bluuebunny/crossref_metadata_2025 huggingface dataset:
Endangered Chinese Dialects
Authors: Zhang Qingwen , Chen Guanen
Published: September 2024

Starting from an overview of the 10 major Chinese dialect groups, the article aims to provide a comprehensive introduction to endangered Chinese dialects. It delineates the causes and indicators of endangerment, describes the geographical distribution and speaking population of endangered dialects, and elucidates the influence of dominant languages on the linguistic traits of endangered dialects. The paper concludes with an exploration of ongoing preservation efforts dedicated to safeguarding endangered Chinese dialects.

The decrease in language use, influenced by the dominance of Mandarin and other dominant dialects, is identified as the primary cause of endangerment. The implementation of the language policy designating Mandarin as the standard national language to be used in education, administration, and public domains throughout the country has further contributed to this decline. Indicators of endangerment include decreased language use, bilingualism or multilingualism in dominant dialects, and limited domains of usage resulting in language shifting. The disruption of linguistic transmission from older to younger generations is another factor contributing to a diminishing population of speakers. Geographically, the largest cluster of endangered Chinese dialects is distributed at the junction of Guangdong, Guangxi, and Hunan provinces. These dialects have a small population of speakers, ranging from hundreds to tens of thousands.

Linguistically, the impact of dominant dialects on endangered dialects pertains to their phonological, lexical, and grammatical properties. While phonological instability displayed due to the influence of dominant dialects, certain stable features are identified, such as the retention or development of Middle Chinese voiced stops and affricates, as well as the preservation of sharp sounds. Lexical properties of endangered dialects are discussed in two aspects: (a) distinctive words in endangered dialects, including dialect-specific words, ancient Chinese words, and those related to folk culture; (b) word order variation between the endangered dialect and its dominant dialect. The erosion of grammatical properties is also noted, with endangered dialects borrowing features from dominant dialects.

The article emphasizes the importance of preserving linguistic diversity and protecting endangered Chinese dialects. The National Language Resources Protection Project in China is introduced as a comprehensive initiative aimed at surveying, collecting, and recording language resources. The project includes the publication of books, symposia, and an online platform showcasing audio and video recordings of endangered dialects. However, a comprehensive approach that includes explicit language policies and the establishment of dialect-promoting institutions are necessary for comprehensive protection.
Natural Hazards and Supply Chain
Authors: Dai Tinglong , Tang Christopher S.
Published: September 2024

The relationship between natural hazards and supply chain operations is bidirectional: Natural hazards can disrupt supply chain operations, and supply chain operations can influence the causes of natural hazards. The former motivates us to discuss four key steps for managing supply chain risk in the presence of these hazards: (a) identifying risk, (b) assessing risk, (c) mitigating risk, and (d) responding to risk events. The latter prompts us to examine how the environmental, social, and governance movement—a set of standards and practices aimed at creating positive social and environmental impacts—can prompt companies to rethink their supply chain operations to reduce emissions, mitigate the human impact of natural disasters, and mobilize their supply chain partners to combat climate change. Developing supply chains that are resilient to natural hazards requires a collective and collaborative effort among all stakeholders.
An Innovative Approach to Hybridizing Two Established Desalination Technologies or Toward Ensuring a Future Global Water Supply: Using a Hybrid Multieffect Desalination with an Adsorption Cycle
Authors: Shahzad Muhammad Wakil , Ahmad Muhammad
Published: September 2024

The global water supply–demand gap is rising with population growth, urbanization trends, and industrialization. This situation is expected to push 40% of the world’s population below the water scarcity level by 2050. As of 2023, 20,000 desalination plants converting more than 40 bm3 of water annually in 150 countries. However, the energy-intensive operation, high desalination cost, and environmental footprint of conventional desalination systems require a technological breakthrough in the field to sustainably cope with the demand. This study presents a comprehensive and innovative approach to hybridizing two established desalination technologies for higher energy efficiency, higher water productivity, lower cost, and improved environmental operation. The proposed system is a hybrid multieffect desalination (MED) with an adsorption cycle (ad). The advantages of the proposed system include low-temperature operation (below ambient), double water production over the same top brine temperature, and high thermodynamic efficiency. A pilot-scale MEDAD with a water production capacity of 10 m3/day has been developed and tested. The study showed that the hybridization of the AD cycle with the conventional MED system decreased the bottom brine temperature to approximately 20 °C compared to 40 °C of the conventional MED system. Meanwhile, the productivity of hybrid systems surged to 2–3 times that of the conventional system. Moreover, the system operates at approximately 20% of the thermodynamic limit, which is the highest for any desalination system hitherto. Therefore, the system can be scaled up for any higher productivity as the most viable solution to desalinate seawater.
Moving to General Equilibrium: The Role of CGEs for Economic Analysis of Water Infrastructure Projects
Authors: Strzepek Kenneth  M. , Neumann James  E.
Published: September 2024

