Laparoscopic Appendectomy in Italy: An Appraisal of 26,863 Cases

Objective: To evaluate the practice of laparoscopic appendectomy (LA) in Italy. Methods: On behalf of the Italian Society of Young Surgeons (SPIGC), an audit of LA was carried out through a written questionnaire sent to 800 institutions in Italy. The questions concerned the diffusion of laparoscopic surgery and LA over the period 1990 through 2001, surgery-related morbidity and mortality rates, indications for LA, the diagnostic algorithm adopted prior to surgery, and use of LA among young surgeons (<40 years). Results: A total of 182 institutions (22.7%) participated in the current audit, and accounted for a total number of 26863 LA. Laparoscopic surgery is performed in 173 (95%) institutions, with 144 (83.2%) routinely performing LA. The mean interval from introduction of laparoscopic surgery to inception of LA was 3.4 ± 2.5 years. There was an emergent basis for 8809 (32.8%) LA procedures (<6 hours of admission); 10314 (38.4%) procedures were performed on an urgent basis (<24 hours of admission); while 7740 (28.8%) procedures were elective. The conversion rate was 2.1% (561 cases) and was due to intraoperative complications in 197 cases (35.1%). Intraoperative complications ranged as high as 0.32%, while postoperative complications were reported in 1.2% of successfully completed LA. The mean hospital stay for successfully completed LA was 2.5 ± 1.05 days. The highest rate of intraoperative complications was reported as occurring during the learning curve phase of their experience (in their first 10 procedures) by 39.7% of the surgeons. LA was indicated for every case of suspected acute appendiceal disease by 51.8% of surgeons, and 44.8% order abdominal ultrasound (US) prior to surgery. A gynecologic counseling is deemed necessary only by 34.5% surgeons, while an abdominal CT scan is required only by 1.5%. The procedure is completed laparoscopically in the absence of gross appendiceal inflammation by 83%; 79.8% try to complete the procedure laparoscopically in the presence of concomitant disease; while 10.4% convert to open surgery in cases of suspected malignancy. Of responding surgeons aged under 40, 76.3% can perform LA, compared to 47.3% surgeons of all age categories. Conclusions: The low response rate of the present survey does not allow us to assess the diffusion of LA in Italy, but rather to appraise its practice in centers routinely performing laparoscopic surgery. In the hands of experienced surgeons, LA has morbidity rates comparable to those of international series. The higher diagnostic yield of laparoscopy makes it an invaluable tool in the management algorithm of women of childbearing age; its advantages in the presence of severe peritonitis are less clear-cut. Surgeons remain the main limiting factor preventing a wider diffusion of LA in our country, since only 47.3% of surgeons from the audited institutions can perform LA on a routine basis.

A volume of fluid numerical model for wave impacts at coastal structures

The first stages in the development of a new design tool, to be used by coastal engineers to improve the efficiency, analysis, design, management and operation of a wide range of coastal and harbour structures, are described. The tool is based on a two-dimensional numerical model, NEWMOTICS-2D, using the volume of fluid (VOF) method, which permits the rapid calculation of wave hydrodynamics at impermeable natural and man-made structures. The critical hydrodynamic flow processes and forces are identified together with the equations that describe these key processes. The different possible numerical approaches for the solution of these equations, and the types of numerical models currently available, are examined and assessed. Preliminary tests of the model, using comparisons with results from a series of hydraulic model test cases, are described. The results of these tests demonstrate that the VOF approach is particularly appropriate for the simulation of the dynamics of waves at coastal structures because of its flexibility in representing the complex free surfaces encountered during wave impact and breaking. The further programme of work, required to develop the existing model into a tool for use in routine engineering design, is outlined.

The Daedalus system: A tool for the Italian investigating magistrate

Daedalus is a computer tool, developed by an Italian magistrate - Carmelo Asaro - and integrated in his own daily routine as an investigating magistrate conducting inquiries, then as a prosecutor if and when the case investigated goes to court. This tool has recently been adopted by magistrates in judiciary offices throughout Italy, spawning moreover other related projects. First, this paper describes a sample session with daedalus. Next, an overview of an array of judicial tools leads to positioning daedalus in the context of the spectrum.

