Separate Boxes Research Articles

Silver Fast Track – Prioritising People Over 75 in the Emergency Department (ED)

Abstract Background The National Emergency Medicine Programme prioritised the care of older adults in a three-year Unscheduled Care Improvement Programme, coinciding with the “Integrated NCAGL Acute Operations and Older Persons body of work on Older Adults with Frailty in Acute hospitals”. In May 2023 a three-month pilot in the ED commenced to reduce the time for people over the age of 75 awaiting assessment by a doctor. Using the Manchester Triage system, a separate filing box on triage (Category 3+) was created to identify all people aged over 75 years who would then be prioritised to be seen within 4 hours of arrival. In addition, if a person aged over 75 years was waiting over 4 hours to be seen they would be re-triaged and seen within 15 minutes (Category 2). Methods A Prospective analysis of waiting times for people aged over 75 years, assessing: (1) time to be assessed by the Older Persons Assessment and Liaison (OPAL) Team; (2) time to see the ED doctor and (3) time to discharge. Results Four months prior to commencement, the median time from arrival to be seen by OPAL was 10 hours 58 mins. Following commencement, for the remainder of 2023, the median time from arrival to seen by OPAL was 6 hours 36 mins. The time to see the doctor reduced by 49 mins and time to discharge reduced by 1 hour 19 minutes. Conclusion The category 3+ for patients aged over 75 years is now an established feature in the ED. It has enabled the OPAL team to undertake earlier assessment of the patients journey alongside the medical team ensuring a more collaborative discharge pathway. In the future, we hope to further reduce the time to be assessed by OPAL through the introduction of clinical frailty scoring at ED triage & expanding the team.

Noble Dome: A Novel Air-Free Transfer System For Battery Research with Electron Microscopy

"Noble Dome: A Novel Air-Free Transfer System" introduces an innovative solution for loading air-sensitive samples into SEM/FIB instruments. Traditional loading methods expose samples to atmosphere during transfer, hindering investigations of reactive materials. The presented prototype, Noble Dome, directly attaches to the SEM/FIB, enabling sample transfer in an oxygen-free environment. The device's design and operational process are outlined, including airtight chambers, gas introduction, and modified venting systems. Experimental results demonstrate Noble Dome's effectiveness in preserving sample integrity. Compared to existing solutions, which often pose limitations, Noble Dome offers a practical approach for various research needs.Imaging and micromanipulation techniques such as Scanning Electron Microscopy (SEM) and Focused Ion Beam (FIB) can reveal critical information about the microstructure and composition of materials. To utilize these techniques, a sample must be loaded into the chamber of the instrument which is then pumped down to low vacuum conditions. In the process of removing a sample from its packaging and mounting it on the SEM/FIB stage, the sample is briefly exposed to atmosphere. This is problematic for researchers who are interested in investigating air sensitive samples or samples for which atmospheric contamination would detract from the investigation. This set of samples includes metals commonly used as battery materials such as lithium and sodium, which are highly reactive with elements in the air such as moisture or oxygen.We present a prototype for a glove box load lock that addresses this problem directly. This device attaches directly onto the side of a SEM/FIB and allows researchers to remove a sample from packaging and transfer it directly on the stage via an accessory port of the SEM/FIB in an oxygen-free environment and then pump the tool down to vacuum without any atmospheric exposure in the process, eliminating the use of an intermediary shuttle from a separate glove box. We call this device Noble Dome.In order to test Noble Dome’s ability to protect samples from atmosphere, we imaged and collected EDS spectra on the same location of a lithium metal sample in a pristine state, after sitting in Noble Dome for 30 minutes, and after sitting in atmosphere for 30 minutes.We note that there was very little change in the surface topography and oxygen counts between the sample in its pristine state and the sample after sitting in Noble Dome for 30 minutes. However, there is a marked increase in surface oxidation and topography after the sample sat in atmosphere for 30 minutes.Lithium-ion batteries are increasingly prolific in the landscape of modern technology. In order to improve the energy density, life cycle and safety of lithium-ion batteries, researchers require significant amounts of materials characterization pre-assembly, post-assembly and after several charge/discharge cycles. Electron microscopy is crucial for effective materials characterization, which necessitates a solution for loading samples into the vacuum chamber of the microscope without exposing these reactive samples to air.Other solutions currently on the market for loading air sensitive samples into a SEM/FIB involve manipulating the sample in a glove box which is separate from the instrument, loading the sample into an inert gas transfer shuttle which is closed by remote control, removing the shuttle from the glovebox, loading the shuttle into the SEM/FIB, and then opening the sample again via remote control. These solutions are not ideal because they're very expensive, have a variety of limitations on sample size, stage travel, and signal strength, and are high tech solutions prone to costly malfunction. These drawbacks highlight the demand for a more practical and efficient approach.The presented prototype, Noble Dome, addresses the challenge of loading air-sensitive samples into SEM/FIB instruments with a practical and innovative approach. The device eliminates the need for an intermediary glove box and inert gas transfer shuttle, allowing direct sample transfer onto the stage in an oxygen-free environment. The results demonstrate Noble Dome's efficacy in preserving sample integrity by minimizing atmospheric exposure, as evidenced by the minimal changes observed in surface topography and composition compared to samples exposed to atmosphere. Noble Dome enables research on reactive samples, used to pursue a carbon-free future. Figure 1

