bluuebunny/crossref_metadata_2025 huggingface dataset:
A study on landscape feature and emotional perception evaluation of waterfront greenway
Authors: Sun Dong , Zhou Fujian , Lin Junjie , Yang Qianrui , Lyu Mei
Published: September 2024

Waterfront greenway is important spatial carriers for urban residents to engage in walking tours and fitness activities. Improving the quality of its walking spaces can have a positive impact on the mental well-being of pedestrians. This enhancement is a crucial aspect of building healthy cities. This study focused on urban waterfront greenway landscapes. Field surveys combined with questionnaire scales were used to assess pedestrians’ emotional perceptions, while concurrently collecting image data of waterfront greenway walking spaces. Semantic segmentation was employed to identify elements, and landscape metrics were calculated using relevant formulas. Correlation analysis was used to investigate the relationship between landscape metric features and emotional perceptions. And established a multiple regression model of pedestrian spatial perception on waterfront greenways to investigate the influence mechanisms of emotional perception and landscape metrics. The study indicates that greenness, proportion of water area, and vegetation diversity positively impact emotional perception of waterfront leisure greenway walking spaces, whereas path width negatively affects emotional perception. Specifically, the magnitude of influence is ranked as follows: greenness (0.491), proportion of water area (0.356), proportion of trails (−0.272), and vegetation diversity (0.130). The design guidelines for urban waterfront greenway spaces were proposed, guided by quantitative studies on landscape elements of waterfront greenway spaces and based on the measurement features of these elements. Moreover, the environmental experience of the waterfront green walking spaces was further enhanced, satisfying the public’s visual perception and psychological needs. The contribution of this study is to lay the foundation for the development of spatial control items for urban waterfront greenway.
Advanced doping method for highly conductive CNT fibers with enhanced thermal stability
Authors: Choi Minseouk , Cho Young Shik , Lee Kyunbae , Jung Yeonsu , Park Kyung Tae , Kim Taehoon
Published: September 2024

Due to the inherent limitations of metals, such as their poor performance at high temperatures caused by thermo-oxidation and expansion, carbon nanotube yarns (CNTFs) have emerged as promising alternatives because of their high electrical conductivity and thermal stability. Doping of CNTFs has been widely studied because it significantly increases electrical conductivity through a simple process. Despite these advantages, doped CNTFs are not suitable for extreme environments, especially high temperatures. This is due to the weak interaction between dopants and CNTFs, along with the low thermal stability of the dopants themselves, leading to dopant decomposition and oxidation at high temperatures. Herein, we present doped CNTFs that are covalently functionalized with a nitrogen compound composed of imide and nitro groups, which are renowned for good thermal stability. The electron-withdrawing effect of this nitrogen compound polarizes the CNTFs to a positive charge, inducing p-type doping effects and enhancing electrical conductivity from 2989 to 4008 S cm−1. The strong covalent bonding between the nitrogen compound and CNTFs, along with the thermal stability of the dopants, ensures that the electrical conductivity of our doped CNTFs is maintained even after annealing at 300 °C for 12 h. Our proposed doped CNTFs offer a guideline for expanding the practical applications of doped CNTFs to a wider range of high-temperature environments.
Enhancing heat transfer performance in forced convective systems using experimental study with crystalline nano cellulose-dispersed H2O/C2H6O2 nanofluids
Authors: Chaparala Vidya , Sastry G Ravi Kiran , Prasanthi P Phani
Published: September 2024

This work examines the heat transfer properties of a forced convection circular tube heat exchange system employing a nanofluid made of crystalline nano cellulose (CNC) diluted in a 60:40 ratio of distilled water (H2O) and ethylene glycol (C2H6O2). The objective is to measure the generated nano-fluid's thermal characteristics and analyze its potential for usage as a cooling agent in thermal systems, with a focus on encouraging the use of this biodegradable green coolant. A single pipe forced convection system was used for the experimental experiments, which were focused on a temperature range of 30 °C to 100 °C and nanoparticle volume concentrations of 0.1% to 0.9%. The investigation looks at the density, heat conductivity, and viscosity of the nanofluid, among other important thermo-physical characteristics. The findings show that the coolant's density exhibits an inverse relationship with temperature, increasing as nanoparticle dispersion occurs. At a concentration of 0.9% and room temperature, the dynamic viscosity was 0.0096 kg m−1.sec. A 0.9% concentration of nanoparticle dispersion resulted in a significant increase in thermal conductivity of 27.8%. The effectiveness of the nanofluid is demonstrated by the measurement of pressure drop and convective heat transfer coefficients across the flow channel. The maximum convective heat transfer coefficient of 262.2 W m−2K−1 was recorded at a discharge rate of 17.5LPM and a concentration of 0.9% of nanoparticles. A temperature of 70 °C was found to yield the best heat transfer coefficient and the least amount of pressure loss when the nanoparticle volume percentage was 0.65%.
Design, analytical and computational analysis, and development of a high-precision CNC spindle for a vertical machining center
Authors: Abdullah Muhammad , Bukhari Syed Masood Arif , Husnain Naveed , Zaman Muhammad Farooq , Tariq Ammar , Siddiqui Farrukh Arsalan , Ahmad Rauf , Nasir Muhammad Dawood
Published: September 2024

