Adverse drug events in an intensive care unit of a university hospital

Purpose Adverse drug events (ADEs) are harmful and occur with alarming frequency in critically ill patients. Complex pharmacotherapy with multiple medications increases the probability of a drug interaction (DI) and ADEs in patients in intensive care units (ICUs). The objective of the study is to determine the frequency of ADEs among patients in the ICU of a university hospital and the drugs implicated. Also, factors associated with ADEs are investigated. Methods This cross-sectional study investigated 299 medical records of patients hospitalized for 5 or more days in an ICU. ADEs were identified through intensive monitoring adopted in hospital pharmacovigilance and also ADE triggers. Adverse drug reactions (ADR) causality was classified using the Naranjo algorithm. Data were analyzed through descriptive analysis, and through univariate and multiple logistic regression. Results The most frequent ADEs were ADRs type A, of possible causality and moderate severity. The most frequent ADR was drug-induced acute kidney injury. Patients with ADEs related to DIs corresponded to 7% of the sample. The multiple logistic regression showed that length of hospitalization (OR = 1.06) and administration of cardiovascular drugs (OR = 2.2) were associated with the occurrence of ADEs. Conclusion Adverse drug reactions of clinical significance were the most frequent ADEs in the ICU studied, which reduces patient safety. The number of ADEs related to drug interactions was small, suggesting that clinical manifestations of drug interactions that harm patients are not frequent in ICUs.

Tick saliva inhibits the chemotactic function of MIP-1 alpha and selectively impairs chemotaxis of immature dendritic cells by down-regulating cell-surface CCR5

Ticks are blood-feeding arthropods that secrete immunomodulatory molecules through their saliva to antagonize host inflammatory and immune responses. As dendritic cells (DCs) play a major role in host immune responses, we studied the effects of Rhipicephalus sanguineus tick saliva on DC migration and function. Bone marrow-derived immature DCs pre-exposed to tick saliva showed reduced migration towards macrophage inflammatory protein (MIP)-1 alpha, MIP-1 beta and regulated upon activation, normal T cell expressed and secreted (RANTES) chemokines in a Boyden microchamber assay. This inhibition was mediated by saliva which significantly reduced the percentage and the average cell-surface expression of CC chemokine receptor CCR5. In contrast, saliva did not alter migration of DCs towards MIP-3 beta, not even if the cells were induced for maturation. Next, we evaluated the effect of tick saliva on the activity of chemokines related to DC migration and showed that tick saliva per se inhibits the chemotactic function of MIP-1 alpha, while it did not affect RANTES, MIP-1 beta and MIP-3 beta. These data suggest that saliva possibly reduces immature DC migration, while mature DC chemotaxis remains unaffected. In support of this, we have analyzed the percentage of DCs on mice 48 h after intradermal inoculation with saliva and found that the DC turnover in the skin was reduced compared with controls. Finally, to test the biological activity of the saliva-exposed DCs, we transferred DCs pre-cultured with saliva and loaded with the keyhole limpet haemocyanin (KLH) antigen to mice and measured their capacity to induce specific T cell cytokines. Data showed that saliva reduced the synthesis of both T helper (Th)1 and Th2 cytokines, suggesting the induction of a non-polarised T cell response. These findings propose that the inhibition of DCs migratory ability and function may be a relevant mechanism used by ticks to subvert the immune response of the host. (c) 2007 Australian Society for Parasitology Inc. Published by Elsevier Ltd. All rights reserved.

Promoting health in families of children with type 1 diabetes mellitus

This paper presents a study of families of children with type 1 diabetes mellitus, emphasizing the identification of social supports and networks to strengthen interventions aimed at health promotion. The approach selected was a qualitative research, using a case study design. Four families of children with diabetes type 1 were studied, totalling seven participants. Data were collected between April and June 2007, through in-depth interviews and the construction of a genogram and an ecomap. The results presented the families` characterization and testimonies grouped in the following categories: social support, social networks and family roles. To promote care in practice, there is a need to identify the characteristics of each family and resources available that provide better living conditions. We concluded that identifying supports and social networks allows for more personalized care delivery to each family with a view to health promotion.