Reynolds number sensitivity of the vortex dynamics around a long-span rail-cum-road bridge girder with three separated boxes

The novel separated three-box girder is gradually adopted for very long-span cable-stayed bridges due to its excellent flutter stability. Due to its special design of cross section, it exhibits notable Reynolds number effects in the flow patterns and vortex dynamics when subject to incoming flow. To explore its Reynolds number sensitivity, this paper performs a three-dimensional large eddy simulation (LES) on the flow around a static long-span rail-cum-road bridge girder with three separated boxes at different Reynolds numbers. The overall centre height H of the bridge model is chosen as the characteristic length, and the investigated Reynolds number regime falls into the regime of 1e2≤Re≤2.8e4. Through the analysis of the flow characteristics of three distinct regions in the flow field(the windward leading edge region, the gap region and the wake region), a successive transition of the wake flow, gap flow, and leading edge shear flow is observed with increasing Reynolds number. The surrounding flow patterns are divided by different Reynolds number regimes as: laminar separation at the trailing edge (Re<5e2); simultaneous instability of the gap shear layer and the wake (5e2≤Re<1e3); restabilisation of the upstream gap shear layer (1e3≤Re<3e3); secondary instability of the upstream gap shear layer and transition of the wake (3e3≤Re<8e3); transition of the separated shear layer at the leading edge (8e3≤Re≤2.8e4). This paper reveals in detail the complex vortex dynamics in the surrounding flow field of the special cross section with three separated boxes.

Impact of Various Non-Contrast-Enhanced MRA Techniques on Lumen Visibility in Vascular Flow Models with a Surpass Evolve Flow Diverter.

Silent MRA has shown promising results in evaluating the stents used for intracranial aneurysm treatment. A deep learning-based denoising and deranging algorithm was recently introduced by GE HealthCare. The purpose of this study was to compare the performance of several MRA techniques regarding lumen visibility in silicone models with flow diverter stents. Two Surpass Evolve stents of different sizes were implanted in two silicone tubes. The tubes were placed in separate boxes in the straight position and in two different curve configurations and connected to a pulsatile pump to construct a flow loop. Using a 3.0T MRI scanner, TOF and silent MRA images were acquired, and deep learning reconstruction was applied to the silent MRA dataset. The intraluminal signal intensity in the stent (SIin-stent), in the tube outside the stent (SIvessel), and of the background (SIbg) were measured for each scan. The SIin-stent/SIbg and SIin-stent/SIv ratios were higher in the silent scans and DL-based reconstructions than in the TOF images. The stent tips created severe artefacts in the TOF images, which could not be observed in the silent scans. Our study demonstrates that the DL reconstruction algorithm improves the quality of the silent MRA technique in evaluating the flow diverter stent patency.

