bluuebunny/crossref_metadata_2025 huggingface dataset:
Intercomparison to validate implementations of different laboratories of algorithms for the analysis of surface texture
Authors: Hüser Dorothee , Seewig Jörg , Volk Raimund , Deppe Arne , Kustan Eduard , Depiereux Frank , Meyer Maik , Koppert Nils , Weidner Arnim , Feifel Stefan , Müller Alexander , Schwarzer Florian , Xiao Shaojun , Lehmann Matthias , Blumenschein Wilhelm
Published: July 2024

The surface texture is an important feature of machine parts for any kind of contact. The quantification of its properties has been a well-established area in quality assurance for many decades. With the increasing demand for precision and interchangeability in the globalised marketplace, the results of surface analysis must be unambiguous and reliable. This is why the International Standardization’s Technical Committee on Geometric Product Specification has updated its standards. Consequently, instrument manufacturers and calibration laboratories need to ensure that their analysis software complies with the new ISO standards. An intercomparison has therefore been carried out to validate surface texture analysis software. Over the past two decades, a number of tests have been conducted on surface texture measurement and analysis methods, including issues of instrument response, discretisation and quantisation. This article examines the numerical and computational aspects of analysis algorithms that process data sets of discrete values of finite floating-point precision as input. The method of testing texture analysis algorithms utilising software measurement standards (softgauges) and the specification of the test tasks are explained. The results of the comparison are presented and discussed.
A comprehensive study of carbon nanoparticle shape and orientation effects on composite elastic properties using FEA
Authors: Omari Mohammad A , Gharaibeh Dania T , Al-Momani Emad S
Published: July 2024

In this study, three critical parameters that influence the effective composite properties of Carbon nanoparticles were tested and modeled using finite elements through Digimat Finite Element Analysis (FEA) software, employing representative volume elements (RVE). The primary parameters under consideration are the fiber shape, fiber orientation, and fiber volume fraction. Four of the many different shapes of Carbon nanoparticles, namely Tubes, Disk, Sphere, and Cylinder, were investigated, coupled with four distinct orientations for tubes: horizontal, aligned at 45°, random, and vertical each varying in the carbon fiber volume fraction. The material of choice was pure epoxy resin because of the nature of the bonding between its two phases and its wide range of usage. Forces were applied along the X-axis, coupled with shear in the XY plane. This study revealed that the orientation of CNTs primarily influences the Elastic Young’s modulus, whereas the size of the CNTs has the main effect on the shear modulus, followed by orientation. The horizontal CNTs demonstrated superior Young’s modulus, but the random orientation had a more pronounced impact on the shear modulus variation. Regarding the analysis of the nanoparticles shapes, the disk shape with fixed orientation revealed the highest elastic modulus, after which the cylinder shape and the sphere recorded the minimum elastic modulus among the three studied shapes.
A method for the synchronization of inertial sensor signals and local field potentials from deep brain stimulation systems
Authors: D’Ascanio Ilaria , Giannini Giulia , Baldelli Luca , Cani Ilaria , Giannoni Alice , Leogrande Gaetano , Lopane Giovanna , Calandra-Buonaura Giovanna , Cortelli Pietro , Chiari Lorenzo , Palmerini Luca
Published: July 2024

Objective. Recent innovative neurostimulators allow recording local field potentials (LFPs) while performing motor tasks monitored by wearable sensors. Inertial sensors can provide quantitative measures of motor impairment in people with subthalamic nucleus deep brain stimulation. To the best of our knowledge, there is no validated method to synchronize inertial sensors and neurostimulators without an additional device. This study aims to define a new synchronization method to analyze disease-related brain activity patterns during specific motor tasks and evaluate how LFPs are affected by stimulation and medication. Approach. Fourteen male subjects treated with subthalamic nucleus deep brain stimulation were recruited to perform motor tasks in four different medication and stimulation conditions. In each condition, a synchronization protocol was performed consisting of taps on the implanted neurostimulator, which produces artifacts in the LFPs that a nearby inertial sensor can simultaneously record. Main results. In 64% of the recruited subjects, induced artifacts were detected at least in one condition. Among those subjects, 83% of the recordings could be synchronized offline analyzing LFPs and wearables data. The remaining recordings were synchronized by video analysis. Significance. The proposed synchronization method does not require an external system (e.g., TENS electrodes) and can be easily integrated into clinical practice. The procedure is simple and can be carried out in a short time. A proper and simple synchronization will also be useful to analyze subthalamic neural activity in the presence of specific events (e.g., freezing of gait events) to identify predictive biomarkers.
Optical tuning of copolymer-in-oil tissue-mimicking materials for multispectral photoacoustic imaging
Authors: Khodaverdi Azin , Cinthio Magnus , Reistad Esbjörn , Erlöv Tobias , Malmsjö Malin , Zackrisson Sophia , Reistad Nina
Published: July 2024

