AUTOMATED BREATHING AND METABOLIC SIMULATOR (ABMS) EVALUATION OF N95 RESPIRATOR USE WITH SURGICAL MASKS

Objective: To reduce the threat of exhausting N95 filtering face piece respirator (FFR) supplies during pandemic influenza outbreaks, the Institute of Medicine has recommended using surgical mask covers (SM) over FFR among healthcare workers as one strategy to avoid surface contamination of the FFR. The objective of this investigation was to measure and evaluate breathing air quality (average inhaled CO2 and O2 concentrations), peak inhalation (InPr) and exhalation (ExPr) breathing pressures, and average inhaled dry-bulb (Tdb) and wet-bulb (Twb) temperatures when using FFR with FDA-cleared SM and without SM. Methods: Thirty NIOSH-approved FFR models with and without SM were evaluated using the NIOSH Automated Breathing and Metabolic Simulator (ABMS). The ABMS protocol consisted of the following levels of O2 consumption, CO2 production, and minute ventilation performed consecutively for minimum of five min each (units in STPD): 0.5, 0.4, and 9.8 L∙min-1; 1.0, 0.8, and 25.3 L∙min-1; 1.5, 1.3, and 38 L∙min-1; 2.0, 1.9, and 62 L∙min-1; 2.5, 2.5, and 70 L∙min-1; and 3.0, 3.15, and 80 L∙min-1, respectively. Results: The mean across all FFR without SM (FFR-alone) for average inhaled CO2 and O2 ranged from 2.7% and 17.1%, respectively, for the lowest metabolic rate to 1.7% and 19.2%, respectively, for the greatest metabolic rate. The mean across all FFR with SM (FFR+SM) for average inhaled CO2 and O2 ranged from 3.0% and 16.7%, respectively, for the lowest metabolic rate to 1.9% and 18.9%, respectively, for the greatest metabolic rate. The mean across all FFR-alone for InPr and ExPr ranged from -5 and 7 mmH2O, respectively, for the lowest metabolic rate to -41 and 24 mmH2O, respectively, for the greatest metabolic rate. The mean across all FFR+SM for InPr and ExPr ranged from -7 and 8 mmH2O, respectively, for the lowest metabolic rate to -51 and 30 mmH2O, respectively, for the greatest metabolic rate. The mean across all FFR-alone for Tdb and Twb ranged from 29 to 27°C, respectively, for the lowest metabolic rate to 32 and 28°C for the greatest metabolic rate. The mean across all FFR+SM for Tdb and Twb ranged from 29 to 27°C, respectively, for the lowest metabolic rate to 33 and 30°C for the greatest metabolic rate. When grouped by respirator type and compared to FFR-alone, average inhaled CO2 concentration was significantly higher for cup FFR+SM and significantly lower for horizontal flat-fold FFR+SM. Reciprocal significant changes were observed for average inhaled O2 concentrations. ExPr was significantly higher for cup FFR+SM at V.O2 >1.0 L∙min-1. InPr was significantly higher for cup FFR+SM at all levels of energy expenditure, and higher for other flat-fold FFR+SM at V.O2 >1.5 L∙min-1. Tdb and Twb was significantly higher for cup FFR+SM at V.O2 >0.5 L∙min-1. Conclusions: The orientation of the SM on the FFR may have a significant effect on the inhaled breathing quality at lower levels of energy expenditure and breathing pressures at higher levels of energy expenditure. The measureable InPr and ExPr caused by SM on FFR for healthcare users likely will be imperceptible at lower activity levels. While statistically significant, the changes in Tdb and Twb for FFR+SM compared to FFR-alone were small