This research focuses on design, simulation and development of a high precision Computer Numerically Controlled (CNC) spindle for vertical machining center. High speed spindle is designed and analyzed under the varying load conditions. SolidWorks 2020 is used for designing of CNC spindle (based on ISO BT40 standards) and ANSYS Workbench 2020 is used for analysis. Moreover, analytical calculations for deformation are also done. Three different materials i.e. AISI 4340 steel, Grey cast iron, and Ti6Al4V alloy are chosen for the analysis. Effect of varying load on deformation and stress on CNC spindle is discussed. AISI 4340 steel showed better mechanical characteristics as compared to other materials. Moreover, the results showed that steel gives lesser values of deformation as compared to other materials, when applied under different load conditions. Although Grey cast iron can be economical and weight of the spindle can also be reduced but Grey Cast iron has greater value of deformation when load is applied. On the other hand, Ti6Al4V alloy specimen exhibited less stress as compared to other materials but mechanical properties in terms of modulus of elasticity are not that good as AISI 4340 steel. So, AISI 4340 steel could be a good option for spindle materials that require desired properties such as strong corrosion resistance, tensile strength, yield strength, and propagation. This will boost the accuracy and efficiency of spindle. Based on these results, high-precision CNC spindle was developed.
Modeling of specific fuel consumption for compression ignition engines fueled with polymer-based fuel: a response surface methodology approach
Authors: Modi Maulik A , Patel Tushar M
Published: September 2024

Background. Diesel engines play a crucial role in ensuring human comfort and well-being across residential, commercial, transportation, and emergency response sectors because of their reliability and versatility. However, identifying alternative fuels remains a significant challenge. Objective. This study aims to develop a comprehensive mathematical model using Response Surface Methodology (RSM) to optimize the performance of Compression Ignition (CI) engines utilizing different types of plastic pyrolysis oil. Methods. Through systematic data collection and analysis, this study examines the importance of design parameters, specifically injection pressure, compression ratio, engine load, and type of plastic pyrolysis oil, which are important for specific fuel consumption. A prediction model was developed to identify the complex correlations between these factors and the fuel use. Results. The developed model serves as an effective tool for optimizing the CI engine performance under diverse operational conditions. Experimental validation involved testing diesel engines with conventional diesel fuel and various plastic pyrolysis oils, followed by optimization using RSM to achieve optimal engine performance. The engine load was identified as the most significant parameter affecting the specific fuel consumption, followed by the fuel type, injection pressure, and compression ratio. The high R-squared (99.35%) and adjusted R-squared (98.02%) values indicate that the proposed model effectively fits the experimental data. Conclusion. The RSM-based model effectively optimizes CI engine performance under varied operational conditions. It significantly reduces the time and effort required to optimize engine design variables, thus enhancing engine performance and sustainability.
Directions
Authors: Shoemaker David
Published: September 2024

A widespread assumption in the literature is that the conditions of self-blame will simply be drawn from the proper characterization of other-blame. This chapter undercuts this assumption. It is motivated in two ways. The first involves thinking about athletic self-blame, which doesn’t seem to fit well within any extant account of other-blame. The other is a puzzle: if the emotional paradigms of other-blame and self-blame were analogous, different only in terms of their directions, then every single case of self-blame ought to be hypocritical, insofar as the blamer would be unapologetically guilty of the same thing the blamed was guilty of. But there is no such hypocritical self-blame, so their emotional cores are different. The remainder of the chapter draws from research in the psychology of exercise to explain why self-blame’s emotional core is a different kind of anger from other-blame’s, as well as what this means for the architecture.
Stock Repurchases: Antecedents, Outcome, and Implications
Authors: Rasheed Abdul A. , Gu Jenny , Bell Greg
Published: September 2024

Since the early 1980s in the United States and the early 1990s in Europe and Asia, there has been a notable surge in the volume and frequency of share repurchases by companies. There are many different types of repurchases such as open-market repurchases, repurchase tender offers, privately negotiated repurchases, and accelerated share repurchases. Prior research on share repurchases has identified many different motivations identified in prior literature, such as undervaluation, tax advantages, flexibility, takeover defense, and optimal capital structure. In addition, prior research has identified a number of organizational characteristics that can cause a firm to repurchase their shares such as the compensation structure of the executives, managerial characteristics, and managerial entrenchment. A large number of empirical studies have investigated the factors that motivate repurchases and implications of repurchases for stockholders, creditors, executives, and the economy in general. The results of these studies suggest that any generalizations about the benefits of repurchases may be inappropriate and that both the positive and negative effects may be context specific. Stock buybacks are becoming common in countries other than the United States. Empirical research on repurchases in different countries suggests that the motivations, incentives, and effects of repurchases may vary based on not only firm-specific factors but also country-level institutional conditions. We identify several avenues for future research such as the potential for principal–principal conflicts, the implications of governance characteristics for repurchase decisions, different executions strategies, and application of new methodological tools.
Federal and State Appellate Courts in the United States
Authors: Munir Hayley , Martinek Wendy L.
Published: September 2024

