bluuebunny/crossref_metadata_2025_split huggingface dataset:
Evaluating the effectiveness of cost-minimal planning of decarbonized electricity systems in reducing life cycle greenhouse gas emissions
Authors: Tarroja Brian , Mulvaney Dustin , Peer Rebecca , Grubert Emily 
Published: January 2025

Abstract
The decarbonization of regional electricity systems is a critical enabler of broader economy-wide decarbonization strategies and has motivated robust research on how to decarbonize electricity systems at minimum monetary cost. Since these efforts often focus on the operation of electricity systems, however, they do not account for emissions of the full life cycle associated with different resources. Different resource mixes can achieve a similar level of apparent decarbonization through operational emissions, while achieving very different levels of life cycle greenhouse gas (GHG) emissions reductions. To explore these differences, we model the expansion of the California electricity system from 2030 to 2045 using a simplified electricity dispatch model to investigate how the planning of future electricity systems may differ between prioritizing minimum cost versus minimum life cycle GHG emissions under a common target for operational GHG reductions. We find that explicitly planning for minimum life cycle GHG emissions yields an additional 1.6%–2.0% reduction in annual life cycle GHG emissions at a cost penalty of 5.1%–6.9% and that electricity resource mixes that minimize life cycle GHG emissions tend to favor high capacity factor zero-carbon resources and long-duration storage compared to a minimum cost approach. Comparatively, we find that aggressive supply chain decarbonization of generation and storage technologies reduces life cycle GHG emissions of electricity supplies by 3.0% to 14% and combining both increases these reductions to 5.0% to 16%. Further, we find that applying a carbon tax to minimum cost-based capacity expansion can incentivize planning to account for life cycle GHG emissions. Our results indicate that a planning approach focused on minimizing life cycle GHG emissions may not be palatable, but significant reductions in life cycle emissions can be realized through conventional mechanisms like carbon taxes, import standards, and targeted supply chain decarbonization.
O1 Using Machine Learning to predict the Severity of Acute Pancreatitis: A Systematic Review
Authors: Nadeem Zain , Yau Christopher , Chan Anthony 
Published: January 2025

Abstract

Background
Acute pancreatitis (AP) is an inflammatory condition of the pancreas where, in its severe form, has a mortality of up to 30%. The severity of AP is traditionally predicted with using static scoring systems such as Ranson and APACHE II based on clinical observations and/or blood test results. The Revised Atlanta Classification of AP, however, include the assessment of local complications such as peripancreatic fluid collections and necrosis which can be more subjective and relies on human clinical or radiological judgement. The aim of this study is to review the literature and evaluate the potential role and effectiveness of machine learning (ML) in the stratification of AP severity.

Methods
A systematic review was conducted using PubMed with search terms including acute pancreatitis, severity and machine learning. The inclusion criteria selected studies describing the development and validation of ML models predicting AP severity and to those publishing sensitivity and specificity data.

Results
There were 97 articles identified which after applying the inclusion and exclusion criteria, 11 studies were included in the review. ML training datasets ranged from 265 to over 350,000 patients, with inputs varying from patient demographics, clinical observations and blood results as well as radiomic data. The highest sensitivity (96%) and specificity (98%) predictors for severe AP outperformed Ranson, APACHE II and BISAP scoring systems.

Conclusion
ML models display superior accuracy when compared to traditional scoring systems in predicting AP severity. Radiomic data from Computed Tomography images can increase the sensitivity and specific of predictive models.
eP5 Adherence of Diagnosis and Management of Acute Appendicitis in Adults to WSES Jerusalem Guidelines
Authors: Patel Aminah , Alwani Omneya , Alasmar Mohamed , Abdelrahman Asem 
Published: January 2025

Abstract

Aims
This audit aims to assess adherence to the guidelines on diagnosis and treatment of acute appendicitis published by the World Society of Emergency Surgery (WSES) part of their 2020 update of the WSES Jerusalem guidelines. The practical WSES algorithm was used to audit patients’ journey regarding how the diagnosis was made and what management this led to.