Objective. The availability of tissue-mimicking materials (TMMs) for manufacturing high-quality phantoms is crucial for standardization, evaluating novel quantitative approaches, and clinically translating new imaging modalities, such as photoacoustic imaging (PAI). Recently, a gel comprising the copolymer styrene-ethylene/butylene-styrene (SEBS) in mineral oil has shown significant potential as TMM due to its optical and acoustic properties akin to soft tissue. We propose using artists’ oil-based inks dissolved and diluted in balsam turpentine to tune the optical properties. Approach. A TMM was fabricated by mixing a SEBS copolymer and mineral oil, supplemented with additives to tune its optical absorption and scattering properties independently. A systematic investigation of the tuning accuracies and relationships between concentrations of oil-based pigments and optical absorption properties of the TMM across visible and near-infrared wavelengths using collimated transmission spectroscopy was conducted. The photoacoustic spectrum of various oil-based inks was studied to analyze the effect of increasing concentration and depth. Main results. Artists’ oil-based inks dissolved in turpentine proved effective as additives to tune the optical absorption properties of mineral oil SEBS-gel with high accuracy. The TMMs demonstrated long-term stability and suitability for producing phantoms with desired optical absorption properties for PAI studies. Significance. The findings, including tuning of optical absorption and spectral shape, suggest that this TMM facilitates the development of more sophisticated phantoms of arbitrary shapes. This approach holds promise for advancing the development of PAI, including investigation of the spectral coloring effect. In addition, it can potentially aid in the development and clinical translation of ultrasound optical tomography.
Studies on the potential risk of amyloidosis from exposure to cultured fibril from silk fibroin
Authors: Osawa Satomi , Iwaide Susumu , Kobayashi Kyoko , Oba Ryohei , Murakami Tomoaki
Published: July 2024

Amyloid A (AA) amyloidosis is induced by administering amyloid fibrils to animals under inflammatory conditions. Silk fibroin (SF), the main component of silk threads, forms amyloid-like fibrils and has been previously reported to induce AA amyloidosis in mice. In this study, SF was cultured in ethanol solution, and after confirming fibril formation through thioflavin T assay, Congo red assay, and observation under electron microscopy, cultured SF ethanol solutions were administered to mice via various routes to investigate the induction of target organs and amyloidosis. As a result, cultured SF ethanol solutions were confirmed to reach the lungs and spleen, but no amyloid deposition was observed. While SF forms amyloid-like fibril structures through cultivation in ethanol solution, its amyloid-enhancing factor (AEF) activity is considered low in mice.
Sagittarius A* magnetism revealed
Authors: Cooper Keith
Published: July 2024

The magnetic field of the Milky Way’s black hole is surprisingly similar to that of the black hole at the centre of the galaxy Messier 87, as Keith Cooper reports.
Wigner crystal appears in bilayer graphene
Authors: Dumé Isabelle
Published: July 2024

Researchers at Princeton University in the US say they have made the first direct observation of a Wigner crystal – a structure consisting solely of electrons arranged in a latticelike configuration.
NASA demands new designs for Mars Sample Return
Authors: Gwynne Peter
Published: July 2024

NASA is seeking alternative designs for its Mars Sample Return (MSR) mission, which is meant to bring back soil and rocks gathered by the agency’s Perseverance rover.
Researchers split on the use of AI in peer review
Authors: Banks Michael
Published: July 2024

Researchers are divided over whether artificial intelligence (AI) is having a positive or negative impact on peer review.
Going for no growth
Authors: Britton Robin
Published: July 2024

A response to the Forum article “Only degrowth can save us” by Johan Hansson (April 2024), who claimed the world will not meet its climate targets if we continue our “obsession” with growing the global economy.
How places vote
Authors: Furlong Jamie , Jennings Will
Published: July 2024

This chapter explores the extent to which the sociodemographic underpinnings of the electoral geography of England and Wales have changed between 1979 and 2019. It asks what kind of constituencies returned high vote shares for Labour and the Conservatives at each general election over this period. The chapter begins by exploring the bivariate constituency-level relationships between party vote shares and variables associated with three alternative definitions of places being ‘left behind’. We then estimate multiple linear regression models, revealing a significant long-term (though recently accelerating) shift away from Labour to the Conservatives in demographically left behind areas with largely white, working-class populations and lower levels of education. In contrast, Labour’s electoral dominance in areas with high levels of economic deprivation (economically left behind) and higher proportions of people in insecure/precarious employment (precariously left behind) has remained stable over this forty-year period.
Can We Really Ask the Oppressed to Be Reasonable? Serious Injustice, Civility, and Over-Demandingness
Authors: Badano Gabriele , Nuti Alasia
Published: July 2024

On a Rawlsian definition, part of being reasonable is abiding by public reason and therefore being civil when pursuing political change. Critics maintain that in calling on citizens to be reasonable, political liberals are too demanding towards groups that, suffering from a long history of injustice, have every right to be uncooperative. Moreover, disruption and violence might well be their only chance to make progress towards redressing that injustice. This chapter replies to these critiques by arguing that under certain conditions, disruption and violence are perfectly reasonable political strategies. We stress that Rawls’s duty to comply with public reason is conditional on reciprocity. However, in contrast to other analyses of the applicability of public reason in non-ideal conditions, we highlight that Rawls does not consider reciprocity important in itself, but because compliance on the part of others is necessary to avoid sacrificing one’s core interests by following public reason. We then show that being at the receiving end of severe injustices constitutes evidence of a risk of self-sacrifice serious enough to relieve members of oppressed groups of the duty to obey public reason. We specify what injustices count as severe by drawing on Rawls’s definition of a reasonable conception of justice, and we start discussing what normative constraints apply to citizens who, relieved of public reason, are morally allowed to engage in disruption and violence. Indeed, while those suffering from severe injustice have a right to deviate from public reason’s civility, abandoning reasonableness should never be excused.
The Duty of Pressure
Authors: Badano Gabriele , Nuti Alasia
Published: July 2024