Numerical simulation of microwave thawing using a coupled solver approach

Thawing of a frozen food product in a domestic microwave oven is numerically simulated using a coupled solver approach. The approach consists of a dedicated electromagnetic FDTD solver and a closely coupled UFVM multi-physics package. Two overlapping numerical meshes are defined; the food material and container were meshed for heat transfer and phase change solution, whilst the microwave oven cavity and waveguide were meshed for the microwave irradiation. The two solution domains were linked using a cross-mapping routine. This approach allowed the rotation of the food load to be captured. Power densities obtained on the structured FDTD mesh were interpolated onto the UFVM mesh for each timestep/turntable position. The UFVM solver utilised the power density data to advance the temperature and phase distribution solution. The temperature-dependant dielectric and thermo-physical properties of the food load were updated prior to revising the electromagnetic solution. Changes in thermal/electric properties associated with the phase transition were fully accounted for as well as heat losses from product to cavity. Two scenarios were investigated: a centric and eccentric placement on the turntable. Developing temperature fields predicted by the numerical solution are validated against experimentally obtained data. Presented results indicate the feasibility of fully coupled simulations of the microwave heating of a frozen product. (© 2008 WILEY-VCH Verlag GmbH & Co. KGaA, Weinheim)

Open ended microwave oven for packaging

A novel open waveguide cavity resonator is presented for the combined variable frequency microwave curing of bumps, underfills and encapsulants, as well as the alignment of devices for fast flip-chip assembly, direct chip attach (DCA) or wafer-scale level packaging (WSLP). This technology achieves radio frequency (RF) curing of adhesives used in microelectronics, optoelectronics and medical devices with potential simultaneous micron-scale alignment accuracy and bonding of devices. In principle, the open oven cavity can be fitted directly onto a flip-chip or wafer scale bonder and, as such, will allow for the bonding of devices through localised heating thus reducing the risk to thermally sensitive devices. Variable frequency microwave (VFM) heating and curing of an idealised polymer load is numerically simulated using a multi-physics approach. Electro-magnetic fields within a novel open ended microwave oven developed for use in micro-electronics manufacturing applications are solved using a dedicated Yee scheme finite-difference time-domain (FDTD) solver. Temperature distribution, degree of cure and thermal stresses are analysed using an Unstructured Finite Volume method (UFVM) multi-physics package. The polymer load was meshed for thermophysical analysis, whilst the microwave cavity - encompassing the polymer load - was meshed for microwave irradiation. The two solution domains are linked using a cross mapping routine. The principle of heating using the evanescent fringing fields within the open-end of the cavity is demonstrated. A closed loop feedback routine is established allowing the temperature within a lossy sample to be controlled. A distribution of the temperature within the lossy sample is obtained by using a thermal imaging camera.

English Channel towed sledge seabed images. Phase 1: scoping study and example analysis

