A pilot assessment of alpha-stat vs pH-stat arterial blood gas analysis after cardiac arrest

PURPOSE: Resuscitated cardiac arrest (CA) patients typically receive therapeutic hypothermia, but arterial blood gases (ABGs) are often assessed after adjustment to 37°C (alpha-stat) instead of actual body temperature (pH-stat). We sought to compare alpha-stat and pH-stat assessment of PaO2 and PaCO2 in such patients. MATERIALS AND METHODS: Using ABG data obtained during the first 24 hours of intensive care unit admission, we determined the impact of measured alpha vs calculated pH-stat on PaO2 and PaCO2 on patient classification and outcomes for CA patients. RESULTS: We assessed 1013 ABGs from 120 CA patients with a median age of patients 66 years (interquartile range, 50-76). Median alpha-stat PaO2 changed from 122 (95-156) to 107 (82-143) mm Hg with pH-stat and median PaCO2 from 39 (34-46) to 35 (30-41) mm Hg (both P < .001). Using the categories of hyperoxemia, normoxemia, and hypoxemia, pH-stat estimation of PaO2 reclassified approximately 20% of patients. Using the categories of hypercapnia, normocapnia, and hypocapnia, pH stat estimation of PaCO2 reclassified approximately 40% of patients. The mortality of patients in different PaO2 and PaCO2 categories was similar for pH-stat and alpha-stat. CONCLUSIONS: Using the pH-stat method, fewer resuscitated CA patients admitted to intensive care unit were classified as hyperoxemic or hypercapnic compared with alpha-stat. These findings suggest an impact of ABG assessment methodology on PaO2, PaCO2 , and patient classification but not on associated outcomes.

Recommendations for improved data processing from expired gas analysis indirect calorimetry

There is currently no universally recommended and accepted method of data processing within the science of indirect calorimetry for either mixing chamber or breath-by-breath systems of expired gas analysis. Exercise physiologists were first surveyed to determine methods used to process oxygen consumption ([OV0312]O 2) data, and current attitudes to data processing within the science of indirect calorimetry. Breath-by-breath datasets obtained from indirect calorimetry during incremental exercise were then used to demonstrate the consequences of commonly used time, breath and digital filter post-acquisition data processing strategies. Assessment of the variability in breath-by-breath data was determined using multiple regression based on the independent variables ventilation (VE), and the expired gas fractions for oxygen and carbon dioxide, FEO 2 and FECO2, respectively. Based on the results of explanation of variance of the breath-by-breath [OV0312]O2 data, methods of processing to remove variability were proposed for time-averaged, breath-averaged and digital filter applications. Among exercise physiologists, the strategy used to remove the variability in sequential [OV0312]O2 measurements varied widely, and consisted of time averages (30 sec [38%], 60 sec [18%], 20 sec [11%], 15 sec [8%]), a moving average of five to 11 breaths (10%), and the middle five of seven breaths (7%). Most respondents indicated that they used multiple criteria to establish maximum [OV0312]O 2 ([OV0312]O2max) including: the attainment of age-predicted maximum heart rate (HRmax) [53%], respiratory exchange ratio (RER) >1.10 (49%) or RER >1.15 (27%) and a rating of perceived exertion (RPE) of >17, 18 or 19 (20%). The reasons stated for these strategies included their own beliefs (32%), what they were taught (26%), what they read in research articles (22%), tradition (13%) and the influence of their colleagues (7%). The combination of VE, FEO 2 and FECO2 removed 96-98% of [OV0312]O2 breath-by-breath variability in incremental and steady-state exercise [OV0312]O2 data sets, respectively. Correction of residual error in [OV0312]O2 datasets to 10% of the raw variability results from application of a 30-second time average, 15-breath running average, or a 0.04 Hz low cut-off digital filter. Thus, we recommend that once these data processing strategies are used, the peak or maximal value becomes the highest processed datapoint. Exercise physiologists need to agree on, and continually refine through empirical research, a consistent process for analysing data from indirect calorimetry.

