Carbon Dioxide Embolism during Laparoscopic Surgery

Clinically significant carbon dioxide embolism is a rare but potentially fatal complication of anesthesia administered during laparoscopic surgery. Its most common cause is inadvertent injection of carbon dioxide into a large vein, artery or solid organ. This error usually occurs during or shortly after insufflation of carbon dioxide into the body cavity, but may result from direct intravascular insufflation of carbon dioxide during surgery. Clinical presentation of carbon dioxide embolism ranges from asymptomatic to neurologic injury, cardiovascular collapse or even death, which is dependent on the rate and volume of carbon dioxide entrapment and the patient's condition. We reviewed extensive literature regarding carbon dioxide embolism in detail and set out to describe the complication from background to treatment. We hope that the present work will improve our understanding of carbon dioxide embolism during laparoscopic surgery

Usefulness of vessel-sealing devices combined with crush clamping method for hepatectomy: A retrospective cohort study

Background: Blood loss during resection of the hepatic parenchyma in hepatectomy can be minimized using vessel-sealing (VS) devices. Some sealing devices were retrospectively compared to evaluate the efficacy of each device for controlling blood loss, transection time and postoperative complications in hepatectomy as a cohort study. Methods: Between 2005 and September 2012, hepatectomy was underwent in 150 patients using one of three types of LigaSure™ (Dolphin Tip Laparoscopic Instrument, Precise or Small Jaw) or the Harmonic Focus or Ace ultrasonic dissecting sealer. Results were compared to crush-clamping alone as the control method by the historical study (n=81). Results: Irrespective of the vessel-sealing device used for underlying chronic hepatitis, blood loss, blood transfusion rate, operating time and transection time were significantly reduced in the VS group compared with controls (p<0.05). Rates of postoperative bile leakage and intra-abdominal abscess formation were significantly lower in the VS group than in controls (p<0.05). Comparing devices, LigaSure Small Jaw and Harmonic Focus showed lower blood loss, shorter transection time and reduced rates of post-hepatectomy complications, in turn resulting in shorter hospital stays (p<0.05). Tendencies toward uncontrolled ascites and bile leakage were only concern with the use of Harmonic Focus. Satisfactory surgical results were achieved using the sealing device for laparoscopic hepatectomy. Conclusions: The use of energy sealing devices improves surgical results and avoids hepatectomy-related complications. Adequate use of vessel sealers is necessary for safe and rapid completion of hepatic resection

New techniques in liver surgery

The development of liver surgery has a long history and through the years, much knowledge has been gathered concerning various aspects of the liver. The exploration and understanding of liver anatomy and liver regeneration and development of surgical techniques are important landmarks. Liver surgery today is a demanding field in which accumulated knowledge has fused with modern perioperative care to the benefit of the patients. In recent years simultaneous developments in radiological liver imaging, chemotherapeutic regimens and ablative treatment options further increased our ability to treat patients with liver disease. Liver surgery is the only treatment that can offer the patients long term survival or cure from malignant liver disease, but new treatment options are being developed and introduced in the clinic. To ensure patient safety these techniques have to be experimentally evaluated. Two rapidly expanding techniques are Radio Frequency Ablation and laparoscopic liver surgery. The aim of this study was to evaluate recognised risks during Radio Frequency Ablation (bile duct injury caused by heat), and laparoscopic liver surgery (carbon dioxide emboli). To give an overview of liver surgery in Sweden, Paper I is a registry study where liver surgery in Sweden recent years is described. All patients operated by liver resection in Sweden during 1987-1999 were included from the Inpatient Registry. Additional data were collected from the Swedish Cancer Registry and the Cause of Death Registry. Analyses of the patients, indications, mortality and causes of death are presented. In Sweden, 21 persons per million and year have been operated on and the patient selection criteria have probably been strict. Paper II is an animal experimental study evaluating a new technique for bile duct protection during Radio Frequency Ablation. With this technique, called intraductal cooling, cooled saline is infused in the bile ducts and supposedly protects them from heat injury. A protective effect was not proved in this study but the technique has been tested in patients with promising results, and it may need to be evaluated further. Importantly, we observed no negative effect of the cooling procedure on the ability of the Radio Frequency Ablation procedure to create the desired heat necrosis in the target tissue. Paper III and IV are animal experimental studies and focus on laparoscopic liver surgery. During pneumoperitoneum with carbon dioxide and liver parenchymal transection, embolisation to the pulmonary circulation is a recognised risk. Emboli may theoretically increase the morbidity among the patients. In paper III we have demonstrated changes in cardiopulmonary circulation persisting for hours after an experimental embolisation, an observation not earlier reported. In Paper IV we found differences in the risk of such emboli when different devices were used during laparoscopic parenchymal liver transection in pig. Influence on blood gases was apparent and indicates negative influence on the pulmonary gas exchange. The findings in Paper III and IV have clinical implications and have to be further evaluated. In conclusion, we have pointed out that liver surgery is relatively infrequent in Sweden and that future expansion is probably. The new techniques we evaluated are feasible but have recognised risks, confirmed and further described in this study. As we maximise the potential of the techniques, patient safety must have the highest priority

