Richard Steven - Academia.edu (original) (raw)
Papers by Richard Steven
The Journal of Laryngology & Otology, 2021
ObjectivesThis study seeks the opinions of qualified doctors on what they feel medical students s... more ObjectivesThis study seeks the opinions of qualified doctors on what they feel medical students should learn about otolaryngology. It aims to identify both the content deemed relevant and the performance levels for medical students in otolaryngology.MethodsA national survey developed from a content analysis of undergraduate otolaryngology curricula from the UK was undertaken, accompanied by a review of the literature and input from an expert group. Data were collected from a wide range of doctors.ResultsParticipants felt that graduating students should be able to: recognise, assess and initiate management for common and life-threatening acute conditions; take an appropriate patient history; and perform an appropriate examination for the majority of otolaryngology clinical conditions but manage only a select few.ConclusionThis study reports performance levels for otolaryngology topics at an undergraduate level. Participating doctors felt that a higher level of performance should be e...
The technical and administrative restructuring of Agrollanos Agricola del Llano LTDA, located in ... more The technical and administrative restructuring of Agrollanos Agricola del Llano LTDA, located in the city of Bogota D.C., aims to propose improvements in each of its work areas; In the diagnosis were used tools such as the PESTEL analysis and development of the SWOT matrix where internal strengths and weaknesses of the company are established and at the external level strategies are developed to minimize the impact of threats and use of opportunities From the market. In the technical study it was possible to establish by means of the application of engineering tools, as the study of methods and the study of times, a decrease in the times of production and better methods for the elaboration of its products. In the administrative study, an adequate strategic planning was designed giving guidance to the company in order to fulfill its objectives and goals. Finally, in the financial study, a net present value (NPV) of $ 86,724,547 COP was obtained, qualifying the project as feasible and...
arXiv: History and Philosophy of Physics, 2019
This article summarizes some of the most important scientific contributions of Murray Gell-Mann (... more This article summarizes some of the most important scientific contributions of Murray Gell-Mann (1929-2019). (Invited article for Current Science, Indian Academy of Sciences.)
The paper presents measurements taken at the National Engineering Laboratory (UK), K-Lab (Norway)... more The paper presents measurements taken at the National Engineering Laboratory (UK), K-Lab (Norway) and CEESI (USA) wet gas test loops. The test matrices cover a range of conditions up to 15% liquid volume fraction and operating pressure up to 90 bar. Differential and absolute pressure signals were sampled at high frequency across V-cone meters. Turbulence characteristics of the flow captured in the sampled signals were characterized by pattern recognition techniques and related to the fractions and flow rates of individual phases.
Cancer, 2021
BACKGROUND Remote triage for suspected head and neck cancer (HNC) referrals was adopted by many i... more BACKGROUND Remote triage for suspected head and neck cancer (HNC) referrals was adopted by many institutions during the initial peak of the coronavirus disease 2019 pandemic. Its safety in this population has not been established. METHODS A 16-week, prospective, multicenter national service evaluation was started on March 23, 2020. Suspected HNC referrals undergoing remote triage in UK secondary care centers were identified and followed up for a minimum of 6 months to record the cancer status. Triage was supported by risk stratification using a validated calculator. RESULTS Data for 4568 cases were submitted by 41 centers serving a population of approximately 26 million. These represented 14.1% of the predicted maximum referrals for this population outside of pandemic times, and this gave the study a margin of error of 1.34% at 95% confidence. Completed 6-month follow-up data were available for 99.8% with an overall cancer rate of 5.6% (254 of 4557). The rates of triage were as follows: urgent imaging investigation, 25.4% (n = 1156); urgent face-to-face review, 27.8%; (n = 1268); assessment deferral, 30.3% (n = 1382); and discharge, 16.4% (n = 749). The corresponding missed cancers rates were 0.5% (5 of 1048), 0.3% (3 of 1149), 0.9% (12 of 1382), and 0.9% (7 of 747; P = .15). The negative predictive value for a nonurgent triage outcome and no cancer diagnosis was 99.1%. Overall harm was reported in 0.24% (11 of 4557) and was highest for deferred assessments (0.58%; 8 of 1382). CONCLUSIONS Remote triage, incorporating risk stratification, may facilitate targeted investigations for higher risk patients and prevent unnecessary hospital attendance for lower risk patients. The risk of harm is low and may be reduced further with appropriate safety netting of deferred appointments. LAY SUMMARY This large national study observed the widespread adoption of telephone assessment (supported by a risk calculator) of patients referred to hospital specialists with suspected head and neck cancer during the initial peak of the coronavirus disease 2019 pandemic. The authors identified 4568 patients from 41 UK centers (serving a population of more than 26 million people) who were followed up for a minimum of 6 months. Late cancers were identified, whether reviewed or investigated urgently (0.4%) or nonurgently (0.9%), but the overall rate of harm was low (0.2%), with the highest rate being seen with deferred appointments (0.6%).