The desire of policymakers and public finance institutions to understand the contribution of water infrastructure to the wider economy, rather than the value of project-level outputs in isolation, has spawned a multidisciplinary branch of water resource planning that integrates traditional biophysical modeling of water resource systems with economy-wide models, including computable general equilibrium models. Economy-wide models include several distinct approaches, including input–output models, macro-econometric models, hybrid input–output macro-econometric models, and general equilibrium models—the term “economy-wide” usually refers to a national level analysis, but could also apply to a sub-national region, multi-nation regions, or the world. A key common characteristic of these models is that they disaggregate the overall economy of a country or region into a number of smaller units, or optimizing agents, who in turn interact with other agents in the economy in determining the use of inputs for production, and the outcomes of markets for goods. These economic agents include industries, service providers, households, governments, and many more. Such a holistic general equilibrium modeling approach is particularly useful for understanding and measuring social costs, a key aim in most cost–benefit analyses (CBAs) of water infrastructure investments when the project or program will have non-marginal impacts and current market prices will be impacted and an appropriately detailed social accounting matrix is available. This article draws on examples from recent work on low- and middle-income countries (LMICs) and provides an outline of available resources that are necessary to conduct an economy-wide modeling analysis. LMICs are the focus of larger water resource investment potential in the 21st century, including large-scale hydropower, irrigation, and drinking water supply. A step-by-step approach is illustrated and supports the conclusion that conditions exist to apply these models much more broadly in LMICs to enhance CBAs.
The Family of HYDRUS Models
Authors: Šimůnek Jiří , Brunetti Giuseppe , van Genuchten Martinus Th. , Šejna Miroslav
Published: September 2024

HYDRUS is a Windows-based modeling software package that can be used to analyze water flow and heat and solute transport in variably saturated porous media (e.g., soils or the vadose zone). The HYDRUS software includes an interactive graphics-based interface for data preprocessing, soil profile discretization, and graphic presentation of the results. Historically, HYDRUS consisted of two independent software packages. While HYDRUS-1D simulated flow and transport processes in one dimension and was a public domain software, HYDRUS (2D/3D; and earlier HYDRUS-2D) extended the simulation capabilities to the second and third dimensions and was distributed commercially. These two previously independent software packages were merged in 2023 into a single software package called HYDRUS.

The capabilities of the HYDRUS software packages have been significantly expanded by various standard and nonstandard specialized add-on modules. The standard add-on modules are fully incorporated and supported by the HYDRUS graphical user-friendly interfaces (GUIs) and documented in detail in the technical and user manuals. This is not the case for several additional nonstandard modules, which require additional work outside the GUI. A commonality of all HYDRUS add-on modules is that they simulate variably saturated water flow and heat and solute transport in porous media. The specialized add-on modules provide additional capabilities, such as considering general reactive transport (in the HPx models) or reactive transport with specific chemistry (notably the Wetland and UNSATCHEM modules). Other modules provide additional flow and/or transport modeling processes, such as to account for preferential flow (the DualPerm module), colloid-facilitated solute transport (the C-Ride module), or the transport of polyfluoroalkyl substances (PFAS; the PFAS module) or fumigant (the Fumigant module) compounds.

The HYDRUS models are among the most widely used numerical models for simulating processes in the subsurface. There are many thousands of HYDRUS users worldwide, with many applications (also several thousand) appearing in peer-reviewed international literature and many technical reports.
Substance Use and Misuse: Adolescents
Authors: Oh Sehun , Park Daejun
Published: September 2024

Adolescence—typically defined as ages between 10 and 19—is a period of physiological and socio-behavioral development. Characterized by an imbalance in the neurological development that governs the reward/emotion pathways and cognitive functioning as well as a shift toward more complex dynamics in their social environments, adolescents exhibit a unique vulnerability to substance use/misuse. Also importantly, adolescent substance use/misuse has a long-lasting impact on a wide array of current and future development and well-being, including neuropsychological growth, other risky behaviors, and behavioral health outcomes. The costly and long-lasting consequences of adolescent substance use/misuse underscore the importance of early identification and intervention (both prevention and treatment) to promote adolescents’ healthy development.

Despite the overall decline over the past decades in the United States, a large proportion of adolescents continues to engage in substance use/misuse, raising public concerns. With the increasing roles of peers and communities as well as the continued importance of family in substance use initiation and persistent use, an effective intervention approach must account for the influences of these multilevel systems by touching on modifiable determinants at the individual, family, peer, school/community, and macro levels. Furthermore, the ever-changing landscape of substance use/misuse in the United States, such as cannabis legalization, the increasing need for culturally responsive treatment, and the introduction of new technology, need to be considered to guide future directions for effective prevention and treatment.
The American Society for Clinical Pathology’s 2023 wage survey of medical laboratories in the United States
Authors: Garcia Edna , Kundu Iman , Fong Karen
Published: September 2024

Objectives

To inform the pathology and laboratory field of the most recent national wage data. Historically, the results of this biennial survey have served as a basis for additional research on laboratory professional recruitment, retention, education, marketing, certification, and advocacy.

Methods

The 2023 Wage Survey was conducted in collaboration between the American Society for Clinical Pathology’s (ASCP’s) Institute of Science, Technology, and Policy in Washington, DC, and ASCP Board of Certification in Chicago, Illinois.

