Central venous oxygen saturation monitoring

It has been established that mixed venous oxygen saturation (SvO2) reflects the balance between systemic oxygen deliver y and consumption. Literature indicates that it is a valuable clinical indicator and has good prognostic value early in patient course. This article aims to establish the usefulness of SvO2 as a clinical indicator. A secondary aim was to determine whether central venous oxygen saturation (ScvO2) and SvO2 are interchangeable. Of particular relevance to cardiac nurses is the link between decreased SvO2 and cardiac failure in patients with myocardial infarction, and with decline in myocardial function, clinical shock and arrhythmias. While absolute values ScvO2 and SvO2 are not interchangeable, ScvO2 and SvO2are equivalent in terms of clinical course. Additionally, ScvO2 monitoring is a safer and less costly alternative to SvO2 monitoring. It can be concluded that continuous ScvO2 monitoring should potentially be undertaken in patients at risk of haemodynamic instability.

Repeatability of confocal microscopy measurements on the central and peripheral cornea

Purpose To assess confocal microscopy repeatability (ConfoScan3, Nidek, Italy) when assessing the morphology of the limbus, midperipheral and central cornea. Method The central, mid-peripheral and limbal cornea (temporal and nasal) of the right eye of 8 subjects were examined with a ConfoScan3 in two different visits, at least six months apart. Bland-Altman repeatability was measured for 29 parameters: basal cell density and size, anterior and posterior keratocyte densities (AKD/PKD), endothelial cell density, polymegethism, pleomorphism, mean area and sides of endothelial cells - in the five different corneal areas examined. Results As a percentage of the mean absolute values, repeatability of 0–10% was classified as “excellent”, between 10–30% as “acceptable” and over 30% as “poor”. Repeatability was excellent for 14% of parameters and acceptable for 52% of parameters. The number of endothelial cell sides in the central cornea demonstrated the best repeatability (2.0%) whilst mid-temporal PKD showed the poorest repeatability (53.7%). Conclusions Confocal microscopy is at least an adequately repeatablemethodof evaluating the various corneal layers at different locations. Our dataset supports the ongoing use of the technique in research and clinical practice.

Use of observed within-person variation of cardiac troponin in emergency department patients for determination of biological variation and percentage and absolute reference change values

BACKGROUND Many patients presenting to the emergency department (ED) for assessment of possible acute coronary syndrome (ACS) have low cardiac troponin concentrations that change very little on repeat blood draw. It is unclear if a lack of change in cardiac troponin concentration can be used to identify acutely presenting patients at low risk of ACS. METHODS We used the hs-cTnI assay from Abbott Diagnostics, which can detect cTnI in the blood of nearly all people. We identified a population of ED patients being assessed for ACS with repeat cTnI measurement who ultimately were proven to have no acute cardiac disease at the time of presentation. We used data from the repeat sampling to calculate total within-person CV (CV(T)) and, knowing the assay analytical CV (CV(A)), we could calculate within-person biological variation (CV(i)), reference change values (RCVs), and absolute RCV delta cTnI concentrations. RESULTS We had data sets on 283 patients. Men and women had similar CV(i) values of approximately 14%, which was similar at all concentrations <40 ng/L. The biological variation was not dependent on the time interval between sample collections (t = 1.5-17 h). The absolute delta critical reference change value was similar no matter what the initial cTnI concentration was. More than 90% of subjects had a critical reference change value <5 ng/L, and 97% had values of <10 ng/L. CONCLUSIONS With this hs-cTnI assay, delta cTnI seems to be a useful tool for rapidly identifying ED patients at low risk for possible ACS.

Comparison of emission rate values for odour and odorous chemicals derived from two sampling devices

Field and laboratory measurements identified a complex relationship between odour emission rates provided by the US EPA dynamic emission chamber and the University of New South Wales wind tunnel. Using a range of model compounds in an aqueous odour source, we demonstrate that emission rates derived from the wind tunnel and flux chamber are a function of the solubility of the materials being emitted, the concentrations of the materials within the liquid; and the aerodynamic conditions within the device – either velocity in the wind tunnel, or flushing rate for the flux chamber. The ratio of wind tunnel to flux chamber odour emission rates (OU m-2 s) ranged from about 60:1 to 112:1. The emission rates of the model odorants varied from about 40:1 to over 600:1. These results may provide, for the first time, a basis for the development of a model allowing an odour emission rate derived from either device to be used for odour dispersion modelling.

Diversity of accuracy profiles for absolute pitch recognition

Most advanced musicians are able to identify and label a heard pitch if given an opportunity to compare it to a known reference note. This is called ‘relative pitch’ (RP). A much rarer skill is the ability to identify and label a heard pitch without the need for a reference. This is colloquially referred to as ‘perfect pitch’, but appears in the academic literature as ‘absolute pitch’ (AP). AP is considered by many as a remarkable skill. As people do not seem able to develop it intentionally, it is generally regarded as innate. It is often seen as a unitary skill and that a set of identifiable criteria can distinguish those who possess the skill from those who do not. However, few studies have interrogated these notions. The present study developed and applied an interactive computer program to map pitch-labelling responses to various tonal stimuli without a known reference tone available to participants. This approach enabled the identification of the elements of sound that impacted on AP. Pitch-labelling responses of 14 participants with AP were recorded for their accuracy. Each participant’s response to the stimuli was unique. Their accuracy of labelling varied across dimensions such as timbre, range and tonality. The diversity of performance between individuals appeared to reflect their personal musical experience histories.

The impact of flooding on residential property values in England

Severe flooding throughout England in Autumn 1998 and 2000, has seen an increase in the extent of flood liable residential areas throughout England, as well as an increase in the actual levels of flood damage in all previously recognised flood prone residential areas. The increasing cost of rectifying the damage caused to residential properties from flooding has been of some concern to the residential property valuation profession and sales and leasing agency practices. However, the increasing trend in the frequency of flooding in England, combined with an increase in severity of flooding is now causing some degree of concern in the residential insurance and housing finance sectors. In order to determine and quantify the impact of flooding and flood damage on the residential property market in England, a survey of Chartered Surveyors and Chartered Real Estate Valuers has been carried out across the main flood affected counties of England. This survey will provide similar details to the research completed by Eves (1999, 2001) and Fibbens (1993) in relation to residential property flooding in Australia. This survey provides comprehensive responses in relation to the degree of flood affectation across counties, the effect of flooding on residential property values, the impact of flooding on building insurance premiums and possible difficulties in obtaining finance to purchase residential property in recognised flood areas.