bluuebunny/crossref_metadata_2025_split huggingface dataset:
Development and functional testing of battery management system algorithm for an electric bicycle using hardware in the loop testbench
Authors: Siddharth M , A Rammohan 
Published: August 2024

Abstract
An embedded Battery Management System (BMS) ensures the effective functionality and longevity of the vehicle battery systems. Testing the BMS using the Hardware in Loop (HIL) approach effectively increases safety and reduces product development time in the manufacturing sector. This research aims to develop an efficient battery management system with two-level protection for electric bicycles and test its functionality in the HIL configuration. The bicycle traction model and battery management system were first developed using a model-based design. Further, the model is tested and validated using battery emulators in the HIL methodology. The battery management system receives input data, such as current, voltage, and temperature, and monitors these parameters. The first level of protection involves the vehicle user receiving the warning when the monitoring parameters values exceed the given first safety threshold. As per the second safety threshold values, the BMS trips off the charging or discharging process when the voltage is 51V, the charge current is 5A, the discharge current is -5A and the IC temperature is 80 degrees. Also, BMS balances the cells in 3.84 min using passive balancing. Additionally, the BMS delivers a controlled current of 2.5A for safe battery charging. This methodology increases safety by reducing the potential risks of testing the BMS algorithms in the actual electric bicycle.
The Second Reconstruction, 1954–1971
Authors: Wiecek William M 
Published: August 2024

Abstract
This chapter considers the attempts to achieve some measure of equality between whites and African Americans through constitutional and legal change amid the civil rights era. It explains that the second Reconstruction ended servitude based on de jure discrimination, which correlates to how the first Reconstruction ended slavery. However, both Reconstruction eras did not exactly succeed in establishing comprehensive racial equality and came to a premature end. The chapter highlights that the US Supreme Court was the godparent of the civil rights era, citing that the second Reconstruction would not have happened without the Warren Court. It also notes the challenges to state statutes that prohibit interracial sex or marriage.
The Real Self: Who Am I? Who Are We? (Principle 4)
Authors: Boyatzis Richard E 
Published: August 2024

Abstract
Chapter 4 focuses on the second phase of Intentional Change Theory (ICT), the realization of the Real Self. The Real Self may be a constellation of the ways individuals think about themselves, but in ICT, it is the way one is experienced by others. The Faux Self is a false image of oneself often created from self-protective forces. Therefore, collecting observations from others or direct observation is key to determining the Real Self and one’s strengths and weaknesses. Focusing on Real–Ideal Self discrepancies uses a deficiency approach to reduce this gap. Competencies are the behavioral and observable aspect of a person: a capability of a person, not a characteristic of a job, which are a set of behaviors organized around an underlying intent. The use of competency models developed from expert and opinion sources is a deceptive model and a waste of resources. When comparing one’s Real Self to one’s Ideal Self, a picture of relative strengths and weaknesses emerges as a personal balance sheet.
Unintended Souvenirs: Case Report of a Retained Foreign Body During Cosmetic Surgery Tourism
Authors: Shaffrey Ellen C , Larson Jeffrey D 
Published: August 2024

Abstract

Medical tourism has grown exponentially, spurred by incentives such as cost reductions, minimal wait times, and the allure of recuperative vacations. However, this trend carries substantial risks, as illustrated by the case of a 52-year-old female patient who underwent an abdominoplasty as part of a medical tourism package in Miami, FL, which resulted in a retained foreign body. The case highlights the broader issues of continuity of care, patient safety, and the legal and ethical ramifications faced by patients opting for medical tourism surgical procedures domestically and abroad. It also emphasizes the need for updated standards from professional societies and international cooperation to safeguard patient well-being in the expanding medical tourism sector. Lastly, it underscores the need for physicians and surgeons who manage these complications at home to recognize that prompt management and intervention are critical to avoid the escalation of complications and the increased risk of morbidity and mortality.