Results

Compared to 2021, results show that more occupations at the staff level had an increased average hourly wage (pathologists’ assistant, molecular biology technologist, phlebotomist, cytogenetic technologist, and medical laboratory technician [MLT]), after adjusting for inflation. Wages by time in current occupational title are significantly higher in 2023 than in 2021. Histotechnicians, histotechnologists, and MLTs show consistent increases in pay rates for a longer length of time in the laboratory. Over half (52.4%) of the respondents feel the pandemic continues to influence their salary and/or well-being.

Conclusions

Survey results call for continued efforts in promoting visibility of the profession and greater representation through advocacy. While burnout rates are lower compared to 2021, staffing challenges remain a relevant concern. Efforts to support the workforce have multiplied since the pandemic and have been the forefront focus of the laboratory community. However, continued support and advocacy are needed to increase the promotion and value of laboratory careers for laboratory professionals and patients alike.
BJS 2 - Tumour targeted oxygen-generating nanoparticles for enhanced radiotherapy in the treatment of pancreatic cancer
Authors: Farrell Sian , McKaig Thomas , Gillan Tierna , Nesbitt Heather , Talyor Mark , Callan John , McHale Anthony
Published: September 2024

Aim

To determine if novel oxygen-generating nanoparticles, encased in a pH-sensitive polymethacrylate polymer (SOG-01), can enhance radiotherapy-based treatment in a preclinical pancreatic cancer model. SOG-01 nanoparticles are stable in circulation and, at the lower pH in hypoxic tumours, the polymer coating dissolves to expose a solid peroxide core, capable of generating oxygen in the tumour microenvironment. Since hypoxia reduces the efficacy of radiotherapy, this particle could potentially be employed to enhance radiotherapy-based approaches for the treatment of pancreatic cancer.

Methods

A human xenograft pancreatic cancer model (BxPC-3) in mice was employed as a target. SOG-01 was administered systemically and animals (n=6 per experimental group) were subsequently treated with radiation (a single dose of 6 Gy) using a Gulmay (160kV) AGO HS-MP1 X-Ray generator. Control animals were either untreated, treated with SOG-01 alone, or radiation alone. Tumour size and survival were employed as a measure of therapeutic efficacy.

Results

When the mean tumour size of groups treated with SOG-01 or radiation alone was compared with that of the untreated group at day 23 no statistically significant decrease was observed. However, a dramatic 89% and statistically significant decrease (p = 0.001; α = 0.05) was observed for tumours treated with combination of SOG-01 and radiation. Additionally, Kaplan Meier analysis demonstrated enhanced survival to 65 days when compared with 38 day survival for the group treated with radiation alone.

Conclusions

The data suggest that SOG-01 may play a role in enhancing radiotherapy-based approaches for the treatment of pancreatic cancer.
SP1.2 - Laparoscopic versus Robotic ventral hernia repair: a systematic review and meta-analysis comparing the perioperative outcomes randomised controlled trials
Authors: Singh Anurag , Toh Wei , Elzahed Nada , Khera Goldie , Baig Mirza , Sajid Muhammad
Published: September 2024

Objective

The objective of this meta-analysis is to compare the perioperative surgical outcomes and cost-effectiveness of robotic incisional/ventral hernia repair (RIVHR) versus laparoscopic incisional/ventral hernia repair (LIVHR).

Methods

Randomised control trials (RCTs) reporting perioperative outcomes and costs in patients undergoing RIVHR versus LIVHR were selected from medical electronic databases and meta-analysis was conducted under the guidelines of the Cochrane Collaboration using statistical software RevMan version 5.

Results

Four RCTs on 337 patients reporting perioperative outcomes and cost comparison were included. In the random effect model analysis, the duration of operation [standardized mean difference (SMD) -48.07, 95%, CI (-78.06, -18.07), z = 3.14, p = 0.002] was shorter and cost was lower [SMD 0.82, 95%, CI (-1.48, -0.16), z = 2.45, p = 0.01] in the LIVHR group but with significant statistical heterogeneity. However, the variables of hernia recurrence [risk ratio (RR) 2.29, 95%, CI (0.73, 7.12), z = 1.43, p = 0.15] and surgical site complications [RR 0.85, 95%, CI (0.48, 1.50), z = 0.55, p = 0.58] were statistically similar in both groups without any statistical heterogeneity among the included studies.

Conclusion

The RIVHR does not offer any superiority over LIVHR in all perioperative variables and it is not cost effective. Due to the paucity of the RCTs, a major multi-centre RCT is needed to validate these findings.
SP1.6 - To facilitate the consent process efficiency for high volume low complexity cases as part of GIRFT
Authors: Drmota Jan , Hossain Mohammad , Chowdhury Ashim
Published: September 2024

Background

Our department completes a high volume of low complexity surgical cases (appendicectomies, cholecystectomies, inguinal hernia repairs and para-umbilical hernia repairs). Each case must have a completed consent form facilitating autonomous patient informed decision-making. The list of potential risks is key, currently handwritten and not standardised. Get It Right First Time (GIRFT) highlighted the importance of clear risks documentation. (1) The aim of this study is to analyse and evaluate the risks listed in consent forms for these surgeries and their adherence to GIRFT.

