) increased to 93% from 83%, the use of the Lund & Browder chart remained the same, treatment plan documentation increased to 95% from 91%, documentation of admission increased from 24% to 51%, consultant confirmation of TBSA increased to 10% from 5%, but this requires further improvement. Comments stated the proforma was clearer and provided a flowchart layout which made documentation easier.

Conclusions

The Burns Admission Proforma has made significant improvements. Working with the nursing staff and consultant body, we aim to improve our completion rates of vital information further. It sets a high standard for data collection and presents itself as a useful tool for other Burns Units across the United Kingdom.
108 Neck of Femur Fractures: Streamlined Approach to Improve Consenting Practices
Authors: Brown O , Gaukroger A , Raza M , Sturley R , Arnander M
Published: October 2021

Aim

Neck of femur fractures (NOFs) are synonymous with frailty, and successful outcomes are achieved with operative fixation. The United Kingdom’s General Medical Council guidance governing consent highlights the importance of thorough pre-operative discussion of risk with the patient. We aimed to audit consenting practices in NOF patients within our unit against the British Orthopaedic Association’s (BOA) criteria, with the addition of delirium as a risk factor.

Method

In cycle one all operatively managed NOFs over a two-month period in October-November 2019 were retrospectively reviewed. Consent forms 1 (CF1) and 4 (CF4) were assessed against BOA-endorsed criteria. Our intervention included a standardised sticker detailing 14 important risks was introduced and a departmental seminar on delirium. A second cycle was undertaken from August-October 2020 to close the audit loop

Results

No consent form documented all BOA-approved risk factors in cycle one (N = 35). Of cycle two’s 35 patients, 70.8% CF1 were completed using the novel sticker. All of these had 100% BOA-approved risk documentation. Consent forms without the sticker in cycle two documented 9/14 risks (mean value). No CF4 had any risks documented in either cycle. Delirium was documented in 51% in total and in 75% patients with CF1. Delirium documentation improved from 2.9% in cycle one to 51.4% in cycle two.

Conclusions

Clear lapses in operative consenting processes were identified, especially regarding delirium and CF4 documentation. The introduction of a novel consent sticker drastically improved compliance with BOA guidance for CF1. Recognition and departmental education regarding delirium significantly reduced incidence between cycles.
163 Morbidity of Presumed Temporary Loop De-Functioning Stomas in Patients with Colorectal Cancer
Authors: Alfred J , Macdonald S , Kalaiselvan R
Published: October 2021

Objectives

The incidence of parastomal hernia (PSH) can be up to 80% of patients who have a stoma following abdominal surgery (1). Surgical intervention is required in 70% of patients due to pain, obstructive symptoms, or stoma appliance issues (2). This study aims to show the morbidity related to a presumed temporary loop stoma.

Method

This was a retrospective cohort study of all left-sided colorectal cancer resections undertaken in a single centre. Electronic healthcare records and Picture Archiving and Communication System (PACS) were used to gather data on patient demographics, operative details and details of de-functioning stoma fashioned. Morbidity related to de-functioning stoma was determined based on hospital admissions and length of inpatient stay related to stoma, complications in relation to the stoma, return to theatre, stoma reversal and fate of stoma site.

Results

147 patients (87 M; 60 F, median age 69 (23-93)) underwent left sided colorectal cancer resections at a single centre. In total, 50 de-functioning loop stomas were fashioned (49 loop ileostomies and 1 loop colostomy.) At a median follow-up of 23 months (8-44), prior to reversal, 12 PSH were identified. 38 of the de-functioning stomas were reversed at a median time of 11 months (1-44), 5 of which were emergency procedures due to obstruction (n = 3) or high output (n = 2). There were 9 stoma related re-admissions identified in 7 patients.

Conclusions

Presumed temporary defunctioning loop ileostomies in Low anterior resections is associated with significant morbidity, but low risk in terms of life-threatening complication.
181 Preoperative Blood Investigations in Surgical Fixation of Distal Radius Fractures (Jan-Apr 2020)
Authors: Mohamed H A S K
Published: October 2021

Background

Venepuncture is not a risk-free procedure; 1 in 125 000 risk of nerve injury and risk of spreading MRSA. Blood biochemistry and haematology testing is expensive; a Group & Save can cost up to £20 (Inc. VAT). Distal Radius fractures are common injuries seen and treated at the Worthing Hospital. ORIF or MUA + K-wires of Distal Radius are highly unlikely to result in the need for intra-operative transfusion.