Level of Evidence: 5 (Therapeutic)
Genetic determinants of obesity in Korean populations: exploring genome-wide associations and polygenic risk scores
Authors: Jo Jinyeon , Ha Nayoung , Ji Yunmi , Do Ahra , Seo Je Hyun , Oh Bumjo , Choi Sungkyoung , Choe Eun Kyung , Lee Woojoo , Son Jang Won , Won Sungho 
Published: August 2024

Abstract
East Asian populations exhibit a genetic predisposition to obesity, yet comprehensive research on these traits is limited. We conducted a genome-wide association study (GWAS) with 93,673 Korean subjects to uncover novel genetic loci linked to obesity, examining metrics such as body mass index, waist circumference, body fat ratio, and abdominal fat ratio. Participants were categorized into non-obese, metabolically healthy obese (MHO), and metabolically unhealthy obese (MUO) groups. Using advanced computational methods, we developed a multifaceted polygenic risk scores (PRS) model to predict obesity. Our GWAS identified significant genetic effects with distinct sizes and directions within the MHO and MUO groups compared with the non-obese group. Gene-based and gene-set analyses, along with cluster analysis, revealed heterogeneous patterns of significant genes on chromosomes 3 (MUO group) and 11 (MHO group). In analyses targeting genetic predisposition differences based on metabolic health, odds ratios of high PRS compared with medium PRS showed significant differences between non-obese and MUO, and non-obese and MHO. Similar patterns were seen for low PRS compared with medium PRS. These findings were supported by the estimated genetic correlation (0.89 from bivariate GREML). Regional analyses highlighted significant local genetic correlations on chromosome 11, while single variant approaches suggested widespread pleiotropic effects, especially on chromosome 11. In conclusion, our study identifies specific genetic loci and risks associated with obesity in the Korean population, emphasizing the heterogeneous genetic factors contributing to MHO and MUO.
709 An Audit of the Impact of the Introduction of Faecal Immunochemical Testing on Colorectal Two Week Wait Referral Practices and Colorectal Cancer Diagnoses
Authors: O’Connor T , Vallance A , Yim P Y , Shetty S , Grimes H , Hanhausen M R , Waite S , Messenger D 
Published: August 2024

Abstract

Aim
Waiting lists on the colorectal 2 week wait (2WW) pathway have grown more than any other tumour group since the pandemic. Faecal Immunochemical Testing (FIT) has a high sensitivity for the detection of colorectal cancer (CRC). A change in the southwest clinical network 2WW referral criteria was made from 2023, with greater emphasis on FIT. This audit examined the impact of this guideline change on referral practices to the colorectal 2WW service and resultant cancer diagnoses.

Method
A single centre retrospective review of electronic medical records and referral documentation for patients referred to a colorectal 2WW service in 2022 (September-December) prior to guidelines changing, and 2023 (January-April) following guidelines changing, was performed. Referral numbers, use of FIT, endoscopy numbers, and pathologies found were examined and compared between cohorts.
Result: Referrals to the 2WW service reduced by more than 50% (837 in 2022 vs. 399 in 2023). A FIT was performed in 374 (44.8%) patients in 2022 and 297 (75.0%) in 2023. There were 560 colonoscopies performed in the first cohort compared to 270 in the 2023 cohort. A CRC was detected in 24 patients in the 2022 cohort compared to 20 patients in the 2023 cohort (p=0.06).

Conclusions
The introduction of FIT to the 2WW colorectal service has resulted in fewer referrals. This has reduced the requirement for endoscopy with no reduction in diagnosis of colorectal cancer.
975 A Re-Audit on Bowel Preparation for Colonoscopy in a Surgical Unit of a Tertiary Care Hospital, Sri Lanka
Authors: Saranga K G V , Wickramasinghe V C , Madhawa J K G , Piyarathne S A , Prashantha A H A 
Published: August 2024

Abstract

Aim
This re-audit assessed changes in colonoscopy preparation practices at a Sri Lankan tertiary care hospital, aligning with ESGE guidelines. The primary goal was to gauge adherence improvements after introducing a protocol and educational initiatives.

Method
Conducted from May to July 2023, the initial audit identified deficiencies, leading to protocol development based on ESGE guidelines. Educational initiatives for nursing and junior staff were implemented, adjusting split-dose timing, discontinuing enema use, and providing clear instructions. A re-audit from August to October 2023 assessed the impact, analysing records through descriptive statistics.

