In-vitro evaluation of two types of neonatal oxygenators in handling gaseous microemboli and maintaining optimal hemodynamic stability during cardiopulmonary bypass

Abstract Objective: Usually only FDA-approved oxygenators are subject of studies by the international scientific community. The objective of this study is to evaluate two types of neonatal membrane oxygenators in terms of transmembrane pressure gradient, hemodynamic energy transmission and gaseous microemboli capture in simulated cardiopulmonary bypass systems. Methods: We investigated the Braile Infant 1500 (Braile Biomédica, São José do Rio Preto, Brazil), an oxygenator commonly used in Brazilian operating rooms, and compared it to the Dideco Kids D100 (Sorin Group, Arvada, CO, USA), that is an FDA-approved and widely used model in the USA. Cardiopulmonary bypass circuits were primed with lactated Ringer's solution and packed red blood cells (Hematocrit 40%). Trials were conducted at flow rates of 500 ml/min and 700 ml/min at 35ºC and 25ºC. Real-time pressure and flow data were recorded using a custom-based data acquisition system. For gaseous microemboli testing, 5cc of air were manually injected into the venous line. Gaseous microemboli were recorded using the Emboli Detection and Classification Quantifier. Results: Braile Infant 1500 had a lower pressure drop (P<0.01) and a higher total hemodynamic energy delivered to the pseudopatient (P<0.01). However, there was a higher raw number of gaseous microemboli seen prior to oxygenator at lower temperatures with the Braile oxygenator compared to the Kids D100 (P<0.01). Conclusion: Braile Infant 1500 oxygenator had a better hemodynamic performance compared to the Dideco Kids D100 oxygenator. Braile had more gaseous microemboli detected at the pre-oxygenator site under hypothermia, but delivered a smaller percentage of air emboli to the pseudopatient than the Dideco oxygenator.

Do People Order a Lower Calorie Meal When Calorie Information is Printed on Restaurant Menus? A Systematic Review of the Evidence.

Background: Obesity has reached epidemic levels globally and the proportion of overweight and obese people in the United Kingdom is increasing, which has potential health consequences for the nation. Eating out has been linked to obesity. Restaurant customers who have been informed of nutrient content of meals may be in a better position to make healthier choices as to content of meal ordered, thereby reducing number of calories ordered per meal. The aim was to establish whether people order a lower calorie meal when calorie information is printed on restaurant menus. The objective was to conduct a systematic review of evidence given in the literature. Methods: Having gained ethical approval for a desk-based study from Coventry University, a sole investigator conducted a rigorous search of the literature. Only studies answering the research question, of restaurants where specific calorie information was printed on menus, were included. Study types other than randomised controlled trials, cross sectional surveys and cohort studies were excluded. A data collection form was adapted from Cochrane’s data extraction form and completed for each study, to extract data and consider methodological quality in terms of randomisation, baseline imbalances, incomplete data outcome, selective outcome reporting, confounders, withdrawals and exclusions. Results: Ten studies met the inclusion and quality criteria and were included in the systematic review. Five studies found a decrease in calories ordered per meal when calorie information was printed on menus, however the other five found an increase in calories ordered. Number of calories ordered per meal was aggregated across the ten studies and average calories ordered per meal, both with and without calorie information, calculated. The overall result was that that there was no average reduction in calories ordered when calorie information was printed on restaurant menus. Discussion: There were however reductions in calories ordered per meal in some population sub-groups: Child/adult differences: There was a significant reduction of calories ordered for children, particularly when parents had made choices for their children Tandon [1]. Male/female differences: Whilst on average women did order a lower calorie meal when given calorie information, on average men ordered a higher calorie meal (Gerend [2]). Calorie education: Several studies stated that combining greater education regarding calorie information with nutritional labelling on menus might increase use of and/or effectiveness of printing nutritional information on menus Dowray et al. [3]. Label types: There was significant benefit in providing physical activity information, such as miles required to walk, in order to expend the energy of the meal Dowray et al. [3]: 179). A study of children found that printing a “healthy heart” symbol on menus led to children selecting lower calorie meal options Stutts et al. [4]. Conclusion: There is no strong evidence to support printing calorie information on restaurant menus. On average, people do not order a lower calorie meal when calorie information is printed on restaurant menus. These findings are consistent with those of the most recent systematic review (Swartz, Braxton and Viera [5]). More robust studies and further research into the effect of calorie labelling on sub-groups of the population, different types of menu labelling and the effect of greater calorie education to increase understanding of energy content of foods are required. Further education to increase understanding of energy content of foods may increase effectiveness of printing calorie information on restaurant menus.