bluuebunny/crossref_metadata_2025_split huggingface dataset:
eP100 Investigating the incidence of appendiceal neoplasms and peri-operative factors indicating their presence
Authors: Moore Eleanor , Durrell Chloe , Battersby Christopher 
Published: January 2025

Abstract

Aims
Appendiceal neoplasms are rare and are often diagnosed incidentally on histology after appendicectomy. Informed consent for non-operative management of appendicitis must include the risk of missed neoplasia. Surgical technique must minimise the risk of a suboptimal specimen. This study aimed to clarify the incidence of appendiceal neoplasms and investigate peri-operative factors indicating a diagnosis of neoplasia.

Methods
This single-centre retrospective study included all appendix specimens from January 2015 to July 2023. Appendiceal neoplasms were identified from pathology coding. All other data was gathered from review of patient records.

Results
44 appendiceal neoplasms were identified from 1661 appendix specimens (2.65%). The median age of patients with a neoplasm was 60 (IQR 46-71); 52.3% were male.
Histology: mucinous neoplasms (59.1%); neuroendocrine tumours (25.0%); adenocarcinomas (13.6%); adenomas with high grade dysplasia (2.30%). 25 neoplasms (56.8%) were resected as an emergency. 60.0% of emergency patients underwent pre-operative CT scanning; only 20.0% of CTs raised suspicion of an appendiceal neoplasm; 53.3% were reported as uncomplicated appendicitis. Of the neoplasms resected during emergency surgery, there was no intra-operative suspicion of neoplasia in 56.0% of cases. Operation notes did not reliably record mesoappendix management or delivery of the specimen.

Conclusions
Missed primary appendiceal neoplasms are an important consideration when counselling patients for management of acute appendicitis. This study shows that peri-operative suspicion of neoplasia is unreliable. It is, therefore, important to adopt a standardised approach for all appendicectomies to include the mesoappendix in all specimens with clear documentation of operative technique to optimise patient care.
eP106 Jejunal Diverticulosis: A Rare Cause of An Acute Abdomen
Authors: Selorfia Shammael , Pettit Harry 
Published: January 2025

Abstract

Background and Aim
Jejunal diverticulosis is a rare condition with a reported incidence rate of approximately 1% in the literature. Patients with this condition often present with non-specific abdominal pain and occasionally suffer complications including perforation, gastrointestinal bleed and sepsis requiring emergency surgical intervention. Diverticulum refers to the outpouching of any part of a hollow organ in the body. It can often be seen in the large bowel of the gastrointestinal tract and less frequently in the small bowel. Jejunal diverticulae presentations are often seen in the sixth and seventh decades. There have been reports of a slight male to female predominance with ratio of 1.52:1. Here, we present a case of a 36-year-old female with previously undiagnosed jejunal diverticulae, that presented with severe abdominal pain and signs of acute abdomen.

Results
Perioperative Computer Tomography examination suggestive of perforation and examination eliciting signs of generalised peritonitis led to an emergency laparotomy revealing multiple jejunal diverticulae.

Conclusion
It is important to highlight this condition because although rare, it should be considered as a differential diagnosis in patients presenting with an acute abdomen.
eP107 Adherence to guidelines re: providing patient, the copy of consent form prior to procedure
Authors: Najdawi Amal , Selorfia Shammael , Malkawi Hashem , Sajid Muhammad 
Published: January 2025

Abstract

Aims
To identify General Surgery patients on elective and CEPOD theatre case lists and measure how often patients are offered a copy of their consent forms. In accordance with the Royal College of Surgeons guideline on consent- “Consent: Supported Decision-Making ”The patient should be offered a copy of their consent form after signing so they can review and retain. We aim to establish the number and percentage of patients receiving a copy of their consent forms in the General Surgery Departments at a Major Trauma Centre and a DGH.

Methods
Retrospective study. Patients were identified on Elective Surgical lists using Bluespier theatres Patients were identified on the CEPOD list during morning handover, confirmed surgical list from theatre coordinator on the day off and using Bluespier theatres

Results
70 adult consent forms were reviewed during the patients admission over a period of 4 weeks. Data collected included number of patients provided a copy of the consent forms (0%).
Interventions in an attempt to improve adherence to guidelines were introduced.
A repeat audit of a further set of set of 35 patients was completed to assess the effectiveness of our interventions and there was an increased rate of 28% in the patients consent forms copies being offered as part of the consent process.

