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161 Establishing Surgical Safety in Laparoscopic Cholecystectomy- a Multi-Society Consensus Statement on the CholeSafe 1 Course
No full textAbstract Aim
The introduction of laparoscopic cholecystectomy (LC) led to a notable increase in bile duct injury (BDI) rates, rising globally from 0.3% to 0.6%. Despite advancements, current rates persist at 0.2–0.3%. In the UK, BDI remains an indefensible complication. There has been no coordinated national effort to standardise safe LC training.
This study aimed to establish evidence-based criteria for the selection, content, structure, and delivery of the CholeSafe 1 course, a dedicated programme designed to teach standardised techniques for safer cholecystectomy and to reduce BDI incidence.
Method
A multisociety expert panel was formed, comprising consultant faculty and trainees from BBUGSS, AUGIS, the Roux Group, and GBIHPBA. A Delphi process was employed, with consensus defined a priori as ≥70% agreement. Two rounds of structured statements were administered to achieve a consensus of over 75% on key components.
Results
Nineteen faculty representatives participated in the first round and fourteen in the second. Statements that did not reach consensus were revised or removed before re-administration. By the end of the second round, consensus was achieved on several critical aspects: the appropriate level of trainee experience, complexity of cases suitable for teaching, prerequisite understanding of biliary anatomy and BDI implications, standardisation of operative steps and terminology, as well as the course’s overall structure, duration, and delivery format.
Conclusions
The first implementation of the CholeSafe 1 course is planned for the AUGIS Scientific Meeting in 2025. Feedback from this initial rollout will guide future refinements, supporting the broader aim of enhancing surgical safety in LC across the UK
Measurement of treatment burden in cystic fibrosis: A systematic review
Get PDFBackground
Cystic fibrosis (CF) is a chronic condition that requires complex and long-term treatments. While substantial research has explored treatment burden associated with CF; its impact remains complex to quantify. This review aims to identify the different methods used in the literature to measure treatment burden in people with CF (pwCF).
Method
Five databases were searched for interventional and observational studies that focused primarily on treatment burden. The studies were presented using narrative synthesis structured around the perspective of treatment burden (subjective vs. objective).
Results
This review synthesised 17 articles, which utilised subjective and objective measures separately or collectively. Twelve studies used subjective treatment burden measures (CF-specific and generic scales), while 14 studies used objective measures (treatment time, volume and complexity, and cost). Eight studies investigated treatment burden reported by proxy on behalf of children with CF. The most used measures were treatment time (9/17) and CF questionnaire-revised (CFQ-R) treatment burden subscale (6/17). Older age and lower lung function were associated with greater burden, treatment time, and complexity. Caregivers/parents reported worse treatment burden compared to children with CF (6-13 y/o) when completing the same measure.
Conclusion
No single measure used in the reviewed studies fully the multidimensional nature of treatment burden and summarised it in a single score. Given the rapidly evolving landscape of CF care a pragmatic approach to capture a broader array of treatment burden dimensions may be to routinely complement subjective measures with objective measures
Understanding the Experience of Workplace Violence in Hospitals as Documented by Nursing Staff: Using the READ Approach
Get PDFBackground: Workplace violence has a significant impact on patients, families, and staff safety. Workplace violence can produce traumatic results for those involved; the importance of preventive measures needs to be paramount in health service policy and process. Health care staff are required to document their experiences of violent incidents after every occasion, usually via an incident reporting system, which allows for a free text description of the event. There is a lack of understanding of how health care staff document reports of violence and how they explain the events. Methods: This study aims to determine the circumstances surrounding workplace violent events as documented by health care staff. The four-step Review, Extract, Analyze, and Document (READ) approach to document analysis was used to examine workplace violence incident reports over 12 months (September 2021–September 2022) in a tertiary referral hospital. Findings: Six categories of workplace violence were found: (a) “Escalation Dynamics”—patterns and progression of how violence incidents intensify; (b) “Warning Behaviors”—verbal or non-verbal signals that may foreshadow physical violence if not addressed; (c) “Authoritative Institutional Interventions”—how aggression correlates to protocols involving security personnel or law enforcement; (d) “Care Delivery Methods”—how certain treatment procedures and approaches might inadvertently elicit violence; (e) “Situational Stressors”—external circumstances or changes that act as triggers for violence; and (f) “Unprovoked triggers”—sudden and seemingly unprovoked violent outbursts. Conclusions and application to practice: Workplace violence in health care is a multifaceted interplay of events with the nurse involved in all aspects of the process. These findings can be used by occupational health nurses in education and policy development. The findings can be used to focus education on how violent incidents may escalate and provide more opportunities for de-escalation by health care staff
An Investigation of Feature Reduction, Transferability, and Generalization in AWID Datasets for Secure Wi-Fi Networks
