bluuebunny/crossref_metadata_2025_split huggingface dataset:
Mesopredators retain their fear of humans across a development gradient
Authors: Reilly Chloe M , Suraci Justin P , Smith Justine A , Wang Yiwei , Wilmers Christopher C 
Published: December 2021

AbstractAnthropogenic impacts on wildlife behavior arise both from the immediate presence of people, which induces fear responses in many species, and the human footprint (i.e., landscape modification such as residential development), which affects animal movement and habitat use. Where both disturbance types co-occur, disentangling their impacts remains a challenge. Disturbance effects may interact such that species respond to increased human footprint by either reducing (habituation) or increasing (sensitization) avoidance of human presence. We experimentally manipulated perceived human presence, using playbacks of people talking, across a gradient of human footprint in California’s Santa Cruz Mountains and used camera traps to quantify the behavioral responses of bobcats (Lynx rufus), striped skunks (Mephitis mephitis), and Virginia opossums (Didelphis virginiana), mesopredators known to exhibit strong fear response to human presence but which vary in their use of developed areas. Bobcats and skunks reduced activity in response to human playbacks but showed no change in responsiveness to playbacks across the gradient of human footprint, suggesting that these species are similarly fearful of humans at all development levels tested. Opossums exhibited a significant interaction between human footprint and playback treatment such that reductions in activity level in response to human playbacks were strongest at higher levels of building density. Our results indicate that, rather than habituating to human presence, some mesopredators retain a strong fear of humans or become more fearful when inhabiting more developed areas. We suggest that consistently high responsiveness to immediate human presence may benefit mesopredators living in human-dominated landscapes by mitigating the risk of anthropogenic mortality.
Identification of alternative splicing-derived cancer neoantigens for mRNA vaccine development
Authors: Cheng Rui , Xu Zhaochun , Luo Meng , Wang Pingping , Cao Huimin , Jin Xiyun , Zhou Wenyang , Xiao Lixing , Jiang Qinghua 
Published: December 2021

Abstract
Messenger RNA (mRNA) vaccines have shown great potential for anti-tumor therapy due to the advantages in safety, efficacy and industrial production. However, it remains a challenge to identify suitable cancer neoantigens that can be targeted for mRNA vaccines. Abnormal alternative splicing occurs in a variety of tumors, which may result in the translation of abnormal transcripts into tumor-specific proteins. High-throughput technologies make it possible for systematic characterization of alternative splicing as a source of suitable target neoantigens for mRNA vaccine development. Here, we summarized difficulties and challenges for identifying alternative splicing-derived cancer neoantigens from RNA-seq data and proposed a conceptual framework for designing personalized mRNA vaccines based on alternative splicing-derived cancer neoantigens. In addition, several points were presented to spark further discussion toward improving the identification of alternative splicing-derived cancer neoantigens.
On the Dynamic Nature of Omnivory in a Changing World
Authors: Gutgesell Marie K , McCann Kevin S , Gellner Gabriel , Cazelles Kevin , Greyson-Gaito Christopher J , Bieg Carling , Guzzo Matthew M , Warne Connor P K , Ward Charlotte A , O'Connor Reilly F , Scott Alexa M , Graham Brandon C , Champagne Emily J , McMeans Bailey C 
Published: December 2021

AbstractNature's variability plays a major role in maintenance of biodiversity. As global change is altering variability, understanding how key food web structures maintain stability in the face of variation becomes critical. Surprisingly, little research has been undertaken to mechanistically understand how key food web structures are expected to operate in a noisy world and what this means for stability. Omnivory, for example, has been historically well studied but largely from a static perspective. Recent empirical evidence suggests that the strength of omnivory varies in response to changing conditions in ways that may be fundamental to stability. In the present article, we extend existing omnivory theory to predict how omnivory responds to variation and to show that dynamic omnivory responses are indeed a potent stabilizing structure in the face of variation. We end by synthesizing empirical examples within this framework, demonstrating the ubiquity of the theoretical mechanisms proposed across ecosystem types, spatial scales, and taxa.
O-B01 Role of Ursodeoxycholic acid in prevention of gallstones formation in bariatric patients: need to amend recent BOMSS guidelines
Authors: Sharma Amit , Nageswaran Hari , Saad Ahmed , Patel Ameet , Best Lawrence 
Published: December 2021

Abstract

Background
During rapid weight-loss phase following bariatric procedures, biliary cholesterol homeostasis is altered leading to increased propensity to gallstone formation. Incidence of gallstone formation following bariatric procedures is shown to be 10-38%. There is no consensus regarding its prevention and current BOMSS guidelines do not address this issue. This meta-analysis aims to pool high level evidence (RCTs) to assess efficacy of Ursodeoxycholic acid (UDCA) in reducing risk of gallstone formation in this cohort of patients and the need for revision of current guidelines.