Results
The re-audit revealed substantial improvements in colonoscopy preparation adherence to ESGE recommendations. The total number of patients undergoing the procedure was 88 in the initial audit and 96 in the re-audit. Adherence to a low fibre diet rose from 22.72% (n=20) to 90.62% (n=87), and compliance with enhanced instructions improved from 14.7% (n=13) to 70.8% (n=69). Routine enema use was eliminated (0% to 100%). Compliance for split-dose preparation increased from 42.04% (n=37) to 81.25% (n=78), and last dose timing within 5 hours improved similarly. Specific instructions to patients and clinic staff significantly improved from 28.4% (n=25) to 97.9% (n=94).

Conclusions
In conclusion, the re-audit emphasizes significant improvements in colonoscopy preparation, highlighting the positive impact of introduced changes. These findings underscore the effectiveness of evidence-based guidelines, education, and continuous audits. Implementing a checklist, staff, and patient education has proven essential for transforming and enhancing bowel preparation quality. These simple yet focused measures are essential in transforming and streamlining the quality of bowel preparation.
1286 A Closed Loop Audit of the Antibiotic Prophylaxis in Elective Laparoscopic Cholecystectomies at a DGH
Authors: Ikram H , Suleman A H , Ahmad G , Singh R 
Published: August 2024

Abstract

Aim
To re-audit the compliance of departmental practice to the antimicrobial guidelines for elective laparoscopic cholecystectomies. A Cochrane review found no evidence to support the use of antibiotic prophylaxis in elective cases.

Method
A retrospective study looking at all the elective laparoscopic cholecystectomies for the period between 1st June 2023 to 30th September 2023 using local Bluespier theatre software. Electronic operation notes were reviewed to identify cases where antibiotics were given. The main indications were bile spillage, conversion to open and cholecystitis amongst others. Total number of cholecystectomies carried out over the period was 92. At present gentamicin and metronidazole as a single dose was the choice.

Results
Antibiotic use during laparoscopic cholecystectomy is between 39% and 63% due to many cases not documenting the use of antibiotics. Adherence to guidelines reduced from 36% (2019) to 3% in 2023. Patients who received correct antibiotics allergic to penicillin was 75% (2019) and 100% in 2023. Continued lack of antibiotic documentation, use and indication in operation notes. Continued overuse of co-amoxiclav 60% (2019) and 87% in 2023.

Conclusions
Antibiotic prophylaxis in elective cholecystectomies was only performed correctly in 3% of cases. This can have a major impact on patient safety and also the financial aspect to the trust. Understanding why surgeons have failed to adopt the local guidelines may benefit in changing practice. We suggested an education session from the microbiology team to help better understand the importance of antibiotic stewardship and using laminated guidelines in theatre to ensure this is followed closely.
225 The Use of Activated Clotting Time and Prothrombin Time to Predict the Heparin Dose in Paediatric Cardiac Patients on Venoarterial Extracorporeal Membrane Oxygenation Circuits
Authors: Karsan R , Chan-A-Sue T 
Published: August 2024

Abstract

Aim
Venoarterial extracorporeal membrane oxygenation (VA-ECMO) is a salvage intervention used to treat cardiorespiratory failure. Heparin is the main anticoagulation agent used to prevent clots within the lines and thus circuit failure, dosing is traditionally assessed using activated clotting time (ACT). We aimed to investigate the variables influencing circuit anticoagulation to predict therapeutic heparin dosing to reduce surgical re-exploration.

Method
A retrospective analysis of parameters (ACT, heparin, platelet and prothrombin time (PT)) used to identify bleeding at an early interval in paediatrics (N=10) patients on VA-ECMO at a single centre. The mean values of each variable for all samples taken during VA-ECMO for each patient when grouped by re-exploration due to bleeding or not.

Results
None of the patients experienced clots in the VA-ECMO circuit, suggesting an ACT between 146 - 165 was adequate for anticoagulation. There was a statistically significant difference between the mean ACT of each group, with those not requiring re-exploration having a mean 12.44 units higher than the re-exploration group (95% CI [6.17, 18.71] p&lt;0.001) yet no statistically significant difference between platelet level between groups (p=0.098). PT and the off-set heparin dose were shown to have any predictive power of heparin dose using regression equations:
Heparin dose=([Target ACT]-79-(5.2 ×[Prothrombin]))/0.4
Heparin dose=2.5 ×([Target ACT]-79-(5.2 ×[Prothrombin])).