Appellate courts are part of both federal and state judiciaries. They serve to correct lower court errors but, more importantly, serve as key policymakers in their respective jurisdictions. The U.S. Supreme Court is the court of last resort in the federal system, though the U.S. courts of appeals (the primary intermediate appellate court in the federal system) is often the last stop for any federal appeal. Both are staffed by presidential nomination coupled with senatorial confirmation. The states exhibit considerable variation in the staffing, design, and function of their appellate courts. That variation encompasses staffing via appointive, electoral, and hybrid methods, as well organizational structures that may include more than one court of last resort (though the majority of states have only one such court) and may omit an intermediate appellate court (IAC; though the majority of states have at least one such court). Scholars know a great deal about the influences on decision making in the U.S. Supreme Court. They know less but still a considerable amount about how judges on the U.S. courts of appeals and state courts of last resort make decisions. Scholarly understanding of decision making on state IACs is quite limited.
Socialism
Authors: Albertsen Andreas , Tyssedal Jens Jørund
Published: September 2024

Socialism is a large and diverse political tradition, unified by opposition to capitalism. Economically, socialists also typically support common ownership or some form of social, democratic control over the bulk of the means of production. There are various views on whether this requires central planning or is compatible with some form of market economy. Others understand socialism as a set of values, and either way, those who understand socialism in economic terms are often motivated by what they see as the ills of capitalism and the values that can be realized in a socialist society in their pursuit of these economic changes. Socialist values include ending exploitation and alienation and replacing them with human flourishing and self-realization, community, distributive justice, equality, and freedom. Some also see socialism as the way to environmental sustainability, gender equality, and racial justice. The question of socialist strategy—how to achieve socialism—has often been posed as a dichotomy between reform and revolution. This inadequately captures the content of fundamental disagreements among socialists. Instead, the disagreement can be understood as varying views on the use of parliamentary democracy in a capitalist state, the pace of social change, and the nature of the envisioned changes.
Multiliteracies in Professional Education
Authors: Hibbert Kathryn , Ott Mary , Eaton Christopher , Sun Lin
Published: September 2024

Multiliteracies theory is part of a growing and evolving body of research tangled up with multiple, intersecting fields: literacies, technologies, pedagogies, socio-materiality, and semiotics, to name a few. It is a theory that has been taken up largely in the professional practice of teacher education but is rapidly emerging as a useful way to think through the complexities of practice in multiple professions such as medical education, or engineering. As learning has come to be understood and framed in ways that acknowledge the temporal, spatial, material, and embodied layers of understanding, practice-based professions are finding ways to investigate and support knowing in practice.
Seed functional ecology in Brazilian rock outcrop vegetation: an integrative synthesis
Authors: Ordóñez-Parra Carlos A , Medeiros Natália F , Dayrell Roberta L C , Le Stradic Soizig , Negreiros Daniel , Cornelissen Tatiana , Silveira Fernando A O
Published: September 2024

Background and Aims

Rock outcrop vegetation is distributed worldwide and hosts a diverse and unique flora that evolved under harsh environmental conditions. Unfortunately, seed ecology in such ecosystems has received little attention, especially regarding seed traits, germination responses to abiotic factors and the potential role of phylogenetic relatedness in shaping such features. Here, we provide the first quantitative and phylogenetically informed synthesis of the seed functional ecology of Brazilian rock outcrop vegetation, with a particular focus on quartzitic and ironstone campo rupestre.

Methods

Using a database of functional trait data, we calculated the phylogenetic signal for seven seed traits for 371 taxa and tested whether they varied among growth forms, geographic distribution and microhabitats. We also conducted meta-analyses that included 4252 germination records for 102 taxa to assess the effects of light, temperature and fire-related cues on the germination of campo rupestre species and explored how the aforementioned ecological groups and seed traits modulate germination responses.

Key Results

All traits and germination responses showed a moderate to strong phylogenetic signal. Campo rupestre species responded positively to light and had maximum germination between 20 and 25 °C. The effect of temperatures beyond this range was moderated by growth form, species geographic distribution and microhabitat. Seeds exposed to heat shocks above 80 °C lost viability, but smoke accelerated germination. We found a moderating effect of seed mass for responses to light and heat shocks, with larger, dormant seeds tolerating heat better but being less sensitive to light. Species from xeric habitats evolved phenological strategies to synchronize germination during periods of increased soil water availability.

Conclusions

Phylogenetic relatedness plays a major role in shaping the seed ecology of Brazilian rock outcrop vegetation. Nevertheless, seed traits and germination responses varied significantly between growth forms, species geographic distribution and microhabitats, providing support to the regeneration niche hypothesis and the role of functional traits in shaping germination in these ecosystems.
Changes in Volume of Lips in 3-Dimensional Analysis and Projection of Lips in Sonography After Injection of Particle-Type Hyaluronic Acid Filler Utilizing a 9-Point Injection Technique
Authors: Kim Jong Seo
Published: September 2024

Background

Lip augmentation procedure with hyaluronic acid (HA) fillers can make patients younger with more attractive. After the injection on the lips, the result is temporary. Physicians and patients wonder how long the HA filler last on the lips.

Objectives

The main goal of this study is to determine how much volume of HA is reduced after injection on the lips utilizing a “9-point” injection technique.