This chapter starts our normative analysis of containment and, in turn, liberal democratic self-defence by looking at common citizens. Criticizing militant democratic accounts of self-defence, we argue that the liberal value of everyone enjoying equal rights is compatible with legal repressive measures only when softer containment interventions have been attempted earlier on in the build-up to a ‘real threat’ to existing liberal democratic institutions. Also, we demonstrate that although the state has an important (largely preventative) role to play in delivering such interventions, its work needs to be supplemented by the contributions of non-state actors towards soft containment. To start exploring what soft containment by non-state actors should look like, we derive from Rawls’s principle of liberal legitimacy a brand-new moral duty, called ‘duty of pressure’, calling on reasonable common citizens to press the unreasonable persons they know on their political views in an attempt to change their mind. This chapter carefully specifies the duty of pressure, including the circumstances of liberal democratic deconsolidation in which it applies and the range of tailored rhetorical strategies that are morally allowed under it. We also introduce right-wing populism to illustrate the workings of the duty of pressure in greater detail. Developing and re-adapting prominent Rawlsian concepts, this chapter suggests that the bulk of the supporters of right-wing populism display ‘unaware’ unreasonableness while holding partially comprehensive doctrines. In turn, these features illuminate what specific rhetorical strategies are apt to put pressure on them.
The Sound of Slurs
Authors: Mandelbaum Eric , Ware Jennifer , Young Steven G
Published: July 2024

An analysis of a valenced corpus of English words revealed that words that rhyme with slurs are rated more poorly than their synonyms. What at first might seem like a bizarre coincidence turns out to be a robust feature of slurs, one arising from their phonetic structure. We report novel data on phonaesthetic preferences, showing that a particular class of phonemes are both particularly disliked and overrepresented in slurs. We argue that phonaesthetic associations have been an overlooked source of some of the more peculiar, arational aspects of slurs. We conclude by drawing broader morals about the evolution of the lexicon.
Providing Explanations Shifts Preschoolers’ Metaphor Preferences
Authors: Zhu Rebecca , Goddu Mariel K , Gopnik Alison
Published: July 2024

To learn from metaphors, children must not only understand metaphors, but also appreciate their informativeness. Metaphors based on abstract commonalities (e.g., functional metaphors like “Eyes are windows”) typically have greater potential to generate novel inferences, and thus generally allow for more learning, than metaphors based on more superficial commonalities (e.g., perceptual metaphors like “Eyes are buttons”). However, previous research shows that preschoolers prefer perceptual metaphors over functional metaphors. Consequently, we ask whether providing additional context can shift preschoolers’ and adults’ metaphor preferences. In Experiment 1, pedagogical context increases preferences for functional metaphors in adults, but not preschoolers. In Experiment 2, providing explanations for similarities between the concepts in metaphors increases preschoolers’ preferences for functional metaphors. In Experiment 3, preschoolers differentiate between functional and perceptual metaphors when explicitly asked to communicate functional or perceptual information. These findings suggest that providing explanations for metaphors helps preschoolers appreciate their informativeness.
Bank Cases, Stakes, and Normative Facts
Authors: Pinillos N Ángel
Published: July 2024

New experimental evidence is presented which supports the idea that ordinary attributions of knowledge are sensitive to pragmatic factors. It is argued that ordinary knowledge ascriptions are psychologically sensitive to certain normative facts but not stakes, though both factors count as pragmatic. Whereas a difference in stakes can metaphysically necessitate a change in these normative facts, ordinary agents need not spontaneously notice this connection. Once we make this connection explicit to agents in an experimental setting, their attributions of knowledge become sensitive to pragmatic factors. These results can help explain why some prior experimental work did not detect that ordinary knowledge attributions are sensitive to pragmatic factors. It can also help explain why philosophers’ judgments about “bank” cases in the literature differ from the judgments of ordinary people.
134 How to Spot the Recurring Lumbar Disc? Risk Factors for Recurrent Lumbar Disc Herniation in Adult Patients with Lumbar Disc Prolapse: A Systematic Review and Meta-Analysis
Authors: Abdel-Fattah A R , Irving A , Baliga S , Myint P , Martin K
Published: July 2024

Aim

Despite a fast-growing evidence-base examining the relationship of certain clinical and radiological factors such as smoking, BMI and herniation-type with recurrent lumbar disc herniation (rLDH), there remains much debate around which factors are clinically important. We conducted a systematic review and meta-analysis to identify risk factors for rLDH in adults after primary disc surgery.

Method

A systematic literature search was performed using Ovid-Medline, EMBASE, Cochrane library and Web of Science databases from inception to 23rd June-2022. Observational studies of adult patients with radiologically confirmed rLDH ≥3 months after the initial surgery were included, and their quality assessed using the Quality-In-Prognostic-Studies (QUIPS) appraisal tool. Meta-analyses of univariate and multivariate data and a sensitivity-analysis for rLDH post-microdiscectomy were carried out.

