bluuebunny/crossref_metadata_2025_split huggingface dataset:
Three-dimensional temperature and stress field simulation with all-hexahedral element mesh in a high efficiency cooling structure for the fabrication of amorphous ribbons
Authors: Chen Li , Li Yuluo , Shen Ningning , Hui Xidong 
Published: February 2022

Abstract
Planar flow casting is an advanced technology to produce amorphous and nanocrystalline ribbons in electrical application. At present, the utilization rate of roller surface is generally under 20% in industrial production. This work reports a new cooling structure that is designed to produce ribbons width 65 mm with the utilization rate of roller surface up to 65%. The cooling structure is simulated with the software ANSYS by employing three-dimensional temperature and stress field mathematic model incorporating actual production conditions with all-hexahedral element mesh. It is shown that the liquid velocity is uniform with consistent distribution of convective heat transfer coefficient in width direction between cooling water and rotating roller. The thermal expansion difference in the new cooling structure is only 0.0042 mm at the ribbon edge. In this case, it is unnecessary to make the slit with an upward bend. The new cooling structure is expected to be applied for industrial production at an ideal level.
Prevalence and implications of frailty in acute stroke: systematic review & meta-analysis
Authors: Burton Jennifer K , Stewart Jennifer , Blair Mairi , Oxley Sinead , Wass Amy , Taylor-Rowan Martin , Quinn Terence J 
Published: February 2022

Abstract

Background
frailty is common in older adults and associated with poor outcomes following illness. Although stroke is predominantly a disease of older people, our knowledge of frailty in stroke is limited. We aimed to collate the literature on acute stroke and frailty to estimate the prevalence of pre-stroke frailty and its associations with outcomes.

Methods
paired researchers searched multidisciplinary electronic databases for papers describing frailty and acute stroke. We assessed risk of bias using Newcastle-Ottawa tools appropriate to study design. We created summary estimates of pre-stroke frailty using random effects models. We collated whether studies reported significant positive associations between frailty and clinical outcomes in adjusted models.

Results
we included 14 studies (n = 27,210 participants). Seven studies (n = 8,840) used a frailty index approach, four studies (n = 14,924) used Hospital Frailty Risk Scores. Pooled prevalence of pre-stroke frailty was 24.6% (95% confidence interval, CI: 16.2–33.1%; low quality evidence, downgraded due to heterogeneity, bias). Combining frailty and pre-frailty (nine studies, n = 23,827), prevalence of any frailty syndrome was 66.8% (95%CI: 49.9–83.7%). Seven studies were at risk of bias, from participant selection or method of frailty assessment. Pre-stroke frailty was associated with all adverse outcomes assessed, including longer-term mortality (positive association in 6 of 6 studies reporting this outcome; odds ratio: 3.75 [95%CI: 2.41–5.70]), length of admission (3 of 4 studies) and disability (4 of 6 studies).

Conclusions
despite substantial heterogeneity, whichever way it is measured, frailty is common in patients presenting with acute stroke and associated with poor outcomes. This has implications for the design of stroke services and pathways.
Rethinking Nationalism
Authors: Aydin Cemil , Ballor Grace , Conrad Sebastian , Cooper Frederick , CuUnjieng Aboitiz Nicole , Drayton Richard , Goebel Michael , Judson Pieter M , Kott Sandrine , Miller Nicola , Roshwald Aviel , Sluga Glenda , Walker Lydia 
Published: February 2022

Abstract
This forum, curated by Michael Goebel (Freie Univ. Berlin), brings together twelve historians who draw on their own areas of specialization to rethink how we conceptualize the history of nationalism in our present moment of reactivated and often militant nationalist rhetoric.
Evaluating Symptomatic and Psychosocial Well-being After Keloid Treatment With SCAR-Q
Authors: Kim Minji , Mirsky Nicholas , Spielman Amanda , Mathew Prakash , Yechieli Raphael , Tang Jennifer C , Thaller Seth R 
Published: February 2022

Abstract

Background
Many patients with keloids experience symptoms, such as pain and pruritus, and may present with significant psychosocial burdens. However, no single therapeutic regimen has been firmly established for treatment of keloids.

