bluuebunny/crossref_metadata_2025_split huggingface dataset:
616 Addressing Challenges to Enable Better Use of Routinely Collected Clinical Photographs: Evaluating the Largest Cleft Dataset for Machine Learning Analysis
Authors: Turnbull C , Macleod A , Esposito S , Gorantla R , Seth S , Ramamoorthy R , Mehendale F 
Published: November 2022

Abstract

Aim
Orofacial clefts are the most common congenital anomaly to affect the craniofacial region. Surgical repair is usually performed in infancy; however, there are concerning inequalities in access to and quality of surgical care. Scoring aesthetic results after surgery is crucial when determining the success of a repair. A reliable and accurate scoring system utilising large numbers of unstandardised 2-dimentional (2D) photographs of ethnically diverse patients, which is inexpensive, widely accepted and easily applicable, does not exist. Artificial Intelligence (AI) has been applied in various surgical specialities with beneficial results; however, its advantages have not yet been harnessed in cleft care.
We aimed to evaluate the potential use of routinely collected 2D photographs of patients with an orofacial cleft and determine if non-standardised data could be used for machine learning (ML) analysis in cleft research.

Method
A database comprising over 5 million photographs, collected over 20 years, and developed by the international non-governmental organisation Smile Train, was described, and analysed using RStudio and Microsoft Excel.

Results
Description and analysis of the dataset demonstrated that it is the largest and most ethnically inclusive and diverse dataset that currently exists. Preliminary AI analysis confirmed that ML could be used to analyse the data.

Conclusion
The quality of routinely collected data presents challenges for use in research. Addressing such challenges helps ensure that findings are more representative of global burden of disease and will deliver outcomes that are more relevant to a diverse global population. Evidence based minimum standards to optimise future data collection have been identified.
541 Pre-Operative Assessment of Patients Undergoing Elective TURBT or Rigid Cystoscopy + Bladder Biopsy: Is a Group & Save Clinically Required?
Authors: Mak Q , Madden J , Ahmed Z , Kum F , Makanjuola J , Cakir O 
Published: November 2022

Abstract

Aim
Group & Save (G&S) is conducted prior to Transurethral Resection of Bladder Tumour (TURBT) or Rigid Cystoscopy + Bladder Biopsy (BB) during pre-operative assessment (PoA). Each G&S costs £7.54 and 2 samples are required. The aim of this audit was to determine whether G&S is clinically required for these two procedures.

Method
This two-cycle audit reviewed the PoA components of patients undergoing TURBT or BB over a 6month period prior to the COVID-19 pandemic (July-Dec2019), in which PoA were face-to-face, and a subsequent re-audit during telephone PoA (July-Dec2020), where it was deemed unnecessary to have a G&S.

Results
1st Cycle: 64 patients were included, 32.8%(21/64) had a preoperative G&S. 98.4%(63/64) had Hb measured. Mean Hb was 131.56 (79 – 165) g/l. 25%(16/64) were on anti-coagulants, of which 50%(8/16) were continued. No patients required a peri or post-operative blood transfusion.
2nd Cycle: 48 patients were included and 6.25%(3/48) had a G&S within the 1 month preceding their operation. 70.8%(34/48) had their Hb measured, with mean Hb being 135.18 (86 – 168) g/l. 22.9%(11/48) were on anticoagulants, of which 36%(4/11) were continued. There were no complications requiring a blood transfusion.

Conclusions
We found no requirement of blood transfusions following TURBT or BB, therefore routine G&S is not clinically indicated for this series. This reflects departmental savings of £964 over 6months (based on 64 cases). In addition, a relationship between continuing anti-coagulation or a low Hb and post-operative transfusion was not observed.
109 The Impact of Extended Reality on Surgery: A Scoping Review
Authors: Lu V , Zhang J , Logishetty K , Khanduja V 
Published: November 2022

Abstract

Aim
Extended reality (XR) is a spectrum of technologies encompassing augmented reality (AR), virtual reality (VR), augmented virtuality (AV), mixed reality (MR). This scoping review maps out current utilisation and future prospects of XR-assisted surgery.

Method
A systematic search of PubMed, Scopus, Embase was performed. Primary studies describing surgical procedures on human subjects, dentistry, anaesthetic procedures for surgery were included. Non-surgical, rehabilitation, bedside, veterinary procedures, robotic surgery were excluded.
Studies were classified into preoperative planning, intraoperative navigation/guidance, patient pain, patient anxiety, surgical training, surgeon confidence.

