bluuebunny/crossref_metadata_2025_split huggingface dataset:
EP 632 - Management of chest trauma in a District General Hospital - Audit of current practice
Authors: Willis Kelly , Fitz-Gerald Alice , Ali Saqib 
Published: September 2024

Abstract
This abstract was published in Volume 110, Supplement 10, December 2023 ASGBI Emergency General Surgery Symposium. 1st November 2023. Glasgow, UK, and can be accessed at https://academic.oup.com/bjs/article/110/Supplement_10/znad388.012/7455140
EP65 - Case Series of 45 Preterm Neonates with Surgical Necrotizing Enterocolitis
Authors: Duric Bea 
Published: September 2024

Abstract

Aim
The objective of this study was to determine if the timing of surgery from the onset of necrotising enterocolitis (NEC) diagnosis affects clinical outcomes in preterm neonates.

Methods
We enrolled 45 preterm neonates who were transferred to the Evelina Children’s Hospital for surgical management of NEC between 2015 and 2018. Neonates had an established diagnosis of NEC as per Bell’s staging criteria. Surgical indications were: pneumoperitoneum, failure to improve despite medical management, shock, peritonitis, abdominal mass or loops, and unresolving intestinal obstruction.

Results
Average time from NEC onset to surgery was 4.2 days (±9.04) for all neonates, with an average of 5.72 days (±11.42) for neonates with pneumoperitoneum and 2.05 days (±3.22) for neonates without pneumoperitoneum (p=0.09). 26 neonates (57.7%) presented with pneumoperitoneum. Time of NEC onset to surgery was inversely correlated to mortality and directly correlated to postoperative parenteral nutrition at 28 days, although neither were significant (p=0.392 and p=0.744, respectively). 6 neonates (13%) developed short gut postoperatively.

Conclusions
Although pneumoperitoneum is the most reliable indication for surgery, timing to operation took longer for those neonates than those without pneumoperitoneum. Longer timing to surgery was associated with lower mortality and slightly higher odds of requiring parenteral nutrition postoperatively, although not statistically significant. Though preliminary evidence suggests worse clinical outcomes for neonates with sooner surgery, more trials with larger sample sizes are needed to see if this is statistically significant.
EP169 - Volume Replacement Perforator Flaps: Introducing a New Service to a DGH Oncoplastic Surgical Unit
Authors: Allan Jennifer , McIlmunn Colin , Diggin Padraig , Skelly Brendan 
Published: September 2024

Abstract

Aims
Oncoplastic breast conserving surgery (BCS) has developed to facilitate adequate oncological resection whilst maintaining cosmesis. Volume replacement surgery allows immediate reconstruction with transposition of autologous tissue. One approach is the use of chest wall perforator flaps (CWPF). This increases access for patients to enhanced oncoplastic techniques facilitating BCS, in the setting of larger tumour size, reducing the mastectomy rate in our unit.
Our aim was to analyse a series of patients undergoing CWPF in our DGH and determine whether oncological outcomes were comparable to traditional breast conserving surgery.

Methods
Patients undergoing CWPF reconstruction were identified using theatre records for a period of 12 months (Jan-Dec2023). Data was collected including patient demographics, histopathological findings and post-operative course and treatments.

Results
A total of seven patients were identified with median age 48 . Range of tumour sizes: 17mm-51mm. All were performed in the immediate setting with all undergoing SLNB. 3/7 required further surgery in the form of re-excision of margins. One patient developed a seroma, requiring aspiration once without further complication. Patient satisfaction is anecdotally high; however, this has not been quantified.

Conclusions
The utilisation of CWPF within our DGH has shown satisfactory outcomes. Performing these in the immediate setting means some patients have required re-excision of margins and replacement of flaps (similar to local figures for WLE without volume replacement) without impacting patient satisfaction. We advocate that CWPF significantly increases the options available as routine practice for suitable patients. OBCS is possible within the DGH without compromising oncological treatments or cosmesis.
EP186 - Blood transfusion documentation in surgical patients - are we doing it correctly? An audit on the blood transfusion documentation in surgical patients at a district general hospital in the United Kingdom
Authors: Pal Shreya , Limbu Dison Feyang , Pangeni Anang , Shrestha Ashish 
Published: September 2024

Abstract

Aim
Transfusion of blood products is commonly indicated in surgical patients, especially in patients with gastro-intestinal bleeding, gastro-intestinal cancers, and trauma patients. However, the documentation regarding blood transfusion in these patients often does not meet the guidelines.
The aim of this clinical audit was to improve the blood transfusion (BT) related documentation in patients of general surgery (GS) at a district general hospital (DGH) in the United Kingdom, in accordance with the national guidelines (Administration of blood components: a British Society for Haematology Guideline) and the local trust guidelines.