Method
A retrospective analysis was conducted on 92 adult patients who were referred to the emergency general surgical team at a university teaching hospital for query/suspected appendicitis, between December 2022 to February 2023. These patients’ risk was calculated using AAS (Adult Appendicitis Score), Alvarado and AIR (Appendicitis Inflammatory Response) scores and the guidelines were used to record what should be the next step based on the risk score. This was then compared to the actual management that took place.

Results
When reviewing the initial risk scores, 54 patients (59%) had the correct next step based on the algorithm. Majority of the patients (40%) had a CT scan of their abdomen and pelvis and 78% of these showed appendicitis. In total 35 patients had surgery, which included 86% that were appendicectomy and 97% of these confirmed appendicitis on histology. 5% of patients had diagnostic laparoscopy and only 20% of these confirmed appendicitis.

Conclusion
The WSES guidelines provide good guidance onto what the initial investigations should be and the management. In this audit just roughly 60% of patients were managed according to the guidelines, therefore there is room for further adherence.
eP16 Management and outcomes of small bowel obstruction- not just the “now” but what about the “next”
Authors: Inteti Kamalesh , Rashid Rahel , Babiker Mohammed , Magee Conor , Wilson Jeremy 
Published: January 2025

Abstract

Aim
Small bowel obstruction (SBO) is a common surgical emergency with wide inconsistency in management as evidenced by the National Audit on Small Bowel Obstruction (NASBO). We sought to assess our management in the light of the NASBO recommendations.

Methods
A prospective cohort study in a UK district general hospital of patients admitted with SBO from December 2023 to March 2024. Outcomes included demographics, laboratory parameters and pathway milestones. Data were retrieved through an electronic database and analyzed using descriptive statistical software in Excel.

Results
Forty patients with a median age of 75 years were included. Mechanical causes were found in 38 (95%) with adhesions leading the list with 21 (55%). CT was done in everyone while X-ray was in 75% of them. Non-operative management was successful in 24 (60%) patients while surgery was fruitful in 16 (40%). Water soluble oral contrast challenge (WSOC) was successful in 15 out of the 20 patients who received it. Nutrition team input was sought out in 19 (∼50%) patients, among them 12 (30%) required nutritional support.
Of note fifteen (37.5%) patients had a recurrent SBO with 12 (80%) of them operated in an emergency setting.

Conclusion
Non-operative management with WSOC has reported a success rate of 75%. This is encouraging- as is the utilization of nutritional assessment and input.
Recurrent SBO is associated with an increased need for surgical intervention. Patients with index SBO may need closer follow-up arrangements and attention should be on identifying interventions to prevent recurrent SBO.
eP21 Improving Fasting Times: Abdominal Ultrasound for Acute Gallbladder Pathology – a Quality Improvement Project
Authors: Buchanan Emily , Sefa Adwoa , Carswell Kirstin 
Published: January 2025

Abstract

Background/Aims
Patients with acute gallbladder pathology (AGP) spend long periods of time fasting for scans and procedures, causing discomfort and unfavourable outcomes with a lengthened period in a catabolic state. Regular nutrition aids healing and patient satisfaction in the perioperative period. We aim to meet the Royal College of Radiologists’ (RCRs’) recommended 4-6 hour fasting time through streamlining prioritisation of Ultrasound Abdomen (USS-A), preventing complications of fasting, improving patient safety and satisfaction.

Methods
Retrospective data was collected for one month from electronic patient records. Inclusion criteria was patients investigated for AGP with USS-A identified from a daily departmental ‘take’ list. Exclusion criteria was patients who underwent USS-A for indications other than AGP. Our intervention was two-fold – firstly, highlighting USS-A (investigating AGP) to Radiology Department by ‘hot GB’ in indication section of request form, flagging scan completion within 6 hours. Secondly, ‘red’ and ‘green’ signs above beds denoting sips of water or eating and drinking as tolerated, respectively, prompting communication between staff about intake status. Data was collected and analysed using Microsoft Excel and GraphPad Prism.

Results
Median fasting time of 16.95 hours and waiting time of 18.93 hours (n=40) improved to 9.22 hours fasting and 13.45 hours waiting (p=0.21 and p=0.27, respectively). 44% of scan requests had ‘hot GB’ documented as the indication, following implementation of the intervention (n=27).