Dynamics of milk productivity of cows depending on the method of housing and the calving season

The results of the dynamics of milk productivity of cows depending on the method of housing and calving season have been presented in the paper. Under the conditions of the Educational and Experimental Farm “Ramzai” of the Federal State Budgetary Educational Institution of Higher Education “Penza State Agrarian University”, a stall and pasture system and tie-up housing of cows is used. In CJSC “Konstantinovo” a stall system and free-stall method of housing of cows is used with using separate boxes for the animals. For research, animals were divided into groups depending on the method of housing and calving time. Analysis of the average monthly milk yield of fi rst-calf heifers showed that, in general, their dynamics were the same. However, animals housed in free-stall and calved in the spring-summer period showed higher productivity rates, exceeding on average other groups of animals by 124 kg or 20 %. The highest productivity values in the fi rst three months of lactation were in cows of the 1st group, housed in free-stall method. In relation to milk yield for the fi rst 3 months to milk yield for 305 days of lactation, the fluctuations ranged from 19 to 35 % with free-stall housing, and from 26 to 34 % with tie-up housing. It was revealed on the base of study of the milk productivity of cows for 305 days of lactation that the highest indicators were obtained from cows housed in free-stall method 6127–6845 kg of milk, while with the tie-up method of housing 4870–5020 kg only. When assessing the lactation activity of cows by month of lactation, it was found that both the method of housing and the calving season of cows influence milk productivity and the dynamics of milk yield by month of lactation. At the same time, cows housed in freestall method had higher productivity and a stable lactation curve.

The effects of a nonsteroidal anti-inflammatory drug on the behavioural and physiological parameters of beef cows and calves assisted at calving

Non-steroidal anti-inflammatory drugs (NSAIDs) may be administered to the cow or the calf as a pain mitigation strategy to combat the negative impacts of injury or trauma associated with a difficult calving. However, the effects of NSAIDs on beef cows’ and calves’ behaviour related to pain and cow-calf bonding after an assisted calving have not been studied. Therefore, the objective of this study was to investigate the effects of meloxicam administered to beef cows and calves after an assisted calving by measuring differences in behaviours associated with pain and cow-calf bonding, and physiological parameters associated with pain. Twenty-three cow-calf pairs assisted at calving were randomly allocated to two medication groups, meloxicam (Metacam®, 20 mg/ml, 0.5 mg/kg body weight, Boehringer Ingelheim, Ingelheim, Germany) or placebo (0.025 ml/kg). Cow blood samples for serum haptoglobin concentration and thermal images of the vulva were taken within 10 minutes after calving and 24±1 hours after calving. Calf blood samples for L‐lactate concentration and thermal images of the head were taken at birth and images repeated at 24±1 hours after birth. Blood samples for serum IgG concentration were taken at 24±1 hours after birth. After at-birth sample collection and treatment administration, the cow-calf pairs were placed in separate box stalls, and behaviours were video recorded for 24±1 hours. A human approach test and a separation test were performed after the 24±1 hour period. Descriptive statistics, multivariable linear and logistic regression models, and non-parametric tests were used to analyze the data. There were no significant differences between meloxicam and placebo groups for serum IgG concentration, haptoglobin concentration, or changes in temperature in the cows’ vulva or calves’ head. Additionally, there were no significant differences between meloxicam and placebo groups for the cows’ behaviours (i.e., time spent lying in sternal recumbency, standing, feeding, self-grooming, grooming the calf, and frequency of tail flicking, tail raising, and pressing against the box stall). Calves treated with meloxicam were more active (P=0.04) and played more (P=0.01) than placebo calves. No other behaviours (i.e., time spent lying in sternal recumbency, attempting to stand, standing, walking, being in a nursing position, investigating, and frequency of approaching the cow) were significantly different between calves treated with meloxicam or placebo. No significant difference (P=0.83) in bonding behaviours was identified for cows and calves treated with meloxicam or a placebo. The anti-inflammatory effects of meloxicam in calves after an assisted calving may improve calf welfare.