Method

First, thirty-three department members were surveyed for a complete list of risks for each surgery. After seven suggestions a consensus was reached. Second, we prospectively collected data from 05/07/2023 to 12/10/2023, identifying patients undergoing appendicectomies, cholecystectomies, inguinal hernia repairs, para-umbilical hernia repairs and collected risks listed in consent forms, comparing them to the agreed list.

Result

We identified 24 appendicectomies, 14 cholecystectomies, 14 inguinal hernia repairs, 9 para-umbilical hernia repairs. The mean completeness of the list of risks was: appendicectomies 42% (min: 16%, max: 56%); cholecystectomies 37% (min: 24%, max: 50%); inguinal hernia repairs 45% (min: 28%, max: 56%); para-umbilical hernia repairs 44% (min: 24%, max: 62%).

Conclusion

Completeness and standardisation of risks in consent forms is vital as highlighted by GIRFT. Current practices limit surgeons in achieving this.
SP1.12 - Who should manage recurrent foreign body ingestion? A questionnaire survey
Authors: Krishna Anugraha , Duff Sarah
Published: September 2024

Aims

Recurrent foreign body ingestion (RFBI) associated with complex mental health illness is a common presentation to the emergency department. The aim of this study was to explore senior clinician’s experience and views on decision-making, support offered and management of patients with RFBI.

Methods

An anonymous survey, with questions on confidence in decision-making, support levels, and opinions on admitting specialty, was distributed to consultants and registrars in emergency medicine, gastroenterology, general surgery, and psychiatry.

Results

189 responses with 166 complete surveys. 99% had encountered similar patients. 42% felt comfortable with decision-making. However, 35% felt stressed and 15% would delay or even avoid decision-making.

Only 36% felt they received adequate support from legal and higher management teams and 84% were not aware of a management protocol.

60% were not confident in their knowledge of sectioning. 60% did not know when it is appropriate to call the police and 56% believe there is inadequate security staff support.

74% found difficulty referring to other specialties. 49% believe patients should be admitted under psychiatry, 29% believe admission should be under gastroenterology, and 22% believe they should be under surgery.

Conclusion

The majority of clinicians had encountered patients with RFBI but did not feel comfortable making management decisions for them. There is a lack of support, knowledge, and protocols surrounding management. There is difficulty referring between specialties and uncertainty on appropriate admitting specialty.

There is a need for further research and guidance on management of these patients to increase collaborative teamworking and improve patient outcomes.
SP1.13 - An Overview of Laparoscopic Surgical Training Modalities – How Does Augmented Reality Simulation Compare?
Authors: Ludick Courtney , Rawaf David , Street Elliot , Van Flute Jordan , Omurtag Ahmet , Swealem Ahmed , Khalil Miriam
Published: September 2024

Background

Laparoscopic surgery is known to require intensive training to gain the required skills and with the increasing popularity of laparoscopic surgery over open surgery requires novel and efficient ways of training.

AR is a novel introduction to laparoscopic surgical training and can superimpose digital images and physical models with the unique advantage of combining visual realism with true-to-life haptic feedback.

Methods

Compare different types of laparoscopic training modalities and assess how AR compares to the education system, 31 papers were systematically reviewed, and the findings were compiled. Results Both the available products as well as the technology as an educational modality were evaluated.

Results

Studies reported relatively increased speed of learning, improved ability to multitask, procedural accuracy, hand-eye coordination and bimanual operation in a reduced practice time and increased success rate with AR in healthcare education. One of the limitations of AR is that it doesn’t reflect the non-technical skills required in the operation.

Compared with other modalities AR provided faster skill acquisition and was widely preferred, except when compared against a human cadaver model for straight laparoscopic colorectal skills acquisition.

AR tends to have a higher initial purchasing cost but does not require the costly specialist facilities or services that cadaver or animal models do, 150 trusts in the NHS preliminary data is showing an estimated annual saving of £117m.

Conclusion

AR simulation has the potential to become the new gold standard for laparoscopic surgical training, and beyond, pending further development of literature to increase knowledge of the technology and its capabilities, on top of technological evolution to increase clinical realism.
SP1.14 - Advancing Surgical Education: A Pilot Study Evaluating the Impact of Augmented Reality in Post-Graduate Surgical Skill Training
Authors: Aloul Zaina , Colman Samuel , El-Bahnasawi Mohammed , Abdulkader Nayaab , Rawaf David , Khalil Miriam
Published: September 2024

Aim

The landscape of post-graduate surgical education, influenced by the clinical pressures of the COVID-19 pandemic, has prompted a shift towards prioritizing patient safety and embracing simulated technology for skill development and assessment. This study aims to evaluate the influence of (LapAR™) simulation on the acquisition of surgical skills and the overall training experience for junior surgical trainees.

Methods

15 trainees and 2 consultants were recruited across five training sites. Participants used (LapAR™) at home to perform ten appendicectomies, interspersed with LapPass tasks. Objective metrics, including completion time and distance, were quantified, followed by comprehensive interviews.

