bluuebunny/crossref_metadata_2025_split huggingface dataset:
Deference to Moral Testimony and (In)Authenticity
Authors: Brick Shannon 
Published: July 2024

Abstract
The philosophical debate over moral testimony is a debate over whether it is appropriate to trust moral testimony. Most people who have engaged in the debate agree that it seems as though people ought to form moral beliefs by thinking through the issues on their own, rather than by trusting another person’s testimony. This chapter reports the results of two studies designed to investigate one hypothesis about why things seem this way. According to this hypothesis, we think it is inappropriate to trust moral testimony because we are committed to the ideal of personal authenticity, and we think that trusting moral testimony would put one in a condition of inauthenticity.
Do People Understand Determinism?
Authors: Murray Samuel , Dykhuis Elise , Nadelhoffer Thomas 
Published: July 2024

Abstract
Experimental work on free will typically relies on deterministic stimuli to elicit judgments of free will. We call this the Vignette-Judgment model. We outline a problem with research based on this model. It seems that people either fail to respond to the deterministic aspects of vignettes when making judgments or that their understanding of determinism differs from researcher expectations. We provide some empirical evidence for this claim. In the end, we argue that people seem to lack facility with the concept of determinism, which calls into question the validity of experimental work operating under the Vignette-Judgment model. We also argue that alternative experimental paradigms are unlikely to elicit judgments that are philosophically relevant to questions about the metaphysics of free will.
(What) Do We Owe Beautiful Objects? A Case for Aesthetic Obligations
Authors: Schellekens Elisabeth 
Published: July 2024

Abstract
This paper has two main aims. The first is to examine our normative relations to artworks and cultural artefacts threatened by damage or destruction. The second aim is to develop an argument for the notion of aesthetic obligation, offering an alternative model of explanation of our normative relations to artworks and cultural artefacts which relies neither exclusively on the object of appreciation (‘object-oriented approach’) nor on the appreciating subject (‘subject-oriented approach’). Instead, an aesthetic obligation is held to be directed primarily towards the community which appreciates the object on the grounds of its aesthetic value. That which unites an aesthetic community is the practice of valuing an object for its aesthetic character. The notion of aesthetic obligation thus relies both on the community of subjects which holds an object in high aesthetic regard and that same object’s aesthetic value.
Targeted Verifiable Subcision for Management of Cellulite on the Buttock and Thigh: Incorporation Into Real-World Lower Body Rejuvenation Approaches
Authors: Franco Johnny , Calobrace M Brad , Schulman Matthew R 
Published: July 2024

Abstract

Background
Cellulite affects 80% to 98% of postpubertal females, and most patients with the condition are bothered by it. Targeted Verifiable Subcision (TVS; Avéli; Revelle Aesthetics, Inc., Mountain View, CA) is a minimally invasive mechanical subcision device that reduces the appearance of cellulite dimples in the buttocks and thighs. Although clinical trials have demonstrated efficacy, information on real-world surgical and nonsurgical approaches to managing cellulite in buttocks and thighs is needed.

Objectives
To describe how TVS is being used by the authors to improve patient outcomes in the lower body in both surgical and nonsurgical settings.

Methods
Each of the authors described their current practices using TVS for lower body rejuvenation. Author practices have varied proportions of surgical vs nonsurgical cases (from 10% to 100% surgical cases) and a variety of focuses, ranging from primarily facial aesthetics to a near exclusive focus on body contouring.

Results
The authors' diverse approaches to integrating TVS into clinical practice are detailed, along with pearls of clinical success. TVS is discussed as a companion treatment for surgical procedures, while the patient is already under anesthesia, as well as a part of a nonsurgical approach, where the local anesthesia required for TVS can make additional energy-based procedures more comfortable for the patient. The authors provide several examples and include considerations for optimal timing and ordering of treatments.

Conclusions
TVS may become a valuable addition to the treatment armamentarium for surgical or nonsurgical buttock and thigh rejuvenation and can be integrated into surgical and nonsurgical workflows.