Methods

In this prospective study, 25 females were injected using HA filler and evaluated using noninvasive 3-dimensional-scanner analysis before, 1 h, 1 week, 1 month, 6 months, and 9 months after injection. The changes in projection of lips were evaluated using sonography. The patients were treated as usual manner in a single clinic. Using 29-gauge needle, 20 mg/mL of HA filler was injected into the lips. Default injection amount was 1 cc. HA filler was injected submucosally using linear thread and fanning technique.

Results

Twenty-three patients were followed up. The mean age was 34.8 years (range, 20-48 years). The volume of lips became 181.34% (±61.14) at 1 h, 91.18% (±10.12) at 1 week, 75.09% (±11.02) at 1 month, 55.36% (±10.48) at 6 months, and 39.21% (±4.54) at 9 months. The projection of upper lip areas increased 25.3% at 1 h, 22.8% at 1 week, 17.7% at 1 month, 14.8% at 6 months, 11.5% at 9 months in sonography. The projection of lower lip areas increased 23.1% at 1 h, 20.7% at 1 week, 15.9% at 1 month, 13.9% at 6 months, and 10.6% at 9 months in sonography.

Conclusions

Lip augmentation with HA showed improved shape during 9 months. The volume of HA decreased at a constant rate after injection, except for the first week. Injected HA was absorbed at a constant rate, and more than half was absorbed after 9 months utilizing a “9-point” injection technique.

Level of Evidence: 4 (Therapeutic)
High-dimensional multivariate analysis of variance via geometric median and bootstrapping
Authors: Cheng Guanghui , Lin Ruitao , Peng Liuhua
Published: September 2024

The geometric median, which is applicable to high-dimensional data, can be viewed as a generalization of the univariate median used in 1-dimensional data. It can be used as a robust estimator for identifying the location of multi-dimensional data and has a wide range of applications in real-world scenarios. This paper explores the problem of high-dimensional multivariate analysis of variance (MANOVA) using the geometric median. A maximum-type statistic that relies on the differences between the geometric medians among various groups is introduced. The distribution of the new test statistic is derived under the null hypothesis using Gaussian approximations, and its consistency under the alternative hypothesis is established. To approximate the distribution of the new statistic in high dimensions, a wild bootstrap algorithm is proposed and theoretically justified. Through simulation studies conducted across a variety of dimensions, sample sizes, and data-generating models, we demonstrate the finite-sample performance of our geometric median-based MANOVA method. Additionally, we implement the proposed approach to analyze a breast cancer gene expression dataset.
Integrating external summary information in the presence of prior probability shift: an application to assessing essential hypertension
Authors: Chen Chixiang , Han Peisong , Chen Shuo , Shardell Michelle , Qin Jing
Published: September 2024

Recent years have witnessed a rise in the popularity of information integration without sharing of raw data. By leveraging and incorporating summary information from external sources, internal studies can achieve enhanced estimation efficiency and prediction accuracy. However, a noteworthy challenge in utilizing summary-level information is accommodating the inherent heterogeneity across diverse data sources. In this study, we delve into the issue of prior probability shift between two cohorts, wherein the difference of two data distributions depends on the outcome. We introduce a novel semi-parametric constrained optimization-based approach to integrate information within this framework, which has not been extensively explored in existing literature. Our proposed method tackles the prior probability shift by introducing the outcome-dependent selection function and effectively addresses the estimation uncertainty associated with summary information from the external source. Our approach facilitates valid inference even in the absence of a known variance-covariance estimate from the external source. Through extensive simulation studies, we observe the superiority of our method over existing ones, showcasing minimal estimation bias and reduced variance for both binary and continuous outcomes. We further demonstrate the utility of our method through its application in investigating risk factors related to essential hypertension, where the reduced estimation variability is observed after integrating summary information from an external data.
SP2.2 - A Retrospective Audit: Evaluating Changes in Negative Appendicectomy Rates from 2019 Before the Establishment of the Emergency General Surgery Service at a Tertiary Centre to 2022
Authors: Solkar Maseera , Nassr Noon , Jones Sian , Hughes Mike , Kowal Mikolaj , Peckham-Cooper Adam
Published: September 2024

Introduction and Aim

Negative surgical exploration for suspected acute appendicitis remains prevalent, with a reported 20% rate in the UK Right Iliac Fossa Pain Treatment (RIFT) study. WSES guidelines endorse structured diagnostic pathways to decrease negative appendicectomy rates. To enhance acute surgery care, a dedicated Emergency General Surgery (EGS) service was established at a tertiary centre in 2020. This retrospective audit compares the negative appendicectomy rates between 2019 and 2022, therefore the main aim is to assess whether the introduction of a consultant-led EGS service influenced overall negative appendectomy rates.

Methodology

Appendicectomy numbers and histology results from 2019 and 2022 were analyzed. Histologically normal appendix cases were deemed negative appendicectomies, excluding unclear, other conditions, or missing reports. A retrospective review was conducted pre- and post-EGS service implementation.

Results

In 2019, 479 appendicectomies were audited, with a mean age of 34; 51% were female, and 20% were negative. Negative cases averaged 28 years, with 67% females. In 2022, 420 cases had a mean age of 40; 45% were female, 55% male, and negative rates reduced to 13%. Negative cases averaged 29 years, with 62% females.