During the 1970’s and 1980’s, the late Dr Norman Holme undertook extensive towed sledge surveys in the English Channel and some in the Irish Sea. Only a minority of the resulting images were analysed and reported before his death in 1989 but logbooks, video and film material has been archived in the National Marine Biological Library (NMBL) in Plymouth. A scoping study was therefore commissioned by the Joint Nature Conservation Committee and as a part of the Mapping European Seabed Habitats (MESH) project to identify the value of the material archived and the procedure and cost to undertake further work. The results of the scoping study are: 1. NMBL archives hold 106 videotapes (reel-to-reel Sony HD format) and 59 video cassettes (including 15 from the Irish Sea) in VHS format together with 90 rolls of 35 mm colour transparency film (various lengths up to about 240 frames per film). These are stored in the Archive Room, either in a storage cabinet or in original film canisters. 2. Reel-to-reel material is extensive and had already been selectively copied to VHS cassettes. The cost of transferring it to an accepted ‘long-life’ medium (Betamax) would be approximately £15,000. It was not possible to view the tapes as a suitable machine was not located. The value of the tapes is uncertain but they are likely to become beyond salvation within one to two years. 3. Video cassette material is in good condition and is expected to remain so for several more years at least. Images viewed were generally of poor quality and the speed of tow often makes pictures blurred. No immediate action is required. 4. Colour transparency films are in good condition and the images are very clear. They provide the best source of information for mapping seabed biotopes. They should be scanned to digital format but inexpensive fast copying is problematic as there are no between-frame breaks between images and machines need to centre the image based on between-frame breaks. The minimum cost to scan all of the images commercially is approximately £6,000 and could be as much as £40,000 on some quotations. There is a further cost in coding and databasing each image and, all-in-all it would seem most economic to purchase a ‘continuous film’ scanner and undertake the work in-house. 5. Positional information in ships logs has been matched to films and to video tapes. Decca Chain co-ordinates recorded in the logbooks have been converted to latitude and longitude (degrees, minutes and seconds) and a further routine developed to convert to degrees and decimal degrees required for GIS mapping. However, it is unclear whether corrections to Decca positions were applied at the time the position was noted. Tow tracks have been mapped onto an electronic copy of a Hydrographic Office chart. 6. The positions of start and end of each tow were entered to a spread sheet so that they can be displayed on GIS or on a Hydrographic Office Chart backdrop. The cost of the Hydrographic Office chart backdrop at a scale of 1:75,000 for the whole area was £458 incl. VAT. 7. Viewing all of the video cassettes to note habitats and biological communities, even by an experienced marine biologist, would take at least in the order of 200 hours and is not recommended. English Channel towed sledge seabed images. Phase 1: scoping study and example analysis. 6 8. Once colour transparencies are scanned and indexed, viewing to identify seabed habitats and biological communities would probably take about 100 hours for an experienced marine biologist and is recommended. 9. It is expected that identifying biotopes along approximately 1 km lengths of each tow would be feasible although uncertainties about Decca co-ordinate corrections and exact positions of images most likely gives a ±250 m position error. More work to locate each image accurately and solve the Decca correction question would improve accuracy of image location. 10. Using codings (produced by Holme to identify different seabed types), and some viewing of video and transparency material, 10 biotopes have been identified, although more would be added as a result of full analysis. 11. Using the data available from the Holme archive, it is possible to populate various fields within the Marine Recorder database. The overall ‘survey’ will be ‘English Channel towed video sled survey’. The ‘events’ become the 104 tows. Each tow could be described as four samples, i.e. the start and end of the tow and two areas in the middle to give examples along the length of the tow. These samples would have their own latitude/longitude co-ordinates. The four samples would link to a GIS map. 12. Stills and video clips together with text information could be incorporated into a multimedia presentation, to demonstrate the range of level seabed types found along a part of the northern English Channel. More recent images taken during SCUBA diving of reef habitats in the same area as the towed sledge surveys could be added to the Holme images.

An innovative statistical approach to constructing a readily comprehensible food web for a demersal fish community

Many food webs are so complex that it is difficult to distinguish the relationships between predators and their prey. We have therefore developed an approach that produces a food web which clearly demonstrates the strengths of the relationships between the predator guilds of demersal fish and their prey guilds in a coastal ecosystem. Subjecting volumetric dietary data for 35 abundant predators along the lower western Australia coast to cluster analysis and the SIMPROF routine separated the various species x length class combinations into 14 discrete predator guilds. Following nMDS ordination, the sequence of points for these predator guilds represented a 'trophic' hierarchy. This demonstrated that, with increasing body size, several species progressed upwards through this hierarchy, reflecting a marked change in diet, whereas others remained within the same guild. A novel use of cluster analysis and SIMPROF then identified each group of prey that was ingested in a common pattern across the full suite of predator guilds. This produced 12 discrete groups of taxa (prey guilds) that each typically comprised similar ecological/functional prey, which were then also aligned in a hierarchy. The hierarchical arrangements of the predator and prey guilds were plotted against each other to show the percentage contribution of each prey guild to the diet of each predator guild. The resultant shade plot demonstrates quantitatively how food resources are spread among the fish species and revealed that two prey guilds, one containing cephalopods and teleosts and the other small benthic/epibenthic crustaceans and polychaetes, were consumed by all predator guilds.

Changes in the oceanic northeast Pacific plankton populations; what may happen in a warmer ocean

The Continuous Plankton Recorder has been sampling the northeast Pacific on a routine basis since 2000. Although this is a relatively short time series still, climate variability within that time has caused noticeable related changes in the plankton. The earlier part of the time series followed the 1999 La Nina and conditions were cool, but conditions between 2003 and 2005 were anomalously warm. Oceanic zooplankton have responded to this warming in several ways that are discernible in CPR data. The seasonal cycle of mesozooplankton biomass in the eastern Gulf of Alaska has shifted earlier in the spring by a few weeks (sampling resolution is too coarse to be more accurate). The copepod Neocalanus plumchruslflemingeri is largely responsible as it makes up a high proportion of the spring surface biomass and stage-based determinations have shown an earlier maximum in warmer years across much of the northeast Pacific, spanning nearly 20 degrees of latitude. Summer copepod populations are more diverse than in spring, although lower in biomass. The northwards extension of southern taxa in the summer correlates with surface temperature and in warmer years southern taxa are found further north than in cooler years. These findings support the importance of monitoring the open ocean particularly as it is an important foraging ground for large fish, birds and mammals. Higher trophic levels may time their reproduction or migration to coincide with the abundance of particular prey which may be of a different composition and/or lower abundance at a particular time in warmer conditions.