Objectives
The aim of this study was to assess patients’ perspectives on their keloids after treatment by comparing preoperative and postoperative surveys.

Methods
All patients seen at the keloid clinic, both preoperatively and postoperatively, were contacted by telephone call. Information about demographics, keloid characteristics, and levels of pain and pruritus were recorded. Participants also completed all 3 parts (appearance, symptoms, and psychosocial impact) of the SCAR-Q, a validated patient-reported outcome measure questionnaire. Statistical analysis was performed with SPSS version 23 (IBM Corp., Armonk, NY).

Results
Of the 60 patients who participated in the study, 35 preoperative and 34 postoperative surveys were completed. Patients experienced significant reductions in mean [standard deviation] pain levels (from 5.6 [4.0] to 0.1 [0.4], P &lt; 0.001) and pruritus (from 6.5 [3.0] to 0.8 [1.5], P &lt; 0.001) postintervention. Significant improvements in all 3 parts of the SCAR-Q were noted. Appearance improved from 26.5 [22.3] to 73.4 [23.0] (P &lt; 0.001); symptoms from 44.0 [15.7] to 81.4 [16.7] (P &lt; 0.001); and psychosocial impact from 27.7 [30.7] to 82.6 [26.3] (P &lt; 0.001).

Conclusions
Patients with keloids experience significant improvement in their symptomatic and psychosocial burden after treatment. Although management modalities are not well established, it is essential that plastic surgeons do not overlook the therapeutic benefits for their patients’ well-being.
9 The Management of Patients Admitted with Head Injuries at Gozo General Hospital
Authors: Bugeja K. , Jayawardena U. , Vincenti M. Zammit 
Published: February 2022

Abstract

Aim
This audit reviewed management practice of patients admitted to Gozo General Hospital with a head injury, to see whether guidelines are being followed.

Method
All patients admitted to GGH with a head injury over a twelve-month period (December 2019 – November 2020) were retrospectively reviewed. We used National Institute for Health Care Excellence (NICE) clinical guidance 176 as the standard to compare to.

Results
61 patients, with a mean age 33 years, that were admitted to hospital were included. CT head was performed on 36 (59%) patients.
According to NICE guidelines, CT head was warranted in these patients:
24 (39%) patients had a CT scan which may not have been indicated according to NICE guidelines.
Out of the 61 patients admitted to hospital, admission was warranted in the following:
49 (80%) of admitted patients may have not needed admission.

Conclusions
This retrospective review suggests that a significant number of patients are being unnecessarily admitted to Gozo General Hospital following a head injury and a significant number are having an unnecessary CT head. The local issues causing this need to be identified and methods need to be introduced to better follow recommended guidelines.
18 The Rise in Trauma & Orthopaedic Trainee-Led Research and Audit Collaborative Projects in the United Kingdom Since the Start of the COVID-19 Pandemic
Authors: Khaleeq T. , Kabariti R. , Ahmed U. 
Published: February 2022

Abstract

Introduction
There has been a significant rise in trainee-led trauma & orthopaedic (T&O) multi-centre research collaborative projects globally. Since the start of the COVID-19 pandemic, more emphasis has been on global collaborative research efforts to tackle important research questions. The aim was to evaluate the number of T&O trainee-led research collaborative projects that took part since the start of the COVID-19 pandemic in the UK.

Method
A retrospective study that evaluated T&O trainee-led national collaborative projects within the UK since the start of the COVID-19 pandemic lockdown (March 2020 to June 2021). Our exclusion criteria included any regional collaborative projects, projects that were started pre-COVID and projects of other surgical specialities. The number of projects identified was compared to that in 2019.

Results
In 2019, 0 trainee-led collaborative projects were commenced nationally in the UK. Since the COVID-19 pandemic, we identified 10 trainee-led collaborative trauma & orthopaedic projects with 3 being published so far. The level of evidence ranged between 3 and 4.