Results

Twelve studies (n=4497, mean-age: 47.3; 34.5% female) were included, of which 11 studies were meta-analysed (n=4235). The mean follow-up was 38.4 months. Mean recurrence-rate was 13.1% and mean time-to-recurrence was 24.1 months (range: 6-90 months). Clinically, older age (OR:1.04, 95% CI:1.00-1.08, n=1014), diabetes mellitus (OR:3.82, 95% CI:1.58-9.26, n=2330) and smoking (OR:1.80, 95% CI:1.03-3.14, n=3425) increased likelihood of recurrence. Radiologically, Modic-change type-2 (OR:7.93, 95% CI:5.70-11.05, n=1706) and disc-extrusion (OR:12.23, 95% CI:8.60-17.38, n=1706) increased likelihood of recurrence. The evidence did not support an association between rLDH and sex; BMI; occupational-labour; alcohol-consumption; Pfirmann-grade, or herniation-level.

Conclusions

Older patients, smokers, patients with diabetes, those with type-2 Modic-changes or disc-extrusion are more likely to experience rLDH. Higher quality studies with robust adjustment of confounders are required to determine the clinical bearing of all other potential risk factors on rLDH.
442 Prophylactic Peri-Nephric Drain Placement in Renal Transplant Surgery: A Systematic Review and Meta-Analysis
Authors: Lakha A S , Ahmed S , Hunter J , O’Callaghan J
Published: July 2024

Aim

Usage of prophylactic perinephric drains is variable in renal transplantation, drains are associated with risks, and there is a lack of consensus as to the relative benefit of placing a drain intraoperatively in this patient cohort. This meta-analysis assessed whether prophylactic perinephric drainage reduced the need for postoperative intervention to manage collections.

Method

This systematic review and meta-analysis was performed using the Preferred Reporting Items in Systematic Reviews and Meta-Analysis and was prospectively registered on PROSPERO (CRD42021255795). A literature search was carried out in June 2023, and titles and s was screened against our pre-defined criteria. Quality assessment was performed using the Newcastle Ottawa Scale. Summary statistics for outcomes of interest underwent meta-analyses to a confidence interval (CI) of 95% and are presented as Forest Plots for Odds Ratio (OR).

Results

Literature search revealed 1540 unique titles and s across all four databases. Of these, 4 retrospective cohort studies were selected. Meta-analysis of 3 studies showed no evidence of a significant reduction in reintervention rate with drain placement, OR=0.59 (95%CI: 0.16-2.23, p=0.44). Meta-analysis did not show a significant reduction in perinephric collections with drainage OR=0.55 (95%CI: 0.13-2.37, p=0.42). Finally, there is not good evidence that drain placement reduces superficial wound complications or improves 12-month graft survival.

Conclusions

Given the lack of current evidence basis supporting the practice of prophylactic perinephric drain placement in renal transplantation, we advocate for a drain-free strategy in this patient cohort. Well-designed, prospective studies to assess the risks and benefits of intraoperative drain placement in these patients is needed.
152 Three-Dimensional Printing Bespoke Polycaprolactone Tracheal Splint for Treatment of Tracheomalacia
Authors: Gnanalingham S , Wu L , Song W
Published: July 2024

Aim

Tracheomalacia can be a fatal airway disease with limited treatment options. Three-dimensional (3D) printing has led to various patient-specific tracheal stents and splints. However, these are limited by mismatched stiffness and resulting granulation tissue formation and fibrosis. We aimed to develop a non-toxic and biodegradable polycaprolactone expandable tracheal splint by 3D printing. By fine-tuning mechanical properties, we hypothesised that the splint would match the native trachea and accommodate tracheal growth in tracheomalacia patients.

Method

We designed splints consisting of concave topological patterns with varying angles and aspect ratios. Fabrication occurred using polycaprolactone filaments in a 3D fuse deposition modelling printer. Uniaxial tensile studies were performed on splints to assess Young’s Modulus, Toughness, Ultimate strain, Strength, and Poisson ratio. Splints displaying optimal mechanical properties were tested for human lung fibroblast cell viability, proliferation, and morphology.

Results

On a mechanical testing rig, uniaxial tensile studies confirmed that splint designs with smaller angles and negative Poisson ratios of up to strains of 25%, better mimicked mechanical properties of native human trachea, accommodating tracheal growth. In vitro studies using these tracheal splints demonstrated successful human lung cell proliferation with low cell toxicity.

Conclusions

This study characterised 3D printed bespoke tracheal splints with various 2D structures, showing mechanical properties that match the native trachea. However, in vivo studies investigating cellular interactions on our splint must be performed to further evaluate the ability for endogenous tissue formation.
542 Reducing the Burden to Deliver Remote Postoperative Surveillance Using Machine Learning for Surgical-Site Infection (SSI)
Authors: McLean K , Sgrò A , Brown L , Buijs L , Potter M , Bouamrane M M , Harrison E
Published: July 2024

Aim

To develop novel methods for automated assessment of patient-generated data from remote postoperative wound (RPW) surveillance to reduce the burden of clinical triage for in-person assessment.

