Damage Function for Historic Paper: Part II

Background As a result of use of library and archival documents, defined as reading with handling in the context of general access, mechanical degradation (wear and tear) accumulates. In contrast to chemical degradation of paper, the accumulation of wear and tear is less well studied. Previous work explored the threshold of mechanical degradation at which a paper document is no longer considered to be fit for the purpose of use by a reader, while in this paper we explore the rate of accumulation of such damage in the context of object handling. Results The degree of polymerisation (DP) of historic paper of European origin from mid-19th–mid-20th Century was shown to affect the rate of accumulation of wear and tear. While at DP > 800, this accumulation no longer depends on the number of handlings (the process is random), a wear-out function could be developed for documents with DP between 300 and 800. For objects with DP < 300, one large missing piece (i.e. such that contains text) developed on average with each instance of handling, which is why we propose this DP value as a threshold value for safe handling. Conclusions The developed model of accumulation of large missing pieces per number of handlings of a document depending on DP, enables us to calculate the time required for an object to become unfit for use by readers in the context of general access. In the context of the average frequency of document use at The UK National Archives (Kew), this period is 60 years for the category of papers with DP 300, and 450 years for papers with DP 500. At higher DP values, this period of time increases beyond the long-term planning horizon of 500 years, leading to the conclusion that for such papers, accumulation of wear and tear is not a significant collection management concern

Automated retinal image quality assessment on the UK Biobank dataset for epidemiological studies.

Morphological changes in the retinal vascular network are associated with future risk of many systemic and vascular diseases. However, uncertainty over the presence and nature of some of these associations exists. Analysis of data from large population based studies will help to resolve these uncertainties. The QUARTZ (QUantitative Analysis of Retinal vessel Topology and siZe) retinal image analysis system allows automated processing of large numbers of retinal images. However, an image quality assessment module is needed to achieve full automation. In this paper, we propose such an algorithm, which uses the segmented vessel map to determine the suitability of retinal images for use in the creation of vessel morphometric data suitable for epidemiological studies. This includes an effective 3-dimensional feature set and support vector machine classification. A random subset of 800 retinal images from UK Biobank (a large prospective study of 500,000 middle aged adults; where 68,151 underwent retinal imaging) was used to examine the performance of the image quality algorithm. The algorithm achieved a sensitivity of 95.33% and a specificity of 91.13% for the detection of inadequate images. The strong performance of this image quality algorithm will make rapid automated analysis of vascular morphometry feasible on the entire UK Biobank dataset (and other large retinal datasets), with minimal operator involvement, and at low cost

Intraperitoneal drain placement and outcomes after elective colorectal surgery: international matched, prospective, cohort study

Despite current guidelines, intraperitoneal drain placement after elective colorectal surgery remains widespread. Drains were not associated with earlier detection of intraperitoneal collections, but were associated with prolonged hospital stay and increased risk of surgical-site infections.Background Many surgeons routinely place intraperitoneal drains after elective colorectal surgery. However, enhanced recovery after surgery guidelines recommend against their routine use owing to a lack of clear clinical benefit. This study aimed to describe international variation in intraperitoneal drain placement and the safety of this practice. Methods COMPASS (COMPlicAted intra-abdominal collectionS after colorectal Surgery) was a prospective, international, cohort study which enrolled consecutive adults undergoing elective colorectal surgery (February to March 2020). The primary outcome was the rate of intraperitoneal drain placement. Secondary outcomes included: rate and time to diagnosis of postoperative intraperitoneal collections; rate of surgical site infections (SSIs); time to discharge; and 30-day major postoperative complications (Clavien-Dindo grade at least III). After propensity score matching, multivariable logistic regression and Cox proportional hazards regression were used to estimate the independent association of the secondary outcomes with drain placement. Results Overall, 1805 patients from 22 countries were included (798 women, 44.2 per cent; median age 67.0 years). The drain insertion rate was 51.9 per cent (937 patients). After matching, drains were not associated with reduced rates (odds ratio (OR) 1.33, 95 per cent c.i. 0.79 to 2.23; P = 0.287) or earlier detection (hazard ratio (HR) 0.87, 0.33 to 2.31; P = 0.780) of collections. Although not associated with worse major postoperative complications (OR 1.09, 0.68 to 1.75; P = 0.709), drains were associated with delayed hospital discharge (HR 0.58, 0.52 to 0.66; P &lt; 0.001) and an increased risk of SSIs (OR 2.47, 1.50 to 4.05; P &lt; 0.001). Conclusion Intraperitoneal drain placement after elective colorectal surgery is not associated with earlier detection of postoperative collections, but prolongs hospital stay and increases SSI risk