Methods
A systematic literature search was performed using electronic databases (Medline, EMBASE, Cochrane Central Register of Controlled Trials (CENTRAL), Web of Science, PROSPERO and Google Scholar) in line with PRISMA guidelines. Only randomised controlled trials were included without restrictions on study language, year, status of publication and patient’s age. Meta-analysis was performed using Review Manager Software to calculate pooled risk ratios (RR) using random-effects model.

Results
Fifteen trials were included (3952 patients analysed, 2487 in UDCA and 1465 in placebo group). The overall rate of gallstone formation was 16.0% (6.4% in UDCA vs 31.4% in placebo group). Trials included various bariatric procedures (SG/RYGB/OAGB/AGB/Gastroplasty). UDCA dose ranged from 300 to 1200mg per day. UDCA significantly reduced the risk of post-operative gallstone formation (3952 patients, RR 0.24, 95% CI 0.16-0.37, p &lt; 0.0001). The absolute risk reduction and number needed to treat (NNT) were 25% and 4 respectively.

Conclusions
Oral Ursodeoxycholic acid treatment following restrictive bariatric surgical procedures significantly reduces the risks of gallstone formation. As such, its regular use in first 6 months (rapid weight-loss phase) can significantly reduce the risk of complications associated with gallstones. Such treatment would be cost effective and benefit 1 in 4 patients. There is significant evidence available on benefits of using UDCA in post-operative bariatric patients and that this should be added to the recent BOMSS guidelines.
O-BN04 Laparoscopic assisted robotic Heller’s cardiomyotomy in achalasia: a 12-year experience
Authors: Siriwardana Priyantha , Lorenzi Bruno , Qamruddin Mohammad , Kadirkamanathan Sritharan 
Published: December 2021

Abstract

Background
Heller’s cardiomyotomy (HC) using a computer-enhanced (robotic) laparoscopic platform allows for a more precise dissection. This is achieved by utilizing the superior optics of a 3D camera and greater degrees of freedom provided by robotic instrumentation. Our aim was to assess short to long term outcomes in terms of mucosal integrity, hospital stay and symptom improvement and quality of life.

Methods
A retrospective review of prospectively collected data was performed of patients who underwent robotic HC between July 2009- May 2021. HC was performed using a Da Vinci robot S and Xi (Intuitive Surgical Inc.) with 4 laparoscopic ports and liver retractor. Anterior mobilization of the oesophagus was performed leaving the posterior component of phreno-oesophageal ligament intact. A longitudinal myotomy was made extending into the proximal stomach. An anti-reflux procedure (ARP) was not routinely performed. Data collected including demography, Eckardt symptom score, Quality of Life (QoL) with SF-36, surgical technical data and surgical outcome (post-op morbidity, mortality, hospital stay).

Results
Fifty-seven patients underwent surgery (28 males). Median age was 46 years (18-71). Two had surgery for recurrent dysphagia following laparoscopic HC elsewhere. Median length of myotomy was 8cm (5-11). No mucosal breaches were identified at surgery, but one had postoperative leak. Median length of hospital stay was 2 days (1-148). One had chest infection and another DVT. Median follow-up was 61 months (2- 86). There was no mortality. Three patients (5%) needed oesophageal dilatation during follow-up. There was a significant improvement in Eckardt score from 10 (9-12) to 2 (0-6), and in all components of QoL (p &lt; 0.05).