Aerodynamics and surrounding flow patterns of a long-span bridge girder model with triple-separated boxes

The triple-box girder is finding broader applications in super long-span bridges for its excellent performance of flutter stability and traffic adaptability. In the present study, a bridge girder model with three separated boxes is experimentally investigated in detail via wind tunnel tests. In consideration of web modifications and accessory structures, the multi-point surface-pressure measurement and smoke-wire flow visualization are applied to investigate the aerostatic characteristics and flow structures. The “dual-frequency” phenomenon is found and explained for the bare girder with curved webs. For the present girder with linear webs, the global field is dominated by the separated-shear-layer instability. For the bare girder with curved webs, the upstream gap flow is dominated by the separated-shear-layer instability while the downstream gap flow is dominated by the double-shear-layer instability. The downstream gap flow exhibits obvious intermittent characteristics. In addition, non-Gaussian characteristic analysis of the surface wind pressures is introduced and improved for engineering practice. The distinguishing principle based on the skewness and kurtosis has high adaptability to both the bare girder and the completed bridge. In addition, semi-linear webs show better drag reduction. Combinations of accessory structures are also studied. The results show that during the construction process, prioritizing the installation of highway wind barriers can optimize the aerostatic performance of bridges. The present study embraces the booming era of long-span bridges with a triple-box girder and enriches the studies of bridge aerostatics.

Preliminary Investigation on the Effect of Termites on Wood Decay in Selected Sri Lankan Timber Species

&#x0D; &#x0D; &#x0D; Wood in suitable environmental conditions can be attacked by bacteria, fungi, insects, marine borers and some other biological organisms. Wood is the main biodegradation material which is naturally occurred in surrounding environment. As heartwood of wood consist most of the nonliving cells it shows more resistance to decay than sapwood. But insects can cause degrade in both heartwood and sapwood which are not preserved well. Termites belong to Class: Insecta, Order: Isoptera which are one of the most important as ecological contributors by breaking down the organic material of the wood structures directly. This study was done to analyze the effect of termites of selected 27 species with having different densities varying from 400 kg/m3 to 1100 kg/m3 at 12% moisture content. Ten pieces of each and every species of Wewarana, Jack, Badidel, Halmilla, Dawata, Walukeena, Hulanhik, Kaluwara, Hora, Pihimbiya, Damaniya, Godakirilla, Pelan, Hik, Etamba, Lunumidella, Diya Na, Palu, Mora, Kirihembiliya, Nedun, Kon, Kumbuk, Dummala, Milla, Kirikon and Burutha were stored in a separate same type wooden boxes and kept in same environmental conditions where termites can be seen in high densities for one year of time period in Head Office premises of State Timber Corporation at Battaramulla. According to the naked eye observations taken after one year time period Hora, Dummala, Godakirilla species were severely attack by termites while Halmilla, Walukeena, Pihimbiya, Damaniya, Pelan, Etamba, Lunumidella, Diya Na, Kirikon also attack at considerable level by termites. Other species were not attack by termites. Therefore altogether out of 27 species 12 were degraded by termites for the allocated one year time period. The other species of Wewarana, Jack, Bedidel, Dawata, Hulanhik, Kaluwara, Hik, Palu, Mora, Kirihembiliya, Nedun, Kon, Kumbuk, Milla, Burutha species were resistant to the termite attack during one year time period. However further studies are underway to develop the relationships of degradation due to termite attack with climatic conditions, geographical conditions, timber properties such as strength properties as well as the densities, mechanical properties with considerable time period which allocated to degrade.&#x0D; Keywords: Ttermites, Decay, Density, Time period&#x0D; &#x0D; &#x0D;

Pointer Meter Reading Recognition by Joint Detection and Segmentation

To handle the task of pointer meter reading recognition, in this paper, we propose a deep network model that can accurately detect the pointer meter dial and segment the pointer as well as the reference points from the located meter dial. Specifically, our proposed model is composed of three stages: meter dial location, reference point segmentation, and dial number reading recognition. In the first stage, we translate the task of meter dial location into a regression task, which aims to separate bounding boxes by an object detection network. This results in the accurate and fast detection of meter dials. In the second stage, the dial region image determined by the bounding box is further processed by using a deep semantic segmentation network. After that, the segmented output is used to calculate the relative position between the pointer and reference points in the third stage, which results in the final output of reading recognition. Some experiments were conducted on our collected dataset, and the experimental results show the effectiveness of our method, with a lower computational burden compared to some existing works.