The impact of surgical delay on resectability of colorectal cancer: An international prospective cohort study

AIM: The SARS-CoV-2 pandemic has provided a unique opportunity to explore the impact of surgical delays on cancer resectability. This study aimed to compare resectability for colorectal cancer patients undergoing delayed versus non-delayed surgery. METHODS: This was an international prospective cohort study of consecutive colorectal cancer patients with a decision for curative surgery (January-April 2020). Surgical delay was defined as an operation taking place more than 4 weeks after treatment decision, in a patient who did not receive neoadjuvant therapy. A subgroup analysis explored the effects of delay in elective patients only. The impact of longer delays was explored in a sensitivity analysis. The primary outcome was complete resection, defined as curative resection with an R0 margin. RESULTS: Overall, 5453 patients from 304 hospitals in 47 countries were included, of whom 6.6% (358/5453) did not receive their planned operation. Of the 4304 operated patients without neoadjuvant therapy, 40.5% (1744/4304) were delayed beyond 4 weeks. Delayed patients were more likely to be older, men, more comorbid, have higher body mass index and have rectal cancer and early stage disease. Delayed patients had higher unadjusted rates of complete resection (93.7% vs. 91.9%, P = 0.032) and lower rates of emergency surgery (4.5% vs. 22.5%, P < 0.001). After adjustment, delay was not associated with a lower rate of complete resection (OR 1.18, 95% CI 0.90-1.55, P = 0.224), which was consistent in elective patients only (OR 0.94, 95% CI 0.69-1.27, P = 0.672). Longer delays were not associated with poorer outcomes. CONCLUSION: One in 15 colorectal cancer patients did not receive their planned operation during the first wave of COVID-19. Surgical delay did not appear to compromise resectability, raising the hypothesis that any reduction in long-term survival attributable to delays is likely to be due to micro-metastatic disease

Global disparities in surgeons’ workloads, academic engagement and rest periods: the on-calL shIft fOr geNEral SurgeonS (LIONESS) study

: The workload of general surgeons is multifaceted, encompassing not only surgical procedures but also a myriad of other responsibilities. From April to May 2023, we conducted a CHERRIES-compliant internet-based survey analyzing clinical practice, academic engagement, and post-on-call rest. The questionnaire featured six sections with 35 questions. Statistical analysis used Chi-square tests, ANOVA, and logistic regression (SPSS® v. 28). The survey received a total of 1.046 responses (65.4%). Over 78.0% of responders came from Europe, 65.1% came from a general surgery unit; 92.8% of European and 87.5% of North American respondents were involved in research, compared to 71.7% in Africa. Europe led in publishing research studies (6.6 ± 8.6 yearly). Teaching involvement was high in North America (100%) and Africa (91.7%). Surgeons reported an average of 6.7 ± 4.9 on-call shifts per month, with European and North American surgeons experiencing 6.5 ± 4.9 and 7.8 ± 4.1 on-calls monthly, respectively. African surgeons had the highest on-call frequency (8.7 ± 6.1). Post-on-call, only 35.1% of respondents received a day off. Europeans were most likely (40%) to have a day off, while African surgeons were least likely (6.7%). On the adjusted multivariable analysis HDI (Human Development Index) (aOR 1.993) hospital capacity &gt; 400 beds (aOR 2.423), working in a specialty surgery unit (aOR 2.087), and making the on-call in-house (aOR 5.446), significantly predicted the likelihood of having a day off after an on-call shift. Our study revealed critical insights into the disparities in workload, access to research, and professional opportunities for surgeons across different continents, underscored by the HDI

Reducing the environmental impact of surgery on a global scale: systematic review and co-prioritization with healthcare workers in 132 countries

Background Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres. Methods This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was co-prioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, ranked lists of interventions were presented by their relevance to high-income countries and low–middle-income countries. Results In phase 1, 43 interventions were identified, which had low uptake in practice according to 3042 professionals globally. In phase 2, a shortlist of 15 intervention domains was generated. In phase 3, interventions were deemed acceptable for more than 90 per cent of patients except for reducing general anaesthesia (84 per cent) and re-sterilization of ‘single-use’ consumables (86 per cent). In phase 4, the top three shortlisted interventions for high-income countries were: introducing recycling; reducing use of anaesthetic gases; and appropriate clinical waste processing. In phase 4, the top three shortlisted interventions for low–middle-income countries were: introducing reusable surgical devices; reducing use of consumables; and reducing the use of general anaesthesia. Conclusion This is a step toward environmentally sustainable operating environments with actionable interventions applicable to both high– and low–middle–income countries