Aim and Objective

Aim to reduce unnecessary preoperative bloods from wards under T&O “control” during re-audit period to zero.

Results

This audit included 27 patients (4 male, 23 female) (average age 58 years). four patients were ≥ ASA 3, 23 were ASA 1- 2. About 20/27 (74.1%) patients had FBC performed. About 3/4 (75%) patients with ASA ≥ 3 had FBC done and 17/23 (73.9%) patients with ASA 1-2 had FBC. Almost 11/27 (40.7%) patients had Coagulation screen performed, with no previous history of anticoagulation. About 16/27 (59.2%) LFTs performed. About 14/27 (51.8%) G&S performed with 21 samples sent of these figures 7/27 patients had two G&S samples sent and 7/27 patients had only 1 sample sent to pathology lab.

Conclusions

The practice of doctors at Worthing hospital does not meet NICE guideline recommendations in Pre-operative blood investigations for Distal Radius fractures. This can add more cost to the trust, wasting resources and putting extra load on health care professions working in pathology department.
225 The Management of Acute Cholecystitis in a District General setting: An Audit of Practice
Authors: Robinson P , Jones S , Metcalf A , Bond A
Published: October 2021

Aim

The benefits of laparoscopic cholecystectomy during index admission with acute cholecystitis (AC) are multiple. As such, current NICE guidelines dictate that adults with AC undergo laparoscopic cholecystectomy within 1 week of diagnosis. However, significant variation exists with regards to the management of such patients. Here we present the results of an audit of practice at a UK district general hospital and suggest that this standard can be achieved regardless of hospital.

Method

Electronic database search at Salisbury District Hospital over a period of 12 months to identify all patients with a coded diagnosis of AC. Electronic Discharge System (EDS) was consulted to assess whether patients underwent laparoscopic cholecystectomy within 7 days of diagnosis. Notes were reviewed for all patients who failed to meet this target to ascertain reasons why.

Results

Of the 336 patients coded as AC 8 were excluded due to incorrect coding leaving 328. 285 patients (87%) underwent laparoscopic cholecystectomy within 7 days. Of the 43 that did not, 31 (65%) had clinically justified reasons for delay. 285/297 (96%) patients met the NICE standard.

Conclusions

At Salisbury District Hospital 87% patients presenting with AC underwent laparoscopic cholecystectomy within 7 days. Common reasons for failure included: Awaiting further investigation (i.e., ERCP / MRCP), unfit for operative management, patient choice. Excluding justifiable reasons 96% of patients met NICE standards. Poor documentation was the most common cause for failure. Subsequent education and re-audit showed significant improvement. This audit exemplifies that NICE standards for the management of AC can be achieved in a district general setting.
230 Acute Bowel Obstruction - Are We in The Loop?
Authors: Tan J R , Mann K
Published: October 2021

Aim

Acute bowel obstruction (ABO) is a common surgical emergency associated with high mortality and morbidity. The aim of this audit is to compare the quality of local management of ABO against recommendations set by the NCEPOD.

Method

A prospective audit of all patients presented with ABO over 8 weeks from February 2020 at a tertiary centre. Data was collected from electronic records.

Results

34 patients were reviewed with a mean age of 69.8 years. 24 presented with small bowel obstruction and 10 with large bowel obstruction. 25 (73.5%) patients had a CT with IV contrast with a median time to scan of 5 hours. 25 (73.5%) patients were reviewed by consultants within 14 hours and 5/7 high-risk cases were discussed within an hour. Adequate pain control was achieved in 26 (76.5%) cases. All patients had BMI recorded and 29 (85.3%) had MUST score documented. 16/25 (64.0%) patients aged above 64 had their frailty score assessed and 11/25 (44.0%) received geriatrician input. 32 (94.1%) patients had their treatment plan discussed with them and family was informed in 19 (55.9%) cases. 19 (55.9%) patients underwent emergency operation and there was a delay in access to surgery in 7/19 (36.8%) cases. Morbidity and mortality risk was calculated in 3/19 (15.8%) cases.

