Supporting laparoscopic general surgery training with digital technology: The United Kingdom and Ireland paradigm

Surgical training in the UK and Ireland has faced challenges following the implementation of the European Working Time Directive and postgraduate training reform. The health services are undergoing a digital transformation; digital technology is remodelling the delivery of surgical care and surgical training. This review aims to critically evaluate key issues in laparoscopic general surgical training and the digital technology such as virtual and augmented reality, telementoring and automated workflow analysis and surgical skills assessment. We include pre-clinical, proof of concept research and commercial systems that are being developed to provide solutions. Digital surgical technology is evolving through interdisciplinary collaboration to provide widespread access to high-quality laparoscopic general surgery training and assessment. In the future this could lead to integrated, context-aware systems that support surgical teams in providing safer surgical care

Differentiation of Cardiac from Noncardiac Pleural Effusions in Cats using Second-Generation Quantitative and Point-of-Care NT-proBNP Measurements

BACKGROUND: Pleural effusion is a common cause of dyspnea in cats. N‐terminal pro‐B‐type natriuretic peptide (NT‐proBNP) measurement, using a first‐generation quantitative ELISA, in plasma and pleural fluid differentiates cardiac from noncardiac causes of pleural effusion. HYPOTHESIS/OBJECTIVES: To determine whether NT‐proBNP measurements using second‐generation quantitative ELISA and point‐of‐care (POC) tests in plasma and pleural fluid distinguish cardiac from noncardiac pleural effusions and how results compare to the first‐generation ELISA. ANIMALS: Thirty‐eight cats (US cohort) and 40 cats (UK cohort) presenting with cardiogenic or noncardiogenic pleural effusion. METHODS: Prospective cohort study. Twenty‐one and 17 cats in the US cohort, and 22 and 18 cats in the UK cohort were classified as having cardiac or noncardiac pleural effusion, respectively. NT‐proBNP concentrations in paired plasma and pleural fluid samples were measured using second‐generation ELISA and POC assays. RESULTS: The second‐generation ELISA differentiated cardiac from noncardiac pleural effusion with good diagnostic accuracy (plasma: sensitivity, 95.2%, specificity, 82.4%; pleural fluid: sensitivity, 100%, specificity, 76.5%). NT‐proBNP concentrations were greater in pleural fluid (719 pmol/L (134–1500)) than plasma (678 pmol/L (61–1500), P = 0.003), resulting in different cut‐off values depending on the sample type. The POC test had good sensitivity (95.2%) and specificity (87.5%) when using plasma samples. In pleural fluid samples, the POC test had good sensitivity (100%) but low specificity (64.7%). Diagnostic accuracy was similar between first‐ and second‐generation ELISA assays. CONCLUSIONS AND CLINICAL IMPORTANCE: Measurement of NT‐proBNP using a quantitative ELISA in plasma and pleural fluid or POC test in plasma, but not pleural fluid, distinguishes cardiac from noncardiac causes of pleural effusion in cats

Prospective evaluation of the utility of cross‐matching prior to first transfusion in cats: 101 cases

Objectives To: (1) assess the frequency of crossmatch incompatibility in naïve feline blood transfusion recipients using two crossmatching methods, (2) measure the effect of crossmatch incompatibility on change in packed cell volume following transfusion, (3) assess the frequency of acute transfusion reactions and errors in blood transfusions in cats and (4) assess the impact of crossmatch incompatibility on the likelihood of transfusion reactions. Materials and Methods Cats being administered a first AB‐matched transfusion in a veterinary teaching hospital were prospectively recruited for this observational study. A slide agglutination method and a commercial test were both used for major and minor crossmatching. We measured increase in packed cell volume at 12 hours after transfusion relative to the mass of red blood cells given per recipient bodyweight and recorded transfusion reactions. Results A total of 101 cats was included. Crossmatch incompatibility was common using the slide agglutination method (27% and 10% major and minor incompatibility, respectively), but less common with the commercial test (major and minor incompatibility both 4%). Crossmatch incompatibility with any method was not associated with less effective transfusion in terms of change in packed cell volume. Transfusion reactions occurred in 20 cats, most commonly febrile non‐haemolytic transfusion reactions (n = 9) and haemolytic transfusion reactions (n = 7). The commercial test appeared to be most specific for predicting haemolytic transfusion reactions. Clinical Significance Transfusion reactions were fairly common but not associated with increased mortality. Use of crossmatch‐compatible blood did not lead to a greater increase in PCV at 12 hours. The commercial test may predict a haemolytic transfusion reaction

