Fondaparinux verses enoxaparin for the prevention of venous thromboembelism

Venous thromboembolism is a frequent, life-threatening, postoperative complication of hip-fracture and total-knee-replacement surgery. Fondaparinux is a synthetic polysaccharide that selectively binds to antithrombin, the primary endogenous regulator of blood coagulation. Low molecular weight heparins, such as enoxaparin, are less specific inhibitors of coagulation. In patients undergoing hip-fracture surgery, fondaparinux is more effective than once-daily enoxaparin as prophylaxis for venous thromboembolism. Fondaparinux (25 mg/day s.c.) was also more effective than enoxaparin (30 mg s.c. b.i.d.) as prophylaxis for venous thromboembolism in elective knee surgery. These differences may be explained by the fact that there is less prophylaxis cover with enoxaparin, as it has a much shorter duration of action than fondaparinux. Thus, with the present dosing regimens, fondaparinux is probably preferable to enoxaparin for the prevention of venous thromboembolism.

Horizontal rotating cylinder - A compact apparatus for studying the effect of water wetting on carbon dioxide corrosion of mild steel

Water wetting is a crucial issue in carbon dioxide (CO.) corrosion of multiphase flow pipelines made from mild steel. This study demonstrates the use of a novel benchtop apparatus, a horizontal rotating cylinder, to study the effect of water wetting on CO2 corrosion of mild steel in two-phase flow. The setup is similar to a standard rotating cylinder except for its horizontal orientation and the presence of two phases-typically water and oil. The apparatus has been tested by using mass-transfer measurements and CO2 corrosion measurements in single-phase water flow. CO2 corrosion measurements were subsequently performed using a water/hexane mixture with water cuts varying between 5% and 50%. While the metal surface was primarily hydrophilic under stagnant. conditions, a variety of dynamic water wetting situations was encountered as the water cut and fluid velocity were altered. Threshold velocities were identified at various water cuts when the surface became oil-wet and corrosion stopped.

A mechanistic model for carbon dioxide corrosion of mild steel in the presence of protective iron carbonate films - Part 3: Film growth model

A model of iron carbonate (FeCO3) film growth is proposed, which is an extension of the recent mechanistic model of carbon dioxide (CO2) corrosion by Nesic, et al. In the present model, the film growth occurs by precipitation of iron carbonate once saturation is exceeded. The kinetics of precipitation is dependent on temperature and local species concentrations that are calculated by solving the coupled species transport equations. Precipitation tends to build up a layer of FeCO3 on the surface of the steel and reduce the corrosion rate. On the other hand, the corrosion process induces voids under the precipitated film, thus increasing the porosity and leading to a higher corrosion rate. Depending on the environmental parameters such as temperature, pH, CO2 partial pressure, velocity, etc., the balance of the two processes can lead to a variety of outcomes. Very protective films and low corrosion rates are predicted at high pH, temperature, CO2 partial pressure, and Fe2+ ion concentration due to formation of dense protective films as expected. The model has been successfully calibrated against limited experimental data. Parametric testing of the model has been done to gain insight into the effect of various environmental parameters on iron carbonate film formation. The trends shown in the predictions agreed well with the general understanding of the CO2 corrosion process in the presence of iron carbonate films. The present model confirms that the concept of scaling tendency is a good tool for predicting the likelihood of protective iron carbonate film formation.

Numerical investigation of turbulent flow around a rotating stepped cylinder for corrosion study

Direct numerical simulation has been carried out for turbulent flow set up by a rotating cylinder with two backward-facing steps axisymmetrically mounted in the circumferential direction. This flow geometry creates a qualitatively similar flow pattern as observed near, a sudden, pipe expansion or a plane backward-facing step, characterized by flow separation and reattachment. A region of intense turbulence intensity and high wall-shear-stress fluctuations is formed in,the recirculating I region downstream of the step, where high mass-transfer capacity was also experimentally observed. Since, corrosion is frequently mass-transfer., controlled, our findings, put forward this apparatus as useful tool for future corrosion research.

Economic Analysis of Occupational Risk Prevention in the Construction Sector

The construction sector has one of the worst occupational safety and health records in Europe. The costs of this scenario are very high, namely costs for workers and their families, costs to organizations, resulting from the absence of workers due to illness, insurance premiums, costs resulting from reduced productivity, cost of replacement and training of workers, etc., and costs to society, which in turn increases the costs of health systems. This paper presents and discusses the development of a methodology for economic evaluation in the context of risk management, which will allow senior management to support decision making. The possible application of this methodology to the construction sector is discussed.