Level of Evidence: 4
242 The Burden of Penetrating Junctional Injuries in a UK Major Trauma Centre: A Retrospective Cohort Study
Authors: Ramaraj P , Watkins B , Super J , Abdul-Rehman1 A , Huang S , Aylwin C , Hettiaratchy S 
Published: July 2024

Abstract

Aim
Junctional injuries occur at the join of anatomically distinct zones. Recent battlefield casualties have shown junctional wounds account for 21% of potentially survivable deaths from haemorrhage. Although well studied in military literature, this is not the case in civilian setting. This paper aims to describe the civilian injury pattern to improve management and resource allocation.

Method
Retrospective study of all patients with penetrating injuries to a junctional zone presenting to an urban MTC in 2018. Patient records searched and data extracted on site of injury, management, and discharge code. Discharge codes were referenced with the National Schedule of NHS costs to produce a cost.

Results
132 patients, 92.4% (n=122) male; median age 27.5; in hospital mortality 0.8% (n=1). 37.9% (n=50) of injuries were buttock; 22% (n=29) neck; 18.9% (n=25) multiply injured; 8.3% (n=11) axilla; 6.8% (n=9) diaphragm; and 6.1% (n=8) groin. Median Injury Severity Score (ISS) 8; median ISS multiply injured 29; diaphragm 16; groin 9; neck 5; axilla 4; buttock 4.
46.2% (n=61) underwent surgery; 50.8% (n=67) were admitted, 7.6% (n=10) to ITU. Median length of ward-stay 3 days. 15.9% (n=21) received blood products. The overall cost was £914,076; £6925/patient. Per patient for multiply injured £19,676; diaphragm £11,435; groin £7,483; axilla £3,553; neck £3,026; buttock £2,651.

Conclusions
Junctional injuries are a significant resource burden. Buttock wounds were the most common but had the lowest median ISS and cost. Diaphragmatic injuries appear distinct in terms of ISS and cost and should be considered as separate to other junctional wounds.
983 A comparison of the Post-operative Complications Rates in the Removal of Benign Parotid Tumours: Extracapsular Dissection Versus Superficial Parotidectomy and Partial Superficial Parotidectomy
Authors: Collard J , Akhtar S 
Published: July 2024

Abstract

Aim
The objective of this systematic review was to assess the effectiveness of different surgical techniques in the removal of benign parotid tumours. The analysis focused on three specific postoperative complications including: recurrence rate, temporary and permanent facial nerve palsy (FNP) and Frey's syndrome. In this systematic review, patients who underwent extracapsular dissection (ECD) were compared to those who underwent superficial parotidectomy (SP) or partial superficial parotidectomy (PSP).

Method
OVID, Cochrane Library, PubMed, and Scopus databases were searched. Inclusion and exclusion criteria were applied resulting in seven papers; all of which were retrospective cohort studies.

Results
A total of 2282 patient data was pooled (1174 ECD-treated and 1108 SP and PSP-treated patients). Statistical analysis showed there was no significant difference in the rate of recurrence (log odds ratio (LOR) = -0.15, 95% confidence interval (CI): -1.11, 0.80). There were lower rates of both temporary facial nerve injury (LOR = -1.76, 95% CI: -2.75,-0.76) and Frey’s syndrome (LOR = -1.63, 95% CI: -2.90,-0.37) in the ECD treated patients. There is reasonable statistical significance suggesting that ECD has lower rates of Permanent FNP (LOR=-1.00, 95% CI: -2.35, 0.35).

Conclusions
Despite the results showing ECD favourability in terms of FNP and Frey’s syndrome, it is important to understand the limitations of this study. Confounding factors such as, tumour size and placement, patient age and gender and surgical cosmetic outcomes were not analysed in this systematic review (SR). Future research should focus on a prospective cohort study, directly comparing the different surgical techniques.
578 Optimising Emergency Theatre Efficiency with the Use of a Pre-Anaesthetic Holding Bay, a Quality Improvement Project
Authors: Vaughan-Burleigh S , Marsden L , Peagam R , Tyrrell J , Hollyman M 
Published: July 2024

Abstract

Aim
An efficient emergency theatre depends on the coordination of multiple surgical specialties, anaesthetists, and theatre staff. The serial nature of an operating list leads to downtime between cases. We sought to reduce delays between emergency cases by implementing a pre-anaesthetic holding bay.

