bluuebunny/crossref_metadata_2025_split huggingface dataset:
SP11.3 Utilising an Accelerated Delphi Process to Develop Consensus on The Requirement and Components of a Pre-procedural Core Robotic Surgery Curriculum
Authors: Burke Joshua , Fleming Christina , King Martin , El-Sayed Charlotte , Bach Simon P , Collins Justin 
Published: August 2023

Abstract

Aim
Robot-assisted Surgery (RAS) continues to grow globally. Despite this, in the UK and Ireland, it is estimated that over 70% of surgical trainees across all specialities have no access to robot-assisted surgical training (RAST). This study aimed to provide educational bodies guidance on a pre-procedural core robotic surgery curriculum (PPCRC) from the perspective of the end user; the surgical trainee.

Methods
The study was conducted in four Phases: P1: A steering group was formed and a systematic review conducted P2: Pan-Specialty Trainee Panel Virtual Classroom Discussion, P3: Accelerated Delphi Process and P4: Formulation of Recommendations. Forty-three surgeons in training representing all surgical specialties and training levels contributed to a three-round Delphi process. Additions to the second- and third-round surveys were formulated based on the answers and comments from previous rounds. Consensus opinion was defined as ≥80% agreement.

Results
There was 100% response from all three rounds. The formulated guidance showed good internal consistency (Cronbach alpha &gt;0.8). There was 97.7% agreement that a standardised PPCRC would be advantageous to training and that, independent of speciality, there should be a common approach (95.5% agreement). Consensus was reached in multiple areas: 1. Experience and Exposure, 2. Access and context, 3. Curriculum Components, 4 Target Groups and Delivery, 5. Objective Metrics, Benchmarking and Assessment.

Conclusions
Using the Delphi methodology, multispecialty consensus among trainees to develop and reach content validation for the requirements and components of a PPCRC in the UK and Ireland was achieved. This guidance will benefit from further validation following implementation.
SP11.6 UK Medical National Teaching Initiative (UKMNTI): A novel digital platform for the delivery of surgical education
Authors: Gobriel Morcos , Ahmed Nauman , Chan Anthony 
Published: August 2023

Abstract

Introduction
Online teaching delivery has seen a recent rise in popularity, but evidence suggests significant barriers such as inadequate digital infrastructures and limited technical abilities of educators and learners. We have developed a digital platform, UKMNTI.com, as proof of concept for cost-effective and reliable delivery of surgical education.

Methods
The platform was developed using an open-source Moodle content management system with video conferencing and real-time interactive capabilities. An initial session (‘acute abdomen’) was written and delivered using a constructivist pedagogy. A Likert Scale of Confidence was used to objectively assess feedback from learners as well as free-text comments.

Results
A total of 56 participants attended the session and 28 of them participated in the feedback ranging from medical students (n=13) to Foundation doctors (4), Core Trainees and Specialty Registrars (3) and Allied Health Professionals (8) from 8 countries. Access and delivery were conducted without technical issues and rated good overall (4/5). Knowledge of ‘the acute abdomen’ increased from average (2.5/5) to good (4/5), and learners were engaged (4/5) and found the content helpful (4/5).

Discussion
Digital platforms are effective adjuncts to the delivery of medical education and help address socio-economic factors such as the cost of living and contribute to the sustainability agenda.
With the above in mind, we created UKMNTI.com. UKMNTI.com is a new free clinical-oriented medical teaching website that was created to help medical trainees and students to keep their medical knowledge up to date. The website offers a regular teaching schedule along with a wealth of teaching tools, such as interactive modules, quizzes, and case studies.
SP11.11 Getting It Right First Time (GIRFT): An Audit of General Surgical Documentation in a District General Hospital
Authors: Rashid Samin , Tournas Ioannis , Parmar Chetan , Mukhtar Hasan 
Published: August 2023

Abstract

Aim
Getting It Right the First Time (GIRFT) has released national guidance regarding operation documentation for common general surgical procedures, namely laparoscopic appendicectomy, laparotomy & laparoscopic bowel resection surgery, laparoscopic cholecystectomy and inguinal hernia repair. This audit sought to assess compliance in a single District General Hospital Surgical Department.