Low-intensity Ultrasound Increases FAK, ERK-1/2, and IRS-1 Expression of Intact Rat Bones in a Noncumulative Manner

Background Low-intensity pulsed ultrasound stimulation (LIPUS) reportedly increases osteogenesis in fracture models but fails in intact bone, suggesting LIPUS does not act on mechanotransduction and growth factor pathways of intact bone. Questions/Purposes We asked whether daily 20-minute LIPUS applied to intact tibias would act on bone proteins involved in mechanotransduction (focal adhesion kinase [FAK], and extracellular signal-regulated kinase-1/2 [ERK-1/2]), and growth factor signaling (insulin receptor substrate-1 [IRS-1]) pathways at 7, 14, and 21 days of treatment. Methods Immunoblotting was performed to detect FAK, ERK-1/2, and IRS-1 expression and activation from the stimulated intact tibias at 7, 14, and 21 days of daily 20-minute LIPUS. Results LIPUS increased FAK expression (at 7 days), ERK-1/2 (at 14 days), and IRS-1 (at 7 days), but expression decreased 7 days later, indicating a noncumulative effect of LIPUS. As only FAK expression was detected at 21 days, these observations suggest LIPUS influences nuclear reactions that may be modulated by a major cellular mechanism preferentially inhibiting IRS-1 expression and not FAK expression. Increased ERK-1/2 expression at 14 days suggests the differing mechanisms for promoting ERK-1/2, FAK, and IRS-1 syntheses. IRS-1 expression behaved similarly to FAK expression; therefore, LIPUS may modulate growth factor pathways. LIPUS increased sustained FAK and ERK-1/2 activation, but not IRS-1, suggesting sustained ERK-1/2 activation is not the result of mechanically induced growth factor activation. Conclusions LIPUS acts on mechanotransduction and growth factor pathways in intact bone in a noncumulative manner. Clinical relevance These data suggest LIPUS applied to intact bone acts on proteins involved in osteogenesis.

Analytical formulae for electromechanical effective properties of 3-1 longitudinally porous piezoelectric materials

A unidirectional fiber composite is considered here, the fibers of which are empty cylindrical holes periodically distributed in a transversely isotropic piezoelectric matrix, The empty-fiber cross-section is circular and the periodicity is the same in two directions at an angle pi/2 or pi/3. Closed-form formulae for all electromechanical effective properties of these 3-1 longitudinally periodic porous piezoelectric materials are presented. The derivation of such expressions is based on the asymptotic homogenization method as a limit of the effective properties of two-phase transversely isotropic parallel fiber-reinforced composites when the fibers properties tend to zero. The plane effective coefficients satisfy the corresponding Schulgasser-Benveniste-Dvorak universal type of relations, A new relation among the antiplane effective constants from the solutions of two antiplane strains and potential local problems is found. This relation is valid for arbitrary shapes of the empty-fiber cross-sections. Based on such a relation, and using recent numerical results for isotropic conductive composites, the antiplane effective properties are computed for different geometrical shapes of the empty-fiber cross-section. Comparisons with other analytical and numerical theories are presented. (c) 2008 Acta Materialia Inc. Published by Elsevier Ltd. All rights reserved.

An exact conserving algorithm for nonlinear dynamics with rotational DOFs and general hyperelasticity. Part 1: Rods

A fully conserving algorithm is developed in this paper for the integration of the equations of motion in nonlinear rod dynamics. The starting point is a re-parameterization of the rotation field in terms of the so-called Rodrigues rotation vector, which results in an extremely simple update of the rotational variables. The weak form is constructed with a non-orthogonal projection corresponding to the application of the virtual power theorem. Together with an appropriate time-collocation, it ensures exact conservation of momentum and total energy in the absence of external forces. Appealing is the fact that nonlinear hyperelastic materials (and not only materials with quadratic potentials) are permitted without any prejudice on the conservation properties. Spatial discretization is performed via the finite element method and the performance of the scheme is assessed by means of several numerical simulations.

Experimental investigation of flow-induced vibration on isolated and tandem circular cylinders fitted with strakes

The effect of varying the geometric parameters of helical strakes on vortex-induced vibration (VIV) is investigated in this paper. The degree of oscillation attenuation or even suppression is analysed for isolated circular cylinder cases. How a cylinder fitted with strakes behaves when immersed in the wake of another cylinder in tandem arrangement is also investigated and these results are compared to those with a single straked cylinder. The experimental tests are conducted at a circulating water channel facility and the cylindrical models are mounted on a low-damping air bearing elastic base with one degree-of-freedom, restricted to oscillate in the transverse direction to the channel flow. Three strake pitches (p) and heights (h) are tested: p = 5, 10, 15d, and h = 0.1, 0.2, 0.25d. The mass ratio is 1.8 for all models. The Reynolds number range is from 1000 to 10000, and the reduced velocity varies up to 21. The cases with h = 0.1d strakes reduce the amplitude response when compared to the isolated plain cylinder, however the oscillation still persists. On the other hand, the cases with h = 0.2, 0.25d strakes almost completely suppress VIV. Spanwise vorticity fields, obtained through stereoscopic digital particle image velocimetry (SDPIV), show an alternating vortex wake for the p = 10d and h = 0.1d straked cylinder. The p = 10d and h = 0.2d cylinder wake has separated shear layers with constant width and no roll-up close to the body. The strakes do not increase the magnitude of the out-of-plane velocity compared to the isolated plain cylinder. However, they deflect the flow in the out-of-plane direction in a controlled way, which can prevent the vortex shedding correlation along the span. In order to investigate the wake interference effect on the strake efficiency, an experimental arrangement with two cylinders in tandem is employed. The centre-to-centre distance for the tandem arrangement varies from 2 to 6. When the downstream p = 10d and h = 0.2d cylinder is immersed in the wake of an upstream fixed plain cylinder, it loses its effectiveness compared with the isolated case. Although the oscillations have significant amplitude, they are limited, which is a different behaviour from that of a tandem configuration with two plain cylinders. For this particular case, the amplitude response monotonically increases for all gaps, except one, a trait usually found in galloping-like oscillations. SDPIV results for the tandem arrangements show alternating vortex shedding and oscillatory wake. (C) 2010 Elsevier Ltd. All rights reserved.