Uplink Channel Dependent Scheduling for Future Cellular Systems

One goal in the development of future cellular systems is to increase performance. Channel dependent scheduling can possibly contribute to a performance enhancement. It requires channel qualityinformation and uplink channel knowledge is often incomplete. This master thesis work compares channel dependent scheduling and channel independent scheduling for a Single Carrier Frequency Division Multiple Access-based uplink in time domain and time and frequencydomain assuming continuous channel quality information updates. It also evaluates different methods for providing channel quality information by investigating how the limited channel knowledge they supply affects the performance of channel dependent scheduling. Single-cell simulations with perfect channel knowledge indicate small gains for channel dependent scheduling. Large gains are seen when performing frequency and time domain scheduling instead of only time domain scheduling. Limited channel knowledge causes performance loss for channel dependent scheduling. The performance is only slightly decreased if a method with sufficiently frequent providing of channel quality information updates is applied. More realistic multi-cell simulations show large gains for channel dependent scheduling. It is possible that these results are influenced by link adaptation and scheduling problems due to non predictable interference when performing dynamic scheduling. In the comparison between channel dependent and channel independent scheduling the channel dependent scheduling can benefit from the fact that the selected channel dependent scheduling algorithms result in a more static scheduling than the selected channel independent scheduling algorithms do

Den externa redovisningens påverkan på kostnaden för lånat kapital i svenska privata mindre företag : Har den någon betydelse?

Mindre företag är viktiga för den samhällsekonomiska utvecklingen och för skapandet av nyaarbetstillfällen. Lån har visat sig vara en viktig finansieringskälla för dessa företag, men pågrund av informationsasymmetri och högre operationella kostnader har tillgången tillkonkurrenskraftig lånefinansiering framhållits vara problematisk. Den externa redovisningenkan användas för att minska informationsasymmetri och reducera detta problem.Redovisningskvalitet, upplevd revisionskvalitet och revisionens utfall utgör delar av denexterna redovisningen, vilka i tidigare studier visat sig påverka företags kostnad för lånatkapital. Svenska privata mindre företag är en grupp av företag som tidigare inte behandlats idetta avseende och syftet med denna studie är att undersöka hur dessa företags kostnad förlånat kapital påverkas av redovisningskvalitet, upplevd revisionskvalitet och revisionensutfall. Med hjälp av årsredovisningar från ett stickprov om 395 slumpvis utvalda företag ochen regressionsanalys besvaras studiens problemformulering. Hur påverkar den externaredovisningen svenska privata mindre företags kostnad för lånat kapital? Resultatet av dennastudie visar att redovisningskvalitet och revisionens utfall är delar av den externaredovisningen som påverkar svenska privata mindre företags kostnad för lånat kapital, medannågon påverkan inte kunde påvisas gällande den upplevda revisionskvaliteten. Svenskaprivata mindre företag med låg redovisningskvalitet har lägre kostnad för lånat kapital och enoren revisionsberättelse innebär högre kostnad. Detta ger såväl praktiska som teoretiskaimplikationer. Exempelvis tyder resultatet på att företag i viss mån kan vidta manipulerandeåtgärder som sänker redovisningskvaliteten och genom detta förfarande sänka kostnaden förlånat kapital. För långivare kan resultatet fungera som en varningssignal och belysa vikten avatt inte betrakta siffrorna i årsredovisningen som en obestridlig sanning. Teoretisk ges ettbidrag från den svenska kontexten. Resultatet i detta bidrag skiljer sig delvis från resultat itidigare studier, genomförda i andra kontexter.Small firms are important for economic growth and the creation of new job opportunities.Loans are an important source of financing for these firms, but due to information asymmetryand relatively higher operational costs, small firms’ access to debt capital at a competitiveprice have been shown to be problematic. Firms’ financial reports can be used to lowerinformation asymmetry between the firm and its creditors and therefore reduce this problem.Prior studies have found that accounting quality, perceived audit quality and audit outcomeare parts of the financial report which can affect firms’ cost of debt. Swedish private smallfirms has not been studied in this field of research and the purpose of this study is therefore toexamine how these firms’ cost of debt is affected by accounting quality, perceived auditquality and audit outcome. With a sample of 395 randomly selected firms a regressionanalysis is used to answer the study’s research question. How does the financial report affectSwedish private small firms’ cost of debt? The result show that accounting quality and auditoutcome are parts of the financial report that can affect firms’ cost of debt, while nosignificant difference in cost of debt could be found due to differences in perceived auditquality. Swedish private small firms with low accounting quality have lower cost of debt andthose that receive a modified auditor report have higher costs. This result has both practicaland theoretical implications. The result suggests that firms, to some extent, can lower theircost of debt by lowering their accounting quality through manipulating their financial reports.To creditors, the result can be viewed as a warning signal to not blindly trust in the accuracyof the numbers that are presented. Theoretically this study contributes with a result from theSwedish context, a result that in some ways differ from those of studies done in othercontexts