Method

This was a secondary analysis of an interventional study on RPW surveillance: “ImplementatioN of Remote Surgical wOund Assessment During the coviD-19 pandEmic” (INROADE). INROADE included adult patients undergoing gastrointestinal surgery, who could submit images of their surgical wound(s), and patient-reported symptoms of SSI for 30-days postoperatively. Separate models were developed to predict a clinical diagnosis of SSI within 48h based on patient-reported symptoms (logistic regression) and wound images (convolutional neural networks [CNN]). Model performance was evaluated using area under the curve (AUC), with 95% confidence intervals. The impact of implementation of automated assessment was simulated within the RPW surveillance pathway to “rule-out” responses needing clinician triage.

Results

Of 200 patients enrolled, there were 1529 responses with 3.3% (n=51) submitted within 48h of an SSI. There was excellent discrimination using logistic regression with patient-reported symptoms (AUC: 0.830, 0.765-0.894). 2,125 images were used to develop the CNN, which showed moderate discrimination to identify 48h SSI (AUC: 0.615, 0.556-0.674). Usage to screen out “low-risk” responses prior to clinical triage was estimated to half the staff-time to deliver (12.2h vs 25.5h), while maintaining diagnostic accuracy (AUC: 0.760 [0.685-0.834] vs 0.789 [0.717-0.861]).

Conclusions

Automated assessment can be successfully deployed within RPW surveillance pathways to reduce the burden on staff to deliver without compromising care and allow resources to be appropriately directed to those at greatest risk of SSI.
895 Innovating Automated Progress Tracking System (APS) for Laparoscopic Simulation Training in Low-Middle-Income-Countries Using LaApSi Models: Low-Cost High-Fidelity Performance Assessment System with Microcontroller Connectivity
Authors: Karki B B , Sharma S , Neupane P , Phuyal S , Shrestha S , Katuwal S , Loubani M , Satyal S
Published: July 2024

Aim

To develop a Low-Cost Automated Progress tracking system (APS) embedded in the silicon based Laparoscopic Appendicectomy Simulation (LaApSi) Model which enables real-time assessment of Laparoscopic Appendicectomy (LA). To assess its application and validity in the low-resource setting via Laparoscopic Surgery courses.

Method

APS architecture includes thin insulated wires embedded in the LaApSi Models at the mesoappendix, appendicular artery, and the base of the appendix which acts as an indicator when cut during the appendicectomy. These wires are further connected to the Printed Circuit Board (PCB) located at the base of the model which connects with the microcontroller and establishes communication with the computer giving real-time data.

Results

The prototyped APS model was able to establish key features: 1. Total duration of the procedure 2. Identify potential surgical hazard: blood vessel injury 3. Length at which the appendicectomy is performed 4. Injury to surrounding structures. These performance data were recorded in the database for further review, analysis, and comparison for progression in the simulation training. The system is set up on a points basis hence when a user makes a surgical error e.g., blood vessel injury during the surgical simulation in the APS LaApSi Model, -20 points (Blood Vessels Cut) appear on the computer screen (images available). Further assessment and validity of the APS models are planned to be carried out in low-resource settings in the next 8 weeks.

Conclusions

The availability of a model blueprint of this cost-effective APS system (<20£) to LMICs will address the key barrier of surgical simulation in low-resource settings.
356 The Role of Cancer Cachexia in Influencing Outcomes in Pancreatic & Biliary Malignancy
Authors: Jackson S , Dreyer S , Bryce A , Holroyd D , Jamieson N l , Chang D
Published: July 2024

Aim

To investigate the influence of cancer cachexia on outcomes and clinicopathological variables in pancreatico-biliary malignancies.

Method

Patients who underwent pancreaticoduodenectomy for malignancy from 2007-2020 at the Glasgow Royal Infirmary were included in this study. Pre-operative single-slice CT scan images were collected for cross sectional analysis of body composition using the semi-automated segmentation programme, SliceOmatic. Body composition measurements were represented as z-scores to account for age and sex.

Results

Subcutaneous fat radiodensity (SFD) was significantly lower in ampullary adenocarcinoma (-0.17+/-0.95), duodenal adenocarcinoma (-0.03+/-1.08), and cholangiocarcinoma (-0.18+/-1.00) groups compared to the pancreatic cancer group (0.12+/-1.00) (P=0.09). Skeletal muscle index (SMI) was significantly higher in those diagnosed with cholangiocarcinoma compared to all other indications (0.20+/-0.91 vs -0.04+/-1.02, P=0.05). Disease-specific and recurrence-free median survival was lower in those with low SMI compared to those with high SMI for all indications (35 months vs 41 months, 13 months vs 18 months).When comparing those who underwent up-front resection to those who received neoadjuvant therapy, visceral fat index (VFI) was found to be higher (0.06+/-1.00 vs -0.21+/-0.99, P=0.03) and skeletal muscle density was found to be lower (-0.05+/-1.01 vs 0.18+/-0.96, P=0.04). SFD was also found to be significantly lower in those with AJCC stage 1 compared to all other stages (-0.21+/-0.86 vs 0.07+/-1.01, P=0.03).