Conclusions

Between 2019 and 2022, age groups were comparable. Negative cases in both years were more likely to be younger females compared to positive and total groups. The EGS service introduction demonstrated a notable decrease in negative appendectomy rates from 20% to 13% within two years, suggesting that consultant-led EGS services effectively reduce negative appendicectomy rates.
SP2.5 - The Impact of Timing on Outcomes in Appendicectomy: A Systematic Review and Network Meta-Analysis
Authors: Calpin Gavin , Hembrecht Sandra , Giblin Katie , Hehir Cian , Dowling Gavin , Hill Arnold
Published: September 2024

Aims

Appendicectomy remains the standard treatment for appendicitis. There is a lack of clarity on the timeframe in which surgery should be performed to avoid unfavourable outcomes. We aimed to perform a systematic review and network meta-analysis to evaluate the impact the (1)time-of-day surgery is performed, (2)time elapsed from symptom onset to hospital presentation (patient time), (3)time elapsed from hospital presentation to surgery (hospital time), and (4)time elapsed from symptom onset to surgery (total time) have on appendicectomy outcomes.

Methods

A systematic review was performed as per PRISMA-NMA guidelines. The time-of-day which surgery was done was divided into day, evening and night. The other groups were divided into <24 hours, 24-48 hours and >48 hours. The rate of complicated appendicitis, operative time, perforation, post-operative complications, surgical site infection (SSI), length of stay (LOS), readmission and mortality rates were analysed.

Results

Sixteen studies were included with a total of 232,678 patients. The time of day at which surgery was performed had no impact on outcomes. The incidence of complicated appendicitis, post-operative complications and LOS were significantly better when the hospital time and total time were <24 hours. Readmission and mortality rates were significantly better when the hospital time was <48 hours. SSI, operative time, and the rate of perforation were comparable in all groups.

Conclusion

Appendicectomy within 24 hours of hospital admission is associated with improved outcomes. The time-of-day which surgery is performed does not impact outcomes. Appendicectomy should be performed promptly upon confirmation of diagnosis to reduce complication rates and improve outcomes.
SP3.9 - Evaluating the effects of prehabilitation on patients undergoing resections for colorectal cancer
Authors: Murage Nora Wangari , Noureldin Khaled , Yasmin Humaira , Javed Ahsan , Ahmed Shakil
Published: September 2024

Background

Surgery is the mainstay of treatment for colorectal cancer (CRC), often associated with delayed recovery. Prehabilitation is a trimodal service aimed at optimising the physical, nutritional, and psychological wellbeing of patients prior to surgery. This study aims to compare the effect of prehabilitation on patient outcomes.

Methods

This is a retrospective study including all patients undergoing elective surgical resections for CRC at a tertiary centre between January-July 2022, categorised in two groups: standard pre-op care (non-prehab) vs those getting prehabilitation (prehab). Primary outcomes were length of stay (LOS) and post-operative complications (Clavien Dindo classification). Secondary goals were to identify proportion of patients received screening for nutrition and diabetic control. p<0.05 was considered statistically significant.

Results

Ninety-five patients were included (54 males, 41 females). 76% (n=71) were referred for prehabilitation. Median time to the first prehabilitation appointment was 7 days (IQR 0-61). LOS was reduced by one day (prehab 8 days, non-prehab 9 days, p=0.186). This equated to cost saving of £41,606 in the prehab group (£586.00 per day). Patients in the prehab group developed fewer post-operative complications (46%, n=33) compared to the non-prehab group (67%, n=16), p=0.042) Based on Clavien-Dindo classification, non-prehab group developed more severe post-operative complications compared to prehab (CD 4-5, 4% vs 0% respectively). Only 41% patients of the whole cohort (n=39) had nutritional bloods taken and 57% (n=54) were screened for diabetes.

Conclusion

Prehabilitation is useful in reducing post-operative complications rates and inpatient expenses. Future studies may improve on optimising nutrition and diabetic control.
SP5.10 - Statin use during neoadjuvant therapy is an independent marker for a favourable Neoadjuvant Rectal (NAR) score in locally advanced rectal cancer when analysing common concomitant medications
Authors: Wrobel Aleksandra , McMahon Ross K , Steele Colin W , Roxburgh Campbell S D
Published: September 2024

Aim

The extent of neoadjuvant therapy (NAT) response is an important prognosticator in locally advanced rectal cancer (LARC). The Neoadjuvant Rectal (NAR) is validated as a pseudo-continuous measurement of response, and a surrogate marker of long-term outcomes. We investigated the impact of common concomitant medications (statins, antiplatelets, metformin) on the extent of response using the NAR score.

Methods

A retrospective review of regional cancer centre LARC patients undergoing NAT was performed between June 2016 - 2021. The NAR score was calculated as previously described by George et al (2015).

Results

253 patients were included. 104(34%), 52(17%), and 19(6%) patients took statins, antiplatelets, and metformin respectively. 90% of those on an antiplatelet are also on a statin. Of those on statins, 45.2% and 14.4% also took antiplatelets or metformin respectively.

There was no significant association with concomitant medication use and disease stage or tumour size. Only metformin use associated with the absence of Extramural vascular invasion (EMVI) (p=0.031) on pre-NAT MRI. Neither antiplatelets nor metformin use associated with the extent of NAT response.

