bluuebunny/crossref_metadata_2025 huggingface dataset:
Recent progress in two dimensional Mxenes for photocatalysis: a critical review
Authors: Haneef Tahir , Rasool Kashif , Iqbal Jibran , Nawaz Rab , Raza Ul Mustafa Muhammad , Mahmoud Khaled A , Sarkar Tapati , Shahzad Asif
Published: November 2022

Transition metal carbides and nitrides, generally known as MXenes have emerged as an alternative to improve photocatalytic performance in renewable energy and environmental remediation applications because of their high surface area, tunable chemistry, and easily adjustable elemental compositions. MXenes have many interlayer groups, surface group operations, and a flexible layer spacing that makes them ideal catalysts. Over 30 different members of the MXenes family have been explored and successfully utilized as catalysts. Particularly, MXenes have achieved success as a photocatalyst for carbon dioxide reduction, nitrogen fixation, hydrogen evolution, and photochemical degradation. The structure of MXenes and the presence of hydrophilic functional groups on the surface results in excellent photocatalytic hydrogen evolution. In addition, MXenes’ surface defects provide abundant CO2 adsorption sites. Moreover, their highly efficient catalytic oxidation activity is a result of their excellent two-dimensional nanomaterial structure and high-speed electron transport channels. This article comprehensively discusses the structure, synthesis techniques, photocatalytic applications (i.e. H2 evolution, N2 fixation, CO2 reduction, and degradation of pollutants), and recyclability of MXenes. This review also critically evaluates the MXene-based heterostructure and composites photocatalyst synthesis process and their performance for organic pollutant degradation. Finally, a prospect for further research is presented in environmental and energy sciences.
Correlating electronic properties with M-site composition in solid solution Ti
y
Nb2-

y
CT
x
MXenes
Authors: Yang Yizhou , Han Meikang , Shuck Christopher E , Sah Raj K , Paudel Jay R , Gray Alexander X , Gogotsi Yury , May Steven J
Published: November 2022

High electrical conductivity is desired in MXene films for applications such as electromagnetic interference shielding, antennas, and electrodes for electrochemical energy storage and conversion applications. Due to the acid etching-based synthesis method, it is challenging to deconvolute the relative importance that factors such as chemical composition and flake size contribute to resistivity. To understand the intrinsic and extrinsic contributions to the macroscopic electronic transport properties, a systematic study controlling compositional and structural parameters was conducted with eight solid solutions in the Ti
y
Nb2−y
CT
x
system. In particular, we investigated the different roles played by metal (M)-site composition, flake size, and d-spacing on macroscopic transport. Hard x-ray photoemission spectroscopy and spectroscopic ellipsometry revealed changes to electronic structure induced by the M-site alloying. Consistent with the spectroscopic results, the low- and room-temperature conductivities and effective carrier mobility are correlated with the Ti content, while the impact of flake size and d-spacing is most prominent in low-temperature transport. The results provide guidance for designing and engineering MXenes with a wide range of conductivities.
Improved electrical parameter of graphene in Si/SiO2/Al2O3/graphene heterostructure for THz modulation
Authors: Chouksey Abhilasha , Lal Mohan , Kumar Shivnath , Kumar Prashant , Laishram Radhapiyari , Singh Anupama , Rawat J S , Khare Neeraj
Published: November 2022

We proposed the extraction of necessary electrical parameters of graphene (Gr) on Si/SiO2/Gr and Si/SiO2/Al2O3/Gr heterostructure THz modulators using the THz measurement technique. The obtained average THz absorption is 24.5% more on Si/SiO2/Al2O3/Gr as compared to the Gr on Si/SiO2. The calculated value of the carrier mobility of graphene on Si/SiO2/Al2O3 is 2.33 times more than that on Si/SiO2. The presence of Al2O3 may play a role of a barrier for diffusion of trap and impurity charges from Si/SiO2 to graphene which may lead to higher mobility and higher THz absorption. THz modulation measurements by optical pumping were also performed. Maximum modulation depth was 18.54% on Si/SiO2/Al2O3/Gr modulator at 2W pumping power which is 16.54% higher as compared to Gr on Si/SiO2. This shows that graphene on Si/SiO2/Al2O3 heterostructure exhibits great potential for the development of an efficient electro-optical THz modulator as compared to Si/SiO2/Gr modulator.
A feasible strategy of fabricating camptothecin (SN38)-loaded holmium ferrite nanocarrier delivery for glioma treatment
Authors: Zeng Yu , Chen Huihui , Yang Fan , Li Huiyong , Yang Pengxiang
Published: November 2022

