bluuebunny/crossref_metadata_2025 huggingface dataset:
Results of the first implementation of RF phase signature matching at LANSCE
Authors: Huang E.-C. , Taylor C.E. , Roy P.K. , Upadhyay J.
Published: February 2022

The LINAC at the Los Alamos Neutron Science Center (LANSCE)
has been utilizing the Delta-t method to match the RF cavities to
the design acceleration parameters since its commissioning in 1972.
The differences in time-of-flight between two subsequent Beam
Position and Phase Monitors (BPPMs) are measured with both
accelerated and drifting beams, depending on the whether the module
is set to on or off. The algorithm optimizes the module amplitude
and phase via iterative measurements if the initial phase is in the
vicinity of the design value. With an upgrade to a faster readout
system, a scan over the whole RF cavity phase range requires
relatively less time than the classical optimization procedure. The
Phase Scan Signature Matching (PSSM) method provides a
time-efficient method that ensures the phase selection lands on the
bunching side and empowers future analyses to build module-specific
models. The PSSM also utilizes a direct model to determine the
correct amplitude to sub-percent level instead of using linearized
matrices. Furthermore, lacking a reliable energy measurement method
in the LINAC, we measure the beam phases at two downstream locations
to increase the precision of energy measurements. In this letter,
we also discuss the sensitivities of PSSM, error propagation, and
the implementation results for the 2019 and 2020 beam cycles.
In vitro and in vivo study of magnesium containing bioactive glass nanoparticles modified gelatin scaffolds for bone repair
Authors: Sun Yi , Lin Jie , Li LeiLei , Jia Kai , Xia Wen , Deng Chao
Published: February 2022

Magnesium containing bioactive glass nanoparticles modified gelatin scaffolds (MBGNs/Gel scaffolds) have shown recently the potential for bone regeneration due to its good biocompatibility, bioresorbability and bioactivity. Nevertheless, its use is limited by its complicated manufacturing process and a relatively expensive price. In this study, MBGNs were prepared by sol–gel process. The MBGNs/Gel was synthesized by a simple immersion method. SEM, transmission electron microscopy and dynamic light scattering analysis showed that the particles had spherical morphology with mean particle size of 100 nm. The MBGNs/Gel scaffolds were observed by SEM. The scaffolds showed connected pore structure with pore size ranging from 100 to 300 μm. SEM images with high magnification showed the existence of MBGNs on the surface of micro-pores. The ion release results revealed the release of Mg, Ca and Si elements from the MBGNs. MTT assay and cytotoxicity studies indicated that, the scaffolds provide a suitable ion related micro-environment for cell attachment and spreading. The Reverse Transcription-Polymerase Chain Reaction (RT-PCR) results showed the scaffolds could promote the osteogenesis of MC3T3-E1. The in vivo study also showed higher amount of new bone and trabecular bone which indicated excellent bone induction and conduction property of modified scaffolds. So, the developed MBGNs/Gel scaffolds are a potential candidate for bone regeneration applications.
Global gridded crop models underestimate yield responses to droughts and heatwaves
Authors: Heinicke Stefanie , Frieler Katja , Jägermeyr Jonas , Mengel Matthias
Published: February 2022

Extreme events can lead to crop yield declines, resulting in financial losses and threats to food security, and the frequency and intensity of such events is projected to increase. As global gridded crop models (GGCMs) are commonly used to assess climate change impacts on agricultural yields, there is a need to understand whether these models are able to reproduce the observed yield declines. We evaluated 13 GGCMs from the Inter-Sectoral Impact Model Intercomparison Project and compared observed and simulated impact of past droughts and heatwaves on yields for four crops (maize, rice, soy, wheat). We found that most models detect but underestimate the impact of droughts and heatwaves on yield. Specifically, the drought signal was detected by 12 of 13 models for maize and all models for wheat, while the heat signal was detected by eleven models for maize and six models for wheat. To investigate whether the difference between simulated and observed yield declines is due to a misrepresentation of simulated exposure to heat or water scarcity (i.e. misrepresentation of growing season), we analysed the relationship between average discrepancies between observed and simulated yield losses, and average simulated exposure to extreme weather conditions across all crop models. We found a positive correlation between simulated exposure to heat and model performance for heatwaves, but found no correlation for droughts. This suggests that there is a systematic underestimation of yield responses to heat and drought and not only a misrepresentation of exposure. Assuming that performance for the past indicates models’ capacity to project future yield impacts, models likely underestimate future yield decline from climate change. High-quality temporally and spatially resolved observational data on growing seasons will be highly valuable to further improve crop models’ capacity to adequately respond to extreme weather events.
An NAO-dominated mode of atmospheric circulation drives large decadal changes in wintertime surface climate and snow mass over Eurasia
Authors: Ye Kunhui , Messori Gabriele , Chen Deliang , Woollings Tim
Published: February 2022