Clinical Otolaryngology, 2020
This is an open access article under the terms of the Creative Commons Attribution-NonCommercial ... more This is an open access article under the terms of the Creative Commons Attribution-NonCommercial License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited and is not used for commercial purposes.
BMJ, 2013
Taking a job as an anatomy demonstrator offers trainees the opportunity to improve their knowledg... more Taking a job as an anatomy demonstrator offers trainees the opportunity to improve their knowledge of anatomy, develop teaching skills, and study for postgraduate examinations. Omar Mirza and Richard Steven describe their different experiences of the role
The Bulletin of the Royal College of Surgeons of England, 2017
An ENT perspective on when we should start to worry.
The Journal of Laryngology & Otology, 2016
no primary reconstruction, and to compare the outcomes of Type III cartilage tympanoplasty with p... more no primary reconstruction, and to compare the outcomes of Type III cartilage tympanoplasty with published results of other reconstruction methods. Methods: The records of 160 patients from a single surgeon's 12-year cohort were retrospectively analysed. Postoperative changes in air conduction thresholds (0.5, 1, 2 and 4kHz and average gains) and air-bone gap were calculated for each operated ear 2 years after surgery according to AAO-HHS guidelines. Revision surgery and other complications were documented.
Offshore Technology Conference, 2001
The accurate and reliable measurement of gas flowrate in wet gas conditions continues to be impor... more The accurate and reliable measurement of gas flowrate in wet gas conditions continues to be important to the Oil and Gas Industry. The ability to measure wet gas flows is particularly crucial in small, marginal developments that would otherwise be uneconomic to exploit due to the requirement for expensive separation equipment. This paper presents the results of two independent studies conducted on the new NEL high pressure wet gas test facility that uses nitrogen and a kerosene substitute (Exxsol D80) as test fluids to simulate a natural gas/ condensate system. The first study involved the the testing in wet gas of a 6- inch turbine meter in liquid loadings of up to 2% by mass at a pressure of 60 barg and pipe Reynolds numbers from 1 to 9 million. The maximum shift in the turbine meter factor found due to the presence of the kerosene was -0.75% at a Reynolds number of 2.7 million. Mechanisms that could cause the observed shifts are provided. These results presented here differ from ...
Journal of Diabetes and Obesity, 2015
The Bulletin of the Royal College of Surgeons of England, 2015
How a ‘smart’ device can support and enhance training in a theatre
Terapevticheskiĭ arkhiv, 2001
International Journal of Surgery, 2014
37% of the patients had hypertension, which if well controlled did not affect the suitability of ... more 37% of the patients had hypertension, which if well controlled did not affect the suitability of patients for streamlined direct referral and day case surgery. 7% of patients required overnight admission following the procedure which was unpredictable. An initial consultant led clinic appointment did not affect the overall outcome. Patient with MC score 3 are suitable for the streamlined assessment pathway. Conclusions: This audit has demonstrated a direct referral pathway for suitable patients with groin hernia straight to pre-operative assessment can help deliver cost effective and efficient care. This has the potential to reduce waiting times and help re-allocate clinic for patients with complex needs.
Surgical endoscopy, Jan 24, 2014
This study was undertaken to introduce and establish the value of the Dundee Endoscopic Psychomot... more This study was undertaken to introduce and establish the value of the Dundee Endoscopic Psychomotor Otolaryngology Surgery Trainer (DEPOST) as a customisable, objective real-time scoring system for trainee assessment. The construct validity of the system was assessed by comparing the performance of experienced otolaryngologists with that of otolaryngology trainees, junior doctors and medical students. Forty two subjects (13 Consultants, 8 senior trainees, 13 junior trainees and 8 junior doctors/medical students) completed a single test on DEPOST. The test involved using a 30° rigid endoscope and a probe with position sensor, to identify a series of lights in a complex 3-dimensional model. The system scored subjects for time, success rate, and economy of movement (distance travelled). An analysis of variance and correlation analysis were used for the data analysis, with statistical significance set at 0.05. Increasing experience led to significantly improved performance with the DEPO...
Flow Measurement and Instrumentation, 2002
... Therefore, with the correct Automatic Re-circulation Valve setting the desired flowrate is th... more ... Therefore, with the correct Automatic Re-circulation Valve setting the desired flowrate is then metered and taken to the injection point by a ... for a given value of the Modified LockhartMartinelli (X) as the pressure increases from 20 to 60 bar the over-reading of the meter (ie the ...
