Increased defibrillator therapies during influenza season in patients without influenza vaccines

Background: The association between influenza vaccination and implantable cardiac defibrillator (ICD) therapies during influenza season is not known and is described in this study. Understanding this association is important since reduction in ICD therapies during influenza season via use of influenza vaccination would benefit patients physically and psychologically. Methods: Patients presenting to the Sunnybrook Health Sciences Center ICD clinic between September 1st, 2011 and November 31st, 2011 were asked to complete a survey evaluating their use of the influenza vaccine. The number of patients with any ICD therapy and the total number of ICD therapies in the six months before and the three months during the 2010–2011 influenza season were determined. Poisson regression analysis was employed to assess differences in the average number of ICD therapies received during the influenza season based on vaccine status (vaccinated vs. unvaccinated). The analysis was repeated after limiting the cohort to patients with a left ventricular ejection fraction ≤35%. Results: A total of 229 patients completed the survey, 78% of whom received the influenza vaccine. Four patients had more than one ICD shock during the study period. Electrical storm was rare (n=2). A trend toward more ICD therapies (unadjusted incident rate ratio (IRR)=3.2; P=0.07) and appropriate ICD shocks (unadjusted IRR=9.0; P=0.17) was noted for unvaccinated compared to vaccinated patients. This association persisted when analysis was limited to patients with a left ventricular ejection fraction ≤35% (all ICD therapies: unadjusted IRR=5.8; P=0.045; adjusted IRR=2.6; P=0.33). No patient who received the influenza vaccine, and had a reduced ejection fraction, received an approprite ICD shock during influenza season (unadjusted P<0.002). Conclusion: A trend toward more ICD therapies during influenza season was observed in patients who did not receive the influenza vaccine compared to those who did. The association was stronger in patients who received appropriate ICD shocks and in patients with left ventricular systolic dysfunction. Further work to confirm these findings is recommended

Cracking mechanism in API 5L X65 steel in a CO-₂saturated environment

Hydrogen charging in low alloy steels poses a significant problem in the oil and gas industry. Detrimental hydrogen effects are not commonly expected in CO 2 aqueous environments. However, the acid nature of these environments and the high corrosion rates expected justify the assessment of cracking susceptibility of carbon steel in a CO 2 -saturated environment as presented in this work. The focus of this investigation is to understand how different surface films/corrosion products influence the hydrogen permeation and cracking mechanism of an API 5L X65 carbon steel in a saturated CO 2 environment. The experiments were carried out to assess hydrogen permeation at open circuit potential on steel samples which were either wet-ground, or pre-filmed with iron carbide (Fe 3 C) rich or iron carbonate (FeCO 3 ) layers. Tafel measurements were also performed to determine the effect of the surface composition on the cathodic reactions. Slow strain rate tests (SSRT) were conducted in order to evaluate the effects of hydrogen on the cracking mechanisms of the steel in this sweet environment. Results indicated that at open circuit conditions, Fe 3 C was able to increase the steady state hydrogen permeation current due to accentuation of the cathodic hydrogen-evolution reaction. Although FeCO 3 suppressed the cathodic reaction at the steel surface, the development of the protective and densely packed crystalline layer increased hydrogen uptake marginally from that of the ground steel reduced. SSRT indicated a very moderate loss of ductility in wet-ground and FeCO 3 steel surface conditions. However, a more significant reduction in area was observed in the tests carried out on Fe 3 C rich samples. These results imply that a corroded API 5L X65 steel surface in a CO 2 rich environment can enhance the hydrogen embrittlement (HE) susceptibility and as such, hydrogen permeation susceptibility needs to be considered in material selection

Alterações do nível pressórico e fatores de risco em graduandos de enfermagem Alteraciones del nível de la presión y factores de riesgo en profesionales graduandos en enfermería Risk factors and alterations in blood pressure levels in undergraduate nursing students

Objetivos: Identificar possíveis alterações do nível presóricoem graduandos de Enfermagem da Universidade Federal de São Paulo; Identificar fatores de risco para hipertensão arterial sistêmica; Verificar a associação entre os níveis pressóricos e os fatores de risco para hipertensão arterial sistêmica. Métodos: Estudo de corte transversal, desenvolvido entre novembro de 2006 a maio de 2007. A amostra foi composta por 120 graduandos de enfermagem da Universidade Federal de São Paulo. Foi aplicado um questionário específico sobre fatores de risco para hipertensão arterial e aferição da pressão arterial. O Teste de Fischer foi usado para determinar possíveis associações. Resultados: Dos graduandos, 92,5% apresentaram níveis pressóricos normais, 4,2% eram hipertensos e 3,3% com pressão limítrofe. Notou-se o aparecimento de alguns fatores de risco para hipertensão arterial e doença cardiovascular. Conclusão: De acordo com os resultados, deve-se atentar para mudanças de hábito e estilo de vida mais saudável desses futuros enfermeiros.<br>Objetivos: Medir la presión arterial para identificar posibles alteraciones en profesionales graduandos en Enfermería; identificar factores de riesgo para hipertensión arterial; verificar la asociación entre los niveles de presión y los factores de riesgo para hipertensión arterial. Métodos: Estudio de corte transversal, desarrollado entre noviembre de 2006 y mayo de 2007. La muestra fue compuesta por 120 graduandos de enfermería de la Universidad Federal de Sao Paulo. Fue aplicado un cuestionario específico sobre factores de riesgo para hipertensión arterial y para evaluar la presión arterial. La Prueba de Fischer fue usada para determinar posibles asociaciones. Resultados: 92,5% de los graduandos presentaron niveles de presión normal, 4,2% eran hipertensos y 3,3% tenían presión limítrofe. Se notó el aparecimiento de algunos factores de riesgo para hipertensión arterial y enfermedad cardiovascular. Conclusión: De acuerdo con los resultados, se deben cambiar hábitos y estilo de vida de modo que sean más saludables para los futuros enfermeros.<br>Objectives: To identify risk factors and alterations in blood pressure levels in undergraduate nursing students and to examine the associations between the risk factors and blood pressure levels. Methods: A cross-sectional descriptive study was conducted between November 2006 and May 2007. The sample consisted of 120 undergraduate nursing students from the Federal University of São Paulo. A specific questionnaire on risk factors for high blood pressure was used. Blood pressure measures were taken and recorded. Fisher's exact test was used to determine associations between risk factors and high blood pressure. Results: The majority of participants (92.5%) had normal blood pressure levels. A few students had high (4.2%) or borderline (3.3%) blood pressure levels. Students had some of the risk factors for high blood pressure and cardiovascular diseases. Conclusion: There is a need to emphasize lifestyle changes among those future nurses

The Philosophy of Evidence-Based Principles and Practice in Nutrition

The practice of evidence-based nutrition involves using the best available nutrition evidence, together with clinical experience, to conscientiously work with patients’ values and preferences to help them prevent (sometimes), resolve (sometimes), or cope with (often) problems related to their physical, mental, and social health. This article outlines the 3 fundamental principles of evidence-based practice as applied to the field of clinical nutrition. First, optimal clinical decision making requires awareness of the best available evidence, which ideally will come from unbiased systematic summaries of that evidence. Second, evidence-based nutrition provides guidance on how to decide which evidence is more or less trustworthy—that is, how certain can we be of our patients’ prognosis, diagnosis, or of our therapeutic options? Third, evidence alone is never sufficient to make a clinical decision. Decision makers must always trade off the benefits with the risks, burden, and costs associated with alternative management strategies, and, in so doing, consider their patients’ unique predicament, including their values and preferences