Metrology Organic Solvents in the Shoes Industry to Sfax City (Tunisia)

In spite of the importance to the use of organic solvents in the shoes industry, exposure data of the employees at these solvents in this sector are absent in Tunisia. The objective of this study is to establish a biotoxicological supervision of exposure in shoes manufacturing companies. After the inventory of the most dominant solvents (acetone, cyclohexane, hexane and methylethylketone, toluene) in the preparations used in shoes manufacturing, 18 voluntary companies benefited from 55 dynamic atmospheric samplings realized on a duration of 4 hours. The exposure index some mixture ranged between 0.1 and 8.8 and presented an average value superior to 1, mainly in the partly industrialized process. These values reached, respectively, 1.7, 2.5 and 4.5 for the posts of finishing, shoes collector and glues dispatcher. The atmospheric average concentrations of certain solvents exceeded the limit value of professional exposure mainly for the hexane with a value of 214 mg/m3 in certain posts. The chronic exposure to organic solvents in a shoes industry and to establish a first report on the profiles of exposure to these solvents in this sector. Hence, an approach of evaluation of the professional risk by the biotoxicological supervision of exposure is established in Sfax city

Per- and Trichloroethylene Air Monitoring in Dry Cleaners in the City of Sfax (Tunisia)

The use of chlorinated solvents in dry cleaning poses risks to human health. The occupational health exposure assessment to these volatile chemicals is conducted through quantification of airborne concentrations inside the facilities. Indeed, the lack of such measurements in Tunisia pushed us to conduct the study. After identifying dry cleaners in Sfax city, we conducted door-to-door canvassing in 47 facilities. Then, the levels of perchloroethylene (PCE) and trichloroethylene (TCE) in the indoor air are measured in two sampling positions: fixed and individual. The pollutants are adsorbed with charcoal sorbent tubes where their amounts correspond to given air volumes that are suctioned through the pump. It is later used to calculate their mean concentrations. These solvents are desorbed using carbon disulfide and analyzed by gas chromatography—flame ionization detection. After the analytical validation of the protocol, 19 air samples were quantified. The measured concentrations of TCE are close to the occupational exposure limit value in almost all facilities, whereas the PCE concentrations are about half of the OELV. The overall results showed that the working environment in dry cleaning in Sfax city are concerning and can lead to many adverse health effects up to several types of cancers

Méthodes automatiques pour la pangonométrie, la morphométrie et la reconstruction 3D des os du membre inférieur

L'extraction des informations d'intérêt à partir des images médicales 2D et 3D est essentielle dans plusieurs pratiques médicales. Elle est nécessaire pour 1' établissement de diagnostic, la planification chirurgicale et la conception de prothèses sur mesure. Cependant, cette tâche requiert du clinicien une détection manuelle ou semi-automatique. Entre temps, la liste d'attente pour une intervention clinique s'allonge de jour en jour. Selon le rapport de la Direction de l'évaluation des technologies et des modes d'intervention en santé des centres hospitaliers de l'université de Montréal et de l'université McGill de 2007, la demande pour les arthroplasties du membre inférieur a augmenté de près de 90% au cours des dix dernières années. L'attente pour ce type d'intervention dépasse les 6 mois. L'objectif principal de cette thèse est d'offrir aux cliniciens des outils capables d'extraire à partir des données médicales 2D et 3D une information clinique utile et cela de façon automatique. Cinq applications sont proposées: • un analyseur automatique de la pangonométrie du fémur en vue frontale, • un analyseur automatique de la pangonométrie du fémur en vue latérale, • un outil pour le recalage automatique de modèles génériques 3D du fémur sur une paire de radiographies frontale et latérale, • un outil pour la reconstruction automatique de modèle 3D du fémur pré personnalisé à partir de données radiographiques, • un outil pour l'analyse automatique de la morphométrie du membre inférieur à partir de modèles 3D. La base de ces outils est un modèle mathématique. Ce modèle regroupe des géométries simples telles que sphères et cylindres en une seule fonction algébrique dans le but d'exprimer la surface externe des structures osseuses sous forme d'une surface analytique. Dans cette représentation, chaque géométrie simple modélise une zone anatomique à l'intérieur de l'os. En ayant une paire de radiographies du membre inférieur d'un patient, le modèle mathématique avec des techniques de génération de primitives (transformée de Hough) et de classification ont permis d'estimer les indices cliniques nécessaires pour une analyse pangonométrique. L'estimation de ces indices a permis aussi de recaler sur les radiographies du patient un modèle générique connu a priori. Ce regalage a été à l'origine de la reconstruction d' un modèle 3D pré-personnalisé. En 3D, le modèle mathématique proposé a permis aussi une analyse morphologique et moprhométrique du modèle 3D de l'os (fémur et tibia). Ce modèle peut être obtenu en utilisant notre méthode ou toute autre méthode de reconstruction 3D. Les études comparatives menées ont démontré le potentiel des méthodes développées pour un usage clinique de routine. Tous les outils mis au point offrent des résultats comparables à ceux obtenus par des analyses manuelles faites par des experts. Pour certains repères, nos outils présentent de meilleures précisions que les procédures manuelles, grâce à leur capacité d'identifier plus de données sur les images médicales que le repérage manuel