Method
For the 1st-cycle of the audit, we did retrospective study of all adult patients admitted under GS in our DGH from 1st July 2023 to 15th August 2023 (6weeks) who received BT, and their electronic records were assessed with regards to documentation regarding the following criteria: decision to transfuse, patient's consent and understanding, post-transfusion effect and discharge notes. Following this, we had a discussion with the junior doctors in the department, who do these documentation, to make them aware of the BT guidelines, and to improve adherence. The 2nd-cycle included retrospective data collection from 1st September 2023 to 15th October 2023 (6 weeks).

Results
BT-documentation during the 2nd-cycle showed significant improvement to adherence above 80% in most of the criteria where it needed improvement in the 1st-cycle.

Conclusion
This clinical audit successfully improved the BT-documentation adherence to the guidelines, showing that through simple educational methods, the documentation practices could be improved significantly. Our plans for subsequent improvement includes posters in the departmental resource room to increase the awareness, and to re-audit in December 2023.
EP232 - Delayed Discharges – How do we compare post pandemic?
Authors: Kemp Alison , Selvachandran Haran , Gossedge Gemma 
Published: September 2024

Abstract

Aims
A delayed discharge is when a patient is declared medically fit for discharge (MFFD), yet still requiring an inpatient bed as other circumstances prevent leaving the hospital.
This 2nd cycle audit was to assess the proportion of inpatients that are MFFD in comparison to the previous data collected in 2019, assessing level of improvement, implications of cost on the NHS and reasons for delayed discharge.

Methodology
The data was collected on the 27th of February 2023 encompassing 17 different wards in the hospital, compared to the 1st cycle on 26th February 2019. Analysis covered; Specialty, Age, Reason for the delay, Gender and Number of Days delayed. The number of inpatients on the day (n=432), of which 78 were MFFD (18%). The procurement team provided a figure of £392 for cost per bed per night.

Results
Findings showed approximately 1 in 5.5 patients had a delayed discharged in 2023 in comparison to that of 1 in 4 patients as seen in 2019. With estimated costs incurred being approximately £31,000 on the day cost in the 2nd cycle in comparison to £27,000 in the 1st cycle. The Audit highlighted the most common reason for delay in discharge was Completion of Assessment (Occupational Therapy/Physiotherapy/Social Worker) and Further Non-Acute NHS Care.

Conclusion
Even though there was considerable improvement in the number of people experiencing a delayed discharge, the estimated costing was still appreciably higher. To improve financial sustainability taking advantage of Government funding would see £200milion put towards the safe discharge of patients.
EP290 - Is the Breast Multidisciplinary Meeting Dying?
Authors: Nazeer Mehvish , Olayanju Olalekan , Chianakwalam Chiledu 
Published: September 2024

Abstract

Introduction
Care by a multidisciplinary team (MDT) is the gold standard for patients with cancer. It is mandated by the National Cancer Plan in 2000. However, the concept has been hampered by the increasing workload, shortage of radiologists and pathologists and changing patterns of working since the Covid-19 pandemic.

Method
We carried out a prospective study of the Breast MDT in a single unit looking at the workload and attendance between April 2022 and August 2023.
Percentage absences of key specialists were recorded and workload was calculated by using an online statistics software.

Results
There was a total of 72 MDT meetings over the 17 months. Percentage absences were oncology (2.8%), Pathology (2.8%), and radiology (15%). The median number of patients increased from 58 from April to December 2022 to 68 from January to August 2023.

