The Effect of Respirator Wear on Blood Lactate During Maximal Exertion

The impact of a filtering half-face respirator and a half-face supplied air respirator use on blood lactate production was assessed during maximal exertion to determine if anaerobic strain increased compared to no respirator use. Twenty-eight participants performed a 30 second cycling Wingate anaerobic test (WAnT) wearing a half-face respirator. Blood lactate production was measured to evaluate if there was an increase in anaerobic strain from wearing a tight fitting half-face respirator compared to wearing no respirator. A supplied air respirator WAnT was then performed using 18 participants from the first experiment to evaluate if supplied air decreased anaerobic strain. Data from both experiments were compared to evaluate differences in the physiological effects due to respirator use during maximal exertion. A survey was administered following the second WAnT experiment to measure the participants' perception of acceptability and impact of supplied air respirator use in workplace. The blood lactate levels measured directly after the WAnT yielded lower overall mean values during the half-mask respirator trial (12.1 mmollL) and supplied air respirator trial (12.2 mmollL) than the no respirator trial (13.1 mmoI/L). However, differences in blood lactate levels were not statistically significant (p =0.597). Participants reported an average acceptability of 92.3% to wearing the supplied air respirator while performing light work. However, the average acceptability decreased as the exertion increased to moderate (78.8%) and heavy (46.6%) workloads. The supplied air respirator used provided no significant reduction in anaerobic strain within this study group compared to either the filtering half-face respirator or the no respirator condition. However, there were differences in physiological effects of respirators on each gender identified in this study. Further assessment of the anaerobic impact of respirators on each gender should be conducted.

Special occupational hazard review : alternatives to DI-2-ethylhexyl phthalate ("DOP")in respirator quantitative fit testing.

Mode of access: Internet.

Efeitos da alteração do limite de exposição ocupacional à sílica cristalina no processo de seleção de respiradores.

The purpose of this study was to investigate the respiratory protective device selection process and to identify changes in this process when an exposure limit value is updated. Two previous studies conducted in mining industries in the metropolitan area of Sao Paulo were put through the respiratory protective device selection process. The protection factors of the equipment provided by the companies were compared with the required protection factors and with the FUNDACENTRO`s respiratory protection program. The results showed that until 2005, some companies were providing inadequate protection, and after the change in crystalline silica exposure limit value in 2006, all the analyzed companies were providing inadequate respirators. This study suggests that there is an opportunity to create a web portal, where the selection process can be done by the companies with updated information.

Residuelle Lungenfunktionsveränderungen nach "Adult Respiratory Distress Syndrome" (ARDS) bei Kindern [Residual lung function changes following adult respiratory distress syndrome (ARDS) in children]

Residual lung function abnormalities have been investigated in 9 children (4 boys and 5 girls) a mean 2.7 years after surviving severe adult respiratory distress syndrome (ARDS). All patients had been artificially ventilated for an average of 9.4 days with a FiO2 greater than 0.5 for 34 hours and maximal PEEP levels in the range of 8-20 cm H2O. Since the ARDS, 3 children had presented recurrent respiratory symptoms (moderate exertional dyspnea and cough) and 2 had had evidence of fibrosis on chest radiographs. In all patients abnormal lung functions were found, i.e. ventilation inequalities (8), hypoxemia (7), and obstructive (2) and restrictive (1) lung disease. A significant correlation between respirator therapy and residual lung function was found (duration of FiO2 greater than 0.5 in hours and inspiratory plateau pressure during respirator therapy vs. ventilation inequalities and hypoxemia).

Emission of carbon nanofiber (CNF) from CNF-containing composite adsorbents

In spite of numerous applications of carbon nanofibers (CNFs) in a variety of fields, the potential release of airborne CNF during their special application, which could lead to workers or end-users exposure, has not been well investigated. In this study, the potential release of CNF from an organic vapour respirator cartridge was evaluated by carbon analysis and microscopy analysis. The cartridge consisted of an AC (Activated Carbon)/CNF composite adsorbent and different types of particulate filters. The composite adsorbent CNF were prepared by chemical vapour deposition (CVD). Air was passed through the prepared cartridge for 12 hours at 12 l/min and particles were collected on sampling filters suitable for measuring organic and elemental carbon (OC/EC) by carbon analysis based on the NIOSH 5040 method. Breakthrough of CNFs was also checked by scanning and transmission electron microscopy (SEM/TEM). This study found only minimal amounts of released elemental carbon while passing the air through the cartridge. Meanwhile TEM photos showed a few CNF structures for AC/CNF composite adsorbents which were not in the critical range in terms of length, aspect ratio, or number. [Authors]