Method
Retrospective analysis of operation notes was undertaken for consecutive cases. The audit included 25 laparoscopic appendicectomy, 25 laparoscopic cholecystectomy, 10 laparoscopic inguinal hernia, 20 open inguinal hernia and 10 laparotomy/laparoscopy with bowel resection procedures. Cases were included from a range of Consultants (range: 4 for laparoscopic inguinal hernia to 9 for laparoscopic appendicectomy). Operation notes were compared to the GIRFT guidelines.

Results
Overall compliance was 36% for open inguinal hernia, 44% for laparoscopic cholecystectomy, 45% for laparoscopic inguinal hernia, 54% for laparoscopy/laparotomy with bowel resection and 56% for laparoscopic appendicectomy.
Notable areas of poor compliance included documentation of achievement of the critical view of safety in laparoscopic cholecystectomy (28%), if the appendiceal base was healthy in appendicectomy (60%), if the ilioinguinal nerve was protected or divided (35%) or if the vas deferens/testicular vessels were protected (50%) in open inguinal hernia repair and post operative oral intake status after bowel resection (80%).

Conclusions
Overall there was poor compliance between the operation notes and the GIRFT guidelines. These can potentially jeopardise the position of the surgeon and Trust during medicolegal claims. Use of standardised pre-populated electronic operation notes will be introduced Department-wide and compliance re-audited.
SP11.14 Evaluating the Efficacy and Cognitive Load of a Real-Time Intelligent Coaching System versus Human Expert Instruction in Surgical Technical Skills Training: A Randomized Controlled Study
Authors: Tee Trisha , Yilmaz Recai , Fazlollahi Ali , Bakhdair Mohamad , Alsayegh Ahmad , Del Maestro Rolando 
Published: August 2023

Abstract

Aims
An artificial intelligence-driven tutoring system provides risk-free training on realistic simulated procedures and objective assessment to improve surgical technical skills. This study compared its teaching efficacy to human instructor training.

Methods
Ninety-eight medical students completed 5 simulated brain tumor resections, scored by the intelligent system. Participants were randomly sorted into 3 feedback groups: (1) no real-time feedback, (2) real-time intelligent instruction, (3) real-time human instruction. Each participant completed a base-line repetition without feedback. Group 1 received visual feedback based on expert benchmarks following each repetition. Group 2 was tutored by the intelligent system in real-time. After each repetition, the system provided the student’s error clips and correlating expert-level demonstrations. Group 3 was tutored by human instructors in real-time. After each repetition, instructors provided critiques and demonstrated correction techniques. Following the final repetition, each participant completed a questionnaire of Leppink’s Cognitive Load Index on a 5-point Likert scale. Performance scores were compared from the first to the last repetition of the task within and between-groups to assess learning.

Results
Compared with baseline, groups 2 and 3 significantly improved in performance by the third and second repetition, respectively (p&lt;0.01 and p=0.01). Between-groups comparison revealed significantly higher scores and extrinsic load for group 2 than group 3 in the fifth repetition, respectively (p&lt;0.01 and p&lt;0.01). No between-group differences existed for intrinsic and germane load.

Conclusion
The intelligent system provided more efficient learning than human instruction. Such systems may enhance trainees’ learning and facilitate the shift towards standardized, competency-based surgical training.
SP11.15 Stress Exposure Training in Surgery – A Narrative and Systematic Review
Authors: White Annabelle , Limb Chris , Elahwah Mohamed , Edwards Mark 
Published: August 2023

Abstract

Aim
The operating theatre is an environment associated with intense cognitive stimulus. The coordinated application of technical and non-technical skills is necessary to achieve optimal patient care. Surgeons may undergo a significant “stress response”, activated when perceived demands of a situation exceed perceived resources, leading to measurable variations in physiological and biochemical parameters. This results in impaired performance, demonstrated most acutely in junior and trainee surgeons.

Methods
A narrative and literature was undertaken searching for stress response, exposure, inoculation in healthcare, medicine, or surgery. 1332 eligible papers were identified, refined to 100 on abstract, with 37 undergoing full text review.