Results
213 studies were included for analysis. Thirty-six studies on pre-operative planning noted VR improved surgeon's understanding of anatomical sites, leading to reduced operating time and surgical trauma. Fifty-nine studies on intra-operative planning noted AR headsets highlight ‘negative structures’, reducing chance of accidental incision. Fourteen studies on patients’ pain found VR-induced meditative state resulted in less analgesics for patient comfort. Twelve studies on patient anxiety found VR failed to change patients’ physiological parameters such as arterial blood pressure, cortisol levels, heart rate. Sixty-eight studies explored surgical training, with VR being most cost-effective. Thirteen studies documented increased surgeon confidence.

Conclusions
XR-assisted surgery's growth is fuelled by hardware and software innovations. Training and pre-operative planning are mostly achieved by VR; intraoperative guidance is mostly supplemented with AR. The other sections of XR spectrum, AV and MR, are underexplored. Working time restrictions during surgical training, COVID-19's impact on limiting physical presence and increasing complexity of surgical procedures means that XR-assisted surgery may assume a greater role in coming decades.
1001 Surgical Escape Rooms: A Novel Approach for Teaching Surgical Skills
Authors: Thakkar R , Wharf O , Hanson M , Badenoch T , Hunter I , Bamford R , Cooper S 
Published: November 2022

Abstract

Aim
Traditional classroom-based teaching of surgical skills has been used commonly in the past. Although, use of an escape room is a new form of a practical teaching method to deliver surgical skills teaching. We compared and assessed effectiveness of the traditional classroom teaching versus practical escape room teaching of the basic surgical skills.

Method
Two teaching sessions were delivered to third year medical students. Each session consisted of two groups and two sessions. Each group received either the classroom-based teaching or the escape room teaching, then switching over to the other teaching. Each student was asked to complete a questionnaire before the session, after the first and the second teaching session. Teaching covered interrupted suturing, wound management, and administration of local aesthetic. Likert scores were used to collect feedback.

Results
Total 24 third year medical students attended the two teaching sessions. 100% either agreed or strongly agreed the classroom teaching was useful, compared to 75% for the escape room. 67% either agreed or strongly agreed that escape room style teaching is a better learning method than traditional teaching. Although, 79% either agree or strongly agree that escape room style teaching is a useful adjunct to the traditional teaching. 100% either agree or strongly agree that this teaching will improve their clinical practice.

Conclusions
Traditional classroom-based teaching is a more useful form of teaching compared to the escape room. Although escape room teaching is a useful adjunct to the current common form of classroom based surgical teaching.
173 Debridement, Antibiotics and Implant Retention (DAIR) in the Management of Prosthetic Joint Infections Following Primary Hip and Knee Arthroplaty: A DGH Experience
Authors: Feathers J , Awad F , Punjabi S , Prasad K , Silva C , Sarasin S , Lewis P 
Published: November 2022

Abstract

Aim
Prosthetic joint infections (PJI) are a devastating complication of arthroplasty surgery. Current gold standard one or two-stage revision, poses sincere surgical challenges and carry significant patient morbidity. If diagnosed promptly, a debridement, antibiotics, and implant retention (DAIR) procedure can be performed. We report the results of our experience with the DAIR procedure in a District General Hospital setting.

Method
Our study comprises of a single centre retrospective review of a prospectively updated database. All patients who underwent a DAIR procedure following hip or knee arthroplasty from August 2012 to July 2019 were included in the study with no exclusions.

Results
Four total knee replacements, sixteen total hip replacements (THR), two revision THR and three hemiarthroplasties were included in the study. Average duration from onset of symptoms to DAIR was 22 days for immediate post-operative patients and 6 days in patients presenting later with an acute infection. All patients had exchange of modular components during the DAIR procedure. Out of 25 DAIR procedures, 23 identified a positive microbiology culture. Most common causative organisms identified were Staphylococcos aureus (23%) and Staphylococcus epidermidis (23%). Average follow up in clinic was 55 months. 76% of patients had a stable post-operative recovery with no recurrence of infection. One patient required a revision THR for aseptic loosening; one patient required a knee arthrodesis and four patients died.