The leading mode of wintertime atmospheric variability over the North Atlantic-North Eurasia sector is dominated by the North Atlantic Oscillation (NAO) and accounts for more than one third of the total variability. This study explores the influences of the leading mode on decadal climate variability of Northern Eurasia. We focus on the little-explored decadal covariations of surface air temperature (SAT), snowfall, snow water equivalent (SWE) and snow cover over the region, using extensive model output from the Coupled Model Intercomparison Project sixth phase. Recent decadal trends (−0.92σ per decade) in the leading mode identified, are found to be largely a manifestation of internal climate variability (at least two thirds from the most conservative estimate). These internally-generated decadal trends strongly contributed to recent trends in SAT, snowfall, SWE and snow cover over Eurasia. External forcings should have played a minor role over Eurasia as they usually suggest opposite decadal trends to those observed. An exception is found for snowfall and SWE in east Eurasia, for which external forcings may have driven a large part of the recent upward trends, equally as important as the NAO-dominated mode. This points to a complex interplay between internally-generated and externally-forced climate variability over Northern Eurasia. Model discrepancies are identified in reproducing the linkages between the leading mode and the Eurasian surface climate variability. The internally-generated variability of this leading mode thus represents a large source of uncertainty in future decadal climate projections over Eurasia and, due to the memory effects of snow, also in modelling springtime climate variability.
A slow review of the AGT correspondence
Authors: Le Floch Bruno
Published: February 2022

Starting with a gentle approach to the Alday–Gaiotto–Tachikawa (AGT) correspondence from its 6d origin, these notes provide a wide (albeit shallow) survey of the literature on numerous extensions of the correspondence up to early 2020. This is an extended writeup of the lectures given at the Winter School ‘YRISW 2020’ to appear in a special issue of J. Phys. A. Class S is a wide class of 4d

N
=
2

supersymmetric gauge theories (ranging from super-QCD (quantum chromodynamics) to non-Lagrangian theories) obtained by twisted compactification of 6d

N
=

(

2
,
0

)

superconformal theories on a Riemann surface C. This 6d construction yields the Coulomb branch and Seiberg–Witten geometry of class S theories, geometrizes S-duality, and leads to the AGT correspondence, which states that many observables of class S theories are equal to 2d conformal field theory (CFT) correlators. For instance, the four-sphere partition function of a 4d

N
=
2

S
U

(

2

)

superconformal quiver theory is equal to a Liouville CFT correlator of primary operators. Extensions of the AGT correspondence abound: asymptotically-free gauge theories and Argyres–Douglas theories correspond to irregular CFT operators, quivers with higher-rank gauge groups and non-Lagrangian tinkertoys such as T

N
correspond to Toda CFT correlators, and nonlocal operators (Wilson–’t Hooft loops, surface operators, domain walls) correspond to Verlinde networks, degenerate primary operators, braiding and fusion kernels, and Riemann surfaces with boundaries.
A multifunctional micropore-forming bioink with enhanced anti-bacterial and anti-inflammatory properties
Authors: Wang Mian , Li Wanlu , Luo Zeyu , Tang Guosheng , Mu Xuan , Kuang Xiao , Guo Jie , Zhao Zhibo , Flores Regina Sanchez , Jiang Zewei , Lian Liming , Japo Julia Olga , Ghaemmaghami Amir M , Zhang Yu Shrike
Published: February 2022

Three-dimensional (3D) bioprinting has emerged as an enabling tool for various biomedical applications, such as tissue regeneration and tissue model engineering. To this end, the development of bioinks with multiple functions plays a crucial role in the applications of 3D bioprinting technologies. In this study, we propose a new bioink based on two immiscible aqueous phases of gelatin methacryloyl (GelMA) and dextran, further endowed with anti-bacterial and anti-inflammatory properties. This micropore-forming GelMA-dextran (PGelDex) bioink exhibited excellent printability with vat-polymerization, extrusion, and handheld bioprinting methods. The porous structure was confirmed after bioprinting, which promoted the spreading of the encapsulated cells, exhibiting the exceptional cytocompatibility of this bioink formulation. To extend the applications of such a micropore-forming bioink, interleukin-4 (IL-4)-loaded silver-coated gold nanorods (AgGNRs) and human mesenchymal stem cells (MSCs) were simultaneously incorporated, to display synergistic anti-infection behavior and immunomodulatory function. The results revealed the anti-bacterial properties of the AgGNR-loaded PGelDex bioink for both Gram-negative and Gram-positive bacteria. The data also indicated that the presence of IL-4 and MSCs facilitated macrophage M2-phenotype differentiation, suggesting the potential anti-inflammatory feature of the bioink. Overall, this unique anti-bacterial and immunomodulatory micropore-forming bioink offers an effective strategy for the inhibition of bacterial-induced infections as well as the ability of immune-regulation, which is a promising candidate for broadened tissue bioprinting applications.
Refractive-diffractive hybrid optics array: comparative analysis of simulation and experiments
Authors: Low Mun Ji , Rohith Thazhe Madam , Kim Byunggi , Kim Seung-Woo , Suchand Sandeep C S , Murukeshan Vadakke Matham , Kim Young-Jin
Published: February 2022

