Effect of skin tone on the accuracy of the estimation of arterial oxygen saturation by pulse oximetry: a systematic review

BACKGROUND: Pulse oximetry-derived oxygen saturation (SpO2) is an estimate of true arterial oxygen saturation (SaO2). The aim of this review was to evaluate available evidence determining the effect of skin tone on the ability of pulse oximeters to accurately estimate SaO2. METHODS: Published literature was screened to identify clinical and non-clinical studies enrolling adults and children when SpO2 was compared with a paired co-oximetry SaO2 value. We searched literature databases from their inception to March 20, 2023. Risk of bias (RoB) was assessed using the QUADAS-2 tool. Certainty of assessment was evaluated using the GRADE tool. RESULTS: Forty-four studies were selected reporting on at least 222 644 participants (6121 of whom were children) and 733 722 paired SpO2-SaO2 measurements. Methodologies included laboratory studies, prospective clinical, and retrospective clinical studies. A high RoB was detected in 64% of studies and there was considerable heterogeneity in study design, data analysis, and reporting metrics. Only 11 (25%) studies measured skin tone in 2353 (1.1%) participants; the remainder reported participant ethnicity: 68 930 (31.0%) participants were of non-White ethnicity or had non-light skin tones. The majority of studies reported overestimation of SaO2 by pulse oximetry in participants with darker skin tones or from ethnicities assumed to have darker skin tones. Several studies reported no inaccuracy related to skin tone. Meta-analysis of the data was not possible. CONCLUSIONS: Pulse oximetry can overestimate true SaO2 in people with darker skin tones. The clinical relevance of this bias remains unclear, but its magnitude is likely to be greater when SaO2 is lower. SYSTEMATIC REVIEW PROTOCOL: International Prospective Register of Systematic Reviews (PROSPERO): CRD42023390723

Overcoming Confusion Noise with Hyperspectral Imaging from PRIMAger

The PRobe far-Infrared Mission for Astrophysics (PRIMA) concept aims to perform mapping with spectral coverage and sensitivities inaccessible to previous FIR space telescopes. PRIMA's imaging instrument, PRIMAger, provides unique hyperspectral imaging simultaneously covering 25-235 $\mu$m. We synthesise images representing a deep, 1500 hr deg$^{-2}$ PRIMAger survey, with realistic instrumental and confusion noise. We demonstrate that we can construct catalogues of galaxies with a high purity ($>95$ per cent) at a source density of 42k deg$^{-2}$ using PRIMAger data alone. Using the XID+ deblending tool we show that we measure fluxes with an accuracy better than 20 per cent to flux levels of 0.16, 0.80, 9.7 and 15 mJy at 47.4, 79.7, 172, 235 $\mu$m respectively. These are a factor of $\sim$2 and $\sim$3 fainter than the classical confusion limits for 72-96 $\mu$m and 126-235 $\mu$m, respectively. At $1.5 \leq z \leq 2$, we detect and accurately measure fluxes in 8-10 of the 10 channels covering 47-235 $\mu$m for sources with $2 \leq$ log(SFR) $\leq 2.5$, a 0.5 dex improvement on what might be expected from the classical confusion limit. Recognising that PRIMager will operate in a context where high quality data will be available at other wavelengths, we investigate the benefits of introducing additional prior information. We show that by introducing even weak prior flux information when employing a higher source density catalogue (more than one source per beam) we can obtain accurate fluxes an order of magnitude below the classical confusion limit for 96-235 $\mu$m.Comment: 14 pages, 11 figure

Growing Greener: Creating a New Values-based Environmental Engagement Toolkit for SME Intermediaries

This paper explores a radically different way of facilitating energy and environmental initiatives in small and medium-sized enterprises (SMEs). In terms of energy policy, smaller firms in Europe are exempted from most of the major fiscal and regulatory mechanisms that are applied to larger organisations. Policies to reduce energy demand and associated carbon emissions in SMEs are largely based on providing incentives, such as face-to-face support and grants for energy efficiency in buildings. Energy advisors are therefore key intermediaries, providing advice and encouraging the uptake of low carbon technologies and practices by SMEs. Previous studies have found that advisors often find it difficult to engage effectively with SME owners and managers, and that traditional ‘win-win’ messaging can have limited impact, resulting in implementation problems such as under-investment in energy-saving technologies, reluctance to adopt new environmental practices, and a tendency to revert to previous ways of operating once the incentive is removed. Recent research also suggests that SME owners’ and managers’ personal values play an important mediating role in their response to environmental issues, acting in combination with more established factors such as educational background, access to resources and the views of customers and suppliers. The implication is that policy interventions in this area could be delivered in more cost-effective ways if accompanied by a more nuanced, values-based approach to engagement. This paper reports findings from ‘Growing Greener’ a UK multi-disciplinary project that aims to equip advisors and other types of intermediary with the skills, knowledge and understanding they need in order to incorporate a values-based approach into their existing interactions with SMEs. It opens with an overview of the policy context and a brief overview of the relevant research literature. The main section explains how the research team co-produced a values-based engagement toolkit in conjunction with a group of energy advisors and external specialists. The design process included a series of facilitated ‘narrative workshops’, where advisors shared their experiences and experimented with early versions of the engagement tools. This is followed by an outline of the completed engagement ‘toolkit’, which includes free-to-access online course, a communication guide and an interactive engagement tool. These three inter-related components are designed to help advisors to engage SMEs beyond a narrow, cost-benefit framework, and in turn help SME owners and managers to connect low carbon choices with the personal and business values that are important to them as individuals. Our findings indicate the potential for more effective, longer-lasting interventions beyond the low hanging fruit of building efficiency measures