Hälsan i rullning : Stadsformens inverkan på arbetspendlande cyklisters fysiska och psykiska hälsa

The higher density in our cities requires the effective usage of urban space. Italso demands that health requirements form part of the planning process sincephysical inactivity today is classified as a public health issue. In addition, it hasbeen shown that the denser city and a hurried lifestyle causes mental illness.It is proven that there is a link between the built environment and humanphysical and mental health. In order to promote health in the urban context andthus deal with health- and space related issues, needs knowledge regardingthe influence of the built environment on public health.Demarcation of this thesis includes commuters by bike. Thus, the target groupis chosen with respect to the bike as a space saving and also health promotingmode of transport.The main purpose of this thesis is to contribute to health promoting urbanplanning. Thus the purpose is to translate the definition of health into termsof urban form; to develop a theoretical framework highlighting the connectionbetween them. Furthermore, this thesis aims to, from a basis of this framework,develop a model for investigation of the influence of urban form on the cyclist´shealth and thus assist with a health-promoting tool.The thesis includes a theoretical and an investigative part. The theoreticalpart has included comprehensive literature studies examining the influence ofurban form on the cyclist´s physical and mental health.The investigative part is a workshop undertaken by the undersigned withparticipants from Nacka kommun and Stockholms stad stadsbyggnadskontor.The purpose was to test the model as a process- and assessment tool.The result of this thesis indicates that physical and mental health is mergedthrough urban form. Furthermore, strategies promoting effective commuting bybike seem to play a central role in the current planning process. Also, in termsof prerequisites for health promoting urban planning, it has been shown thatthere are differences between inner city and suburban areas.Altogether, this piece of work highlights the importance of the awareness thaturban form has on health. The work, particularly the model, constitutes a firststep towards methodology development and thus encourages further studiesin this relatively unexplored interdisciplinary field.Validerat; 20160210 (global_studentproject_submitter

A medical device for spinal motion restriction : Development of a device for safe and efficient patient handling