Malignant gliomas are the most prevalent and deadly primary brain tumors. The life expectancy of people with gliomas only slightly increases through surgical procedures, radiation, and chemotherapy. Magnetic nanocarriers must be developed to enable drug delivery using a magnetic field. A utilized to fabricate holmium ferrite nanoparticles is described herein. β-Cyclodextrin-polyethylene glycol (PEG) conjugate is used as a coat for the holmium ferrite nanoparticles. X-ray diffraction, energy dispersive x-ray spectroscopy, and x-ray photoelectron spectroscopy are all used to study the nanoparticles. This size range of nanoparticles is optimal for efficient drug delivery. The in vitro cytotoxicity of the fabricated nanoparticles was examined using U87MG and LN229 glioma cancer cells. The acridine orange/ethidium bromide and nuclear staining methods examined the morphological changes in the U87MG and LN229 glioma cells. The mode of cell death mechanism was investigated by Annexin V-FITC/PI flow cytometry methods. The possibility for successful SN38 delivery for the treatment of glioma cancer exists with the SN38@HF-β-CD-PEG.
Microstructure evolution and strengthening mechanism of A356 composites reinforced with micron and nano SiCp
Authors: Song Yahu , Wang Aiqin , Ma Douqin , Xie Jingpei , Wang Wenyan
Published: November 2022

The single scale SiCp reinforcement has a limited effect on the comprehensive performance of the composite, which restricts the optimization and improvement of its comprehensive performance. In order to improve the material’s strong plasticity, wear resistance, thermal expansion and other properties of the comprehensive requirements. The (micron and nano) dual-scale SiCp/A356 composites with different volume fractions were prepared using the combination of powder metallurgy and hot extrusion. The effects of different volume fractions of dual-scale SiCp (15, 20, 25, 30 vol.%) on the microstructure and mechanical properties of A356 composites were studied, and the strengthening mechanism of dual-scale SiCp/A356 composites was analyzed. The results show that with the increasing of dual-scale SiCp content, the distribution uniformity and mechanical properties of SiCp first increase and then decrease. When the content of dual-scale SiCp is 25%, the mechanical properties reach their maximum values, with the hardness, yield strength and tensile strength of 112.3 HBW, 228 MPa and 310 MPa, respectively. They are improved by 86.9%, 81.0%, 74.2% as compared with those of A356 alloy, respectively. The fracture modes of dual-scale SiCp/A356 composites are mainly Al matrix tearing and SiCp fracture. The main strengthening mechanism is Orowan strengthening, along with thermal mismatch strengthening, load transfer strengthening and fine grain strengthening.
Direct graphene synthesis on LiNbO3 substrate by C implantation on Cu covering layer
Authors: Xu Yuhang , Lu Fei , Liu Yifan , Ma Changdong
Published: November 2022

We directly synthesized multi-layer graphene with an area of several hundred square microns on the lithium niobate (LN, LiNbO3) substrate by Carbon (C) implantation into the copper (Cu)-covered LiNbO3. The energy of C ion implantation was optimized per SRIM simulation to ensure that the distribution of C covers the Cu/LiNbO3 interface. The optimized energy was established at 55 keV, such that the formation of C peaks in the respective materials on each side of the Cu/LiNbO3 interface. The diffusion of the accumulated C to the Cu/LiNbO3 interface can form a more uniform C distribution at the interface, which is beneficial to the synthesis of graphene. Following the annealing process and removal of the Cu coating, a multi-layer graphene with an area of several hundred square microns on the surface of LiNbO3 was identified and characterized using Scanning Electron Microscopy (SEM), Energy-Dispersive x-ray Spectroscopy (EDS), Raman spectroscopy, and Atomic Force Microscopy (AFM). This remarkable advancement encourages the industrialization of direct graphene synthesis on LiNbO3 substrates via ion implantation.
Segmenting 3D geometry of left coronary artery from coronary CT angiography using deep learning for hemodynamic evaluation
Authors: Sadid Sadman R , Kabir Mohammed S , Mahmud Samreen T , Islam Md Saiful , Islam A H M Waliul , Arafat M Tarik
Published: November 2022

While coronary CT angiography (CCTA) is crucial for detecting several coronary artery diseases, it fails to provide essential hemodynamic parameters for early detection and treatment. These parameters can be easily obtained by performing computational fluid dynamic (CFD) analysis on the 3D artery geometry generated by CCTA image segmentation. As the coronary artery is small in size, manually segmenting the left coronary artery from CCTA scans is a laborious, time-intensive, error-prone, and complicated task which also requires a high level of expertise. Academics recently proposed various automated segmentation techniques for combatting these issues. To further aid in this process, we present CoronarySegNet, a deep learning-based framework, for autonomous and accurate segmentation as well as generation of 3D geometry of the left coronary artery. The design is based on the original U-net topology and includes channel-aware attention blocks as well as deep residual blocks with spatial dropout that contribute to feature map independence by eliminating 2D feature maps rather than individual components. We trained, tested, and statistically evaluated our model using CCTA images acquired from various medical centers across Bangladesh and the Rotterdam Coronary Artery Algorithm Evaluation challenge dataset to improve generality. In empirical assessment, CoronarySegNet outperforms several other cutting-edge segmentation algorithms, attaining dice similarity coefficient of 0.78 on an average while being highly significant (p < 0.05). Additionally, both the 3D geometries generated by machine learning and semi-automatic method were statistically similar. Moreover, hemodynamic evaluation performed on these 3D geometries showed comparable results.
Metal single atom doped 2D materials for photocatalysis: current status and future perspectives
Authors: Wahid Fazli , Ali Sajjad , Ismail Pir Muhammad , Raziq Fazal , Ali Sharafat , Yi Jiabao , Qiao Liang
Published: November 2022

