Oxygen targeting in preterm infants using the Masimo SET Radical pulse oximeter

BACKGROUND: A pretrial clinical improvement project for the BOOST-II UK trial of oxygen saturation targeting revealed an artefact affecting saturation profiles obtained from the Masimo Set Radical pulse oximeter.

METHODS: Saturation was recorded every 10 s for up to 2 weeks in 176 oxygen dependent preterm infants in 35 UK and Irish neonatal units between August 2006 and April 2009 using Masimo SET Radical pulse oximeters. Frequency distributions of % time at each saturation were plotted. An artefact affecting the saturation distribution was found to be attributable to the oximeter's internal calibration algorithm. Revised software was installed and saturation distributions obtained were compared with four other current oximeters in paired studies.

RESULTS: There was a reduction in saturation values of 87-90%. Values above 87% were elevated by up to 2%, giving a relative excess of higher values. The software revision eliminated this, improving the distribution of saturation values. In paired comparisons with four current commercially available oximeters, Masimo oximeters with the revised software returned similar saturation distributions.

CONCLUSIONS: A characteristic of the software algorithm reduces the frequency of saturations of 87-90% and increases the frequency of higher values returned by the Masimo SET Radical pulse oximeter. This effect, which remains within the recommended standards for accuracy, is removed by installing revised software (board firmware V4.8 or higher). Because this observation is likely to influence oxygen targeting, it should be considered in the analysis of the oxygen trial results to maximise their generalisability.

The effects of transients on photospheric and chromospheric power distributions

We have observed a quiet Sun region with the Swedish 1-meter Solar Telescope (SST) equipped with CRISP Imaging SpectroPolarimeter. High-resolution, high-cadence, H-alpha line scanning images were taken to observe different layers of the solar atmosphere from the photosphere to upper chromosphere. We study the distribution of power in different period-bands at different heights. Power maps of the upper photosphere and the lower chromosphere show suppressed power surrounding the magnetic-network elements, known as "magnetic shadows". These also show enhanced power close to the photosphere, traditionally referred to as"power halos". The interaction between acoustic waves and inclined magnetic fields is generally believed to be responsible for these two effects. In this study we explore if small-scale transients can influence the distribution of power at different heights. We show that the presence of transients, like mottles, Rapid Blueshifted Excursions (RBEs) and Rapid Redshifted Excursions (RREs), can strongly influence the power-maps. The short and finite lifetime of these events strongly affects all powermaps, potentially influencing the observed power distribution. We show that Doppler-shifted transients like RBEs and RREs that occur ubiquitously, can have a dominant effect on the formation ofthe power halos in the quiet Sun. For magnetic shadows, transients like mottles do not seem to have a significant effect in the power suppression around 3 minutes and wave interaction may play a key role here. Our high cadence observations reveal that flows, waves and shocks manifest in presence of magnetic fields to form a non-linear magnetohydrodynamic system.