Get PDFThe widespread use of wireless networks to transfer an enormous amount of sensitive information has caused a plethora of vulnerabilities and privacy issues. The management frames, particularly authentication and association frames, are vulnerable to cyberattacks and it is a significant concern. Existing research in Wi-Fi attack detection focused on obtaining high detection accuracy while neglecting modern traffic and attack scenarios such as key reinstallation or unauthorized decryption attacks. This study proposed a novel approach using the AWID 3 dataset for cyberattack detection. The retained features were analyzed to assess their transferability, creating a lightweight and cost-effective model. A decision tree with a recursive feature elimination method was implemented for the extraction of the reduced features subset, and an additional feature wlan_radio.signal_dbm was used in combination with the extracted feature subset. Several deep learning and machine learning models were implemented, where DT and CNN achieved promising classification results. Further, feature transferability and generalizability were evaluated, and their detection performance was analyzed across different network versions where CNN outperformed other classification models. The practical implications of this research are crucial for the secure automation of wireless intrusion detection frameworks and tools in personal and enterprise paradigms
Scout In, Scout Out: Savi Scout Reflector Traversing A Dilated Duct to the Nipple in Breast Cancer Localisation - A Case Report
Get PDFAbstract
Introduction:
Savi scout system is being widely used for localising and excising breast tumours. While the migration of scout reflectors has been documented, this is the first case of a Savi Scout reflector migrating through a dilated duct near the lesion and coming out of the nipple.
Case Presentation:
A 56-year-old postmenopausal woman with a history of right breast intraductal papilloma which transformed to Grade II Invasive Ductal Carcinoma (IDC) has a Savi Scout reflector placed in the tumour. However, it migrated through a dilated duct and emerged at the nipple, causing severe pain. The reflector was then surgically removed, and the patient subsequently underwent wide local excision with skin marker localisation.
Conclusion:
Anatomical variations such as presence of dilated ducts need to be considered before placing scout reflectors. Appropriate positioning would prevent them from migrating through such ducts avoiding patient discomfort and further procedures for localisation
A Compendium of the Life and Genealogy of Cometan
No full textThe Compendium of the Life and Genealogy of Cometan is a compilation of years of family history research conducted by Cometan on his maternal and paternal ancestry. The book is formatted as an index of individual family members with key biographical details, photographs and extracts from various sources collected over the years. The book has over 300 pages of life stories of members of the Cottam, Moon, Prescott, Taylor and Warbrick families. The life stories include religious conversions, tragic deaths, details of married life, the births of children, burials, poetry, interviews, extracts of newspaper articles, paintings, wartime stories, emigration, illustrations of key events, religious tracts, details of people’s careers, pictures of gravestones and letters. This book embodies an ethnography of the lives of several families in Lancashire using a methodology of family history
Citizen Diplomacy Through Peace Tourism
Get PDFPeace tourism is a niche form of tourist activity that, as its name suggests, is driven by an interest in peace. Peace tourism is a broad category of tourist activity that can have both positive and negative contributions to the host destination. This chapter explores the ways in which peace tourism enables individuals to satisfy this interest in peace by exercising citizen diplomacy. In doing so, it addresses a methodological gap in diplomacy research, which conventionally adopted a state-centric perspective and overlooked the political agency of the individual – and as such, the tourist. The chapter examines the ways in which citizen diplomacy is applied through peace tourism and whether it can positively contribute to sustainable peace within and beyond state boundaries. Using the case study of Israel/Palestine, this chapter identifies initiatives of citizen diplomacy through peace tourism and examines their impact using Anderson’s model of six levels to peace. The study’s findings show that citizen diplomacy through peace tourism can yield positive contributions to peace. The findings are discussed in reference to the United Nations’ Sustainable Development Goals (SDGs) framework, and specifically SDG 16 on Peace, Justice and Strong Institutions
Acoustic analysis of like in North-West England shows context effects, but not function effects
Get PDFIf supposedly homophonous words were acoustically distinct despite sharing phonemic form, theories of mental storage may have to account for the consistent differences with
separate storage for each homophone. Previous studies of the homophonous functions or word classes of the English word like showed such sub-phonemic differences
between functions, though some studies also found effects of utterance context alongside these. Schleef & Turton (2018) argued that all these function effects reduce to
context effects, since function is not independent of context – for example, quotative like typically occurs before a pause and thus is typically subject to lengthening because
of its position, not due to a lexicalised acoustic distinction between functions. Testing this argument with new data from a different regional variety to those used by Schleef &
Turton, we only find differences that can be explained by context, in line with their argument. This casts prior findings of acoustic distinctions between like functions in
new light, and introduces the need for further research (especially including the frequency of different functions)
Simple Size Tuning of Magnetic Nanoparticles using a Microwave Solvothermal Method and their Application to Facilitate Solid Phase Synthesis of Smart Polymers.
