Use of transcutaneous oxygen and carbon dioxide tensions for assessing indices of gas exchange during exercise testing

AbstractThe slow response characteristics of the combined transcutaneous electrode have been viewed as a major disadvantage when compared with other types of non-invasive assessment of gas exchange during exercise testing. We have previously shown that by using the highest recommended temperature of 45°C to reduce response times, and combining this with an exercise protocol of gradual work load increments, that this allows changes in arterial blood gases to be closely followed by transcutaneous values. In the present study we have validated the use of a transcutaneous electrode for estimation of alveolar–arterial oxygen gradient (A aO2) and dead space to tidal volume ratio (VD/VT) during exercise, against values calculated from direct arterial blood gas analysis. One hundred measurements were made in 20 patients with various cardiopulmonary disorders who underwent exercise testing. Exercise testing was performed by bicycle ergometry with a specific protocol involving gradual work load increments at 2 min intervals. Transcutaneous gas tensions were measured by a heated combined O2and CO2electrode. Arterial blood was sampled at the midpoint of each stage of exercise and transcutaneous tensions noted at the end of each stage. The mean difference of the A aO2gradient calculated from blood gas tensions obtained by the two methods was 0.14 kPa. The limits of agreement were −0·26 and 0·63 kPa. The same values for VD/VT calculated from gas tensions measured by the two methods were: mean difference 0·001; limits of agreement −0·0242 and 0·0252. For both these parameters there was an even scatter around the mean value on Bland and Altman analysis. The findings of this study suggest that estimation of parameters of gas exchange using transcutaneous values during exercise testing is reliable, provided the electrode is heated to a slightly higher temperature than usual and the work load increments are gradual, allowing for the latency in the response time of the system. This system allows the assessment of the contribution of ventilation/perfusion inequality to breathlessness on exertion in patients, provided an initial arterial or ear lobe capillary sample is obtained for calibration purposes. This technique is particularly valuable in patients undergoing repeat exercise tests as it circumvents the need for arterial cannulation

The Therapeutic Potential for PI3K Inhibitors in Autoimmune Rheumatic Diseases.

The class 1 PI3Ks are lipid kinases with key roles in cell surface receptor-triggered signal transduction pathways. Two isoforms of the catalytic subunits, p110γ and p110δ, are enriched in leucocytes in which they promote activation, cellular growth, proliferation, differentiation and survival through the generation of the second messenger PIP3. Genetic inactivation or pharmaceutical inhibition of these PI3K isoforms in mice result in impaired immune responses and reduced susceptibility to autoimmune and inflammatory conditions. We review the PI3K signal transduction pathways and the effects of inhibition of p110γ and/or p110δ on innate and adaptive immunity. Focusing on rheumatoid arthritis and systemic lupus erythematosus we discuss the preclinical evidence and prospects for small molecule inhibitors of p110γ and/or p110δ in autoimmune disease

Health promotion in an Australian Aboriginal community: the Growing Strong Brains® toolkit

Aim: The aim of this paper is to describe the implementation and evaluation of the Growing Strong Brains® (GSB) toolkit in a remote Aboriginal community in Western Australia (WA) over a 2-year period, 2018–2019. Background: Ngala, a community service organisation in WA, developed the GSB toolkit in 2014, a culturally appropriate and interactive resource to build knowledge of early childhood development within Aboriginal communities. This was in response to evidence that a higher percentage of children in Aboriginal communities were developmentally vulnerable compared to the rest of the population. The GSB toolkit promotes awareness and understanding of early brain development pre-birth and in the early years of a child’s life. Methods: The project was underpinned by participatory action research (PAR). Reflective PAR review cycles (n = 5) monitored local community engagement, navigated challenges and utilised community strengths. Fifty-nine local service providers attended a 2-day formal training. Data were collected by using various methods throughout the project, including feedback following training, focus groups, surveys, one-on-one interviews using yarning techniques and reflective feedback from the Project Lead. Findings: Establishing local Aboriginal project staff was pivotal to the success of the project. When delivering services for and with Aboriginal people, it is essential that cultural competence, safety and decision-making is carried through from planning to implementation and evaluation, and involves genuine, respectful and authentic relationships. Sufficient time allocation directed towards building relationships with other service providers and local community members needs to be considered and built into future projects. The Growing Strong Brains® project is embedded within the local community, and anticipated implementation outcomes were achieved. The support of the local people and service providers was beyond expectation, enabling the building of local capacity, and the development of a common understanding of the key messages from the GSB toolkit to allow integration throughout all levels of the community. This project has been important to build on the strategies necessary to introduce, implement and evaluate the GSB toolkit in other remote Aboriginal communities