Conclusions
Heller’s myotomy can be performed very precisely using a Da Vinci Robot. It minimises the risk of mucosal breach reflecting in the low leak rate. No patient had developed troublesome reflux which may well be due to the preservation of the posterior component of the phreno-oesophageal ligament. It also improves symptoms and quality of life for many years. Robotic HC may become the standard treatment for achalasia in the very near future.
O-EGS06 Trials and Tribulations: Educational Impact and Recommendations from the Implementation of Student-Led Recruitment in a Clinical Trial
Authors: Cambridge William , Riad Aya , Henshall David , McAdam Heather , Glasbey James , Harrison Ewen , McLean Kenneth 
Published: December 2021

Abstract

Background
Medical students have an essential role in medical research, yet often feel unprepared and lack opportunities for involvement as recruiters within research studies. This study aimed to understand the educational effect of involvement in clinical trial recruitment on medical students, and to derive generalisable future recommendations.

Methods
Tracking wound infection with smartphone technology (TWIST) was a randomised controlled trial enrolling adult emergency abdominal surgery patients across two university teaching hospitals. All recruiters underwent pre-recruitment training based on “Generating Student Recruiters for Randomised Trials” (GRANULE) principles, and completed pre-and post-recruitment surveys. Respondent agreement with statements were assessed using 5-point Likert scales (from 1 [“strongly disagree”] to 5 [“strongly agree”]). Quantitative data were analysed using paired t-tests to compare differences pre- and post-involvement, and a thematic analysis approach adopted for anonymised free-text answers.

Results
Of 492 patients recruited to TWIST from 2016 to 2020, 86.0% (n = 423) were recruited by medical students. Following student involvement, the monthly recruitment rate tripled (4.8 to 15.7 patients). Thirty student recruiters (96.8%), completed both surveys, reporting significant improvements in clinical and academic competencies. This included increased confidence in gaining and documenting consent, as well as interest in pursuing a clinical-academic career. Over half (58.2%) felt the undergraduate curriculum had not prepared them for involvement in clinical trials (mean:2.47, SD: 0.94). There were three emergent themes regarding recommendations for involvement of students, based on their engagement, preparation, and support during recruitment.

Conclusions
Student recruitment in clinical trials is feasible and provides a route to developing a research-active medical workforce. It also accelerates recruitment to clinical trials, as well as benefiting students through development of clinical competencies and provision of additional exposure to research. Adequate training, support, and selection of suitable trials are essential for successful student engagement.
O-L04 Peri-operative thrombophilia in patients undergoing liver resection for colorectal metastases
Authors: Walsh Caoimhe , Welsh Fenella , Rathnaweera Wasula , Chandrakumaran Kandiah , Roy Ashok , Needham Jane , Cresswell Ben , McVey John , Rees Myrddin 
Published: December 2021

Abstract

Background
The risk of major haemorrhage during liver surgery has decreased considerably in the modern era. However, there remains reluctance amongst liver surgeons to give routine peri-operative chemical thromboprophylaxis, either because of the perceived risk of bleeding, or transient post-operative abnormalities in conventional coagulation studies. The aim of this study was to ask whether a defined, homogeneous population of patients undergoing liver resection for colorectal metastases (CRM) were at risk from venous thromboembolism (VTE) prior to surgery, and what the impact of liver resection was on that risk.

Methods
A single-centre prospective observational cohort study comparing pre-, peri- and post-operative haemostasis variables in patients undergoing liver resection for CRM. Patients with cirrhosis, history of VTE or anticoagulated were excluded, as were patients undergoing small wedge, or laparoscopic liver resections. Blood samples for coagulation assays were collected pre-operatively, peri-operatively (after transection) and first post-operative day (13–20 hours post-operatively). Pre- and post-operative Tissue Factor messenger ribonucleic acid (TFmRNA) activation was measured from peripheral blood mononuclear cells (PBMCs) using semi-quantitative polymerase chain reaction (PCR). Patients received peri-operative mechanical thromboprophylaxis until mobile, plus chemical thromboprophylaxis on the first post-operative day, after venesection.