Conclusions

This audit has highlighted numerous positive management measures but also the need for improved radiological resources, better emergency capacity planning and risk assessment. There needs to be a focus on predicting outcomes, especially in the elderly and setting limitations and expectations before surgery.
263 Improving the Timing of Operative Management of Closed Hand Fractures – A Closed-Loop Audit of Compliance with BSSH Guidelines in One of The Largest Teaching Hospitals in Europe
Authors: Prokopenko M , Verma Y
Published: October 2021

Introduction

Hand fractures are a common injury resulting in significant morbidity if managed incorrectly. The final outcome is determined by the initial injury but is also affected by timely and appropriate intervention. The British Society for Surgery of the Hand (BSSH) national guidelines recommend that when operative fixation is first choice, surgery should occur within 7-days of injury or within 72-hours when conservative management fails.

Method

We assessed compliance with BSSH closed hand fracture guidelines retrospectively using electronic patient records. Interventions involved department-wide education of national BSSH guidelines alongside suggestion of a dedicated closed hand fracture list. A sporadic WALANT list staffed by hand fellows was provided. The efficacy of the interventions was re-audited five months later.

Results

The first and second cycles included 100 and 56 cases respectively. Compliance improved between the two cycles from 59% to 75% when operative management was first choice. Average number of days until operative management was carried out, when operative fixation was first choice, improved from 7.47 to 5.44 between the two cycles. 23/156 (15%) cases underwent operative management on the additional list, where overall compliance was 78%.

Conclusions

Departmental education and the additional operating list improved compliance to BSSH guidelines. Education of staff involved in the management of closed hand fractures should continue regularly, especially considering the frequent rotation of trainee doctors. Patients should be provided with information leaflets to promote early presentation. The key intervention to improve compliance with national guidelines however remains the provision of a weekly closed hand fracture theatre list.
267 An Audit of The Management of Acute Cholecystitis At ELHT
Authors: Ahmed A E
Published: October 2021

Aim

Acute cholecystitis is a common condition on the surgical take. The evidence shows that the optimal approach is with early laparoscopic cholecystectomy in patients suitable for surgery (Cao, 2015). The aim of this audit was to assess the adherence of the surgical department at ELHT to NICE guidance CG 188 in the management of patients with gallstone disease (NICE, 2014): Offer early laparoscopic cholecystectomy (within 1 week of diagnosis) for acute cholecystitis.

Method

Retrospective study of all patients with image confirmed diagnosis of acute cholecystitis between 25th January to 1st October 2018. Any unsuitable candidates for surgery were not counted.

Results

The case notes of 153 patients were reviewed. 109 were included in this study, as the other patients were not likely to be offered surgery due to their comorbidities. Of these 109 patients, 51 (47%) had a laparoscopic cholecystectomy within a week of diagnosis.

Conclusions

ELHT is not meeting the target of management within 7 days for over half of patients. The modifiable reasons for not meeting the targeted treatment time are a lack of capacity in theatre and Consultants’ decisions to delay treatment. The addition of a dedicated hot gallbladder theatre list can increase the numbers treated within the target time.
285 Improving the Identification of Symptomatic or Ruptured AAA in The Emergency Department
Authors: Al-Khazaali B
Published: October 2021

Background

rAAA is a life-threatening emergency. Without early treatment, it can be fatal. Patient > 50 presented with abdominal/back pain &hypotension or collapse a diagnosis of rAAA should be considered. Aortic ultrasound is recommended as it is the standard technique used in clinical practice and the screening program.

Objective

The project aimed to determine the number of patients who were screened for rAAA according to Royal College of Emergency Medicine (RCEM) guidelines and increase the adherence in clinical practice in the emergency department.

Method

Retrospective baseline data were obtained for 40 patients >50 with abdominal/back pain, hypotension and collapse between 1st of November to 31st of December 2019. Re-auditing was conducted after the first intervention (phase one), which included informing colleagues about RCEM guidance via emails and paper forms to record the scans’ results. In August 2020, a final cycle (phase two) was performed after educational posters were put up in the department.

