bluuebunny/crossref_metadata_2025_split huggingface dataset:
Tribo-performance analysis of white ark shell powder/grewia optiva fiber reinforced brake friction composites
Authors: Nain Sunil , Kumar Ankit , Ahlawat Vishal 
Published: August 2023

Abstract
This work presents a comparative tribo-performance of two eco-friendly brake friction composites (EBFC’s), developed using white ark shell powder (WASP) and treated Grewia Optiva (GO) fibers as key ingredients, with a commercial brake friction material (CBFM). EBFC-1 and EBFC-2 were developed with 30/5: WASP/GO fiber and 25/10: WASP/GO fiber respectively using compression molding. The physico-mechanical properties of the developed samples were investigated as per IS2742: Part 3 standards. Thermal gravimetric analysis (TGA) was performed up to 800 °C to predict the thermal stability. The specimens were characterized for friction and wear properties using a tribo-test setup as per ASTM G99 standards under the normal loads varying from 100 N to 200 N at 1.7 m s−1 and 3.3 m s−1 of sliding velocities. The EBFC specimens offered lower friction coefficient and better wear resistance than the CBFM. The developed EBFCs offered better stability coefficient than the CBFM. The EBFC specimens showed good compatibility and integrity with the resin material as compared to the CBFM as evident from SEM analysis. Based on the performance, WASP may be recommended as a potential filler and GO fibers as reinforcement in brake friction compositions to enhance wear resistance, stability and minimizing the friction fluctuations.
Should we all die asleep? The problem of the normalization of palliative sedation
Authors: van Delden Johannes J M , Heijltjes Madelon T , Harwood Rowan H 
Published: August 2023

Abstract
Palliative sedation is a medical intervention to manage distress in dying patients, by reducing consciousness when symptom-directed therapies fail. Continuous deep sedation is ethically sensitive because it may shorten life and completely prevents communication. But sedation short of this is also common. There has been a steady increase in the use of sedation over recent decades. Sedation may have become a means to die while sleeping, rather than a method of last resort to alleviate suffering. Sedation may be requested or expected by patients, families or staff. The need for sedation may be being interpreted more loosely. The acceptance of a ‘tolerable amount of discomfort’ may have lost ground to a desire to get the final phase over with quickly. Sedation is not always a bad thing. Medical care is otherwise unable to completely control all distressing symptoms in every patient. Sedation may result from other necessary symptom control drugs. Dying when sedated can be seen by as ‘peaceful’. We feel it is necessary, however, to highlight three caveats: the need to manage expectations, the cost in terms of loss of communication, and the grey area between continuous deep sedation and euthanasia. We conclude that there may be good grounds for sedation in palliative care, and in some cases, continuous deep sedation may be used as a last resort. But the criteria of necessary and proportionate drug treatment should remain. The normalisation of sedation into dying while sleeping should be resisted.
RibDif2: expanding amplicon analysis to full genomes
Authors: Murphy Robert , Strube Mikael Lenz 
Published: August 2023

Abstract

Motivation
As previously described, amplicon analysis of the bacterial 16S gene has several limitations owing to fundamental characteristics of both the 16S gene and technological restrictions. Previously, RibDif was introduced to help quantify these limitations by detailed analysis of a given genera and the 16S gene profile of its members, notably multiplicity and divergence of 16S alleles within genomes as well as shared alleles between species. Apart from using amplicon analysis for only the 16S gene, amplicons derived from genus-specific genes or even functional genes are increasingly being utilized. Moreover, long-read technologies are progressively being used to sequence longer amplicons, and since these inherently contain more information, they may likely alleviate the issues proposed in RibDif.