Reducing the environmental impact of surgery on a global scale: systematic review and co-prioritization with healthcare workers in 132 countries

Abstract Background Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres. Methods This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was co-prioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, ranked lists of interventions were presented by their relevance to high-income countries and low–middle-income countries. Results In phase 1, 43 interventions were identified, which had low uptake in practice according to 3042 professionals globally. In phase 2, a shortlist of 15 intervention domains was generated. In phase 3, interventions were deemed acceptable for more than 90 per cent of patients except for reducing general anaesthesia (84 per cent) and re-sterilization of ‘single-use’ consumables (86 per cent). In phase 4, the top three shortlisted interventions for high-income countries were: introducing recycling; reducing use of anaesthetic gases; and appropriate clinical waste processing. In phase 4, the top three shortlisted interventions for low–middle-income countries were: introducing reusable surgical devices; reducing use of consumables; and reducing the use of general anaesthesia. Conclusion This is a step toward environmentally sustainable operating environments with actionable interventions applicable to both high– and low–middle–income countries

Past and future colouring patterns of historic stone buildings

The patterns of colour on stone buildings change with time. Buildings were blackened by coal soot, but now mostly diesel particles and in future, wind-driven rain may alter the patterns and oxidation of surface organics. Colouring patterns that outline or shadow architectural elements are publicly more acceptable than those that cut across them e.g. rain streaking. Thresholds of acceptability for blackening can be related to soot loading. When soot loading of the ambient air is high, e.g. near busy roads, buildings are dark and typically viewed as unacceptable. However at lower concentrations (2-3 &#206;&#188;g m^-3 elemental carbon), building appearance is typically seen as more acceptable. The future offers a potential for variation in building colour, arising through different biological growth under changing climates or the presence of different pollutants. In future urban atmospheres more dominated by organic pollutants a yellowing process may be more important. Diesel soot has many organic compounds that can oxidise to brownish-coloured humic-like (HULIS) materials. We illustrate the development of colour patterns on the Cathedral Church of St John the Baptist, Norwich UK from its opening (beginning of the 20th century) to the end of the 21st century derived from historic photographs, observations and predictions for the future appearance. The latter has to consider removal of deposits by changed rainwater flow and enhanced biological activity. Blackening from coal smoke may have reached a peak around 1960s and 1970s, but diesel soot predominates now.<br><br>La distribuci&#243;n del color en edificios de piedra var&#237;a con el tiempo. En el pasado, el ennegrecimiento se deb&#237;a principalmente a la combusti&#243;n de carb&#243;n. Actualmente, se debe fundamnetalmente al dep&#243;sito de part&#237;culas derivadas del diesel. En el futuro, se ver&#225; modificado por la acci&#243;n de la lluvia y el viento. La percepci&#243;n del p&#250;blico sobre el ennegrecimineto depende de su distribuci&#243;n. Si se resaltan las formas arquitect&#243;nicas, ser&#225; en general aceptable. Los umbrales de aceptaci&#243;n tambi&#233;n dependen de la concentraci&#243;n de carbono elemental. Si la concentraci&#243;n es elevada, como en &#225;reas de tr&#225;fico intenso, los edificios estar&#225;n oscurecidos y probablemente se percibir&#225;n como inaceptablemente sucios. A menores concentracions de carbono elemental (2-3 &#206;&#188;g m^-3), el aspecto de los edificios es en general m&#225;s aceptable. En el futuro, los cambios de color se ver&#225;n favorecidos por la diferente actividad biol&#243;gica, resultante del cambio clim&#225;tico y los diferentes tipos de contaminantes. Un proceso de amarilleamento ser&#225; probalemente m&#225;s relevante. Las part&#237;culas derivadas del diesel son ricas en sustancias org&#225;nicas que se pueden oxidar a materiales similares a compuesto h&#250;micos (HULIS) de colores marron&#225;ceos. Finalmente, se ilustra la evoluci&#243;n de la distribuci&#243;n del color en la Catedral de San Juan Bautista, Norwich (UK) desde su apertura (principios del siglo XX) hasta finales del siglo XXI, usando fotograf&#237;as hist&#243;ricas, observaciones y prediciones del aspecto futuro, considerando la redistribuci&#243;n de los dep&#243;sitos por el agua y la actividad biol&#243;gica. El ennegrecimiento por carb&#243;n probablemte alcanz&#243; su m&#225;ximo hacia 1960-70. Actualmente el diesel es predominate