Value of a UK medical degree for international students (VISION): a cross-sectional study

Objectives: It is estimated that NHS staff consist of over 200 different nationalities, with a reported 30.7% of doctors holding a nationality other than British. Despite this, international medical students represent 7.5% of all medical students studying in the UK and pay on average, 4–6 times more in tuition fees when compared with the £9250 per annum (Great British Pounds (£) in 2021) paid by home students. This study’s aim and objective are to evaluate the perception of the financial cost and value of the UK medical degree for international students and their motivations for pursuing such a degree. Methods: This is a cross-sectional observational study enquiring about international premedical, medical and medical school graduates’ perception of the value of the UK medical degree and factors influencing their decision to study in the UK. A questionnaire was developed and distributed to 24 medical schools and 64 secondary schools both internationally and across the UK. Results: A total of 352 responses from 56 nationalities were recorded. 96% of international students identified clinical and academic opportunities as the most important factors to study medicine in the UK, closely followed by quality of life (88%). The least important factor was family reasons, with 39% of individuals identifying this factor. Only 4.82% of graduates in our study considered leaving the UK after training. Overall, 54% of students felt the UK degree was value for money. This belief was significantly higher in premedical students compared with existing students and graduates (71% vs 52% and 20%, p<0.001 for all comparisons). Conclusion: The quality of medical education and international prestige are attractive factors for international students to study medicine in the UK. However, further work is needed to ascertain reasons for the differing perceptions of the value by international students at different stages in their clinical training

SP11.11 Developing the Mobile App ‘ABCs of Breast Health’ - Pioneering Digital Innovation to raise awareness of Breast Health in India

Aims Breast cancer is the most common cancer affecting women, both in India &amp; the world. Due to a lack of awareness and the absence of an organised population-based screening programme in India, more than 60% of breast cancers present in the advanced stages, with most succumbing to the illness within a year of being diagnosed. This mobile app aims to empower people about various aspects of Breast cancer &amp; Benign breast disease explained in simple, easy-to-understand format. Methods To help address these striking realities, I worked with a Breast Cancer Charity based out of India, to create the Mobile App - ‘ABC's of Breast Health’ - available in English and 11 regional Indian Languages. The app has an interactive ‘Myths &amp; Facts’ section which is aimed at debunking many of the common myths surrounding breast cancer and ensuring that users are well informed with accurate information, thus filling a huge void in the delivery of Breast Health Care in India where counselling is not given much importance. A dedicated breast health helpline was launched in 2021 to further support users. Results This App is South Asia's First Mobile App on Breast Health and is also the World's first breast health app available in so many languages. Within the first month of its launch, it recorded 9000+ downloads. Conclusion The content of the app in 11 commonly spoken regional languages has ensured that accurate information relating to breast health is accessed by women in rural India, where 70% of the population resides

On quantifying damage severity in composite materials by an ultrasonic method

This work reports a study aimed at quantifying damage severity in composite materials by an in-field inspection technique known as Acousto-Ultrasonics (AU) where Lamb waves are transmitted through a damage zone by exciting a pulse onto the composite surface and capturing the received waves after their interactions with the damage. It builds on a previous study that proposed as quantitative descriptors of the received signal a set of stress wave factors (SWFs) extracted from the power spectral density (PSD) distribution of the AU signal. The SWFs were previously shown to detect the spatial extent of impact damage, but the severity of the damage within the impact damage zone was not quantified. The present study takes a step in the direction to achieve that goal. Lamb waves are transmitted through a cross ply laminate in which transverse ply cracks of increasing density (number of cracks per unit axial length) are induced. The PSD distribution is first analyzed for the case of an undamaged laminate and then the SWFs are correlated with the crack density. The implications of the correlations obtained and the future prospects of quantifying the damage severity by such correlations are discussed