Conclusion
The results of this study suggests important areas of improvement. Our intervention has improved the quality of consenting within our hospitals. With these enhancements set to continue to further develop.
eP108 Analysis of outcomes of anterior resections in an emergency setting for large bowel pathologies.Is defunctioning mandatory?
Authors: Subramanian Atreya Mukund , Swaminathan Christie , Brooks Benjamin 
Published: January 2025

Abstract

Aim
Analysis of outcomes of emergency anterior resections.

Methods
This was a retrospective single centre study conducted over 5 years, including all emergency anterior resections. Elective/semi-elective cases with adequate bowel preparation were excluded .Soft and healthy bowel proximal to the staple line with no contamination were additional criteria considered to not defunction the anastamosis. Cases with perforation/peritonitis/ high physiological risk (ASA &gt;=4) were defunctioned. Patients refusing a stoma were also excluded. The primary outcome of this study was to determine the complication/leak rates following an emergency anterior resection in both groups(defunctioned vs not defunctioned) . Complications were classified as major or minor (clavien-dindo score &gt;=3 Vs &lt;=2) respectively.

Results
47 patients were studied of which 13 were not defunctioned. Major complications in the non-defunctioned vs defunctioned group were 1 and 2 respectively (7.7%, 5.9%); all being secondary to anastamotic leaks. Minor complications were 3 and 20 respectively (23%, 58.8%); majority being wound infections. Both groups had a comparable duration of hospital stay at 21.6 and 21.3 days respectively. Similarly ITU admission rates were 4 and 14 respectively (30.7%, 41.1%) Readmission rates were 0 vs 4 respectively.Both groups were physiologically comparable with ASA grades of 2.18 and 1.91 respectively.

Conclusion
The leak rates for both groups were similar, despite a higher septic complication rate in the defunctioned group. With careful case selection defunctioning of an anterior resection anastamosis maybe avoided even in the emergency setting, though further studies will be needed to validate our results.
eP120 Adoption of a "mass casualty" model of triage on the surgical SDEC. A model to allow prioritisation of the Senior Decision Maker resource
Authors: McArdle Alistair , Evans Luke 
Published: January 2025

Abstract
Traditional models of acute care have been changing to meet targets of ambulance offload and ED decompression. This has led to a step change in the number of patients sent to the surgical SDEC without an increase in pathology. The most precious resource on the SDEC is the availability of the Senior Decision Maker and is not sufficient to meet the aspiration that every patient has early SDM input. Patients without pathology are often harder to manage for less experienced staff and can endure over investigation and unnecessary admission without the input of SDM's. As a corollary, patients with more urgent surgical pathology often have a simpler process of decision making in the initial stages. We sought to determine if a model can be found to predict which patients were likely to be discharged (and therefore benefit from SDM input) and which need admission and protocolised (intial)care.
3000 consecutive GI surgical referrals were analysed to determine which patients were more or less likely to be admitted based on pre-admission referral information.
There was a significant increased risk of admission for male sex, age and NEWS2. RR of admission was four times higher for male, over the age &gt;70yr with NEWS2 ≥2 RR 2.01 (1.4-2.9) vs female, &lt;50yr with NEWS2 ≤1 RR 0.46 (0.36 - 0.57).
When faced with a mass-casualty situation where flow is paramount, SDM resources should be directed to younger, female patients with normal physiology as these are most likely to be discharged.
eP129 Malnutrition risk assessment of patients with acute small bowel obstruction; a ‘MUST’ for all members of the surgical team
Authors: Obure Ralph , Lin Naychi , Krishna A , Patel Panna 
Published: January 2025

Abstract

Aim
The Malnutrition Universal Screening Tool (MUST) is widely utilised however is frequently completed by the least experienced healthcare providers who may not fully appreciate the impact and management course for Small Bowel Obstruction (SBO). Patients with SBO have acute intestinal failure with unpredictable periods of nil nutritional intake hence score a minimum of 2 (high risk) on MUST.

Methods
Records of patients managed for small bowel obstruction over a 6-month period (January to June 2024) meeting the inclusion criteria of the 2017 National Audit on Small Bowel Obstruction (NASBO) were reviewed.