Results
Taking these phenomena into account, we here propose RibDif2. RibDif2 retains the 16S-optimized functionality of the original RibDif but can now run any set of primers on any part of the genome in any set of organisms, be it prokaryote, eukaryote, or archaea. We demonstrate this new functionality by showing full species resolution of Pseudoalteromonas using complete rRNA-operon amplicons, as well as selection of optimally discriminatory primers for Staphylococcus and Pseudomonas. Moreover, we show a potential bias toward terrestrial bacteria relative to marine ones for primers amplifying biosynthetic gene clusters and lastly suggest optimal primers to differentiate the members of the insect genus Drosophila. We believe that RibDif2 will facilitate the work of all scientists using amplicon sequencing, especially in the era of long-read sequencing.

Availability and implementation
Ribdif2 is freely available at https://github.com/Rob-murphys/ribdif.
QuTIE: quantum optimization for target identification by enzymes
Authors: Ngo Hoang M , Thai My T , Kahveci Tamer 
Published: August 2023

Abstract

Summary
Target identification by enzymes (TIE) problem aims to identify the set of enzymes in a given metabolic network, such that their inhibition eliminates a given set of target compounds associated with a disease while incurring minimum damage to the rest of the compounds. This is a NP-hard problem, and thus optimal solutions using classical computers fail to scale to large metabolic networks. In this article, we develop the first quantum optimization solution, called QuTIE (quantum optimization for target identification by enzymes), to this NP-hard problem. We do that by developing an equivalent formulation of the TIE problem in quadratic unconstrained binary optimization form. We then map it to a logical graph, and embed the logical graph on a quantum hardware graph. Our experimental results on 27 metabolic networks from Escherichia coli, Homo sapiens, and Mus musculus show that QuTIE yields solutions that are optimal or almost optimal. Our experiments also demonstrate that QuTIE can successfully identify enzyme targets already verified in wet-lab experiments for 14 major disease classes.

Availability and implementation
Code and sample data are available at: https://github.com/ngominhhoang/Quantum-Target-Identification-by-Enzymes.
Aquaporin 9 causes recurrent spontaneous abortion by inhibiting trophoblast cell epithelial-mesenchymal transformation and invasion through the PI3K/AKT pathway
Authors: Ma Nana , Liu Bo , Jin Yufu , Wang Jiawei , Qin Weili , Zheng Fengque , Qin Rongyan , Li Jiaxu , Hang Fu , Qin Aiping 
Published: August 2023

Abstract

Background
Invasion of the endometrium by trophoblast cells is a key event during pregnancy, although the underlying mechanism remains unclear. Aquaporin 9 (AQP 9) is expressed in many eukaryotes and is associated with cell invasion. The objective of this study was to evaluate the significance of AQP9 in recurrent spontaneous abortion.

Methods
We screened the GSE22490 dataset and further differentiated aquaporin 9 expression in villi. AQP9 was evaluated as one of the key factors in abortion by injecting AQP9 overexpressed plasmid into the uterus of CD1 mice. Trophoblast cells were transfected with AQP9-overexpressing plasmid or siAQP9 to measure cell proliferation, migration, invasion, and apoptosis. Western blot was used to measure changes in the expression of invasion, epithelial-mesenchymal transformation process, and PI3K/AKT pathway. Finally, the role of AQP9 in PI3K/AKT signaling pathway was determined using the PI3K/AKT inhibitor, LY294002, and activator, 740Y-P.

Results
AQP9 is highly expressed in recurrent spontaneous abortion villus. Intrauterine injections of AQP9-overexpressing plasmid into CD1 mice resulted in atrophy and blackness of the gestational sac and increased the absorption rate, it is the causative factor of abortion. AQP9 upregulation inhibited the proliferation, invasion, migration, and epithelial-mesenchymal transformation process in vitro of trophoblast cells and increased cell apoptosis. The opposite result was observed after silencing AQP9. AQP9 overexpression also inhibited the PI3K/AKT pathway. LY294002 and 740Y-P partially recovered AQP9-induced trophoblast invasion and migration via the PI3K/AKT pathway.