Prehospital emergency care is facing a paradigm shift. Spinal motion restriction (SMR) is a way to treat trauma patients with symptoms of spinal injury. It was earlier entitled as ‘routine SMR’, and included spine board and cervical collar. During the 2000s, it has been noted that there is a lack of scientific evidence that proves the benefits with ‘routine SMR’. This led an expert group to the development of the national guidelines, that were published in 2019. The national guidelines can be described as ‘selective SMR’, where the cervical collar and spine board is excluded. It means that the SMR shall be adapted to the patient and not the equipment. Furthermore, the patient should be involved as much as possible in the treatment. This master thesis has been conducted at the Luleå University of Technology (LTU), in collaboration with AB Germa. The objective was to enable paramedics (the users in this project) to provide trauma patients with safe and efficient SMR by improving the usability of available or future products for SMR. Therefore, the project aim was to deliver a conceptual suggestion with feedback from the users. Furthermore, a mapping with experienced problems was delivered, and a review of the available medical devices with recommendations on how the future product development of medical devices for SMR could head in a user-centred direction. The theoretical framework included both ergonomics, including anthropometry and anatomy, and semiotics to involve both the physical and cognitive aspects of good usability, as a complement to the contextual immersion to be able to develop a thought through conceptual suggestion. The contextual immersion involved contact with Sweden’s 21 regions, and 16 paramedics. Through visits, interviews, and observations information was gathered about available medical devices for SMR, and challenges that paramedics are facing with them where mapped. This was compiled in a user need specification, which formed the basis for the idea generation. The ideation resulted in over 200 ideas. Iterative feedback sessions together with the users generated five concepts, that by further feedback, and iterative work converged into one final concept. The project delivers a vest with vacuum technology that enables paramedics to perform safe and efficient SMR of trauma patients with various anatomy. The concept has the flexibility of a KED and the adaptability of a vacuum mattress. It enables ’selective SMR’ in confined spaces, and facilitates the patient to be more involved in the treatment. The project has generated insights about ’selective SMR’, and the meaning of it for future product development. Generally, we are moving towards medical devices for SMR that does not restrict movement as strictly as before. Many products in ambulance care have not been updated for a long time, and there is no doubt that there is a need for it.Inom prehospital akutsjukvård pågår just nu ett paradigmskifte. Spinal rörelsebegränsning (SRB) är ett sätt att vårda patienter som varit utsatta för trauma och som uppvisar symtom på spinal skada. Det benämndes till en början som ’rutinmässig SRB’ och inkluderade användning av spineboard och nackkrage. Under 2000-talet visade det sig finnas en avsaknad av vetenskapliga bevis som talade för fördelarna med ’rutinmässig SRB’, vilket ledde till att nackkrage och spineboard exkluderades. Det här föranledde en expertgrupp att ta fram nya nationella riktlinjer som publicerades 2019. De nationella riktlinjerna kan beskrivas som ’selektiv SRB’, vilket handlar om att SRB ska anpassas utifrån patientens tillstånd och inte efter utrustningen. Patienten ska även involveras så mycket som möjligt i omhändertagandet. Det här examensarbetet har utförts vid Luleå Tekniska Universitet (LTU), tillsammans med AB Germa. Syftet var att underlätta för ambulanssjukvårdare (användarna i det här projektet) att utföra säker och effektiv SRB på traumapatienter, genom att förbättra användbarheten hos befintliga eller framtida produkter för SRB. Målet var därför att leverera ett konceptuellt förslag med feedback från användarna. Utöver detta skulle en kartläggning av dagens utrustning och problem med dessa undersökas, med rekommendationer om hur den framtida utvecklingen kan gå mot en mer användarcentrerad riktning. För att få med de fysiska såväl som de kognitiva aspekterna av en god användbarhet så inkluderades både ergonomi, inkluderande antropometri och anatomi, samt semiotik i den teoretiska referensramen. Det här användes som ett komplement till den kontextuella undersökningen för att försäkra sig om att det framtagna konceptet var väl genomtänkt. Den kontextuella undersökningen inkluderade kontakt med Sveriges 21 regioner och 16 ambulanssjukvårdare. Genom besök, intervjuer och observationer samlades information om dagens utrustning för SRB, som utgjorde underlag för en kartläggning av de upplevda problemen. Allt sammanställdes som användarbehov i en lista. Det här kom att ligga till grund för den kommande idégenereingen, som resulterade i över 200 idéer. Iterativa feedbacksessioner tillsammans med användarna resulterade i fem koncept, som genom ännu mer feedback och iterativt arbete resulterade i ett slutgiltigt koncept. Projektet levererar en väst med vakuumteknologi som möjliggör för användarna att utföra säker och effektiv SRB på traumapatienter med varierande anatomi. Konceptet har smidigheten av en KED och följsamheten av en vakuummadrass. Den möjliggör ’selektiv SRB’ i trånga utrymmen och underlättar för patienten att vara deltagande i omhändertagandet. Projektet har också levererat insikter om vad ’selektiv SRB’ kan innebära för framtida produktutveckling. Det har visat sig att trenden går mot att utrustningen inte ska rörelsebegränsa lika mycket som den gjort tidigare. Många produkter inom ambulansen har inte uppdaterats på länge och det finns inga tvivel om att det finns ett behov för detta