Ammonia dissociation in the fluidised bed furnace

Ammonia dissociation is the controlling reaction for several important thermochemical heat treatment processes; nitriding, nitrocarburising (ferritic and austenitic) and carbonitriding. The fluidised bed furnace is a convenient and widely used medium for all of these treatments, yet understanding of the reaction in a fluidised bed context is minimal. This paper deals with the influence of process parameters on nitrogen activity aN; temperature, fluidising flowrate, ammonia inlet level, carbonaceous gas. Two basic behaviours were observed; inlet NH3-dependant and inlet NHr insensitive, with a transition region at intermediate temperatures. The nitrocarburising response of steel specimens was measured by optical microscopy of the layer thicknesses and glow discharge optical emission spectroscopy (GD-OES) determination of nitrogen depth-penetration profiles. aN was found by gas analysis of the exit stream ammonia with the aid of a dissociation burette.

Peak oxygen uptake of 12-18-year-old boys living in a densely populated urban environment

The purposes of this study were to provide data on the peak Vo 2 of 12-18-year-old boys from Hong Kong, a densely populated urban environment; to compare these data with those for other similarly aged populations; and to examine the correlations between peak Vo 2 and various anthropometric parameters of this group. A stratified, random sample of 86 ethnic Chinese boys had their peak Vo 2 determined using an on-line gas analysis system during incremental, treadmill running. The mean peak 17o2 of the boys was 2.7 SD 0.44 1- rain - 1 or, when expressed in relation to body mass, 52.0 SD 5-8 ml- kg- 1. min - 1. Peak Vo 2 (1. min - 1) was significantly correlated with body mass (r = 0.72, p < 0.001, age (r = 0.49, p < 0.001) and height (r = 0.71, p = 0-001). Peak Vo 2 (ml 'kg- 1. min- 1) showed no correlation with age or height. These data suggest that this population group has peak Vo 2 values very similar to those observed in boys from most other population groups.

Cholinesterase Research Outreach Project (CROP): measuring cholinesterase activity and pesticide use in an agricultural community

BACKGROUND: Australian farmers and their workers are exposed to a wide variety of pesticides. Organophosphate (OP) insecticides are a widely used class of pesticide used for animal husbandry practices (Naphthalophos for sheep dipping, jetting and drench), crop production for pest control (Dimethoate) and in public health (Maldison for head lice). Acute poisonings with this class of insecticide are reported among agricultural workers and children around the globe, due to the inhibition of acetylcholinesterase (AChE). Less is known about chronic exposures. Regular monitoring of erythrocyte AChE will enable farmers to identify potential exposure to organophosphate insecticides and take action to reduce exposures and improve their health and safety practices. This study aims to assess and improve the integration of AChE monitoring into routine point of care health clinics, and provide farming and non-farming people with a link between their AChE activity and their household chemical and agrichemical use. METHODS/DESIGN: The research will target individuals who work on mixed farming enterprises and routinely using OPs (n = 50) and non-farmers (n = 30). Baseline data are collected regarding demographic, health conditions and behaviours, Kessler 10 (K10) scores, chemical use and personal protection. Baseline anthropometric measures include height, weight, hip and waist circumference, body fat analysis and, biochemical analysis of fasted total serum cholesterol, triglycerides, low-density cholesterol (LDL), high-density cholesterol (HDL) and blood glucose. Analysis of erythrocyte cholinesterase (EAChE) activity is also conducted using a finger prick test. Testing of EAChE is then repeated in all participants every 3 weeks for a maximum of three times over a period 10 weeks. Participants are provided with full feedback and counselling about their EAChE activity after each reading and a detailed summary provided to all participants at the completion of the study. Data will be analysed using repeated measures within a general linear model. DISCUSSION: This work will provide an evidence base and recommendations for the integration of EAChE monitoring into Australian rural health clinics, leading to research which will further quantify pesticide exposure both on the farm and in the home, highlighting the importance of sustaining and providing a safe work and home environment for farming communities. TRIAL REGISTRATION: ACTRN12613001256763.

