Do clinicians know how to use pulse oximetry? A literature review and clinical implications

Pulse oximerry has become one of the most commonly used tools in the clinical environment for assessing patients' oxygenation status. It is employed almost continuously in critical care areas and frequently in the general ward environment. Although it is a much better tool for determining hypoxia than the human eye, its use is limited if clinicians do not understand relevant physiological principles, such as the oxyhaemoglobin dissociation curve and the inherent limitations of the device. Furthermore, the risk for compromised patient safety is significant if clinicians fail to recognise the potential for false or erroneous readings. This paper explores the research which has examined clinicians' comprehension of pulse oximetry. Fourteen studies examining clinicians' knowledge of pulse oximerry were reviewed. These studies revealed significant knowledge deficits about pulse oximerry amongst nurses, doctors and allied health professionals, all of whom used this technology frequently. Alarmingly, those lacking an adequate understanding of pulse oximerry included senior, experienced clinicians. The studies were limited by their use of convenience sampling and small sample sizes. Further research is needed to better understand the significance of this problem and to examine how principles of pulse oximerry are taught to nurses and other health professionals at the undergraduate and postgraduate levels. Educators and clinicians alike must ensure that a safe level of knowledge for the use of pulse oximerry is maintained in order to ensure that patient outcomes are not compromised.

Maternal and neonatal influences on, and reproducibility of, neonatal aortic pulse wave velocity

Aortic pulse wave velocity (aPWV), a noninvasive measure of vascular stiffness, is an independent predictor of cardiovascular disease both before and in overt vascular disease. Its characteristics in early life and its relationship to maternal factors have hardly been studied. To test the hypothesis that infant aPWV was positively related to maternal anthropometry and blood pressure (BP) at 28 weeks gestation, after adjusting for neonatal anthropometry and BP, 148 babies born in Manchester were measured 1 to 3 days after birth. A high reproducibility of aPWV, assessed in 30 babies within 3 days of birth, was found with a mean difference between occasions of –0.04 m/s (95% CI: –0.08 to 0.16 m/s). Contrary to our hypothesis, a significant inverse relation was found between neonatal aPWV (mean: 4.6 m/s) and maternal systolic BP (mean: 108.9 mm Hg; r=–0.57; 95% CI: –0.67 to –0.45) but not maternal height nor weight. Neonatal aPWV was positively correlated with birth length, birth weight, and systolic BP. In multiple regression, neonatal aPWV remained significantly inversely associated with maternal systolic BP (adjusted ß coefficient: –0.032; 95% CI: –0.040 to –0.024; P<0.001), after adjustment for maternal age, birth weight, length, and neonatal BP (all independently and positively related to aPWV) and for gestational age, maternal weight, and height (unrelated). These results suggest that infant aPWV may be a useful index of infant vascular status, is less disturbing to measure than infant BP, and is sensitive to the gestational environment marked by maternal BP.

Polyhedral studies for minimum-span graph labelling with integer distance constraints

This paper studies the polytope of the minimum-span graph labelling problems with integer distance constraints (DC-MSGL). We first introduce a few classes of new valid inequalities for the DC-MSGL defined on general graphs and briefly discuss the separation problems of some of these inequalities. These are the initial steps of a branch-and-cut algorithm for solving the DC-MSGL. Following that, we present our polyhedral results on the dimension of the DC-MSGL polytope, and that some of the inequalities are facet defining, under reasonable conditions, for the polytope of the DC-MSGL on triangular graphs.

Exploring the opportunities for sustainable food labelling : a supply chain perspective

This study examines supply chain members’ beliefs regarding the opportunities to develop foods produced under an 'eco-friendly' label. The study involved in-depth interviews with 17 Australian senior managers in food organisations who have marketing responsibilities and who have expert product and consumer knowledge (c.f. Clift and Wright 2000, Peattie 2000). The findings suggest that respondents have widely different beliefs regarding the meaning of 'eco-friendly' and believe that claims regarding 'eco-friendly' characteristics are difficult to substantiate. They further suggested that 'eco-friendly' considerations are not a major influencer of consumer food purchase decisions at present and thus 'eco-friendly' production was not a strategic focus of their companies. Respondents felt that 'eco-friendly' labelling would not be successful until consumers’ value 'eco-friendly' food attributes.