Conclusions
Infection was successfully eradicated in 19 patients. The success reported within the literature stem predominantly from tertiary units. Our study reflects this success in a DGH setting.
906 Schistosomiasis: The New ‘Gap Year’ Problem
Authors: Humayon D , Baby A , Mahesan T 
Published: November 2022

Abstract

Introduction
Schistosomiasis is endemic in Africa, Asia, and South America. The parasite, found in freshwater lakes, ultimately deposits eggs in the veins around organs including the bladder. It causes chronic inflammation resulting in fibrosis of the urogenital tract and malignancy. In the UK, cases of schistosomiasis are unusual and historically confined to the immigrant population.

The patient
We present the case of a British born 21-year-old who returned from a round-the-world gap year. Upon return he reported dysuria, abdominal pain, poor flow, and malaise. He was investigated for tropical diseases, treated for recurrent urine infections, and sexually transmitted infections before disclosing on direct questioning to swimming in Malawi. Cystoscopy demonstrated tight pan-urethral strictures. Sandy patches were seen throughout the bladder. Histology from bladder biopsy confirmed schistosomiasis eggs. The patient was treated with Praziquantel. Despite treatment he will likely require repeat urethral dilatations.

Discussion
Changes in travel practice has led to a shift in patients who present with schistosomiasis. Clinicians should consider the diagnosis in anyone with lower urinary tract symptoms who has visited Asia, Africa, or South America. In those diagnosed, clinicians have a duty to encourage them to urge fellow swimmers to seek urological input. Similarly travel-clinics should be encouraged to warn travellers against fresh-water swimming prior to travel.
To avoid long term schistosomiasis sequelae, prevention is preferable, but early and prompt intervention is the next best alternative. Clinicians need a low threshold to suspect and exclude this damaging diagnosis.
548 A 10-Year Longitudinal Cohort Study Assessing Growth Rates and Surveillance Intervals for Common Iliac Artery Aneurysms
Authors: Laloo R , Aimar K , Khanom J , Jamjoom A , Bailey M , Scott J 
Published: November 2022

Abstract

Aim
The European Society for Vascular Surgery defines common iliac artery (CIA) aneurysms as greater than 1.8cm in men and 1.5cm in women. Their reported growth rate is 1–4mm/year depending on their diameter. This study aimed to assess the natural history and surveillance intervals for CIA aneurysms as intervention threshold is based on low-quality evidence.

Method
Patients diagnosed with an IAA at a single vascular centre between 1st January 2010 and 31st August 2021 were identified from a prospectively collected departmental database and Caldicott-approved data collection performed. The primary outcomes included diameter-based mean aneurysm growth rates and median surveillance intervals. Statistical analysis with SPSS® was performed using chi-squared tests.

Results
Of the 203 patients included, 90.6% were men and median (IQR) age at detection was 77 (71–83). IAA were located in the CIA (85.2%), IIA (21.7%) and EIA (2.0%) with the majority being asymptomatic (78.8%). CT was most frequently used as the imaging modality for IAA surveillance (66.3%), followed by ultrasound scan (29.8%) and MRA (3.9%). Growth rate for CIA aneurysms measuring 1.0–1.9cm were -2.1mm/year, 2.0–2.9cm were 0.8mm/year, 3.0–3.9cm were 3.5mm/year, 4.0–4.9cm were 9.4mm/year, 5.0–5.9cm were 2.9mm/year and &gt;6.0cm were 13.8mm/year. Median surveillance intervals for CIA aneurysms at 1.0–1.9cm were 12-monthly, 2.0–2.9cm were 11-monthly, 3.0–3.9cm were 5-monthly, 4.0–4.9cm were 5-monthly, 5.0–5.9cm were 5.5-monthly and &gt;6.0cm were 14.5-monthly. Mean(SD) CIA diameter at rupture was 4.6 (2.4)cm.

Conclusions
CIA aneurysms demonstrate faster growth rates as they enlarge and may require more frequent clinical assessments, surveillance, and consideration for repair prior to rupture.
Predicting performance of the HAS-BLED and ORBIT bleeding risk scores in patients with atrial fibrillation treated with Rivaroxaban: Observations from the prospective EMIR Registry
Authors: Esteve-Pastor María A , Rivera-Caravaca José M , Roldán Vanessa , Sanmartin Fernández Marcelo , Arribas Fernando , Masjuan Jaime , Barrios Vivencio , Cosin-Sales Juan , Freixa-Pamias Román , Recalde Esther , Pérez-Cabeza Alejandro I , Manuel Vázquez Rodríguez José , Ràfols Priu Carles , Anguita Sánchez Manuel , Lip Gregory Y H , Marin Francisco 
Published: November 2022

