A randomised controlled trial of the effectiveness of soft silicone multi-layered foam dressings in the prevention of sacral and heel pressure ulcers in trauma and critically ill patients: The border trial

The prevention of hospital acquired pressure ulcers in critically ill patients remains a significant clinical challenge. The aim of this trial was to investigate the effectiveness of multi-layered soft silicone foam dressings in preventing intensive care unit (ICU) pressure ulcers when applied in the emergency department to 440 trauma and critically ill patients. Intervention group patients (n = 219) had Mepilex^® Border Sacrum and Mepilex^® Heel dressings applied in the emergency department and maintained throughout their ICU stay. Results revealed that there were significantly fewer patients with pressure ulcers in the intervention group compared to the control group (5 versus 20, P = 0·001). This represented a 10% difference in incidence between the groups (3·1% versus 13·1%) and a number needed to treat of ten patients to prevent one pressure ulcer. Overall there were fewer sacral (2 versus 8, P = 0·05) and heel pressure ulcers (5 versus 19, P = 0·002) and pressure injuries overall (7 versus 27, P = 0·002) in interventions than in controls. The time to injury survival analysis indicated that intervention group patients had a hazard ratio of 0·19 (P = 0·002) compared to control group patients. We conclude that multi-layered soft silicone foam dressings are effective in preventing pressure ulcers in critically ill patients when applied in the emergency department prior to ICU transfer.

Faster than the speed of white (noise): potential pressure points in research partnerships and processes

White noise occurs in the thinking, decision making and communication of dominant Settler cultures. It inhibits clear reception of messages, somewhat like the indistinct, fuzzy static of an un-tuned radio. As much a systemic issue as an individual one, it results from assumed privilege and lack of knowledge of worldviews other than the dominant. Until white noise is acknowledged, development of partnerships between Indigenous and non-Indigenous groups is likely to be limited by having to continually start at a point of inequality where nonIndigenous gaps in knowledge and understanding remain unrecognised. This paper/workshop considers challenges encountered while researching experiences of Aboriginal education in Western Australian prisons. Each pressure point occurred where the dominant world view prevailed without question. Discussion will focus on the specific pressure points of ethics approval, project development, informed consent and application of outcomes and findings. The paper asks the questions ‘Who decides what stories are created at these pressure points? What informs those stories?’ As individuals, we might not be able to crash through the white noise barrier but we can chip away and be transparent about its existence with the goal of eventually moving faster than the speed of white (noise).

Cortisol, blood pressure, and heart rate responses to food intake were independent of physical fitness levels in women

This research tested the hypothesis that women who had higher levels of physical fitness will have lower hypothalamo-pituitary-adrenal axis (cortisol) and sympatho-adrenal medullary system (blood pressure and heart rate) responses to food intake compared with women who had low levels of physical fitness. Lower fitness (n = 22; maximal oxygen consumption = 27.4 ± 1.0 mL∙kg(-1)·min(-1)) and higher fitness (n = 22; maximal oxygen consumption = 41.9 ± 1.6 mL∙kg(-1)·min(-1)) women (aged 30-50 years; in the follicular phase of the menstrual cycle) who participated in levels of physical activity that met (lower fitness = 2.7 ± 0.5 h/week) or considerably exceeded (higher fitness = 7.1 ± 1.4 h/week) physical activity guidelines made their own lunch using standardised ingredients at 1200 h. Concentrations of cortisol were measured in blood samples collected every 15 min from 1145-1400 h. Blood pressures and heart rate were also measured every 15 min between 1145 h and 1400 h. The meal consumed by the participants consisted of 20% protein, 61% carbohydrates, and 19% fat. There was a significant overall response to lunch in all of the parameters measured (time effect for all, p < 0.01). The cortisol response to lunch was not significantly different between the groups (time × treatment, p = 0.882). Overall, both groups showed the same pattern of cortisol secretion (treatment p = 0.839). Systolic blood pressure, diastolic blood pressure, mean arterial pressure, or heart rate responses (time × treatment, p = 0.726, 0.898, 0.713, and 0.620, respectively) were also similar between higher and lower fitness women. Results suggest that the physiological response to food intake in women is quite resistant to modification by elevated physical fitness levels.