The Journal of Laryngology & Otology, 2021
ObjectivesThis study seeks the opinions of qualified doctors on what they feel medical students s... more ObjectivesThis study seeks the opinions of qualified doctors on what they feel medical students should learn about otolaryngology. It aims to identify both the content deemed relevant and the performance levels for medical students in otolaryngology.MethodsA national survey developed from a content analysis of undergraduate otolaryngology curricula from the UK was undertaken, accompanied by a review of the literature and input from an expert group. Data were collected from a wide range of doctors.ResultsParticipants felt that graduating students should be able to: recognise, assess and initiate management for common and life-threatening acute conditions; take an appropriate patient history; and perform an appropriate examination for the majority of otolaryngology clinical conditions but manage only a select few.ConclusionThis study reports performance levels for otolaryngology topics at an undergraduate level. Participating doctors felt that a higher level of performance should be e...
The technical and administrative restructuring of Agrollanos Agricola del Llano LTDA, located in ... more The technical and administrative restructuring of Agrollanos Agricola del Llano LTDA, located in the city of Bogota D.C., aims to propose improvements in each of its work areas; In the diagnosis were used tools such as the PESTEL analysis and development of the SWOT matrix where internal strengths and weaknesses of the company are established and at the external level strategies are developed to minimize the impact of threats and use of opportunities From the market. In the technical study it was possible to establish by means of the application of engineering tools, as the study of methods and the study of times, a decrease in the times of production and better methods for the elaboration of its products. In the administrative study, an adequate strategic planning was designed giving guidance to the company in order to fulfill its objectives and goals. Finally, in the financial study, a net present value (NPV) of $ 86,724,547 COP was obtained, qualifying the project as feasible and...
arXiv: History and Philosophy of Physics, 2019
This article summarizes some of the most important scientific contributions of Murray Gell-Mann (... more This article summarizes some of the most important scientific contributions of Murray Gell-Mann (1929-2019). (Invited article for Current Science, Indian Academy of Sciences.)
The paper presents measurements taken at the National Engineering Laboratory (UK), K-Lab (Norway)... more The paper presents measurements taken at the National Engineering Laboratory (UK), K-Lab (Norway) and CEESI (USA) wet gas test loops. The test matrices cover a range of conditions up to 15% liquid volume fraction and operating pressure up to 90 bar. Differential and absolute pressure signals were sampled at high frequency across V-cone meters. Turbulence characteristics of the flow captured in the sampled signals were characterized by pattern recognition techniques and related to the fractions and flow rates of individual phases.
Cancer, 2021
BACKGROUND Remote triage for suspected head and neck cancer (HNC) referrals was adopted by many i... more BACKGROUND Remote triage for suspected head and neck cancer (HNC) referrals was adopted by many institutions during the initial peak of the coronavirus disease 2019 pandemic. Its safety in this population has not been established. METHODS A 16-week, prospective, multicenter national service evaluation was started on March 23, 2020. Suspected HNC referrals undergoing remote triage in UK secondary care centers were identified and followed up for a minimum of 6 months to record the cancer status. Triage was supported by risk stratification using a validated calculator. RESULTS Data for 4568 cases were submitted by 41 centers serving a population of approximately 26 million. These represented 14.1% of the predicted maximum referrals for this population outside of pandemic times, and this gave the study a margin of error of 1.34% at 95% confidence. Completed 6-month follow-up data were available for 99.8% with an overall cancer rate of 5.6% (254 of 4557). The rates of triage were as follows: urgent imaging investigation, 25.4% (n = 1156); urgent face-to-face review, 27.8%; (n = 1268); assessment deferral, 30.3% (n = 1382); and discharge, 16.4% (n = 749). The corresponding missed cancers rates were 0.5% (5 of 1048), 0.3% (3 of 1149), 0.9% (12 of 1382), and 0.9% (7 of 747; P = .15). The negative predictive value for a nonurgent triage outcome and no cancer diagnosis was 99.1%. Overall harm was reported in 0.24% (11 of 4557) and was highest for deferred assessments (0.58%; 8 of 1382). CONCLUSIONS Remote triage, incorporating risk stratification, may facilitate targeted investigations for higher risk patients and prevent unnecessary hospital attendance for lower risk patients. The risk of harm is low and may be reduced further with appropriate safety netting of deferred appointments. LAY SUMMARY This large national study observed the widespread adoption of telephone assessment (supported by a risk calculator) of patients referred to hospital specialists with suspected head and neck cancer during the initial peak of the coronavirus disease 2019 pandemic. The authors identified 4568 patients from 41 UK centers (serving a population of more than 26 million people) who were followed up for a minimum of 6 months. Late cancers were identified, whether reviewed or investigated urgently (0.4%) or nonurgently (0.9%), but the overall rate of harm was low (0.2%), with the highest rate being seen with deferred appointments (0.6%).
