Detection of preanalytical errors in arterial blood gas analysis

IntroductionBlood gas analysis (BGA) is an essential test used for years to provide vital information in critically ill patients. However, the instability of the blood gases is a problem. We aimed to evaluate time and temperature effects on blood gas stability.Materials and methodsArterial blood was collected from 20 patients into syringes. Following BGA for baseline, syringes were divided into groups to stand at 4°C and 22°C for 30, 60, 90, 120 minutes. All were tested for pH, partial pressure of carbon dioxide (pCO₂), partial pressure of oxygen (pO₂), oxygen saturation (sO₂), oxyhemoglobin (O₂Hb), sodium, potassium, glucose, lactate, oxygen tension at 50% hemoglobin saturation (p50), and bicarbonate. A subgroup analysis was performed to detect the effect of air on results during storage. Percentage deviations were calculated and compared against the preset quality specifications for allowable total error.ResultsAt 4°C, pO₂ was the least stable parameter. At 22°C, pO₂ remained stable for 120 min, pH and glucose for 90 min, lactate and pCO₂ for 60 min. Glucose and lactate were stable when chilled. Air bubbles interfered pO₂ regardless of temperatures, whereas pCO₂ increased significantly at 22°C after 30 min, and pH decreased after 90 min. Bicarbonate, sO₂, O₂Hb, sodium, and potassium were the unaffected parameters.ConclusionsCorrect BGA results are essential, and arterial sample is precious. Therefore, if immediate analysis cannot be performed, up to one hour, syringes stored at room temperature will give reliable results when care is taken to minimize air within the blood gas specimen.     

Beyond Heroes and Villains: Examining Explanatory Mechanisms Underlying Moral Disengagement

In recent years, theorizing regarding the role and importance of media entertainment in everyday life has garnered much serious attention by media effects scholars. The role of moral judgments, sanctions, and lack thereof are areas in which theoretical development has expanded. The present study examines narrative exposure, identification, and moral judgment as indicators of the degree to which individuals may morally disengage during mediated entertainment experiences. In addition, this study attempts to further expand disposition theory and theorizing about the role of moral disengagement by moving beyond conceptualizations of good, bad, and morally ambiguous characters to explore more subtle moral distinctions between characters as they exist within the same narrative and along a continuum. Results suggest that identification and moral judgment serve as important mediators predicting moral disengagement; however, the nature of these relationships are moderated by the perception of the character’s moral fortitude.     

The effect of extremely high glucose concentrations on 21 routine chemistry and thyroid Abbott assays: interference study

Introduction

Extremely high glucose concentrations have been shown to interfere with creatinine assays especially with Jaffe method in peritoneal dialysate. Because diabetes is the fastest growing chronic disease in the world, laboratories study with varying glucose concentrations. We investigated whether different levels of glucose spiked in serum interfere with 21 routine chemistry and thyroid assays at glucose concentrations between 17-51 mmol/L.

Materials and methods

Baseline (group I) serum pool with glucose concentration of 5.55 (5.44-5.61) mmol/L was prepared from patient sera. Spiking with 20% dextrose solution, sample groups were obtained with glucose concentrations: 17.09, 34.52, and 50.95 mmol/L (group II, III, IV, respectively). Total of 21 biochemistry analytes and thyroid tests were studied on Abbott c8000 and i2000sr with commercial reagents. Bias from baseline value was checked statistically and clinically.

Results

Creatinine increased significantly by 8.74%, 31.66%, 55.31% at groups II, III, IV, respectively with P values of < 0.001. At the median glucose concentration of 50.95 mmol/L, calcium, albumin, chloride and FT4 biased significantly clinically (-0.85%, 1.63%, 0.65%, 7.4% with P values 0.138, 0.214, 0.004, < 0.001, respectively). Remaining assays were free of interference.

Conclusion

Among the numerous biochemical parameters studied, only a few parameters are affected by dramatically increased glucose concentration. The creatinine measurements obtained in human sera with the Jaffe alkaline method at high glucose concentrations should be interpreted with caution. Other tests that were affected with extremely high glucose concentrations were calcium, albumin, chloride and FT4, hence results should be taken into consideration in patients with poor diabetic control.Key words: assay interference, glucose interference, preanalytical phase, creatinine, Jaffe kinetic assay, thyroid function tests     

Turkish children’s human figure drawings: can we borrow norms?