Results

Junior surgical trainees demonstrated improvements in completion time, distance travelled, smoothness, acceleration, and ambidexterity during repeated laparoscopic appendicectomies. It is of interest that trainees were meeting consultant benchmarks across all modalities. Qualitative analysis emphasized the relevance of Augmented Reality in early surgical training, advocating for its mandatory integration. Participants sought prolonged access to (LapAR™), acknowledging its value for list preparation, skill acquisition, and knowledge enhancement. Home-based training offered flexibility, contrast to the pressures of traditional surgical environments. Despite technical challenges, (LapAR™) delivered realistic educational benefits.

Conclusion

(LapAR™) presents a scalable and transformative approach to enhancing surgical skills while addressing common challenges faced by trainees. This study validates its efficacy through improved skills aligned with objective metrics, positive evaluations of educational content, and unanimous agreement on the realism of the simulation. Augmented Reality bridges the gap between surgical training and practice, offering a scalable solution to elevate the standards of surgical education.
SP2.7 - A Consultant General Surgeon's approach to evaluating malnutrition in emergencies: a qualitative study
Authors: Ashmore Daniel , Baker Daniel , Wilson Tim , Halliday Vanessa , Lee Matthew
Published: September 2024

Background

Patients undergoing an emergency laparotomy are often malnourished. Identifying malnourished patients is a prerequisite to offering targeted nutritional support. This study explores how consultants identify malnourished patients, why they use that approach and the barriers experienced.

Methods

General surgical consultants involved in emergency surgery were invited. We used purposive sampling to ensure a broad representation of consultant experience across different practice settings. Following ethical approval (UREC 050436), semi-structured interviews were conducted online, audio-visually recorded and transcribed verbatim. Interviews were coded and analysed in NVivo. A framework was developed and reviewed by an independent researcher and supervising team. Interviews continued until saturation.

Results

Eighteen interviews were conducted (14 male, consultant experience 6 months-23 years) across three hospital settings (4 district general, 10 teaching, 4 intestinal failure unit). Identifying malnutrition consisted of three themes: ‘surgeon’ (knowledge, experience, planning ahead); ‘patient’ (selection, composition, clinical progress, operative considerations); and ‘institution’ (collaboration, extended surgical team). Three themes also encompass the barriers experienced: ‘surgeon’ (understanding, culture, ownership, time constraints); ‘institution’ (provision, staffing, conflict, hospital setting); and ‘wider context’ (research, external factors). These influenced clinical decision making, which had two themes; ‘to join or not to join’ (risk taking, site of anastomosis) and ‘nutritional support’ (timing, delivery).

Discussion

This study highlights a range of barriers that consultants experience when assessing patients for malnutrition, which affects operative and clinical decision making. It provides a framework upon which issues can be addressed by surgeons and policy makers in order to improve outcomes for malnourished patients.
SP3.1 - Could shorter length of stay and oncological non inferiority justify a radical paradigm shift towards RAS to be the gold standard for all rectal cancer resections
Authors: Qazalbash Zeeshan Ali , Khopekar Faid , Tan Chin , Khan Junaid , Mukherjee Arijit
Published: September 2024

Aim

Robotic-assisted surgery (RAS) has proven to be an effective alternative to open (OP) and laparoscopic-assisted (LAP) rectal cancer resections. We aim to evaluate pathological and peri-operative outcomes of patients in a single centre undergoing rectal cancer resections using all three surgical techniques to evaluate whether RAS should be the gold-standard.

Methods

We retrospectively identified all elective rectal cancer resection cases since 2019 at our centre offering OP, LAP, and RAS services. We audited length-of-stay (LoS), complications, readmission rates, margin clearance status, and lymph node yield.

Results

Since 2019, there were 28 OP, 77 LAP, and 35 RAS resections performed. The median LoS for OP resections was 11 days, for LAP was 8 days (p=0.02) and was lowest for RAS resections (3 days, p=0.005). Readmission rates were highest for OP resections (21.4%) and were identical for LAP and RAS resections (14.2% each). Complications (OP 25%, LAP 34%, RAS 37%; p>0.05) were categorized using Clavien-Dindo (CD) classification with LAP having highest proportions of CD-IV (7.7%) and CD-V (7.7%), whereas RAS and OP resections had no severe complications (CD-IVa/IVb/V).

Conclusion

Our analysis shows significantly superior outcomes for shorter LoS and clear non-inferiority of RAS in all other aspects as compared to conventional approaches. Efforts must be bolstered to introduce RAS for rectal cancer resections in the long run considering the need for increasing training opportunities and improved resources to allow for a stable transition to RAS led services, rather than a radical conversion. Further studies are warranted to substantiate our observation.
SP5.4 - Is Fecal Calprotectin a useful test?
Authors: Tamanna Dr , Brodie Arjuna , Rao Milind
Published: September 2024

Aim

To identify whether there is a correlation between a positive Fecal Calprotectin level(FCP) and a diagnosis of Inflammatory Bowel Disease.

Method

Data was collected retrospectively from a database of all colonoscopies performed at a District General Hospital. Data was collected including patient demographics, FCP result, colonoscopy and histology report from the hospital electronic record system.