With the increase of energy crisis and greenhouse effect, the development of new photocatalytic systems with efficient solar-driven fuels/chemicals production is of great practical and scientific importance. In this scenario, single atom photocatalytic (SAP) systems are considered a significant breakthrough in the development of heterogeneous photocatalysis due to their superior catalytic efficiency, large surface area, and high atomic utilization. SAPs are consisting of isolated single atoms (SAs) distributed on/or coordinated with surface atoms of a suitable support. The anchoring of SAs on 2D substrates endows the developed SAPs with excellent properties, including high loading, uniform coordination, high light harvesting capability, and enhanced photocatalytic activities. Recently, many 2D substrates, including carbon materials, MXenes, and transition metal chalcogenides, have been used to anchor metal SAs for different photocatalytic applications. This review systematically discusses SAPs and the confining of metal SAs on 2D supports. Moreover, this review highlights the recent advances of SAPs for energy conversion, the existing challenges, and future perspectives. We expect that this review will offer some ideas for the future discovery of novel photocatalytic systems.
Investigating the low-velocity impact behaviour of sandwich composite structures with 3D-printed hexagonal honeycomb core—a review
Authors: Nur Ainin F , Azaman M D , Abdul Majid M S , Ridzuan M J M
Published: November 2022

This study aims to comprehensively review previous and present research on the dynamic responses of 3D-printed sandwich composite structures. The low-velocity impact and failure mechanisms caused by the impact load and energy absorption capabilities are discussed. Investigating the processes and mechanics of a material is an essential step in addressing the structural failure problems, which are mostly caused by a fracture. The encouraging impact resistance results have prompted researchers to explore the capabilities of structural integrity to optimize performance, which can be accomplished leveraging the enhanced material and architectural combinations of sandwich composites. The ongoing research into low-velocity behaviour of fabricated sandwich composite structures with 3D-printed hexagonal honeycomb cores and varying core materials is emphasized in this study.
P07 The intraoperative use of augmented and mixed reality technology to improve surgical outcomes: a systematic review
Authors: Bollen E , Awad L , Langridge B , Butler PEM
Published: November 2022

Introduction

Augmented reality and mixed reality technology give the user an altered perception of their surroundings. The intraoperative use of this technology is a novel and rapidly developing area of research. While they show the potential to advance surgical practice, the evidence supporting their proposed benefits is unclear. This systematic review aims to critically appraise the intraoperative use of augmented and mixed reality technology to improve surgical outcomes.

Methods

This study followed PRISMA guidelines and is registered with PROSPERO (registration number CRD42020205892). A search of PubMed and Scopus, Cochrane Central Register of Controlled Trials, ClinicalTrials.gov and WHO ICTRP was performed. All studies were included which reported empirical data on surgical outcomes with the use of augmented or mixed reality technology intraoperatively. Risk of bias was assessed in accordance with Cochrane Handbook for Systematic Reviews of Interventions.

Results

The literature search identified 6826 articles initially. This number was ultimately reduced to 92 studies on 2462 patients, comprising 76 studies on augmented reality, 15 on mixed reality and one on both. This technology has been used intraoperatively in a broad range of contexts with varying effects. While the current evidence is generally of low quality, it suggests that, when applied correctly, this technology can significantly improve surgical outcomes.

Conclusion

Augmented and mixed reality can improve intraoperative navigational speed and accuracy, thereby improving surgical outcomes. However, they have technical limitations which are the subject of ongoing investigation. Further research is necessary to elucidate how this technology can be best applied intraoperatively.

Take-home message

Research across surgery shows that AR and MR can improve operative speed and accuracy by importing images into the operative field, with good effect on surgical outcomes. However, current evidence and technology are not without their limitations, which necessitates further research.
P09 The golden patient initiative: a systematic review
Authors: Khan S , Elbayouk A , Azam B , Qureshi MK , Ali AM , Hadi S , Halim UA
Published: November 2022

Introduction

Operating theatres and surgical resource consumption comprise a significant proportion of all healthcare costs. Inefficiencies in theatre lists remain an important focus for cost management. During COVID-19 pandemic, the number of patients on theatre waiting lists has surged. Hence there is a pressing need to utilise already limited theatre time and fraught resources with innovative methods. In this systematic review we consider the Golden Patient Initiative (GPI), in which the first patient on the operating list is pre-assessed the day prior to surgery, and we aimed to assess its overall efficacy.

Methods

A literature search using four databases: MEDLINE, CINAHL, EMBASE, and the Cochrane library identified all clinical research concerning the GPI. Two independent authors screened articles against eligibility criteria, using a process adapted from PRISMA guidelines. Data extracted included outcomes measured, follow-up period and study design. The result displayed significant heterogeneity; therefore a narrative review was conducted.

Results

13 of 73 eligible articles were included for analysis. Outcomes included delay in theatre start time, number of surgical case cancellations and changes to total case numbers. Across the studies, a 19–30 minute improvement of theatre start time was reported (P<0.05), as was a statistically significant decrease in case cancellations.

Conclusion

Our analysis gives encouraging conclusions for theatre efficiency with the GPI, a low cost solution which can easily be implemented to help improve patient safety lead to cost savings. However, at present it is largely implemented amongst local trusts, hence larger multicentre studies are required to provide conclusive evidence.