A review of the possible effects of physical activity on low-back pain

Objective: Low back pain (LBP) and injury represents the most prevalent and costly repercussion from musculoskeletal injury in the work place. This review examines the earlier and current research reported on the significance of physical activity on musculoskeletal injuries and LBP, the benefits and limitations of therapeutic exercise, and the potential features of various exercise modalities that may contribute to the secondary and tertiary prevention of low-back pain. Methods: A search was performed using MEDLINE to identify original studies published in English from January 1990 to December 2013. Physical activity in the form of aerobic, muscle strengthening, flexibility, and occupational (labor) activities among working adults (18 – 65 years of age) alone and with other non-surgical therapies were selected. A hand-searched collection from a personal literature library also was used. Results: Fifteen studies met the inclusion criteria, addressing aerobic exercise (n=4), muscle strengthening exercise (n=3), combination of aerobic, muscle strengthening, and flexibility exercises (n=5), and occupational labor/exercise (n=3). The investigations generally supported the benefits of programmed and structured exercise alone and with other therapies for the treatment of LBP. Conclusions: Given the physical and financial burden to treat LBP, this issue remains a great public health importance. With the burden on society from LBP and the prevalence of the disorder among populations, research from physical activity on LBP has produced varied results without a specific type of exercise that results in resolved LBP better than most. Most agree that some activity is better than none, but no one activity is better than the others when the multifactorial etiology of LBP remains inconsistent. Isolating the vertebrae that causes the LBP would be beneficial for participant selection with future research. Different forms of pathological evidence or combinations of pathological measurements may help to establish proof of beneficial exercise or a combination of exercise therapies

A Scoping Review of Respirator Literature and a Survey among Dental Professionals

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) virus was discovered in China in late 2019 and subsequently triggered a global pandemic. Dentists, like many other health professionals, are at an increased risk of contracting the virus as they work in close proximity to patients, especially when performing aerosol-generating procedures. Thus, in order for dentists to protect themselves and their patients, it is recommended that practitioners wear filtering facepiece 2 (FFP2) respirators. The prolonged use of these FFP2 respirators has been linked to several side effects. The aim of this paper is to assess the perceived experience associated with N95/FFP2 respirators based on the available literature and data collected through an online survey completed by Italian dental professionals. Articles were included up to May 2020 and literature searches were conducted through The National Library of Medicine, Cochrane Central Register of Controlled Trials, and Embase databases. The search terms included COVID-19, respirators, masks, and discomfort. An online survey was administered to 256 Italian dentists. The results from this survey were in agreement with the available literature. The findings concurred that the prolonged use of respirators was associated with headaches (47.5%), severe exertion and discomfort (50.8%), moderate concentration problems (54.3%), moderate breathing difficulties (63.5%), and consequently, an impaired work ability (85.5%). These findings were not influenced by the number of hours spent wearing the respirator. Despite several side effects, FFP2 respirators are fundamental in protecting dentists and their importance was acknowledged

Key regulatory drivers affecting shipments of mixed transuranic waste from Los Alamos National Laboratory to the Waste Isolation Pilot Plant

A number of key regulatory drivers affect the nature, scope, and timing of Los Alamos National Laboratory`s (LANL`s) plans for mixed transuranic (MTRU) waste shipments to the Waste Isolation Pilot Plant (WIPP), which are planned to commence as soon as possible following WIPP`s currently anticipated November, 1997 opening date. This paper provides an overview of some of the key drivers at LANL, particularly emphasizing those associated with the hazardous waste component of LANL`s MTRU waste (MTRU, like any mixed waste, contains both a radioactive and a hazardous waste component). The key drivers discussed here derive from the federal Resource Conservation and Recovery Act (RCRA) and its amendments, including the Federal Facility Compliance Act (FFCAU), and from the New Mexico Hazardous Waste Act (NMHWA). These statutory provisions are enforced through three major mechanisms: facility RCRA permits; the New Mexico Hazardous Waste Management Regulations, set forth in the New Mexico Administrative Code, Title 20, Chapter 4, Part 1: and compliance orders issued to enforce these requirements. General requirements in all three categories will apply to MTRU waste management and characterization activities at both WIPP and LANL. In addition, LANL is subject to facility-specific requirements in its RCRA hazardous waste facility permit, permit conditions as currently proposed in RCRA Part B permit applications presently being reviewed by the New Mexico Environment Department (NNED), and facility-specific compliance orders related to MTRU waste management. Likewise, permitting and compliance-related requirements specific to WIPP indirectly affect LANL`s characterization, packaging, record-keeping, and transportation requirements for MTRU waste. LANL must comply with this evolving set of regulatory requirements to begin shipments of MTRU waste to WIPP in a timely fashion