Abnormal platelet activity in dogs and cats – impact and measurement

Abnormal platelet activity can either lead to bleeding tendencies or inappropriate thrombus formation and can occur secondarily to a wide variety of disease processes, with a range of clinical consequences and severity. This article will discuss the pathophysiology of platelet function abnormalities and consider a logical diagnostic approach applicable to veterinary practice. Recent advances in platelet function testing will then be discussed, with regards to detection of platelet dysfunction and tailoring of pharmacological manipulation. Although many of these tests are still confined to research or academic institutions, techniques for indirectly assessing platelet function are starting to become more widely available. Although we still require further research to develop guidelines for the use of these tests in clinical decision‐making, the recent advances in this field are an exciting step forward in being able to detect and manage platelet dysfunction in both primary care and referral practice

Characteristics of the Mars Pathfinder Landing Site from CRISM Hyperspectral Imaging

Preliminary analysis of CRISM imaging of the Mars Pathfinder landing site is consistent with previously reported results from landed imaging. At tens of meters scale, the surface is largely dust-covered. Lee portions of topographic knobs are reddest and show most evidence for ferric mineralogy. The nearby 1.5-km diameter "Big Crater" exposes olivine, which is atypical of the northern plains. Big Crater may have penetrated northern plains material to expose buried basaltic highlands

Impacts of Lower Thermospheric Atomic Oxygen on Thermospheric Dynamics and Composition Using the Global Ionosphere Thermosphere Model

The exchange of energy between the lower atmosphere and the ionosphere thermosphere system is not well understood. One of the parameters that is important in the lower thermosphere is atomic oxygen. It has recently been observed that atomic oxygen is higher in summer at ∼95 km. In this study, we investigate the sensitivity of the upper thermosphere to lower thermospheric atomic oxygen using the Global Ionosphere Thermosphere Model (GITM). We use the Whole Atmosphere Community Climate Model with thermosphere and ionosphere extension (WACCM‐X) to drive the lower atmospheric boundary of atomic oxygen in GITM between ∼95 and 100 km and compare the results with the current mass spectrometer incoherent scatter (MSIS) driven GITM. MSIS has higher atomic oxygen in the winter hemisphere while WACCM‐X has higher atomic oxygen in the summer hemisphere. The reversal of atomic oxygen distribution affects the pressure distribution between 100 and 120 km, such that the hemisphere with larger O number density has stronger equatorward winds, and lower temperature mainly due to adiabatic and radiative cooling. This affects thermospheric scale heights such that the hemisphere with more O has lower N2 and thus enhanced O/N2. This behavior is observed in the opposite hemisphere when MSIS is used as the lower boundary for GITM. Overall, O/N2 for WACCM‐X driven GITM matches better with the global ultraviolet imager (GUVI) data. We find that the impact of lower thermospheric atomic oxygen on upper thermosphere is not just through diffusive equilibrium but also through secondary effects on winds and temperature

Initial Results from the MRO Crism Hyperspectral Imaging Spectrometer for the Columbia Hills in Gusev Crater on Mars

Initial results from the Mars Reconnaissance Orbiter (MRO) Compact Reconnaissance Imaging Spectrometer for Mars (CRISM) instrument are reported for the Columbia Hills region in Gusev Crater, Mars. The imaged region (data product FRT00003192_07) includes the surface traversed by the Mars Exploration Rover (MER) Spirit. CRISM hyperspectral data (approx. 0.4 to 2.6 micrometers) are compared with multispectral data (approx. 0.4 to 1.0 micrometers) obtained by Spirit's Panoramic Camera (Pancam) instrument