Results
Stress Exposure Training (SET) facilitates high performances in acutely stressful situations by inoculating individuals from the psychological and physiological impacts of stress. SET was initially a clinical intervention to treat stress-induced psychopathology. Routed in cognitive-behavioural therapy principles, it is now a generalisable training approach implemented by other high-stress high-performance industries, including the military and aeronautics.
High-fidelity simulation training is a recognised tool that is commonly applied in medical education. It promotes decision-making, team-working, and technical and communication skills in a controlled environment. Importantly, this tool has been shown to elicit an equivalent stress response to “live” clinical scenarios.

Conclusion
This review explores the current literature on mitigating stress responses in surgeons and SET, including its current applications and research localised to surgical education.   Finally, we propose a high-fidelity simulation training programme, aimed at junior surgeons-in-training based on the principles of SET comprised of gradually increasing stressors and appropriate psychological training in stress-response management.
Astrogliosis marker 11C-SL25.1188 PET in traumatic brain injury with persistent symptoms
Authors: Koshimori Yuko , Cusimano Michael D , Vieira Erica L , Rusjan Pablo M , Kish Stephen J , Vasdev Neil , Moriguchi Sho , Boileau Isabelle , Chao Thomas , Nasser Zahra , Ishrat Husain M , Faiz Khunsa , Braga Joeffre , Meyer Jeffrey H 
Published: August 2023

Abstract
Traumatic brain injury (TBI) is common but little is known why up to a third of patients have persisting symptoms. Astrogliosis, a pathophysiological response to brain injury, may be a potential therapeutic target, but demonstration of astrogliosis in the brain of humans with TBI and persistent symptoms is lacking.
Astroglial marker monoamine oxidase B (MAO-B) total distribution volume (11C-SL25.1188 VT), an index of MAO-B density, was measured in 29 TBI and 29 similarly aged healthy control cases with 11C-SL25.1188 PET, prioritizing prefrontal cortex (PFC) and cortex proximal to cortical convexity. Correlations of PFC 11C-SL25.1188 VT with psychomotor and processing speed; and serum blood measures implicated in astrogliosis were determined.
11C-SL25.1188 VT was greater in TBI in PFC (P = 0.00064) and cortex (P = 0.00038). PFC 11C-SL25.1188 VT inversely correlated with Comprehensive Trail Making Test psychomotor and processing speed (r = −0.48, P = 0.01). In participants scanned within 2 years of last TBI, PFC 11C-SL25.1188 VT correlated with serum glial fibrillary acid protein (r = 0.51, P = 0.037) and total tau (r = 0.74, P = 0.001).
Elevated 11C-SL25.1188 VT argues strongly for astrogliosis and therapeutics modifying astrogliosis towards curative phenotypes should be tested in TBI with persistent symptoms. Given substantive effect size, astrogliosis PET markers should be applied to stratify cases and/or assess target engagement for putative therapeutics targeting astrogliosis.
Female-specific enhancement of eosinophil recruitment and activation in a type 2 innate inflammation model in the lung
Authors: Karkout Rami , Gaudreault Véronique , Labrie Lydia , Aldossary Haya , Azalde Garcia Noelia , Shan Jichuan , Fixman Elizabeth D 
Published: August 2023

Abstract
A sex disparity in asthma prevalence and severity exists in humans. Multiple studies have highlighted the role of innate cells in shaping the adaptive immune system in chronic asthma. To explore the sex bias in the eosinophilic response, we delivered IL-33 to the lungs of mice and delineated the kinetics by which the inflammatory response was induced. Our data demonstrate that females recruited more eosinophils capable of responding to IL-33. Eosinophil activation occurred selectively in the lung tissue and was enhanced in females at all time points. This increase was associated with increased ex vivo type 2 cytokine and chemokine production and female-specific expansion of group 2 innate lymphoid cells lacking expression of the killer-cell lectin-like receptor G1. Our findings suggest that the enhanced eosinophilic response in females is due, firstly, to a greater proportion of eosinophils recruited to the lungs in females that can respond to IL-33; and secondly, to an enhanced production of type 2 cytokines in females. Our data provide insight into the mechanisms that guide the female-specific enhancement of eosinophil activation in the mouse and form the basis to characterize these responses in human asthmatics.
Simplified tree marking guidelines enhance value recovery as well as stand vigour in northern hardwood forests under selection management
Authors: Moreau Guillaume , Chagnon Catherine , Cecil-Cockwell Malcolm J L , Pothier David , Achim Alexis , Bédard Steve , Guillemette François , Caspersen John 
Published: August 2023