Economic analysis of occupational risk prevention: a case study in a textile company

Work accidents affect business and society as a whole. Fewer accidents mean fewer sick leaves, which results in lower costs and less disruption in the production process, with clear advantages for the employer. But workers and their households bear also a significant burden following a work accident, only partially compen-sated by insurance systems. Furthermore, the consequences of work accidents to the State and Society need also to be considered. When an organization performs an integrated risk analysis in evaluating its Occupational Health and Safety Management System, several steps are suggested to address the identified risk situations. Namely, to avoid risks, a series of preventive measures are identified. The organization should make a detailed analysis of the monetary impact (positive or negative) for the organization of each of the measures considered. Particularly, it is also important to consider the impact of each measure on society, involving an adequate eco-nomic cost-benefit analysis. In the present paper, a case study in a textile finishing company is presented. The study concentrates on the dyeing and printing sections. For each of the potential risks, several preventive measures have been identified and the corresponding costs and benefits have been estimated. Subsequently, the Benefit/Cost ratio (B/C) of these measures has been calculated, both in financial terms (from the organisa-tion’s perspective) and in economic terms (including the benefits for the worker and for the Society). Results show that, while the financial analysis in terms of the company does not justify the preventive measures, when the externalities are taken into account, the B/C ratio increases significantly and investments are fully justified.

Financial and economic analysis of prevention of needlesticks in the hospital sector

This paper discusses the financial and economic analysis of prevention of needlestick accidents related to Occupational Health and Safety projects and presents the application to a case study involving a Hospital.

The effect of the angle of incidence on the aqueous corrosion of ion implanted M50 steel substrates

Following work on tantalum and chromium implanted flat M50 steel substrates, this work reports on the electrochemical behaviour of M50 steel implanted with tantalum and chromium and the effect of the angle of incidence. Proposed optimum doses for resistance to chloride attack were based on the interpretation of results obtained during long-term and accelerated electrochemical testing. After dose optimization from the corrosion viewpoint, substrates were implanted at different angles of incidence (15°, 30°, 45°, 60°, 75°, 90°) and their susceptibility to localized corrosion assessed using open-circuit measurements, step by step polarization and cyclic voltammetry at several scan rates (5–50 mV s-1). Results showed, for tantalum implanted samples, an ennoblement of the pitting potential of approximately 0.5 V for an angle of incidence of 90°. A retained dose of 5 × 1016 atoms cm-2 was found by depth profiling with Rutherford backscattering spectrometry. The retained dose decreases rapidly with angle of incidence. The breakdown potential varies roughly linearly with the angle of incidence up to 30° falling fast to reach -0.1 V (vs. a saturated calomel electrode (SCE)) for 15°. Chromium was found to behave differently. Maximum corrosion resistance was found for angles of 45°–60° according to current densities and breakdown potentials. Cr+ depth profiles ((p,γ) resonance broadening method), showed that retained doses up to an angle of 60° did not change much from the implanted dose at 90°, 2 × 1017 Cr atoms cm-2. The retained implantation dose for tantalum and chromium was found to follow a (cos θ)8/3 dependence where θ is the angle between the sample normal and the beam direction.

Missed opportunities for congenital syphilis and HIV perinatal transmission prevention

OBJECTIVE: To estimate the prevalence of missed opportunities for congenital syphilis and HIV prevention in pregnant women who had access to prenatal care and to assess factors associated to non-testing of these infections. METHODS: Cross-sectional study comprising a randomly selected sample of 2,145 puerperal women who were admitted in maternity hospitals for delivery or curettage and had attended at least one prenatal care visit, in Brazil between 1999 and 2000. No syphilis and/or anti-HIV testing during pregnancy was a marker for missed prevention opportunity. Women who were not tested for either or both were compared to those who had at least one syphilis and one anti-HIV testing performed during pregnancy (reference category). The prevalence of missed prevention opportunity was estimated for each category with 95% confidence intervals. Factors independently associated with missed prevention opportunity were assessed through multinomial logistic regression. RESULTS: The prevalence of missed prevention opportunity for syphilis or anti-HIV was 41.2% and 56.0%, respectively. The multivariate analysis showed that race/skin color (non-white), schooling (<8 years), marital status (single), income (<3 monthly minimum wages), having sex during pregnancy, history of syphilis prior to the current pregnancy, number of prenatal care visits (<6), and last prenatal visit before the third trimester of gestation were associated with an increased risk of missed prevention opportunity. A negative association with missed prevention opportunity was found between marital status (single), prenatal care site (hospital) and first prenatal visit in the third trimester of gestation. CONCLUSIONS: High rates of non-tested women indicate failures in preventive and control actions for HIV infection and congenital syphilis. Pregnant women have been discontinuing prenatal care at an early stage and are failing to undergo prenatal screening for HIV and syphilis.