Ultrasonic Inspection of Weld Defects Using Total Focusing Method

Ultrasonic arrays have been widely employed in industrial applications because of their ability to perform quick inspections for detection and characterization of flaws. The total focusing method (TFM) is an advanced ultrasonic imaging technique that utilizes the full matrix capture (FMC) data of the phased array elements to generate a high-resolution image by focusing on every image pixel in both transmission and reception. In this work, the time of flight framework involved for the TFM post-processing is illustrated for an angular wedge configuration. Further, the TFM algorithm is extended for imaging using multiple direct and half-skip wave modes by taking into account the wave mode conversions in the specimen. The implications of the mode conversions on the TFM images are analyzed, and the challenges posed on the TFM, specific to weld inspection, are explained in detail. In this work, experimental studies are performed on weld specimens with five common weld defects using the TFM algorithm. FMC data is acquired from the ultrasonic instrument and is post-processed to get the TFM images. The TFM results of weld defects show high resolution, better defect detectability, and easy visualization of defects compared to phased array sector scan images. © 2021, The Author(s), under exclusive license to Springer Nature Singapore Pte Ltd

Oncoplastic Breast Surgery-Common Complications and Management

The goal of oncoplastic procedures is to resect the breast cancer with negative histological margins while preserving the contour of the breast. Volume displacement and volume replacement oncoplastic procedures have different spectrum of complications. The most significant patient factors that affect outcome are smoking and high BMI, apart from the other comorbid conditions. Bleeding, hematoma and seroma are prevented by meticulous hemostasis and leaving a drain at the reconstructed site. Wound infection at surgical site can be prevented by administering pre-and intraoperative antibiotics routinely. Post-BCT deformity should be classified depending on the morphology and reconstructive choices. In such patients delayed partial breast reconstruction must be considered. Postoperative surveillance is an important approach to detect early recurrence, such that adequate measures can be taken. The effect of radiation therapy is different on the two categories of reconstruction methodologies—implants and flaps which are managed by local flaps and free tissue transfers. In general local and free flaps have few common complications like donor site morbidity, fat necrosis, breast and contour asymmetry, flap loss, contracture and scars, sensory loss and other complications specific to each type of flap. Even with the mentioned complications oncoplastic can be done safely, in most cases with low morbidity and complications resulting in excellent cosmetic results

An Overview of Experience with Preoperative Skin Marking and Clip Insertion in Non-palpable Breast Cancer Lesions in a Tertiary Care Cancer Center and Its Impact on Breast Conservation Surgery

Newer adjuncts in breast conservation surgery are striving for more precise excision of these cancerous lesions. This study evaluates two such techniques, preoperative ultrasound-guided lesion clipping and skin marking, and their effects on the surgical outcomes of early breast cancer lesions undergoing breast conservation surgery. This retrospective study includes 56 consecutive patients with non-palpable (upfront or post-neoadjuvant chemotherapy) biopsy-proven early breast cancers (T1, T2, T3 lesions). These patients underwent breast conservation surgery using ultrasound-guided percutaneous clipping and skin marking techniques at Manipal Comprehensive Cancer Center, between January 2019 and May 2021. Post excision, their total specimen volume and tumor volume were studied. Of the total of 56 patients, based on institutional protocol, 33 were clipped before neoadjuvant chemotherapy, and 23 patients underwent skin marking. Mean specimen volume was 99.25 ± 60 cm3, and mean tumor volume was 7.38 ± 13.6 cm3. Forty-seven patients (84%) were managed with a simple local type I oncoplastic procedure. In nine patients (16%), local perforator-based flap reconstruction was done. These techniques help to achieve precise excision of these tumors, requiring a lower volume of resection to achieve negative margins, with better cosmetic outcomes

Impact of the COVID-19 pandemic on paediatric patients with cancer in low-income, middle-income and high-income countries: protocol for a multicentre, international, observational cohort study