Predicting physiological capacity of human load carriage - a review

This review article aims to evaluate a proposed maximum acceptable work duration model for load carriage tasks. It is contended that this concept has particular relevance to physically demanding occupations such as military and firefighting. Personnel in these occupations are often required to perform very physically demanding tasks, over varying time periods, often involving load carriage. Previous research has investigated concepts related to physiological workload limits in occupational settings (e.g. industrial). Evidence suggests however, that existing (unloaded) workload guidelines are not appropriate for load carriage tasks. The utility of this model warrants further work to enable prediction of load carriage durations across a range of functional workloads for physically demanding occupations. If the maximum duration for which personnel can physiologically sustain a load carriage task could be accurately predicted, commanders and supervisors could better plan for and manage tasks to ensure operational imperatives were met whilst minimising health risks for their workers.

Conservative oxygen therapy in mechanically ventilated patients following cardiac arrest: a retrospective nested cohort study

Background: In mechanically ventilated (MV) cardiac arrest (CA) survivors admitted to the intensive care unit (ICU) avoidance of hypoxia is considered crucial. However, avoidance of hyperoxia may also be important. A conservative approach to oxygen therapy may reduce exposure to both. Methods: We evaluated the introduction of conservative oxygen therapy (target SpO2 88-92% using the lowest FiO2) during MV for resuscitated CA patients admitted to the ICU. Results: We studied 912 arterial blood gas (ABG) datasets: 448 ABGs from 50 'conventional' and 464 ABGs from 50 'conservative' oxygen therapy patients. Compared to the conventional group, conservative group patients had significantly lower PaO2 values and FiO2 exposure (p <0.001, respectively); more received MV in a spontaneous ventilation mode (18% vs 2%; p =0.001) and more were exposed to a FiO 2 of 0.21 (19 vs 0 patients, p =0.001). Additionally, according to mean PaO2, more conservative group patients were classified as normoxaemic (36 vs 16 patients, p <0.01) and fewer as hyperoxaemic (14 vs 33 patients, p <0.01). Finally, ICU length of stay was significantly shorter for conservative group patients (p =0.04). There was no difference in the proportion of survivors discharged from hospital with good neurological outcome (14/23 vs 12/22 patients, p =0.67). Conclusions: Our findings provide preliminary support for the feasibility and physiological safety of conservative oxygen therapy in patients admitted to ICU for MV support after cardiac arrest (Trial registration, NCT01684124).

The relationship between patient blood pathology values and patient falls in an acute-care setting : a retrospective analysis

Few studies have investigated the relationship between patient falls and patient blood pathology values, which can reveal objective information about the health and nutritional status of a patient. It could be that some abnormal values are associated with patients that fall. The objectives of the current study were to determine whether blood pathology values were different in patients who fell compared to patients who did not fall, and whether there was a difference in the type and number of currently documented risk factors for falls found for patients who fell compared to patients who did not fall. A retrospective audit of patient incident reports and medical records was conducted in an acute-care hospital for 220 patients who fell and who did not fall. Faller and non-faller patients were matched by casemix type and length of stay. Findings revealed a significant relationship between patients who fell and the variables of age, confusion status and alkaline phosphatase blood values.

Gas chromatography-chemical ionization-mass spectrometric fatty acid analysis of a commercial supercritical carbon dioxide lipid extract from New Zealand green-lipped mussel (Perna canaliculus)

Supercritical fluid extracts of New Zealand green-lipped mussels (NZGLM) have been suggested to have therapeutic properties related to their oil components. The large number of minor FA in NZGLM extract was characterized by a GC-CIMS/MS method that excels at identification of double-bond positions in FAME. The extract contained five major lipid classes: sterol esters, TAG, FFA, sterols, and polar lipids. The total FA content of the lipid extract was 0.664 g/mL. Fifty-three unsaturated FA (UFA) were fully identified, of which 37 were PUFA, and a further 21 UFA were detected for which concentrations were too low for assignment of double-bond positions. There were 17 saturated FA, with 14∶0, 16∶0, and 18∶0 present in the greatest concentration. The 10 n−3 PUFA detected included 20∶5n−3 and 22∶6n−3, the two main n−3 FA; n−3 PUFA at low concentrations were 18∶3, 18∶4, 20∶3, 20∶4, 21∶5, 22∶5, 24∶6, and 28∶8. There were 43 UFA from the n−4, n−5, n−6, n−7, n−8, n−9, n−10, n−11 families, with 16∶2n−4, 16∶1n−5, 18∶1n−5, 18∶2n−6, 20∶4n−6, 16∶1n−7, 20∶1n−7, 16∶1n−9, 18∶1n−9, and 20∶1n−9 being the most abundant. In general, we estimated that FAME concentrations greater than 0.05% (w/w) were sufficient to assign double-bond positions. In total, 91 FA were detected in an extract of the NZGLM, whereas previous studies of fresh flesh from the NZGLM had reported identification of 42 FA. These data demonstrate a remarkable diversity of NZGLM FA.