Conclusion
There are several headwinds affecting the breast MDT including shortage of ancillary support specialists and increasing workload. To remain effective, Breast MDTs would need to evolve to continue providing excellent care to breast cancer patients
EP354 - Acute pancreatitis – an unusual cause
Authors: Saraee Danial , Kaur Geetinder 
Published: September 2024

Abstract

Introduction
Drugs are responsible for only 0.1%-2% of acute pancreatitis. Whilst the link between some drugs and pancreatitis is well-established, (steroids, azathioprine), we found only one previous case-report linking testosterone replacement therapy (TRT) to pancreatitis. We report a case of acute pancreatitis secondary to TRT.

Case Report
A 55-year-old man presented with history of upper abdominal pain. He denied alcohol/illicit drug use, no recent infection/changes to medication. His amylase was raised; CT scan confirmed acute pancreatitis. When interrogating his past medical history for a cause, we learned of his bilateral orchidectomy, radiotherapy and chemotherapy for seminoma in 1993, following which, he was on Testogel. He was managed conservatively, with success.

Discussion
Although drug-related causes of pancreatitis are uncommon, management is easy with identification/cessation of the causative agent. Therefore, a detailed medical history (including exposure to toxins and medication changes) is important. In our patient, an extensive surgical, medical and social history, CT and bloods excluded other main causes of acute pancreatitis i.e. alcohol, gallstones/infection, hypertriglyceridemia, toxins and trauma. The WHO database of “drugs suspected to cause pancreatitis” includes evidence from published literature, mostly case reports. Testosterone does not feature amongst the 525 drugs mentioned.

Conclusion
Our anecdotal evidence may provide a possible link between TRT and pancreatitis, however further research is needed to ascertain a definite causality. Reporting such potential links is important due to increased TRT use recently as treatment for female-to-male sex transition and young adults for performance enhancement, as well as remaining the primary treatment for hypogonadism.
EP442 - An Audit on the Application of Enhanced Recovery Post Emergency Laparotomy
Authors: Basit Nawshin , Satchidanand Rajesh , Azam Muhammad 
Published: September 2024

Abstract

Aim
This audit aims to evaluate the efficiency of NG tube and catheter removal post emergency laparotomies, assess the occurrence of postoperative complications, and analyse hospital practices related to enhanced recovery in the context of emergency laparotomies.

Methods
Data was collected retrospectively from [Hospital Name] for a specified time period, including patient demographics, surgical details, time to NG tube and catheter removal, postoperative complications, and adherence to enhanced recovery protocols. The audit included a thorough review of medical records, nursing notes, and relevant documentation.

Results
Preliminary findings indicate variations in the time taken for NG tube and catheter removal across emergency laparotomy cases. The occurrence of postoperative complications, such as infections, delayed recovery, and prolonged hospital stays, was also assessed. Furthermore, an analysis of hospital practices, including the implementation of enhanced recovery protocols, was conducted.

Conclusion
The results of this audit will contribute valuable insights into the effectiveness of current practices related to NG tube and catheter management post emergency laparotomies. The findings may highlight areas for improvement in enhancing recovery, optimising patient outcomes, and minimising complications. Recommendations for refining hospital protocols and promoting timely interventions will be proposed based on the audit results, with the ultimate goal of improving the overall quality of care for patients undergoing emergency laparotomies.
Increased expression of proton pump and allergic inflammation genes predicts PPI failure in pediatric eosinophilic esophagitis
Authors: Bose Paroma , Zhang Wenwu , Mehrpouya-Bahrami Pegah , Collins Katrina , Zhao Jennifer , Cannon Anthony M , Albright Eric , Idrees Muhammad T , Perkins Anthony , Gupta Sandeep K , Hon Emily C , Kaplan Mark H 
Published: September 2024