Results
Sixty-two patients were managed for SBO over the period reviewed. Post-operative adhesions was the commonest aetiology (53%). Overall, 36 patients (58%) had surgical management. All patients had a MUST assessment at admission however only 26% of patients had a score of ≥ 2. Majority of patients presented within 2 days of onset of symptoms. Restoration of enteral nutrition was achieved within 72 hours for 90% of patients managed conservatively and 67% for those managed operatively. A dietician review and/or any form of nutritional intervention was undertaken in 42% of patients.

Conclusion
Malnutrition risk was underestimated in patients with small bowel obstruction despite all patients having a MUST assessment. This may have led to missed opportunities for nutritional interventions. It is imperative to not only educate staff delegated to complete the MUST score but also to have more experienced members of the team involved in malnutrition risk assessment.
eP136 Enhancing Morbidity Prediction in Emergency Laparotomy: A Comparative Study of NELA and ACS Risk Calculators
Authors: Ahmed Nauman , Khawaja Zeeshan 
Published: January 2025

Abstract

Introduction
Emergency laparotomy (EL) is a high-risk procedure often linked to significant morbidity and mortality. While efforts have reduced mortality in EL patients, limited research focuses on predicting and improving morbidity outcomes. Current tools like the National Emergency Laparotomy Audit (NELA) and the American College of Surgeons (ACS) calculators mostly estimate mortality risks, with less focus on morbidity. This study aims to compare the predictive accuracy of these calculators to address the gap in morbidity predictions for EL patients.

Methods
A descriptive cross-sectional study analyzed data from 330 patients who underwent emergency laparotomy from January 2021 to January 2023, using the Hospital NELA database. Patient characteristics, surgery type, estimated risk, and adverse events were assessed with SPSS version 26. Stepwise Multiple Linear Regression, Spearman and Pearson correlation coefficients, and Paired Sample T-tests were used to evaluate morbidity predictors and compare outcomes.

Results
The study found significant discrepancies between the NELA and ACS morbidity predictions. NELA overestimated both preoperative (Mean = 70.17, SD = 23.14) and postoperative morbidity (Mean = 70.58, SD = 24.23), compared to ACS (Mean = 33.20, SD = 15.55), which was much higher than the actual observed morbidity (Mean = 1.37, SD = 0.49). No significant correlation was found between morbidity predictions, although a moderate correlation was noted for hospital stay predictions (r = 0.560, p &lt; 0.001).

Conclusion
This study underscores the need for improved morbidity prediction tools in EL. NELA significantly overestimates morbidity, highlighting the importance of refining these models to better guide clinical decisions.
eP138 A Surgical Remote Monitoring Virtual Ward (RMVW); A one year experience
Authors: Pospyelova Darya , Sheehan Ciara , Uttley Abigail , D’angelo Alissia , Peckham-Cooper Adam 
Published: January 2025

Abstract

Background
Virtual wards are becoming an integral part of NHS service delivery, offering hospital-level care at patients’ usual place of residence. They aim to reduce hospital bed occupancy and pressure on hospital resources. In September 2023 a tertiary teaching hospital introduced a RMVW accessible to acute surgical patients, and offering novel digitally supported healthcare solutions.

Aims & Methods
This study aimed to evaluate the effectiveness of the RMVW in managing acute surgical patients. Prospective data was collected of all patients admitted to the RMVW on any of four bespoke pathways from October 2023. Data was collected using the local electronic patient record and organised in Excel before analysis by two clinical professionals.

Results
Since inception in October 2023, 267 patients were admitted to the RMVW across four pathways: 83:ERCP, 102:general surgical monitoring (GSM), 52:hot gallbladder (HGB) and 30:ambulatory pancreatitis. Average length of stay (LOS) was 5.7, 6.4, 5.6 and 4.5 days respectively. Readmission rates were highest for both ERCP and GSM (13%). Cumulatively the RMVW saved x acute inpatient beds in a year.