Method
Anonymised data was collected from a prospectively maintained mandatory database of theatre activity. Exclusion criteria were non-surgical procedures, first case, out-of-hours procedures, and critical care admissions. Suitability was determined from a period pre-implementation and a pre-defined trial period to ensure safe rollout. Pre-, trial, and post-implementation were compared.

Results
349 emergency procedures were performed in three months post-implementation. After exclusion criteria 110 were suitable for pre-anaesthetic holding bay use, and in 35 (31.8%) it was utilised. Most cases were general surgery (61%), vascular surgery (15%), and gynaecology (12%). Holding bay use decreased time without a patient in the anaesthetic room from 50 to 5 minutes (p&lt;.001) and the time between procedures from 86 to 43 minutes (p&lt;.001). There was no difference in anaesthetic time between the groups (36 vs 38 minutes, p=.40). Over the three months 40 more in-hours cases were completed in 48 days with no difference in procedures across the periods.

Conclusions
Pre-anaesthetic holding bay use reduced theatre downtime by 90%, allowing more procedures to be performed in-hours. All specialties engaged with the holding bay but to varying extent, and ensuring investment from surgeons, anaesthetists, and theatre staff is essential. This intervention, implemented with no extra resources, has increased efficiency and improved safety in the emergency theatre list.
627 Epidemiology, Admissions Outcomes, and Mortality for Geriatric Trochanteric Fractures. A Major Trauma Centre Study
Authors: Zhang J , Shah B , Zhu J , Bradshaw F , Krkovic M 
Published: July 2024

Abstract

Aim
Femur trochanteric fractures are very debilitating injuries yet are under investigated in orthopaedic literature. We study the epidemiology, hospital admission factors, and mortality for elderly patients with trochanteric fractures.

Method
All patients over 65 years old at a level-1 trauma-centre with a trochanteric hip fracture from January-2015 to June-2021 were included. Fractures were subdivided with AO/OTA subclassifications into intertrochanteric (31-A1,A2,A3) and subtrochanteric (32-A1,A2) sub-types. Patient demographics, preadmission mobility, time-to-surgery, length-of-surgery, surgical fixation used, inpatient rehabilitation/mobilisation, and post-operative mortality at 1,3,6 and 12 months, were collected. Patients were followed up for minimum of 2-years. Statistical significance was p&lt;0.05.

Results
A total of 1101 patients were included. The AO/OTA classification was: 31-A1(123), 31-A2(491), 31-A3(105), 32-A1(221), 32-A2(161). Average age was 84.9, with 72.8% patients being female. Average admission-to-surgery, surgery-time, and surgery-to-discharge-time was 21.6hours, 1.2hours, and 15.5days respectively.
Overall mortality was 7.2%(1-month), 15.4%(3-months), 20.4%(6-months) and 27.1%(12-months). There were no statistically significant associations of type of fracture, operative method, or surgery-within-36hours, with mortality at any scale. Post-operative mobilisation within 24-hours, with or without physiotherapist aid, was associated with lower mortality on all investigated time scales, compared to no mobilisation (p&lt;0.05).

Conclusions
Our study presents a large and detailed cohort of patients with trochanteric fractures classified with AO/OTA, the first in the UK, and investigated the associations with inpatient admission and mortality outcomes. Our detailed analysis and high-resolution data will allow for cross region and country comparisons and inform guideline and quality improvement efforts.
236 Post-Splenectomy Patients: Reaudit of Current Practice at Living Well Partnership PCN
Authors: Samarth G , Pigott L , Lloyd M , Hughes M , Aggarwal P , Freeman A , Hunt P 
Published: July 2024

Abstract

Aim
Post-splenectomy patients are at increased risk of sepsis and overwhelming post-splenectomy infection (OPSI). This reaudit aimed to look at a primary care network’s (PCN) compliance with established immunisation guidelines and antibiotic prophylaxis post-splenectomy.

Method
A retrospective study of 29 splenectomy or asplenia patients between 2018-2022 was conducted within a primary care network. Hospital and GP records were reviewed for antibiotic prescriptions (prophylactic and emergency), vaccination records, electronic splenectomy alert and admission for infection. Interventions included a 15-minute patient intervention GP consultation and correction of EMIS coding.