Conclusions
Covid has placed significant challenges across healthcare. One positive aspect that has been noted is the increase in multi-centre trainee-led collaborative projects within the UK. Our study highlights the feasibility of a trainee-led high quality collaborative research projects in the UK, emphasising the growing contribution of trainees towards research. Wide-spread availability of new technological tools such as social media and Redcap® facilitates such projects in terms of recruitment and data collection. We would, therefore, recommend expanding this trainee-led collaborative platform across in Europe and Worldwide.
21 One-Shot Tract Dilatation for Supine Percutaneous Nephrolithotomy (PCNL) in Obese Patients
Authors: Sheng Z. , Warner R. , Caddeo G. 
Published: February 2022

Abstract

Introduction
With the rising incidence of both obesity and urolithiasis, the need to perform stone surgery in high BMI patients is increasing. We analysed the safety and efficacy of the one-shot tract dilatation (OSD) technique in obese patients undergoing supine percutaneous nephrolithotomy (PCNL).

Method
Retrospective review of all supine PCNLs performed by a single surgeon between January 2014 and December 2020. Patient factors (age and BMI), stone complexity and procedural characteristics (tract size and dilatation technique) were collected. Outcomes included access success, length of stay, operating duration, and inpatient complications.

Results
Overall 104 supine PCNLs were performed in 93 patients. Forty-four had a BMI &gt;/ =  30 kg/m2 with a median age of 53 years, median BMI 35.12 kg/m2 and median Guy’s stone score of 2. When initial puncture was successful (43 cases (98%)), tract dilatation was satisfactory on all occasions. Dilatation was performed using a balloon dilator (24Ch) in 12 cases and OSD in 31 cases (range 16Ch to 24Ch, median 22Ch). Median length of stay was lower when OSD used (1 day) versus balloon (2 days), P = 0.03. Median operating time using OSD was 98 minutes versus 120 minutes using balloon (P = 0.10). There was no significant difference in operative time or length of stay when using OSD compared with BMI &lt; 30 kg/m2. There were two Clavien-Dindo Grade I and one Grade II complications in patients where OSD was used. No transfusions were required.

Conclusions
One shot dilatation is an effective and safe means of access in obese patients when performing a supine PCNL.
25 Tender Is the Spine: Thoracolumbar Fractures and Patterns of Referrals
Authors: Saad A.R. , Mueller M. , Pillai D. 
Published: February 2022

Abstract

Introduction
This study investigates the pattern of referrals of thoracolumbar fractures between trauma and orthopaedic department in a district general trauma unit (TU) and the affiliated Major Trauma Centre (MTC). Our TU has got no out of hour emergency spinal surgeons on site. Patients who are admitted with thoracolumbar fractures get referred to MTC for advice on management. The TLICS score and the AO Thoracolumbar fracture classification system are two well recognized classification systems for thoracolumbar fractures. The main aim of this project is to evaluate current practice and its effectiveness.

Method
Data was retrospectively collected from the trauma board for patients referred to the orthopaedic on call services for thoracolumbar fractures over a 16-month period. Patients’ demographics, mechanism of injury, TLICS scores and AO classification were recorded, and outcome registered.

Results
From 92 patients identified most had low energy trauma and the majority had low TLICS score (&lt;2) and AO class (A1,2,3). 24 of the patients were referred to MTC of whom 10 required a follow-up appointment. 39 were discussed with the local spinal consultants. 91 were treated conservatively and locally.

Conclusions
Most thoracolumbar fractures are treated locally. It can be argued that the emergency spinal services at MTC are unnecessarily burdened for advice and reassurance. A change of the current pathway can possibly be put in place for patients with low AO classification (A1,2,3), that can be treated with local spinal surgeon input. This calls for a follow-on multi-centre study.
26 Running a Safe Aortic Service in the Covid-Era
Authors: Beavis J. 
Published: February 2022

Abstract

Introduction
Within the Covid-19 pandemic, elective surgery has been cancelled to increase critical care capacity. With two thirds of abdominal aortic aneurysm ruptures lethal, it is important to consider how to run a safe aortic service within the pandemic. Vascular patients have an increased risk of mortality from Covid-19. By considering ambulatory care, shortening hospital stay and discharging to level 1 care for non-complex infrarenal endovascular aneurism repairs (EVAR), critical care capacity can be kept available and exposure to nosocomial Covid-19 can be reduced.

Method
A retrospective audit of EVAR patient’s documentation examined the ASA, level of postoperative care, time to discharge, geographical and personal care factors. These were compared with pre-established criteria deeming suitability for ambulatory or ward level care. Results were presented locally and subsequent reaudit conducted.