Conclusions
The application of the formula has the potential to predict heparin dose in paediatric patients on ECMO which could help reduce the postoperative complication of returning to surgery due to rebleeding when extrapolated to a larger data set.
404 A Reflection on a 3-Cycle Audit in the Use of Perioperative ACE-Inhibitors and A2RBs in Cardiac Surgery
Authors: Rao E , Allam M , Karamanou D 
Published: August 2024

Abstract

Aim
ACE inhibitors and Angiotensin-2-receptor blockers are stopped 24 hours preoperatively as continued use can cause hemodynamic instability and complications including kidney dysfunction, atrial fibrillation and increased mortality. To reflect on the results across 3 cycles to see if our recommendations have led to any improvements towards meeting the standard of 100% patients having ACEi and A2RBs being stopped at least 24 hours preoperatively with any clinical exceptions documented.

Method
There were 3 rounds of data collection (corresponding with each cycle) where patient inpatient notes and drug charts were reviewed. Emergencies and those not on ACE/A2RB were excluded. The first round of data was collected from 50 sequential patients admitted from October 2019 to January 2020, second round from 51 patients reviewed in December 2021 and the third round had been collected from 50 sequential patients admitted from January to June 2023.

Results
In cycle 1, 96% ACEi/A2RBs stopped with reasoning not documented for continuations (n=1). Recommendation was a team meeting to remind of protocol. In cycle 2, 76% ACEi/A2RBs stopped with reasoning not documented for 50% of continuations (n=12). Recommendation was a team meeting to remind of protocol, particularly ward and in-house-unit (IHU) staff. In cycle 3, 92% ACEi/A2RBs stopped with reasoning not documented for continuations (n=2).

Conclusions
The results suggest our recommendations have been effective along with the trust’s recent implementation of an online prescribing platform which has made it easier to track medications patients are given, reinforcing the positive impact of technology in reducing medical errors and ultimately improving patient outcomes.
876 To Score or Not to Score - Is Caprini the Best Tool for Post-Operative VTE Risk Stratification in Patients Undergoing Thoracic Surgery?
Authors: Ajdarpasic D , Hawari M 
Published: August 2024

Abstract

Aim
The incidence of venous thromboembolism (VTE) is high post thoracic surgery, particularly following lung resection. However, there is no consensus to effectively identify and prevent post-op VTE. The modified Caprini score is already used by many surgical specialties, but not all UK Thoracic centres utilise this tool as part of pre-operative assessment. Our centre has implemented the Caprini score since April 2019.

Method
This retrospective single-centre study evaluated patients who underwent thoracic surgery in 2020 and had a diagnosis of VTE at any point post-surgery. Patients were included if they underwent thoracic surgery regardless of pathology or procedure, had a documented Caprini score during pre-operative assessment, and, radiologically confirmed diagnosis of VTE irrespective of imaging modality.

Results
Thirteen patients from a total of 664 thoracic surgery admissions in 2020 were diagnosed with post-op VTE within 3 years. No patient developed VTE within 30 days post-surgery. The shortest period from operation date to VTE diagnosis was 86 days and longest was 1057 days. Seven patients were prescribed Enoxaparin post-discharge and six were not. Of these six patients, three were already on pre-operative anticoagulation therapy for pre-existing co-morbidities.

Conclusions
The Caprini is a useful risk stratification tool in patients undergoing thoracic surgery to prevent VTE within 30 days post-surgery. However, more research is required to analyse specific risk factors and procedure performed to quantify the likelihood of post-op VTE in high-risk patients. This scoring system could then be expanded and implemented within the community based on the timescales of VTE diagnosis in our study.
1176 Osteomyelitis as a Rare Complication of Delayed Diagnosis Spontaneous Bladder Perforation Post-Pelvic Radiotherapy: A Case Report
Authors: EL-Gheryani M , Kumar A 
Published: August 2024