The CPR: Antique technology observing today's oceans

First designed in the 1920s and in routine use in the Atlantic since the 1930s, the Continuous Plankton Recorder (CPR) is an ocean observing tool that has been used in the north Pacific since 2000 and still retains its relevance. It was the sampler of choice in 2000 because it is reliable, cost-effective, samples on the scale of an entire ocean and, while not a perfect sampler, its limitations are mostly well-known. Earlier this year, the GOOS Scientific Steering Committee endorsed the north Pacific CPR survey as an ocean observing tool. Data from the seven years of sampling in the North Pacific have already shown responses in open ocean plankton to changes from cool to warm ocean conditions, from which we can start to make predictions on responses to future climate changes. This presentation describes and presents results from the survey, and ends with some thoughts on development of the north Pacific CPR survey.

The Continuous Plankton Recorder: towards a global perspective

The Continuous Plankton Recorder (CPR) began its first routine deployment to collect plankton samples in the North Sea in 1931. The better part of a century after that event, the Recorder is used for sampling plankton widely in many oceans. The CPR is designed to be towed behind ships of opportunity (such as commercial and passenger vessels) and to collect plankton samples along the ship’s path. The samples provide information on the broad scale spatial distributions of larger hard-shelled phytoplankton and robust mesozooplankton organisms (Richardson et al., 2006). Changes in these distributions provide indices for the biological health of the ocean including those required for fisheries and for assessment of climate change impacts.

Can the Continuous Plankton Recorder (CPR) be used to infer sardine diet?

Knowledge on the impact of climate variability in the diet of planktivorous fish is limited by the laborious work involved in stomach content analysis, impractical for large scale studies. Routine measurements of plankton such as the Continuous Plankton Recorder (CPR) survey provide valuable information of the temporal variation of phyto- and zooplankton prey availability for higher trophic levels. Sardines are a world-wide distributed and commercially important planktivorous fish, at the basis of the pelagic marine food web. Being predominantly non-selective filter-feeders, their diets closely correspond to the water plankton species and a significant relationship was recently found between Sardina pilchardus feeding intensity and remotely sensed chlorophyll alpha . Data of sardine stomach prey composition and CPR were obtained during 2003 for the same location off the west coast of Portugal, an area characterised by strong seasonality of plankton abundance and composition, mainly governed by upwelling events. Phyto- and zooplankton prey in sardine stomachs were identified to the lowest possible taxa and their numerical and volumetric abundance was registered, as well as their contribution to the prey carbon content. The seasonal variation of the abundance and composition of sardine diet was then compared to the abundance and composition of the water plankton obtained with the CPR at the same time and for the same area where the fish were collected, in order to evaluate if CPR data can be used to proxy sardine prey availability and diet composition at large temporal scales.

Toxic marine microalgae and shellfish poisoning in the British isles: history, review of epidemiology, and future implications

The relationship between toxic marine microalgae species and climate change has become a high profile and well discussed topic in recent years, with research focusing on the possible future impacts of changing hydrological conditions on Harmful Algal Bloom (HAB) species around the world. However, there is very little literature concerning the epidemiology of these species on marine organisms and human health. Here, we examine the current state of toxic microalgae species around the UK, in two ways: first we describe the key toxic syndromes and gather together the disparate reported data on their epidemiology from UK records and monitoring procedures. Secondly, using NHS hospital admissions and GP records from Wales, we attempt to quantify the incidence of shellfish poisoning from an independent source. We show that within the UK, outbreaks of shellfish poisoning are rare but occurring on a yearly basis in different regions and affecting a diverse range of molluscan shellfish and other marine organisms. We also show that the abundance of a species does not necessarily correlate to the rate of toxic events. Based on routine hospital records, the numbers of shellfish poisonings in the UK are very low, but the identification of the toxin involved, or even a confirmation of a poisoning event is extremely difficult to diagnose. An effective shellfish monitoring system, which shuts down aquaculture sites when toxins exceed regularity limits, has clearly prevented serious impact to human health, and remains the only viable means of monitoring the potential threat to human health. However, the closure of these sites has an adverse economic impact, and the monitoring system does not include all toxic plankton. The possible geographic spreading of toxic microalgae species is therefore a concern, as warmer waters in the Atlantic could suit several species with southern biogeographical affinities enabling them to occupy the coastal regions of the UK, but which are not yet monitored or considered to be detrimental.

