ABSTRACT
BACKGROUND: Several studies have reported significant airborne lead exposures during training at indoor firing ranges. Scarce attention has been given to airborne lead exposures in outdoor shooting ranges with automatic weapons. OBJECTIVE: To assess the prevalence and magnitude of airborne and blood lead levels (BLL) among firing instructors and shooters in military outdoor ranges. METHODS: Exposure assessment, for both trainees and instructors, included airborne and BLL during basic and advanced training at outdoor firing ranges. Personal airborne samples were collected in both day and night shooting during both training periods. RESULTS: During basic training, there is 95% likelihood that up to 25% of instructors and 99% likelihood that up to 5% of trainees might be exposed above the action level (AL) (25 µg/m(3)). During advanced training, there is 90% likelihood that 10% of instructors and 99% likelihood that up to 10% of trainees might be exposed above the AL. CONCLUSIONS: Military personnel participating in automatic weapon marksmanship training can be exposed to considerable levels of airborne lead during outdoor firing range training. As a result, the Israel Defense Force Medical Corp has classified firing range instructors as workers that require periodic medical examinations.
Subject(s)
Air Pollution/analysis , Lead/analysis , Military Personnel/statistics & numerical data , Occupational Exposure/analysis , Adolescent , Cross-Sectional Studies , Female , Firearms , Humans , Israel , Lead/blood , Male , Risk Factors , Young AdultABSTRACT
PURPOSE: To determine the feasibility and effectiveness of using a single injection of diluted sodium bicarbonate, while monitoring exhaled carbon dioxide changes, to reliably confirm correct placement of intravenous (IV) catheters. METHODS: The study was conducted in the oncology day care clinic at a tertiary care center and included a selected group of patients with various oncological conditions who required IV chemotherapy. In each patient a newly inserted peripheral IV catheter or newly accessed central line was deemed positively intravascular if they had good blood return or most probably intravascular if there was no blood return but they flushed easily. This clinical diagnosis of correct positioning, was correlated with the results of a single injection of dilute sodium on the exhaled carbon dioxide, and with the ability of a blinded observer to report whether sodium bicarbonate or saline was injected. RESULTS: A total of 67 patients were enrolled in the study; 56 had positively intravascular IV catheter while 11 had most probably intravascular IV catheter. A single injection of 20 mL 4.2% sodium bicarbonate had a positive and clinically detectable response that was diagnosed with high sensitivity and specificity. CONCLUSIONS: IV injection of 20 mL of 4.2% sodium bicarbonate with exhaled carbon dioxide monitoring can be used to reliably confirm correct intravascular placement of a catheter intended to be used for chemotherapy.
Subject(s)
Antineoplastic Agents/administration & dosage , Breath Tests , Carbon Dioxide/metabolism , Catheterization, Central Venous/instrumentation , Catheterization, Peripheral/instrumentation , Catheters, Indwelling , Sodium Bicarbonate/administration & dosage , Vascular Access Devices , Administration, Intravenous , Adult , Aged , Catheterization, Central Venous/adverse effects , Catheterization, Central Venous/methods , Catheterization, Peripheral/adverse effects , Catheterization, Peripheral/methods , Central Venous Catheters , Equipment Design , Exhalation , Feasibility Studies , Female , Humans , Male , Middle Aged , Predictive Value of Tests , Sodium Bicarbonate/metabolism , Tertiary Care CentersABSTRACT
Parents' wish for antibiotics is a significant determinant of antibiotic prescription for their children. The objective of the study was to assess the effect of an educational intervention on parents' attitudes towards antibiotic use. Parents accompanying their children to primary pediatric clinics of Jerusalem-Hashfela District of Maccabi Healthcare Services responded to a survey regarding their wish for antibiotic treatment. Two groups of parents were surveyed: A (control) in a pre-intervention period and B (intervention) during the intervention period. The intervention included posters, pamphlets, and drawing booklets for children in the waiting rooms. A per-protocol analysis that included from group B only parents that stated they noticed the educational material (B1) was also performed. Eight hundred and sixty-eight parents were surveyed during the pre-intervention period and 688 parents during the intervention period. Children's median age was 4 years (8 days-16 years). Most (86%) of the parents were mothers. Groups were similar in socio-demographic characteristics and children's medical complaints. Factors associated with parent's low expectation for antibiotics were a general negative attitude to antibiotics (OR 1.66, 95% CI 1.20-2.30), current upper respiratory tract symptoms (OR 0.29, 95% CI 0.21-0.39), advanced knowledge regarding antibiotics (OR 1.72, 95% CI 1.26-2.34), and being in group B (intervention) (OR 1.47, 95% CI 1.08-2.00). The effect of the intervention was greater in the per-protocol analysis (OR 1.75, 95% CI 1.20-2.55). A simple educational intervention was effective in reducing parents' expectation for antibiotics but was significantly more effective when parents reported they noticed the campaign. Improving parents' knowledge regarding antibiotics can reduce parents' wish for antibiotic treatment.