Conclusions

Adverse body composition may influence outcomes in pancreatic and biliary malignancy; however, this influence appears to be modest at best. Clinical applications of body composition analysis may be limited to serial monitoring of patients within the context of their treatment pathway.
617 Patient Harm Is Underreported Due to an Inadequate Reporting System for Serious Incidents
Authors: Marla A , Borra P , Lau J , Parthiban S , Butler P , Ponniah A
Published: July 2024

Aim

The Royal Free London Skin Cancer Service (RFL-SCS) is the largest referral centre in London, having received 26,114 two-week-wait referrals since January 2022. Patients are filtered through a complex Skin Cancer Pathway (SCP) involving multiple disciplines (dermatology, plastic surgery, oncology). This root cause analysis of Serious Incidents (SIs) attempts to pinpoint their underlying causes and identify key themes for the re-design of the SCP to ensure patient safety.

Method

A retrospective analysis of SIs recorded by the RFL-SCS between January 2022 and September 2023 was conducted. Incidents were attributed to various stages in the SCP, which was mapped out in detail. Related information was gathered by interviewing staff at significant points in the pathway and reviewing relevant procedures. A survey of practitioners was conducted to understand if SI reporting through the Datix system was accurate.

Results

From 26,114 referrals, 1326 needed treatment. 657 of these patients breached the two-week-referral target, with 10 SIs identified. 83% of practitioners surveyed felt that this was an underestimation. Major event types involved no follow-up appointments being booked after: MDT (3); surgery (2); scans (5); patient lost to follow up (1); and poor communication with patients (2).

Conclusions

System-wide changes must be implemented to prevent SIs from reoccurring. The Datix reporting system was described as convoluted and inadequate, leading to under-reporting of patient harm. More research needs to be conducted in designing an automated tracking system to flag-up and action MDT outcomes for patients with completed excisions, histology, and scans. This will prospectively avoid delays in onward referrals.
565 Robot-Assisted Surgery for Thoracic Endometriosis Syndrome – a Single-Centre, Retrospective Review of the First Fifty Cases
Authors: Kawka M , Barton-Smith P , Routledge T , So C , Dhond G , Jiao L R
Published: July 2024

Aim

Thoracic endometriosis syndrome (TES) is underdiagnosed, due to cyclical thoracic symptoms being underreported. Management of TES also remains controversial, with abdominal and thoracic approaches proposed, both laparoscopically and robotically, and no guidelines available. We aimed to characterise our experience with a multidisciplinary, robot-assisted approach, with a focus on symptom prevalence and surgical outcomes.

Method

A retrospective review of all consecutive procedures for TES between July 2020 and March 2023 surgery was performed. Robot-assisted removal of endometriosis from the underside of the diaphragm, from the pleura or superior diaphragm, or wedge resection of the lung through videoscope-assisted thoracic surgery, in any combination with or without pelvic endometriosis removal, were included. Presenting symptoms, intra-operative, and histological outcomes were analysed.

Results

Fifty robotic TES procedures, on forty-six patients were undertaken; median age was 32 (IQR 26–36). Cyclical shoulder tip pain (n = 29, 63%), costal margin pain (n=18, 39.1%), and scapular pain (n=11, 23.9%). There were no major Clavien-Dindo complications. Median blood loss was 10ml (IQR 6.25–27.25), and median length of stay was 1 day (IQR 1–2 ). The majority of the underside of the diaphragm specimen (n=35, 77.8%), and the pleural, and lung specimens (n=17, 85%) were either histologically positive for endometriosis or showed inflammation consistent with endometriosis.

Conclusions

Robotic-assisted surgery can be safely used for TES. Management of TES should involve an MDT including gynaecologic, hepato-pancreatico-billary, and thoracic surgeons, with minimally invasive experience. Going forward, long-term, patient-reported outcomes need to be analysed to ensure the effectiveness of robot-assisted surgery in TES.
619 Training the Trainees in Robotic Surgery – a UK Pilot Scheme
Authors: Al Ani M , Jayawardena P , Hashmi K , Assaf N , Lo T , Sudlow A , Patel V
Published: July 2024

Aim

Training the trainees in robotic surgery is a specialised and crucial process, given the precision and complexity involved in performing operations using robotic systems. Robotic training for trainees is challenging due to limited access to robotic systems and the lack of training opportunities. We describe how we implemented a training programme for trainees at West Hertfordshire Teaching Hospitals (WHTH) NHS Trust within a year of the consultants starting their robotics programme.

Method

Specialist trainees at WHTH who would have been offered training in laparoscopic surgery in colorectal, upper gastrointestinal and general surgery were selected to train as console surgeons on the CMR Surgical Versius system. All trainees had been on a first assist course and had experience in assisting in robotic surgery. Training included online modules, metrics-based virtual training, and technical skills assessment. Live operating was supervised by consultant trainers who sat beside the trainee.

Results

Six trainees ranging from ST4 to ST8 level were selected to partake in the training programme over a period of six months. Operations were broken down into modular parts and included segmental colectomies, anterior resections, cholecystectomy, and inguinal hernia repair. The trainees have participated in over thirty operations. Feedback from consultant trainers was given verbally and through work-based assessments. No adverse events were reported in training cases.