Semantic learning from keyframe demonstration using object attribute constraints.

Learning from demonstration is an approach that allows users to personalize a robot's tasks. While demonstrations often focus on conveying the robot's motion or task plans, they can also communicate user intentions through object attributes in manipulation tasks. For instance, users might want to teach a robot to sort fruits and vegetables into separate boxes or to place cups next to plates of matching colors. This paper introduces a novel method that enables robots to learn the semantics of user demonstrations, with a particular emphasis on the relationships between object attributes. In our approach, users demonstrate essential task steps by manually guiding the robot through the necessary sequence of poses. We reduce the amount of data by utilizing only robot poses instead of trajectories, allowing us to focus on the task's goals, specifically the objects related to these goals. At each step, known as a keyframe, we record the end-effector pose, object poses, and object attributes. However, the number of keyframes saved in each demonstration can vary due to the user's decisions. This variability in each demonstration can lead to inconsistencies in the significance of keyframes, complicating keyframe alignment to generalize the robot's motion and the user's intention. Our method addresses this issue by focusing on teaching the higher-level goals of the task using only the required keyframes and relevant objects. It aims to teach the rationale behind object selection for a task and generalize this reasoning to environments with previously unseen objects. We validate our proposed method by conducting three manipulation tasks aiming at different object attribute constraints. In the reproduction phase, we demonstrate that even when the robot encounters previously unseen objects, it can generalize the user's intention and execute the task.

DESIGN AND BUILD AN OUTDOOR EQUIPMENT RENTAL INFORMATION SYSTEM BY APPLYING THE FIRST IN FIRST OUT ALGORITHM

The rental system currently implemented at Mandala Outdoor Equipement requires customers who want to rent outdoor equipment to come directly or via telephone/WA communication to Mandala Outdoor Equipement. Rental of outdoor equipment sometimes causes problems, such as customers who are disappointed because they were previously confirmed to be able to rent outdoor equipment, after receiving information that they could not or that it was canceled by the provider because it turned out the stock had run out, even though this happens. After all, sometimes they prioritize renters with proximity factors because of the courage of new renters. with higher rental costs. Based on these existing problems, this research aims to build a website-based information system by applying the First in First Out (FIFO) algorithm for outdoor equipment rental at Mandala Outdoor Equipment. The method used in this research is the waterfall method. The result of this research is an outdoor equipment rental application by applying the FIFO algorithm to the web-based Mandala Outdoor Equipment so that rentals can be done via the website (anywhere and at any time) and rentals are served according to the rental time sequence (First in First Out). From the results of testing the application using a separate black box, seen from the functional aspect, both features and access rights, everything went well, successfully, and validly.

Comparing oxidation of aluminum by oxygen and ozone using reactive force field molecular dynamics simulations

Ozone has attracted more scholars’ attention due to its less environmental injury during oxidation. Oxidation with ozone has been more regarded because ozone evaluates oxygen and can form a terrific oxide layer even at lower temperatures compared to oxygen. This work investigated the Al(100) surface oxidation simulations by O2 and O3 molecules at 400, 600, and 800 K temperatures with the reactive force field (ReaxFF) method. In separate simulation boxes, one hundred ozone molecules and 150 oxygen molecules have been placed in a space above the Al(100) surfaces to examine this metal’s behavior with them (gases incipient density of 0.47 g/cm3). We found further growth of the oxide layer in the case of ozone-aluminum. Subsequently, we surveyed the correlation between temperatures and the development of alumina layers in the case of oxygen and ozone in separate sets through ReaxFF simulation to untangle the mechanism of oxidation kinetics of the Al(100) surface by ozone. Even though there are demonstrated constraints on growing an oxide layer with ozone and oxygen, it is possible to produce a thicker oxide layer at lower temperatures using ozone. Here, we used LAMMPS as our program package for all simulations and used reactive molecular dynamics simulation, which is a relatively inexpensive tool for studying complex conditions that are impossible to reproduce with other techniques.