Conclusions
AQP9 reduces the invasive ability of trophoblast cells by regulating PI3K/AKT signaling pathway, participating in recurrent spontaneous abortion.
SP1.1 Comparison of major abdominal emergency surgery outcomes across different organisational models of emergency surgical care: analysis of the UK NELA national database
Authors: Anand Easan , Rahman Saqib , Pucher Philip , Mercer Stuart 
Published: August 2023

Abstract

Aims
Emergency General Surgery (EGS) admissions are high risk and account for 14000 intensive care admissions costing over £88 million per year. This aim of this study is to understand the impact of the emergency general surgery model of care on outcomes from emergency laparotomies.

Methods
Data was obtained from the NELA database. Patients were dichotomised into either EGS hospital or non - EGS Hospital. EGS hospital is defined as a hospital where &gt;5 % of the in-hours emergency laparotomy operating is performed by an emergency general surgeon.
The primary outcome was in – hospital mortality. Secondary outcomes were ITU length of stay and duration of hospital stay. A propensity score weighting approach was used to reduce confounding and selection bias.

Results
115,509 patients were included in the final analysis. Patient characteristics were similar between the 2 groups. Following propensity score weighting, mean SMD reduced from 0.034 to &lt;0.001.
In-hospital mortality was similar (10.8% vs 11.1%, p=0.094), with mean length of stay (16.7 vs 16.1 days, p&lt;0.001) and ITU stay (2.8 vs 2.6 days, p&lt;0.001) persistently longer in patients treated in EGS systems.

Conclusions
There is no significant association between the emergency surgery hospital model of care and in – hospital mortality in emergency laparotomy patients, suggesting the emergency surgery model of care can be utilised effectively without adversely affecting patient outcomes. There is, however, a significant association between the emergency surgery hospital model of care and an increased length of ITU stay and overall hospital stay. Further studies are required to examine the impact of changing models of EGS delivery in the UK.
SP1.12 Laparoscopic Hartmann’s procedure for diverticular perforation reduces length of stay and mortality
Authors: Finch Louise , Eid Joana , Mercer Stuart 
Published: August 2023

Abstract

Introduction
Hartmann's procedure for perforated diverticular disease is a common emergency abdominal operation; with a mean length of stay of over 2 weeks and a mortality of 8%. This study looks at whether the laparoscopic approach is feasible and might lead to improved outcomes.

Methods
The national NELA dataset was interrogated to find patients undergoing Hartmann's procedure for diverticular disease. Data were analysed according to surgical approach, length of stay and 30-day mortality.

Results
Over a 4-year period, 4061 patients underwent Hartmann's procedure for diverticular disease; 459 (11%) were started laparoscopically, and 162 (4%) were completed laparoscopically. 30 of 176 acute hospitals performed over half of laparoscopic cases, and 139 of 176 hospitals performed fewer than 1 each year. Mean length of stay was 17 days after open Hartmann's versus 11 days after the laparoscopic approach. Mortality in the open group was 8.2% versus 5.2% if surgery was started laparoscopically, and 1.3% if surgery was completed laparoscopically. This relationship remained when only patients with a predicted NELA mortality of less than 10% were considered (2.5% versus 1.4%). Observed versus expected mortality in the open group was 0.95, versus 0.63 in those undergoing laparoscopic surgery.

Conclusions
The laparoscopic approach to Hartmann's procedure for diverticulitis is associated with shorter hospital stay and reduced mortality. There is undoubtedly bias from patient selection, but some hospitals offer laparoscopy in over 50% of cases, which at least gives them the option of performing a laparoscopic Hartmann's if necessary and possible.
SP2.3 Evaluating the Impact of Electronic Documentation on the Consent Process for Laparoscopic Choelcystectomies Within a HPB Department
Authors: Fadipe Toks , Iqbal Affan , Patel Agastya 
Published: August 2023

Abstract

Background
Over 60,000 laparoscopic cholecystectomies are performed annually in the UK. There are common complications such as bleeding and infection. More infrequently, there are serious risks of bile leak, bile duct or visceral injury. Documented risks and additional procedures stated on a consent form often vary significantly depending on the consenting clinician. We aim to assess the effect of a transition to an entirely electronic patient record (EPR) system on the documentation of consent and the subsequent impact of standardised electronic consent forms.