The present study was undertaken to provide preliminary data on norms for the Human Drawings test for children ages 5–11, in Turkey. Four hundred and thirty children from two different schools, in two different socio‐economic levels, were given the Human Figure Drawings. One was a private school in an affluent part of the city, and the other one was a public school in an economically deprived part of the city. There were 208 boys and 222 girls between the ages of five years and 11 years. Koppitz’s Scoring System was utilised. As expected, the results indicated that as children got older they produced more details in their drawings. There were significant differences in the total number of details produced in terms of sex and socio‐economic level. When compared with Koppitz norms it was seen that Turkish children at some age levels produced more details and that the application of Koppitz’s ‘Expected’ and ‘Exceptional’ items tables would not be appropriate to estimate cognitive ability for this group. The need for developing local norms for tests that are supposed to be culture free was discussed. Further research in terms of validity of the test for this sample is also recommended.     

灾难事件中新闻舆论引导存在的问题及其调控策略

灾难事件的发生,具有很强的破坏性,对社会生活产生极大的负面影响,往往导致社会舆论的畸变,媒体正确的新闻舆论引导显得尤为重要。当前,在灾难事件报道中,媒体的新闻舆论引导取得了很大的进步,但同时也存在一些问题。分析这些问题,找出相应的对策,将有助于媒体在灾难事件报道中更有效的新闻舆论引导、稳定社会、安抚民心。     

Inspirational Reality TV: The Prosocial Effects of Lifestyle Transforming Reality Programs on Elevation and Altruism

In light of recent theories of meaningful media that suggest a host of psychological benefits, the present study uniquely extends the boundaries of the effects of reality TV from simply offering pleasure, diversion, and amusement to its viewers to also providing deep insight and meaning. In particular, a between-subjects experiment (N = 143) examined differences in affective, cognitive, and motivational responses to lifestyle transforming versus game based reality programs. Findings indicate that lifestyle transforming reality TV produced stronger feelings of elevation and perceptions of the program as moving and thought-provoking than game reality TV, which in turn increased motivations for altruism. Avenues for future research and theoretical implications of meaningful and inspiring reality TV for positive psychology are discussed.     

Stability studies of common biochemical analytes in serum separator tubes with or without gel barrier subjected to various storage conditions

Introduction

The collected and shipped blood samples are exposed to a various extra-analytical factors prior to analysis. The aim of the study was to determine the stability of analytes in serum gel tubes and plain tubes exposed to a range of storage temperatures and times after centrifugation.

Materials and methods:

Fifteen healthy volunteers were recruited and venous blood was collected into four tubes, two with and two without gel separator. Analyzing the baseline samples in 30 min, all were stored at 4ºC or 24ºC for 6, 12, 18, 24, 30, 36, 48 and 72 hours and 1 week. Sixteen biochemical anaytes were measured on each sample. Variations remained under the desirable bias considered as clinically insignificant.

Results:

On day three, most analytes remained stable including albumin, protein, creatinine, cholesterol, triglycerides, gamma-glutamyl transferase (GGT), alkaline phosphatase (ALP), alanine aminotransferase (ALT), creatine kinase (CK), lactate dehydrogenase (LD) regardless of tube types. Glucose concentration decreased markedly (P = 0.001) beginning from the first hours of storage in plain serum. The stability maximized for the analytes including glucose, total bilirubin, urea nitrogen (BUN), uric acid stored at 4 ºC in gel tubes. Aspartate aminotransferase (AST) activity increased significantly (P = 0.002) up to 48-h, however bias was not significant clinically. High density lipoprotein (HDL) concentration was stable in gel tubes at 24 ºC, in plain tubes at 4 ºC stored up to 36-h.

Conclusion:

Serum gel or non-gel tubes might be used interchangeably for 11 analytes chilled or at 24 ºC, whereas some restrictions must be applied for glucose, AST, BUN, HDL, and uric acid.     

美国高校学业指导综合改革及启示——以佐治亚州立大学为例

创新高等教育管理,提升人才培养质量,是我国高等教育普及化后面临的重大课题.本文以美国佐治亚州立大学为例,分析美国高校以大数据技术为中介,推动学生学业指导综合改革,实现人才培养质量跃升的实践路径及其运作特征.通过对GSU的深度案例分析,提出以学生学业指导助推人才培养质量提升、以跨部门协作构建高校共同育人体系、以学习分析优化学业指导流程、以个性化指导改善学生就读体验,为我国本科人才培养和高等教育管理提供参考借鉴.     

Travelling policies and contextual considerations: on threshold criteria

Educational policy borrowing has become rather common in our globalised world. However, the literature lacks contextual criteria that may be employed by researchers and policy makers to assess the correspondence of a particular policy to the local context of a borrowing system. Based on a secondary analysis of documents and research reports, this paper describes the process of policy borrowing in the Israeli and Turkish educational systems. Discrepancies were found between the basic qualities of the borrowed policies and the contextual features and processes that characterise each educational system. The lack of congruency appears to be even deeper in centralised structures where the act of policy setting is done by top-level policy makers who are isolated from local school circumstances. Threshold criteria referring to fundamental considerations during decision making are offered and their theoretical and practical implications for centralised structures are discussed.