Whole blood analysis of phagocytosis, apoptosis, cytokine production, and leukocyte subsets in healthy older men and women: the ZENITH study

Few studies to date have examined age-related changes in markers of immune status in healthy older individuals. The immune status of 93 healthy individuals aged 55–70 years was assessed by two- and three-color flow cytometry and biochemical analysis. There were significant age effects (p ≤.05) on monocyte phagocytic activity and cluster of differentiation (CD) 3/human leukocyte antigen-D-related (HLA-DR) late-activated T lymphocytes (% expression). There was a significant (p ≤ 0.1) Age x Sex interaction in absolute counts (x 10⁹/L) of CD3/CD8 total cytotoxic T lymphocytes (CTL), the CD4 T- helper to CD8 CTL ratio, the CD3/CD4/CD45RA naïve T helper to CD3/CD4/CD45RO memory T helper lymphocyte ratio, and interleukin (IL)-1ß (% expression) by activated monocytes. The study shows that alterations in markers of immune status occur between 55 and 70 years, and provides reference values for the lymphocyte measures in healthy men and postmenopausal women in this age group. The study further highlights the need for sex-specific reference ranges for such markers.

Bivariate variance-component analysis, with application to systolic blood pressure and total cholesterol levels in the Framingham Heart Study

Background :
The correlations between systolic blood pressure (SBP) and total cholesterol levels (CHOL) might result from genetic or environmental factors that determine variation in the phenotypes and are shared by family members. Based on 330 nuclear families in the Framingham Heart Study, we used a multivariate normal model, implemented in the software FISHER, to estimate genetic and shared environmental components of variation and genetic and shared environmental correlation between the phenotypes. The natural logarithm of the phenotypes measured at the last visit in both Cohort 1 and 2 was used in the analyses. The antihypertensive treatment effect was corrected before adjustment of the systolic blood pressure for age, sex, and cohort.
Results :
The univariate correlation coefficient was statistically significant for sibling pairs and parent-offspring pairs, but not significant for spouse pairs. In the bivariate analysis, the cross-trait correlation coefficients were not statistically significant for all relative pairs. The shared environmental correlation was statistically significant, but the genetic correlation was not significant.
Conclusion :
There is no significant evidence for a close genetic correlation between systolic blood pressure and total cholesterol levels. However, some shared environmental factors may determine the variation of both phenotypes.

Seasonal changes in the diet of the long-nosed bandicoot (Perameles nasuta) assessed by analysis of faecal scats and of stable isotopes in blood

The diet of long-nosed bandicoots (Perameles nasuta) on the central coast of New South Wales, Australia, was examined over two summers and two winters using a combination of faecal scat analysis for food fragments and stable isotope analysis (ratios of ¹³C/¹²C and ¹⁵N/¹⁴N) of blood. Isotope ratios in blood overlapped most strongly with those in invertebrate prey, and varied much less between seasons than did those in most dietary items, suggesting that the assimilated diet of long-nosed bandicoots is dominated by invertebrates throughout the year. Invertebrate remains dominated collected faeces in both seasons, even though the availability of invertebrate prey was higher in summer. Thus both techniques indicated that long-nosed bandicoots were primarily insectivorous year-round. Faecal scat analysis indicated that invertebrate eggs were more abundant in summer than winter. At a finer scale, spiders, orthopterans, lepidopteran larvae, ants, leaf material (non-grass monocot) and seeds were more abundant in summer, while cicada larvae, roots, fungi, grass leaves and Acacia bract (small modified leaves appearing as scales) were more abundant in winter. Subterranean foods (cicada larvae, plant roots and hypogeous fungi) were more abundant in winter and more abundant in the diet of males than of either lactating or non-lactating females.