Hybrid optical elements, which combine refractive and diffractive optical components to enhance optical performance by taking advantage of the optical characteristics of the individual components, have enormous potential for next-generation optical devices. However, there have not been many reports on the simulation methodology to characterize such hybrid optical systems. Here, we present a method for simulating a hybrid optical element realized by attaching an ultra-thin, flexible diffractive optics array onto a refractive optical element. The ultra-thin diffractive optical element is fabricated by direct-laser-writing using a femtosecond pulsed laser as the light source. A systematic investigation of the proposed simulation method, which does not require extensive hardware resources or computational time, but retains resolution and accuracy, is presented. The proposed scheme is validated by comparing simulation and experimental results. The simulation and experimental results on the spot size and focal length for the diffractive Fresnel zone plate (FZP) match well, with typical errors of less than 6%. The aspect ratio of the focal spot sizes at the compound and FZP focal planes of the hybrid optical system from the simulation and experiment also match quite well, with typical errors below 7%. This simulation scheme will expedite the designs for novel hybrid optical systems with optimal optical performances for specific applications, such as microfluidics and aberration-controlled optics.
Phased array ultrasonic S-scan testing of near-detection-surface defects based on a background subtraction algorithm
Authors: Tian Yukuo , Xu Guocheng , Wei Lingbo , Zhou Guanghao , Lin Yuting , Fan Qiuyue , Gu Xiaopeng
Published: February 2022

In phased array ultrasonic sector scanning testing, echoes from defects near the detection surface are often overlapped with interface echoes and cannot be characterized. Based on linear acoustic theory, a mathematical model combining the background subtraction and the sum of squares differences algorithm is established to extract the characteristics of near-detection-surface defect echoes. The upper surface of the artificial notch defect is used as a near-detection-surface defect for detection. Specially, linear interpolation algorithm is used to suppress the effect of residual interface echo on the defect echo feature extraction and the effect of different interpolation factors is analyzed. The defect location and size were calculated based on the extracted defect characteristics. The simulation and experimental results indicate that the model can effectively extract the near-detection-surface defect echoes characteristics. Furthermore, when the interpolated signal reaches at least 500 MHz, residual interface echoes can be effectively suppressed. More importantly, according to the extracted defect echo characteristics, the localization and quantitative accuracies of near-surface defects can reach 0.2 mm and 0.3 mm, respectively. These findings provide an effective strategy for phased array ultrasonic sector scanning testing of near-detection-surface defects.
Three-dimensional temperature and stress field simulation with all-hexahedral element mesh in a high efficiency cooling structure for the fabrication of amorphous ribbons
Authors: Chen Li , Li Yuluo , Shen Ningning , Hui Xidong
Published: February 2022

Planar flow casting is an advanced technology to produce amorphous and nanocrystalline ribbons in electrical application. At present, the utilization rate of roller surface is generally under 20% in industrial production. This work reports a new cooling structure that is designed to produce ribbons width 65 mm with the utilization rate of roller surface up to 65%. The cooling structure is simulated with the software ANSYS by employing three-dimensional temperature and stress field mathematic model incorporating actual production conditions with all-hexahedral element mesh. It is shown that the liquid velocity is uniform with consistent distribution of convective heat transfer coefficient in width direction between cooling water and rotating roller. The thermal expansion difference in the new cooling structure is only 0.0042 mm at the ribbon edge. In this case, it is unnecessary to make the slit with an upward bend. The new cooling structure is expected to be applied for industrial production at an ideal level.
Prevalence and implications of frailty in acute stroke: systematic review & meta-analysis
Authors: Burton Jennifer K , Stewart Jennifer , Blair Mairi , Oxley Sinead , Wass Amy , Taylor-Rowan Martin , Quinn Terence J
Published: February 2022

Background

frailty is common in older adults and associated with poor outcomes following illness. Although stroke is predominantly a disease of older people, our knowledge of frailty in stroke is limited. We aimed to collate the literature on acute stroke and frailty to estimate the prevalence of pre-stroke frailty and its associations with outcomes.

Methods

paired researchers searched multidisciplinary electronic databases for papers describing frailty and acute stroke. We assessed risk of bias using Newcastle-Ottawa tools appropriate to study design. We created summary estimates of pre-stroke frailty using random effects models. We collated whether studies reported significant positive associations between frailty and clinical outcomes in adjusted models.

Results

we included 14 studies (n = 27,210 participants). Seven studies (n = 8,840) used a frailty index approach, four studies (n = 14,924) used Hospital Frailty Risk Scores. Pooled prevalence of pre-stroke frailty was 24.6% (95% confidence interval, CI: 16.2–33.1%; low quality evidence, downgraded due to heterogeneity, bias). Combining frailty and pre-frailty (nine studies, n = 23,827), prevalence of any frailty syndrome was 66.8% (95%CI: 49.9–83.7%). Seven studies were at risk of bias, from participant selection or method of frailty assessment. Pre-stroke frailty was associated with all adverse outcomes assessed, including longer-term mortality (positive association in 6 of 6 studies reporting this outcome; odds ratio: 3.75 [95%CI: 2.41–5.70]), length of admission (3 of 4 studies) and disability (4 of 6 studies).