Abstract
In northern hardwood forests, tree markers select the trees to be harvested during logging operations using classification systems that assign harvest priorities based on the presence of a wide range of individual defects. According to the most recent advances in our understanding of the impact of defects on both tree vigour (the risk of mortality or decline in growth) and quality (the potential for recovering valuable sawlogs), tree markers should adopt a simpler classification system that considers fewer defects than the current operational practice, and they should prioritize the removal of trees with crown dieback. Since the probability of developing defects and dying increases substantially with tree diameter, tree markers should also favour the removal of larger trees that have maintained their quality. However, these recommendations were developed based on tree-level analyses. To provide further validation at the stand scale, we compared stand improvement and value recovery under three tree marking regimes: a new, simplified regime based on the recommendations above, and two regimes used in the province of Quebec, Canada. To do so, we conducted tree marking simulations and value recovery assessments in 14 managed stands distributed across the northern hardwood range of Quebec. Our results confirmed that the simplified tree marking regime not only facilitated stand improvement by removing a greater proportion of low-vigour trees, but also recovered significantly more value (17% on average) at the stand scale. By prioritizing the removal of trees with crown dieback, the simplified regime was superior at salvaging the current value of low-vigour trees before they die or decline in quality. Based on our results, we propose simplified and empirically-validated tree marking guidelines for northern hardwood forests.
Sp converted waves reveal the structure of the lithosphere below the Alps and their northern foreland
Authors: Kind Rainer , Schmid Stefan M , Schneider Felix , Meier Thomas , Yuan Xiaohui , Heit Ben , Schiffer Christian ,   AlpArray and SWATH-D Working Groups
Published: August 2023

SUMMARY
The structure of the lithosphere is reflecting its evolution. The Moho of the European lithosphere has already been studied intensively. This is, however, not yet the case for the lower boundary of the lithosphere, that is the lithosphere–asthenosphere boundary (LAB). We are using S-to-P converted seismic waves to study the structures of the Moho and the LAB beneath Europe including the greater Alpine Area with data from the AlpArray project and the European networks of permanent seismic stations. We use plain waveform stacking of converted waves without deconvolution and compare the results with stacking of deconvolved traces. We also compare Moho depths determinations using S-to-P converted waves with those obtained by other seismic methods. We present more detailed information about negative velocity gradients (NVG) below the Moho. Its lower bound may be interpreted as representing the LAB. We found that the thickness of the European mantle lithosphere is increasing from about 50°N towards the Alps along the entire east–west extension of the Alps. The NVG has also an east dipping component towards the Pannonian Basin and the Bohemian Massif. The Alps and their northern foreland north of about 50°N are surrounded in the east, west and north by a north dipping mantle lithosphere. Along 50°N, where the NVG is reversing its dip direction towards the north, is also the area along which the volcanoes of the European Cenozoic Rift System are located. Our results possibly indicate that the Alpine collision has deformed the entire lithosphere of the Alpine foreland as far north as about 50°N.
Using intersectionality to study gender and antimicrobial resistance in low- and middle-income countries
Authors: Gautron Juliette M C , Tu Thanh Giada , Barasa Violet , Voltolina Giovanna 
Published: August 2023