Results
Of 336 hepatectomies performed October 2017-December 2019, 60 resections in 57 patients were recruited. This included 46.7% major resections, with median (interquartile range [IQR]) blood loss 150.0mls (76.3-263.7), no blood transfusions, post-operative VTE events or deaths. Patients were prothrombotic pre-operatively (high factor VIIIC and thrombin generation velocity index), an effect exacerbated post-hepatectomy. Major hepatectomies had a significantly greater drop in Protein C, rise in Factor VIIIC and von Willebrand Factor, versus minor resections (p = 0.001,0.005,0.001 respectively). Patients with transection times greater than median (40minutes), had significantly increased median (IQR) PMBC-TFmRNA expression [1.65 (0.93-2.70)2ddCt], versus quicker transections [0.99 (0.69-1.28)2ddCt, p = 0.020].

Conclusions
These data show the risk of major haemorrhage in elective liver resection in a high volume unit is low and administration of chemical thromboprophylaxis within 13-20 hours of surgery is safe and effective. The study demonstrates that patients with CRM are prothrombotic pre-operatively. Furthermore, this thrombophilia is exacerbated by liver resection, and most marked in patients with longer, more complex operations. These data suggest that chemical thromboprophylaxis should be considered earlier in the patient pathway, and has resulted in a change in practice for the authors.
P-B01 First Inventory of Access and Quality of Metabolic Surgery across Europe
Authors: Sinclair Piriyah , Vijgen Guy , Aarts Edo , Van Nieuwenhove Yves , Maleckas Almantas 
Published: December 2021

Abstract

Background
Europe consists of 51 independent countries. Variation in healthcare regulations results in differing challenges faced by patients and professionals. The obesity pandemic has multiple health, economic and social implications. However, metabolic surgery is not universally accessible, with significant variations in its provision. This study aimed to gain insight into compliance with international guidelines; the accessibility and barriers to surgery; patient pathways and qualitor indicators of both metabolic and body contouring surgery after weight loss in different European countries.

Methods
This study was initiated during the European Obesity Academy (EOA). Expert representatives in the metabolic field from all 51 European countries were sent a novel, 37-item, electronic self-administered online questionnaire on their data and experiences from the previous year exploring accessibility to and quality indicators for metabolic surgery and body contouring surgery after weight loss. The survey tool was peer-reviewed by experienced researchers and piloted by fifteen experienced researchers with a spread of seniority and specialty. Content and face validity were ensured by peer-review and the piloting process. 45 completed responses were collected.

Results
68% of countries had eligibility criteria for metabolic surgery; 59% adhered to these. 46% had reimbursement criteria for metabolic surgery. 41% had eligibility criteria for plastic surgery and 31% reimbursement criteria. Average tariffs for a metabolic procedure varied (€800-€ 16000). MDTs were mandated in 78%, with team members varying significantly. Referral practises differed. In 45% metabolic surgery is performed by pure metabolic surgeons. 23% had a metabolic training program. Access to metabolic surgery was rated poor/ very poor in 33%. 35% had a bariatric registry. 24% required a minimum procedure number for metabolic centres; varying from 25 to 200 procedures.

Conclusions
This is the first study to describe accessibility and quality data on metabolic and body contouring surgery from most European countries. There are myriad differences between European countries in terms of accessibility to metabolic surgery. Lack of funding, education and structure fuels this disparity. We hope this study will impact standardisation of access and quality indicators for metabolic and body contouring surgery across European countries, as well as be a springboard for further evaluation of international metabolic surgery practices.
P-BN02 Experience in Transitioning From Laparoscopic to Robotic-Assisted ParaEsophageal Hernia Repair - A Single Centre Experience
Authors: Azzawi Mohammed Al , Ismael Ghazi , Bolger Jarlath , Robb William 
Published: December 2021

Abstract

Background
Paraesophageal hernias (PEH) constitute only 5% of hiatal hernias. They may give rise to significant post-prandial symptoms, acute episodes of obstruction or gastric ischaemia and patient mortality. Surgical repair of symptomatic PEHs is the current standard of care. This study explores our centre’s experience with the introduction of Robotic Assisted PEH (RA-PEH) repair in comparison to our longer established technique of laparoscopic repair.

Methods
Retrospective review of all laparoscopic and robotic PEH repair using the DaVinci Xi between January 2017 and May 2020 by a single surgeon in 2 institutions. A total of 27 cases were included in our review. An analysis of patient demographics, operative time and approach, morbidity and mortality was performed.