Conclusions

despite substantial heterogeneity, whichever way it is measured, frailty is common in patients presenting with acute stroke and associated with poor outcomes. This has implications for the design of stroke services and pathways.
Rethinking Nationalism
Authors: Aydin Cemil , Ballor Grace , Conrad Sebastian , Cooper Frederick , CuUnjieng Aboitiz Nicole , Drayton Richard , Goebel Michael , Judson Pieter M , Kott Sandrine , Miller Nicola , Roshwald Aviel , Sluga Glenda , Walker Lydia
Published: February 2022

This forum, curated by Michael Goebel (Freie Univ. Berlin), brings together twelve historians who draw on their own areas of specialization to rethink how we conceptualize the history of nationalism in our present moment of reactivated and often militant nationalist rhetoric.
Evaluating Symptomatic and Psychosocial Well-being After Keloid Treatment With SCAR-Q
Authors: Kim Minji , Mirsky Nicholas , Spielman Amanda , Mathew Prakash , Yechieli Raphael , Tang Jennifer C , Thaller Seth R
Published: February 2022

Background

Many patients with keloids experience symptoms, such as pain and pruritus, and may present with significant psychosocial burdens. However, no single therapeutic regimen has been firmly established for treatment of keloids.

Objectives

The aim of this study was to assess patients’ perspectives on their keloids after treatment by comparing preoperative and postoperative surveys.

Methods

All patients seen at the keloid clinic, both preoperatively and postoperatively, were contacted by telephone call. Information about demographics, keloid characteristics, and levels of pain and pruritus were recorded. Participants also completed all 3 parts (appearance, symptoms, and psychosocial impact) of the SCAR-Q, a validated patient-reported outcome measure questionnaire. Statistical analysis was performed with SPSS version 23 (IBM Corp., Armonk, NY).

Results

Of the 60 patients who participated in the study, 35 preoperative and 34 postoperative surveys were completed. Patients experienced significant reductions in mean [standard deviation] pain levels (from 5.6 [4.0] to 0.1 [0.4], P < 0.001) and pruritus (from 6.5 [3.0] to 0.8 [1.5], P < 0.001) postintervention. Significant improvements in all 3 parts of the SCAR-Q were noted. Appearance improved from 26.5 [22.3] to 73.4 [23.0] (P < 0.001); symptoms from 44.0 [15.7] to 81.4 [16.7] (P < 0.001); and psychosocial impact from 27.7 [30.7] to 82.6 [26.3] (P < 0.001).

Conclusions

Patients with keloids experience significant improvement in their symptomatic and psychosocial burden after treatment. Although management modalities are not well established, it is essential that plastic surgeons do not overlook the therapeutic benefits for their patients’ well-being.
9 The Management of Patients Admitted with Head Injuries at Gozo General Hospital
Authors: Bugeja K. , Jayawardena U. , Vincenti M. Zammit
Published: February 2022

Aim

This audit reviewed management practice of patients admitted to Gozo General Hospital with a head injury, to see whether guidelines are being followed.

Method

All patients admitted to GGH with a head injury over a twelve-month period (December 2019 – November 2020) were retrospectively reviewed. We used National Institute for Health Care Excellence (NICE) clinical guidance 176 as the standard to compare to.

Results

61 patients, with a mean age 33 years, that were admitted to hospital were included. CT head was performed on 36 (59%) patients.

According to NICE guidelines, CT head was warranted in these patients:

24 (39%) patients had a CT scan which may not have been indicated according to NICE guidelines.

Out of the 61 patients admitted to hospital, admission was warranted in the following:

49 (80%) of admitted patients may have not needed admission.

Conclusions

This retrospective review suggests that a significant number of patients are being unnecessarily admitted to Gozo General Hospital following a head injury and a significant number are having an unnecessary CT head. The local issues causing this need to be identified and methods need to be introduced to better follow recommended guidelines.
18 The Rise in Trauma & Orthopaedic Trainee-Led Research and Audit Collaborative Projects in the United Kingdom Since the Start of the COVID-19 Pandemic
Authors: Khaleeq T. , Kabariti R. , Ahmed U.
Published: February 2022

Introduction

There has been a significant rise in trainee-led trauma & orthopaedic (T&O) multi-centre research collaborative projects globally. Since the start of the COVID-19 pandemic, more emphasis has been on global collaborative research efforts to tackle important research questions. The aim was to evaluate the number of T&O trainee-led research collaborative projects that took part since the start of the COVID-19 pandemic in the UK.

Method

A retrospective study that evaluated T&O trainee-led national collaborative projects within the UK since the start of the COVID-19 pandemic lockdown (March 2020 to June 2021). Our exclusion criteria included any regional collaborative projects, projects that were started pre-COVID and projects of other surgical specialities. The number of projects identified was compared to that in 2019.

Results

In 2019, 0 trainee-led collaborative projects were commenced nationally in the UK. Since the COVID-19 pandemic, we identified 10 trainee-led collaborative trauma & orthopaedic projects with 3 being published so far. The level of evidence ranged between 3 and 4.

Conclusions

Covid has placed significant challenges across healthcare. One positive aspect that has been noted is the increase in multi-centre trainee-led collaborative projects within the UK. Our study highlights the feasibility of a trainee-led high quality collaborative research projects in the UK, emphasising the growing contribution of trainees towards research. Wide-spread availability of new technological tools such as social media and Redcap® facilitates such projects in terms of recruitment and data collection. We would, therefore, recommend expanding this trainee-led collaborative platform across in Europe and Worldwide.
21 One-Shot Tract Dilatation for Supine Percutaneous Nephrolithotomy (PCNL) in Obese Patients
Authors: Sheng Z. , Warner R. , Caddeo G.
Published: February 2022

Introduction

With the rising incidence of both obesity and urolithiasis, the need to perform stone surgery in high BMI patients is increasing. We analysed the safety and efficacy of the one-shot tract dilatation (OSD) technique in obese patients undergoing supine percutaneous nephrolithotomy (PCNL).