Methods
Comparison of documented risks and additional procedures against gold standard EIDO consent leaflet for laparoscopic cholecystectomies performed by a tertiary centre hepatobiliary surgery department. Paper consent forms from July to September 2022 compared to electronically signed consent forms obtained from the EPR from September to November 2022. Intervention in December 2022 (introduction of automated consent forms for clinicians to use). Re-audit from December 2022 to January 2023. Descriptive statistical analysis.

Results
Twenty-one risks and four additional procedures in gold standard consent. 84% of consents performed by middle grades (53/63). Transition to EPR shows infrequent documentation of common complications, such as pain, bleeding and infection. Rarer complications such bile duct injury mentioned more often with EPR. Additional procedures poorly documented with paper consent forms not improved by transition to EPR. All risks and additional procedures documented more frequently with pre-filled consent form.

Conclusions
Large variation in the consenting process. Simple, targeted interventions have added uniformity and consistency to the consenting process. Further assessment of the consenting process for other index procedures of hepatobiliary surgery to follow.
SP3.8 Evaluation of remote surgical wound assessment in routine surgical practice: a mixed-methods pilot implementational study of a novel mobile digital intervention
Authors: McLean Kenneth , Sgrò Alessandro , Brown Leo R , Buijs Louis , Potter Mark , Harrison Ewen 
Published: August 2023

Abstract

Introduction
Remote postoperative wound surveillance provides an opportunity to strengthen postoperative community care and minimise the burden of surgical-site infection (SSI). This study aimed to pilot remote digital postoperative wound surveillance and evaluate the readiness for implementation in routine practice.

Methods
A single-arm implementation study of remote postoperative wound surveillance in two tertiary care hospitals (clinicaltrials.gov: NCT05069103). Adults undergoing abdominal surgery received smartphone-delivered wound assessment for 30-days postoperatively (photographs and patient-reported SSI symptoms). Technology acceptance was assessed using 5-point Likert scales from the validated Telehealth Usability Questionnaire (TUQ) and summarised using means and 95% confidence intervals (CI). A mixed-methods approach was used with synthesis according to the WHO framework for monitoring and evaluating digital health interventions.

Results
200 patients participated between July 2021 and April 2022, with 115 (57.5%) undergoing emergency procedures. The 30-day SSI rate was 16.5% (n=33/200), with 72.7% (n=24) diagnosed post-discharge. Usage of the intervention was 83.0% (n=166/200), with subsequently 74.1% (n=123/166) TUQ completion. Patient acceptance was high with regards to satisfaction (4.27, CI: 4.13-4.41) and usefulness (4.07, CI: 3.92-4.23). Communication was rated lowest (3.86, CI: 3.71-4.02), related to the desire for more frequent and personalised interactions with the surgical team. Nevertheless, the majority perceived improved quality (3.72, CI: 3.56-3.89) and efficiency (4.08, CI: 3.93-4.23) over routine postoperative care.

Conclusion
Remote postoperative wound surveillance successfully demonstrates readiness for implementation according to the WHO framework. Both patients and healthcare services can benefit from enhanced community support to ensure appropriate and timely management.
SP4.8 Can we risk stratify surgical waiting lists using patient level and demographic data? A novel waiting list analyser tool
Authors: Johnson Nathan , Blow Sophie , Bassi Vinod , Mitchell Thomas , Peckham-Cooper Adam 
Published: August 2023

Abstract

Introduction
7.2 million patients are currently awaiting NHS treatment. It is imperative that trusts are able to interrogate waiting lists in order to understand the impact of ‘long waits’, on both patients and hospital services. An ability to prioritise, optimise and risk stratify care would be invaluable. In collaboration with clinicians, managers and patient level information and costing (PLICS) team we present a big data waiting list analyser tool that allows the delivery of patient focused decision making and analysis.