Statin use associated with a favourable NAR score (p=0.008). On multivariate analysis with pre-NAT mrEMVI and nodal status, concomitant statin use independently predicted a favourable NAR score of <16 (OR 2.019, 95%CI 1.11-3.67, p=0.021).

Conclusion

Concomitant statin use at time of neoadjuvant therapy associates with a favourable response. Antiplatelet and metformin use does not appear to influence response. Analysis through a clinical trial of statin use combined with neoadjuvant therapy may give more insight into how it influences response.
SP8.3 - Institutional initial experience and outcomes for the first 100 robotic upper gastrointestinal cases: A single tertiary centre results
Authors: Brooks Benjamin , Harrington Bertram , Elshaer Ahmed , Athanasiou Antonious
Published: September 2024

Background

Robotic surgery is a widespread technique with potential benefits including shorter admissions, fewer complications as well as better surgeon ergonomics and precision. Evidence suggests that robotic surgery has a rapid learning curve, with number of cases linked to operative time. In this study, we report our preliminary results after initiation of upper gastrointestinal robotic assisted surgery.

Methods

This retrospective study included all robotic elective upper gastrointestinal cases, performed by two surgeons using Da Vinci XI from August 2022 to May 2023. Cholecystectomy and anti-reflux surgeries were performed. Demographics, console timing, number of cases per list and post-operative complications (Clavien-Dindo Scale) were analysed.

Results

100 Robotic UGI cases were analysed consisting of 86 cholecystectomies and 14 anti-reflux surgeries. Females represented the majority of cases (68%). Mean age was 53.0 years (18-78) while mean ASA and BMI were 2 and 30.3 kg/m^2 respectively. Cholecystectomies required 43.0 minutes while anti-reflux surgeries required 119.3 minutes on average. The mean length of stay was 0.90 days for cholecystectomies, and 1.46 days for anti-reflux surgery. There were two readmissions post cholecystectomy for pneumonia and liver bed collection. Only one patient developed a Clavien-Dindo grade >3 complication for port site hernia repair post cholecystectomy.

Average console time fell with increasing case number, creating a tangible impact on efficiency as surgeons increased the number of cases per list from three to four.

Conclusion

Our initial experience has shown favorable outcomes of robotic surgery. There was a noticeable rapid learning curve, encountering only one major post-operative complication. This high effectiveness should stimulate the swift introduction of robotic surgery to other hospitals.
SP8.8 - Inspiring Overseas Surgeons for a Life in the NHS: Results from an International Cohort
Authors: Matwala Kabir , Shakir Taner , Mota Laura , Djemil Talya , Lingam Gita , Lovett Bryony
Published: September 2024

Aims

Entry into the NHS can be fraught with difficulty, especially when entering from outside of the UK. Numerous socioeconomic and cultural barriers exist, which can be prohibitory. Currently only extremely limited methods of motivating international medical graduates (IMG) exist. Surgical specialist training recruitment has decreased over the past few years. We instigated an innovative introduction to the NHS with the aim of inspiring overseas doctors to pursue a career within surgery in the NHS.

Methods

An agenda was created targeted at medical students and IMG. Speakers were recruited based upon these including students and doctors who had visited the NHS or are current workers. Collaboration was sought with international students who aided with distribution. Individuals were invited to sign up via an electronic link. The session was delivered with free online video conferencing software. Participants answered a series of 5-point Likert scale questions.

Results

102 registrations were received. Participants attended from Brazil (64.3%), USA (14.3%), India (7.1%) and the UK (7.1%). The event attracted a wide range of seniority from medical students (35.7%) to residents (7.1%). 100% of participants stated they had a better understanding of the NHS and 100% were more likely to attempt to enter the NHS after attending the event.

Conclusions

Chronic staffing shortages are a ubiquitous problem in the NHS. Application rates for surgical posts have been declining. Our innovative method of inspiring surgeons of the future has been shown to be effective in our international cohort.
SP8.12 - Evaluating the pig tissue model for acute proctology simulation at General Surgery ST3 Bootcamp
Authors: Clarke Rory , Kuligowska Anna , Scott Patrick , Biyani Shekar , Cooper Adam Peckham
Published: September 2024

Evaluating the pig tissue model for acute proctology simulation at General Surgery ST3 Bootcamp

Background

Acute proctology is an important skill for any general surgical trainee; however it is a skill which often is overlooked when it comes to training. Most, if not all teaching happens during patient procedures. Simulation in this area is underdeveloped and there is a lack of validated models for simulation. These models are also usually expensive and difficult to obtain. The aim of this study was to assess face validity of a low-cost model for teaching acute proctology during the ST3 general surgical bootcamp.

Methods

We created a model using a pig rectum and perineum. This provided two uses. Firstly, we were able to teach relevant clinical anatomy. Secondly, we were able to simulate EUA, rigid sigmoidoscopy, decompression of volvulus and haemorrhoidal banding. The models allowed for repeated use.

Results

Twenty-five trainees took part in this simulation. Overall, the trainees felt the rectal examination was realistic (76%), the sigmoidoscope moved realistically in the model (72%) as did the proctoscope (88%).