The sexual motivation of boars housed adjacent to ovariectomised gilts did not affect the efficiency of detecting hormonally induced oestrus using the back pressure test

This study tested the hypothesis that the efficiency of detecting oestrus in gilts, using the back pressure test (BPT), will be reduced when gilts are housed adjacent to a boar of high sexual motivation compared to when gilts are housed adjacent to a boar of low sexual motivation. The experiment was a 2 x 2 Latin square design with three replicates. Boars of high and low sexual motivation were selected on the basis of the total number of copulations and the mean reaction time to first mount during three mating tests. Twelve boars were observed in mating tests and the three highest and lowest ranking boars were assigned to three palm, each pair containing a boar of high and a boar of low sexual motivation. One pair was used in each replicate. In each replicate, two groups of six ovariectomised gilts were housed for 14 days, commencing 7 days prior to hormonally induced destrus, adjacent to a boar of either high or low sexual motivation. All gilts were checked twice daily for oestrus using the BPT. In the first replicate, the level of proceptive behaviour of the gilts was quantified immediately after checking for oestrus in a 3-rain test in which the amount of time that the gilts spent within 0.5 m of a pen containing a sexually mature boar was recorded. There were no effects of housing gilts adjacent to boars of high or low sexual motivation on the percentage of gilts detected in oestrus, the percentage of gilts detected in oestrus for more than I day, the duration of oestrus or the level of proceptive behaviour of gilts. These data suggest that the level of sexual motivation of boars does not influence the efficiency of detecting hormonally induced oestrus, using the BPT, in ovariectomised gilts housed adjacent to boars.

Brazil: the pressure points in labor legislation

Brazil’s experience shows that the economic and political history of a country is a critical determinant of which labor laws influence wages and employment, and which are not binding. Long periods of high inflation, illiteracy of the workforce, and biases in the design and enforcement of labor legislation bred by the country’s socioeconomic history are all important in determining the reach of labor laws. Defying conventional wisdom, these factors are shown to affect labor market outcomes even in the sector of employment regarded as unregulated. Following accepted practice in Brazil, we distinguish regulated from unregulated employment by determining whether or not the contract has been ratified by the Ministry of Labor, viz., groups of workers with and without signed work booklet. We then examine the degree of adherence to labor laws in the formal and informal sectors, and finds “pressure points” – viz., evidence of the law on minimum wage, work-hours, and payment timing being binding on outcomes – in both the formal and informal sectors of the Brazilian labor market. The findings of the paper imply that in terms of the design of legislation, informality in Brazil is mainly a fiscal, and not a legal phenomenon. But the manner in which these laws have been enforced is also critical determinant of informality in Brazil: poor record-keeping has strengthened the incentives to stay informal that are already built into the design of the main social security programs, and ambiguities in the design of labor legislation combined with slanted enforcement by labor courts have led to workers effectively being accorded the same labor rights whether or not they have ratified contracts. The incentives to stay informal are naturally higher for workers who are assured of protection under labor legislation regardless of the nature of their contract, which only alters their financial relationship with the government. The paper concludes that informality in Brazil will remain high as long as labor laws remain ambiguous and enforced with a clear pro-labor bias, and social security programs lack tight benefitcontribution linkages and strong enforcement mechanisms.

Intraocular pressure evaluation of equines anesthetized with romifidine, tiletamine/zolazepam, halothane and vecuronium

O objetivo deste estudo foi o de avaliar uma associação anestésica com e sem a utilização de relaxante muscular não-despolarizante e seu efeito sobre a pressão intra-ocular de eqüinos. Também objetivou-se uma técnica anestésica sem efeitos adversos que possa ser utilizada em procedimentos e cirurgias oftálmicas nesta espécie animal. Para tanto, dezesseis eqüinos foram divididos aleatoriamente em dois grupos de oito animais cada. Os animais do grupo I foram pré-medicados com romifidina, induzidos com tiletamina/zolazepam e a anestesia foi mantida com halotano e vecurônio. Os animais do grupo II receberam a mesma associação anestésica, com exceção do vecurônio. No decorrer do experimento, a pressão intra-ocular, a pressão arterial e a freqüência cardíaca foram avaliadas em diferentes momentos. A associação anestésica composta pela romifidina, tiletamina/ zolazepam e halotano com e sem vecurônio não promoveu alterações estatisticamente significativas na pressão intra-ocular de eqüinos e o seu uso é exeqüível em procedimentos oftálmicos nesta espécie animal.