Results
Sixteen patients underwent laparoscopic repairs and 11 underwent elective robotic repair. Fundoplication was performed in both groups while mesh repair was used in 18% of the laparoscopy group. Type IV hiatal hernia was found in 50% and 37% in the laparoscopy and RA-PEH groups, respectively. Mean operative time was 144 minutes in the laparoscopy group and 153 minutes for RA-PE (p = 0.07). Median length of stay was 2 days for both groups (p = 0.18). Post-operative morbidity occurred in 37% and 9% in the laparoscopy and RA-PEH groups respectively (p = 0.18). There was 1 case of acute post-operative recurrence and re-operation in the laparoscopy group.

Conclusions
Minimally invasive surgery is the standard of treatment in PEH repair. The robotic technique is a safe and effective approach when compared to the standard laparoscopic repair. It may have an advantage in reducing reliance on the necessity of having experienced assistance in the operating theatre without utilising more theatre time.
P-BN03 A systematic review of pre-operative low-calorie diets for laparoscopic cholecystectomy
Authors: Cheung Tiffany , Findlay John 
Published: December 2021

Abstract

Background
Laparoscopic cholecystectomy is the fourth most common procedure in the UK. Increased liver adiposity, commonly encountered in obesity, anecdotally may increase technical difficulty and surgical risk. Pre-operative low-calorie diets are well-established in bariatric surgery to reduce liver bulk, thereby ameliorating difficulty and risk. Similar diets are often used before laparoscopic cholecystectomy, however, the supporting evidence base is unclear; we performed the first systematic review on their use in this context.

Methods
PubMed, Embase and Cochrane Central Register of Controlled Trials databases were searched in February 2021. We included English language clinical studies describing pre-operative low-calorie diet for laparoscopic cholecystectomy. Data were extracted for specifics of / adherence to diet, weight change, operative time / difficulty, complications and length of stay. Study quality was qualified using Scottish Intercollegiate Guidelines Network criteria and Jadad score.

Results
One randomised controlled trial (RCT) and one prospective observational study were identified. Both utilised a pre-operative very low-calorie diet of &lt; 800 kcal/day. Overall weight loss was greater in patients deemed compliant with the intervention. Both demonstrated tendency towards reduced operative difficulty with the intervention. Only the RCT found improvement in operative time.

Conclusions
Pre-operative very low-calorie diets (&lt; 800 kcal/day for two weeks) may aid weight loss and reduce operative difficulty in laparoscopic cholecystectomy, although evidence supporting their continued use is limited. Further RCTs are warranted to fully evaluate their role in clinical and cost-effectiveness.
P-BN24 Quality assessment of online patient information on upper gastrointestinal endoscopy using the Modified Ensuring Quality Information for Patients (EQIP) tool
Authors: Miller Gillian , Chien Siobhan , Huang Ivory , Cunningham Danielle , Carson Daniel , Gall Lewis , Khan Khurram 
Published: December 2021

Abstract

Background
Online resources are rapidly becoming patients’ primary source of healthcare information due to the Internet’s ease of access. The availability of high-quality online information is paramount to improving patient education and clinical outcomes. Upper gastrointestinal (UGI) endoscopy is the gold standard investigation for UGI symptoms, yet little is known regarding the quality of patient oriented websites. This study aims to analyse the quality of online patient information on UGI endoscopy using the modified Ensuring Quality Information for Patients (EQIP) tool.

Methods
A systematic review was conducted using 10 search terms. The top 100 websites for each term identified using Google search were assessed using the modified EQIP tool (score 0-36). Sub-analysis was performed on high-scoring websites. Websites for medical professional use or containing video and marketing content were excluded.

Results
378 websites were eligible for analysis. The median modified EQIP score for UGI endoscopy was 18/36 (IQR 14-21). Median EQIP scores for the content, identification and structure domains were 8/18, 1/6 and 9/12, respectively. Websites produced by government health departments and NHS hospitals had a higher modified EQIP score (p = 0.007). Complication rates were included in only 20.4% of websites. High-scoring websites were significantly more likely to provide balanced information on risks and benefits (94.6% vs. 34.4%; p &lt; 0.001).

Conclusions
The current quality of online patient information on UGI endoscopy is limited, with minimal information available on risks of the procedure, potentially hindering patients’ ability to make informed healthcare decisions. There is an immediate need for high-quality online resources to improve patient education.