In terms of ability, trainees felt the simulation improved their confidence in EUA (68%), rectal examination (72%) and banding (80%). A total of 80% of trainees thought the model was overall “Good or Excellent”.

Conclusions

Our study demonstrates that this low-cost, high-fidelity simulation model has a high face validity and may be explored for the use for training new general surgical registrars.
SP9.7 - Emergency vs. elective biliary admissions in the elderly on a unit adopting index admission cholecystectomy and bile duct exploration. Patients over 70 years with biliary emergencies have more acute cholecystitis and empyema and need significantly more bile duct explorations
Authors: Omran Asmaa , Al-Shaye Ahmad R A , Hayyawi Israa , Khan Khurram S , Nassar Ahmad H M
Published: September 2024

Aim

To compare operative and postoperative outcomes of benign biliary surgery in elderly patients.

Methods

A prospective database of cholecystectomies and bile duct explorations was analysed, comparing index admission surgery for biliary emergencies (Group I, 559, 63.2%) to elective surgery (Group II, 325, 36.8%) in the over 70.

Results

Group I Group II Females 312 (55.8) 210 (64.6) ASA grade 3 0r 4 236 (42.2) 102 (31.4) Presentations: Acute cholecystitis 132 (23.7) -- Pancreatitis 97 (17.4) -- Jaundice/Cholangitis 323 (57.8) -- Previous episodes Pain 40 (7.2) 7 (2.2) Cholecystitis 33 (5.9) 45 (13.8) Pancreatitis 9 (1.6) 24 (7.4) Jaundice 51 (9.1) 35 (10.8) Ultrasound findings GB Thick wall or contraction 162 (29) 53 (16.3) Bile duct dilatation 247 (44.2) 56 (17.2) Operative GB findings Acute 41 (7.3) 4 (1.2) Empyema 119 (21.3) 12 (3.7) Contracted 89 (15.9) 64 (19.7) Cholecystectomy Difficulty Grade I & II 188 (33.6) 183 (56.3) III 140 (25) 77 (23.7) IV 183 (32.7) 56 (17.2) V 46 (8.2) 9 (2.7) Abnormal IOC 314 (56.2) 122 (37.5) Bile Duct Exploration 308 (55.1) 97 (29.8) Operative time; median/range) 90 min/ 23-345 78.6min/ 21-270 Open conversion 7 (1.25) 2 (0.6) Morbidity 40 (6.7) 30 (10) Readmissions 49 (8.7) 12 (3.7) Reoperations 4 (0.6) 2 (0.6) Hospital stay; median/range 12 days/ 1-100 3 days/ 1-160 Mortality 6 (1.1) 0 Resolved in one episode 350 (62.8) 175 (53.8) * bold > statistically significant.

Conclusions

In spite of increased difficulty and higher incidence of bile duct exploration more emergencies than electives resolve in one episode. Other outcomes compare favourably with elective surgery. Index admission surgery is justified in the elderly.
SP9.11 - Characteristics and predictive factors associated with on table mortality in emergency laparotomy: insights from the National Emergency Laparotomy Audit
Authors: Javanmard-Emamghissi Hannah , Doleman Brett , Lund Jon , Pearce Lyndsay , Moug Susan , Tierney Gillian
Published: September 2024

Aims

Mortality during emergency laparotomy is a rare but significant event that can have a profound impact on patient’s families and the healthcare team. The aims of this study were to define the frequency of this occurrence within the National Emergency Laparotomy Audit (NELA) database and to investigate predictive factors.

Methods

All patients entered into the database between 2013-2020 were included. Multilevel logistic regression was used, with clinically important factors identified a a priori, to identify variables associated with intra-operative mortality.

Results

The overall incidence of intra-operative mortality was 1 in 400 cases (450/180,985). There was no difference in mortality rate between day-time and night-time operations. These patients presented critically unwell with signs of shock (50%, 225/450) and an ASA grade of ≥4 (76%, 343/450). Their baseline function status was good with a high proportion residing in their own home (97%, 437/450) and minimal signs of frailty. Acute mesenteric ischaemia was the indication for laparotomy for 46% of patients (207/450) and was associated with a threefold increase in the risk of intra-operative death (OR 2.97 (95% CI 2.35-3.75)). Other important predictive factors were hypotension at presentation (OR 1.56 (95% CI 1.22-1.99)) and a blood lactate of 4-6 (OR 3.89 (95% CI 2.62-5.76)).

Conclusions

Intra-operative mortality during emergency laparotomy is rare but remains a significantly higher occurrence than in other emergency surgical specialities. The strong association with acute mesenteric ischaemia necessitates optimisation of UK emergency department assessment pathways and more nuanced discussions about the risks of surgery in such high-risk patients.
SP9.14 - Gastro-oesophageal reflux disease outcomes in patients with obesity following gastric bypass surgery: a systematic review and meta-analysis
Authors: Ali Iihan , Namgoong Christopher , Das Bibek , Fehervari Matyas , Fadel Michael G , Sargsyan Narek
Published: September 2024

Introduction

Obesity is associated with increased incidence of gastro-oesophageal reflux disease (GORD). Gastric bypass is one of the most common bariatric procedures and has favourable weight loss outcomes leading to a decrease in morbidity and mortality. However, the exact impact of gastric bypass on GORD symptoms remains less well understood. This systematic review and meta-analysis aimed to investigate the relationship between gastric bypass surgery and GORD.