Resting Heart Rate is Associated with Blood Pressure in Male Children and Adolescents

Objectives To analyze the association between resting heart rate and blood pressure in male children and adolescents and to identify if this association is mediated by important confounders.Study design Cross-sectional study carried out with 356 male children and adolescents from 8 to 18 years old. Resting heart rate was measured by a portable heart rate monitor according to recommendations and stratified into quartiles. Blood pressure was measured with an electronic device previously validated for pediatric populations. Body fatness was estimated by a dual-energy x-ray absorptiometry.Results Obese subjects had values of resting heart rate 7.8% higher than nonobese (P = .001). Hypertensive children and adolescents also had elevated values of resting heart rate (P = .001). When the sample was stratified in nonobese and obese, the higher quartile of resting heart rate was associated with hypertension in both groups of children and adolescents.Conclusions This study confirms the existence of a relationship between elevated resting heart rate and increased blood pressure in a pediatric population, independent of adiposity, ethnicity and age. (J Pediatr 2011; 158:634-7).

Treatment of PET and PU polymers by atmospheric pressure plasma generated in dielectric barrier discharge in air

Plasma treatments are frequently employed to modify surface properties of materials such as adhesivity, hydrophobicity, oleophobicity etc. Present work deals with surface modification of common commercial polymers such as polyethylene terephthalate (PET) and polyurethane (PU) by an air dielectric barrier discharge (DBD) at atmospheric pressure. The DBD treatment was performed in a plain reactor in wire-duct geometry (non-uniform field reactor), which was driven by a 60 Hz power supply. Material characterization was carried out by water contact angle measurements, atomic force microscopy (AFM) and X-ray photoelectron spectroscopy (XPS). The plasma-induced modifications are associated with incorporation of polar oxygen and nitrogen containing groups on the polymer surface. The AFM analysis reveals that the plasma treatment roughens the material surface. Due to these structural and morphological changes the surface of DBD-treated polymers becomes more hydrophilic resulting in enhanced adhesion properties. (C) 2010 Elsevier B.V. All rights reserved.

Surface modification of siloxane containing polyurethane polymer by dielectric barrier discharge at atmospheric pressure

Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)

Modification of polyethylene terephthalate by atmospheric pressure dielectric barrier discharge (DBD) in view of improving the polymer wetting properties

Surface treatment of polymers by discharge plasmas has increasingly found industrial applications due to its capability of modifying uniformly the surface without changing the material bulk properties. This work deals with surface modification of polyethylene terephthalate (PET) by a dielectric barrier discharge (DBD) at atmospheric pressure. The treatments were conducted in air, nitrogen or argon plasma. The polymer surface was characterized by contact angle measurement, X-ray photoelectron spectroscopy (XPS) and atomic force microscopy (AFM). The results show that the plasma treatment introduces oxygen-and nitrogen-related polar groups on the polymer surface and promotes the surface roughening. Both plasma-induced surface modifications contribute to the enhancement of the polymer wettability.

Surface characteristics analysis of polypropylene treated by dielectric barrier discharge at atmospheric pressure

Polypropylene (PP) samples were treated by Dielectric Barrier Discharge (DBD) in order to modify their surface characteristics. The XPS analysis reveals that the DBD treatment added oxygen atoms to the PP surface. These polar groups cause increase in the wettability as shown by water contact angle measurements. The formation of low-molecular-weight oxidized materials (LMWOMs) in the form of small nodules on the PP surface was observed by atomic force microscopy (AFM). The presence of oxygen polar groups on the PP surface was also confirmed by infrared spectroscopy (FTIR). All analysis were performed before and after rinsing the treated samples in water and showed that the LMWOM can be removed from the surface by polar solvents.

Does sealing endotracheal tube cuff pressure diminish the frequency of postoperative laryngotracheal complaints after nitrous oxide anesthesia?