Abstract
Different sexes and genders experience differentiated risks of acquiring infections, including drug-resistant infections, and of becoming ill. Different genders also have different health-seeking behaviours that shape their likelihood of having access to and appropriately using and administering antimicrobials. Consequently, they are distinctly affected by antimicrobial resistance (AMR). As such, it is crucial to incorporate perspectives on sex and gender in the study of both AMR and antimicrobial use in order to present a full picture of AMR’s drivers and impact. An intersectional approach to understanding gender and AMR can display how gender and other components ‘intersect’ to shape the experiences of individuals and groups affected by AMR. However, there are insufficient data on the burden of AMR disaggregated by gender and other socio-economic characteristics, and where available, it is fragmented. For example, to date, the best estimate of the global burden of bacterial AMR published in The Lancet does not consider gender or other social stratifiers in its analysis. To address this evidence gap, we undertook a scoping review to examine how sex and gender compounded by other axes of marginalization influence one’s vulnerability and exposure to AMR as well as one’s access to and use of antimicrobials. We undertook a gendered analysis of AMR, using intersectionality as a concept to help us understand the multiple and overlapping ways in which different people experience exposure vulnerability to AMR. This approach is crucial in informing a more nuanced view of the burden and drivers of AMR. The intersectional gender lens should be taken into account in AMR surveillance, antimicrobial stewardship, infection prevention and control and public and professional awareness efforts, both donor and government funded, as well as national and international policies and programmes tackling AMR such as through national action plans.
Alternating Arenavirus Vector Immunization Generates Robust Polyfunctional Genotype Cross-Reactive Hepatitis B Virus–Specific CD8 T-Cell Responses and High Anti–Hepatitis B Surface Antigen Titers
Authors: Schmidt Sarah , Mengistu Meron , Daffis Stephane , Ahmadi-Erber Sarah , Deutschmann Daniela , Grigoriev Tetiana , Chu Ruth , Leung Cleo , Tomkinson Adrian , Uddin Mohammad Nizam , Moshkani Safiehkhatoon , Robek Michael D , Perry Jason , Lauterbach Henning , Orlinger Klaus , Fletcher Simon P , Balsitis Scott 
Published: August 2023

Abstract
Hepatitis B Virus (HBV) is a major driver of infectious disease mortality. Curative therapies are needed and ideally should induce CD8 T cell-mediated clearance of infected hepatocytes plus anti-hepatitis B surface antigen (HBsAg) antibodies (anti-HBs) to neutralize residual virus. We developed a novel therapeutic vaccine using non-replicating arenavirus vectors. Antigens were screened for genotype conservation and magnitude and genotype reactivity of T cell response, then cloned into Pichinde virus (PICV) vectors (recombinant PICV, GS-2829) and lymphocytic choriomeningitis virus (LCMV) vectors (replication-incompetent, GS-6779). Alternating immunizations with GS-2829 and GS-6779 induced high-magnitude HBV T cell responses, and high anti-HBs titers. Dose schedule optimization in macaques achieved strong polyfunctional CD8 T cell responses against core, HBsAg, and polymerase and high titer anti-HBs. In AAV-HBV mice, GS-2829 and GS-6779 were efficacious in animals with low pre-treatment serum HBsAg. Based on these results, GS-2829 and GS-6779 could become a central component of cure regimens.
Neuropeptide Calcitonin Gene-Related Peptide Promotes Immune Homeostasis of Bacterial Meningitis by Inducing Major Histocompatibility Complex Class II Ubiquitination
Authors: Li Yuxiang , Wang Lanying , Gao Zhenfang , Zhou Jie , Xie Shun , Li Ge , Hou Chunmei , Wang Zhiding , Lv Zhonglin , Wang Renxi , Han Gencheng 
Published: August 2023

Abstract

Background
Calcitonin gene-related peptide (CGRP), an immunomodulatory neuropeptide, is important for regulating pain transmission, vasodilation, and the inflammatory response. However, the molecular mechanisms of the CGRP-mediated immune response remain unknown.

Methods
The effects of CGRP on bacterial meningitis (BM) and its underlying mechanisms were investigated in BM mice in vivo and macrophages in vitro.

Results
Peripheral injection of CGRP attenuated cytokine storms and protected mice from fatal pneumococcal meningitis, marked by increased bacterial clearance, improved neuroethology, and reduced mortality. When the underlying mechanisms were investigated, we found that CGRP induces proteasome-dependent degradation of major histocompatibility complex class II (MHC-II) in macrophages and then inhibits CD4+ T-cell activation. MARCH1 was identified as an E3 ligase that can be induced by CGRP engagement and promote K48-linked ubiquitination and degradation of MHC-II in macrophages. These results provide new insights into neuropeptide CGRP-mediated immune regulation mechanisms.

Conclusions
We conclude that targeting the nervous system and manipulating neuroimmune communication is a promising strategy for treating intracranial infections like BM.