Take-home message

Our analysis gives encouraging conclusions for greater theatre efficiency with the GPI, a low cost solution which can easily be implemented to help improve patient safety lead to cost savings.
P12 Sustainability: staff knowledge of which items of waste can be recycled in the orthopaedic operating theatre
Authors: Peacock C , Liu P , Gurung B , Fu H , Phoon K , Afzal I , Sochart D , Kader D , Asopa V
Published: November 2022

Introduction

NHS England generates over 20 million tonnes of CO2 per year, representing 4% of the nation's greenhouse gas emissions. One third of all hospital waste comes from operating theatres. Our aim was to investigate the degree of knowledge of sustainable waste segregation amongst theatre staff in an elective orthopaedic centre and identify ways to improve their waste segregation practice.

Methods

Over a one-week period, 20 randomly selected theatre staff of different roles, completed a questionnaire asking them which disposal bin 11 commonly used orthopaedic theatre items should be placed in – general waste or recycling. After initial data collection, posters specifically identifying recyclable items were created and displayed in each operating theatre. Following this intervention, data was re-collected from another 20 randomly selected theatre staff using the same questionnaire.

Results

Results from the initial questionnaire showed general waste and recyclable items were correctly identified by staff in 65% (78/120 responses) and 59% (59/100 responses), respectively. Following the educational intervention, the percentage of correct responses increased to 68.3% (82/120 responses) and 85% (85/100 responses); i.e. staff knowledge of what can go into a recycling bin improved by 36%.

Conclusion

Educating staff by placing posters in the operating theatre can improve knowledge of what orthopaedic theatre items can be recycled and is a simple and effective way of producing sustainable change in surgery. Guiding and empowering individuals to exercise sustainable practice in the operating theatre will help the NHS to overcome the significant challenge of achieving net zero carbon by 2045.

Take-home message

Educating staff by placing posters in the operating theatre is a simple and effective way of improving waste segregation practice and will help the health service to overcome the significant challenge of achieving net zero carbon.
O033 Video tuition of intracavernosal alprostadil injection for management of erectile dysfunction
Authors: Śluzar P , MacAskill F , Gordon P , Briggs K , Sandher A , Hewson S , Barron E , Yap T , Eardley I , Shabbir M
Published: November 2022

Introduction

Intracavernosal injections (ICI) are the second line treatment of erectile dysfunction (ED). To reduce the risk of complications, primarily priapism, the first administration has traditionally required face-to-face appointments. With a move to remote working, the safety and feasibility of an instructional video for the first self-administration of ICI was assessed.

Methods

Two centres recruited patients, with participants receiving a pack comprising a written instruction leaflet and a Viridal Duo prescription, followed by an email with our instructional video. Patients were given a specific time to self-administer their ICI (Alprostadil 2.5 micrograms), when our CNS was available for support. The same CNS would follow up two hours later via telephone to assess the experience using a Likert scale semi-structured interview.

Results

Thirty-nine patients were recruited between two centres, with 35 continuing to injection. The median age was 63 years (range 34–78). The most common ED aetiology was post-prostatectomy (18/35). Thirty-four (97%) recruits found the video instructions clear, with it being watched a mean 2 (range 1–8) times. Only 1 patient (3%) required telephone support. At the 2.5mcg dose, the mean erection hardness score was 2 (range 1–4) after an average of 5 minutes. No patients reported significant bruising at the injection site and there was no priapism. Thirty-three patients (94%) were very or extremely likely to recommend this method for starting ICI therapy.

Conclusion

Our study shows ICI tuition does not require direct supervision, thereby reducing face-to-face contact and will tackle significant waiting lists by increasing productivity.

Take-home message

Our study shows ICI tuition does not require direct supervision, thereby reducing face-to-face contact and will tackle significant waiting lists by increasing productivity.
O073 Triple neuroprotection during emergency carotid endarterectomy for acute stroke after failed TPA or beyond the 24-hour window of opportunity
Authors: Sultan S , Acharya Y , Hynes N
Published: November 2022

Introduction

Clinical dilemma during tissue plasminogen activator (tPA) failure in ischemic stroke management is a daunting challenge. We propose an innovative approach called triple neuro-protection (TNP), which encompasses three technical domains - targeted hypothermia, systemic induced hypertension, and barbiturates infusion.

Methods

From 2002–2019, we performed 832 carotid interventions amongst more than 12,000 patients referred to our tertiary vascular services with carotid artery disease. Amongst them, 25 patients presented between March 2015 and 2019 with acute dense stroke with either failed tPA or passed the recommended timing for acute stroke intervention. Fifteen (60%) had hemineglect with acute infarct on MRI brain and a Rankin score of 4 or 5, and 96% had 80–99% stenosis on the symptomatic side (mean ABCD3-I score 11.35). All patients underwent emergency carotid endarterectomy (CEA) with therapeutically induced hypothermia (32–34°C), targeted hypertension (systolic blood pressure 180–200 mm of Hg), and brain suppression with a barbiturate.