Fish data from the Continuous Plankton Recorder survey

The Continuous Plankton Recorder (CPR) survey has been sampling plankton in the North Sea since 1931. However the identification of the larval and juvenile fish taken in the survey has not been a part of the routine analysis of the samples. Specialist analysis of the fish was carried out between 1948 and the early 1980s but the data were available as hard copy only. As part of MarBEF, data on >60 taxa from 1948 to 1972 have been entered on a database which is now linked to EUROBIS to show the biogeographical information and the data are available for general research. Examples of the data are shown. These data provide a background on the variability of fish stocks before the recent period of rapid warming and in some cases before significant fisheries developed. Data for subsequent years will be made available as possible and work is now underway to bring the analysis up to date. This will provide time series over six decades.

The Importance of Regional, System-Wide and Local Spatial Scales in Structuring Temperate Estuarine Fish Communities

An extensive literature base worldwide demonstrates how spatial differences in estuarine fish assemblages are related to those in the environment at (bio)regional, estuary-wide or local (within-estuary) scales. Few studies, however, have examined all three scales, and those including more than one have often focused at the level of individual environmental variables rather than scales as a whole. This study has identified those spatial scales of environmental differences, across regional, estuary-wide and local levels, that are most important in structuring ichthyofaunal composition throughout south-western Australian estuaries. It is the first to adopt this approach for temperate microtidal waters. To achieve this, we have employed a novel approach to the BIOENV routine in PRIMER v6 and a modified global BEST test in an alpha version of PRIMER v7. A combination of all three scales best matched the pattern of ichthyofaunal differences across the study area (rho = 0.59; P = 0.001), with estuary-wide and regional scales accounting for about twice the variability of local scales. A shade plot analysis showed these broader-scale ichthyofaunal differences were driven by a greater diversity of marine and estuarine species in the permanently-open west coast estuaries and higher numbers of several small estuarine species in the periodically-open south coast estuaries. When interaction effects were explored, strong but contrasting influences of local environmental scales were revealed within each region and estuary type. A quantitative decision tree for predicting the fish fauna at any nearshore estuarine site in south-western Australia has also been produced. The estuarine management implications of the above findings are highlighted.

Volcanic ash supply to the surface ocean – remote sensing of biological responses and their wider biogeochemical significance

Transient micronutrient enrichment of the surface ocean can enhance phytoplankton growth rates and alter microbial community structure with an ensuing spectrum of biogeochemical feedbacks. Strong phytoplankton responses to micronutrients supplied by volcanic ash have been reported recently. Here we: (i) synthesize findings from these recent studies; (ii) report the results of a new remote sensing study of ash fertilization; and (iii) calculate theoretical bounds of ash-fertilized carbon export. Our synthesis highlights that phytoplankton responses to ash do not always simply mimic that of iron amendment; the exact mechanisms for this are likely biogeochemically important but are not yet well understood. Inherent optical properties of ash-loaded seawater suggest rhyolitic ash biases routine satellite chlorophyll-a estimation upwards by more than an order of magnitude for waters with <0.1 mg chlorophyll-a m-3, and less than a factor of 2 for systems with >0.5 mg chlorophyll-a m-3. For this reason post-ash-deposition chlorophyll-a changes in oligotrophic waters detected via standard Case 1 (open ocean) algorithms should be interpreted with caution. Remote sensing analysis of historic events with a bias less than a factor of 2 provided limited stand-alone evidence for ash-fertilization. Confounding factors were poor coverage, incoherent ash dispersal, and ambiguity ascribing biomass changes to ash supply over other potential drivers. Using current estimates of iron release and carbon export efficiencies, uncertainty bounds of ash-fertilized carbon export for 3 events are presented. Patagonian iron supply to the Southern Ocean from volcanic eruptions is less than that of windblown dust on thousand year timescales but can dominate supply at shorter timescales. Reducing uncertainties in remote sensing of phytoplankton response and nutrient release from ash are avenues for enabling assessment of the oceanic response to large-scale transient nutrient enrichment.