Dr. Clayton Forrester's Science Roundup

[Bob Gray]

Re: Dr. Clayton Forrester's Science Roundup

There was an interesting story on the Beeb this morning about the environmental risk/reward of nuclear power. It hasn't been posted to their Science page yet, but when it is I recommend it.

To any nuclear engineers (or anyway someone more related than Playwriting majors) out there: is there an online resource you recommend for a good overview of the topic? I'm taking Wiki as the baseline.

Nuclear power is a big trade-off for environmentalists. The lack of emissions from a true base load power plant is really great. On the other hand, concern for the fuel potential/past issues surrounding it is a significant negative (like here in AZ there are water issues due to uranium getting in the water up around the Navajo Reservation). That's why you have seen over time environmental folks come out on both sides of the issue. Obama's proposed EPA 111(d) carbon rules generated a lot of discussions regarding nukes. Among other things, several Southern states that are constructing new nuke plants wouldn't get credit for them toward their carbon reduction goals.

 

[Kepler]

Re: Dr. Clayton Forrester's Science Roundup

Nuclear power is a big trade-off for environmentalists. The lack of emissions from a true base load power plant is really great. On the other hand, concern for the fuel potential/past issues surrounding it is a significant negative (like here in AZ there are water issues due to uranium getting in the water up around the Navajo Reservation). That's why you have seen over time environmental folks come out on both sides of the issue. Obama's proposed EPA 111(d) carbon rules generated a lot of discussions regarding nukes. Among other things, several Southern states that are constructing new nuke plants wouldn't get credit for them toward their carbon reduction goals.

There was a debate (well, shouting contest) tacked on to the end of the story between an anti-nuclear Green and a formerly-anti-nuclear-now-pro-nuclear ex-Green environmentalist. The two major issues they discussed (well, shouted over each other about) were the carbon emissions of coal and "base load," (the floor you need on the grid at all times to keep it on). It also introduced to me the quaint term "Deaths per Terawatt Hour," which is exactly what you'd think it is.

 

[Bob Gray]

Re: Dr. Clayton Forrester's Science Roundup

There was a debate (well, shouting contest) tacked on to the end of the story between an anti-nuclear Green and a formerly-anti-nuclear-now-pro-nuclear ex-Green environmentalist. The two major issues they discussed (well, shouted over each other about) were the carbon emissions of coal and "base load," (the floor you need on the grid at all times to keep it on). It also introduced to me the quaint term "Deaths per Terawatt Hour," which is exactly what you'd think it is.

I'd curious what they'd be arguing about on carbon emissions and base load power? Nuclear is the ultimate base load plant (very high up front cost, but then low variable costs per kWh generated). Coal emissions are what they are, though some of them vary a lot whether you're an older coal plant that hasn't had a lot of upgrades or a new plant with all the latest emissions controls. Though apart from sequestration the carbon piece of coal emissions doesn't vary greatly between an older and newer coal plant.

 

[walrus]

Re: Dr. Clayton Forrester's Science Roundup

There was a debate (well, shouting contest) tacked on to the end of the story between an anti-nuclear Green and a formerly-anti-nuclear-now-pro-nuclear ex-Green environmentalist. The two major issues they discussed (well, shouted over each other about) were the carbon emissions of coal and "base load," (the floor you need on the grid at all times to keep it on). It also introduced to me the quaint term "Deaths per Terawatt Hour," which is exactly what you'd think it is.

Interesting graphs.

 

[WisconsinWildcard]

Re: Dr. Clayton Forrester's Science Roundup

Stop being silly and evasive. You knew exactly what I asked. If you'd not dance around things in this way, maybe there could be some actual discussion.

I am not sure how many times it has to be said but this will be my last. I said NO, I do not believe only doctors who receive the flu shot are rational, capable, and should practice medicine.

Stop harping on something that I did not say. There are several posters here who read my answer the way I intended it, so I do not think I was unclear.

 

[Bob Gray]

Re: Dr. Clayton Forrester's Science Roundup

I am not sure how many times it has to be said but this will be my last. I said NO, I do not believe only doctors who receive the flu shot are rational, capable, and should practice medicine.