Biotoxicological Monitoring of Organic Solvents in the Tunisian Footwear Industry

Organic solvents (OS) are widely used in Tunisian footwear industry; however, there are no data related to employees’ exposure. The objective of this study was therefore to adjust analytical methods in our laboratory for exposure assessment purposes. The predominant solvents are acetone, cyclohexane, hexane, methyl ethyl ketone, and toluene. Eighteen companies benefited from 55 airborne and 190 urine samples. Quantification of solvents and their metabolites was achieved by analytical methods that were adapted and validated in our laboratory. Airborne solvents were determined using gas chromatography (GC-FID). Urinary solvents or metabolites were measured either by GC or high-performance liquid chromatography (HPLC). Validation criteria were determined and used to judge the methods reliability. For airborne solvents, the concentrations exceeding the threshold limit value are mainly for hexane. For urines, the hippuric acid concentrations exceeded the biological limit value in semi-industrial process. Surprisingly, trans, trans-muconic acid was found in industrial and artisanal processes even though benzene was not among the used products. GC and HPLC methods have been adjusted, optimized, and effectively used to quantify OS and their metabolites in airborne and urine samples. Thus, a process of occupational risk assessment via a biotoxicological and airborne monitoring for solvents is now set

What are the Health Risks of Occupational Exposure to Adhesive in the Shoe Industry?

The term “shoe” covers a wide range of products made from various materials. Organic solvents (OS) are components of various products such as the adhesives which are used in many industries. The shoe industry consumes large amounts of adhesives. This chemical risk assessment (CRA) is to validate the hypothesis of decreasing gradient of RA craft enterprises to industrial enterprises through the semi-industrial. The simplified methodology CRA of INRS was applied. For each chemical, a hazard class is assigned based on the sign, and then the potential exposure class is determined according to parameters “quantity and frequency of use”. Our RA process is complete with ambient measurements for solvents to which employees are most frequently exposed. Adhesives being constituted as solvent mixture, we have conventionally used an exposure index which is compared with the limit values. The simplified method CRA of INRS was chosen because it is one of the reference methods in RA established from the Kinney model. If these atmospheric samples and toxicology tests were made for the first time in the shoe industry in Sfax, they concerned a sample of companies of the three shoe manufacturing processes preceded by a preliminary RA with post-study and inventory of products handled

Understanding patient non-transport decision theories in the pre-hospital setting: a narrative review