Results

A total of 450 patients underwent a colonoscopy for any reason with 250 male and 200 female. The average age was 63.5 years. Patients undergoing surveillance or interventional colonoscopies were excluded.

90 patients were referred for colonoscopy with a change in bowel habit and all these patients had a FCP. Out of these, 42 had a FCP greater than 99 ug/g. Only 4 had IBD confirmed on histology, 3 had non-specific bowel inflammation. Of the other 360 patients who underwent a colonoscopy for other indications, 33 had a FCP sent, with 6 being positive.

Out of a total of 48 patients who had a positive FCP, 25 had a FCP result greater than 250 ug/g. however, only three of these patients had IBD confirmed on histology.

Conclusion

The results show no correlation between a positive FCP and a diagnosis of IBD even using a higher cut off at 250 ug/g. For most cases with altered bowel habits or rectal bleeding, a FCP should not be recommended as it will not change the need for a colonoscopy.
SP5.6 - Sleep Quality and Barriers to Sleep on a Postoperative Surgical Ward
Authors: Gray Carol , Lumsden Emma , Watson Hannah , Payne Christopher
Published: September 2024

Aim

Sleep is an essential part of recovery post-operatively and poor sleep quality has been linked to increased patient pain, increased rates of post-operative complications such as delirium and to longer hospital stays. It is widely accepted that adults need at least seven hours of sleep at night. Surgery can induce a degree of insomnia and thus we sought to identify quality of sleep on a postoperative general surgical ward and to identify common barriers to sleep and reasons patients experience interruptions to sleep.

Methods

Using patient questionnaires, we investigated quality of sleep and explored factors, both intrinsic and extrinsic, which influenced patients both falling asleep and being woken throughout the night.

Results

Average age of participants was 73yrs. Average length of sleep was only 5.4 hours. 89% patients reported having sleep interrupted throughout the night and on average patients were awoken 2.4 times throughout the night. Only 11% reported feeling refreshed in the morning after sleep. Noise and pain were the most common barriers identified to falling asleep affecting 73% of patients. The predominant reasons for being awoken from sleep were noise (94%), interruptions for observations/bloods (67%) and thirst (33%).

Conclusions

This study has identified a high prevalence of poor sleep quality in postoperative surgical patients. Common factors influencing this are noise, pain and interruptions by medical staff. Many of these can be addressed through simple interventions to promote better recovery of patients by recognising and supporting the need for high quality sleep.
SP6.6 - Examining the Immunomodulatory Effects of Fibrosis Induced by Radiation Using Adipose-derived Stem Cells
Authors: Cui Xiangmei , Wai Jasmine , Frommer Marvin , Langridge Benjamine , Butler Peter
Published: September 2024

Background and Introduction

Radiation-induced fibrosis (RIF) is a complication of radiotherapy in the treatment of head and neck cancer. RIF is characterised by the formation of fibrous tissue and is associated with significant morbidity. Autologous fat grafting (AFG) is a promising approach for treating RIF, and adipose-derived stem cells (ADSC) have been identified as key contributors to this therapeutic effect.

Method

The experimental group included subjecting human-derived fibroblasts (iHDF) to radiation, whereas the control group remained radiation-free. Both groups were then treated with ADSC-controlled medium and co-cultured with ADSC. The amounts of important immunomodulators produced by iHDF cells were then collected and evaluated using enzyme-linked immunosorbent assays (ELISA) and real-time reverse transcription-polymerase chain reaction (RT-PCR).

Results

Co-cultured iHDF samples demonstrated a slight reduction in CCL2 concentrations compared to untreated iHDF samples (p = 0.0006). The iHDF co-culture samples exhibit a marginal elevation in CCL3 levels compared to the untreated iHDF samples (p = 0.0247). The co-culture samples of iHDF demonstrate a substantial and measurable elevation in IL-8 levels compared to the untreated iHDF samples (p = 0.027). The expression of Col1A1 is decreased in iHDF samples in comparison to control groups.

Discussion

CCL2 is implicated in the recruitment of ADSCs to specific locations. The elevated production of IL-8 in ADSC samples is associated with the pro-angiogenic characteristics of ADSC secretions, which promote healing in fibrotic tissue.

Conclusion

ADSCs were shown to possess anti-fibrotic properties via stimulating pro-angiogenic factors. However, experimental data indicates a concomitant elevation in pro-inflammatory factors. Further research is needed to explore the in-vivo effects of ADSC.
SP6.9 - Assessing European Pancreas Transplant Practices to Optimize Patient Outcomes
Authors: Sharma Hemant , Masood Omar , Vandellen David , Moinuddin Zia , Forgacs Bence , Tavakoli Afshin , Augustine Titus , Dhanda Raman
Published: September 2024

Purpose

Practise variability exists in pancreas transplantation, but the extent across the EU is unknown. We surveyed pancreas transplant surgeons to assess current practices.

Methods

A 40-question survey was sent to 84 surgeons at 17 centres in 8 EU countries. Validity and reliability were analysed. Variability was evaluated using descriptive statistics and random effects modelling.

