Changing Operating Lists on the Day of Surgery - a Service Evaluation

This study aims to explore how often the operating list is changed on the day of surgery, and the reasons why this may occur. The purpose being to analyse the wider potential impact of changing the list on the day of surgery has on patient safety, patient satisfaction and theatre efficiency. Survey data was collected across a multi-specialty elective operating department. The findings demonstrated a significant (P <0.001) change in operating lists occurred in 37.3% of sessions with a variety of potentially avoidable reasons. We concluded that improved organisation and communication before the planned session could reduce the occurrence of changes, increasing patient safety, theatre efficiency and potentially reducing incidents

Ultrasound navigated RFA of liver tumors

Primary liver tumors and liver metastases are of high clinical relevance. They are the fifth most common kind of malignant tumors and the third most common cause of death in the group of malignant tumors. Ultrasound controlled Radio Frequency Ablation (RFA) is accepted as a gentle and inexpensive treatment but suffers from higher recurrence of tumors compared to surgical resection. The main reasons are that only ultrasound images are available during the intervention and radiological data can not be mapped onto the patient. Therefore, exact positioning of the applicator and control of ablation are very difficult to perform. Thus, RFA as therapy usually is chosen only in cases where surgical resection is not possible. As a part of the BMBF project "FUSION" we are developing a 3D ultrasound based navigation system and aim to improve the interventional process to achieve better outcome for patients who are treated with transcutane, ultrasound controlled RFA. The navigation system provides assistance by mapping radiological information (image sets as well as annotations) onto the patient. During an iterative process 3D ultrasound data can be acquired and target positions as well as trajectories of applicator positions can be planned. Ultrasound probe and applicator needle are navigated continuously and independently. Intuitive navigation scenes enable the physician to gain more orientation and confidence during the different steps of applicator positioning. The incorporation of 3D ultrasound fulfills different purposes: On the one hand, intrainterventional 3D data can be used to improve the registration process, on the other hand they can support the pre- and postinterventional comparison of treated tumors

Transport and mixing between airmasses in cold frontal regions during Dynamics and Chemistry of Frontal Zones (DCFZ)

[1] The passage of two cold front systems over the United Kingdom are compared and contrasted, using the results of a detailed aircraft and ground-based study. The measurements are interpreted by means of three-dimensional, reverse-domain-filling trajectories using both global models and limited-area mesoscale models. This method provides a three-dimensional picture of the interleaving air-masses in the frontal zone as defined by their Lagrangian histories. The two systems studied differ in that the first is associated with an intense surface low in January and the second is associated with a relatively weak surface low in April. In the intense surface low case the trajectory study suggests that a dry intrusion with stratospheric characteristics penetrated deep into the troposphere along the upper level front. Measurements indeed revealed an unsaturated layer with anomalously high ozone. This layer was intersected at four levels in the troposphere (at 8.5, 7.1, 5.2 and 3.7 km), and the lower the intersection, the lower the measured anomalous ozone and the higher the water vapor content. It is argued that this is best explained by the dry-intrusion layer becoming mixed with background air by three-dimensional turbulence, also encountered by the aircraft, along the upper level front. Evidence for this mixing is apparent on tracer-tracer scatterplots. In the weak surface low case, by contrast, the dry intrusion has a more complex structure, with up to three separate layers of enhanced ozone and low humidity. Strong evidence for mixing was apparent only in the lowest layer. The weaker system may therefore be much more efficient at transporting upper tropospheric/stratospheric ozone to the lower troposphere. The transport of boundary layer air to the upper troposphere in the warm conveyor belt (WCB), however, was found to be around 8 times stronger in the intense system. Sonde measurements suggested that the WCB was ventilated by convection from the surface front in some regions to about 5-6 km, while it was stably stratified in other regions, suggesting layerwise long-range transport

Cognitive domain-independent aberrant frontoparietal network strength in individuals with excessive smartphone use

Excessive smartphone use (ESU) may fulfill criteria for addictive behavior. In contrast to other related behavioral addictions, particularly Internet Gaming Disorder, little is known about the neural correlates underlying ESU. In this study, we used functional magnetic resonance imaging (fMRI) to acquire task data from three distinct behavioral paradigms, i.e. cue-reactivity, inhibition, and working memory, in individuals with psychometrically defined ESU (n = 19) compared to controls (n-ESU; n = 20). The Smartphone Addiction Inventory (SPAI) was used to quantify ESU-severity according to a novel five-factor model (SPAI-I). A multivariate data fusion approach, i.e. joint Independent Component Analysis (jICA) was employed to analyze fMRI-data derived from three separate experimental conditions, but analyzed jointly to detect converging and domain-independent neural signatures that differ between persons with vs. those without ESU. Across the three functional tasks, jICA identified a predominantly frontoparietal system that showed lower network strength in individuals with ESU compared to n-ESU (p < 0.05 FDR-corrected). Furthermore, significant associations between frontoparietal network strength and SPAI-I's dimensions “time spent” and “craving” were found. The data suggest a frontoparietal cognitive control network as cognitive domain-independent neural signature of excessive and potentially addictive smartphone use

Neurochemical Correlates of Cue Reactivity in Individuals with Excessive Smartphone Use

Background: Excessive smartphone use (ESU), that is, a pattern of smartphone use that shows specific features of addictive behavior, has increasingly attracted societal and scientific interest in the past years. On the neurobiological level, ESU has recently been related to structural and functional variation in reward and salience processing networks, as shown by, for example, aberrant patterns of neural activity elicited by specific smartphone cues. Objectives: Expanding on these findings, using cross-modal correlations of magnetic resonance imaging (MRI)-based measures with nuclear imaging-derived estimates, we aimed at identifying neurochemical pathways that are related to ESU. Methods: Cross-modal correlations between functional MRI data derived from a cue-reactivity task administered in persons with and without ESU and specific PET/SPECT receptor probability maps. Results: The endogenous mu-opioid receptor (MOR) system was found to be significantly (FDR-corrected) correlated with fMRI data, and z-transformed correlation coefficients showed an association (albeit nonsignificant after FDR-correction) between MOR and the Smartphone Addiction Inventory "withdrawal"dimension. Conclusions: We could identify the MOR system as a neurochemical pathway associated with ESU. The MOR system is closely linked to the reward system, which has been recognized as a key player in addictive disorders. Together with its potential link to withdrawal, the MOR system hints toward a biologically highly relevant marker, which should be taken into consideration in the ongoing scientific discussion on technology-related addictive behaviors