13CO2 recovery fraction in expired air of septic patients under mechanical ventilation

The continuous intravenous administration of isotopic bicarbonate (NaH13CO2) has been used for the determination of the retention of the 13CO2 fraction or the 13CO2 recovered in expired air. This determination is important for the calculation of substrate oxidation. The aim of the present study was to evaluate, in critically ill patients with sepsis under mechanical ventilation, the 13CO2 recovery fraction in expired air after continuous intravenous infusion of NaH13CO2 (3.8 µmol/kg diluted in 0.9% saline in ddH2O). A prospective study was conducted on 10 patients with septic shock between the second and fifth day of sepsis evolution (APACHE II, 25.9 ± 7.4). Initially, baseline CO2 was collected and indirect calorimetry was also performed. A primer of 5 mL NaH13CO2 was administered followed by continuous infusion of 5 mL/h for 6 h. Six CO2 production (VCO2) measurements (30 min each) were made with a portable metabolic cart connected to a respirator and hourly samples of expired air were obtained using a 750-mL gas collecting bag attached to the outlet of the respirator. 13CO2 enrichment in expired air was determined with a mass spectrometer. The patients presented a mean value of VCO2 of 182 ± 52 mL/min during the steady-state phase. The mean recovery fraction was 0.68 ± 0.06%, which is less than that reported in the literature (0.82 ± 0.03%). This suggests that the 13CO2 recovery fraction in septic patients following enteral feeding is incomplete, indicating retention of 13CO2 in the organism. The severity of septic shock in terms of the prognostic index APACHE II and the sepsis score was not associated with the 13CO2 recovery fraction in expired air.

Preliminary Study on Safety Conditions in Health Workers Exposed to Antineoplastic Drugs

A study was done to establish work practices and preventive measures for nurses handling antineoplasticdrugs (AND) and to determine the risk of developing AND-related symptoms. A descriptive cross sectional study was made. Workers from 5 health centers in Valencia, Venezuela, were selected. Demography, occupational and clinical history, shift, work practices, safety precautions, antineoplastic drugs used, residues disposal and life styles were obtained via a questionnaire. Most prevalent symptoms were adjusted for age, shift, and smoking. Age was significant for cough and dizziness; smoking was significant for abdomipo seleccionado de trabajadores que manejan FAN en cinco centros de salud de la ciudad de Valencia, Venezuela, con el propósito de evaluar de forma preliminar su riesgo potencial de desarrollar signos-síntomas derivados de este oficio; a su vez, establecer si existe la necesidad de continuar con una evaluación más profunda que permita hacer recomendaciones concluyentes para evitar sus efectos adversos. Metodología La población estuvo constituida por el personal de las unidades de oncología de cinco centros de salud de la ciudad de Valencia, Venezuela. La muestra la conformaron veinte trabajadores que pertenecen a dichos centros. La participación fue voluntaria y mediante firma de una carta de consentimiento. Recolección de datos Se realizó una entrevista a cada participante con información que hizo referencia a datos demográficos, historia ocupacional, turnos de trabajo, entrenamiento en medidas de seguridad para el manejo de este tipo de fármacos, actividades que realizan, uso de equipos de protección personal (EPP), sitio de manipulación de nal pain and shift was significant for nausea and cough. Nauseas were the most prevalent symptom (55%). Dizziness was directly associated with use of gowns and inversely half-face respirator. None of the studied centers had satisfactory working conditions. A follow up study should be made including physical exam and environmental and biological monitoring.