Results

There were no perioperative complications and mortality. There were no myocardial infarction cases, death, cranial nerve injury, wound hematoma, or procedural bleeding. Mean hospital stay was 8.4±5.5 days. All patients had resolution of neurological symptoms, except three (failed thrombolysis previously). Eighty percent had a postoperative Rankin score of 0 on discharge, and 88% of patients were discharged home with three requiring rehabilitation.

Conclusion

We observed positive neurological outcomes without serious adverse events with TNP during emergency CEA in acute brain injury patients. Based on our experience, we recommend a large scale study on TNP.

Take-home message

Triple neuroprotection showed positive neurological outcomes without serious adverse events during emergency carotid endarterectomy in acute brain injury patients.
O078 Why do patients decline to participate in clinical trials? The view of potential participants having varicose vein treatments
Authors: Sharma A , Belramman A , Bootun R , Lane T R A , Davies A H
Published: November 2022

Introduction

Varicose veins are prevalent throughout the UK population, affecting a third of adults. Various treatments exist and must be validated by rigorous testing. Randomised control trials (RCTs) are the accepted gold standard in the hierarchy of evidence, comparing the effectiveness of interventions. Poor recruitment is common among surgical trials and threatens their success. To ensure adequate participation, the underlying barriers to recruitment need to be identified. The objective of this study was to identify the reasons for refusal in four varicose vein RCTs. Secondary aims analysed patient characteristics to assess patient trends.

Methods

A qualitative survey was offered to eligible patients refusing recruitment, recording their reasons. Patients were identified and given an information leaflet before confirming a decision. Patient characteristics, demographics and themes were assessed using qualitative and statistical analysis. Ethical approval was not required.

Results

Overall, 115/429 of patients refused RCT participation and all (n=115) completed the survey. Patients mainly expressed refusal due to preferences for different treatments (25%) followed by employment commitments (14%). Follow-up procedures dissuade patients and anxiety was associated with patient characteristics. Females are more concerned about their autonomy (26.4%) whereas males express worry about external obligations (14.6%). Misunderstanding the severity of risks of treatments and varicose veins elevated concerns across both genders.

Conclusion

Unwillingness to participate is determined by individual circumstances, patient bias and altruism. Multiple factors influence decision making such as familial views and personal demographics. Creating a more robust recruitment process relies on encouraging the acceptance of clinical equipoise and targeting patient beliefs through enhanced communication and improving accessibility.

Take-home message

Patients undergoing recruitment into surgical trials are influenced by their ability to understand and recall information, patient preference and individual characteristics which are influenced by demographics such as anxiety and employment. Targeting these identified barriers to participation will improve accessibility into RCTs.
O083 A proof of principle study of cell targeted delivery of sirna guided by innate repair receptor epor/βcr highly expressed by injured tubular epithelial cells in porcine kidneys subjected to extended cold ischaemia times
Authors: Black J , Cox M , Chung W , Lowe M , Barber J , Dennison AR , Bagul A , Yang B
Published: November 2022

Introduction

Small interfering RNA (siRNA) has been used in biological models for disease modification. Whilst challenges remain with targeted cell delivery, caspase-3, an executing enzyme of apoptosis and inflammation, plays a crucial role in acute kidney injury. Using caspase-3 siRNA or erythropoietin derived peptide CHBP, we have demonstrated renoprotection against ischaemia-reperfusion injury in isolated kidney preservation, and further applied the conjugate of both.

Methods

Porcine kidneys (n = 3) subjected to 10 minutes of warm ischemia were retrieved and perfused with 500 mL hyperosmolar citrate. In comparison with the control (Kidney 1) caspase-3 siRNAHBSP (Kidney 2) or CHBP (Kidney 3) conjugate was administered into the kidney and autologous blood and stored for 22 hours in ice. Organs were then preserved by normothermic perfusion (NP) for 3 hours using clinical-grade cardiopulmonary bypass. Functional parameters were recorded, and kidney biopsies were taken at time zero (pre-perfusion) and hourly intervals following NP.

Results

Preliminary findings showed increased arterial flow rate and urine output together with neutralised perfusate pH in the kidneys (2 and 3) receiving both conjugates compared to the control.

Conclusion

Improved physiological outcomes in kidneys subjected to the novel agent treatment suggest protective effects against ischaemia. We hypothesise outcomes should be transferrable to human kidneys, which may facilitate the use of marginal kidneys following prolonged ischaemia, otherwise deemed unsuitable for transplantation. Renal histological and molecular studies of the effect of the agent are underway.

Take-home message

Despite a small sample, this pilot proof of principle study suggests that caspase-3 inhibitors may have a role in limiting the detrimental effects of ischaemia on renal tissues subjected to prolonged cold ischaemic times. It is hoped that this may be beneficial if replicated in the human kidney model at increasing the deceased donor organ pool by enabling use of marginal kidneys subjected to prolonged ischaemic times.
EP-195 The effect of medical and surgical rotations on confidence in managing acute kidney injury
Authors: Rees Chantal Olivia Blanch , George Jayan
Published: November 2022

Aims

Methods

FY1 doctors were surveyed throughout July – August 2021 and December 2021 across two sites. Six questions used Likert scales (1 to 5: not at all confident to very confident) to assess AKI management. Data was initially inputted using Google Docs and analysed in Microsoft Excel.