Therapeutic emails

BACKGROUND: In this paper, we show how counselors and psychologists can use emails for online management of substance abusers, including the anatomy and content of emails that clinicians should send substance abusers. Some investigators have attempted to determine if providing mental health services online is an efficacious delivery of treatment. The question of efficacy is an empirical issue that cannot be settled unless we are explicitly clear about the content and nature of online treatment. We believe that it is not the communications via internet that matters, but the content of these communications. The purpose of this paper is to provide the content of our online counseling services so others can duplicate the work and investigate its efficacy. RESULTS: We have managed nearly 300 clients online for recovery from substance abuse. Treatment included individual counseling (motivational interviewing, cognitive-behavior therapy, relapse prevention assignments), participation in an electronic support group and the development of a recovery team. Our findings of success with these interventions are reported elsewhere. Our experience has led to development of a protocol of care that is described more fully in this paper. This protocol is based on stages of change and relapse prevention theories and follows a Motivational Interviewing method of counseling. CONCLUSION: The use of electronic media in providing mental health treatment remains controversial due to concerns about confidentiality, security and legal considerations. More research is needed to validate and generalize the use of online treatment for mental health problems. If researchers have to build on each others work, it is paramount that we share our protocols of care, as we have done in this paper

Telomerase activity, apoptosis and cell cycle progression in ataxia telangiectasia lymphocytes expressing TCL1

Individuals affected by ataxia telangiectasia (AT) have a marked susceptibility to cancer. Ataxia telangiectasia cells, in addition to defects in cell cycle checkpoints, show dysfunction of apoptosis and of telomeres, which are both thought to have a role in the progression of malignancy. In 1-5% of patients with AT, clonal expansion of T lymphocytes carrying t(14;14) chromosomal translocation, deregulating TCL1 gene(s), has been described. While it is known that these cells can progress with time to a frank leukaemia, the molecular pathway leading to tumorigenesis has not yet been fully investigated. In this study, we compared AT clonal cells, representing 88% of the entire T lymphocytes (AT94-1) and expressing TCL1 oncogene (ATM- TCL1 +), cell cycle progression to T lymphocytes of AT patients without TCL1 expression (ATM- TCL1-) by analysing their spontaneous apoptosis rate, spontaneous telomerase activity and telomere instability. We show that in ATM- TCL1+ lymphocytes, apoptosis rate and cell cycle progression are restored back to a rate comparable with that observed in normal lymphocytes while telomere dysfunction is maintained. © 2003 Cancer Research UK

Internal audit and engagement outcomes communication

This diploma work deals with the manner in which the internal auditor should communicate the results of their engagement findings to other departments within the organization. This diploma work deals with to whom the internal auditor should disclose certain facts and how to choose the appropriate form of audit reports in order to give their addressees best possibility to point to these audit findings and create follow-up with an effective remedy for the irregularities found

Spanelsko : ilustrovany casopis : orgán vyboru pro pomoc demokratiskému Spanelsku.

Traducción del tít: Desafío eterno vasc

Katastr nemovitostí

Práce popisuje vývoj evidování nemovitostí a práv s nimi spojených od počátku až do dnešní doby. Zabývá se dnešním stavem s pohledu běžného uživatele. Popisuje průběh základních operací katastrálních úřadů

Spanelsko : ilustrovany casopis : orgán vyboru pro pomoc demokratiskému Spanelsku.

Traducción del tít: Un año de guerra en Españ