Methods

A literature search of MEDLINE, Embase, Emcare and CINAHL was performed for studies that reported on GORD outcomes following gastric bypass from January 2000 to June 2023. Meta-analysis was performed using random-effect models and between-study heterogeneity was assessed. The study was registered in the PROSPERO database (CRD42023495567).

Results

16 studies with 28,438 patients (follow-up ranging from 6-100 months), with laparoscopic Roux-en-Y gastric bypass being the most common procedure performed (25,567; 90%). The mean operative time for gastric bypass was 101 ± 14.0 minutes, with a re-operation rate of 0.025% ± 0.005. Sixty percent of patients permanently stopped proton-pump inhibitors following surgery. Overall, gastric bypass surgery led to a significant improvement in GORD symptoms (OR 5.31%; 95% CI: 1.77-15.91; p<0.003), with a postoperative mortality rate of 0.037% ± 0.009.

Conclusions

The findings of this systematic review and meta-analysis showed that gastric bypass surgery is an effective and safe treatment for GORD. This has significant implications for counselling patients with obesity and GORD for bariatric surgery. Further research is required to understand the precise mechanism of the improvement in GORD symptoms following bariatric surgery.
WP1.15 - Advances in remote electronic monitoring of patient-reported outcomes following discharge after surgery: a systematic review
Authors: Anderton Nathan , Richards Hollie , Shah Maximilian , Blazeby Jane , Avery Kerry
Published: September 2024

Aims

Standardising post-discharge care is critical to improving surgical recovery. The COVID-19 pandemic caused major changes to in-person visits and surgical follow-up. An earlier review examined the pre-pandemic capture of electronic patient-reported outcomes (ePRO) post-discharge after surgery. This updated review explores how the pandemic has influenced the use of ePRO systems.

Methods

Databases (Medline/Embase/PsycINFO/CINAHL/Cochrane) were searched from July 2019-August 2023 using terms for ‘patient-reported outcomes’, ‘electronic’, ‘surgery’ and ‘at home’. Primary research studies collecting ePROs in adult surgical patients post-discharge were included. Data extraction/analyses characterised study design, patient characteristics, ePRO system features, the scope within which ePROs are used post-discharge, what PRO data is collected, adherence to ePRO monitoring, impact on primary/secondary outcomes and the patient and clinician experience of using ePRO systems.

Results

12,805 articles were identified, of which 81 were included. Emerging findings indicate an increase in research examining ePRO systems in the post-discharge care of surgical patients, with ∼20 articles/year published post-pandemic, compared to ∼3/year in the 5 years pre-pandemic. Usage of ePROs seems to be most prevalent in orthopaedic and gastrointestinal surgery. Full findings will be available for presentation at the conference.

Conclusions

Interest in using ePROs to support post-discharge care of surgical patients is growing, in response to service provision changes. Important advances in the capabilities of ePRO systems include real-time clinician feedback and integration with hospital electronic records. The findings of this review will highlight important directions for improving the design of ePRO systems and future research examining the effectiveness of ePRO systems at improving post-surgical recovery.
WP3.2 - Craniectomy With Soft Tissue Reconstruction for Locally Advanced Non-Melanoma Skin Cancer of Scalp with Calvarial Invasion: the Nottingham experience
Authors: Wong Zhen Yu , Wickham Neil , Bagirathan Shenbana , Pollock Jonathan
Published: September 2024

Introduction

Locally advanced non-melanoma skin cancer (NMSC) involving the periosteum or calvarium remain clinically challenging for patients unfit for immunotherapy due to medical comorbidities and/or frailty. This case series aims to explore outcomes for patients that underwent craniectomy and soft tissue reconstruction.

Method

Patients underwent craniectomy and soft tissue reconstruction for invasive NMSC with calvarium or periosteal invasion from 2016 to 2022 were included. Data including demographics, operative details, and clinical outcomes were sourced from Nottingham University Hospitals digital health record and the histopathology electronic database.

Result

8 patients (Age: 78.4, 3F 5M) with significant comorbidities and varying degrees of periosteal or bone invasion fulfilled the inclusion criteria. These included four squamous cell carcinoma, two basal cell carcinoma and two pleomorphic dermal sarcomas. Five patients had a history of prior incomplete deep margin excision. The median soft tissue defect, tumour and bone defect size was 51.83cm2, 34.63cm2 and 42.25cm2 respectively. Intraoperative complications included one dural tear. Four patients underwent local flap reconstruction and with split thickness skin grafting, four patients underwent free flap reconstruction. Adjuvant radiotherapy was administered to three. Complications comprised partial graft loss in two and complete graft loss in one. There was partial flap loss in one case. One patient required subsequent parotidectomy due to regional progression before achieving disease control. All patients achieved lasting locoregional disease control (average follow up 29.7 months).

Conclusion

Craniectomy with soft tissue reconstruction is a safe and effective treatment option in advanced NMSC of the scalp in patients unsuitable for immunotherapy due to frailty or medical co-morbidity.