Results

The response rate was 92% (78/84). The survey demonstrated good validity and reliability (Cronbach’s alpha 0.82). Substantial variability existed in donor selection criteria such as acceptable BMI (range <10 to 35) and age (<30 to >60 years). Back-bench preparation also varied, including arterial reconstruction (52% continuous vs. 48% interrupted sutures) and duodenal closure (66% always buried staple line, 34% not). Systemic portal venous drainage was most common (70%), but 22% used portal drainage. Post-operative anticoagulation varied from 1 week to 3 months in duration. Random effects modelling found significant variability attributable to individual surgeons, centres, and case factors.

Conclusions

This rigorous survey identified modifiable targets to improve the quality and consistency of pancreas transplantation across the EU. Standardised best practise guidelines should focus on reducing variability in donor selection, back-bench preparation, surgical techniques, and post-operative management.

Volume of Pancreas Transplants Performed Annually per CenterNumber of Transplants PerformedRespondents, n (%)<1036 (46%)11-2016 (21%)21-4013 (17%)41-608 (10%)605 (6%)

Surgical Experience of RespondentsNumber of PancreasTransplants Performed AnnuallyRespondents, n (%)<24 (5%)2-528 (36%)6-817 (22%)8-129 (12%)1520 (26%)
SP6.10 - The Inevitable Way Ahead: “Small Bites” Closure For Extraction Sites In Colorectal Resections
Authors: Mony Damien , Ninkovic-Hall George , Wilson Jeremy , Magee Conor
Published: September 2024

Background

“Small bites" technique is widely recognised for its benefits in reducing incisional hernias after laparotomy. In 2018, our institution introduced a standardised closure technique using 2-0 PDS sutures in a small bites fashion for laparotomies in colorectal surgery, in contrast to the previously favoured 'loop' PDS mass closure. Training on this technique was provided to surgical staff, although its adoption was not mandatory.

This study aimed to review our local rate of incisional hernia at extraction sites following small bites vs mass closure.

Method

Our retrospective study included all adult patients who underwent laparoscopic or robotic colorectal resections involving an extraction site between 2018 and 2022. The closure technique used and incidence of hernia was evaluated; all patients had a minimum of 2 years clinical or radiological follow up.

Results

Of the 403 resections over 5 years, 249 met the inclusion criteria (47% female; median age 69 years, range 31-89). Robotic procedures accounted for 21.7% (n=54), and 54.6% (n=136) were for T3 cancers, with 69.1% (n=172) classified as N0. Most cases, 77.5% (n=193), featured midline extraction sites, while 22.5% were off-midline (i.e. transverse).

Mass closure was employed in 54.6% of cases (n=136), with 19.9% (n=27) developing confirmed extraction site hernias.

Small bites closure was utilised in 45.4% of cases (n=113), with 5.3% (n=6) experiencing confirmed extraction site hernias (p<0.05).

Conclusion

Our data, the first of its kind, highlights a potential significant difference in extraction site hernia rates between mass closure (19.9%) and small bites closure (5.3% (p<0.05)).

Moving forward, if done correctly, small bites closure should be considered the gold standard for extraction sites.
SP6.14 - The Burden of Penetrating Junctional Injuries in a UK Major Trauma Centre: a Retrospective Cohort Study
Authors: Ramaraj Prashanth , Watkins Ben , Super Jonathan , Aylwin Christopher , Hettiaratchy Shehan
Published: September 2024

Background

Junctional injuries occur at the join of ‘anatomically distinct zones’. The emergence of junctional injuries in trauma care has been a consequence of recent battlefield casualties; accounting for 21% of potentially survivable deaths from haemorrhage. Although well described in military literature, there are no civilian studies into junctional injuries. This study aims to examine the epidemiology and resource burden of junctional penetrating injuries.

Methods

Retrospective study of adult and paediatric patients with penetrating injuries to a junctional zone presenting to an urban MTC in one year. Electronic patient records were searched and data on anatomical distribution of injury, imaging and theatre utilisation, inpatient stay, and discharge codes extracted. Discharge codes were referenced with the National Schedule of NHS costs to produce a cost.

Results

In 132 patients 92.4% (n=122) were male with median age 27.5 and in hospital mortality 1.6% (n=2). Saturday and Sunday were most frequent 37.9% (n=50) and 81.8% (n=108) attended after 1700 and before 0800.

37.9% (n=50) of injuries were buttock; 22% (n=29) neck; 18.9% (n=25) multiply-injured; 8.3% (n=11) axilla; 6.8% (n=9) diaphragm; and 6.1% (n=8) groin. Median Injury Severity Score (ISS) 8.

46.2% (n=61) underwent surgery; 50.8% (n=67) were admitted, 7.6% (n=10) to ITU. Median length of ward stay was 3 days. 15.9% (n=21) received blood products. The overall cost was £914,076.

Conclusion

Junctional injuries are a significant resource burden. Buttock wounds were the most common but had the lowest median ISS and cost. Diaphragmatic injuries appear distinct from junctional wounds in terms of ISS and cost, and may be separate to other junctional zones.
SP7.4 - Analyzing Geriatric Trauma Patterns: Prevalence, Injury Types, and Transfer Delays in Riyadh, Saudi Arabia
Authors: Khan Lubna , Aldarsouni Fayez , Alsubaie Norah
Published: September 2024

Aim

To analyze geriatric trauma prevalence, injury pattern, transfer delays to trauma centers, and assess undertriage to non-trauma centers in Riyadh City.