Get PDFWe demonstrate a simple, economical, rapid and scalable microwave method to produce magnetite-based magnetic nanoparticles (MNPs) at a desired size and their application to facile synthesis of high value polymer products. One solvothermal method gaining traction is the use of microwave synthesis as it offers a rapid and green method to MNP production. In this work, we report a previously unreported simple and reliable method where adjusting the microwave temperature ramp time (between 2-15 minutes) during synthesis produces size control of superparamagnetic MNP@CHO nanoparticles. Nanoparticles size distributions measured using dynamic light scattering range from for 14 nm ±8 nm (at 2-minute ramp time) and 122 nm ± 49 nm (at 10-minute ramp time) and are produced within 20-30 minutes. Magnetic sizing analysis using the method of Chantrell confirmed iron-oxide core size increases as a function of ramp time over the range 7.91 to 11.25 nm in terms of median diameter and with lognormal σ values within (0.22 ≤ σ ≤ 0.33). Particle cluster size increase with increasing ramp time measured using transmission electron microscopy was found to be a function of particle agglomeration. Further, we demonstrate that the MNP@CHO functionalised with a protein of interest can then be applied to the rational solid phase synthesis of molecularly imprinted polymer nanoparticles (nanoMIPs) with high affinity for protein biomarkers. We demonstrate that there is an optimal MNP size for highly efficient MNP-based nanoMIP production which is key to mass production and commercialisation of low-cost and sustainable bespoke size-tuned MNPs and artificial antibodies
Investigating Transposed Word Effects in Reading
Get PDFAccording to the recently established OB1 Reader model (Snell, van Leipsig, et al., 2018), word position coding is noisy, and words are assigned to sentence positions via a spatiotopic sentence-level mechanism on the basis of length cues and syntactic expectations. A critical prediction that follows from this assumption is that readers should sometimes fail to detect an ungrammaticality created by transposing two adjacent words within a sentence. In line with this prediction, Mirault et al. (2018) initially found that readers are worse at judging the (un)grammaticality of sentences containing a word transposition only, versus sentences containing a word transposition and a syntactically illegal final word – a Transposed-Word effect. Since then, word transpositions have become increasingly relevant to the investigation of whether lexical processing is serial or parallel. The present thesis was aimed at investigating how word transpositions may influence moment-to-moment online cognitive processing during silent sentence reading via eye-tracking. The first experiment explored the influence of word transpositions and final word ungrammaticality on eye movements and grammaticality decisions. The second experiment explored the effects of word transpositions in the parafovea versus the fovea on eye movements and grammaticality decisions via the boundary paradigm (Rayner, 1975). The third experiment investigated the influence of word transpositions in comparison to letter masks in the parafovea on eye movements via the boundary paradigm as well. Across the three experiments, readers exhibited no sensitivity to the presence of a word transposition in parafoveal vision. However, from Experiment 1 and Experiment 2, it was clearly evident that upon fixating the first of the two transposed target words in a sentence, readers experienced significant and immediate disruption to processing. Furthermore, findings from Experiment 2 and Experiment 3 indicated that readers were sensitive to a preview change created by changing the order of the two target words in parafoveal versus foveal vision. Importantly, that sensitivity was likely due to the visual and orthographic rather than the syntactic mismatch between preview and targets and was driven primarily by the invalid preview of the first rather than the second target word. Overall, the results from the three experiments suggest that words are lexically processed serially and sequentially rather than in parallel. Moreover, readers do indeed sometimes fail to detect word transpositions, however, that is likely not driven by the processing mechanisms proposed by the OB1 Reader model. Consequently, current serial attention shift computational models of reading need to be expanded and modified in order to account for why readers fail to detect word transpositions under serial lexical processing assumptions