Experimental investigation of a precast segmental Twin‐Deck box girder bridge simultaneously erected with double bridge erection gantries

AbstractPrecast segmental construction can shorten the construction time of the bridge and reduce the impacts on traffic and environment. Thus, this approach has been widely used in many countries. The relevant literature suggests that in the existing segmental precast bridges, nearly all of the centerlines of the girders are aligned with the centerline of the bridge piers. This paper introduces a wide urban viaduct comprising twin separate box girder cells using segmental prefabrication. To save space under the bridge, the bridge has only one row of piers and long cantilever crossbeams are set at the top of each pier. Additionally, the centerline of the girder and the centerline of the pier do not overlap. To prevent eccentric loading and improve the construction speed, two bridge erection gantries are used for synchronous construction. This study is a pioneering attempt at bridge construction with a precast segmental twin‐deck box girder bridge simultaneously erected with double gantries. To investigate the stress state of the whole system (crossbeam, gantries, and box girder segments) during construction and demonstrate the feasibility of the construction method, a real bridge was used. The test results provide a reference for the design and construction of similar projects.

The VASCERN-VASCA Working Group Diagnostic and Management Pathways for Venous Malformations.

VASCERN-VASCA (https://vascern.eu/) is a European network of multidisciplinary centers for Vascular Anomalies. The Nominal Group Technique was used to establish the pathways. Two facilitators were identified: one to propose initial discussion points and draw the pathways, and another to chair the discussion. A dermatologist (AD) was chosen as first facilitator due to her specific clinical and research experience. The draft was subsequently discussed within VASCERN-VASCA monthly virtual meetings and annual face-to-face meetings. The Pathway starts from the clinical suspicion of a venous type malformation (VM) and lists the clinical characteristics to look for to support this suspicion. Strategies for subsequent imaging and histopathology are suggested. These aim to inform on the diagnosis and to separate the patients into 4 subtypes: (1) sporadic single VMs or (2) multifocal, (3) familial, multifocal, and (4) combined and/or syndromic VMs. The management of each type is detailed in subsequent pages of the pathway, which are color coded to identify sections on (1) clinical evaluations, (2) investigations, (3) treatments, and (4) associated genes. Actions relevant to all types are marked in separate boxes, including when imaging is recommended. When definite diagnoses have been reached, the pathway also points toward disease-specific additional investigations and recommendations for follow up. Options for management are discussed for each subtype, including conservative and invasive treatments, as well as novel molecular therapies. The collaborative efforts of VASCERN-VASCA, a network of the 9 Expert Centers, has led to a consensus Diagnostic and Management Pathways for VMs to assist clinicians and patients. It also emphasizes the role of multidisciplinary expert centers in the management of VM patients. This pathway will become available on the VASCERN website (http://vascern.eu/).

The vortex-induced vibrations of a triple-box girder model of a long-span rail-cum-road bridge

Triple-box girders, i.e., three separated box girders are arranged in tandem, are gradually used in super-span bridges because of their excellent flutter stability. However, the gaps between triple boxes can lead to complex vortex dynamics around the structures that result in vortex-induced vibrations (VIVs). In the present study, we experimentally investigate VIVs in a long-span bridge with a triple-box girder cross-section using wind tunnel tests. In the static test, in which the test model is fixed, a ‘dual-frequency’ phenomenon that expands the VIV lock-in region is observed in the global flow field. Furthermore, the results of a dynamic test indicate that the existence of gaps is essential to the occurrence of VIVs in triple-box girders. The smoke-wire flow visualization technique is employed to explore the excitation mechanism by examining the surrounding flow dynamics of the triple-box model. Separated motion-induced vortices (MIVs) and von Karman vortices (KVs) are found to be coupled with structural vibrations to sustain the VIVs. Five stages of VIV regions, along with five types of vortices in the surrounding flow field, are identified for the girder model. Finally, the effects of accessory structures of the bridge model on the VIV responses are also studied. This study contributes to our understanding of the unsteady flow dynamics and VIV mechanisms of a typical triple-box girder.