Results

44 FY1 doctors (27 Surgery, 17 Medicine) completed the initial questionnaire.

19 FY1 doctors (13 Surgery, 6 Medicine) completed the questionnaire post rotation.

Confidence levels were greater for FY1 doctors in surgery than those in medicine at recalling the five most common drugs that cause AKI and understanding the significance of lactate and bicarbonate.

Confidence levels were greater for FY1 doctors in medicine than in surgery at assessing a patient's fluid status.

Confidence levels in identifying causes and management of AKI in both surgical and medical patients were similar for FY1 doctors in either group.

Conclusions

Confidence levels are similar post first rotation management of AKI between medical and surgical specialties. Confidence levels are slightly higher for surgical FY1 doctors overall. Further research is required in this area to improve FY1 doctor education.
EP-235 Improving working conditions of junior surgeons
Authors: Hammett Felix , Saha Arin , Hurley Anna , Fifer Helen , Moran Emily , Patel Bhavika
Published: November 2022

Aims

Significant exception reporting is reflective of difficult working conditions though well-recognised barriers exist to reporting which may reflect the culture within a unit. This study used exception reporting data to understand and improve the working conditions of juniors.

Methods

Junior surgeons were surveyed in December 2019 to evaluate additional hours worked, reasons for this work and whether exception reports were completed; where they were not, doctors were asked why.

After data analysis, rota structures and surgical teams were changed and formal education about exception reporting given at departmental induction. The main changes involved greater opportunities to take leave and enhanced staffing on evenings and weekends.

Surgical juniors were re-surveyed in September 2021.

Results

In December 2019, 49.2 additional hours were worked between 18 juniors. No exception reports were completed with the main reasons being a personal decision to stay late (for training opportunities), lack of understanding on how to report and cultural issues that made juniors unsure about how exception reports would be viewed.

In September 2021, only 30 additional hours were worked between 17 respondents. Again, no exception reports were completed with over 95% of respondents citing a personal decision to stay late. Cultural issues within the department were no longer cited and knowledge of how to exception report was greatly increased.

Conclusions

A positive and open culture, where consultants and surgical leaders engage with juniors about rotas and working conditions can lead to a reduction in additional hours and improve the understanding of exception reporting.
EP-262 Neoadjuvant imatinib for Resectable Gastrointestinal Stromal Tumors. A State-of-the-art
Authors: Peristeri Dimitra , Jaunoo Shameen
Published: November 2022

Aims

Surgical removal remains the cornerstone of primary GIST treatment and complete surgical resection offers prognostic value toward risk of relapse. However, primary tumors, particularly of the stomach, are of advanced size when detected, and multivisceral resection seems to be the treatment of choice. Existing results of recent clinical trials have established the feasibility of neoadjuvant imatinib therapy mainly in unresectable GISTs. Yet, proof of the survival effectiveness of neoadjuvant imatinib therapy in borderline resectable tumors has not been sufficiently demonstrated.

Methods

A review of the literature was performed to identify the current evidence for preoperative treatment of large GISTs with Imatinib regarding R0 resection and oncological outcome.

Results

Data supporting benefit of neoadjuvant imatinib are available from several case reports and small retrospective series, most of which include a mix of patients with borderline resectable and unresectable primary disease. In addition, a single-phase II United States Intergroup trial and an Asian phase II trial of neoadjuvant therapy in large stomach tumors, concluded that Neoadjuvant imatinib therapy is preferred for marginally resectable tumors. Progressive disease after neoadjuvant treatment was a rare event, and partial response was achieved in 40–80% of all patients.

Conclusion

Neoadjuvant therapy with imatinib is safe and recommended for patients with resectable, locally advanced GIST. It may also enable less invasive and organ-sparing surgery, increase the complete resection rate, and avoid the surgical rupture by decreasing the tumor size. Clinical questions still remain about the most appropriate period of pre- and post-operative imatinib administration in the neoadjuvant protocol.
EP-280 Title: The impact of agricultural injuries on a regional Major Trauma Service
Authors: Gribbon Mary Catherine , Magill Eilis , Houston Ruth , Yoong Susan
Published: November 2022

Aims

This study aims to review the impact of agricultural trauma on a Regional Major Trauma service. In this study we identify the patient demographic most likely to be admitted with agricultural injuries, and the most common mechanisms of injury in this patient cohort. Furthermore, we outline the proportion of patients who require surgical intervention, and examine which surgical specialties were involved in the care of these patients. Finally, this study reviews the mortality associated with agricultural injuries in our Regional Major Trauma Centre.

Methods

Using data from the electronic care record and the major trauma database we retrospectively identified patients admitted with agricultural trauma over a two year period from January 2019 to January 2022.

Results

58 patients were admitted to the Major Trauma service over the two year period. 72% required surgical intervention, while 28% were managed conservatively. Of the patients that required surgical intervention, the majority required orthopaedic surgery (68%) followed by thoracic surgery (14%), general surgery (8%) neurosurgery (6%), and interventional radiology (4%). There was a 3.3% mortality rate. Median length of stay was 12 days. The average patient age was 48 years.