Clinical Otolaryngology, 2020
This is an open access article under the terms of the Creative Commons Attribution-NonCommercial ... more This is an open access article under the terms of the Creative Commons Attribution-NonCommercial License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited and is not used for commercial purposes.
BMJ, 2013
Taking a job as an anatomy demonstrator offers trainees the opportunity to improve their knowledg... more Taking a job as an anatomy demonstrator offers trainees the opportunity to improve their knowledge of anatomy, develop teaching skills, and study for postgraduate examinations. Omar Mirza and Richard Steven describe their different experiences of the role
The Bulletin of the Royal College of Surgeons of England, 2017
An ENT perspective on when we should start to worry.
The Journal of Laryngology & Otology, 2016
no primary reconstruction, and to compare the outcomes of Type III cartilage tympanoplasty with p... more no primary reconstruction, and to compare the outcomes of Type III cartilage tympanoplasty with published results of other reconstruction methods. Methods: The records of 160 patients from a single surgeon's 12-year cohort were retrospectively analysed. Postoperative changes in air conduction thresholds (0.5, 1, 2 and 4kHz and average gains) and air-bone gap were calculated for each operated ear 2 years after surgery according to AAO-HHS guidelines. Revision surgery and other complications were documented.
Offshore Technology Conference, 2001
The accurate and reliable measurement of gas flowrate in wet gas conditions continues to be impor... more The accurate and reliable measurement of gas flowrate in wet gas conditions continues to be important to the Oil and Gas Industry. The ability to measure wet gas flows is particularly crucial in small, marginal developments that would otherwise be uneconomic to exploit due to the requirement for expensive separation equipment. This paper presents the results of two independent studies conducted on the new NEL high pressure wet gas test facility that uses nitrogen and a kerosene substitute (Exxsol D80) as test fluids to simulate a natural gas/ condensate system. The first study involved the the testing in wet gas of a 6- inch turbine meter in liquid loadings of up to 2% by mass at a pressure of 60 barg and pipe Reynolds numbers from 1 to 9 million. The maximum shift in the turbine meter factor found due to the presence of the kerosene was -0.75% at a Reynolds number of 2.7 million. Mechanisms that could cause the observed shifts are provided. These results presented here differ from ...
Journal of Diabetes and Obesity, 2015
The Bulletin of the Royal College of Surgeons of England, 2015
How a ‘smart’ device can support and enhance training in a theatre
Terapevticheskiĭ arkhiv, 2001
International Journal of Surgery, 2014
37% of the patients had hypertension, which if well controlled did not affect the suitability of ... more 37% of the patients had hypertension, which if well controlled did not affect the suitability of patients for streamlined direct referral and day case surgery. 7% of patients required overnight admission following the procedure which was unpredictable. An initial consultant led clinic appointment did not affect the overall outcome. Patient with MC score 3 are suitable for the streamlined assessment pathway. Conclusions: This audit has demonstrated a direct referral pathway for suitable patients with groin hernia straight to pre-operative assessment can help deliver cost effective and efficient care. This has the potential to reduce waiting times and help re-allocate clinic for patients with complex needs.
Surgical endoscopy, Jan 24, 2014
This study was undertaken to introduce and establish the value of the Dundee Endoscopic Psychomot... more This study was undertaken to introduce and establish the value of the Dundee Endoscopic Psychomotor Otolaryngology Surgery Trainer (DEPOST) as a customisable, objective real-time scoring system for trainee assessment. The construct validity of the system was assessed by comparing the performance of experienced otolaryngologists with that of otolaryngology trainees, junior doctors and medical students. Forty two subjects (13 Consultants, 8 senior trainees, 13 junior trainees and 8 junior doctors/medical students) completed a single test on DEPOST. The test involved using a 30° rigid endoscope and a probe with position sensor, to identify a series of lights in a complex 3-dimensional model. The system scored subjects for time, success rate, and economy of movement (distance travelled). An analysis of variance and correlation analysis were used for the data analysis, with statistical significance set at 0.05. Increasing experience led to significantly improved performance with the DEPO...
Flow Measurement and Instrumentation, 2002
... Therefore, with the correct Automatic Re-circulation Valve setting the desired flowrate is th... more ... Therefore, with the correct Automatic Re-circulation Valve setting the desired flowrate is then metered and taken to the injection point by a ... for a given value of the Modified LockhartMartinelli (X) as the pressure increases from 20 to 60 bar the over-reading of the meter (ie the ...