Stop harping on something that I did not say. There are several posters here who read my answer the way I intended it, so I do not think I was unclear.

Fair enough with your clarification.

 

[WisconsinWildcard]

Re: Dr. Clayton Forrester's Science Roundup

I'll give you the benefit of the doubt that you're not being purposely misleading. The info I cited was old CDC numbers, something you have yet to dispute.

I cannot dispute because I cannot find the original source. I have tried to look but I have not been able to track down numbers that coincide with what the ABC article states. You are citing something from a secondhand source which is difficult to dispute for me, because I do not know where the information actually came from.

Nothing opinion related there. Someone took the time to look them up and the new numbers are noticeably higher, though your 8 percent number is misleading, as the overall number is 1 in 4 healthcare workers still don't get a flu shot.

I would argue that is the wrong number to use. The (more) important number is the percentage in health care workers who actually contact patients. Look at the numbers, and it is about 90% vaccination among them. Would you agree it is not as important for the secretary in the admin building to get a vaccine than the nurse who is taking care of sick patients?

Also note, "Coverage was highest among HCP working in settings with flu vaccination requirements (97.8%)." Flu vaccination requirements work, and people get the vaccine. Those hospitals that have the requirement tend to have lower influenza morbidity and mortality. Do you not think it is important to reduce hospital acquired infections that injure and kill patients?

The number not getting shots is particularly high in long term care, dealing with the elderly.

Do you think this is a good thing?
"In addition, multiple studies have demonstrated health benefit to patients, including reduced risk for death, with vaccination of HCP in LTCF"

Carman WF, Elder WG, Wallace LA, et al. Effects of influenza vaccination of health-care workers on mortality of elderly people in long-term care: a randomized controlled trial. Lancet 2000;355:93–7.

Hayward AC, Harling R, Wetten S, et al. Effectiveness of an influenza vaccine programme for care home staff to prevent death, morbidity, and health service use among residents: cluster randomised controlled trial. BMJ 2006;333:1241.

Lemaitre M, Meret T, Rothan-Tondeur M, et al. Effect of influenza vaccination of nursing home staff on mortality of residents: a cluster-randomized trial. J Am Geriatr Soc 2009;57:1580–6.

O****ani* H, Saito R, Seki N, et al. Influenza vaccination levels and influenza-like illness in long-term-care facilities for elderly people in Nigata, Japan, during an influenza A (H3N2) epidemic. Infect Control Hosp Epidemiol 2000;21:728–30.

*Lol, I like that an author's name gets censored

Your radical stand that these people should not be practicing medicine is still just that, even if the number you would remove from the healthcare system isn't as high as it would have been seven or eight years ago.

My "radical" stand is that healthcare workers should be held to a higher standard. We have a tremendous privilege to take care of the sick. I think we should do everything we can (within reason) to try to protect the ill from increased suffering and death. My hands are chapped and painful in the winter due to washing my hands 20, 30, 40 times a day. You better believe that I would never consider not washing my hands, it saves lives. You better believe I would never consider not getting a flu shot, it saves lives.

 

[burd]

Re: Dr. Clayton Forrester's Science Roundup

Do you only think doctors (and nurses) who get a flu shot are reasonable and rational and should be allowed to practice medicine?

No.

I asked if they should be allowed to practice medicine if they don't get a flu shot. You said no.

Stop being silly and evasive. You knew exactly what I asked. If you'd not dance around things in this way, maybe there could be some actual discussion.

Are you seriously this obtuse, Bob, or just playing games?

 

[Bob Gray]

Re: Dr. Clayton Forrester's Science Roundup

I cannot dispute because I cannot find the original source. I have tried to look but I have not been able to track down numbers that coincide with what the ABC article states. You are citing something from a secondhand source which is difficult to dispute for me, because I do not know where the information actually came from.

I would argue that is the wrong number to use. The (more) important number is the percentage in health care workers who actually contact patients. Look at the numbers, and it is about 90% vaccination among them. Would you agree it is not as important for the secretary in the admin building to get a vaccine than the nurse who is taking care of sick patients?