Method

Retrospective review of all supine PCNLs performed by a single surgeon between January 2014 and December 2020. Patient factors (age and BMI), stone complexity and procedural characteristics (tract size and dilatation technique) were collected. Outcomes included access success, length of stay, operating duration, and inpatient complications.

Results

Overall 104 supine PCNLs were performed in 93 patients. Forty-four had a BMI >/ =  30 kg/m2 with a median age of 53 years, median BMI 35.12 kg/m2 and median Guy’s stone score of 2. When initial puncture was successful (43 cases (98%)), tract dilatation was satisfactory on all occasions. Dilatation was performed using a balloon dilator (24Ch) in 12 cases and OSD in 31 cases (range 16Ch to 24Ch, median 22Ch). Median length of stay was lower when OSD used (1 day) versus balloon (2 days), P = 0.03. Median operating time using OSD was 98 minutes versus 120 minutes using balloon (P = 0.10). There was no significant difference in operative time or length of stay when using OSD compared with BMI < 30 kg/m2. There were two Clavien-Dindo Grade I and one Grade II complications in patients where OSD was used. No transfusions were required.

Conclusions

One shot dilatation is an effective and safe means of access in obese patients when performing a supine PCNL.
25 Tender Is the Spine: Thoracolumbar Fractures and Patterns of Referrals
Authors: Saad A.R. , Mueller M. , Pillai D.
Published: February 2022

Introduction

This study investigates the pattern of referrals of thoracolumbar fractures between trauma and orthopaedic department in a district general trauma unit (TU) and the affiliated Major Trauma Centre (MTC). Our TU has got no out of hour emergency spinal surgeons on site. Patients who are admitted with thoracolumbar fractures get referred to MTC for advice on management. The TLICS score and the AO Thoracolumbar fracture classification system are two well recognized classification systems for thoracolumbar fractures. The main aim of this project is to evaluate current practice and its effectiveness.

Method

Data was retrospectively collected from the trauma board for patients referred to the orthopaedic on call services for thoracolumbar fractures over a 16-month period. Patients’ demographics, mechanism of injury, TLICS scores and AO classification were recorded, and outcome registered.

Results

From 92 patients identified most had low energy trauma and the majority had low TLICS score (<2) and AO class (A1,2,3). 24 of the patients were referred to MTC of whom 10 required a follow-up appointment. 39 were discussed with the local spinal consultants. 91 were treated conservatively and locally.

Conclusions

Most thoracolumbar fractures are treated locally. It can be argued that the emergency spinal services at MTC are unnecessarily burdened for advice and reassurance. A change of the current pathway can possibly be put in place for patients with low AO classification (A1,2,3), that can be treated with local spinal surgeon input. This calls for a follow-on multi-centre study.
26 Running a Safe Aortic Service in the Covid-Era
Authors: Beavis J.
Published: February 2022

Introduction

Within the Covid-19 pandemic, elective surgery has been cancelled to increase critical care capacity. With two thirds of abdominal aortic aneurysm ruptures lethal, it is important to consider how to run a safe aortic service within the pandemic. Vascular patients have an increased risk of mortality from Covid-19. By considering ambulatory care, shortening hospital stay and discharging to level 1 care for non-complex infrarenal endovascular aneurism repairs (EVAR), critical care capacity can be kept available and exposure to nosocomial Covid-19 can be reduced.

Method

A retrospective audit of EVAR patient’s documentation examined the ASA, level of postoperative care, time to discharge, geographical and personal care factors. These were compared with pre-established criteria deeming suitability for ambulatory or ward level care. Results were presented locally and subsequent reaudit conducted.

Results

The initial audit included 40 records. 30% of patients were potential targets for ambulatory care with the median discharge on postoperative day 3. All patients were admitted to the high dependency unit (HDU) with 12.5% of patients receiving treatment that required a HDU level of care. Upon reaudit, 8 records were included with all patients admitted to HDU and the median day of discharge postoperative day 2. Notably, 37.5% patients were discharged on postoperative day 1 and a day of surgery admission (DOSA) process was implemented.

Conclusions

By reviewing a health board’s EVAR caseload, suitability for short stay EVARs can be assessed. Implementing an early discharge and DOSA process keeps care capacity available and may protect against nosocomial Covid-19.
29 Ankle Syndesmotic Injury: Tightrope vs Screw Fixation, a Clinical Academic Survey
Authors: Shafiq H. , Khan B.G. , Jamshed H.
Published: February 2022

Aim

Unstable syndesmotic ankle injury requires surgical management in the form of screw or tightrope fixation. However, the superiority of one technique over the other remains debatable. Our Study aims to identify the fixation of choice in unstable ankle syndesmotic injury based on the surgeon’s level of experience.

Methods

A survey was undertaken to analyse the management of ankle syndesmotic injuries AO 44c in a 35-year-old patient. Surgeons attending an orthopaedic course were invited to participate in a survey categorised into groups: junior surgeons, middle grades and experienced. X-ray was shown to the 100 participants and treatment options were asked.