Conclusions

Agricultural injuries represent a significant proportion of patients admitted to our major trauma centre. Many of these injuries are potentially avoidable, and ongoing work is required from a public health perspective to minimise the risk of injury and improve safety in this sector.
BJS Prize 4 PANC Study (Pancreatitis: A National Cohort Study)
Authors: Kosti Angeliki
Published: November 2022

Aims

Acute pancreatitis (AP) is a common, yet complex, emergency surgical presentation. Multiple guidelines exist and management can vary significantly. This first UK, multicentre, prospective audit aims to assess variation in management of AP to guide resource planning and optimise treatment.

Method

All patients ≥18 years presenting with AP, as per the Atlanta criteria, from March-April 2021 were included and followed up for 30 days prospectively. Anonymised data was uploaded to a secure electronic database in line with local governance approvals.

Results

113 hospitals contributed data on 2580 patients, with 1287 (49.8%) female and a mean age of 57 years. The aetiology of AP was gallstones in 50.6% (n=1306), alcohol in 17.5% (n=452) and idiopathic in 22.4% (n=579). 34.7% (n=893) received antibiotics within 48 hours of which 4.7% (n=121) had confirmed infection. CT was performed in 54.5% (n=1406), most commonly within 24 hours of admission (41%). MRCP was performed in 39.9% (n=1029); gallstones were diagnosed in 18.3% (48/262) who had not been seen on ultrasound. EUS was performed in 1.1% (n=29). 34.1% (n=441) of patients with gallstone disease underwent cholecystectomy by 30 days.

Conclusion

Management of AP in the UK deviates from national and international guidelines. Recommendations include improving antibiotic stewardship, further investigation to be performed in idiopathic cases of AP, consideration of further biliary imaging when looking for gallstones and improving appropriate timing of CT. Further work will look at guidance for diagnostic pathways and development of protocols for ambulatory management in mild AP.
Moynihan Prize 2 Cholecystectomy in patients with cirrhosis: a population-based cohort study from England
Authors: Adiamah Alfred , Crooks Colin , Hammond John , Jepsen Peter , West Joe , Humes David
Published: November 2022

Introduction

There is an increased risk of cholelithiasis in patients with liver cirrhosis irrespective of the underling aetiology. Cholecystectomy is the recommended definitive treatment for symptomatic gallstones. However, in patients with cirrhosis the postoperative outcomes after cholecystectomy are not fully defined. This population-based cohort study aimed to determine postoperative outcomes after emergency and elective cholecystectomy in patients with cirrhosis.

Methods

Linked electronic healthcare data from England were used to identify all patients undergoing cholecystectomy between January 2000 and December 2017. Length of stay (LOS), 30-day re-admission, case fatality and the odds ratio (OR) of 90-day mortality were calculated for patients with and without cirrhosis, adjusting for age, sex and co-morbidity using logistic regression.

Results

Of the total 69141 eligible patients who underwent a cholecystectomy, 511 (0.74%) had cirrhosis. In patients without cirrhosis 86.55% underwent a laparoscopic procedure compared with 57.53% in patients with cirrhosis (p<0.0001). LOS was longer in those with cirrhosis (3 IQR 1–8days vs 1 IQR 1–3days, p<0.0001). The 30-day re-admission rate was greater in patients with cirrhosis, 36.79% compared with 14.95% in those without cirrhosis. The 90-day case fatality after elective cholecystectomy in patients with and without cirrhosis was 2.79% and 0.43%; and 12.82% and 2.39% following emergency cholecystectomy. This equated to a 3-fold (OR 3.22 (95%-CI 1.72–6.02)) and a 4-fold (OR 4.52 (95%-CI 2.46–8.33)) increased odds of death at 90-days following elective and emergency cholecystectomy after adjusting for confounders.

Conclusion

Patients with cirrhosis undergoing cholecystectomy have an increased 90-day risk of postoperative mortality, which is significantly worse after emergency procedures.
Sustainability Prize 2 Calculating the Carbon Footprint of Surgical Scrubbing
Authors: Cannings Ella , Kenington Cleo , Cox Kofi
Published: November 2022

Aims

This study aims to measure the estimated carbon emissions that could be saved if alcohol-based hand rubs (ABHRs), which have been shown to be as effective at antisepsis as antimicrobial soap and hot water (1), are used to scrub for all operations at a UK teaching hospital over 1 year.

Methods

The number of operations performed during October 2021 was obtained via hospital database.

Across 25 cases, the volume of water per case was estimated by multiplying the time using water by the volume calculated per second flow. This data was used to calculate an estimate of the total volume of hot water used per year and therefore the carbon, cost, and water savings that could be made.

Results

Conclusion

This study shows that 2.2 tonnes of carbon could be saved in a year if a single teaching hospital converted to ABHR. The outcome could contribute to the current Greener NHS trajectories: a Net Zero NHS by 2050.