Methods
Using Structured Query Language (SQL), the analyser pulls data including waiting times (RTT), patient ethnicity and deprivation deciles directly from trust systems. The analyser cross references associated morbidity and hospital attendances to delineate the impact and resource utilisation of acute attendance whilst awaiting treatment. Coding is used to calculate additional bed or theatre requirements for every patient awaiting treatment. Financial costs, lost bed days and associated morbidity are analysed and used to identify at risk patient groups.

Results
The analyser itself takes the form of a fully interactive database. It provides dynamic analysis for any surgical procedure across three zones; waiting list times, acute presentation, and resources required to deliver elective activity. There is also a population health management section, which includes ethnicity and deprivation deciles.

Conclusions
This first of a kind analyser is an exciting new tool that will aid data driven decision making. It will allow us to target patients based not only on their waiting time, re-attendance risk but also based on their socioeconomic risk factors.
SP5.4 A review of conservative management of fingertip amputations
Authors: Downes Graeme 
Published: August 2023

Abstract

Aims
Fingertip amputations are a common presentation, with no definitive guideline, the decision between surgical and non-operative management of these injuries is controversial.
This review aims to identify evidence supporting the use of non-operative treatment methods for fingertip amputations. It is hoped that the evidence gathered will guide treatment decisions and identify areas for further work.

Methods
A search was conducted using Pubmed, Google Scholar and Sage journals. The search terms were ‘Fingertip semi-occlusive’ and ‘fingertip amputation dressing’.

Results
33 papers, published between 1972 and 2022 were reviewed, 1789 fingertip amputations treated non-operatively across the identified literature. There were overwhelmingly positive outcomes for fingertip amputations treated non-operatively; with healing time between 15 and 60 days, excellent two-point discrimination of between 2.5 and 6mm and low rates of infection and other complications. In the limited studies comparing non-operative to surgical treatment, better functional and aesthetic outcomes were found with non-operative management, another ceased recruitment to the surgical management arm due to the lack of benefit over non-operative management and a third found no benefit to surgery by experienced hand surgeons.

Conclusion
There is limited experimental data available in this area, and well conducted randomised control studies are needed. With that limitation in mind, the available literature provides evidence that management of fingertip amputations with dressings produces comparable, if not superior results to surgical management. Given the elimination of surgical morbidity, and ability to provide non-operative management in any location it Is recommended that this be offered as an excellent treatment modality.
SP5.8 Laparoscopy for small bowel obstruction improves outcomes
Authors: Finch Louise , Eid Joana , Mercer Stuart 
Published: August 2023

Abstract

Aims
Adhesional small bowel obstruction is the commonest cause of emergency general surgery. Fewer than 20% of cases are started laparoscopically, but there is huge variability across the country from 80% in some units to 0% in others. This study examines whether the laparoscopic approach reduces length of stay and mortality.

Methods
The national NELA database was interrogated to identify patients operated for small bowel obstruction due to adhesions. Post-operative length of stay and mortality were analysed according to surgical approach.

Results
20,597 patients with small bowel obstruction due to adhesions were identified; overall 30-day mortality was 6.2%. 3870 of these 20,597 cases (18.5%) were started laparoscopically. Mortality in this group was 3.2% compared with 7.0% in the laparotomy group. This association was also demonstrated in patients with predicted mortality &lt;5% (0.9% v 1.4%) and with predicted mortality &lt;10% (1.6% v 2.5%). In the laparoscopic group, more patients were discharged within 3 days (23% v 3%) and within 7 days (58% v 34%) compared to the laparotomy group. When surgery could be completed laparoscopically, all of these associations became stronger – mortality in this group was 1.9%, and 40% of patients were discharged within 3 days.

Conclusions
The laparoscopic approach to adhesional small bowel obstruction is safe and effective, and is associated with shorter length of stay and reduced mortality. The association holds even in patients converted to open surgery, and is not dependent on patient selection. Laparoscopy should be the approach of choice for adhesional small bowel obstruction.