Results

100 surgeons from 20 nations took part in the event. Juniors made up 39%, registrars 38% and experienced surgeons were 29%. 93% chose screw fixation, out of which 66% favoured a single screw over two screws. 3–4 cortices were virtually evenly divided in choice, with 54 % preferring three and 46% preferring four cortices. Only 22% of the time did they utilise a washer with screws. 52% of the surgeons allowed weight-bearing 4 to 6 weeks after surgery. 34% preferred to remove the screw at 1–2 months and 29% at 2–3 months post-operatively.

Conclusions

Data show that majority of junior level doctors manage their patients according to AO principles. The majority prefer one 3.5mm screw positioned between 2–4 cm above the ankle joint, with three cortices being somewhat preferred. Despite the lack of data to support one procedure, the majority of people remove their screws within 1 to 3 months.
74 Implications of Pre-Operative Ng Fasting on Nutrition in Major Burn Patients: An Audit of Practice
Authors: Khera B. , Lewis C. , Lancaster N.
Published: February 2022

Background

Nasogastric (NG) feeding is commonly employed as a first line method of enteral feeding. This needs to be stopped pre-operatively resulting in missed calories and protein. Nasojejunal (NJ) feeding is an alternative method that can continue during surgery and can be used in gastric stasis.

In this audit we want to determine the calorie and protein loss in major burns patients at the Northern Regional Burn Centre who have had enteral feeding via the nasogastric route.

Method

A retrospective analysis of the NG feeding, and fasting times was carried out for major burns patients at the Royal Victoria Infirmary in Newcastle from 2019 to 2021. Nine patients were identified, and their NG feeding prescriptions and delivery times were looked at. The number of calories and protein prescribed by the dietitian were compared against the amount missed when the NG feed was paused. A percentage loss was calculated for each parameter.

Results

Of the 9 patients analysed over 3 years, the calories lost ranged from 2226kcal to 23,929kcal. Of the induvial prescribed calorie intake, the calorie loss was from 7% to 39% with a mean calorie loss of 17.6%. The protein lost ranged from 143g to 1,240g. Of the individual prescribed protein intake, the protein loss was from 7% to 40% with a mean protein loss of 19.4%.

Conclusions

We recommend that the addition of NJ feeding as an alternative method of enteral feeding to the NUTH burns nutritional policy would help optimise the management of major burns patients by minimising nutritional losses.
81 An Audit of Venous Thromboembolism (VTE) Risk Assessment & Prophylaxis Implementation
Authors: Woolner B. , Moore P. , Parker S.
Published: February 2022

Introduction

VTE is considered one of the most common preventable causes of death and significant co-morbidity in inpatients and is responsible for approximately 60,000 deaths occur per annum in the UK. The NHS Standard Contract requires all inpatients to undergo a VTE risk assessment, with a 95% patient assessment threshold. In January 2020 we identified that 72% of patients within our trust had a risk assessment completed, and 15% of these were accurate. We subsequently implemented mandatory VTE prescribing training for all junior doctors joining the trust.

Aim

Review the impact of mandatory training module on VTE risk assessment and prescribing, in compliance with NICE Guidelines.

Method

All inpatient medical notes, VTE risk assessments, and VTE prescriptions were reviewed to assess accurate risk assessment completion and subsequent appropriate prophylaxis prescribing. The standards were as set out in the NICE guidelines [NG89]. Paediatric, Obstetric and ITU patients were excluded.

Results

Our VTE risk assessment completion rates increased from 72.1% to 94.2%, and the accuracy of these assessments from 15.4% to 34.5%. Our prescription rate increased from 84.6% to 90.6%, and prescribing accuracy from 41.2% to 79.5%.

Conclusions

By implementing mandatory VTE prophylaxis training for all junior doctors joining a new NHS trust, we can see increased compliance with appropriate risk assessment and prophylaxis prescribing. This will reduce the risk of unnecessary death from VTE in hospital inpatients.
114 Urology Stent Recall Registry
Authors: Narayan P. , Wood H. , Mukhtar S. , Papikinos P.
Published: February 2022

Aim

To analyse how many stent procedures were recorded (on the stent registry tool in CERNER introduced at our busy DGH) for patients undergoing an insertion of ureteric stent, this ensures patient safety is not compromised by making sure stent(s) are removed or replaced at the right time.

Method

Retrospective Collection of data for 3 months. Which was followed by intervention, and a further collection of data for 3 months after implementation of changes. Parameters collected included age, gender, stent recall registered, comments present in registry, removal date.

Results

In the first loop only 32.6% of the patient had the stent recall registered on the directory. Post Intervention (IT training, Posters, presenting half audit at clinical governance) the registry rate was 59%. The most common reason for insertion was for stone, followed by longstanding hydronephrosis. It was also interesting to note that 2 patients were found who were lost in follow up and an urgent action was taken to review them.

Conclusions

Cerner, which is popular in NHS trusts across UK has the feasibility of having an online stent register where the information recorded gets transferred straight to the Urology office, hence ensuring correct time of removal/ exchange of stents. Trusts across UK can develop this online registration scheme in their IT system. Developing the online registry system and encouraging this audit in all NHS trusts will significantly impact the welfare and safety of patients and reduce the economic burden of NHS in dealing with complications associated with stents.
117 Management of Spinal Accessory Nerve Palsy
Authors: Rupra R. , Malone P. , Power D. , Chaudhry T.
Published: February 2022

Aim

To discuss our strategies employed in our peripheral nerve injury unit for spinal accessory nerve (SAN) injury and a potential algorithm for future use.

