PubMed · 12183736
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David Kwee. 2002. Optimizing immunization--going beyond parent reminders.. https://doi.org/10.1067/mpd.2002.126007
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Infection-control recommendations include the use of gowns and gloves to prevent horizontal transmission of vancomycin-resistant enterococci (VRE). This study sought to determine whether the use of a gown and gloves gives greater protection than glove use alone against VRE transmission in a medical intensive care unit (MICU). From 1 July 1997 through 30 June 1998 and from 1 July 1999 through 31 December 1999, health care personnel and visitors were required to don gloves and gowns upon entry into rooms where there were patients infected with nosocomial pathogens. From 1 July 1998 through 30 June 1999, only gloves were required under these same circumstances. During the gown period, 59 patients acquired VRE (9.1 cases per 1000 MICU-days), and 73 patients acquired VRE during the no-gown period (19.6 cases per 1000 MICU-days; P<.01). The adjusted risk estimate indicated that gowns were protective in reducing VRE acquisition in an MICU with high VRE colonization pressure.
The objective of this study was to use finite-element analysis to model tensilometer tests of polymerizing dental composites. A typical sample in polymerization shrinkage stress tests is shaped like a flat disk, that is, has a high aspect ratio (ratio of diameter to height). In the experimental literature it is implied that the induced stress state in the flat disk composite samples is uniaxial. Three published tensilometer tests of curing dental composite samples with similar high aspect ratios (varying from 3 to 5) were modeled, but with test configurations having low, intermediate and high relative compliance (a tenfold variation). With the use of linear elastic finite element analysis, an instantaneous volumetric shrinkage of 1% was applied to the composite via the thermal analogy and the following questions were addressed: 1. Does the numerically predicted state of stress in composite samples tested in this fashion differ substantially from the uniaxial stress state assumed in the experiments?2. How do the numerically predicted stresses compare with the experimentally determined nominal stresses?3. Does compliance of the mountings influence the numerically predicted stress state? The finite-element results predicted a complex triaxial stress state that was strongly influenced by the compliance of the mountings. For the low and intermediate system compliance the model overpredicted the polymerization contraction stress, as would be anticipated due to the inability of the model to account for viscoplastic flow. For high system compliance, the numerical and experimental stress values were in better agreement, mainly because the linear elastic mountings accounted for most of the measured system compliance.
BACKGROUND: Total effective vascular compliance (TEVC), may be increased in cirrhosis. However, its significance is unclear. AIMS: To investigate TEVC in patients with cirrhosis, and the effects of propranolol. METHODS: Seven patients without liver disease and 44 cirrhotic patients were studied before and after double-blind administration of propranolol (n=33) or placebo (n=11). MEASUREMENTS: TEVC (right atrial pressure response to rapid central volume expansion), hepatic venous pressure gradient (HVPG) and systemic hemodynamics. RESULTS: TEVC (ml x mmHg(-1) x kg(-1)) was increased in cirrhotics (1.67 +/- 0.66 versus 1.33 +/- 0.32 in controls; P<0.05). TEVC was not modified by placebo, but was markedly reduced by propranolol (from 1.74 +/- 0.75 to 1.33 +/- 0.56; P<0.01). Propranolol decreased HVPG >10% in 20 patients ('responders': -20 +/- 9%) but <10% in 13 'non-responders'. TEVC was normalized by propranolol in HVPG 'responders' (from 1.76 +/- 0.88 to 1.21 +/- 0.51; P<0.01), but not in 'non-responders' (1.69 +/- 0.48 to 1.52 +/- 0.59; NS). Reduction of TEVC in responders was accompanied by increased free hepatic vein pressure (+21 +/- 20%, P=0.05; approximately 60% of the fall in HVPG), which was not observed in non-responders (+3 +/- 11%, NS). CONCLUSIONS: TEVC is increased in cirrhosis. This abnormality is corrected by propranolol in patients exhibiting a >10% fall in HVPG, suggesting that changes in vascular compliance may influence the portal pressure response to propranolol.