Conclusions
Average fasting time improved significantly but still falls short of RCR recommendation. Future scope includes education to ensure requests include ‘hot GB’, and development of a national AGP pathway.
eP29 High Alvarado score is independently associated with appendicitis in children with inconclusive ultrasound
Authors: Soliman Ahmed Bahgat 
Published: January 2025

Abstract
Acute appendicitis (AA) is a challenging diagnosis in the paediatric population. It usually requires meticulous examination of clinical, laboratory and radiological data. In most studies, ultrasound (US) was found to be highly reliable and accurate for diagnosing paediatric appendicitis. However, an inconclusive US in children with right lower quadrant pain is likely to be challenging for the emergency physician.
We performed a retrospective investigation in a paediatric emergency unit from 1st January 2020 to 31st December 2023. All paediatric patients under 14 years of age with right lower quadrant pain and an inconclusive US were included. The Alvarado score, based on a combination of clinical and laboratory factors, was computed for all patients. The surgeon was free to decide whether or not to order a CT scan.
Our analysis showed that patients with proven appendicitis had higher WBC counts, CRP levels, and Alvarado scores. Thus, this analysis identified that children with Alvarado scores ≥ 7 were over 34 times more likely to have AA than those with Alvarado scores &lt; 7, Leukocytosis &gt; 15 x109/L, and CRP&gt; 50 mg/l were also identified as independent predictors of AA in these children. Our study showed that the Alvarado score, potentially combined with laboratory data, is highly useful for diagnosing appendicitis in children with right lower quadrant abdominal pain and inconclusive US. These factors would make it possible not only to provide an accurate pre- operative diagnosis, but also to inform the patient and his/her family, and ultimately to spare the child from unnecessary radiation.
eP31 Safety of bowel anastomosis in emergency laparotomy
Authors: Claydon Oliver , Paduraru Mihai 
Published: January 2025

Abstract

Aims
Anastomotic leakage (AL) is a dreaded complication of surgical bowel anastomosis, associated with higher post-operative morbidity and mortality. Prevalence of AL varies from 1-19%, but is higher in the emergency setting due to risk factors including contamination, ionotrope use, shock and hypoalbuminemia. Consideration must be given to the safety of anastomosis vs stoma in this setting. Our objective was to perform a local audit of outcomes of bowel anastomoses formed during emergency laparotomy.

Methods
All cases of emergency laparotomy with bowel anastomosis performed at our hospital between 5/5/22 and 31/12/23 were retrospectively identified from hospital records. Enterotomy closure alone and patients &lt;16 were excluded. Returns to theatre for post-operative complication were included. Details of pathology, anastomosis, and outcome were collected from medical notes.

Results
100 cases fitting criteria were identified. The most common pathologies requiring bowel resection were adhesional obstruction (26%), obstructing cancer (15%) and incarcerated hernia (10%). 69% of anastomoses were small bowel; 26% were ileo-colic. There were 9 Clavien-Dindo 3+ complications. There were 6 anastomotic leaks; 2 from small bowel anastomoses, which were both managed as controlled entero-cuteneous fistulas, and 4 from ileo-colic anastomoses, which were all returned to theatre for stoma. There was one mortality.

Conclusions
Our AL rate of 6% is comparable to reported leak rate of electively-formed anastomoses. Bowel anastomosis formed during emergency laparotomy is not inherently unsafe. The decision for anastomosis vs stoma should be made on an individual basis with the patient counselled pre-operatively if possible about the risk of leak.
eP32 Intestinal Obstruction: Case study on a different presentation of Systemic Amyloidosis
Authors: Nesnas Leen , Alabbasi Iea , Bunting David 
Published: January 2025

Abstract

Aim
This study aims to evaluate treatment strategies for acute presentations of systemic amyloidosis in the gastrointestinal tract. Systemic amyloidosis, identified by the extracellular deposition of β-sheet protein fibrils, often affects the GI tract, particularly in primary (AL) amyloidosis. GI amyloidosis can severely disrupt organ function, requiring prompt and effective treatment. This study focuses on optimizing the management of these acute GI manifestations.