Method

A retrospective analysis was undertaken on 9 patients with SAN injury undergoing surgical intervention. Neurophysiological results were obtained. MRC grades were compared at presentation and post-operatively. DASH (Disability of the arm, shoulder, and hand) scores were also collected post-operatively.

Results

7 patients presented to us following an iatrogenic injury to the SAN.

6 patients underwent neurolysis only, 3 underwent nerve transfer, 2 underwent nerve grafting (1 autologous, 1 processed nerve allograft).

The mean time frame from presentation to operation was 13 months. MRC grading of shoulder function increased from a mean MRC 2 to 4 at a mean of 8 months post-operatively. DASH scores of the 7 participating patients were 30.8 at a mean of 47 months post-operatively. 2 patients had experienced a sensory deficit.

Conclusions

Nerve grafting allows bridging of a gap when the injury is well defined with a suitable window for re-innervation. Allograft has a role in small gaps where there may be concerns with autograft. Nerve transfer may allow earlier re-innervation and be a more reliable option where the proximal extent of nerve injury is poorly defined. We found nerve wraps to be a useful addition when an injured nerve may be adherent to a heavily scarred bed. We will present some worked examples along with a potential algorithm for a surgical strategy.
131 The Health-Related Quality of Life of Patients Waiting for Anterior Cruciate Ligament Reconstruction Is Worse Than an Age and Sex Match Population: Increasing Time on Waiting List Was Independently Associated With a Worse Quality of Life
Authors: Raja A. , Clement N.D. , Sripada S. , Loader H. , Kam M. , Haggart J. , Fawcett T. , Peattie C. , Molyneux S.
Published: February 2022

Aim

To assess the health-related quality of life (HRQoL) of patients waiting for an anterior cruciate ligament (ACL) reconstruction compared to the population at risk, and whether knee specific function was predictive of HRQoL and to identify factors associated with a worse HRQoL.

Method

Sixty-seven patients (male n = 50, female n = 17, mean age 29) identified from the surgical waiting list completed a questionnaire that included demographics, BMI, time of injury, EuroQol 5-demension (EQ-5D), short-form (SF-)36 and International Knee Documentation Committee (IKDC) scores. Age and sex matched HRQoL data were obtained from population level data.

Results

The mean EQ-5D score for the study cohort was significantly worse than the matched score (difference 0.367, p<0.001), and the same trend was observed for all eight dimensions of the SF-36 score. Thirty-three (49%) patients felt their health in general was somewhat or much worse compared to one-year ago. There was a correlation between the IKDC and EQ-5D scores (r = 0.540, p<0.001), and linear regression was used to formulate the EQ-5D score: EQ-5D = (IKDCx0.013)–0.015(constant). The SF-36 physical component and the length of time on the waiting list were independently associated the HRQoL, with each 14-point drop or for every 200-days a clinically significant deterioration in a patients HRQoL occurred, respectively.

Conclusions

Patients had a significantly worse HRQoL when compared to age and sex match population, which deteriorates with worsening physical function and increasing length of time on the waiting list. The knee specific IKDC correlated with HRQoL and could be used to estimate the EQ-5D score.
133 A Quality Improvement Project to Improve the Appropriateness of Acute Clinic Referrals to a Local ENT Department Using an Electronic Booking System
Authors: Parmar V. , Maity A. , Singh P.
Published: February 2022

Aim

Assess and improve the proportion of inappropriate acute clinic referrals being made to our local ENT department via a telephone referral system with regards to nature and suitability for a junior grade doctor run clinic with senior supervision. Additionally, to make a more efficient, timely and failproof booking system with an auditable trail by transitioning to an electronic referral system.

Method

A guideline was created using based on common protocols from major Trusts within the UK which was then used to assess 101 acute clinic referrals taken from February 2021 to our local service. An electronic referral system was created, and guidelines disseminated to departments commonly making referrals to the acute clinic in anticipation for re-audit in September 2021 alongside introduction of the guideline to new doctors rotating to the specialty at induction in August.

Results

Initial audit revealed 29% of referrals were inappropriate, 50% of which were too complex, 45% were not acute and 5% were due to accidental double-bookings. Additionally, nasal fracture reviews were seen within 10 days only one third of the time, 37% of patients referred did not have a recorded contact number and 13.8% of all referrals were made with incorrect or unclear clinical information.

Conclusions

The lack of clear clinical guidance on referrals to an acute ENT service at our local centre with an outdated telephone referral system is associated with a large proportion of inappropriate referrals, delays to timely care and transcription errors potentially putting patients at risk of harm.
137 A Review of Current Criteria for Risk of Aneurysmal Subarachnoid Haemorrhage
Authors: Sharma S. , Daga K.
Published: February 2022

Introduction

There is a need to evaluate the existing guidelines regarding the size criteria for the risk of rupture of intracranial aneurysms. The current understanding is that small intracranial aneurysms (less than 7 mm) are not at significant risk for rupture according to the ISUIA 1 & 2 trials. However, there have been several published series of rupture and subarachnoid haemorrhage from aneurysms less than 5 mm in both, anterior and posterior cerebral circulation.