Also note, "Coverage was highest among HCP working in settings with flu vaccination requirements (97.8%)." Flu vaccination requirements work, and people get the vaccine. Those hospitals that have the requirement tend to have lower influenza morbidity and mortality. Do you not think it is important to reduce hospital acquired infections that injure and kill patients?



Do you think this is a good thing?
"In addition, multiple studies have demonstrated health benefit to patients, including reduced risk for death, with vaccination of HCP in LTCF"

Carman WF, Elder WG, Wallace LA, et al. Effects of influenza vaccination of health-care workers on mortality of elderly people in long-term care: a randomized controlled trial. Lancet 2000;355:93–7.

Hayward AC, Harling R, Wetten S, et al. Effectiveness of an influenza vaccine programme for care home staff to prevent death, morbidity, and health service use among residents: cluster randomised controlled trial. BMJ 2006;333:1241.

Lemaitre M, Meret T, Rothan-Tondeur M, et al. Effect of influenza vaccination of nursing home staff on mortality of residents: a cluster-randomized trial. J Am Geriatr Soc 2009;57:1580–6.

O****ani* H, Saito R, Seki N, et al. Influenza vaccination levels and influenza-like illness in long-term-care facilities for elderly people in Nigata, Japan, during an influenza A (H3N2) epidemic. Infect Control Hosp Epidemiol 2000;21:728–30.

*Lol, I like that an author's name gets censored



My "radical" stand is that healthcare workers should be held to a higher standard. We have a tremendous privilege to take care of the sick. I think we should do everything we can (within reason) to try to protect the ill from increased suffering and death. My hands are chapped and painful in the winter due to washing my hands 20, 30, 40 times a day. You better believe that I would never consider not washing my hands, it saves lives. You better believe I would never consider not getting a flu shot, it saves lives.

1 in 4 is not the wrong number to use. Even you then say it's not the most important number. What number is more or less important is open to debate, but 1 in 4 is not "wrong", maybe just inconvenient to certain arguments being made. Plus of course the low vaccination rate in long term care workers discussed below would I assume involve a lot of people in contact with patients, and elderly at that, undermining your 90 percent number argument.

I didn't say long term care workers getting a shot was a good thing, as you seem to surmise. I was just noting that those numbers are particularly low, so they statistically contribute to the overall 1 in 4 number when other sectors have higher percentages that get vaccinated. Just doing the math is all.

My radical stand comment was in response to what appeared to be your previous statement that unvaccinated doctors and such shouldn't practice medicine. You must have missed my last post where I said with your clarification on what you meant to say that I recognize you're not saying that. So you're again arguing an issue with yourself.

 

[WisconsinWildcard]

Re: Dr. Clayton Forrester's Science Roundup

1 in 4 is not the wrong number to use. Even you then say it's not the most important number. What number is more or less important is open to debate, but 1 in 4 is not "wrong", maybe just inconvenient to certain arguments being made. Plus of course the low vaccination rate in long term care workers discussed below would I assume involve a lot of people in contact with patients, and elderly at that, undermining your 90 percent number argument.

Answer this. Do you think vaccination rates of people in the admin building (often separate from the actual hospital) is equally important as vaccination rates among those who interact with patients?

I didn't say long term care workers getting a shot was a good thing, as you seem to surmise. I was just noting that those numbers are particularly low, so they statistically contribute to the overall 1 in 4 number when other sectors have higher percentages that get vaccinated. Just doing the math is all.

Imagine being old, feeble, and balancing on a razors edge of homeostasis. Would you rather be cared for by people who are mandated to get the influenza vaccination or those that are not? Keep in mind, the latter carries a significantly increased chance of injury and death.

 

[Bob Gray]

Re: Dr. Clayton Forrester's Science Roundup

Answer this. Do you think vaccination rates of people in the admin building (often separate from the actual hospital) is equally important as vaccination rates among those who interact with patients?

Imagine being old, feeble, and balancing on a razors edge of homeostasis. Would you rather be cared for by people who are mandated to get the influenza vaccination or those that are not? Keep in mind, the latter carries a significantly increased chance of injury and death.