Reference

1. WHO Guidelines on Hand Hygiene in Health Care: First Global Patient Safety Challenge Clean Care Is Safer Care. Geneva: World Health Organization; 2009. 13, Surgical hand preparation: state-of-the-art.
Sustainability Prize 3 Surgeons’ awareness and opinions on sustainability in surgery: the ECOS-Surgery global survey
Authors:   ESCP ECOS-Surgery Collaborators, Cunha Miguel
Published: November 2022

Aims

Healthcare is one of the largest waste-generating activities contributing to climate change, with surgery the most energy-intense sector. This international survey aimed to evaluate current understanding and perspectives of colorectal surgeons on sustainability, with a specific focus on surgical practice.

Methods

The European Society of Coloproctology (ESCP) designed an online survey - ECOS-Surgery (ESCP Collecting Opinions on Sustainable Surgery). Questions were divided into three sections to capture demographic characteristics of participants, their awareness on global sustainability with its application to surgical practice, and their perspectives on future directions in sustainability.

Results

370 participants from 57 countries answered the survey (median age 39; 75% men; 73% consultant surgeons). Around 60% of them were unaware that the health sector contributed to global greenhouse gas emissions. Delivering sustainable surgery was perceived as a matter of great importance for most (92%), and 97% of participants were willing to change their practice to improve sustainability. However, 78% of them had no local or national guidance on this subject. Lack of understanding by the surgical community was recognised as the primary key barrier in improving sustainable pathways (63%). Research in sustainability was perceived to play a role in improving sustainability in surgery by the majority (97.5%). Promoting healthy lifestyle among patients (38%) and use of low-carbon alternatives in surgery (29%) were the solutions most commonly suggested.

Conclusion

Our survey shows the surgical community's interest in supporting a sustainable surgery pathway, although underlining the lack of contemporary guidance/support to achieve this goal.
NELA Prize The correlation between actual and predicted 30-day mortality for emergency laparotomies in adults, using National Emergency Laparotomy Audit (NELA) risk predicting tool – a multi-center, retrospective, observational, cohort study.
Authors: Moscalu Andrei , Saravanan Balakrishnan , Kamal Aryal , Sinclair Martin
Published: November 2022

Background

Emergency laparotomy (EL) is associated with a high 30-day-mortality (30-dm) risk. More than 22,000 EL are performed annually in the UK, half of patients being ≥70 years. To improve patient outcomes, reliable preoperative risk assessment is of paramount importance. 30-dm can be assessed by a multitude of tools, including the National-Emergency-Laparotomy-Audit risk prediction tool (NELA-RPT). No one tool is perfect in preoperative risk prediction, with over or underprediction requiring special consideration.

Methods

This is a multi-center, retrospective, observational, cohort study investigating the correlation between predicted 30-dm using NELA-RPT and actual 30-dm in patients aged ≥18, following EL, in two UK District General Hospitals, over a 2-year period. The correlation between actual 30-dm and the: day of the week the laparotomy took place, subspecialty of the main surgeon, grade of surgeon or primary-procedure performed were also analyzed. Sample size was calculated at 385. Statistical analysis was done using Stata Version 14.2.

Results

626 cases were analyzed. Male/female ratio was 1.17 and mean age 66.03. 50.65% cases were ≥70 years of age. Actual 30-dm for the entire cohort was 9.74% and 13.96% for the over 70's. Mean NELA-RPT 30-dm was 9.8% and 14.01% for over 70's. There was no statistically significant association between actual or NELA-RPT 30-dm and the day of the week the laparotomy took place, the subspecialty of the main operating surgeon, the grade of the main surgeon or the primary-procedure performed.

Conclusion

NELA-RPT is a tool that can reliably estimate the 30-dm risk following EL.
SP2.1.1 Safety of Bariatric Surgery in The Older Patients During the COVID-19 Pandemic
Authors: Singhal Rishi , Omar Islam , Madhok Brijesh , Rajeev Yashasvi , Graham Yitka , Mahawar Kamal
Published: November 2022

Background

The progressive growth of the older patients with obesity represents a challenge to the weight management teams. Although initially, old age was a relative contraindication to the surgical option, current advances in laparoscopic techniques and perioperative optimization protocols have changed the old notion. However, the performance of bariatric procedures in the older patients during the ongoing COVID-19 pandemic carries a potential risk. This study aimed to assess the safety of bariatric surgery (BS) in older patients during the pandemic.

Methods

We conducted a prospective international study of patients who underwent BS between 1/05/2020 and 31/10/2020. Patients were divided into two groups - older patients ≥65-year-old (Group I) and young < 65-year-old (Group II). Two groups were compared for 30-day morbidity and mortality.

Results

We included 7084 patients, the mean age was 40.35±11.9 years, and 5197 (73.4%) were females. The mean preoperative weight and BMI were 119.49±24.4 Kgs and 43.03±6.9 Kg/m2, respectively.

The overall comorbidities were significantly higher in Group I, p= <0.001. In Group II, 14.8% were current smokers, compared to 7.4% of Group I. The complications in Group I were significantly higher (11.4%) compared to Group II (6.6%), p= 0.022. However, the mortality rate and COVID-19 infection within 30 days were not significantly different between the two groups.

Conclusions

Bariatric surgery during the COVID-19 pandemic in the older patients (≥65 years old) is associated with a higher complication rate than the younger age group. However, the mortality and postoperative COVID-19 infection rates are comparable to the younger age group.