Method

We conducted a retrospective review of 11,140 incident reports from 50 Red crescent Center in Riyadh City from the official data registry of the Red Crescent of Saudi Arabia from January 2021 to March 2023. Cases meeting "red criteria" (SBP < 110 mmHg or HR > SBP) were identified. Using QGIS, we mapped the regional distribution of dispatch and non-trauma centers. Network service zone analysis delineated level 1 and 2 trauma center service areas reachable within 15-, 30-, 45-, and 60-minute intervals. Dispatch centers were grouped to assess mistriaging of red criteria cases. Delays were defined as travel time >60 minutes to a non-trauma center. Data were analyzed using SPSS 26 and R statistics.

Results

Majority of geriatric trauma patients (65.6%, n=7312/11140) were classified under red criteria. Penetrating injuries were the most common (51.2%, n=5704/11140), followed by fall-related injuries (38%, n=4234/11140), and finally motor vehicle accidents (6%, n=669/11140). Among red criteria cases, majority of the patients (65.6%, n=2360/3419) transferred to level 1 and 2 trauma centers were delayed, most commonly seen in the 15-minute area of south and middle Riyadh and the 45-minute service area of northern and southern Riyadh. Nearly of quarter of the red criteria patients (23.54%, n=1721/7312) were transferred to a non-trauma center.

Conclusions

Addressing delays in accessing trauma centers and transfers to non-trauma facilities is imperative, warranting focused intervention. Addressing preventable delays and enhancing the capabilities of Red Crescent centers are vital for improving geriatric trauma care in Riyadh.
SP7.6 - Incidence of hepatic pseudoaneurysm formation following blunt and penetrating abdominal trauma in the paediatric cohort: A 6-year retrospective analysis
Authors: Green James , Patel Neeral , Bunting Chris , Yung Diana , Rati Kuran , Cox Seth
Published: September 2024

Introduction

Hepatic pseudoaneurysm (HPA) is a rare but potentially life-threatening sequelae of liver trauma. Little data exists in the literature in regards HPAs in paediatric patients. We aimed to determine the incidence and risk factors of HPA formation in children with blunt and penetrating liver trauma.

Methods

A retrospective analysis was performed on patients admitted to our institution under the age of 18, found to have liver injury on initial trauma protocoled CT imaging between 2017 & 2022. Patients were identified from The Trauma Audit and Research Network (TARN) database. Data relevant to the study aims was collected.

Results

34 patients were identified. (mean age 12 ± 5.4 years 76.5% male 23.5% female) 67.6% of patients suffered blunt injury (mean ISS 34.3 +/- 20.4 95% CI [25.4-43.1] median AAST 3) and 32.4% patients suffered penetrating liver injury (mean ISS 19.5 +/- 9.61 95% CI [12.6-26.4] median AAST 3) Four patients were excluded from further analysis due to loss of life from the primary injury. 18 patients (60%) underwent repeat CT. Of the 12 patients that did not have a repeat scan, 6 patients (50%) had a repeat USS at 6 weeks. follow up CT identified 4 HPAs (11.7%), of which two were treated with embolization.

Conclusion

HPA formation in paediatric liver trauma presents a significant clinical challenge. While the lack of standardised protocols poses a hurdle, a personalised approach informed by individual patient factors and the use of contrast enhanced ultrasound (CEUS) may optimise HPA detection while minimising radiation exposure.
SP8.13 - Exploring General Surgeons' Experiences of Adverse Events Perceptions of Support: A Scoping Review and Qualitative Study of General Surgical Trainees
Authors: Beling Jacob , Banks Jessica , Moug Susan , Bisset Carly
Published: September 2024

Aims

This study aimed to deepen understanding of the psychosocial impacts of adverse events on general surgical trainees and evaluate the experiences of current support mechanisms.

Methods

The study was conducted in two parts: a scoping review and a qualitative focus group study. The scoping review was conducted in accordance with the PRISMA-ScR guidelines and JBI methodology. These themes were taken forward for extended discussion as part of a focus group study of general surgical trainees (n = 10; split in two discrete groups of five participants). Reflexive thematic analysis using anonymised transcripts and contemporary field notes were used to analyse the data.

Results

The scoping review identified six themes related to the impact of adverse events on surgeons' well-being and professional performance. These were clarified and elaborated on through qualitative analysis of focus group data, developing three key themes with associated subthemes: (1) Support structures and external factors influencing responses to adverse events, (2) impact on clinical practice and professional development and (3) methods of learning from adverse events. Surgical trainees experience significant emotional and professional repercussions in the aftermath of adverse events, often exacerbated by insufficient formal support and a prevalent blame culture within hospital environments.

Conclusions

Substantial deficiencies exist in the support structures available to surgical trainees dealing with adverse events. It is evident that the existing systems fail to adequately address the complex needs of trainees, leading to significant emotional distress and professional insecurity. System changes are necessary for surgical trainees, including the establishment of mentorship and peer support networks.