I'm just pointing out the numbers, though you keep trying to project things onto me that I haven't said. So I guess the 1 in 4 number is no longer "wrong"?

 

[WisconsinWildcard]

Re: Dr. Clayton Forrester's Science Roundup

I'm just pointing out the numbers, though you keep trying to project things onto me that I haven't said. So I guess the 1 in 4 number is no longer "wrong"?

Again, you are selectively quoting. I said "wrong number to use." My god this is laborious. Per the CDC "Coverage by occupation was lowest for assistants/aides (57.7%) and non-clinical personnel (68.6%). Non-clinical personnel include administrative supportstaff or managers, and non-clinicalsupport staff (food service workers, housekeeping staff, maintenance staff, janitors, laundry workers, etc.)."

I am supporting why this number is not the most crucial. Do you honestly think that a laundry worker being vaccination is as important as nurse or physician? Stop clinging to 1 in 4 like it is an argument and engage with what I am actually saying. Answer my questions.

 

[GrinCDXX]

Re: Dr. Clayton Forrester's Science Roundup

My god this is laborious.

If you don't think that is by design, I fear you may be a bit naive.

 

[Bob Gray]

Re: Dr. Clayton Forrester's Science Roundup

Again, you are selectively quoting. I said "wrong number to use." My god this is laborious. Per the CDC "Coverage by occupation was lowest for assistants/aides (57.7%) and non-clinical personnel (68.6%). Non-clinical personnel include administrative supportstaff or managers, and non-clinicalsupport staff (food service workers, housekeeping staff, maintenance staff, janitors, laundry workers, etc.)."

I am supporting why this number is not the most crucial. Do you honestly think that a laundry worker being vaccination is as important as nurse or physician? Stop clinging to 1 in 4 like it is an argument and engage with what I am actually saying. Answer my questions.

These people seem to be on contact with patients.

"◦Coverage by setting was lowest for those working in LTC settings (63.0%) Vaccination of HCP in LTC settings is extremely important because: People 65 years and older are at greater risk of serious complications from the flu.
Flu vaccine effectiveness is generally lowest in the elderly, making vaccination of close contacts even more critical.
Multiple studies have demonstrated health benefits to patients, including reduced flu-related complications and reduced risk of death, with vaccination of HCP in LTC settings."

Your question of how important it would be to me was already answered awhile back, but don't let that stop your complaining.


Interestingly, flu vaccinations in settings requiring vaccination was only 97.8 percent. So 2.2 percent didn't do it even though it was required?

Also, interesting that when there isn't a policy on vaccinations, the percentage vaccinated drops to 44 percent. So basically it sounds like more folks are requiring vaccinations, but the 44 percent is in the ballpark of the 40 percent cited by ABC back in 2007 or so.

 

[WisconsinWildcard]

Re: Dr. Clayton Forrester's Science Roundup

These people seem to be on contact with patients.

"◦Coverage by setting was lowest for those working in LTC settings (63.0%) Vaccination of HCP in LTC settings is extremely important because: People 65 years and older are at greater risk of serious complications from the flu.
Flu vaccine effectiveness is generally lowest in the elderly, making vaccination of close contacts even more critical.
Multiple studies have demonstrated health benefits to patients, including reduced flu-related complications and reduced risk of death, with vaccination of HCP in LTC settings."

Also, interesting that when there isn't a policy on vaccinations, the percentage vaccinated drops to 44 percent. So basically it sounds like more folks are requiring vaccinations, but the 44 percent is in the ballpark of the 40 percent cited by ABC back in 2007 or so.

So you agree with the statement that mandatory vaccination policies for health care workers are important and save lives?

Interesting "article" that notes that many doctors and nurses oppose mandatory flu shots. But, I'm sure they'll somehow be discounted. They just cite antiquated ideas like "freedom".

Do you still stand by this statement? Do you acknowledge that their "freedom" comes at the cost of the lives of their patients?

As already noted, that's not something I'd ever think to ask. If it did ever occur to me to ask and they would tell me their vaccination stats, it wouldn't matter much one way or another.