Abstract
Spontaneous, delayed bladder perforation is a rare and serious complication of pelvic radiotherapy. Due to its rarity and late presentation, it usually causes further complications which warrant long inpatient stays before a diagnosis is made. Whilst most published cases highlight peritonitis as a common complication, our case has presented differently with pelvic osteomyelitis as another potential complication. Therefore, our objectives are to increase awareness about this presentation and highlight key aspects of quick diagnosis and management to prevent further complications.
A 76-year-old gentleman, with background of Parkinson’s disease and pelvic radiotherapy for prostate cancer 11 years ago, presented with gradual onset suprapubic pain. He was managed initially with antibiotics and long-term urethral catheter for pelvic osteomyelitis secondary to urinary bladder perforation and then discharged. However, he was readmitted two weeks later with worsening osteomyelitis, delirium and sub-therapeutic Parkinson’s disease. Therefore, bilateral nephrostomies were inserted for acute kidney injury (AKI), further antibiotics given via a peripheral central catheter (PICC) and a prolonged recovery ensued.
The clinical complications of delayed diagnosis of spontaneous bladder perforation in patients with history of pelvic radiotherapy are rare but difficult to manage. In addition, our case is the first one that highlights osteomyelitis as another potential complication and whilst there are different treatment modalities, the decision should be individualised.
1267 A Case of Cardiac Metastasis: Distant Rare Entity of Colorectal Cancer
Authors: Maharjan A , Paul A , Kalaiselvan R 
Published: August 2024

Abstract

Background
Cardiac metastasis arising from colorectal cancer is extremely rare (1.4-2%) and carries a poor prognosis. The literature review suggests only 31 case reports. Incidence might be underestimated as the majority remain clinically asymptomatic. Symptoms if present are consistent with heart failure. There are no established treatment protocols for managing this aggressive condition, necessitating an individualized treatment approach.

Case Report
A 66-year-old female with a past medical history of hypercholesterolemia and smoking was diagnosed with a recto-sigmoid tumour during a bowel cancer screening colonoscopy. The radiological staging was T4a N1b M0. MDT recommended neo-adjuvant radiotherapy ( SCRT). After SCRT restaging, the tumour showed regression in size. She underwent a robotic low anterior resection and de-functioning loop ileostomy, followed by adjuvant chemotherapy with a good response. During the pre-anaesthetic review for reversal of de-functioning loop ileostomy, an echocardiogram and CT PET revealed a mass in the right ventricle wall. This was histologically confirmed as adenocarcinoma on endomyocardial biopsy. MDT advised targeted adjuvant chemotherapy as this mass was inoperable. After 14 cycles of FOLFIRI (Irinotecan+Flurouracil+folinic acid)+Panitumumab, her repeat scans showed a reduction in right ventricular mass. She successfully underwent a reversal of her loop ileostomy with an uneventful recovery.

Conclusions
Colonic carcinoma can spread to the heart, which is aggressively fatal. Standardizing surveillance is crucial to early detection and improved outcomes. Requires further research to better understand this rare disease progression.
138 Intravenous Morphine Negatively Affects the Length of Hospital Stay in Elective Laparoscopic Major Colorectal Surgery
Authors: Moolamannil M C , Georgiades F , Bevan K 
Published: August 2024

Abstract

Aim
To identify if Morphine, a strong opioid with undesirable effects on bowel motility, during post-operative recovery from abdominal surgery , adversely affects the length of hospital stay.

Method
Data was collected retrospectively from patients who underwent elective laparoscopic colorectal surgery over a period of 6 months (July 2022 – December 2022).

Results
64 patients were identified, and 4 patients were excluded due to missing data, with a total of 60 patients included in this study. There was no difference in patient characteristics when right-sided and left-sided colonic resections were compared. 15mg of intravenous (IV) morphine delivered by patient-controlled analgesia (PCA) was identified as the median dose in our cohort. The length of hospital stays in those patients who received less than 15mg of IV morphine (50%) had a mean length of stay in the hospital of 5 days (median 4 days; range: 2-15 days) compared to those receiving more than 15mg with a mean length of stay in hospital of 9 days (median 5.5 days; range: 3-43 days; p&lt;0.001).

Conclusions
Our study reaffirms that increased use of IV morphine has a negative effect on time to opening bowels and a consequent adverse effect on the duration of hospital stay. Hence, alternate analgesia options, strict monitoring, and potential limitation of the total amount of IV morphine prescribed may be beneficial in selected patients undergoing laparoscopic colorectal surgery.