Abstract

Background
Assessing bleeding risk during the decision-making process of starting oral anticoagulation (OAC) therapy in atrial fibrillation (AF) patients is essential. Several bleeding risk scores have been proposed for vitamin K antagonist users but, few studies have focused on validation of these bleeding risk scores in patients taking direct oral anticoagulants (DOACs). The aim was to compare the predictive ability of HAS-BLED and ORBIT bleeding risk scores in AF patients taking rivaroxaban in the EMIR (‘Estudio observacional para la identificación de los factores de riesgo asociados a eventos cardiovasculares mayores en pacientes con fibrilación auricular no valvular tratados con un anticoagulante oral directo [Rivaroxaban]) Study.

Methods and results
EMIR Study was an observational, multicenter, post-authorization, and prospective study that involved AF patients under OAC with rivaroxaban at least 6 months before enrolment. We analysed baseline clinical characteristics and adverse events after 2.5 years of follow-up and validated the predictive ability of HAS-BLED and ORBIT scores for major bleeding (MB) events.
We analysed 1433 patients with mean age of 74.2 ± 9.7 (44.5% female). Mean HAS-BLED score was 1.6 ± 1.0 and ORBIT score was 1.1 ± 1.2. The ORBIT score categorised a higher proportion of patients as ‘low-risk’ (87.1%) compared with 53.5% using the HAS-BLED score. There were 33 MB events (1.04%/year) and 87 patients died (2.73%/year). Both HAS-BLED and ORBIT had a good predictive ability for MB{Area under the curve (AUC) 0.770, [95% confidence interval (CI) 0.693–0.847; P &lt;0.001] and AUC 0.765 (95% CI 0.672–0.858; P &lt;0.001), respectively}. There was a non-significant difference for discriminative ability of the two tested scores (P = 0.930) and risk reclassification in terms of net reclassification improvement (NRI) −5.7 (95% CI −42.4–31.1; P = 0.762). HAS-BLED score showed the best calibration and ORBIT score showed the largest mismatch in calibration, particularly in higher predicted risk patients.

Conclusion
In a prospective real-world AF population under rivaroxaban from EMIR registry, the HAS-BLED score had good predictive performance and calibration compared with ORBIT score for MB events. ORBIT score presented worse calibration than HAS-BLED in this DOAC treated population.
The Genesis of Miracle Stories in Jihad
Authors: de la Paz Alexander 
Published: November 2022

Abstract
Stories of miracles, or karamat, are ubiquitous and influential in jihad. Yet, they remain poorly understood. Current treatments are limited to descriptions of reports in individual conflicts. None have systematically studied their genesis: from whom, and where do they originate? Some, to be sure, imply origins—especially in deception. But they have done so based on impressions, and not systematic investigation. However, the question is of considerable interest and warrants closer study. Examining it would not only illuminate an understudied aspect of the movements in question but also advance scholarship on religion on the battlefield, a budding field of inquiry. This article thus traces the genesis of official and semiofficial reports of karamat, drawing on a wide range of evidence, including hundreds of reports culled from books, magazines, and video and audio recordings from multiple groups and individuals spanning decades, and interviews. The results point to origins in experience, misrepresentation, rumor, and tradition. The findings advance our understanding of karamat, and the documentary value of reports of them. More generally, they sensitize us to the significance of elusive phenomena seldom studied in the conflict literature: religious experience, propaganda about religious experience, rumor about religious experience, and folklore about religious experience.
When Are Female Suicide Bombings More Likely? The Case of Boko Haram
Authors: Weeraratne Suranjan 
Published: November 2022

Abstract
This research delineates the conditions more conducive to the use of female suicide bombings through a detailed analysis of attacks carried out by Boko Haram. Using a novel dataset of 473 suicide attacks, the study finds that females are more likely to be deployed against non-religious civilian targets. Further, fragmentation of the group increases the likelihood of more female suicide bombers as different factions seek to outbid one another. Third, the expectation of extensive and favorable coverage in non-local (Western) media sources increases the odds of female suicide attacks.
Kidney utilization in the Netherlands – do we optimally use our donor organs?
Authors: Schutter Rianne , Vrijlandt Willemijn A L , Weima Gelske M , Pol Robert A , Sanders Jan-Stephan F , Crop Meindert J , Leuvenink Henri G D , Moers Cyril 
Published: November 2022