Abstract
Proton pump inhibitors (PPIs) are one of the standards of care of eosinophilic esophagitis (EoE) treatment, though PPI response rates are variable ranging from 23 to 63% in pediatric studies. We sought to determine if expression of select genes in esophageal mucosa can predict PPI responsiveness in EoE. Children with a new diagnosis of EoE (15 or more eosinophils/hpf on esophageal biopsy) were prospectively treated with 8 weeks of PPI therapy before follow-up esophagogastroduodenoscopy (EGD). Children with &lt;15 eosinophils/hpf on follow-up were classified as having PPI-Responsive EoE (PPI-R) and ≥ 15 eosinophils/hpf as PPI-Nonresponsive EoE (PPI-NR). Using the Nanostring nCounter Analysis System, mRNA expression of a custom panel of genes was measured in esophageal biopsies. Immunohistochemical staining of biopsies was performed. Among children with EoE, 32% (8/25) had PPI-R EoE. ATP12A, ATP4A, tryptase-beta 2 (TPSB2), CLC and IL13 had higher expression in PPI-NR EoE compared to PPI-R EoE or controls. Immunohistochemical staining of ATP12A was higher among PPI-R EoE and PPI-NR EoE, compared to non-EoE controls. In this study, PPI-NR EoE had significantly higher baseline gene expression of mast cell, cytokine, proton pump, and eosinophil genes compared to PPI-R EoE. PPIs may be involved in an inflammatory cascade of mast cell activation that stimulates IL-13 release, which upregulates ATP12A and ATP4A that leads to eosinophil recruitment. Histologic PPI failure may occur when increased gene expression of these components is high and cannot be overcome pharmacologically, especially in the case of proton pump genes.
Prediction of cardiovascular markers and diseases using retinal fundus images and deep learning: a systematic scoping review
Authors: Li Livie Yumeng , Isaksen Anders Aasted , Lebiecka-Johansen Benjamin , Funck Kristian , Thambawita Vajira , Byberg Stine , Andersen Tue Helms , Norgaard Ole , Hulman Adam 
Published: September 2024

Abstract
Rapid development in deep learning for image analysis inspired studies to focus on predicting cardiovascular risk using retinal fundus images. This scoping review aimed to identify and describe studies using retinal fundus images and deep learning to predict cardiovascular risk markers and diseases. We searched MEDLINE and Embase on 17 November 2023. Abstracts and relevant full-text articles were independently screened by two reviewers. We included studies that used deep learning for the analysis of retinal fundus images to predict cardiovascular risk markers or cardiovascular diseases (CVDs) and excluded studies only using predefined characteristics of retinal fundus images. Study characteristics were presented using descriptive statistics. We included 24 articles published between 2018 and 2023. Among these, 23 (96%) were cross-sectional studies and eight (33%) were follow-up studies with clinical CVD outcomes. Seven studies included a combination of both designs. Most studies (96%) used convolutional neural networks to process images. We found nine (38%) studies that incorporated clinical risk factors in the prediction and four (17%) that compared the results to commonly used clinical risk scores in a prospective setting. Three of these reported improved discriminative performance. External validation of models was rare (21%). There is increasing interest in using retinal fundus images in cardiovascular risk assessment with some studies demonstrating some improvements in prediction. However, more prospective studies, comparisons of results to clinical risk scores, and models augmented with traditional risk factors can strengthen further research in the field.
Size fractionation informs microbial community composition and interactions in the eastern tropical North Pacific Ocean
Authors: Thompson Madeleine A , Valentine David L , Peng Xuefeng 
Published: September 2024

Abstract
Marine microorganisms are drivers of biogeochemical cycles in the world’s oceans, including oxygen minimum zones (OMZs). Using a metabarcoding survey of the 16S rRNA gene, we investigated prokaryotic communities, as well as their potential interactions with fungi, at the coastal, offshore, and peripheral OMZ of the eastern tropical North Pacific. Water samples were collected along a vertical oxygen gradient, and large volumes were filtered through three size fractions, 0.22, 2, and 22 µm. The changes in community composition along the oxygen gradient were driven by Planctomycetota, Bacteroidota, Verrucomicrobiota, and Gammaproteobacteria; most are known degraders of marine polysaccharides and usually associated with the large particle-associated (LPA) community. The relative abundance of Nitrososphaerota, Alphaproteobacteria, Actinomycetota, and Nitrospinota was high in free-living and small particle-associated (SPA) communities. Network analyses identified putative interactions between fungi and prokaryotes in the particle-associated fractions, which have been largely overlooked in the ocean. In the SPAnetwork analysis, fungal amplicon sequence variants (ASVs) had exclusively negative connections with SAR11 nodes. In the LPA network analysis, fungal ASVs displayed both negative and positive connections with Pseudomonadota, SAR324, and Thermoplasmatota. Our findings demonstrate the utility of three-stage size-fractioned filtration in providing novel insights into marine microbial ecology.
The ambiguous impact of populist trade discourses on the international economic order
Authors: Meislová Monika Brusenbauch , Chryssogelos Angelos 
Published: September 2024