Conclusion
The RMVW is both effective and safe for managing a variety of acute surgical patients at home. This study demonstrates a clear reduction in hospital bed occupancy and good safety profile with low readmission rates reported. With increasing pressures on the established hospital bed base these pathways present a huge opportunity to deliver novel and innovative strategies to manage the unselected emergency surgical patients better.
Toward comparative analysis of right-authoritarian politics: Argentina, India, and the US
Authors: Bauer A J , Roy Srirupa , Gago Verónica 
Published: January 2025

Abstract
Right-wing parties and ideologies have grown more salient in several country contexts over the course of the past decade, coinciding with widespread international adoption of social media. This interview, which features specialists in the contexts of Argentina, India, and the US, challenges conventional media determinist approaches. Emphasizing historical contingency and country-level political specificity, it models a comparative approach to studying right authoritarianism across distinct country contexts—against determinism and toward international resistance.
Stabilized mascon solutions through combinations of GRACE and SLR normal equations
Authors: Croteau M J , Loomis B D , Sabaka T J 
Published: January 2025

SUMMARY
A new global mascon solution using the Gravity Recovery and Climate Experiment (GRACE) and GRACE Follow-On data is co-estimated with satellite laser ranging (SLR) measurements to seven major geodetic satellites. This combined solution is compared with an otherwise similar GRACE-only solution to determine improvements in the estimate. We find similar performance between both solutions in the recovered mass change, but significant improvements in the associated errors in the combination solution. Errors in recovered basin mass change are 10–20 per cent better for the combination solution across all basin sizes, with the greatest improvements in high-latitude ice sheets. These results lead to our recommendation that all GRACE Level 3 mascon and spherical harmonic user-oriented gridded solutions should include SLR information during the solution inversion. As an ancillary contribution, we also provide validation of the choice of truncated spherical harmonics used in determining GRACE Technical Note 14, the current recommended mechanism for including SLR information with GRACE solutions in post-processing.
Nutrition literacy in Vietnamese pregnant women: a cross-sectional study
Authors: Nguyen Hoan Thi , Tran Hang Thi Thuy , Dao-Tran Tiet-Hanh , Huang Li-Chi 
Published: January 2025

Abstract
Inadequate nutrition intake during pregnancy elevates the risk of adverse health outcomes during pregnancy, with potential long-term repercussions for both mother and child, extending to subsequent generations. Current initiatives to improve individual dietary habits emphasize promoting nutrition literacy (NL), which encompasses the ability to access, comprehend, and use basic nutrition information and services necessary for making appropriate nutrition decisions. However, there were limited data on the NL of pregnant women in Vietnam. Therefore, this study aims to explore the NL levels of Vietnamese pregnant women and examine the factors related to their NL. A total of 360 Vietnamese pregnant women participated in the study from May to September 2023. A validated questionnaire (Nutrition Literacy Assessment Instrument for Pregnant Women, NLAI-P), assessing the knowledge, behavior and skill, was applied. A general linear model with univariate linear regression analysis was conducted to identify predictor factors of NL. The findings revealed that 70.3% of participants had inadequate NL. Among the three dimensions, nutrition knowledge was particularly low, with no respondents achieving an adequate level and 94.7% scoring at an inadequate level. High household monthly income, age, normal prepregnancy weight and indoor work were statistically associated with higher NL scores. This study highlights the limited NL among Vietnamese pregnant women. Increasing NL is crucial for supporting their optimal healthy diet, enhancing the health of pregnant women and their offspring and future generations.
Measurement tools used to assess individual health assets among refugee populations: a scoping review
Authors: Ewunie Temesgen Muche , Hayen Andrew , Dawson Angela 
Published: January 2025

Abstract
Forced migration is increasing globally, which has detrimental effects on the physical and mental health of refugees, who may face significant challenges accessing healthcare services. However, refugees also possess considerable strengths or assets that can protect against various health challenges. Identifying and strengthening the individual health assets of refugees is critical to promoting their health and mitigating these health challenges. Yet, there is a paucity of data on refugees’ individual health assets, including tools to measure them. Therefore, this scoping review aimed to identify and summarise the available measurement tools to assess the individual health assets of refugees. We conducted a comprehensive literature search using six electronic databases and a Google search without restrictions on publication dates. We used Arksey and O’Malley’s methodological framework approach to streamline the review processes. Forty-one eligible studies were included, from which 28 individual health asset tools were identified. Of these, 11 tools were tested for validity in refugee populations. Among the validated tools, the reliability scores for the measures of individual health asset outcomes, including resilience (Child and Youth Resilience Measure, Wagnild and Young's Resilience Scale, and Psychological Resilience Scale), acculturation (Vancouver Index of Acculturation and Bicultural Involvement Questionnaire), self-esteem (Rosenberg Self-Esteem Scale), and self-efficacy (Generalized Self-Efficacy Scale), ranged from good to excellent. The findings provide guidance for health service planners, humanitarian organisations, and researchers regarding the appropriateness and quality of tools that can be applied to assess individual health assets, which are crucial for designing culturally sensitive asset-based health promotion interventions for refugees.
Genome-wide association study of urinary cadmium levels in current smokers from the multiethnic cohort study
Authors: Sullivan Shannon M , Murphy Sharon E , Stram Daniel O , Wilkens Lynne R , Haiman Christopher A , Le Marchand Loïc , Stepanov Irina , Park S Lani 
Published: January 2025

