RESUMO
BACKGROUND: Despite over a decade of research and technological advances, sublingual microcirculatory monitoring has not yet reached clinical utility. Offline analysis is time consuming and occurs away from the patient. A system to assess the microcirculation at the point of care is desirable. We present a novel 5-point grading system (the point of care microcirculation (POEM) scoring system) that can be used at the point of care during non-invasive sublingual microcirculatory monitoring. METHODS: The POEM score is an ordinal scale from 1 (worst) to 5 (best), based on a composite assessment of flow and heterogeneity of four individual sublingual video-microscopy clips. Thirty-two healthcare professionals were trained in how to assign POEM scores. Following training they assigned scores to five test sequences (each consisting of four video clips). They were blinded to clinical status. Inter-user consistency and agreement were assessed using intra-class correlation coefficient (ICC) analysis. In addition, blinded expert scores for 68 video clips were compared to offline computer analysis using traditional microcirculatory parameters including total vessel density (TVD), perfused vessel density (PVD), proportion of perfused vessels (PPV), microcirculatory flow index (MFI) and microcirculatory heterogeneity index (MHI). The time taken to assign each was recorded. RESULTS: Participants showed good inter-rater consistency (ICC 0.83, 95 % CI 0.626, 0.976) and agreement (ICC 0.815, 95 % CI 0.602, 0.974) for assigned POEM scores. Expert scoring of videos correlated with offline values for PVD (R 2 = 0.39; p < 0.05), PPV (R 2 = 0.71; p < 0.001), MFI (R 2 = 0.75; p < 0.001), and MHI (R 2 = 0.68; p < 0.001). POEM scores took less time to assign than conventional offline computer analysis (2 minutes versus 44 minutes). CONCLUSION: We present for the first time a novel 5-point ordinal scale of microcirculatory flow and heterogeneity that can be used at the point of care. It has minimal inter-user variability amongst healthcare professionals after just 1 hour of training. POEM scores take a short time to assign, and correspond well to traditional offline computer-analyzed parameters.
Assuntos
Sistemas Computacionais/normas , Microcirculação/fisiologia , Microscopia de Vídeo/normas , Sistemas Automatizados de Assistência Junto ao Leito/normas , Índice de Gravidade de Doença , Choque/diagnóstico , Velocidade do Fluxo Sanguíneo/fisiologia , Pessoal de Saúde/normas , Humanos , Microscopia de Vídeo/métodos , Distribuição Aleatória , Choque/fisiopatologia , Método Simples-CegoRESUMO
The selective detection of individual hazardous volatile organic compounds (VOCs) within a mixture is of great importance in industrial contexts due to environmental and health concerns. Achieving this with inexpensive, portable detectors continues to be a significant challenge. Here, a novel thermal separator system coupled with a photoionization detector has been developed, and its ability to selectively detect the VOCs isopropanol and 1-octene from a mixture of the two has been studied. The system includes a nanoporous silica preconcentrator in conjunction with a commercially available photoionization detector (PID). The PID is a broadband total VOC sensor with little selectivity; however, when used in conjunction with our thermal desorption approach, selective VOC detection within a mixture can be achieved. VOCs are adsorbed in the nanoporous silica over a 5 min period at 5 °C before being desorbed by heating at a fixed rate to 70 °C and detected by the PID. Different VOCs desorb at different times/temperatures, and mathematical analysis of the set of PID responses over time enabled the contributions from isopropanol and 1-octene to be separated. The concentrations of each compound individually could be measured in a mixture with limits of detection less than 10 ppbv and linearity errors less than 1%. Demonstration of a separation of a mixture of chemically similar compounds, benzene and o-xylene, is also provided.
Assuntos
Nanoporos , Compostos Orgânicos Voláteis , 2-Propanol/análise , Cromatografia Gasosa , Dióxido de Silício , Compostos Orgânicos Voláteis/análiseRESUMO
The structure of a new metastable geometric isomer of [Ru(NH3)4(H2O)(SO2)][MeC6H4SO3]2 in which the SO2 group is coordinated through a single oxygen in an eta1-OSO bonding mode has been determined at 13 K; the new isomer was obtained as a 36% component of the structure within a single crystal upon irradiation using a tungsten lamp.