Health-Related Quality of Life (HRQoL) changes in South Australia: comparison of burden of disease morbidity and survey-based health utility estimates

Background: Global research shows a clear transition in health outcomes over the past two decades where improved survival was accompanied by lower health related quality of life (HRQoL) as measured by morbidity and disability. These trends suggest the need to better understand changes in population HRQoL. This paper compares two perspectives on population HRQoL change using burden of disease morbidity estimates from administrative data and self-reports from random and representative population surveys. Methods: South Australian administrative data including inpatient hospital activity, cancer and communicable disease registrations were used within a Burden of Disease study framework to quantify morbidity as Prevalent Years of Life lived with Disease and injury related illness (PYLD) for 1999 to 2008. Self-reported HRQoL was measured using the Assessment of Quality of Life (AQoL) in face to face interviews with at least 3000 respondents in each of South Australia ’ s Health Omnibus Surveys (HOS) in 1998, 2004 and 2008. Results: Age specific PYLD rates for those aged 75 or more increased by 5.1%. HRQoL dis-utility in this age group also increased significantly and beyond the minimally important difference threshold. Underlying increased dis-utility were greater difficulties in independent living (particularly requiring help with household tasks) and psychological well-being (as influenced by pain, discomfort and difficulty sleeping). Conclusions: Consistent with increased quantity of life being accompanied by reduced HRQoL, the analysis indicates older people in South Australia experienced increased morbidity in the decade to 2008. The results warrant routine monitoring of health dis-utility at a population level and improvement to the supply and scope of administrative data.David Banham, Graeme Hawthorne, Robert Goldney, and Julie Ratcliff

The Houses of Parliament and Reid's Inquiries into User Perception

This paper provides a brief overview of the role of user perception in the development of Reid ventilation system for the Palace of Westminster. User-perception was used as a performance indicator in the day-to-day management of the ventilation, but also it was also a major design factor underlying the development of the ventilation system for the Permanent Houses of Commons

Archaeobotanical Investigations into Golbai Sasan and Gopalpur, Two Neolithic-Chalcolithic Settlements of Odisha

This paper presents the results of plant macro-remain and phytolith analyses from two Neolithic-Early Historic mounded settlement sites in Odisha, eastern India: Gopalpur and Golbai Sasan. Macrobotanical and phytolith samples were taken throughout the stratigraphy and the results are presented here. The plant remains confirm the presence of a distinct agricultural economy in Neolithic-Chalcolithic Odisha based on rice (Oryza sativa), pulses (Vigna spp., Macrotyloma uniflorium and Cajanus cajan) and millets (Bracharia ramosa, Panicum spp., Setaria spp. and possibly Paspalum sp.). Crop processing activities have been reconstructed using both phytoliths and macro-remains, and suggest that threshing occurred off site as part of a communal harvesting strategy. Potential differences between the economies of Golbai Sasan and Gopalpur are suggested, with a broader range of pulses present at Gopalpur. Radiocarbon dates from individual rice grains and legumes provide a secure chronology for the sites. This paper therefore provides the first published details for the agricultural base of the Neolithic-Chalcolithic coastal lowlands in Odisha, as well as new AMS radiocarbon dates for the Odishan Neolithic-Chalcolithic period

An Orbital Comparison of a Late Mantling Unit on Aeolis Mons With Other Erosion-Resistant Strata Explored by MSL in Gale Crater, Mars

Previous investigations along Curiosity's traverse in Gale crater have explored the relationship between orbital and in situ observations. This work aims to better understand the geologic environment of units only observable from orbit and compare them to the properties of units examined by Curiosity. Here, we map an erosion-resistant dark-toned mantling unit that overlies the modern topography of Aeolis Mons (informally known as Mt. Sharp) and compare this unit to two other previously mapped dark-toned resistant units, the marker band and the mound skirting unit (MSU), that have been inferred to represent different geologic environments (lacustrine and aeolian, respectively). Visible to short wave infrared spectra from the Compact Reconnaissance Imaging Spectrometer for Mars and visual images from the High Resolution Imaging Science Experiment and Context Cameras aboard the Mars Reconnaissance Orbiter are used for this comparison. Spectral data suggest a mafic composition with minor alteration, although the composition varies more with location around Mt. Sharp rather than between units. Morphologically, the mantling unit has strong similarities to the marker band based on their consistent low-albedo, erosion-resistance, and smooth appearance, contrasting with the highly variable surface texture of the MSU. We hypothesize that all three units had a similar sediment source but experienced aqueous alteration at different times: early ubiquitous cementation in a surface aqueous environment in the mantling unit and marker band versus patchy late diagenesis in the MSU. If true, these results suggest that water activity continued within the Gale crater long after the erosion of Mt. Sharp