The importance of social relationships in the workplace duringthe Covid-19 pandemic : A qualitative study of the mental healthof professionals

Syftet med studien var att undersöka hur Covid-19 pandemin har påverkat yrkesarbetandes psykiska hälsa till följd av minskad social kontakt på arbetsplatsen. Tidigare forskning har berört ämnet globalt, denna studie avsåg därför att ta reda på hur yrkesarbetande i Sverige har påverkats. Genomförandet av studien baserades på en kvalitativ metod. Semistrukturerade intervjuer användes för att samla in data och ett bekvämlighetsurval tillämpades. Totalt deltog 16 individer (sju kvinnor och nio män), alla var yrkesarbetande och arbetade hemifrån fullständigt eller i viss omfattning. Insamlade data analyserades med hjälp av tematisk analys. Resultatet visade att respondenterna hade delade upplevelser om hemarbetet. Fördelarna ansågs vara att kunna planera sin arbetstid, slippa pendla och förbereda sig inför arbetsdagen. Distansarbetets nackdelar var att arbetslivet inkräktade på privatlivet, att det upplevdes som tråkigt samt en avsaknad av kollegor. Dock fick majoriteten av respondenterna utlopp för sitt sociala behov utanför arbetet. Några enstaka respondenter upplevde lätta psykiska besvär, men majoriteten påvisade psykiskt välbefinnande. Studiens slutsats är därför att den sociala kontakten med kollegor på arbetsplatsen inte har så stor betydelse för respondenternas psykiska hälsa

Factors that Impact the Will to Invest in Swedish Logistics

Studien syftar till att utveckla förståelsen för hur det svenska logistiksegmentet ser ut idag, samt hur det kan komma att utveckla sig. Faktorer som påverkar investeringsvilja, hur investeringsvolymen kommer att utveckla sig och e-handelns påverkan på detta, undersöks. Arbetet är kvalitativt och baserar sig på litteraturstudier, teori, marknadsrapporter och intervjuer. Resultat av rapporter visar ökningar av efterfrågan hos investerare, mer investering och byggnation, höjda hyresnivåer, lägre yield och vakans samt ökad omsättning av e-handel. Övergripande tycker de respondenter som har intervjuats att e-handeln har påverkat lager och logistikmarknaden för fastigheter med viss geografisk placering och vissa tekniska egenskaper. Hur det kommer utveckla sig i framtiden beror mycket på framtida tro om konsumentbeteenden. Det går att dra slutsatser genom intervjuerna, i samband med litteraturen, teorin och rapporterna. Hyresnivåer och yielder är faktorer som påverkar viljan att investera i logistiksegmentet. Dessa faktorers utveckling förväntas leda till ökade investeringsvolymer. Efterfrågan från hyresgäster påverkar även investerare. Denna efterfrågan är driven av konsumentbeteenden. Byggnationen är en del av investeringarna, vilken påverkas av kostnader, alternativa möjligheter och risk. Investeringsviljan påverkas även av möjligheter att skapa värde samt efterfrågan på viss geografisk placering. Det råder ingen konsensus kring e-handelns påverkan på logistik idag, men e-handeln kan ha en stark påverkan i framtiden. E-handeln har påverkat viljan att investera i lager och logistik men bara för vissa fastigheter och i vissa geografiska lägen. Om konsumenter ändrar sina förväntningar kan efterfrågan på last mile logistics öka framöver, vilket skulle flytta en del av investeringarna närmare städerna.The study aims to develop an understanding of what the Swedish logistics segment looks like today, and how it may develop. Factors that affect the will to invest, how the investment volume will develop and the impact of e-commerce on this are examined. The work is qualitative and is based on literature studies, theory, market reports and interviews. Results of reports show increases in investor demand, increased investment and construction, increased rental levels, decreased yield and vacancy and increased sales of e-commerce. Overall, the respondents who were interviewed believe that e-commerce has affected the warehouse and logistics market for properties with a certain geographical location and certain technical attributes. How it will develop in the future depends a lot on future beliefs about consumer behavior. It is possible to draw conclusions through the interviews, in connection to the literature, the theory and the reports. Rental levels and yields are factors that affect investment in the logistics segment. The development of these factors is expected to lead to increased investment volumes. Demand from tenants also affects investors. This demand is driven by consumer behavior. Construction is part of the investments that are made, which is affected by costs, alternative opportunities and risk. The will to invest is also affected by opportunities to create value and the demand for certain geographical locations. There is no consensus on the impact of e-commerce on logistics today, but e-commerce may have a strong impact in the future. E-commerce has affected the willingness to invest in warehousing and logistics, but only for certain properties and in certain geographical locations. If consumers change their expectations, the demand for last mile logistics may increase in the future, which would move some investments closer to the cities