Results
The 2018 audit showed that a proportion of splenectomy patients were not appropriately prescribed antibiotics. There was lack of patient insight into their condition (asplenia v splenectomy). An active, patient-centred intervention was employed to improve rates of antibiotic prescribing, perform counselling on regular recommended vaccinations and ensure correct clinical coding for follow up. Compliance to audit criteria increased across all measures between the 3 PDSA cycles. Antibiotic prophylaxis prescription increased from 53% (2018) to 71% in 2022. Emergency antibiotic prescription increased from 6% (2018) to 39% in 2022. Influenza vaccination rates increased from 71% (2018) to 82% in 2022. Following the intervention consultation, 85% of patients had appropriate antibiotic prophylaxis prescription and 64% had appropriate emergency antibiotics prescribed.

Conclusions
Prescription for emergency and prophylactic antibiotics, and correct coding for annual and 5-year vaccinations were improved for this cohort of splenectomy and asplenia patients. Patients valued a structured consultation leading to improved understanding and self-management.
165 Schools Engagement Will Improve Equality and Diversity Within Orthopaedics and Surgery
Authors: Schenk E , Maggs R , Franklin M 
Published: July 2024

Abstract

Aim
Inclusivity and diversity of individuals from lower socioeconomic backgrounds is unequal within surgery. Diversification of the workforce is a requirement for the future of surgery to ensure high quality patient care is provided (Hassan, 2023). The School’s Engagement Session, originating with the British Hip Society and replicated with British Orthopaedic Association (BOA), aimed to introduce the idea of a career in medicine or surgery to children from non-selective state schools.

Method
Three school groups, twenty-four students and three staff members, attended day three of the annual BOA conference. Highly engaging medical student presentations, industry stand activities, and hands-on consultant led surgical based stations sparked interest and provided ‘work-experience’ opportunities; an increasingly challenging pre-requisite for applicants to acquire. Resources, lunch, and room availability were all supported by the BOA.

Results
Directly addressing students from lower socioeconomic backgrounds about a career in surgery, which many had not previously considered, stimulated their interest in this as a career. Feedback from accompanying educators, acknowledged their lack of insight regarding accessibility, and students explicitly demonstrated the positive impact of these in-person engagement events. Many students explained how this newly acquired knowledge had empowered the possibility of pursuing a medical career.

Conclusions
Replication of this highly successful event demonstrated the impact of engagement with individuals from diverse backgrounds upon future surgical diversity. Nationwide reproducible events are therefore warranted to reduce inequality in medicine and surgery. Medical student through to consultant involvement with future engagement work will diversify and sustain the surgical workforce within the UK.
550 Implementation of Inclusive Initiatives at a Grassroot Level to Ensure Long-Term Equality, Diversity, and Inclusivity in Surgery
Authors: Salem Fouda S , Asim N , Alberto I , Irfan M 
Published: July 2024

Abstract

Aim
Promoting equality, diversity and inclusion in surgery begins at ensuring accessible initiatives are executed at a grassroot level for prospective students. The Royal College of Surgeons illustrated that 20% of their surgical leadership positions were from BAME communities.
SGUL MedEd Society aims to support students from widening participation (WP) backgrounds in their medical application by addressing disparities and providing support within these areas.

Method
We conducted free sessions aimed at different aspects of the medicine application with the intention of facilitating understanding and support for WP students. Multiple domains were covered such as a UCAT webinar, an ‘Experience into medicine’ simulated workshop covering the key learning styles employed in university as well as multiple mini-interview (MMI) preparation through an online webinar and in-person mock. Feedback forms were implemented before and after sessions using 5-Point Likert scales to measure changes in confidence.

Results
An increase in confidence applying to medical school was observed in the ‘Experience into medicine’ workshop (n=25) with a 60% rise in students rating 4/5. Statistical analysis was carried out on the results obtained from the MMI webinar (n=169) using the Wilcoxon signed-rank test which suggested the initiative significantly improved students’ confidence (w=14, a=0.005). This was followed by a practice MMI session (n=68) whereby 50% of students reported feeling more prepared for a real MMI.