Abstract
The relationship between populism and free trade has historically been a complex one. This article argues that populism affects trade not by expressing consistent economic preferences, but by operating as a discourse that articulates external policies as a struggle for popular recognition. We analyse trade discourses of Donald Trump and Brexiteers following their victories in the 2016 United States presidential election and the referendum on European Union membership in the United Kingdom. These populist movements expressed opposing trade preferences: Trumpism was identified with protectionism, while Brexiteers supported free trade. However, they both articulated trade as a way to regain popular sovereignty from elites and hostile outsiders. A discursive approach helps identify a common logic in how populists articulate foreign relations despite pursuing nominally opposing policies. While this populist logic pertains primarily to domestic mobilization, it has implications for the international order as well, as evidenced in the persistence of protectionist instincts in the US under President Biden and the acceptance of a ‘global’ trade policy outside the EU as the new frame of reference for UK external economic relations.
Left populism and foreign policy: Bernie Sanders and Podemos
Authors: Eklundh Emmy , Stengel Frank A , Wojczewski Thorsten 
Published: September 2024

Abstract
This article analyses how populism is conceptualized and studied in International Relations (IR) and argues that it should be seen as a political logic instead of a political ideology. It does so by demonstrating that ‘populist foreign policy’ looks radically different in analyses of the populist left, refuting the possibility of any distinctly ‘populist’ foreign policy positions. We argue that large parts of IR scholarship practise a form of concept-stretching that undermines the quality of analysis as well as the ability to make meaningful policy recommendations. Using the empirical case-studies of the politician Bernie Sanders in the United States and the political party Podemos in Spain, the article demonstrates that populism does not translate into any shared ideological positions, but is a way of formulating and performing—in these cases—leftist politics through which political actors can interpellate and mobilize different societal groups and demands behind their political projects. In particular, the analysis debunks common assumptions about populism's alleged effects on foreign policy and dangers to pluralist democracy, and shows that populism neither necessarily opposes multilateralism, migration and global public good provision nor formulates an authoritarian claim to power.
Shigella and Enterotoxigenic Escherichia coli Have Replaced Rotavirus as Main Causes of Childhood Diarrhea in Rwanda After 10 Years of Rotavirus Vaccination
Authors: Munyemana Jean Bosco , Kabayiza Jean Claude , Nilsson Staffan , Andersson Maria E , Lindh Magnus 
Published: September 2024

Abstract
The causes of diarrhea after 10 years of rotavirus vaccination in Rwanda were investigated with real-time polymerase chain reaction in 496 children with diarrhea and 298 without. Rotavirus was detected in 11% of children with diarrhea (odds ratio, 2.48; P = .002). Comparison of population attributable fractions (PAFs) shows that Shigella (PAF, 11%) and enterotoxigenic Escherichia coli producing labile toxin (PAF, 12%) have replaced rotavirus as the main causative agents. The PAF for rotavirus had declined from 41% prevaccination to 6.5% postvaccination, indicating that rotavirus has become one among several similarly important causes of childhood diarrhea in Rwanda. A rotavirus genotype shift to G3P[8] points at the importance of continued genotype surveillance.
Virtual active power sensor for eolic self-consumption installations based on wind-related variables
Authors: Díaz-Longueira Antonio , Arcano-Bea Paula , Casado-Vara Roberto , Piñón-Pazos Andrés-José , Jove Esteban 
Published: September 2024

Abstract
Green energy production is expanding in individual and large-scale electricity grids, driven by the imperative to reduce greenhouse gas emissions. This research performs a comparative analysis of several linear and non-linear regression models, intending to identify the most effective method to estimate the active power produced for a mini wind turbine using meteorological variables, looking for a reliable virtual sensor. The modeling process followed a feature selection step before applying eight machine learning techniques whose results were statistically analysed to determine the best performance. The implemented virtual sensor accurately estimated the active power, being an interesting tool for anomaly detection, maintenance management or decision-making.