Results
The initial audit included 40 records. 30% of patients were potential targets for ambulatory care with the median discharge on postoperative day 3. All patients were admitted to the high dependency unit (HDU) with 12.5% of patients receiving treatment that required a HDU level of care. Upon reaudit, 8 records were included with all patients admitted to HDU and the median day of discharge postoperative day 2. Notably, 37.5% patients were discharged on postoperative day 1 and a day of surgery admission (DOSA) process was implemented.

Conclusions
By reviewing a health board’s EVAR caseload, suitability for short stay EVARs can be assessed. Implementing an early discharge and DOSA process keeps care capacity available and may protect against nosocomial Covid-19.
29 Ankle Syndesmotic Injury: Tightrope vs Screw Fixation, a Clinical Academic Survey
Authors: Shafiq H. , Khan B.G. , Jamshed H. 
Published: February 2022

Abstract

Aim
Unstable syndesmotic ankle injury requires surgical management in the form of screw or tightrope fixation. However, the superiority of one technique over the other remains debatable. Our Study aims to identify the fixation of choice in unstable ankle syndesmotic injury based on the surgeon’s level of experience.

Methods
A survey was undertaken to analyse the management of ankle syndesmotic injuries AO 44c in a 35-year-old patient. Surgeons attending an orthopaedic course were invited to participate in a survey categorised into groups: junior surgeons, middle grades and experienced. X-ray was shown to the 100 participants and treatment options were asked.

Results
100 surgeons from 20 nations took part in the event. Juniors made up 39%, registrars 38% and experienced surgeons were 29%. 93% chose screw fixation, out of which 66% favoured a single screw over two screws. 3–4 cortices were virtually evenly divided in choice, with 54 % preferring three and 46% preferring four cortices. Only 22% of the time did they utilise a washer with screws. 52% of the surgeons allowed weight-bearing 4 to 6 weeks after surgery. 34% preferred to remove the screw at 1–2 months and 29% at 2–3 months post-operatively.

Conclusions
Data show that majority of junior level doctors manage their patients according to AO principles. The majority prefer one 3.5mm screw positioned between 2–4 cm above the ankle joint, with three cortices being somewhat preferred. Despite the lack of data to support one procedure, the majority of people remove their screws within 1 to 3 months.
74 Implications of Pre-Operative Ng Fasting on Nutrition in Major Burn Patients: An Audit of Practice
Authors: Khera B. , Lewis C. , Lancaster N. 
Published: February 2022

Abstract

Background
Nasogastric (NG) feeding is commonly employed as a first line method of enteral feeding. This needs to be stopped pre-operatively resulting in missed calories and protein. Nasojejunal (NJ) feeding is an alternative method that can continue during surgery and can be used in gastric stasis.
In this audit we want to determine the calorie and protein loss in major burns patients at the Northern Regional Burn Centre who have had enteral feeding via the nasogastric route.

Method
A retrospective analysis of the NG feeding, and fasting times was carried out for major burns patients at the Royal Victoria Infirmary in Newcastle from 2019 to 2021. Nine patients were identified, and their NG feeding prescriptions and delivery times were looked at. The number of calories and protein prescribed by the dietitian were compared against the amount missed when the NG feed was paused. A percentage loss was calculated for each parameter.

Results
Of the 9 patients analysed over 3 years, the calories lost ranged from 2226kcal to 23,929kcal. Of the induvial prescribed calorie intake, the calorie loss was from 7% to 39% with a mean calorie loss of 17.6%. The protein lost ranged from 143g to 1,240g. Of the individual prescribed protein intake, the protein loss was from 7% to 40% with a mean protein loss of 19.4%.

Conclusions
We recommend that the addition of NJ feeding as an alternative method of enteral feeding to the NUTH burns nutritional policy would help optimise the management of major burns patients by minimising nutritional losses.
81 An Audit of Venous Thromboembolism (VTE) Risk Assessment & Prophylaxis Implementation
Authors: Woolner B. , Moore P. , Parker S. 
Published: February 2022

Abstract

Introduction
VTE is considered one of the most common preventable causes of death and significant co-morbidity in inpatients and is responsible for approximately 60,000 deaths occur per annum in the UK. The NHS Standard Contract requires all inpatients to undergo a VTE risk assessment, with a 95% patient assessment threshold. In January 2020 we identified that 72% of patients within our trust had a risk assessment completed, and 15% of these were accurate. We subsequently implemented mandatory VTE prescribing training for all junior doctors joining the trust.