Conclusions

Robotic surgical training for specialist trainees can be implemented safely and in a timely manner. Objective metrics such as docking time, console time and volumetric hand motion may help with trainee assessment in the future.
772 Assessing the Impact of Gaming Skills on Robotic Surgical Skill Acquisition and Learning Curves
Authors: Ike D I , Asemota N , Jacob A , Okorocha C , Stamenkovic S
Published: July 2024

Robotic surgery has rapidly advanced across various medical specialties over the past decade. Extensive research has confirmed the benefits of robotic surgery, leading to improved surgical outcomes and patient satisfaction. Historically, only highly experienced consultants in laparoscopic and open surgery received training in robotic surgery to the detriment of junior surgical trainees.

Virtual reality simulators have introduced gamification to enhance surgical skills. Studies have shown that individuals with gaming experience, musical aptitude, and sports backgrounds exhibit improved psychomotor skills relevant to surgery, including hand-eye coordination, reaction time, and visuospatial awareness. Despite this, there is a lack of research on how gaming and musical abilities impact robotic surgical skill acquisition and learning curves.

This prospective, observational, and comparative study involved 15 novice surgeons with no prior robotic experience recruited from various UK medical institutions. Participants were divided into two groups based on their video game experience.

While statistical significance was not reached (p 0.26), an observed trend favoured the gaming cohort's performance (M 56.29, SD 57.85) on the robotic surgical simulator compared to the non-gamer group (M 38.41, SD 46.77) possibly due to the limited sample size. Gamers exhibited notably superior reaction time scores (p 0.037) Additionally, gamers demonstrated enhanced overall performance in spatial reasoning and the Beat Saber game, assessing hand-eye coordination, though these differences did not reach statistical significance.

This study suggests that video gaming experience may provide novice surgeons with certain advantages when beginning training on the high-fidelity dVSS robotic surgical simulator. Further research with larger participant groups may confirm these findings.
1170 Bridging the Gap in Surgical Robotics Education
Authors: San N T , Rahman K R , Wongsikhee J R , Brahmbhatt K , George J , Mahmood A , Bowrey D
Published: July 2024

Aim

Despite rapid evolution of surgical robotics systems, training opportunities are very limited especially for medical students and junior doctors. We organised a free-of-charge regional robotics workshop in collaboration with CMR Surgical with the goal of increasing exposure to surgical robotics technology. We also evaluated the delegates’ perception on current surgical robotics training and the workshop.

Method

CMR Surgical was invited to exhibit their Versius® robot and Virtual-Reality trainer for a one-day workshop at Glenfield Hospital, Leicester. The workshop was advertised across universities and hospital trusts in East Midlands. Registration form included pre-workshop questionnaire which assessed the motivation and barriers to attending surgical robotics courses, and their familiarity with robotics surgery. After 1-hour hands-on exercise supervised by consultants and CMR Surgical trainers, delegates were asked to complete post-workshop questionnaire to evaluate shift in familiarity, interest, and confidence in basic robotic skills.

Results

75 delegates registered with 93% having never attended similar workshop before and the barriers were perceiving that robotics surgery skills are for advanced surgeons only (37%), cost (26%), no accessible courses (24%), time constraints (9%) and others (4%). The primary motivation to attend this workshop were learning basic robotic skills (49%), exploring innovative technology (44%) and networking (7%). 30 delegates were shortlisted for 1-hour hands-on experience into six groups consisting of 18 students and 12 junior doctors. Post-workshop feedback showed a positive shift in familiarity, interest, and confidence in basic robotic skills. Delegates also expressed increased interest in surgical specialties after this workshop. They also found VR station was enjoyable and believed it has potential in training future robotic surgeons.

Conclusions

These findings highlight the feasibility and importance of creating accessible training opportunities to bridge the gap in surgical robotics education.
363 Development and Validation of a Virtual Teaching Method for Minimally Invasive Surgery Skills
Authors: Ali I , Das B , Ledesma F , Law S , Pai M , Ashrafian H , Spalding D , Fehervari M
Published: July 2024

Aim

Remote teaching of surgical skills has rapidly emerged as a promising alternative to the traditional face-to-face (F2F) format. This study sought to evaluate whether minimally invasive surgery (MIS) skills could be taught remotely using available technology with objective assessments of proficiency.

Method

In a pilot study, we compared face-to-face (F2F) and virtual training for novice MIS learners, evaluating proficiency through objective parameters. The pilot refined methods, and the subsequent course was the evaluation basis. Virtual training shifted from conventional to personalised teaching in the second round, introducing headphones for enhanced guidance. Optimisation achieved comparable online teaching quality to F2F. Evaluation tasks included peg transfer (MISTELS) and suturing (SUTT) on box trainers.

Results

Technical challenges in delivering a virtual MIS skills course were successfully addressed, particularly through the personalised approach in an isolated fashion in the second pilot course. Participants (n = 20) in the final course had similar baseline characteristics and were randomly allocated to F2F (n = 8) and virtual (n = 12) teaching groups. Participants in the virtual group demonstrated faster completion of the peg transfer task compared to the F2F group (11.25 minutes vs. 16.88 minutes; p = 0.015). However, no significant differences were observed in other MISTELS and SUTT performance measures or cognitive workload. parameters.