Influência da função distribuição de quebra na modelagem e simulação do circuito de moagem de Carajás - Parte 1 - ajuste de modelos

The perfect mixing model (PMM) is based on parameters derived from the equipment characteristics as well as ore breakage characteristics. Ore characteristics are represented through the appearance function. This function may be determined using JKMRC laboratorial methods or by standard functions. This work describes the model fitting process of the Carajas grinding circuit, using the JKSimMet simulator Two scenarios were used in model fitting exercises: 1) standard appearance function; and 2) appearance fund ion based on testing carried out on samples taken at circuit feed. From this assessment, the appearance function`s influence in the PMM,fit and it`s relation with the breakage rate were determined. The influence of the appearance function on the respective breakage rate distribution was assessed.

Cement stabilization of runoff residuals: A study of stabilization/solidification of urban rainfall-runoff residuals in type 1 Portland cement by XRD and Si-29 NMR analysis

Urban rainfall-runoff residuals contain metals such as Cr, Zn, Cu, As, Pb and Cd and are thus reasonable candidates for treatment using Portland cement-based solidification-stabilization (S/S). This research is a study of S/S of urban storm water runoff solid residuals in Portland cement with quicklime and sodium bentonite additives. The solidified residuals were analyzed after 28 days of hydration time using X-ray powder diffraction (XRD) and solid-state Si-29 nuclear magnetic resonance (NMR) spectroscopy. X-ray diffraction (XRD) results indicate that the main cement hydration products are ettringite, calcium hydroxide and hydrated calcium silicates. Zinc hydroxide and lead and zinc silicates are also present due to the reactions of the waste compounds with the cement and its hydration products. Si-29 NMR analysis shows that the coarse fraction of the waste apparently does not interfere with cement hydration, but the fine fraction retards silica polymerization.

Effect of alpha prime due to 475 degrees C aging on fracture behavior and corrosion resistance of DIN 1.4575 and MA 956 high performance ferritic stainless steels

The 475 degrees C embrittlement in stainless steels is a well-known phenomenon associated to alpha prime (alpha`) formed by precipitation or spinodal decomposition. Many doubts still remain on the mechanism of alpha` formation and its consequence on deformation and fracture mechanisms and corrosion resistance. In this investigation, the fracture behavior and corrosion resistance of two high performance ferritic stainless steels were investigated: a superferritic DIN 1.4575 and MA 956 superalloy were evaluated. Samples of both stainless steels (SS) were aged at 475 degrees C for periods varying from 1 to 1,080 h. Their fracture surfaces were observed using scanning electron microscopy (SEM) and the cleavage planes were determined by electron backscattering diffraction (EBSD). Some samples were tested for corrosion resistance using electrochemical impedance spectroscopy (EIS) and potentiodynamic polarization. Brittle and ductile fractures were observed in both ferritic stainless steels after aging at 475 degrees C. For aging periods longer than 500 h, the ductile fracture regions completely disappeared. The cleavage plane in the DIN 1.4575 samples aged at 475 degrees C for 1,080 h was mainly {110}, however the {102}, {314}, and {131} families of planes were also detected. The pitting corrosion resistance decreased with aging at 475 degrees C. The effect of alpha prime on the corrosion resistance was more significant in the DIN 1.4575 SS comparatively to the Incoloy MA 956.

Selective corrosion of 550 degrees C aged Cu10Ni-3Al-1.3Fe alloy in NaCl aqueous solution

This work studied the electrochemical behavior of a solution treated or 550 degrees C aged Cu10Ni-3Al-1.3Fe alloy, in 0.01 M NaCl aqueous solution, through potentiodynamic polarization in both stagnant condition or under erosion process. Results showed the occurrence of a passivity break potential (E(pb)), related to the beginning of the denickelification process, which occurred as a localized attack under stagnant electrolyte. Under erosion conditions localized denickelification was not observed, despite of the presence of E(pb). This could indicate that selective corrosion of Ni, which caused the observed E(pb), occurred as a dissolution-redeposition process, with removal of the Cu deposits during erosion process. (C) 2011 Elsevier Ltd. All rights reserved.