Aim
Review the impact of mandatory training module on VTE risk assessment and prescribing, in compliance with NICE Guidelines.

Method
All inpatient medical notes, VTE risk assessments, and VTE prescriptions were reviewed to assess accurate risk assessment completion and subsequent appropriate prophylaxis prescribing. The standards were as set out in the NICE guidelines [NG89]. Paediatric, Obstetric and ITU patients were excluded.

Results
Our VTE risk assessment completion rates increased from 72.1% to 94.2%, and the accuracy of these assessments from 15.4% to 34.5%. Our prescription rate increased from 84.6% to 90.6%, and prescribing accuracy from 41.2% to 79.5%.

Conclusions
By implementing mandatory VTE prophylaxis training for all junior doctors joining a new NHS trust, we can see increased compliance with appropriate risk assessment and prophylaxis prescribing. This will reduce the risk of unnecessary death from VTE in hospital inpatients.
114 Urology Stent Recall Registry
Authors: Narayan P. , Wood H. , Mukhtar S. , Papikinos P. 
Published: February 2022

Abstract

Aim
To analyse how many stent procedures were recorded (on the stent registry tool in CERNER introduced at our busy DGH) for patients undergoing an insertion of ureteric stent, this ensures patient safety is not compromised by making sure stent(s) are removed or replaced at the right time.

Method
Retrospective Collection of data for 3 months. Which was followed by intervention, and a further collection of data for 3 months after implementation of changes. Parameters collected included age, gender, stent recall registered, comments present in registry, removal date.

Results
In the first loop only 32.6% of the patient had the stent recall registered on the directory. Post Intervention (IT training, Posters, presenting half audit at clinical governance) the registry rate was 59%. The most common reason for insertion was for stone, followed by longstanding hydronephrosis. It was also interesting to note that 2 patients were found who were lost in follow up and an urgent action was taken to review them.

Conclusions
Cerner, which is popular in NHS trusts across UK has the feasibility of having an online stent register where the information recorded gets transferred straight to the Urology office, hence ensuring correct time of removal/ exchange of stents. Trusts across UK can develop this online registration scheme in their IT system. Developing the online registry system and encouraging this audit in all NHS trusts will significantly impact the welfare and safety of patients and reduce the economic burden of NHS in dealing with complications associated with stents.
117 Management of Spinal Accessory Nerve Palsy
Authors: Rupra R. , Malone P. , Power D. , Chaudhry T. 
Published: February 2022

Abstract

Aim
To discuss our strategies employed in our peripheral nerve injury unit for spinal accessory nerve (SAN) injury and a potential algorithm for future use.

Method
A retrospective analysis was undertaken on 9 patients with SAN injury undergoing surgical intervention. Neurophysiological results were obtained. MRC grades were compared at presentation and post-operatively. DASH (Disability of the arm, shoulder, and hand) scores were also collected post-operatively.

Results
7 patients presented to us following an iatrogenic injury to the SAN.
6 patients underwent neurolysis only, 3 underwent nerve transfer, 2 underwent nerve grafting (1 autologous, 1 processed nerve allograft).
The mean time frame from presentation to operation was 13 months. MRC grading of shoulder function increased from a mean MRC 2 to 4 at a mean of 8 months post-operatively. DASH scores of the 7 participating patients were 30.8 at a mean of 47 months post-operatively. 2 patients had experienced a sensory deficit.

Conclusions
Nerve grafting allows bridging of a gap when the injury is well defined with a suitable window for re-innervation. Allograft has a role in small gaps where there may be concerns with autograft. Nerve transfer may allow earlier re-innervation and be a more reliable option where the proximal extent of nerve injury is poorly defined. We found nerve wraps to be a useful addition when an injured nerve may be adherent to a heavily scarred bed. We will present some worked examples along with a potential algorithm for a surgical strategy.