Results

Baseline showed that out of the 40 patients only 10% of them received the U/S scan. After phase one, the audit demonstrated an increase in screening to 42%, and in the final cycle, the percentage improved to 53%.

Conclusions

Routine screening of rAAA were minimal in the emergency department. As a result of the project, more patients received the U/S screening and adherence to RCEM guidelines improved.
317 Audit of The Management of Ankle Fractures in The Emergency Department of Leighton Hospital
Authors: Ugwu K , Lowsby R
Published: October 2021

Background

Ankle fractures are common presentations in the emergency department. The aim of treatment is to provide stability and restore alignment of the joint to as close as possible to the pre – injury state. The British Orthopaedic Association Audits Standards for Trauma (BOAST) guidelines provide clear recommendations for effective management of ankle fractures. Specific aspects of this guidelines that could be objectively assessed were selected for this audit to check if practices in the emergency department were meeting the national recommendations.

Method

Data was collected retrospectively. All patients with closed ankle fractures seen in the emergency department between 01/08/2020 and 31/08/2020 were included. Patients’ emergency department notes as well as electronic radiographic records were reviewed and analysed.

Results

There was 100% compliance rate for 3 of the domains assessed which include: clear documentations of mechanism of injury and clinical findings; documentation of co-morbidities of patients that can influence treatment and urgent performance of radiographs in clinically deformed ankles before manipulation.There was 75% compliance in performing and documentation of radiographs before transfer from the emergency. The worst domain was the re-assessment and documentation of neurovascular status post manipulation with only one reviewer out of five assessed documenting clearly after the process was completed.

Conclusions

Posters circulated in the department highlighting the findings of the audit. Furthermore, the LocSSIPs for reduction of ankle fractures was edited to include re-assessment of neurovascular status post manipulation.
347 Read the First Page: An Audit on Medicine Reconciliation in General Surgery Inpatients at London District General Hospital
Authors: Vutipongsatorn K , Patel P , Prakash A , Musawi J. Al
Published: October 2021

Aim

Medication-related incidents occur more frequently when medicine reconciliation happens more than 24 hours after admission. The National Institute for Health and Care Excellence recommends a complete reconciliation within 24 hours of admission. General Surgery is a busy specialty with a high patient turnover rate. Hence, this audit was conducted to assess the extent of a problem and mitigate it.

Method

Every adult General Surgery inpatient who were admitted for over 24 hours were included. Patients on intensive care or high dependency unit were excluded. Drug charts were reviewed every Thursday for nine weeks between October and December 2020. Data from the first three weeks were used to establish baseline. Three interventions were introduced, each lasting two weeks. Any significant harm to patients due to incomplete reconciliation was recorded.

Results

At baseline (n = 100), 38.0% of patients had incomplete reconciliation. This significantly reduced to 23.4% (n = 64, p-value=0.037) between Weeks 4 and 5 after baseline data was presented at a team meeting and posters were put up. Allowing pharmacists to flag up missing medications on a daily job’s list did not significantly reduce the incompletion rate (23.0%, n = 74, p-value>0.999). Finally, performing a medicine reconciliation ward round on Weeks 8 and 9 further reduced the incompletion rate to 2.8% (n = 74, p-value=0.001). One significant harm was noted on Week 1.

Conclusions

Medicine reconciliation is a vital aspect of patient safety. Raising awareness of the issue significantly reduced the incompletion rate. However, the most effective intervention is conducting a medicine reconciliation ward round.
359 Incidental Fatty Liver Disease; Are We Adhering to Guidelines?
Authors: O'Sullivan N l , Tyrrell J , McIntyre T , Burke E , Schmidt K
Published: October 2021

Aim

Hepatic steatosis is an increasingly prevalent condition, with estimates of up to 30% amongst western populations. Fatty liver is a common incidental finding on abdominal imaging. Current British Society of Gastroenterology guidelines suggest the use of scoring systems, such as FIB-4 or NFS, to stratify these patients into risk categories for the development of non-alcoholic steatohepatitis, and subsequent liver failure or hepatocellular carcinoma. We carried out an audit of our own practice, to see if these guidelines were being followed.