HIV rapid testing as a key strategy for prevention of mother-to-child transmission in Brazil

OBJECTIVE: To assess the feasibility of HIV rapid testing for pregnant women at maternity hospital admission and of subsequent interventions to reduce perinatal HIV transmission. METHODS: Study based on a convenience sample of women unaware of their HIV serostatus when they were admitted to delivery in public maternity hospitals in Rio de Janeiro and Porto Alegre, Brazil, between March 2000 and April 2002. Women were counseled and tested using the Determine HIV1/2 Rapid Test. HIV infection was confirmed using the Brazilian algorithm for HIV infection diagnosis. In utero transmission of HIV was determined using HIV-DNA-PCR. There were performed descriptive analyses of sociodemographic data, number of previous pregnancies and abortions, number of prenatal care visits, timing of HIV testing, HIV rapid test result, neonatal and mother-to-child transmission interventions, by city studied. RESULTS: HIV prevalence in women was 6.5% (N=1,439) in Porto Alegre and 1.3% (N=3.778) in Rio de Janeiro. In Porto Alegre most of women were tested during labor (88.7%), while in Rio de Janeiro most were tested in the postpartum (67.5%). One hundred and forty-four infants were born to 143 HIV-infected women. All newborns but one in each city received at least prophylaxis with oral zidovudine. It was possible to completely avoid newborn exposure to breast milk in 96.8% and 51.1% of the cases in Porto Alegre and Rio de Janeiro, respectively. Injectable intravenous zidovudine was administered during labor to 68.8% and 27.7% newborns in Porto Alegre and Rio de Janeiro, respectively. Among those from whom blood samples were collected within 48 hours of birth, in utero transmission of HIV was confirmed in 4 cases in Rio de Janeiro (4/47) and 6 cases in Porto Alegre (6/79). CONCLUSIONS: The strategy proved feasible in maternity hospitals in Rio de Janeiro and Porto Alegre. Efforts must be taken to maximize HIV testing during labor. There is a need of strong social support to provide this population access to health care services after hospital discharge.

Corrosão das armaduras do betão armado: causas, consequências, prevenção e projeto de durabilidade

Trabalho Final de Mestrado para obtenção do grau de Mestre em Engenharia Civil

Use of medicines recommended for secondary prevention of acute coronary syndrome

ABSTRACT OBJECTIVE : To analyze if the demographic and socioeconomic variables, as well as percutaneous coronary intervention are associated with the use of medicines for secondary prevention of acute coronary syndrome. METHODS : In this cohort study, we included 138 patients with acute coronary syndrome, aged 30 years or more and of both sexes. The data were collected at the time of hospital discharge, and after six and twelve months. The outcome of the study was the simultaneous use of medicines recommended for secondary prevention of acute coronary syndrome: platelet antiaggregant, beta-blockers, statins and angiotensin-converting-enzyme inhibitor or angiotensin receptor blocker. The independent variables were: sex, age, education in years of attending, monthly income in tertiles and percutaneous coronary intervention. We described the prevalence of use of each group of medicines with their 95% confidence intervals, as well as the simultaneous use of the four medicines, in all analyzed periods. In the crude analysis, we verified the outcome with the independent variables for each period through the Chi-square test. The adjusted analysis was carried out using Poisson Regression. RESULTS : More than a third of patients (36.2%; 95%CI 28.2;44.3) had the four medicines prescribed at the same time, at the moment of discharge. We did not observe any differences in the prevalence of use in comparison with the two follow-up periods. The most prescribed class of medicines during discharge was platelet antiaggregant (91.3%). In the crude analysis, the demographic and socioeconomic variables were not associated to the outcome in any of the three periods. CONCLUSIONS : The prevalence of simultaneous use of medicines at discharge and in the follow-ups pointed to the under-utilization of this therapy in clinical practice. Intervention strategies are needed to improve the quality of care given to patients that extend beyond the hospital discharge, a critical point of transition in care.