Conclusions
These results suggest there is a substantial improvement in confidence in WP students after the event, increasing the likelihood of inclusivity in medicine. This has wider implications in supporting applications into surgery in the future.
711 Bullying Culture Within Neurosurgery and Spinal Surgery Centres - a Scoping Review of the Current Social Inclusion Policy Surrounding Neurosurgical Practice in the United Kingdom
Authors: Wellington J , Yu Ka Chun J , Yassa B 
Published: July 2024

Abstract

Aim
Homogeneity within surgical academia has been shown to precipitate increased risks of erroneous diagnoses and impede innovation. Successive generations have introduced equality, diversity, and inclusivity (EDI) to the surgical workforce. However, healthcare professionals, especially those in training, still experience bullying and harassment, particularly in neurosurgery and spinal surgery (SS). Therefore, a scoping review (SR) was conducted to evaluate bullying culture within neurosurgery and SS centres globally, focussing on British institutions.

Method
SR complied with the Arksey and O'Malley framework, where PubMed/MEDLINE, Embase, and Google Scholar were searched between 2020-current. Only relevant papers were screened per inclusion criteria to keywords: ‘bully’, ‘harass’, ‘neurosurgery’, and ‘spine surgery’, adhering to PRISMA-SR guidelines. Using pretested forms, two separate reviewers conducted review selection and characterisation.

Results
Articles searched surmounted 13,298, where 37 select articles, of which 8 were included in final analysis. Of these, letters, editorials, and cross-sectional surveys accounted for 25%, 37.5%, and 37.5%, respectively. Common themes comprised EDI workforce embracement and collective policy implementation for dynamic social change (n=62.5%). Issues related to institutional reputation (n=50%), barriers to career prospects (n=25%), retaliation (n=12.5%), and stress (n=25%) amongst healthcare professionals raising concerns.

Conclusions
Facing discrimination, prejudice, and harassment is immoral and unethical in the context of neurosurgical or SS training. While original research evaluating EDI issues in surgery has proliferated, emphasis should be exercised when assessing this impact among neurosurgical and SS trainees. Our SR elucidates that social change remains contentious in neurosurgery and SS. Further work is warranted to establish such perspectives within the UK.
439 Predictors of Treatment Pathway Completion in Stage IV Rectal Cancer: A Nationwide Observational Study of 15,727 Patients
Authors: Lakha A S , Chammas L , Morris E , Gordon-Weeks A 
Published: July 2024

Abstract

Aim
Stage IV rectal cancer carries a 10% 5-year survival rate. Curative-intent management requires treatment of both the primary and metastatic disease. This study aimed to identify patterns in stage IV rectal cancer treatment pathway at population level across the UK, and to identify predictors of treatment pathway completion.

Method
Patient demographics and treatment data were extracted from the UK Colorectal Cancer Intelligence Hub’s CORECT-R repository, national chemotherapy (SACT), and radiotherapy (RTDS) datasets. Treatment pathway completion was defined as receipt of intervention to the primary tumour (radiotherapy and/or surgery) in addition to metastasis-directed therapy (surgery, radiotherapy, OR ablation), or the combination alongside chemotherapy. Multivariable logistic regression analysis was performed to identify independent predictors of treatment completion.

Results
A total of 15,727 patients with stage IV rectal cancer diagnosed between 2010-19 were identified. Multivariable analyses showed that sex, age, number of cancer alliances (CAs) attended, ethnicity, and deprivation score were all statistically significant in predicting completion of treatment (p-values&lt;0.02). The number of CAs attended was identified as having the strongest predictive effect of treatment completion (OR=3.9, CI: 3.5–4.3). Being male also increased the odds of completing treatment (OR=1.2, CI: 1.1-1.3), while increased deprivation reduced odds of completing treatment.

Conclusions
Across the UK, there is variation in Stage IV rectal cancer patients completing treatment for both their primary and metastatic disease. Further work is needed to determine whether differences in treatment pathways stem from variation in access to specialist services between alliances or whether they are due to differences in MDT decision making.