ABSTRACTBackgroundTo ensure optimal utilization of deceased donor kidneys, it is important to understand the precise reasons why kidneys are discarded. In this study we aimed to obtain a comprehensive overview of kidney utilization and discard during the entire donation process in the Netherlands.MethodsIn this retrospective cohort study we analysed kidney utilization of 3856 kidneys in the Netherlands between 1 January 2015 and 31 December 2020. For every kidney that was not transplanted, we determined the moment of and reason for discard through a unique case-by-case assessment.ResultsKidney discard according to the traditional definition (procured but not transplanted) was 7.8%. However, when kidneys that seemed medically suitable at the beginning of the donation process were also included, many more potential donor kidneys were lost and the total non-utilization was 24.4%. Subjectively presumed impaired organ quality was responsible for 34.2% of all discarded kidneys. Two-thirds of kidneys discarded due to acute kidney injury (AKI) had only AKI stage 1 or 2.ConclusionThe classical definition of organ discard underestimates the non-utilization of deceased donor kidneys. Strategies to improve kidney utilization could be a revision of the maximum allowed agonal time in donation after circulatory death, careful consideration in reporting and accepting kidneys from donors with AKI and a prospectively filled registry of detailed organ discard reasons, including the ‘silent’ non-utilization before procurement.
In-situ constructed Cu/CuNC interfaces for low-overpotential reduction of CO2 to ethanol
Authors: Yang Yan , Fu Jiaju , Ouyang Yixin , Tang Tang , Zhang Yun , Zheng Li-Rong , Zhang Qing-Hua , Liu Xiao-Zhi , Wang Jinlan , Hu Jin-Song 
Published: November 2022

Abstract
Electrochemical CO2 reduction (ECR) to high-value multi-carbon (C2+) products is critical to sustainable energy conversion, yet the high energy barrier of C-C coupling causes catalysts to suffer high overpotential and low selectivity toward specific liquid C2+ products. Here, the electronically asymmetric Cu-Cu/Cu-N-C (Cu/CuNC) interface site is found, by theoretical calculations, to enhance the adsorption of *CO intermediates and decrease the reaction barrier of C-C coupling in ECR, enabling efficient C-C coupling at low overpotential. The catalyst consisting of high-density Cu/CuNC interface sites (noted as ER-Cu/CuNC) is then accordingly designed and constructed in situ on the high-loading Cu-N-C single atomic catalysts. Systematical experiments corroborate the theoretical prediction that the ER-Cu/CuNC boosts electrocatalytic CO2-to-ethanol conversion with a Faradaic efficiency toward C2+ of 60.3% (FEethanol of 55%) at a low overpotential of −0.35 V. These findings provide new insights and an attractive approach to creating electronically asymmetric dual sites for efficient conversion of CO2 to C2+ products.
High-efficiency retron-mediated single-stranded DNA production in plants
Authors: Jiang Wenjun , Sivakrishna Rao Gundra , Aman Rashid , Butt Haroon , Kamel Radwa , Sedeek Khalid , Mahfouz Magdy M 
Published: November 2022

Abstract
Retrons are a class of retroelements that produce multicopy single-stranded DNA (ssDNA) and participate in anti-phage defenses in bacteria. Retrons have been harnessed for the overproduction of ssDNA, genome engineering and directed evolution in bacteria, yeast and mammalian cells. Retron-mediated ssDNA production in plants could unlock their potential applications in plant biotechnology. For example, ssDNA can be used as a template for homology-directed repair (HDR) in several organisms. However, current gene editing technologies rely on the physical delivery of synthetic ssDNA, which limits their applications. Here, we demonstrated retron-mediated overproduction of ssDNA in Nicotiana benthamiana. Additionally, we tested different retron architectures for improved ssDNA production and identified a new retron architecture that resulted in greater ssDNA abundance. Furthermore, co-expression of the gene encoding the ssDNA-protecting protein VirE2 from Agrobacterium tumefaciens with the retron systems resulted in a 10.7-fold increase in ssDNA production in vivo. We also demonstrated clustered regularly interspaced short palindromic repeats-retron-coupled ssDNA overproduction and targeted HDR in N. benthamiana. Overall, we present an efficient approach for in vivo ssDNA production in plants, which can be harnessed for biotechnological applications.
Graphical Abstract