Abstract

Background
Cadmium (Cd), classified as an International Agency for Research on Cancer (IARC) Group 1 human carcinogen, is present in cigarette smoke. Recent studies have illustrated the potential role of genetics in influencing Cd biomarker levels.

Methods
We conducted a genome-wide association study (GWAS) of urinary Cd levels in 1977 current smokers from the Multiethnic Cohort Study, comprising participants from five different racial and ethnic groups. Linear regression models were adjusted for age at urine collection, sex, self-reported race/ethnicity, and the top ten leading principal components.

Results
Among the 11 710 497 single nucleotide polymorphisms (SNP) analyzed, no associations with urinary Cd reached genome-wide significance (P &lt; 5.0 × 10−8). Notably, five variants demonstrated suggestive associations with urinary Cd levels (P &lt; 1.0 × 10−6). Lead variants included: rs10097646 in the SCARA gene at 8q13.2 (P = 2.62 × 10−7); rs7444817 in the NIPBL gene at 5p13.2 (P = 3.10 × 10−7), rs830422 in the SPINK4 gene at 9q13.2 (P = 4.89 × 10−7); chrX:145489901 in the SLC9A7 gene at Xq121.1 (P = 5.38 × 10−7); and rs73074456 at 5p13.3 (P = 5.86 × 10−7).

Conclusions
Our GWAS of urinary Cd levels in a diverse population of people who smoke, revealed suggestive associations with variants in SCARA5, NIPBL, SPINK4, SLC9A7, and 5p13.3. These findings underscore the potential role of genetic factors in understanding and mitigating the health risks associated with internal dose of carcinogens, particularly in the context of tobacco-related carcinogens.
Flexibility and Rigidity of Conformal Embeddings in Lorentzian Manifolds
Authors: Boukholkhal Alaa 
Published: January 2025

Abstract
We prove that for any Riemannian metric $g$ on a closed orientable surface $\Sigma $ and any spacelike embedding $f:\Sigma \rightarrow M$ in a pseudo-Riemannian manifold $(M,h)$, the embedding $f$ can be $C^{0}$-approximated by a smooth conformal embedding for $g$. If in addition, $M$ is a quotient of the $(2+1)$-dimensional solid timelike cone by a cocompact lattice of $SO^{\circ }(2,1)$, we show that the set of negatively curved metrics on $\Sigma $ that admit isometric embeddings in $M$ projects into a relatively compact set in the Teichmüller space.
Sofosbuvir as post-exposure prophylaxis for yellow fever–associated viscerotropic disease (YEL-AVD)
Authors: Barrett Jessica , Muntengesa Ernest , Warrell Clare , Rampling Tommy , Owen Jodie , Patel Dipti , Bhagani Sanjay , Moores Rachel , Scobie Antonia 
Published: January 2025

Abstract

Objectives
Yellow fever–associated viscerotropic disease (YEL-AVD) is a rare but serious complication arising from administration of live-attenuated yellow fever vaccine to individuals with risk factors such as thymectomy. At present there is no evidence-based treatment, and case fatality rates are high. Sofosbuvir, an NS5B nucleotide inhibitor, has activity against yellow fever virus in vitro and in vivo.

Patient and methods
Here we describe clinical and virological response to use of off-licence sofosbuvir as post-exposure prophylaxis for a patient inadvertently given yellow fever vaccine despite previous thymectomy.

Results
A 14-day course of oral sofosbuvir was administered in an outpatient setting with regular clinical and biochemical monitoring. The patient remained well without developing clinical features of YEL-AVD and did not experience adverse effects from the treatment.

Conclusions
This supports the use of sofosbuvir as post-exposure prophylaxis in patients at high risk of developing YEL-AVD. Ongoing trials of efficacy of sofosbuvir in yellow fever infection may result in stronger support for this approach in the future.