Methods
66 year old female presented to ED, with 6 days abdominal pain, distention, vomiting, and not opening her bowels for one week. She had a background of amyloidosis secondary to multiple myeloma on medical treatment. CT scan showed the stomach and the majority of the small bowel are grossly distended with fluid. There appeared to be at least one transition point with faecalis loop of small bowel proximal to it. She then had an emergency laparotomy.

Results
Intraoperative findings showed abnormal, hardened fecal matter throughout the small bowel. An enterotomy was performed with manual evacuation of the bowel contents. Postoperatively, she required ICU support, intravenous fluids, and empirical antibiotics She had a post-operative ileus with high NG output. This was managed with prokinetic agents including erythromycin, metoclopramide, and prucalopride. She was discharged with home based TPN.

Conclusion
Management of GI amyloidosis varies by type and presentation, focusing on symptomatic relief and systemic treatment. Prokinetic agents are crucial for dysmotility, and severe cases may require parenteral nutrition. Surgical intervention is necessary for obstructions, uncontrolled haemorrhage, or ischemia. Early identification and appropriate management are essential for improved outcomes.
eP36 Quality improvement Project: Optimizing necrotizing fasciitis management; Evaluation and development of comprehensive guidelines for improved patient outcomes
Authors: Ansar Mehwish , Mustafai Muneeba , Kaur Smonica , Inteti Kamlesh , Magee Conor , Wilson Jeremy 
Published: January 2025

Abstract

Aims
The study was conducted to scrutinize the current approaches for management of necrotizing fasciitis (NF) at our centre and aimed to formulate evidence-based guidelines to optimize care, outcomes and reduce mortality. The primary objective was refining diagnosis, early surgical intervention, antibiotics protocol and multidisciplinary approach for comprehensive management.

Methods
A comprehensive retrospective three-year review on 16 patients, diagnosed with NF was conducted. Data were extracted on the site of infection, multidisciplinary involvement, timing and frequency of surgeries, antibiotic regimen, and outcomes. This analysis provide insight to develop the management guidelines to enhance the quality of care.

Results
In six (37.5%) patients the infection site was premium. Triple assessment by surgery, anaesthesia and critical care was received by ten (62%) patients and ten patients required intensive care admission, reflecting multidisciplinary collaboration. Inconsistencies was observed in antibiotics, mostly clindamycin and Tazocin were administered, initiated within 5 hours of diagnosis. Ten (62%) had surgical intervention, mostly within 12 hours. Multiple debridement ranging from 1 to 9 were performed in eight (50%) patients. Two patients were referred to plastic surgery. 100% cultures have shown polymicrobial growth. Mortality rate was 20% among those who had surgery. The absence of standardized protocol and variability in management in different trust was highlighted in this study.

Conclusion
The study highlights the need for standardized, evidence-base guidelines for management of NF. The observed variability in patients care and outcome suggest a multicentre audit, to formulate comprehensive guidelines to manage this life-threatening condition to standardized care and enhance outcomes.
eP41 CORES model scoring system for predicting post-operative mortality in patients undergoing Emergency Laparotomy and its comparison with APACHE II: An observational study
Authors: Kumar Navin , Panga Harshavardhan , Singh Sudhir Kumar , Basu Somprakas 
Published: January 2025

Abstract

Aim
To determine the effectiveness of the CORES model in predicting post-operative in-hospital and 30-day mortality in patients undergoing emergency laparotomy.

Methods
The CORES and APACHE-II scoring were done in 211 patients aged&gt; 18 years undergoing emergency laparotomy, and both scores were compared, with calculating mortality rate being the primary objective. Abdominal trauma, pregnancy and ASA grade V were excluded. CORES was constructed using a regression model based on the presence or absence of Japan coma scale &gt;30, ASA class III, ASA class IV, WBC &lt;2500 cells/ μL, Platelet count &lt;150000 / &gt;300000 cells/ μL and blood urea nitrogen &gt;/= 40mg/dL.