Factors that Impact the Will to Invest in Swedish Logistics

Studien syftar till att utveckla förståelsen för hur det svenska logistiksegmentet ser ut idag, samt hur det kan komma att utveckla sig. Faktorer som påverkar investeringsvilja, hur investeringsvolymen kommer att utveckla sig och e-handelns påverkan på detta, undersöks. Arbetet är kvalitativt och baserar sig på litteraturstudier, teori, marknadsrapporter och intervjuer. Resultat av rapporter visar ökningar av efterfrågan hos investerare, mer investering och byggnation, höjda hyresnivåer, lägre yield och vakans samt ökad omsättning av e-handel. Övergripande tycker de respondenter som har intervjuats att e-handeln har påverkat lager och logistikmarknaden för fastigheter med viss geografisk placering och vissa tekniska egenskaper. Hur det kommer utveckla sig i framtiden beror mycket på framtida tro om konsumentbeteenden. Det går att dra slutsatser genom intervjuerna, i samband med litteraturen, teorin och rapporterna. Hyresnivåer och yielder är faktorer som påverkar viljan att investera i logistiksegmentet. Dessa faktorers utveckling förväntas leda till ökade investeringsvolymer. Efterfrågan från hyresgäster påverkar även investerare. Denna efterfrågan är driven av konsumentbeteenden. Byggnationen är en del av investeringarna, vilken påverkas av kostnader, alternativa möjligheter och risk. Investeringsviljan påverkas även av möjligheter att skapa värde samt efterfrågan på viss geografisk placering. Det råder ingen konsensus kring e-handelns påverkan på logistik idag, men e-handeln kan ha en stark påverkan i framtiden. E-handeln har påverkat viljan att investera i lager och logistik men bara för vissa fastigheter och i vissa geografiska lägen. Om konsumenter ändrar sina förväntningar kan efterfrågan på last mile logistics öka framöver, vilket skulle flytta en del av investeringarna närmare städerna.The study aims to develop an understanding of what the Swedish logistics segment looks like today, and how it may develop. Factors that affect the will to invest, how the investment volume will develop and the impact of e-commerce on this are examined. The work is qualitative and is based on literature studies, theory, market reports and interviews. Results of reports show increases in investor demand, increased investment and construction, increased rental levels, decreased yield and vacancy and increased sales of e-commerce. Overall, the respondents who were interviewed believe that e-commerce has affected the warehouse and logistics market for properties with a certain geographical location and certain technical attributes. How it will develop in the future depends a lot on future beliefs about consumer behavior. It is possible to draw conclusions through the interviews, in connection to the literature, the theory and the reports. Rental levels and yields are factors that affect investment in the logistics segment. The development of these factors is expected to lead to increased investment volumes. Demand from tenants also affects investors. This demand is driven by consumer behavior. Construction is part of the investments that are made, which is affected by costs, alternative opportunities and risk. The will to invest is also affected by opportunities to create value and the demand for certain geographical locations. There is no consensus on the impact of e-commerce on logistics today, but e-commerce may have a strong impact in the future. E-commerce has affected the willingness to invest in warehousing and logistics, but only for certain properties and in certain geographical locations. If consumers change their expectations, the demand for last mile logistics may increase in the future, which would move some investments closer to the cities