Zinc Finger Recombinases with Adaptable DNA Sequence Specificity

Site-specific recombinases have become essential tools in genetics and molecular biology for the precise excision or integration of DNA sequences. However, their utility is currently limited to circumstances where the sites recognized by the recombinase enzyme have been introduced into the DNA being manipulated, or natural ‘pseudosites’ are already present. Many new applications would become feasible if recombinase activity could be targeted to chosen sequences in natural genomic DNA. Here we demonstrate efficient site-specific recombination at several sequences taken from a 1.9 kilobasepair locus of biotechnological interest (in the bovine β-casein gene), mediated by zinc finger recombinases (ZFRs), chimaeric enzymes with linked zinc finger (DNA recognition) and recombinase (catalytic) domains. In the "Z-sites" tested here, 22 bp casein gene sequences are flanked by 9 bp motifs recognized by zinc finger domains. Asymmetric Z-sites were recombined by the concomitant action of two ZFRs with different zinc finger DNA-binding specificities, and could be recombined with a heterologous site in the presence of a third recombinase. Our results show that engineered ZFRs may be designed to promote site-specific recombination at many natural DNA sequences

Adjunctive rifampicin for Staphylococcus aureus bacteraemia (ARREST): a multicentre, randomised, double-blind, placebo-controlled trial.

BACKGROUND: Staphylococcus aureus bacteraemia is a common cause of severe community-acquired and hospital-acquired infection worldwide. We tested the hypothesis that adjunctive rifampicin would reduce bacteriologically confirmed treatment failure or disease recurrence, or death, by enhancing early S aureus killing, sterilising infected foci and blood faster, and reducing risks of dissemination and metastatic infection. METHODS: In this multicentre, randomised, double-blind, placebo-controlled trial, adults (≥18 years) with S aureus bacteraemia who had received ≤96 h of active antibiotic therapy were recruited from 29 UK hospitals. Patients were randomly assigned (1:1) via a computer-generated sequential randomisation list to receive 2 weeks of adjunctive rifampicin (600 mg or 900 mg per day according to weight, oral or intravenous) versus identical placebo, together with standard antibiotic therapy. Randomisation was stratified by centre. Patients, investigators, and those caring for the patients were masked to group allocation. The primary outcome was time to bacteriologically confirmed treatment failure or disease recurrence, or death (all-cause), from randomisation to 12 weeks, adjudicated by an independent review committee masked to the treatment. Analysis was intention to treat. This trial was registered, number ISRCTN37666216, and is closed to new participants. FINDINGS: Between Dec 10, 2012, and Oct 25, 2016, 758 eligible participants were randomly assigned: 370 to rifampicin and 388 to placebo. 485 (64%) participants had community-acquired S aureus infections, and 132 (17%) had nosocomial S aureus infections. 47 (6%) had meticillin-resistant infections. 301 (40%) participants had an initial deep infection focus. Standard antibiotics were given for 29 (IQR 18-45) days; 619 (82%) participants received flucloxacillin. By week 12, 62 (17%) of participants who received rifampicin versus 71 (18%) who received placebo experienced treatment failure or disease recurrence, or died (absolute risk difference -1·4%, 95% CI -7·0 to 4·3; hazard ratio 0·96, 0·68-1·35, p=0·81). From randomisation to 12 weeks, no evidence of differences in serious (p=0·17) or grade 3-4 (p=0·36) adverse events were observed; however, 63 (17%) participants in the rifampicin group versus 39 (10%) in the placebo group had antibiotic or trial drug-modifying adverse events (p=0·004), and 24 (6%) versus six (2%) had drug interactions (p=0·0005). INTERPRETATION: Adjunctive rifampicin provided no overall benefit over standard antibiotic therapy in adults with S aureus bacteraemia. FUNDING: UK National Institute for Health Research Health Technology Assessment

Electrophoretic Deposition of Hydroxyapatite Coatings on Metal Substrates: A Nanoparticulate Dual-Coating Approach

Hydroxyapatite coatings can be readily deposited on metal substrates by electrophoretic deposition. However, subsequent sintering is highly problematic owing to the fact that temperatures in excess of 1100 °C are required for commercial hydroxyapatite powders to achieve high density. Such temperatures damage the metal and induce metal-catalysed decomposition of the hydroxyapatite. Furthermore, the firing shrinkage of the hydroxyapatite coating on a constraining metal substrate leads to severe cracking. The present study has overcome these problems using a novel approach: the use of aged nanoparticulate hydroxyapatite sols (lower sintering temperature) and a dual coating strategy that overcomes the cracking problem. Dual layers of uncalcined hydroxyapatite (HAp) powder were electrophoretically coated on Ti, Ti6A14V and 316L stainless steel metal substrates, sintered at 875-1000 ° C, and characterised by SEM and XRD, and interfacial shear strength measurement. Dual coatings on stainless steel had an average high bond strength (about 23 MPa), and dual coatings on titanium and titanium alloy had moderate strengths (about 14 and 11 MPa, respectively), in comparison with the measured shear strength of bone (35 MPa). SEM and XRD demonstrated that the second layer blended seamlessly with the first and filled the cracks in the first. The superior result on stainless steel is attributed to a more appropriate thermal expansion match with hydroxyapatite, the thinner oxide layer, or a combination of these factors