Blind Spot: Trade and Competition Law—the Space Between the Silos

AbstractTrade law and competition law have grown up in their separate silos. This means that restraints by the states and restraints by private parties are treated in separate boxes, and with few exceptions, they have been treated so through the years. Yet, some of the worst restraints that do some of the greatest damage are best characterized by the synergy between the two. These trade-and-competition, or hybrid public/private, restraints fall under the radar screen, and defendants in litigation play one set of laws off against the other, hiding behind limits and immunities. This is the Blind Spot of the Article’s title – the space between the silos. This Article unearths the Blind Spot, gives examples of what we know and what we need to know, and proposes a methodology to illuminate and eliminate the Blind Spot.

A Dynamic Web-based Application for the Classification of Vascular Anomalies

The International Society for the Study of Vascular Anomalies (ISSVA) released the most recent version of the classification of vascular anomalies in 2018.1 This revision of the 2014 classification expanded the scope of clinical entities and included molecular diagnostics. The 2018 report incorporated recent discoveries in the field and was released as a 20-page PDF file navigable through embedded links. The links lead users through the classification hierarchy, and each page lists anomalies, their corresponding genetic mutations (if known), and other details. Further information is found in five appendices in the last seven pages of the report. The document is comprehensive, but the structure has drawbacks in usability, organization, and sustainability. The format is rigid and difficult to update. The vascular anomaly field is new and ever growing. In just the past few years, there have been significant advances in discovering new clinical entities and uncovering the genetic basis for these conditions. The PDF-based classification cannot be updated routinely without reformatting entirely. Therefore, this format is unsustainable as new discoveries are made. The PDF format classification also limits organization, ease of use, and navigability. It includes a hierarchy of anomalies and categories organized into tables with internal page links that are difficult to navigate. The embedded links guide users to various pages throughout the document, which provides a nonlinear and somewhat confusing user experience. Additionally, the format of each page was unique (to accommodate custom information), and this lack of standardization stifles the user experience because of the inconsistent location of relevant information. Finally, the indices store information that cannot be placed on the appropriate PDF pages (because of space limitations), which makes navigating back and forth tedious. The aim for a new format was to streamline the design and solve the limitations of the current PDF format. We engineered an interactive web app format, which sustainably supports future updates. The classification is organized into a tree, with nested expandable nodes containing the anomalies in a hierarchical structure, similar to that of a file explorer. With this format, a user can expand the tree to view individual anomalies, associated information, and the entire hierarchy in a common location. The visual hierarchy provides a natural organization of the classification for a more intuitive experience. The app has a consistent format throughout, and it is easily modified. Minor additions and changes can be implemented quickly, without altering or compromising the framework of the format. The web app supports including additional anomaly-specific data through the use of popover buttons, which improves organization while providing comprehensive information. Popovers may contain clinical and radiological images (Figure 1), footnotes for unusual or exceptional cases (Figure 2), genomic information, and others if necessary. Additionally, we included search functionality via autocomplete “smart” select boxes (Figure 3). The user can search for a specific term by selecting it from an alphabetical list, or by typing into a free text field that limits selection to specific options dynamically. When searching for a specific anomaly, the web app opens the tree to the selected entry while briefly highlighting the entry itself and its parent nodes. Separate selectable dialog boxes allow the user to search genes and abbreviations without navigating away (Figure 4).Figure 1.: Expanded tree view of vascular anomalies classification hierarchy. Image popover shows clinical image of infantile hemangioma.Figure 2.: Popover with additional information about rapidly involuting congenital hemangioma.Figure 3.: Search function opens the tree to the selectable term (arteriovenous malformation in this case), automatically scrolls down the page, and highlights hierarchy.Figure 4.: Gene Search and Abbreviation Search dialog boxes with option filtering and autofill. The search buttons remain affixed to the bottom for easy look-up even as one scrolls up and down the tree. One can lookup terms without losing one’s place in the tree.The tree is rendered dynamically from a single data structure, which allows for flexible modification and efficiency. When data are changed it is instantly reflected in the classification. This makes minor or major alterations feasible and practical, in contrast to labor-intense reformats of PDF releases. The vascular anomaly field is changing rapidly with the recognition of new clinical entities and the identification of genes responsible for disease. This app format allows for real-time classification updates. The web app was created using React, a JavaScript library. It is a mobile-friendly application currently hosted at https://vascularanomalies.net. A pure client-side program, it can be embedded easily on the ISSVA website and updated to reflect any future changes rapidly.