Exposición acumulada de polvo respirable como predictor de enfermedad respiratoria

En la minería de carbón se presenta exposición prolongada a polvo de carbón y a polvo de sílice en diferentes porcentajes, encontrándose una asociación con las alteraciones obstructivas, bronquitis crónica, Neumoconiosis de los trabajadores de carbón y Silicosis. Se han establecido varias formas de estimar el riesgo de desarrollar dichas enfermedades respiratorias no malignas secundarias a la exposición a estos polvos (carbón y sílice) en el ámbito ocupacional, siendo el cálculo de la exposición acumulada, la que ha demostrado mayor utilidad. Con el fin de establecer el riesgo de desarrollar alteraciones funcionales, a partir de la exposición acumulada de polvo respirable - y en los trabajadores de una empresa de minería a cielo abierto en Colombia, se estructuró este estudio de cohorte. Se contó con el registro de 566 trabajadores distribuidos en 29 Grupos de Exposición Similar (GES). El cálculo de la dosis acumulada se realizó considerando las medianas de exposición para cada GES y el tiempo de exposición de cada trabajador. Y posteriormente se estimó el riesgo empleando una regresión de poisson con varianza robusta. Los resultados más importantes del estudio muestran la exposición acumulada en niveles inferiores a los reportados en la literatura, sin embargo se encuentra un riesgo ligeramente elevado, IRR 1.000124 (IC95% 1 - 1.000248) en los expuestos, estimando que por cada unidad de medición de la exposición acumulada que se incremente, el riesgo de que aparezca una alteración respiratoria funcional se incrementa en 1.000124 veces entre los trabajadores expuestos y los no expuestos.

Morbilidad y mortalidad en prematuros menores de 1500 gramos en un hospital regional del 2011 a 2013

Introducción: El presente estudio pretende determinar la mortalidad y caracterizar morbilidad de este grupo de recién nacidos, para establecer planes de mejoramiento. Materiales y método: Estudio descriptivo retrospectivo de corte transversal. Se revisaron 158 historias clínicas de los recién nacidos prematuros menores de 1500 gramos hospitalizados en la unidad de cuidados intensivos neonatales del Hospital Universitario Departamental de Nariño durante el periodo 2011 al 2013. La información fue analizada estadísticamente. Resultados: Se encontró que de 5447 nacidos vivos el 2,9 % fueron menores de 1500 gramos. 52,5 % eran de género masculino, 63,9% nacieron por cesárea. El 23,4 % no recibió esteroides antenatales. La tasa de mortalidad para el periodo de estudio en este grupo de pacientes fue de 7.3 por mil nacidos vivos. El 100% de los recién nacidos de menos de 750 gr fallecieron. Mientras que no se registro ninguna sobrevida de menos de 24 semanas. Conclusiones: Podría establecerse este como límite de viabilidad el peso al nacer < 750 gr y menos de 24 semanas de gestación, en donde la muerte es prácticamente la regla, siempre teniendo en cuenta evaluar cuidadosamente cada caso particular. La morbilidad de los prematuros de muy bajo peso al nacer esta en los rangos reportados en la literatura.

Förebyggande åtgärder vid ventilatorassocierad pneumoni : En systematisk litteraturstudie

Syftet med litteraturstudien var att beskriva förebyggande omvårdnadsåtgärder vid ventilatorassocierad pneumoni (VAP), vilket är en form av pneumoni som är sjukhusförärvad och relaterad till att patienten är intuberad, så kallad nosokomial infektion. Längre vårdtid, ökad kostnad samt mortalitet ses vid VAP. Resultatet som framkom var att personal ska ha god handhygien vilket var en av viktigaste åtgärden för att förebygga VAP. Andra förebyggande omvårdnadsåtgärder är att vårdpersonal ska hjälpa patienten som vårdas i respirator med munvården och använda hjälpmedel för detta. Personal ska även hjälpa patienten med lämplig höjning på huvudgärden då detta också minskar riken för VAP, även sugning och befuktning av luftvägar är en åtgärd som patienten behöver hjälp med.