Impact of front-of-pack 'traffic-light' nutrition labelling on consumer food purchases in the UK

Front-of-pack ‘traffic-light’ nutrition labelling has been widely proposed as a tool to improve public health nutrition. This study examined changes to consumer food purchases after the introduction of traffic-light labels with the aim of assessing the impact of the labels on the ‘healthiness’ of foods purchased. The study examined sales data from a major UK retailer in 2007. We analysed products in two categories (‘ready meals’ and sandwiches), investigating the percentage change in sales 4 weeks before and after traffic-light labels were introduced, and taking into account seasonality, product promotions and product life-cycle. We investigated whether changes in sales were related to the healthiness of products. All products that were not new and not on promotion immediately before or after the introduction of traffic-light labels were selected for the analysis (n = 6 for ready meals and n = 12 for sandwiches). For the selected ready-meals, sales increased (by 2.4% of category sales) in the 4 weeks after the introduction of traffic-light labels, whereas sales of the selected sandwiches did not change significantly. Critically, there was no association between changes in product sales and the healthiness of the products. This short-term study based on a small number of ready meals and sandwiches found that the introduction of a system of four traffic-light labels had no discernable effect on the relative healthiness of consumer purchases. Further research on the influence of nutrition signposting will be needed before this labelling format can be considered a promising public health intervention.

Determination of anabolic steroids by differential pulse polarography

Determination of anabolic steroids often requires the use of elaborate techniques such as gas chromatography - mass spectrometry (GC-MS), gas liquid chromatography (GLC) and more recently high performance liquid chromatography (HPLC). Most of these methods employ derivatisation techniques prior to detection which makes them tedious and relatively time consuming. Other methods demand a great deal of skill. A simple and rapid analytical method, based on differential pulse polarography at a dropping mercury electrode has been developed for the determination of various anabolic steroids in a range of commercially available pharmaceutical preparations. Detailed investigation of the electrochemical behaviour of these steroids was made in order to elucidate the electrode processes involved, in addition to optimising the method. Several other analytical methods such as GC-MS, NMR, ultraviolet (UV), infrared (IR) spectroscopy were also used to confirm the products of the chemical and electrochemical reactions. Possible reactions are suggested. Various extraction procedures were examined for separation of selected steroids from the oil-based or pill matrix and their suitability for polarographic determination is discussed.

Toward sustainable forest management : the potential contribution of timber certification and product labelling in Victoria

Sustainable forest management has emerged as a major international forestry issue. This research assessed the potential contribution of certification and labelling to sustainable forest management in Victoria. The results indicate a potential demand for certified forest products and a consumer willingness to pay to ensure forests are managed sustainably.

'Traffic-light' nutrition labelling and 'junk-food' tax : a modelled comparison of cost-effectiveness for obesity prevention

