Usefulness of gastric intramucosal pH for monitoring hemodynamic complications in critically ill children

OBJECTIVE: To assess the efficacy of gastric intramucosal pH for the evaluation of tissue perfusion and prediction of hemodynamic complications in critically ill children. DESIGN: Open prospective study without controls. SETTING: Pediatric intensive care unit (ICU) of a tertiary care university pediatric hospital. PATIENTS: Thirty critically ill children (16 boys and 14 girls), age range: 3 months-12 years. MEASUREMENTS AND RESULTS: A tonometry catheter was placed in the stomach of all patients on admission to the pediatric ICU. Simultaneous tonometry and arterial gas measurements were made on admittance and every 6-12 h throughout the study; a total of 202 measurements were made. The catheter was removed after extubation and/or when the patient was hemodynamically stable. Intramucosal pH was calculated using the Henderson-Hasselbalch equation based on the pCO2 of the tonometer and arterial bicarbonate. Intramucosal pH values between 7.30 and 7.45 were considered to be normal. The patient's condition was analyzed using the Pediatric Risk Mortality Score (PRISM). The relations between intramucosal pH and the presence of major hemodynamic complications (cardiopulmonary arrest, shock), minor hemodynamic complications (hypotension, hypovolemia or arrhythmia), death, PRISM score and the duration of the stay in the pediatric ICU were analyzed. Intramucosal pH on admission was 7.48 +/- 0.15 on average (range 7.04-7.68). Five patients (16%) had an intramucosal pH lower than 7.30 on admission; these patients did not have a higher incidence of hemodynamic complications. The 16 patients (53%) who had an intramucosal pH of less than 7.30 at some time during the course of their disease had more hemodynamic complications than the patients who did not have pH lower than 7.30 (p < 0.0001). Every case of cardiopulmonary arrest and shock was related to intramucosal pH of less than 7.30. Patients with major complications (cardiopulmonary arrest and shock) had lower intramucosal pHs than those with minor hemodynamic complications (p = 0.03); similarly, they had low intramucosal pH readings more often than those with minor complications (p = 0.0032). Intramucosal pH values less than 7.30 had a sensitivity of 90% and a specificity of 98% as a predictor of hemodynamic complications. There was no relation between intramucosal pH lower than 7.30 and either PRISM or the duration of the stay in the pediatric ICU. Patients with intramucosal pH less than 7.20 had a higher PRISM than the patients who did not have pH lower than 7.20 (p < 0.05). A patient who died during the study due to cardiopulmonary arrest had prior intramucosal pH measurements of 7.23 and 7.10, and three patients died of late complications after the end of the study. Hemodynamic complications were not detected with arterial pH. Gap pH (arterial pH-intramucosal pH) and standard pH measurements yielded the same results as gastric intramucosal pH. CONCLUSION: Intramucosal pH could provide a useful early indication of hemodynamic complications in critically ill children.     

Sustainable consumption and production: how to make it possible

Consumer demand and consumption, if shifted to a sustainable pattern, in theory, should influence producers to meet that demand with sustainable production processes, greater choice of green products, and different consumption options, for instance, services instead of products. At the same time, increased choice and expanded consumption options should drive down relative prices, make green goods and services more affordable and accessible, and create a closed cycle leading to sustainable consumption and production (SCP) system. The paper reviews different cases of resource efficient and cleaner production as well as sustainable products and services developed in Austria, Bulgaria, Estonia, Lithuania, and Spain. These research cases were selected from the presentations at the second international conference “Sustainable consumption and production: how to make it possible,” held on September 28–30 in Kaunas, Lithuania. An overwhelming message of the review is that the best results could be achieved when all stakeholders work together for a common vision of SCP for current and future generations. Multistakeholder cooperation together with new economics approach is challenging, but essential for the planet currently imperiled by overpopulation and over-consumption and, for the first time in human history, facing the situation of breaching the planetary boundaries.     

Enzymatic polymerization of polythiophene by immobilized glucose oxidase

In this study ‘green’, environmentally friendly enzymatic reaction-based synthesis of conducting polymer polythiophene (PTP) is proposed. Glucose oxidase (GO_x) was shown as an effective catalyst, which, in the presence of glucose, produces hydrogen peroxide suitable for the oxidative polymerization of PTP under ambient conditions at neutral pH. Enzymatically induced formation of the PTP layer over GO_x-modified graphite rod electrode (GRE) was demonstrated and evaluated amperometrically and by attenuated total reflectance – Fourier transform infrared (ATR-FTIR) spectroscopy. Surface morphology of GO_x- and PTP-modified GR electrodes was characterized by atomic force microscopy. It was clearly shown that the apparent kinetic Michaelis constant (K_M(app.)) of GO_x/PTP-modified GRE increased by increasing the duration of polymerization reaction. Therefore, enzymatic polymerization could be applied in adjustment and/or tuning of K_M(app.) and other kinetic parameters of GO_x-based electrodes used in biosensor design.     