© 2023 The Author(s). This is an open access article distributed under the terms of the Creative Commons Attribution License (CC BY), https://creativecommons.org/licenses/by/4.0/Background In pre-hospital emergency care, decisions regarding patient non-conveyance emerged as significant determinants of healthcare outcomes and resource utilization. These complex decisions became integral to the progress of emergency medical services, thus warranting an evolving exploration within the medical discourse. Objectives and methods This narrative review aimed to synthesize and critically evaluate various theoretical stances on patient non-conveyance in the pre-hospital emergency. The focus on studies published between January 2012 and August 2022 was intentional to capture contemporary practices and insights. PubMed and Google Scholar served as the primary databases for the investigation, while the AL-Rayyan® software facilitated a thorough screening process. Results and discussion Twenty-nine studies—encompassing articles, books, and theses—were discovered through our search, each presenting unique perspectives on patient non-transport, thus highlighting its criticality as a healthcare concern. Predominant factors influencing non-transport decisions were classified into patient-initiated refusals (PIR), clinician-initiated decisions (CID), and dispatcher-initiated decisions (DID). Conclusions The issue of patient non-conveyance to hospitals continues to pose a crucial challenge to the seamless operation of emergency healthcare systems, warranting increased attention from various healthcare entities. To comprehend and pinpoint potential areas of improvement, a comprehensive analysis of pre-hospital non-transport events is imperative. A well-informed, strategic approach could prevent resource waste while ensuring patients receive the required and definitive care.Peer reviewe

Epidemiological Determinants of Patient Non-Conveyance to the Hospital in an Emergency Medical Service Environment

© 2023 by the authors. Licensee MDPI, Basel, Switzerland. This is an open access article distributed under the terms of the Creative Commons Attribution License (CC BY), https://creativecommons.org/licenses/by/4.0/Background: The increasing prevalence of comorbidities worldwide has spurred the need for time-effective pre-hospital emergency medical services (EMS). Some pre-hospital emergency calls requesting EMS result in patient non-conveyance. Decisions for non-conveyance are sometimes driven by the patient or the clinician, which may jeopardize the patients’ healthcare outcomes. This study aimed to explore the distribution and determinants of patient non-conveyance to hospitals in a Middle Eastern national Ambulance Service that promotes the transportation of all emergency call patients and does not adopt clinician-based non-conveyance decision. Methods: Using R Language, descriptive, bivariate, and binary logistic regression analyses were conducted for 334,392 multi-national patient non-conveyance emergency calls from June 2018 to July 2022, from a total of 1,030,228 calls to which a response unit was dispatched. Results: After data pre-processing, 237,862 cases of patient non-conveyance to hospital were retained, with a monthly average of 41.96% (n = 8799) of the emergency service demands and a standard deviation of 5.49% (n = 2040.63). They predominantly involved South Asians (29.36%, n = 69,849); 64.50% (n = 153,427) were of the age category from 14 to 44 years; 61.22% (n = 145,610) were male; 74.59% (n = 177,424) from the urban setting; and 71.28% (n = 169,552) had received on-scene treatment. Binary logistic regression with full variables and backward methods identified the final models of the determinants of patient non-conveyance decisions with an Akaike information criterion prediction estimator, respectively, of (250,200) and (250,169), indicating no significant difference between both models (Chi-square test; p-value = 0.63). Conclusions: Despite exercising a cautious protocol by encouraging patient transportation to hospital, patient non-conveyance seems to be a problem in the healthcare system that strains the pre-hospital medical response teams’ resources. Policies and regulations should be adopted to encourage individuals to access other primary care centers when required rather than draining emergency services for non-emergency situations.Peer reviewe

Hazardous material and chemical, biological, radiological, and nuclear incident readiness among prehospital care professionals in the State of Qatar