Geochemical variation in the Stimson formation of Gale crater: Provenance, mineral sorting, and a comparison with modern Martian dunes

The Mars Science Laboratory Curiosity rover has encountered both ancient lithified and modern active aeolian dune deposits within Gale crater, providing an opportunity to study how aeolian processes have changed during Gale crater's geological history. This study uses data from the Chemistry and Camera (ChemCam) and Chemistry and Mineralogy (CheMin) instrument suites onboard Curiosity to; (1) constrain the diagenetic processes that lithified and altered the ancient aeolian Stimson formation, (2) investigate whether the geochemical signature in the Stimson formation is consistent with the aeolian mafic-felsic mineral sorting trend identified in the modern Bagnold dune fields in Gale crater, and (3) discuss the provenance of the Stimson sediments, comparing it to those identified in the modern dune and ancient river and lake deposits also analyzed along Curiosity's traverse. The ancient Stimson dune deposits that stratigraphically overlie the Gale fluvio-lacustrine units were analyzed in two locations; the Emerson and the Naukluft plateaus. ChemCam data show that the Stimson formation has subtle variations in MgO, Al2O3, Na2O, and K2O between the two localities. An agglomerative cluster analysis of the constrained Stimson dataset reveals five clusters, four of which relate to different proportions of mafic and felsic minerals analyzed by ChemCam. In general, the cluster analysis shows that the Emerson plateau has a greater proportion of mafic minerals and fewer coarse, felsic grains relative to the Naukluft plateau. This variation in mafic and felsic minerals between localities suggests a southwest to northeast net sediment transport direction due to aeolian mineral sorting dynamics preferentially transporting mafic minerals that are easier to saltate than the elongate, often coarser, felsic minerals. This derived transport direction for the Stimson formation supports that determined by sedimentological evidence and is opposite to that previously determined for the active Bagnold dunes inferring a change in the wind regime with time. An opposite sediment transport direction between the ancient and modern dunes in Gale crater further supports geochemical and mineralogical evidence that suggests different basaltic source regions. Compositionally, the bulk Stimson formation is most similar to the subalkaline basalt source region that is inferred to be the dominant sediment source of the fluvio-lacustrine Bradbury group. This is likely the result of the Stimson formation and basaltic Bradbury group sediments sharing a similar local basaltic source region such as the rim and walls of Gale crater

Cancer data and Aboriginal disparities (CanDAD)-developing an Advanced Cancer Data System for Aboriginal people in South Australia: a mixed methods research protocol

Introduction: In Australia, Aboriginal and Torres Strait Islander People carry a greater burden of cancerrelated mortality than non-Aboriginal Australians. The Cancer Data and Aboriginal Disparities Project aims to develop and test an integrated, comprehensive cancer monitoring and surveillance system capable of incorporating epidemiological and narrative data to address disparities and advocate for clinical system change. Methods and analysis: The Advanced Cancer Data System will integrate routinely collected unit record data from the South Australian Population Cancer Registry and a range of other data sources for a retrospective cohort of indigenous people with cancers diagnosed from 1990 to 2010. A randomly drawn non- Aboriginal cohort will be matched by primary cancer site, sex, age and year at diagnosis. Cross-tabulations and regression analyses will examine the extent to which demographic attributes, cancer stage and survival vary between the cohorts. Narratives from Aboriginal people with cancer, their families, carers and service providers will be collected and analysed using patient pathway mapping and thematic analysis. Statements from the narratives will structure both a concept mapping process of rating, sorting and prioritising issues, focusing on issues of importance and feasibility, and the development of a real-time Aboriginal Cancer Measure of Experience for ongoing linkage with epidemiological data in the Advanced Cancer Data System. Aboriginal Community engagement underpins this Project. Ethics and dissemination: The research has been approved by relevant local and national ethics committees. Findings will be disseminated in local and international peer-reviewed journals and conference presentations. In addition, the research will provide data for knowledge translation activities across the partner organisations and feed directly into the Statewide Cancer Control Plan. It will provide a mechanism for monitoring and evaluating the implementation of the recommendations in these documents.Paul Henry Yerrell, David Roder, Margaret Cargo, Rachel Reilly, David Banham, Jasmine May Micklem, Kim Morey, Harold Bundamurra Stewart, Janet Stajic, Michael Norris, Alex Brown, On behalf of the CanDAD Aboriginal Community Reference Group and CanDAD Investigator