Medical treatment and the good death: an ethical analysis of euthanasia, physician assisted suicide, and the right to die

Frequent advances in medical technologies have brought fonh many innovative treatments that allow medical teams to treal many patients with grave illness and serious trauma who would have died only a few years earlier. These changes have given some patients a second chance at life, but for others. these new treatments have merely prolonged their dying. Instead of dying relatively painlessly, these unfortunate patients often suffer from painful tenninal illnesses or exist in a comatose state that robs them of their dignity, since they cannot survive without advanced and often dehumanizing forms of treatment. Due to many of these concerns, euthanasia has become a central issue in medical ethics. Additionally, the debate is impacted by those who believe that patients have the right make choices about the method and timing of their deaths. Euthanasia is defined as a deliberate act by a physician to hasten the death of a patient, whether through active methods such as an injection of morphine, or through the withdrawal of advanced forms of medical care, for reasons of mercy because of a medical condition that they have. This study explores the question of whether euthanasia is an ethical practice and, as determined by ethical theories and professional codes of ethics, whether the physician is allowed to provide the means to give the patient a path to a "good death," rather than one filled with physical and mental suffering. The paper also asks if there is a relevant moral difference between the active and passive forms of euthanasia and seeks to define requirements to ensure fully voluntary decision making through an evaluation of the factors necessary to produce fully informed consent. Additionally, the proper treatments for patients who suffer from painful terminal illnesses, those who exist in persistent vegetative states and infants born with many diverse medical problems are examined. The ultimate conclusions that are reached in the paper are that euthanasia is an ethical practice in certain specific circumstances for patients who have a very low quality of life due to pain, illness or serious mental deficits as a result of irreversible coma, persistent vegetative state or end-stage clinical dementia. This is defended by the fact that the rights of the patient to determine his or her own fate and to autonomously decide the way that he or she dies are paramount to all other factors in decisions of life and death. There are also circumstances where decisions can be made by health care teams in conjunction with the family to hasten the deaths of incompetent patients when continued existence is clearly not in their best interest, as is the case of infants who are born with serious physical anomalies, who are either 'born dying' or have no prospect for a life that is of a reasonable quality. I have rejected the distinction between active and passive methods of euthanasia and have instead chosen to focus on the intentions of the treating physician and the voluntary nature of the patient's request. When applied in equivalent circumstances, active and passive methods of euthanasia produce the same effects, and if the choice to hasten the death of the patient is ethical, then the use of either method can be accepted. The use of active methods of euthanasia and active forms of withdrawal of life support, such as the removal of a respirator are both conscious decisions to end the life of the patient and both bring death within a short period of time. It is false to maintain a distinction that believes that one is active killing. whereas the other form only allows nature to take it's course. Both are conscious choices to hasten the patient's death and should be evaluated as such. Additionally, through an examination of the Hippocratic Oath, and statements made by the American Medical Association and the American College of physicians, it can be shown that the ideals that the medical profession maintains and the respect for the interests of the patient that it holds allows the physician to give aid to patients who wish to choose death as an alternative to continued suffering. The physician is also allowed to and in some circumstances, is morally required, to help dying patients whether through active or passive forms of euthanasia or through assisted suicide. Euthanasia is a difficult topic to think about, but in the end, we should support the choice that respects the patient's autonomous choice or clear best interest and the respect that we have for their dignity and personal worth.

Workers and respirators: What factors influence medical clearance? Experience in the petrochemical industry 2004--2008

This retrospective cohort study analyzed data from more than 2200 OSHA-mandated respirator medical evaluations performed between 2004 and 2008, with information initially obtained using an online questionnaire, to determine what factors influence medical clearance and the ability to safely wear respiratory protection in a large petrochemical company.^ The employees were mostly white males with a high school education, ranging in age from 25 to 60 years of age, who had been employed with the company an average of eight years. Their work was typically performed outdoors in a rural or offshore setting. Respirators were typically required for emergency response – escape or rescue only – and/or limited to less than four hours per month.^ Approximately 90% of the population achieved medical clearance by utilizing the online questionnaire. Of the remaining 10%, 66% were cleared after additional "hands-on" medical examination exam; 28% of the individuals' jobs were modified by their supervisor in order to not use a respirator, and 6% of the individuals (n=13) were excluded from wearing a respirator on the basis of the medical examination. The primary causes for exclusion from respirator use were cardiovascular (37.5%) and respiratory (31.3%) issues, followed by psychological (18.8%) and musculoskeletal (12.5%) concerns. Ultimately, over 99% of workers evaluated under this system were found capable of using respiratory protection safely. This questionnaire has proven to be an excellent health screening tool capable of initiating early detection and further investigation of potentially serious medical conditions within a large and diverse population in multiple locations. ^