Methods

We conducted a systematic review of aneurysmal subarachnoid haemorrhage, specifically to identify their size and the anatomical location at the time of rupture, using the healthcare databases advanced search.

Results

Our search yielded 1438 results matching our inclusion criteria. Our results demonstrated that 50.4 – 76.8% of aneurysms were under 7 mm in diameter at the time of rupture. Subarachnoid haemorrhage from smaller aneurysms (<5 mm) was also shown to present with poor prognoses (Hunt and Hess grades 4–5). There were no significant differences observed between the anterior and posterior circulation.

Conclusions

The existing criterion to determine the risk of rupture of intracranial aneurysms need to be updated, accounting for multiple clinical factors including, but not limited to, the size. With advances in endovascular treatments in recent years, the associated intra-procedural risks are greatly reduced compared to traditional neurosurgical approaches, making the argument for intervention at earlier presentations.
141 Evaluation of Use of NABCOP Frailty Score and Interprofessional Variety of WHO Performance Score in Breast Cancer Patients Over 70 Years of Age
Authors: Rezacova M. , Clark S.
Published: February 2022

Aim

There is requirement to assess frailty of older patients with breast cancer as it can influence practice of treatment. In our department the fitness assessment was inconsistent. Therefore, we have decided to conduct qualitative study to evaluate ease of use of NABCOP frailty score (in comparison with other scales) as well as interprofessional variety of WHO performance score.

Method

We have conducted prospective data over 2 weeks period in our busy fast track breast clinic. All new patients over 70 years of age have been identified and asked to perform self-rating assessment. The patient has been later evaluated by NABCOP frailty score and WHO performance score by consultant, nurse, and HCA. This was compared to GP assessment which is part of 2WW referral.

Results

There have been matching results between patient’s self-assessment, clinician, and HCA in majority of patients. HCA perform assessment well with no discrepancy to other physician.

Conclusions

Self-rating and HCA assessment of performance status is accurate and can speed up clinic time. WHO performance scale is found easier and less time consuming by users (and felt provides similar information). We have now provided new assessment system which is undergoing trial in practice at present.
151 Relevance of ESCC Grading and SINS System in the Management of Neurosurgical Patients with MSCC
Authors: Peris R. , Golash A.
Published: February 2022

Introduction

The use of ESCC and SINS scoring in the planning of surgery in Neurosurgical patients is something of mutual habit and standard practise. This project looks at the outcomes of patients referred to the centre via the Metastatic Spinal Cord Compression (MSCC) referral, the relevance of ESCC scoring and SINS scoring in surgical patients as well as the post-operative outcomes between neurosurgical and orthopaedic surgeons when treating the same cohort of patients.

Method

We looked at patients referred to a tertiary centre in the UK between January 2018 and December 2018, and June 2020 and December 2020 via the MSCC coordinator.

Results

The most common cancer that resulted in MSCC were urological malignancies, followed by cancers of the lung. Out of the patients that received radiotherapy, patients with urological malignancies had the best survival rate at 6 months post treatment, while gynaecological malignancies produced the lowest survival numbers.

Conclusions

In the groups that underwent surgery via the neurosurgeons and orthopaedic surgeons, there was no significant difference in outcome between the two, despite the those referred via neurosurgery having worse outcomes as a whole. We noted that there was a statistical significance between ESCC grading and patient’s mobility status in those who had MSCC between C7 and L1 vertebrae (p = 0.0478)- contrary to that mentioned in the literature. A higher ESCC score was associated with better mobility. We also found that the SINS score recommended guidance correlated with management of surgical patients who presented with MSCC within the tertiary centre.
153 The Patient Perspective on Day Case Arthroplasty
Authors: Jain A. , O'Dowd Booth C. , Cay P.
Published: February 2022

Introduction

Day Case Arthroplasty has been validated as a safe strategy for reducing length of stay for patients undergoing elective arthroplasty. With the ongoing recovery of elective activities following the COVID pandemic and long waiting lists; day case arthroplasty offers a solution for both hospitals and patients. Reducing length of stay will reduce the cost of day case arthroplasty which benefits hospitals, whilst the faster discharge reduces unnecessary exposure to an increased risk of COVID for patients. This study aims to establish the patient perspective on day case arthroplasty to inform the set-up of a patient cantered day case arthroplasty service.

Method

Data was collected at routine preoperative assessment clinics via a structured questionnaire which combined both quantitative and qualitative methods. The questionnaire covered patient demographics, issues pertaining to same-day discharge, level of concern related to common problems faced by patients after joint replacement surgery and patient preference for same day discharge versus more traditional rehabilitation methods.

Results

The study included 79 patients with 43% preferring same day discharge. Postoperative pain, surgical complications and wound healing were the most significant concerns elicited. Patients who preferred same day discharge were statistically younger. The majority of patients felt that their rehabilitation could be completed at home.

Conclusions

The results of this study highlight the demand for day case arthroplasty in this cohort of patients with younger patients preferring same day discharge. Identifying significant concerns will be important to formulate effective perioperative protocols to ensure successful implementation of a patient cantered day case arthroplasty service.