СОВЕРШЕНСТВОВАНИЕ СИСТЕМЫ РАЗДАЧИ ЖИДКИХ КОРМОВ ДЛЯ ТЕЛЯТ

Maintenance and care of calves during the milk period, when it is necessary to distribute mainly liquid feed, is very laborious. Most of the time is associated with the delivery of feed on a cart in milk flasks and filling buckets from flasks when hand-watering the calves. proposed Feeder device on a mobile frame (rod), which moves on rollers with the help of an electric drive, proposed for distributing liquid feed to calves in boxes. It consists of a carrier conveyor with fixed buckets, which alternately reciprocates towards the feeders. This technical solution is applicable on farms where separate group cages or boxes are used for keeping calves. The proposed liquid feed distribution technology raises the level of the entire calf feeding process. It was found that as a result of the work of the distributor, the use of manual labor decreased by 90%. The actual labor productivity was at least 400 heads per hour, therefore, one operator, when working with a distributor, is fully capable of drinking 200 calves in 0.5 hours. The use of a mechanized system for distributing liquid feed on farms has a positive effect on reducing the level of morbidity in calves associated with the digestive organs - by 20%. Gross and average daily gains in live weight increase by 5-6%.

OGC P48 Improving documentation in Surgical Operation Notes in An Upper GI Surgery Tertiary Unit: A Quality Improvement Project

Abstract Background Good Surgical Practice are a set of guidelines that surgeons should adhere by to ensure efficiency of services, patient's quality of care and safety. One of the standards focuses on good medical record keeping; within this standard, it is dictated that there should be operative notes for every procedure, where each note should include the following: D date and time, elective/emergency procedure, names of the operating surgeon and assistant, name of the theatre anaesthetist, operative procedure carried out, incision, operative diagnosis, operative findings, any problems/complications, any extra procedure performed and the reason why it was performed, details of tissue removed, added or altered, identification of any prosthesis used, including the serial numbers of prostheses and other implanted materials, details of closure technique, anticipated blood loss, antibiotic prophylaxis (where applicable), DVT prophylaxis, detailed postoperative care instructions and signature. Methods Surgical operative notes of 97 patients within our tertiary Upper GI Surgery Unit were retrospectively reviewed to investigate how many of the criteria listed in RCS guidelines were adhered to. These 97 operative notes were recorded using two different template forms on the trust's electronic system.39 of the operations were recorded using an old operation notes template in 2019; the documentation details of these were compared to 58 operation notes that were recorded using the newly implemented template in 2021. Results We found that documentation was excellent with use of both templates when including date of surgery (100% vs 100%), name of surgeon (100% vs 100%), name of assistant (100% vs 100%), operative procedure (100% vs 100%), incision type (100% vs 100%), operative findings (100% vs 100%), details of tissue removed, added, or altered (100% vs 100%), details of closure technique (100% vs 100%), DVT prophylaxis (100% vs 100%) and detailed postoperative care instructions (100% vs 100%). Documentation was poor in both the 2019 and 2021 operative notes when specifying whether procedure was elective or emergency (5% vs 12%), when specifying whether any complications/problems occurred (10% vs 43%) and whether an extra procedure was performed (8% vs 52%). However, there was notable improvement in documentation with the implementation of the new procedural note template; this was especially true for time of operation (3% vs 100%) and estimated blood loss (15% vs 100%). Conclusions Documentation detail was generally good in the 97 operative notes reviewed, with notable improvement seen after the implementation of a more comprehensive template. There is, however, still room for improvement; this could be achieved by creating a new template to include separate text boxes allowing the surgeon to describe whether the procedure was elective/emergency, whether there were any complications/problems to declare and if there were any additional procedures to declare. Further actions would be to present these results to the local surgical department and re-review these operation notes in 6 months’ time after implementation of new template.

Avant la lettre: Philip Perry, Reconversionist Aesthetics, and the Medieval Literary

<i>Avant la lettre</i>: Philip Perry, Reconversionist Aesthetics, and the Medieval Literary