Introduction: Cost-effectiveness analyses are important tools in efforts to prioritise interventions for obesity prevention.
Modelling facilitates evaluation of multiple scenarios with varying assumptions. This study compares the cost-effectiveness of
conservative scenarios for two commonly proposed policy-based interventions: front-of-pack ‘traffic-light’ nutrition labelling
(traffic-light labelling) and a tax on unhealthy foods (‘junk-food’ tax).
Methods: For traffic-light labelling, estimates of changes in energy intake were based on an assumed 10% shift in consumption
towards healthier options in four food categories (breakfast cereals, pastries, sausages and preprepared meals) in 10% of adults. For the ‘junk-food’ tax, price elasticities were used to estimate a change in energy intake in response to a 10% price increase in seven food categories (including soft drinks, confectionery and snack foods). Changes in population weight and body mass index by sex were then estimated based on these changes in population energy intake, along with subsequent impacts on disability-adjusted life years (DALYs). Associated resource use was measured and costed using pathway analysis, based on a health sector perspective (with some industry costs included). Costs and health outcomes were discounted at 3%. The cost-effectiveness of each intervention was modelled for the 2003 Australian adult population.
Results: Both interventions resulted in reduced mean weight (traffic-light labelling: 1.3 kg (95% uncertainty interval (UI): 1.2;
1.4); ‘junk-food’ tax: 1.6 kg (95% UI: 1.5; 1.7)); and DALYs averted (traffic-light labelling: 45 100 (95% UI: 37 700; 60 100);
‘junk-food’ tax: 559 000 (95% UI: 459 500; 676 000)). Cost outlays were AUD81 million (95% UI: 44.7; 108.0) for traffic-light
labelling and AUD18 million (95% UI: 14.4; 21.6) for ‘junk-food’ tax. Cost-effectiveness analysis showed both interventions were
‘dominant’ (effective and cost-saving).
Conclusion: Policy-based population-wide interventions such as traffic-light nutrition labelling and taxes on unhealthy foods are
likely to offer excellent ‘value for money’ as obesity prevention measures.

Pulse-lavage brushing followed by hydrogen peroxide-gauze packing for bone-bed preparation in cemented total hip arthroplasty : a bovine model

To compare the effectiveness of pulse-lavage brushing followed by hydrogen peroxide-gauze packing with either technique alone or normal-saline irrigation in bone-bed preparation for cemented total hip arthroplasty. 44 fresh-frozen ox femoral canals were prepared for cemented total hip arthroplasty using 4 techniques: normal-saline irrigation, pulse-lavage brushing, hydrogen peroxide-soaked gauze packing, and a combination of the latter 2 techniques. The maximum tensile pull-out force required to separate the prosthesis from the femoral canal was measured as an indicator of the strength of the cement-bone interface. The mean pull-out force to separate the prosthesis from the femoral canal was significantly higher in specimens prepared with pulse-lavage brushing followed by hydrogen peroxide-soaked gauze packing or pulse-lavage brushing alone than those prepared with normal-saline irrigation or hydrogen peroxide-soaked gauze packing alone 300(p<0.001). Pulse-lavage brushing is more effective at cleansing the femoral canal and increasing mechanical strength at the cement-bone interface than preparation with normal-saline irrigation or hydrogen peroxide-soaked gauze packing.

An approximate numerical technique for characterizing optical pulse propagation in inhomogeneous biological tissue

An approximate numerical technique for modeling optical pulse propagation through weakly scattering biological tissue is developed by solving the photon transport equation in biological tissue that includes varying refractive index and varying scattering/absorption coefficients. The proposed technique involves first tracing the ray paths defined by the refractive index profile of the medium by solving the eikonal equation using a Runge-Kutta integration algorithm. The photon transport equation is solved only along these ray paths, minimizing the overall computational burden of the resulting algorithm. The main advantage of the current algorithm is that it enables to discretise the pulse propagation space adaptively by taking optical depth into account. Therefore, computational efficiency can be increased without compromising the accuracy of the algorithm.

Laguerre Runge-Kutta-Fehlberg method for simulating laser pulse propagation in biological tissue

An efficient algorithm for solving the transient radiative transfer equation for laser pulse propagation in biological tissue is presented. A Laguerre expansion is used to represent the time dependency of the incident short pulse. The Runge–Kutta– Fehlberg method is used to solve the intensity. The discrete ordinates method is used to discretize with respect to azimuthal and zenith angles. This method offers the advantages of representing the intensity with a high accuracy using only a few Laguerre polynomials, and straightforward extension to inhomogeneous media. Also, this formulation can be easily extended for solving the 2-D and 3-D transient radiative transfer equations.