Method

We interrogated the national imaging management system to identify all scans performed in Wexford general hospital from 16th April to 16th October 2020 which identified “hepatic steatosis” or “fatty liver”. Data extracted included: patient demographics, imaging modality & finding. We correlated this data with the patient’s LFTs to calculate their FIB-4/NFS score and investigated whether suitable patients had been referred to gastroenterology.

Results

Of the 145 patients identified as having hepatic steatosis on imaging, 65 (44.8%) had ALT derangement, 42 (29%) had ALP derangement, 81 (56%) had GGT derangement and 23 (16%) had an elevated total bilirubin. Only 26 (17.9%) of these patients had evidence of subsequent liver serology studies, and only 11 (7.6%) had been referred to gastroenterology. None of the patient cohort had either a FIB-4 or NFS score calculated.

Conclusions

There is clear evidence that guidelines are not being followed in the management of patients who are incidentally found to have hepatic steatosis.
402 Assessed and Discharged - An Audit of Discharge Summaries Completion During On-Calls
Authors: Ma J , Oyewole B
Published: October 2021

Aim

Effective health care provision is heavily dependent on timely, reliable transfer of patient information. Failure of this communication between professionals could result in redundancy of tests, delay in treatment, which may in turn endanger patient safety. The NHS Standard Contract requirements state discharge summaries should be completed within 24 hours of hospital assessment and discharge. Discharge summaries for patients who were reviewed but not admitted have been observed to be poorly completed and this audit aims to clarify this.

Method

On-Call Patient Lists between 1 December to 14 December 2020 were studied retrospectively. Patients who were assessed by the on-call surgical team but not admitted were included in the audit. Patients referred to other specialties were excluded. Hospital electronic system was reviewed for electronic records frim the encounter including clinical note or discharge summary.

Results

In total, 47 patients were identified during the 2 week- period. 40/47 patients were referred from AE and 9 of these patients were discharged from AE directly. 3 of the patients had a clinical note or discharge summary completed on the hospital electronic system. Overall, 18 of the 47 (38.3%) patients had a clinical note or discharge summary on the electronic system, with 6 (12.8%) of them being recorded as discharge summaries.

Conclusions

The overall completion of discharge summaries for this group of patients was poor. Awareness of this failing and the importance of professional communication should be highlighted with the juniors during surgical meeting to improve compliance before re-audit.
417 Initial Choice of Imaging Investigation for Patients Presenting with Acute Pancreatitis: Should MRCP Be First Line in Selected Patients?
Authors: Yao L , Briggs C , Labib P
Published: October 2021

Introduction

Current guidelines for acute pancreatitis advocate abdominal ultrasound (AUS) as the first-line imaging investigation to identify if gallstones are the cause of pancreatitis. However, many patients have a history of cholecystectomy or present with known gallstones and deranged liver function tests (LFTs). In these patients, magnetic resonance cholangiopancreatography (MRCP) is indicated due to its higher sensitivity and specificity for detecting choledocholithiasis.

Method

This retrospective audit reviewed all consecutive patients who presented to the surgical assessment unit with acute pancreatitis over one month. Their past surgical history, bloods and imaging were reviewed.

Results

Of the 30 patients, seventeen (57%) had no previous cholecystectomy or known gallstones, nine (30%) had previous cholecystectomy and eight (27%) had known gallstones, seven (88%) of which presented with deranged LFTs. Of the seventeen patients who should have had AUS first (n = 17), thirteen (76%) had AUS first, none had MRCP first and four (24%) had computerised tomography (CT) first. Of the patients in whom MRCP was indicated first-line (n = 13), seven (54%) had AUS first, none had MRCP first, four (31%) had CT first and two (15%) went straight to endoscopic retrograde cholangiopancreatography having had recent outpatient MRCPs. In the seven patients in whom MRCP was indicated but AUS was performed first, six (86%) underwent subsequent MRCP.

Conclusions

MRCP should be considered the first line imaging investigation for patients presenting with acute pancreatitis and a history of cholecystectomy or known gallstones with deranged LFTs, as AUS rarely prevents the need for subsequent MRCP.