Results
The CORES in-hospital and 30-day mortality prediction score was marginally less than the APACHE II (Table 1& 2)Table 1:APACHE II versus CORES in-hospital mortality scorePredictorAUROC95% CIpSn%Sp%PPV%NPV%DA%ORAPACHE II0.9010.85-0.94&lt;0.00170937889871.42CORES0.8600.80-0.91&lt;0.00181735391752.35Table 2:APACHE II versus CORES 30-day mortality scorePredictorAUROC95% CIpSn%Sp%PPV%NPV%DA%ORAPACHE II0.8850.834-0.937&lt;0.00170927490861.42CORES0.8670.808-0.926&lt;0.00176876691842.67AUROC: Area under ROC curve; CI: Confidence interval; Sn: Sensitivity; Sp: Specificity; PPV: Positive predictive value; NPV: Negative predictive value; DA: Diagnostic Accuracy.

Conclusion
CORES accurately predicting post-operative mortality. However, CORES was less effective than APACHE II in calculating in-hospital mortality but equally effective in predicting 30-day postoperative mortality.
eP48 Multi-cycle audit on antibiotic duration and stepdown following laparotomy
Authors: Lonergan Rebecca Murphy , Singh Anaida , Kalidindi Venugopala 
Published: January 2025

Abstract

Aims
To audit adherence to local guidelines on antibiotic stewardship in patients who underwent laparotomy, particularly, duration of antibiotics following definitive surgery/source control To increase antibiotic stewardship by reducing duration of antibiotic course and promoting consideration of early stepdown of antibiotics where clinically appropriate in patients following laparotomy

Methods
Data were reviewed for all adult general surgery patients who underwent laparotomy over a 4-month period in late 2023. Patients were excluded if there were incomplete or unavailable documentation relating to their operation or post-operative care. Data were extracted relating to patient demographics, type of operation and duration of antibiotic treatment post-operatively.
Results were presented locally to the surgical team, highlighting trust-specific guidance on prescribing in intra-abdominal infection, and input from the microbiology team.
A second 4-month cycle was completed in early 2024.

Results
Cycle 1: Data were extracted from 30 post-laparotomy patients. The most common indication for laparotomy was bowel obstruction (n=25), with confirmed perforation (n=8). The average duration of antibiotic treatment post-operatively was 11.2 days (± 7.7).
Cycle 2: Data were reviewed from 49 post-laparotomy patients. 34 patients had bowel obstruction with 8 confirmed perforations intra-operatively. The average duration of post-operative antibiotic treatment was 8.6 days (± 5.8).

Conclusions
Duration of antibiotic therapy is significantly beyond what is recommended by microbiologists and local guidelines following source-control surgery. Possible contributing factors include surgical apprehension to stepdown or stop antibiotics in the peri-operative period, and system barriers caused by electronic prescribing.
eP51 Introducing the Use of Local Anaesthetic Spray for the Insertion of Nasogastric Tubes in Emergency General Surgery
Authors: Sellers Alexandra , Lenzi Elisa , Gull Sadaf 
Published: January 2025

Abstract

Aims
Nasogastric tube (NGT) insertion is a common procedure used within Emergency General Surgery for patients who present with small bowel obstruction. As per current clinical guidelines, this is typically carried out without any analgesic agents, which has anecdotally resulted in reports of pain, nausea and distress from patients.
A service improvement project was undertaken to determine if using local anaesthetic (Xylocaine) spray can also improve the patient experience of having a NGT inserted with the aim of introducing a Patient Group Directive (PGD) for its use.

Methods
46 patients were given a questionnaire prospectively asking them to rate their experience of pain, nausea/vomiting and distress/anxiety following successful insertion of NGTs. Half of the group had Xylocaine spray administered prior to insertion. They were asked to rate their experiences of pain, nausea and distress on a Likert scale of 1-5 (5 being severe), as well as provide any other feedback.

Results
When prior experience was compared to the experience where Xyloxaine spray was used, fewer patients reported pain, nausea and distress at the severe end of the scale. Qualitative feedback also suggested that using Xylocaine spray improved the experience for many patients through alleviating pain to the nose and throat.

Conclusion
Local anaesthetic spray can improve the experience of pain, nausea and anxiety when undergoing NGT insertion, and numerous studies support its use. A PGD and Clinical Guideline for its use is now underway with the aim to improve patient experience and increase compliance with this intervention.