Cracking of 2.25Cr-1.0Mo steel tube/stationary tube-sheet weldment of a heat-exchanger

The premature failure of a horizontal heat-exchanger, which occurred after service exposure at 580 degrees C for 50,000 h, revealed the occurrence of extensive through-thickness cracking in approximately 40% of the tube/stationary tube-sheet welds. Additionally, the internal surface of the welded joint featured intensive secondary intergranular cracking (up to 250 mu m deep), preferential formation of a 150 mu m thick layer of (Fe, Cr)(3)O-4 and internal intergranular oxidation (40 mu m deep). The welded region also showed intense carbon pick-up and, as consequence, severe precipitation of intergranular M7C3 and M23C6 carbides. The fracture surface was composed of two distinct regions: a ""planar"" region of 250 mu m, formed due to the stable crack growth along by the intergranular oxidation; and a slant region with radial marks, formed by the fast crack growth along the network of intergranular carbides. The association of intergranular oxidation pre-cracks with microstructural embrittlement promoted the premature failure, which took place by an overload mechanism, probably due to the jamming of the floating tube-sheet during the maintenance halt (cooling operation). (C) 2007 Elsevier Ltd. All rights reserved.

Use of SECM to study the electrochemical behavior of DIN 1.4575 superferritic stainless steel aged at 475 degrees C

In order to lower the excessive costs of metallic prosthesis materia Is alternatives to Ti and Ti alloys have been searched. in this study, the corrosion resistance of the DIN 1.4575 superferritic stainless steel, either solution annealed or solution annealed and aged at 475 degrees C for periods varying from 100 to 1080 h, was investigated by electrochemical impedance spectroscopy (EIS) and potentiodynamic polarization methods in Hanks` solution. The solution annealed and the aged for 1080 h samples were also tested using scanning electrochemical microscopy (SECM) in a 0.1 mol/L NaCl solution at 25 degrees C. The EIS results showed that the corrosion resistance of the DIN 1.4575 steel decreases with heat treatment time at 475 degrees C probably due to alpha prime formation. Besides the diminution of the overall impedance values, the low frequency limit of the Nyquist diagrams show a progressive change from an almost capacitive response to a resistive behavior as the heat treatment time increases. Pitting corrosion resistance also decreased with aging time at 475 degrees C.

Transport Barkhausen-like noise in uniaxially pressed Bi(1.65)Pb(0.35)Sr(2)Ca(2)Cu(3)O(10+delta) ceramic samples

We report on the detection of the transport Barkhausen-like noise (TBN) in polycrystalline samples of Bi(1.65)Pb(0.35)Sr(2)Ca(2) Cu(3)O(10+delta) (Bi-2223) which were subjected to different uniaxial compacting pressures. The transport Barkhausen-like noise was measured when the sample was subjected to an ac triangular-shape magnetic field (f similar to 1 Hz) with maximum amplitude B(max) approximate to 5.5 mT, in order to avoid the flux penetration within the superconducting grains. Analysis of the TBN signal, measured for several values of excitation current density, indicated that the applied magnetic field in which the noise signal first appears, B(a)(t(i)), is closely related to the magnetic-flux pinning capability of the material. The combined results are consistent with the existence of three different superconducting levels within the samples: (i) the superconducting grains; (ii) the superconducting clusters; and (iii) the weak-links. We finally argue that TBN measurements constitute a powerful tool for probing features of the intergranular transport properties in polycrystalline samples of high-T(c) superconductors. (C) 2010 Elsevier B.V. All rights reserved.

Study of copper electrodeposition mechanism from a strike alkaline bath prepared with 1-hydroxyethane-1,1-diphosphonic acid through cyclic voltammetry technique

Copper strike baths are extensively used in metal plating industry as they present the ability to plate adherent copper layers on less-noble metal substrates such as steel and zinc die castings. However, in the last few years, due to environmental controls and safety policies for operators, the plating industry has been interested in replacing the toxic cyanide copper strike baths with environmentally friendly baths. A broad bibliographic review showed that the published papers, referring to the new nontoxic copper strike baths, are patents, having little or no emphasis focused on electrodeposition mechanisms. Therefore, it was decided to study the copper electrodeposition mechanism from a strike alkaline bath prepared with one of the most nontoxic chelating agents cited in many patents which is the 1-hydroxyethane-1,1-diphosphonic acid, known as HEDP. This acid forms very stable water soluble complexes with Cu(2+) ions, thus cupric sulfate was used for preparing the plating bath. The results obtained through a cyclic voltammetry technique showed that Cu(2+) ion reduction to Cu from an HEDP electrodeposition bath occurs via a direct reduction reaction without a formation of Cu(+) intermediates. (C) 2010 Elsevier Ltd. All rights reserved.