Introduction Childhood cancers are a leading cause of non-communicable disease deaths for children around the world. The COVID-19 pandemic may have impacted on global children’s cancer services, which can have consequences for childhood cancer outcomes. The Global Health Research Group on Children’s Non-Communicable Diseases is currently undertaking the first international cohort study to determine the variation in paediatric cancer management during the COVID-19 pandemic, and the short-term to medium-term impacts on childhood cancer outcomes.Methods and analysis This is a multicentre, international cohort study that will use routinely collected hospital data in a deidentified and anonymised form. Patients will be recruited consecutively into the study, with a 12-month follow-up period. Patients will be included if they are below the age of 18 years and undergoing anticancer treatment for the following cancers: acute lymphoblastic leukaemia, Burkitt lymphoma, Hodgkin lymphoma, Wilms tumour, sarcoma, retinoblastoma, gliomas, medulloblastomas and neuroblastomas. Patients must be newly presented or must be undergoing active anticancer treatment from 12 March 2020 to 12 December 2020. The primary objective of the study was to determine all-cause mortality rates of 30 days, 90 days and 12 months. This study will examine the factors that influenced these outcomes. χ2 analysis will be used to compare mortality between low-income and middle-income countries and high-income countries. Multilevel, multivariable logistic regression analysis will be undertaken to identify patient-level and hospital-level factors affecting outcomes with adjustment for confounding factors.Ethics and dissemination At the host centre, this study was deemed to be exempt from ethical committee approval due to the use of anonymised registry data. At other centres, participating collaborators have gained local approvals in accordance with their institutional ethical regulations. Collaborators will be encouraged to present the results locally, nationally and internationally. The results will be submitted for publication in a peer-reviewed journal

Impact of the COVID-19 pandemic on patients with paediatric cancer in low-income, middle-income and high-income countries: a multicentre, international, observational cohort study

OBJECTIVES: Paediatric cancer is a leading cause of death for children. Children in low-income and middle-income countries (LMICs) were four times more likely to die than children in high-income countries (HICs). This study aimed to test the hypothesis that the COVID-19 pandemic had affected the delivery of healthcare services worldwide, and exacerbated the disparity in paediatric cancer outcomes between LMICs and HICs. DESIGN: A multicentre, international, collaborative cohort study. SETTING: 91 hospitals and cancer centres in 39 countries providing cancer treatment to paediatric patients between March and December 2020. PARTICIPANTS: Patients were included if they were under the age of 18 years, and newly diagnosed with or undergoing active cancer treatment for Acute lymphoblastic leukaemia, non-Hodgkin's lymphoma, Hodgkin lymphoma, Wilms' tumour, sarcoma, retinoblastoma, gliomas, medulloblastomas or neuroblastomas, in keeping with the WHO Global Initiative for Childhood Cancer. MAIN OUTCOME MEASURE: All-cause mortality at 30 days and 90 days. RESULTS: 1660 patients were recruited. 219 children had changes to their treatment due to the pandemic. Patients in LMICs were primarily affected (n=182/219, 83.1%). Relative to patients with paediatric cancer in HICs, patients with paediatric cancer in LMICs had 12.1 (95% CI 2.93 to 50.3) and 7.9 (95% CI 3.2 to 19.7) times the odds of death at 30 days and 90 days, respectively, after presentation during the COVID-19 pandemic (p<0.001). After adjusting for confounders, patients with paediatric cancer in LMICs had 15.6 (95% CI 3.7 to 65.8) times the odds of death at 30 days (p<0.001). CONCLUSIONS: The COVID-19 pandemic has affected paediatric oncology service provision. It has disproportionately affected patients in LMICs, highlighting and compounding existing disparities in healthcare systems globally that need addressing urgently. However, many patients with paediatric cancer continued to receive their normal standard of care. This speaks to the adaptability and resilience of healthcare systems and healthcare workers globally

Twelve-month observational study of children with cancer in 41 countries during the COVID-19 pandemic

Childhood cancer is a leading cause of death. It is unclear whether the COVID-19 pandemic has impacted childhood cancer mortality. In this study, we aimed to establish all-cause mortality rates for childhood cancers during the COVID-19 pandemic and determine the factors associated with mortality