This study aimed to determine whether the Hamad Medical Corporation Ambulance Service (HMCAS) personnel fulfil the pre-hospital readiness requirements for hazardous material and chemical, biological, radiological, and nuclear (HazMat-CBRN) incidents. This cross-sectional study performed an online assessment of non-specialist paramedics’ behaviour and knowledge about HazMat-CBRN incident management, followed by a ‘HazMat-CBRN incident management’ course with pre-and post-activity assessments. The validity and reliability of the knowledge assessment questions were also tested. The pre-and-post course assessement responses revealed certain deficiencies in staff knowledge. The multiple linear regression and paired groups t-test demonstrated that this was rectified after the training intervention. The results indicate that the implemented course helped HMCAS staff acquire a satisfactory level of knowledge to ensure their readiness for safe and effective responses to potential HazMat-CBRN incidents in Qatar

Exploring pre‐hospital healthcare workers' readiness for chemical, biological, radiological, and nuclear threats in the State of Qatar: A cross‐sectional study

Background Hazardous Material—Chemical, Biological, Radiological, and Nuclear (HazMat-CBRN) incidents, though infrequent, are environmentally precarious and perilous to living beings. They can be deliberate or accidental or follow the re-emergence of highly contagious diseases. Successful management of such incidents in pre-hospital settings requires having well-trained and prepared healthcare workers. Aims This study aimed to explore the reliability and validity of a satisfaction survey, answered by Specialized Emergency Management (SEM) personnel from a national Middle Eastern ambulance service, with a “Hazardous Material Incident Management” course offered to them as a continuing professional development activity and seek their opinion regarding Hamad Medical Corporation Ambulance Service personnel needs for other HazMat-CBRN related training topics. Method In the cross-sectional study, we conducted an online satisfaction survey for this group of course participants to obtain their feedback as subject matter experts. Aiken's content validity coefficient (CVC) was calculated to assess the content validity. Cronbach's α coefficient was determined to explore the survey's reliability. IBM®-SPSS® version 26 was utilized to explore the data. Results The SEM satisfaction survey demonstrated important satisfaction with the implemented training with its robust reliability and content validity (Cronbach's α = 0.922 and CVC = 0.952). The participants also recommended additional related topics. Conclusion Sustaining and reinforcing the HazMat-CBRN Incident Management course was strongly recommended, considering the increase of HazMat-CBRN threats worldwide

Exploring factors influencing time from dispatch to unit availability according to the transport decision in the pre-hospital setting: an exploratory study

© 2024 The Author(s). This is an open access article distributed under the terms of the Creative Commons Attribution License (CC BY), https://creativecommons.org/licenses/by/4.0/Background: Efficient resource distribution is important. Despite extensive research on response timings within ambulance services, nuances of time from unit dispatch to becoming available still need to be explored. This study aimed to identify the determinants of the duration between ambulance dispatch and readiness to respond to the next case according to the patients’ transport decisions. Methods: Time from ambulance dispatch to availability (TDA) analysis according to the patients’ transport decision (Transport versus Non-Transport) was conducted using R-Studio™ for a data set of 93,712 emergency calls managed by a Middle Eastern ambulance service from January to May 2023. Log-transformed Hazard Ratios (HR) were examined across diverse parameters. A Cox regression model was utilised to determine the influence of variables on TDA. Kaplan–Meier curves discerned potential variances in the time elapsed for both cohorts based on demographics and clinical indicators. A competing risk analysis assessed the probabilities of distinct outcomes occurring. Results: The median duration of elapsed TDA was 173 min for the transported patients and 73 min for those not transported. The HR unveiled Significant associations in various demographic variables. The Kaplan–Meier curves revealed variances in TDA across different nationalities and age categories. In the competing risk analysis, the ‘Not Transported’ group demonstrated a higher incidence of prolonged TDA than the ‘Transported’ group at specified time points. Conclusions: Exploring TDA offers a novel perspective on ambulance services’ efficiency. Though promising, the findings necessitate further exploration across diverse settings, ensuring broader applicability. Future research should consider a comprehensive range of variables to fully harness the utility of this period as a metric for healthcare excellence.Peer reviewe