Study Objectives: To study endotracheal tube (ETT) cuff pressures during nitrous oxide (N2O) anesthesia when the cuffs are inflated with air to achieve sealing pressure, and to evaluate the frequency of postoperative laryngotracheal complaints.Design: Prospective, randomized, blind study.Setting: Metropolitan teaching hospital.Patients: 50 ASA physical status I and II patients scheduled for elective abdominal surgery.Interventions: Patients received standard general anesthesia with 66% N2O in oxygen. In 25 patients, the ETT cuff was inflated with air to achieve a sealing pressure (P-seal group). In 25 patients, the ETT cuff was inflated with air to achieve a pressure of 25 cm H2O (P-25 group).Measurements and Main Results: ETT intracuff pressures were recorded before (control) and at 30, 60, 90, 120, and 150 minutes during N2O administration. We investigated the frequency and intensity of sore throat, hoarseness, and dysphagia in patients in the Post-Anesthesia Care Unit (PACU) and 24 hours following tracheal extubation. The cuff pressures in the P-seal group were significantly lower than in the P-25 group at all time points studied (p < 0.001), with a significant increase with time in both groups (p < 0.001). The cuff pressures exceeded the critical pressure of 30 cm H2O only after 90 minutes in the P-seal group and already by 30 minutes in the P-25 group. The frequency and intensity of sore throat, hoarseness, and dysphagia were similar in both groups in the PACU and 24 hours after tracheal extubation (p > 0.05).Conclusions: Minimum ETT sealing cuff pressure during N2O anesthesia did not prevent, but instead attenuated, the increase in cuff pressure and did not decrease postoperative laryngotracheal complaints. (C) 2004 by Elsevier B.V.

High-Frequency Oscillatory Ventilation Associated With Inhaled Nitric Oxide Compared to Pressure-Controlled Assist/Control Ventilation and Inhaled Nitric Oxide in Children: Randomized, Non-Blinded, Crossover Study

Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)

Comparison between intermittent mandatory ventilation and synchronized intermittent mandatory ventilation with pressure support in children

Objective: To compare intermittent mandatory ventilation (IMV) with synchronized intermittent mandatory ventilation plus pressure support (SIMV+PS) in terms of time on mechanical ventilation, duration of weaning and length of stay in a pediatric intensive care unit (PICU).Methods: This was a randomized clinical trial that enrolled children aged 28 days to 4 years who were admitted to a PICU between October of 2005 and June of 2007 and put on mechanical ventilation (MV) for more than 48 hours. These patients were allocated to one of two groups by drawing lots: IMV group (IMVG; n = 35) and SIMV+PS group (SIMVG; n = 35). Children were excluded if they had undergone tracheotomy or had chronic respiratory diseases. Data on oxygenation and ventilation were recorded at admission and at the start of weaning.Results: There were no statistical differences between the groups in terms of age, sex, indication for MV, PRISM score, Comfort scale, use of sedatives or ventilation and oxygenation parameters. The median time on MV was 5 days for both groups (p = 0.120). There were also no statistical differences between the two groups for duration of weaning [IMVG: 1 day (1-6) vs. SIMVG: 1 day (1-6); p = 0.262] or length of hospital stay [IMVG: 8 days (2-22) vs. SIMVG: 6 days (3-20); p = 0.113].Conclusion: Among the children studied here, there was no statistically significant difference between IMV and SIMV+ PS in terms of time on MV, duration of weaning or time spent in the PICU.ClinicalTrials.govID: NCT00549809.

Incidence of high blood pressure in a group of tannery workers in Brazil

O objetivo deste estudo foi medir a incidência de hipertensão arterial sistêmica em um curtume de médio porte em Botucatu, São Paulo, Sudeste do Brasil, onde havia sido observada, em estudo prévio, uma correlação positiva entre tempo de trabalho e níveis pressóricos, bem como uma alta prevalência de hipertensão. Para tanto, uma coorte de trabalhadores desse curtume foi acompanhada durante sete anos. Ao final do seguimento, estimou-se a taxa de incidência de hipertensão arterial como 0,0964.ano-1, valor considerado elevado se comparado com o encontrado em outros grupos profissionais.