Conclusions

This study demonstrates that virtual teaching of MIS skills using a web-based streaming platform is feasible and effective, providing the foundation for scalable future programs. Online surgical skills teaching offers simultaneous access for learners in different regions and reduces costs and travel time.
821 Impact of a One-Day Conference on Perceptions and Understanding of T&O - Outcomes of the South West Orthopaedic Conference 2023
Authors: Drake W , El-Hassan M , Jones C
Published: July 2024

Aim

This study aimed to evaluate the effects of a student-organised conference on delegates’ motivation and understanding of orthopaedic surgery.

Method

This was a conference organised by students with the support of consultants from the Princess Elizabeth Orthopaedic Centre in The Royal Devon and Exeter Hospital. Identical questionnaires were completed immediately before and after the conference on google forms. The google forms were distributed to the delegates via their registered email address. The pre- and post-conference questionnaire had three sections comprising of understanding, motivations, and barriers to pursing orthopaedic surgery. Pre- and post-conference responses which were recorded on a Likert scale and were compared using Wilcoxon signed rank test. All data analysis performed was using IBM SPSS (v.28, USA).

Results

62 delegates completed the questionnaires, the majority of which were medical students with 4 junior doctors. Understanding of orthopaedics showed a significant increase in the majority of questions (p<0.001), except the intention to pursue orthopaedics which showed no significant difference. Delegates were attracted to orthopaedics due to the work-life balance, prestige and salary (p<0.001), however they showed a reduced interest in case variety and private practice. There was no difference in the barriers to pursuing orthopaedic surgery, except lack of patient contact which showed a significant increase (p<0.001).

Conclusions

Orthopaedic conferences improve delegates understanding, perceptions and motivations to pursue a career in orthopaedic surgery. We therefore encourage orthopaedic surgeons and educationalists to increase exposure to orthopaedics for undergraduates by supporting more student-led initiatives to promote recruitment into orthopaedic surgery.
678 Investigating the Fidelity and Usability of Virtual Reality Surgical Training Platforms
Authors: Lestas F , Avrova A , Shoker J , Burke J , Harji D
Published: July 2024

Introduction

Virtual Reality (VR) technology has existed for decades; however, the fidelity of current applications has resulted in limited adoption in surgical training and no framework exists to assess usability of VR in surgery. This study aimed to define immersion quality and identify which metrics surgical trainees and trainers prioritise when utilising VR.

Method

Surgical trainees and trainers were eligible for inclusion. Participants were purposively sampled from delegates at the RCS England Future Surgery Show 2023. A 14-point questionnaire generated through steering-group expert consensus was utilised. Immersion was measured using the NASA Fidelity Rating Scale (1;excellent–6;very bad) and a usability importance metric (1;extremely important–5;not important). Parametric statistical tests were used following test of normality (µ=0.05).

Results

34(23M:10F) responses were analysed. 50%(n=17) were completing or had completed surgical training with experience across 8 different VR systems. 18%(n=6) had experienced side-effects. Mean immersion across the systems was 2.7±0.8(Good/Fair). ‘Ease of Use’(1.4±0.6) and ‘Translatable Training’(1.4±0.5) were the highest priority usability metrics with ‘Access’(1.9±0.8), ‘User Comfort’(1.6±0.6) and improvement in ‘Economy of Movement’(1.9±0.7) also regarded as Extremely important or Important. There was an observed difference in ‘User Comfort’ importance between Male(1.6±0.4) and Female(1.1±0.2) participants which approached significance(p=0.07).

Conclusions

Immersion of available VR surgical training platforms requires improvement. Side-effects remain common. Ease of use and translatable training are the highest priority metrics for end-users and should be central to any framework. Gender differences in VR usability requires further investigation.
1211 Patterns of Recurrences After Mastectomy for Invasive Breast Cancer and DCIS Followed by Immediate Breast Reconstruction: 13-Year Follow-Up from a Single institution
Authors: Reddy D , Amin H , Shergill M , Narayanan S , Sumian S , Jafferbhoy S , Marla S , Gopalan V , Hasan A , Nael E
Published: July 2024

Aim

A retrospective review was conducted at a single centre to analyse the patterns of recurrence in IBR.

Method

Between January 2009 and December 2021, 347 patients who had IBR for either invasive (244) or DCIS (125), were analysed retrospectively. The study included patients who received implants without ADM (10.8%), ADM with +implant (69%), Latissimus Dorsi flap +/- implant (18.1%), and deep inferior epigastric perforator-free flaps (2.5%).

Results

During the study period, 29 patients developed recurrence over a median period of 74 months (ranging from 24 to 125 months). Two patients had local cancer recurrence only (0.5%), 5 patients had local recurrence associated with distant or regional metastasis, (1.4%) and 19 cases with distal metastasis were identified (8.3%). The study found an overall survival rate of 96.4% and a disease-free survival rate of 91.7%. The most familiar sites of recurrence in breast cancer are distal recurrence, (Bone being the most common site), followed by local recurrence.

Discussion

This rate is in line with the expected range, assuming a standard of recurrence of 1% per year. Nevertheless, it is crucial to acknowledge the possibility of selection bias, as patients with advanced diseases and significant comorbidities may not have been offered IBR.

Conclusions

Based on the findings of the study, it can be inferred that mastectomy with (IBR) is a safe option for mastectomy.