Responsibility and the elderly: Applications to psychotherapy.

Based on the analysis of P. Brickman et al (see record 1982-30315-001), 4 models of psychotherapy are proposed. It is argued that a key element in clinical interventions with the elderly is the extent to which the intervention affects the elderly clients' perceived responsibility for the cause of and solution to their presenting complaints. The dangers of a medical model psychotherapeutic orientation that strips clients' feelings of control are discussed. (26 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Cleaner production financing: possibilities and barriers

There are several players who could facilitate the promotion of cleaner production (CP) by establishing an effective financing mechanism; for instance, government, international assistance bodies, banks and other financing organizations. In a few developing countries in South East Africa and Latin America and in Vietnam several international organizations, development banks and donors have initiated and implemented projects to facilitate the introduction of CP investments. Most projects have been in the form of technical assistance grants and training to industries and/or loans at below market rates from dedicated trust funds. Yet the present level of lending through such projects is far from sufficient to trigger widespread adoption of CP. Therefore, experts from The Institute of Environmental Engineering, Lithuania performed an investigation to create a CP development scheme for developing countries.     

Industrial ecology in university curriculum: new M.Sc. Programme in Environmental Management and Cleaner Production

To ensure long-term capacity building in the area of industrial ecology, a new M.Sc. Programme in Environmental Management and Cleaner Production has been developed in the framework of the BALTECH consortium, which consists of technical universities in the Baltic Sea region. The programme was started at Kaunas University of Technology in September 2002. This paper presents prerequisites for the establishment of the new M.Sc. programme , its aims, goals and structure as well as the relation of different subjects of the programme to the concept of industrial ecology.     

Integrating resource criticality assessment into evaluation of cleaner production possibilities for increasing resource efficiency

A stable and secure source of raw materials is the key to any successful industrial activity. Resource criticality is often discussed in the context of the impact on the economies of certain geographic regions. However, the availability of required resources first of all concerns the competitiveness of industrial companies, especially in those countries which do not possess abundant natural resources. The Lithuanian economy relies heavily on imports since the country does not have abundant natural resources. The paper introduces resource criticality as an additional dimension for evaluating and prioritizing resource efficiency improvement options. Evaluation of resource criticality was integrated into the methodology for evaluation of Cleaner Production. Simple additive weighting (SAW) was used to solve the multi-criteria decision-making problem. The previous study on the natural resources that are imported to Lithuania revealed that metals are among the most important raw materials in terms of economic importance, supply, and environmental risks. Therefore, a typical metal processing company in Lithuania was selected for the detailed investigation of technological processes and Cleaner Production possibilities. The selected company processes about 3000 tons of various metals per year. The results of Process Material Flow Analysis show that most of the metal waste is generated during the metal plate cutting process (about 30.3 % of total metal consumption). Three resource efficiency improvement alternatives were evaluated and compared. The suggested decision support system was tested in order to decide on a definitive solution. The results reveal that evaluation of resource criticality in terms of geostrategic supply risk and economic importance can be used as an advantageous criterion to support the prioritization of Cleaner Production alternatives.     

pH-dependent water penetration through CNT sub-layers arranged on the polycarbonate membrane filters

A carbon nanotube (CNT) membrane that included fragments of buckypaper and aligned nanotube forests was produced from industrial single-walled CNTs functionalized with carboxyl functional groups and a polycarbonate membrane substrate. Water penetration measurements demonstrated the flow rate dependence on the pH of the solution. This phenomenon is a consequence of the specific membrane structure and can be exploited to control liquid flow in a variety of processes.     

Models of helping and coping, responsibility attributions, and well-being in community elderly and their helpers.

The analysis of P. Brickman et al (see record 1982-30315-001), which separates attribution of a problem's cause and solution, was tested in 4 studies. Young and elderly adults' (n?=?210) well-being was related only to taking responsibility for solutions. The elderly compared with the young adults assumed less responsibility for problem cause and solution. They also preferred helping and coping models that assume low self-responsibility for solutions (e.g., medical model). This result was replicated with Meals on Wheels clients (n?=?51). An intragenerational helping pattern was found in Study 3. Lay helpers (n?=?63) helped mainly same-age recipients. Elderly and middle-aged helpers compared with young adults preferred using a medical model. Overall, a cohort bias in model preference was suggested. In Study 4, problem type and recipient age moderated attributions and model choice of young and middle-aged Ss (n?=?92). Relevance to the control literature and ethical and clinical implications of a medical-model bias are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)