So does your answer remain that it does not matter if you are taken care of in a setting that increases your risk for injury or death because you care more about the heath worker's freedom than your own safety?

Interestingly, flu vaccinations in settings requiring vaccination was only 97.8 percent. So 2.2 percent didn't do it even though it was required?

Medical exemptions and religious exemptions.

 

[Bob Gray]

Re: Dr. Clayton Forrester's Science Roundup

So you agree with the statement that mandatory vaccination policies for health care workers are important and save lives?

Do you still stand by this statement? Do you acknowledge that their "freedom" comes at the cost of the lives of their patients?

So does your answer remain that it does not matter if you are taken care of in a setting that increases your risk for injury or death because you care more about the heath worker's freedom than your own safety?

Medical exemptions and religious exemptions.

I notice you don't respond to a lot of the points I make, but just ask me more and more questions. Par for the course around here unfortunately.

 

[WisconsinWildcard]

Re: Dr. Clayton Forrester's Science Roundup

If you don't think that is by design, I fear you may be a bit naive.

I am under no illusion that I will convince Bob of anything. I am on a research month with minimal clinical responsibilities and am far ahead on my writing. This leaves me with a looser schedule, with time to exercise and bum around on the internet.

At the very worst, my labor may help some of you more easily combat the vast amount of misinformation out there on vaccinations. Plus, it is at least a bit fun

 

[burd]

Re: Dr. Clayton Forrester's Science Roundup

I am under no illusion that I will convince Bob of anything. I am on a research month with minimal clinical responsibilities and am far ahead on my writing. This leaves me with a looser schedule, with time to exercise and bum around on the internet.

At the very worst, my labor may help some of you more easily combat the vast amount of misinformation out there on vaccinations. Plus, it is at least a bit fun

And who knows: this may lead to better understanding of and eventual cure for Gray's syndrome.

 

[WisconsinWildcard]

Re: Dr. Clayton Forrester's Science Roundup

I notice you don't respond to a lot of the points I make, but just ask me more and more questions. Par for the course around here unfortunately.

Ok Bob. I sometimes ask questions because I honestly do not know where you stand on some of these points and it is my opinion that you have significantly lacked clarity of thought on this topic.

Here is my argument. I will number it is easier for you to specifically disagree with any of my points.
1. The influenza vaccination, even with variable efficacy, prevents some level of the spread of influenza.
2. Influenza can kill anyone, but it is especially deadly in the young, elderly, and immunocomprimised (among others) depending on the strain.
3. Heath care workers are a source of influenza spread.
4. Facilities that have high rates of influenza vaccination among workers have lower morbidity and mortality from influenza. The vaccine saves lives.
5. Mandatory vaccinations are a very effective way to increase vaccination rates. The number we have is 97.8%. That is pretty **** good when compared to 40-45% when not mandated.
6. Long term care facilities have an appalling rate of vaccination. I support mandatory vaccinations for their workers to cut their morbidity and mortality risk to the patients they serve.
7. Around 90% of workers with patient contact are vaccinated. That number drops to 75% when you take into account those that do not interact with patients. I think the more important number to focus on is those with actual patient contact (low hanging fruit) as they are the ones most likely to impact patient safety. However, anyone with even a superficial understanding of herd immunity could easily make the argument that patients would benefit if all workers are immunized.
8. A health care worker's freedom ends when in significantly impacts patient safety. You are free to find employment elsewhere or in another field if you do not respect this. You do not have the freedom to choose to not wash your hands, to not follow aseptic technique, to put a patient at risk because you are not vaccinated (in the vast majority of cases). Exceptions should be made for medical reasons. That is why it is so important that those able to get the vaccine do. In fact, at most institutions (as busterman noted), the worker is free to avoid the vaccination if they agree to wear a mask while at work. This is not that out of the ordinary as nurses and physicians do it all the time if they are feeling under the weather in order to protect patients.

 

[Bob Gray]

Re: Dr. Clayton Forrester's Science Roundup

And who knows: this may lead to better understanding of and eventual cure for Gray's syndrome.

Watch out. It's rumored to be spread via message board!